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Biomedical subjects

G Hellers

Publications and source records attributed to G Hellers.

At least 55 records · Page 3Linked to original sources
PubMed1989

Surgical treatment of ulcerative colitis in Stockholm County, 1955 to 1984.

Time trends in surgical treatment of ulcerative colitis in Stockholm County over the 30-year period 1955 to 1984 were investigated. Four hundred eighty-six patients (263 men and 223 women) were submitted to colectomy with or without proctectomy. In elective cases, proctocolectomy was the procedure of choice until the 1980s, when subtotal colectomy became more common. In acute cases subtotal colectomy was the procedure of choice during the entire period. Major complications developed in 162 patients (33 percent) and 103 (21 percent) underwent another operation. The frequency of major complications increased, with the urgency of intervention being 25 percent in elective cases and 46 percent in acute cases (P less than .001). The postoperative mortality was 1.7 percent in 301 elective cases and 9.2 percent in 185 acute cases (P less than .001). The overall postoperative mortality was 4.5 percent and fell from 13 percent during 1960 to 1964 to 2.0 percent during 1980 to 1984 (P less than .01). In acute cases, the mortality during the same two periods fell from 36 to 3.0 percent (P less than .001). The postoperative mortality for proctocolectomy (2.7 percent) was significantly lower (P less than .01) than for subtotal colectomy (9.0 percent). Seventy-four percent of the patients treated by subtotal colectomy were acute cases, however, with a mortality of 11 percent and only 30 percent of the proctocolectomy cases were acute cases, with a mortality of 6.5 percent.

Acute Disease↗
PubMed1989

Evidence for a major additive gene in ulcerative colitis.

Complex segregation analysis of 124 families with ulcerative colitis with two or more affected individuals suggests a rare additive major gene causing the disease with about 20% affected among the heterozygotes for the gene. There was no evidence for multifactorial inheritance.

Colitis, Ulcerative↗
PubMed1989

Studies on acyl-coenzyme A: cholesterol acyltransferase activity in human liver microsomes.

The aim of the present study was to characterize the acyl-coenzyme A: cholesterol acyltransferase (ACAT) activity in human liver microsomes. Liver biopsies were obtained from patients undergoing elective cholecystectomy under highly standardized conditions. In 34 patients the enzyme activity of the microsomal fraction averaged 6.6 +/- 0.7 (mean +/- SEM) pmol.min-1.mg protein-1 in the absence of exogenous cholesterol. Freezing of the liver biopsy in liquid nitrogen increased the enzyme activity five- to sixfold. Similarly, freezing of the microsomal fraction prepared from unfrozen liver tissue increased the enzyme activity about twofold. These results may help to explain previous disparate results reported in the literature. The enhanced ACAT activity obtained by freezing was at least partly explained by a transfer of unesterified cholesterol to the microsomal fraction and possibly also by making the substrate(s) more available to the enzyme. Preincubation of the microsomal fraction, prepared from unfrozen liver tissue, with unlabeled cholesterol increased the enzyme activity about fivefold. This finding indicates that hepatic ACAT in humans can also utilize exogenous cholesterol as substrate. Addition of cholesterol to frozen microsomes prepared from unfrozen liver tissue increased the ACAT activity two- to threefold, whereas addition of cholesterol to microsomes prepared from frozen liver tissue did not further increase the enzyme activity. No evidence supporting the concept that ACAT is activated-inactivated by phosphorylation-dephosphorylation could be obtained by assaying the enzyme under conditions similar to those during which the human HMG-CoA reductase is inactivated-activated.

Acyl Coenzyme A↗
PubMed1988

Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres.

A retrospective cohort of 823 patients with ulcerative colitis who resided at the time of diagnosis in one of three defined geographical areas (West Midlands region, Oxford region, England and Stockholm County, Sweden) was assembled. The patients were first seen at named hospitals in these areas and the diagnosis of ulcerative colitis established within five years of onset of symptoms between 1945-1965. All patients were 15 years of age or more at onset of disease and were followed for a minimum of 17 years and a maximum of 38 years. Ninety seven per cent completeness of follow up was achieved. Examining the colorectal cancer risk in the series relative to the risk in the general population by standardised morbidity ratios, there was an eight fold increased risk of cancer in the series as a whole. Dividing the series by extent of colitis, extensive colitis patients showed a 19 fold increase in risk. A four fold increased risk was shown in the remainder of the series (left sided colitis, proctitis and extent unknown). Life table analyses in extensive colitis gave cumulative risks of 7.2% (CI 3.6-10.8) at 20 years from onset of disease and 16.5% (CI 9.0-24.0) at 30 years from onset. No significant effect of age at onset, sex or referral centre could be detected. Examination of the data by interval from onset to cancer and by actual age at development of cancer suggests that patients who develop colorectal cancer will do so in a distribution around 50 years of age independent of duration of disease in adult onset ulcerative colitis (greater than 15 years at onset of disease). An inverse relationship was shown between age at onset of disease and interval from onset of disease to cancer. Further age specific rates for cancer increased up to 50 years and decreased thereafter. These results suggest that extensive colitis patients have a genetic predisposition to colorectal cancer and that longstanding inflammation is not of primary importance in the initiation/promotion of cancer in this disease.

Actuarial Analysis↗
PubMed1988

Education and training in gastroenterology. Report from the OMGE symposia at the International Congress of Gastroenterology, Lisbon, Portugal, September 1984, and at the 8th World Congress of Gastroenterology, São Paulo, Brazil, September 1986.

Gastroenterology is recognized as a speciality in most countries, especially in Europe and North America. The requirements for being acknowledged as a specialist vary from 1 1/2 to 4 years of training and education in gastroenterology in addition to 1-6 years of training and education in internal medicine/surgery. The requirement of theoretical education varying from 40 to 300 h is practiced in some countries only. In some countries training in endoscopy is separated from gastroenterology. A formal examination and post-specialization training program is required in only some of the countries answering the questionnaire. The number of centres per million inhabitants recognized for training and education also varied greatly. The number of specialists per million inhabitants was 3.6 to 15. In the Middle and Far East the organisation of gastroenterology was much inferior to that in Europe and North America because of insufficient education and organization programs and lack of economic support to perform them. The answers from the gastroenterological associations and personal reporters agreed on the following: A speciality in medical and surgical gastroenterology should be established in all countries around the world. Programs for training and education should be agreed upon in recognized teaching and training institutions of gastroenterology, probably of 3 years' duration in combination with a speciality in internal medicine. A gastroenterologist will in most cases be dealing with other diseases as well. The number of specialists per million inhabitants may be estimated to 10, the exact number not being possible to determine at present. In most countries the post-specialization programs were not required but were offered, a problem that has to be clarified.(ABSTRACT TRUNCATED AT 250 WORDS)

Congresses as Topic↗
PubMed1988

Education and training in gastroenterology. A report from Europe.

A questionnaire was sent to all associations of gastroenterology in Europe. The answers provided the basis for the conclusion that gastroenterology does not seem to be as established a speciality in Europe as many other specialities. There are clear future needs and growth potentials. There is also a clear need for increased international communication and cooperation.

Education, Medical↗
PubMed1987

Prevalence of inflammatory bowel disease among relatives of patients with ulcerative colitis.

The familial occurrence of inflammatory bowel disease (IBD) was investigated among 963 patients with ulcerative colitis (UC) diagnosed in 1955-1979 in Stockholm County. For 76 patients who had a relative with IBD a pedigree was drawn. The diagnoses of the diseased relatives were verified. There was a general prevalence of 7.9% for IBD among relatives. In 80% one relative was affected, in most cases a first-degree relative with UC. Sibship was the commonest relationship. No concordance for UC was found among three pairs of monozygotic twins. The prevalence of UC in first-degree relatives was 15 times higher than in non-relatives. The age of onset was significantly lower among patients with a family history for UC; they also had a higher incidence of total colitis. The prevalence of Crohn's disease in first-degree relatives of patients with UC was almost 3.5 times higher than in non-relatives.

Adolescent↗
PubMed1987

Prognosis and mortality of ulcerative colitis in Stockholm County, 1955-1979.

All 1274 patients in Stockholm County who were diagnosed as having ulcerative colitis during the 25-year period 1955-79 were followed up and studied with regard to prognosis and mortality. There were 109 deaths recorded--41 caused by ulcerative colitis and 68 from other causes. The cumulative survival probability (computed by life-table methods) was worse than expected. For males it was approximately 80% at 20 years, to be compared with the approximately 97% expected in the background population. For females the corresponding figures were approximately 85% and 98%, respectively. The excess death risk increased with increasing age and was more commonly due to unrelated causes than to ulcerative colitis as such. In patients with total colitis at onset the death risk was greater than for other patients during the first years of disease. Thereafter the prognosis was, if anything, better than in other cases. There was no major change in postoperative mortality or general mortality pattern during the 25 years of observation.

Adolescent↗
PubMed1987

A controlled randomized trial of budesonide versus prednisolone retention enemas in active distal ulcerative colitis.

Sixty-four patients with active distal ulcerative colitis participated in a multicentre, randomized, investigator-blind trial to compare the effect of budesonide enema, 2 mg/100 ml, with prednisolone disodium phosphate enema, 31.25 mg/100 ml. Budesonide is a new potent corticosteroid with a rapid first-pass elimination. The patients were treated for 4 weeks, and the efficacy of the drugs were evaluated by sigmoidoscopy, histology, and subjective symptoms after 2 and 4 weeks. After 4 weeks of treatment 16 of 31 patients (52%) receiving budesonide enema had healed endoscopically, compared with 8 of 33 (24%) (p = 0.045) receiving prednisolone enema. Budesonide was superior to prednisolone in terms of both significantly improved sigmoidoscopic and histologic scores and subjective symptoms evaluated by visual analogue scales. The patients receiving prednisolone had a significant depression of endogenous cortisol levels during the treatment period, but not the patients receiving budesonide. Budesonide enema seems to be a promising therapy for active distal ulcerative colitis and causes no adverse reactions.

Adolescent↗
PubMed1987

The risk of colorectal cancer in ulcerative colitis. An epidemiologic study.

Patients with a definite diagnosis of ulcerative colitis in Stockholm County during the 35-year period 1945-79 were identified and followed up with regard to the development of cancer of the colon. We found 25 patients who had developed 31 cancers. In 24 of 25 cases this occurred in patients with total colitis. The cumulative risk of developing cancer for patients with total colitis at follow-up study was calculated by means of life-table methods. It was 13% at 25 years (SD +/- 4.2%) among patients diagnosed in 1945-79, compared with the 1.9% expected in a population matched for age and sex. Among patients diagnosed in 1955-79 the risk was approximately 5% at 20 years (SD +/- 3.0%), compared with 1.4% for the background population. The cancer risk for all patients with colitis was higher but not significantly higher than that of the general population. The outcome of patients who developed cancer was dependent on histologic staging (Dukes's) at surgery but not on age at cancer diagnosis.

Adult↗
PubMed1985

Incidence of ulcerative colitis in Stockholm County 1955-1979.

The epidemiology of ulcerative colitis in Stockholm County over a 25-year period, 1955-79, was investigated. Only definite cases in accordance with specified acceptance criteria were included. There were 1274 cases--681 males and 593 females. The proportion of patients with proctitis, left-sided, and total extent of disease of diagnosis remained constant over the study period, as did the time interval between onset of symptoms and definite diagnosis. The peak incidence in relation to age increased slightly but remained in the 3rd and 4th decade through the study period. The incidence in men over 40 years old increased markedly towards the end of the study.

Adolescent↗
PubMed1983

Breast-feeding during infancy in patients who later develop Crohn's disease.

Breast milk is of importance for protection against infection and for normal development of the intestinal mucosa. This study is a case-control study comparing the length of the breast-feeding period of patients who later in life develop Crohn's disease with matched control individuals. In 308 matched pairs both patient and control were able to produce information concerning the length of their period of breast-feeding. The mean length of the breast-feeding period was 4.59 months among patients and 5.76 months among controls, a significant difference (p less than 0.01). Crohn's disease patients were particularly overrepresented among those with no or very short periods of breast-feeding.

Adult↗