Biomedical subjects

K Borch

Publications and source records attributed to K Borch.

86 records · Page 5Linked to original sources

PubMed1986

Pancreatic cancer.

During 1972-1981, a total of 177 individuals were diagnosed as having pancreatic cancer at the Central Hospital of Eskilstuna, Sweden. The mean crude incidence rate was 15.0 X 10(-5) year-1. Only 56% of the patients had the diagnosis made prior to death. 63% of the cancers had advanced beyond therapeutic range. Symptoms compatible with upper abdominal disease for more than six months prior to diagnosis occurred in 27% of the cases, and 15% had sought medical advice more than 6 months prior to diagnosis. Radical surgery was performed on 5 patients of whom one died postoperatively, and 61 patients (34%) underwent palliative treatment. The postoperative mortality rate after palliative treatment was 28%. The mean survival time for the whole series was 2.6 months, and 13% survived for one year. One patient survived for 2 years after palliative treatment. It is concluded that the only means by which the prognosis for patients with pancreatic cancer may be improved is to define populations at high risk and to develop more specific and sensitive diagnostic methods.

Adult↗

PubMed1985

Gastric endocrine cell hyperplasia and carcinoid tumors in pernicious anemia.

Endoscopic screening in 123 patients with pernicious anemia (PA) yielded 4 patients with solitary and 1 patient with multiple gastric carcinoid tumors. Quantitative histologic studies of multiple standardized biopsy specimens showed a significantly increased number of fundic mucosal argyrophil endocrine cells in 40 patients with PA when compared with 15 patients with simple fundic atrophic gastritis (p = 0.002) or 8 normal controls (p = 0.0001). Patients with simple atrophic gastritis had increased numbers of fundic mucosal argyrophil cells as compared with normal controls (p = 0.02). A significant difference was also noticed in the number of antral mucosal argyrophil cells between patients with PA and normal controls (p = 0.01), but not between patients with PA and patients with simple atrophic gastritis. It is concluded that, in addition to having hyperplasia of gastric mucosal argyrophil endocrine cells, patients with PA run an increased risk of developing gastric argyrophil cell carcinoid tumors, which should be regarded as potentially malignant.

Adenocarcinoma↗

PubMed1985

Decreased sulfation of serum and tissue gastrin in hypergastrinemia of antral origin.

The sulfation of gastrin in serum, antrum and duodenum was studied in 22 normo- and 20 hypergastrinemic patients. The ratio between gastrin-17 and gastrin-34 was measured in antrum and duodenum. The degree of sulfation was reduced in the antrum of hypergastrinemic patients (35.3 +/- 1.3%, mean +/- SEM) compared with 48.0 +/- 2.1% in normo-gastrinemic patients (p less than 0.001). The degree of sulfation in serum and duodenum was similar to that of the antral gastrins in all patients. The percentage of gastrin-34 in antrum was increased (7.3 +/- 0.7%) in hypergastrinemic compared with 4.9 +/- 0.3% in normogastrinemic patients (p less than 0.01). In the duodenum the percentage of gastrin-34 was similar in normo- and hypergastrinemia. When classified according to clinical diagnosis, sulfation of antral gastrin was normal in duodenal ulcer (47.6 +/- 4.5%) but decreased in gastric ulcer (36.7 +/- 1.6%, p less than 0.01) and pernicious anemia (31.3 +/- 1.9%, p less than 0.001) compared with 48.2 +/- 2.2% in control patients. In pernicious anemia a larger proportion of antral gastrins occurred as gastrin-34 (8.2 +/- 0.9%) compared with 4.8 +/- 0.4% in control patients (p less than 0.01). Our study suggests that both sulfation and proteolytic processing of the gastrin precursor is diminished in hypergastrinemia of antral origin.

Anemia, Pernicious↗

PubMed1985

Endoscopic sphincterotomy in the treatment of choledocholithiasis and ampullar stenosis. Experience with 202 patients.

Endoscopic sphincterotomy (EST) was performed on 202 patients (265 EST) in the 5-year period 1978-1983 because of choledocholithiasis or benign stenosis of the ampulla of Vater. The indications for EST in choledocholithiasis included residual or recurrent stone(s) in 80 cholecystectomized patients, and 96 had choledocholithiasis with the gallbladder in situ. Ductal calculi passed spontaneously after EST in 87 cases (50%) and were actively extracted in 73 (41%). Ductal clearance failed in 16 patients. The overall success rate thus was 91%. Ampullar stenosis was successfully treated in 26 patients. Sphincter stenosis after EST was diagnosed in one patient. Immediate complications of EST arose in 31 patients (11.7%), one of whom died. Emergency laparotomy was required in three cases (1.1%). EST with or without stone extraction is a relatively safe procedure for managing choledocholithiasis in high-risk patients before cholecystectomy is considered, and also for stones retained or reformed after cholecystectomy. Endoscopic treatment may offer appreciable clinical and financial benefits by reducing morbidity and mortality rates and shortening hospitalization and convalescence time.

Adult↗

PubMed1984

Rupture of fetal membranes and premature delivery associated with group B streptococci in urine of pregnant women.

68 of a group of 2745 consecutive pregnant women had group B streptococci in their urine. In this group primary rupture of the membranes and premature delivery occurred in 35% and 20% respectively. In women without group B streptococci 15% had primary rupture of the membranes and premature delivery occurred in 8.5%. Group B streptococcal sepsis occurred in five infants, all had mothers with positive urine culture. Women with group B streptococci in their urine seem to have a significantly increased risk of primary rupture of the fetal membranes and premature delivery.

Adolescent↗

PubMed1984

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with jaundice and suspected biliary obstruction.

During a 4-year period (1978-1982), 206 patients were examined with endoscopic retrograde cholangiopancreatography (ERCP) because of jaundice with suspected biliary obstruction. The total of examinations was 223. Duodenoscopy with ERCP gave a positive primary diagnosis in 160 cases (78%), six (4%) of which later proved to be incorrect. Extrahepatic obstruction could be excluded in 16 patients with normal cholangiogram (8%). Clinically relevant information thus was obtained in 176 cases (85%). The main cause of extrahepatic obstruction was common bile duct stone(s), which were found in 73 patients. Immediate endoscopic sphincterotomy was performed in 64 of them and cleared the duct of stones in 54 (84%). Benign stenosis of the ampulla of Vater was relieved with endoscopic sphincterotomy in six patients. Malignant bile duct obstruction was diagnosed in 56 patients, and in three of them an endoprosthesis for internal drainage of the biliary tract was endoscopically inserted. Immediate complications after ERCP without endoscopic sphincterotomy occurred in 5 of 136 patients (4%), one of whom died. The authors conclude that ERCP is a rapid, reliable and safe diagnostic method in patients with extrahepatic biliary obstruction.

Adult↗

PubMed1984

Prevalence and incidence of pernicious anemia. An evaluation for gastric screening.

To evaluate the feasibility of gastroscopic screening for gastric malignancy in patients with pernicious anemia, all individuals treated with vitamin B12 in a well-defined population were identified. Individuals treated for an uncertain diagnosis were submitted to supplementary examinations. Of all individuals treated with vitamin B12 41% had unequivocal pernicious anemia, 13% possible pernicious anemia, 26% vitamin B12 malabsorption other than pernicious anemia, and 20% no verified vitamin B12 deficiency. The maximum crude prevalence of pernicious anemia was 1.98 per mile and the crude maximum incidence 16.7 x 10(-5) x year-1. The estimated annual cost of endoscopic gastric screening at 3-year intervals in patients with pernicious anemia younger than 75 years of age would be SEK 15,000/100,000 inhabitants, a cost that to a great extent could be financed by a more adequate prescription of vitamin B12 treatment.

Adult↗

PubMed1983

Variations in the sulfation of circulating gastrins in gastrointestinal diseases.

The basal concentrations of sulfated and non-sulfated gastrins in serum were measured radioimmunochemically in healthy subjects and in normo- and hyper-gastrinemic diseases. The degree of sulfation in patients with duodenal and gastric ulcer, chronic pancreatitis, gallstone disease, and chronic renal failure were similar to that of healthy controls, in whom 37.7 +/- 1.9% (mean +/- SEM) of serum gastrins were sulfated. In eight patients with the Zollinger-Ellison syndrome 57 +/- 5.4% of the gastrins were sulfated (p less than 0.005, compared with controls). In patients with pernicious anemia (no. = 20) only 24.4 +/- 2.0% of the gastrins were sulfated (p less than 0.005, compared with controls). An inverse correlation (r = -0.63, p less than 0.01) was found between the degree of sulfation and the total gastrin concentration in pernicious anemia but not in gastrinoma patients. The results indicate that diseases with increased synthesis of gastrin are accompanied by an abnormal degree of sulfation.

Adult↗

PubMed1982

Evaluation of parathyroid function in patients with hypergastrinaemia and pernicious anaemia.

In order to evaluate the possible causal relationship between raised serum gastrin levels and the development of primary hyperparathyroidism (HPT) which is suggested from experimental studies we evaluated parathyroid function in a group of 32 patients with hypergastrinaemia and pernicious anaemia. The values for serum calcium and parathyroid hormone were determined as well as the fasting urinary excretions of cyclic AMP and calcium. There was no relationship between the serum gastrin levels and any of the other studied parameters and there was no consistent pattern suggesting parathyroid hyperfunction. A retrospective analysis of hospital records from 441 patients operated for primary HPT showed a prevalence of pernicious anaemia of 1.8%. This figure is higher than that found in the unselected age-matched population (0.31%). However, taken together this study does not support the hypothesis that hypergastrinaemia is of particular importance for the pathogenesis of primary HPT.

Adult↗

PubMed1982

Gastric cancer. Diagnosis, treatment and prognosis in clinical routine.

During 1972-1978, 235 cases of gastric cancer were diagnosed at the Central Hospital of Eskilstuna which serves 115 000 inhabitants. The diagnosis was histologically verified in 193 cases (82%). Only half of the cases were definitely diagnosed prior to exploratory laparotomy or death. More than one fourth of the patients had experienced symptoms consistent with gastric cancer for a period of 1-5 years prior to diagnosis. Gastric X-ray had been performed in 184 cases during the year preceding diagnosis. In 44 cases (24%) the examination gave no suspicion of cancer. One hundred and thirty-five patients were operated upon. Tumour resection was possible in 73, of which 12 (16%) died postoperatively. The crude 5-year survival rate after diagnosis was a mere 7% in the entire series and 19% after tumour resection. Only 14 patients were alive at the end of 1980, 13 after radical surgery. Eleven early gastric cancers (4.7%) were diagnosed, 9 prior to death. We conclude, that the symptoms of gastric cancer were regularly misinterpreted, that the diagnostic tools were dull and that the prognosis is still poor. Prompt recognition of the symptoms and liberal indications of gastroscopy might allow diagnosis at an earlier stage and thus, hopefully, an improved prognosis.

Adenocarcinoma↗

PubMedDate not supplied

Chronic pancreatitis: results of operations for relief of pain.

Pancreaticojejunostomy is the method of choice for surgical treatment of pain in chronic pancreatitis in the case of ductal dilation. The operative risk is small and all remaining glandular tissue preserved. At 5 years postoperatively, about two-thirds of the patients still experience pain relief. In the absence of dilated ducts, the surgical options are somewhat more controversial. Parenchyma-saving alternatives such as nerve-cutting procedures have not met expectations. Instead, percutaneous blockage of the celiac plexus using alcohol and phenol have been more commonly used for short-term pain relief. The relatively great number of different resective procedures probably reflects the dissatisfaction with the effect of each one of them. Neither left resection nor total pancreatectomy is, today, an attractive alternative due to the relatively high mortality and morbidity (short- and long-term) risks, especially when evaluated against the backdrop of the limited pain reduction in many patients. The Whipple procedure is still the best alternative, although it should be used with critical selection by both the patient and the surgeon. As for the new operations presented during the 1980's, it is too early to foresee their possible future role. We feel, however, that we still have to await the operation which fulfills the criteria of an ideal operation for pain in chronic pancreatitis.

Chronic Disease↗

PubMedDate not supplied

Bacteremia following diagnostic and therapeutic ERCP.

The occurrence of bacteremia in association with diagnostic or therapeutic ERCP was studied in 180 patients undergoing a total of 194 examinations. Nineteen (15%) of 126 diagnostic procedures and 18 (27%) of 68 therapeutic procedures were associated with bacteremia (p less than 0.1). Nine patients had polymicrobial bacteremia and a total of 16 species were detected. Different streptococci, mainly alpha-hemolytic, were the most common bacteria which were identified in 38% of the bacteremic patients. There were no significant differences with regard to the occurrence of fever, pancreatitis, or septic complications between the diagnostic and therapeutic groups of patients. Neither did the complication rate in patients with bacteremia differ from that in patients without bacteremia, whether the procedure was diagnostic or therapeutic. Complication rates did not differ between patients with and patients without pancreaticobiliary obstruction. However, the majority of patients with biliary stasis had drainage with relief of the obstruction at the time of the diagnostic ERCP. We conclude that general routine antibiotic prophylaxis is not indicated in patients undergoing diagnostic or therapeutic ERCP. The question whether such prophylaxis should be given with certain diagnoses or treatments, or in patients with valvular heart disease, remains to be answered in controlled randomized studies.

Aged↗

PubMedDate not supplied

Beta-microseminoprotein in gastric carcinoids: a marker of tumour progression.

Gastric carcinoid disease may have a highly varying clinical course depending on the malignancy of the tumour. Many biochemical markers, such as peptides and biogenic amines, have been found in carcinoid tumour tissue but none has been reported to be useful as a predictor of the degree of malignancy of the carcinoid. beta-Microseminoprotein is a small disulphide-rich protein with unknown function present in the secretions on most mucosal surfaces in the body, including the stomach where it is also found in some endocrine cells. We have studied beta-microseminoprotein by immunohistochemistry in the tumour tissue of 29 patients with gastric carcinoid disease. Beta-Microseminoprotein was present in the tumour tissue in 62% of the patients and its presence was correlated to tumour diameter and tissue invasion depth. The presence of beta-microseminoprotein in tumour tissue was corroborated by in situ hybridisation. All 4 patients with the solitary sporadic type of tumour and all 6 patients with metastasis had positive immunostaining of the tumour tissue. The serum concentration of beta-microseminoprotein, measured by radioimmunoassay, was increased in all but 2 of 13 patients with gastric carcinoid disease. To a large part the increase was due to the concomitant atrophic corpus gastritis. We conclude that beta-microseminoprotein in tumour tissue is a marker of tumour progression and that measurement of beta-microseminoprotein in serum is less informative than immunohistochemistry.

Adult↗

PubMedDate not supplied

Bacteremia associated with extracorporeal shockwave lithotripsy of gallbladder stones.

BACKGROUND/AIMS: The possible induction of bacteremia by extracorporeal shock wave lithotripsy (ESWL) of gallbladder stones was studied. MATERIALS AND METHODS: Seventy-six patients undergoing a total of 107 ESWL treatments were studied. RESULTS: Twenty-four (22%) of the 107 treatments were associated with bacteremia. Staphylococcus epidermidis was cultured during and/or after 23 (96%) of the treatments associated with bacteremia. The ESWL-induced tissue damage of the skin in the pass-way of the shock-waves was the most likely cause of bacteremia in these patients. There was no correlation between the occurrence of bacteremia and the age or body mass index of the patients. Neither was there any correlation of bacteremia related to the duration of the treatment, the number of shock waves, the energy delivered, the stone volume or the occurrence of calcified stones. No patient developed sepsis or endocarditis. Transient fever shortly after treatment was recorded in 5 patients (5%), one of whom had bacteremia. CONCLUSIONS: Routine antibiotic prophylaxis is not indicated in patients undergoing ESWL for gallbladder stones. The question whether such prophylaxis should be given to patients at special risk, for instance patients with artificial heart valves or known valvular heart disease, remains to be answered in larger controlled and randomized studies.

Antibiotic Prophylaxis↗