Biomedical subjects
Publications and source records attributed to H Forssell.
Osteochondroma (osteocartilaginous exostosis) is a rare tumour in the region of the mandibular condyle. Much confusion seems to exist in the literature in differentiating these tumours from condylar chondromas as well as from condylar hyperplasias. A case of condylar osteochondroma with a review of the literature is presented.
To analyse the effect of treatment of mandibular dysfunction on headache, 35 patients with migraine, 20 patients with combination headache and 36 patients with muscle contraction headache were studied in a clinical double-blind trial. Patients in the treatment group received occlusal adjustment and those in the placebo group mock occlusal adjustment. After eight months and four months, respectively, the neurologist evaluated the treatment outcome. The frequency of headache was reduced in 79% and the intensity in 53% of patients suffering from muscle contraction headache or combination headache in whom the adjustment of the dental occlusion had been successfully accomplished. The difference from the placebo group was statistically significant. The decrease in headache frequency as calculated from the headache diaries correlated with the decrease in the index of clinical signs of mandibular dysfunction.
A method for continuous determination of gastric bicarbonate secretion in man has been developed. A computer-based system calculated the total bicarbonate secretion every 30 sec throughout the experiment on the basis of the continuously recorded pH and Pco2 measurements. A high gastric perfusion rate facilitated the identification of duodenogastric reflux, which was observed as rather short-lived spikes on the curves. The contribution of alkaline saliva to the measured gastric bicarbonate secretion was minimized by continuous salivary suction and was corrected for after determining amylase in the gastric aspirate. Validation of the measuring system, by introducing bicarbonate in the range of 50-400 mumol into the stomach, demonstrated a correlation value of 0.91 (p less than 0.001) between added and recovered bicarbonate. Basal gastric bicarbonate output in seven healthy subjects was 379 +/- 105 mumol/h (mean +/- SEM). Intragastric instillation of 16,16-dimethyl prostaglandin E2 in five subjects resulted in a fourfold increase in gastric bicarbonate output.
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Ethyl cyanacrylate (Cyacrine) was used as bone cement in osteosynthesis of experimental osteotomies. The osteotomies were produced in the scapulas of rabbits by detaching a rectangular fragment with an ultrasonic bone saw. The control osteotomies were immobilized by steel wire fixation. The control fragments united uneventfully. The experimental osteotomies were fixed with a mixture of bone chips and liquid Cyacrine, polymerized in situ with ultrasound. No adjunctive fixation was used. Stable fixation was difficult to obtain. Further, healing of the osteotomies consistently failed because of inhibited new bone formation on surfaces in contact with Cyacrine. Cyacrine also provoked a prolonged inflammatory reaction with round cell and macrophage infiltration in the region of the osteosynthesis.
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The effect of treatment for 4 weeks with the H2-receptor antagonist ranitidine 200 mg daily on ulcer healing, clinical symptoms and antacid consumption, and on gastric acid secretion, was studied in a double blind trial in 48 patients with a total of 50 endoscopically confirmed duodenal, prepyloric or corporeal gastric ulcer. Patients whose ulcers did not show complete healing within 28 days were continued openly on ranitidine for up to a further 4 weeks. Endoscopy, basal gastric acid secretion (BAO) and pentagastrin-stimulated maximal secretion (PAO) studies were performed at 2-week intervals. After four weeks, 73% of the gastro-duodenal ulcers in the ranitidine group showed complete healing versus 42% in the placebo group (p less than 0.05). Gastric acid secretion was considerably inhibited both under basal (89%; p less than 0.001) and maximal challenge (71%; p less than 0.001) conditions. The inhibitory effect was still pronounced 13-15 h after administration of ranitidine 100 mg. Symptoms and the need for antacids were significantly reduced. Ranitidine appears to be an efficacious, safe and well tolerated medicine principle for the treatment of gastro-duodenal ulcer disease.
The gastric acid response to insulin hypoglycemia represents an effect of several stimulatory and inhibitory mechanisms. In the intact stomach the direct vagal excitation of the acid secreting glands is the predominant mechanism. After vagotomy, however, the balance between the stimulatory and inhibitory mechanisms is unpredictable. Some stimulatory and inhibitory mechanisms are non-vagal, and may after vagotomy result in a false conception of remaining vagal fibers and complete vagotomy, respectively. Sham feeding may be a safer and more reliable test of completeness of vagotomy. A study of the spontaneous variation of basal acid secretion over several hours after vagotomy in 22 patients showed in 15-min samples a maximal range of 0.49 and 0.65 mmol with a P value of 0.05 and 0.01, respectively. A higher range may thus indicate a true acid response to a given stimulus. In 3 patients with an acid response to sham feeding but no acid response to insulin in a dose of 0.2 IU/kg after vagotomy, a repeated test with a lower dose of insulin resulted in an unequivocal acid response. In 4 patients with no acid response to sham feeding and a substantial acid response to insulin after vagotomy, the acid response to insulin was abolished after pretreatment with an adrenergic blocker. The insulin test may thus give false negative and positive information about the completeness of vagotomy.
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