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Biomedical subjects

K G Tranberg

Publications and source records attributed to K G Tranberg.

At least 37 records · Page 2Linked to original sources
PubMed1996

Implantation metastases from gastrointestinal cancer after percutaneous puncture or biliary drainage.

OBJECTIVE: Evaluation of incidence and outcome of implantation metastases after percutaneous fine-needle biopsy or biliary drainage. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: Eight patients with implantation metastases from gastrointestinal cancers after percutaneous fine-needle biopsy (n = 7) or biliary drainage (n = 1). MAIN OUTCOME MEASURES: Incidence of implantation metastases, treatment and influence on outcome and survival. RESULTS: In two out of three patients who had had otherwise radical operations, the implantation metastases meant that the operations were palliative rather than curative. Patients who had had palliative resections of the implantation metastases developed major local complications. One patient is alive with no signs of disease after 106 months, while one is alive with disease 30 months after the diagnosis of the implantation metastases. The remaining patients have died after 6 to 23 months. CONCLUSION: The incidence of implantation metastases after fine-needle procedures is probably underestimated. There is a slight but definite risk that the procedure may render an otherwise curative resection palliative. Implantation metastases cause local complaints of varying severity and seems to have a tendency to recur locally. We recommend that fine-needle biopsy should be restricted to patients who will truly benefit from a more accurate preoperative diagnosis.

Adult↗
PubMed1995

Follow-up after curative surgery for colorectal carcinoma. Randomized comparison with no follow-up.

PURPOSE: This study investigated the value of intense follow-up compared with no follow-up after curative surgery of cancer in the colon or rectum. METHODS: One hundred seven patients were randomized to no follow-up (control group; n = 54) or intense follow-up (follow-up group; n = 53) after surgery and early postoperative colonoscopy. Patients in the follow-up group were followed at frequent intervals with clinical examination, rigid proctosigmoidoscopy, colonoscopy, computed tomography of the pelvis (in patients operated with abdominoperineal resection), pulmonary x-ray, liver function tests, and determinations of carcinoembryonic antigen and fecal hemoglobin. Follow-up ranged from 5.5 to 8.8 years after primary surgery. RESULTS: Tumor recurred in 18 patients (33 percent) in the control group and in 17 patients (32 percent) in the follow-up group. Reresection with curative intent was performed in three patients in the control group and in five patients (four of whom were asymptomatic) in the follow-up group. In the follow-up group two asymptomatic patients with elevated carcinoembryonic antigen levels were disease-free three and five and one-half years after reresection and were the only patients apparently cured by reresection. No patient underwent surgery for metastatic disease in the liver or lungs. Symptomatic metachronous carcinoma was detected in one patient (control group) after three years. Five-year survival rate was 67 percent in the control group and 75 percent in the follow-up group (P > 0.05); the corresponding cancer-specific survival rates were 71 percent and 78 percent, respectively. CONCLUSION: Intense follow-up after resection of colorectal cancer did not prolong survival in this study.

Aged↗
PubMed1995

The YAG laser and Wallstent endoprosthesis for palliation of cancer in the esophagus or gastric cardia.

The need for frequent retreatment is a disadvantage of using endoscopic laser therapy (ELT) alone for palliative treatment of esophageal carcinoma. In this prospective study, therefore, we investigated the potential and feasibility of combining ELT with a self-expanding metallic stent (Wallstent). Twelve patients received ELT followed by stent placement (stent group) and were compared with 39 patients receiving ELT alone (ELT group). Swallowing ability was similar in the two groups. About one-third of the patients who had a short life expectancy, did not appear to benefit from stenting, whereas the interval between retreatments was prolonged by a factor of 2-4 in the remaining patients. Median survivals were 5.5 (range 1.0-23.5) months in patients with stents, and 4.5 (range 1.2-24.6) months in patients without stents. There were few complications related to stenting. In one patient, technical problems caused stent dislodgement into the stomach. Another stent patient died of hemorrhage from an untreated tumor in the stomach, but it was considered unlikely that the bleeding was caused by the stent. In conclusion, this preliminary trial suggests that a Wallstent endoprosthesis, used in combination with laser treatment, may become a valuable tool for prolonging the dysphagia-free interval in selected patients.

Aged↗
PubMed1993

Malignant esophageal strictures: treatment with a self-expanding nitinol stent.

A self-expanding esophageal nitinol stent was implanted under fluoroscopic guidance in 40 patients with malignant esophageal strictures and clinically significant dysphagia. The strictures were caused by squamous cell carcinoma (n = 14), adenocarcinoma (n = 12), recurrent anastomotic carcinoma (n = 8), and mediastinal tumors (n = 6). Eight stents were balloon dilated to maximum diameter immediately after insertion. Sixteen stents self-expanded to maximum diameter within 24 hours, and the other stents expanded to maximum diameter during further observation. There were no serious stent-related complications, and the dysphagia was reduced considerably in all patients immediately after stent insertion. Persistent tumor bleeding occurred in two patients, and ingrowth of tumor into the stent was seen in eight patients. Two stents occluded due to tumor ingrowth but were successfully recanalized with endoscopic laser coagulation. At the end of the study, 28 patients were dead with a mean survival of 2.9 months (range, 0.1-7.0 months), and 12 patients were alive with a mean follow-up of 8.8 months (range, 4.0-15.0 months).

Adult↗
PubMed1993

Detection of hepatic metastases in colorectal cancer: a prospective study of laboratory and imaging methods.

OBJECTIVE: To assess and compare the accuracy of imaging methods (ultrasonography (US), computed tomography (CT), angiography, arterially enhanced CT with computed tomographic arterial portography (CTA)), biochemical analyses, and surgical assessment during the operation, in detecting the presence of absence of hepatic metastases in patients with colorectal cancer. DESIGN: Open study. SETTING: University of Lund, Sweden. SUBJECTS: 71 consecutive patients without clinical evidence of liver metastases at the time of the operation for removal of the primary tumour. INTERVENTIONS: Regular biochemical tests for five to seven years, and CT and US one year after operation in all patients without confirmed metastases. MAIN OUTCOME MEASURES: Presence or absence of hepatic metastases. RESULTS: Accuracy of surgical assessment, angiography, US, CT and CTA was 90, 77, 80, 82 and 83%, respectively, and corresponding predictive values of a negative test were 87, 75, 77, 80 and 84%. Measurement of bilirubin concentration and hepatic enzyme activities were not helpful, and that of carcinoembryonic antigen had an accuracy of only 70%. Accuracy and predictive values were not improved by combining tests. CONCLUSION: The accuracy of US, CT or CTA was not good enough to merit routine use before operations for colorectal cancer. They are potentially valuable for monitoring progress at follow up, but this remains to be confirmed.

Adult↗
PubMed1993

Accuracy of CT arterial portography of the liver compared with findings at laparotomy.

To evaluate the accuracy of CT arterial portography (CTAP) of the liver, CTAP examinations from 111 patients were retrospectively reviewed and compared with the findings at laparotomy. Laparotomy had been performed within 3 weeks after the CTAP examination. In cases of resectable liver tumor, the result from the pathologic examination report was used to calculate the accuracy of CTAP. In cases of nonresectable liver tumor or liver without tumor, CTAP findings were compared with the result of a thorough inspection and palpation of the liver. The right liver lobe and the medial and lateral segments of the left lobe were separately evaluated. Thus, a total of 333 lobes/segments were evaluated. Tumor was found at laparotomy in 80 of 333 lobes or segments. At CTAP a total of 94 lobes were evaluated as positive for tumor growth, 23 of these were falsely interpreted as positive and 9 were falsely interpreted as negative when compared with the findings at laparotomy. However, 3 patients called false-positives later turned out to be true-positives since the lesions were overlooked at operation. A sensitivity of 89%, a specificity of 91%, and an accuracy of 90% was calculated for CTAP. It is concluded that CTAP has a higher accuracy than other radiologic methods and should be considered suitable for preoperative evaluation of potentially resectable liver tumor.

Adult↗
PubMed1992

A new self-propelling nasoenteric feeding tube.

A new fine-bore nasoenteric feeding tube was tested in 19 post-operative patients. It is a silicone rubber tube, which at its distal end has 5 loops with a diameter of approximately 4 cm. The loops are easily straightened during insertion into the stomach, but ease transpyloric passage after removal of the guidewire. 4 h after insertion, 18 tubes had reached the duodenum or upper part of the jejunum. In only 1 patient was there regurgitation of the tube into the stomach after insertion.

Journal Article↗
PubMed1991

Effect of bile on growth, peritoneal absorption, and blood clearance of Escherichia coli in E coli peritonitis.

The effect of intraperitoneal bile on growth, peritoneal absorption, and clearance of Escherichia coli was determined in E coli peritonitis in the rat. In E coli peritonitis, intraperitoneal bacterial counts gradually decreased, whereas they increased (after 2 hours) with subsequent development of bacteremia in E coli plus bile peritonitis. After an intraperitoneal injection of labeled bacteria, blood radioactivity was only initially lower in E coli plus bile peritonitis compared with E coli peritonitis. Clearance from blood was lower in E coli plus bile peritonitis than in E coli peritonitis. Organ localization was similar in E coli peritonitis and E coli plus bile peritonitis with decreased splenic, increased pulmonary, and unchanged hepatic uptakes compared with controls. Impaired peritoneal absorption of bacteria, together with impaired local host defense, is likely to enhance the noxious effect of bile in E coli peritonitis.

Animals↗
PubMed1991

Surgical treatment of pancreatic cancer. The Swedish experience.

The development at a university hospital of radical surgery for exocrine pancreatic cancer has been studied for the time period 1958-1989. It was found that the number of operations per year increased gradually, being 6.6/year during the last 5 years, giving a resection rate of 15%. The resection rate did not change during the studied time period. The size, grade of differentiation, or stage of tumor did not change. There was no significant tendency toward decreasing operation time and blood loss, although a technically more complicated operation has been done in the last 30 cases (change from total to subtotal duodenopancreatectomy). The hospital mortality rate decreased from 33 to 3%. The rate and severity of post-operative complications also strongly decreased. For the last 30 cases, there was also a prolonged long-term survival. We conclude that the total management of patients radically operated on for exocrine pancreatic cancer is today much better than it was a decade or two ago.

Diabetes Mellitus, Type 1↗
PubMed1991

Bile increases lipopolysaccharide release in experimental E. coli peritonitis.

Previous studies in rats showed increased mortality when bile was added to intraperitoneally injected Escherichia coli. In the present study bacterial counts and levels of lipo-polysaccharide (LPS) were determined in the peritoneal cavity and in blood 0.5, 1, 4 and 10 hours after induction of peritonitis with E. coli alone or together with bile. LPS was measured with gas chromatographic analysis of beta-hydroxymyristic acid, a characteristic component of E. coli-LPS. Bacterial counts and LPS levels in peritoneal fluid and blood rose higher in E. coli + bile peritonitis than in E. coli peritonitis. The intergroup difference in LPS levels was evident at 0.5 and 1 hour, whereas the bacterial counts began to differ at 2 hours. Presence of intraperitoneal bile in E. coli peritonitis thus produced rapid rise in LPS levels that could not be caused by bacterial numbers alone. This early load of LPS may help to explain the noxious effect of bile in E. coli peritonitis.

Animals↗
PubMed1991

Palliation of colorectal carcinoma with the Nd-YAG laser.

The Nd-YAG laser used for endoscopic palliation of carcinoma of the rectum (n = 16) or the sigmoid colon (n = 5). Indications were cardiorespiratory insufficiency, advanced disease, severe concomitant illness or patient's refusal of surgery. The treatment was repeated every 2-3 (range 1-5) months, with about half the sessions on an out-patient basis. Symptomatic relief was excellent in 16 of 20 patients, moderate in three and poor in one case (1 patient was asymptomatic). The treatment was effective against bleeding, mucous discharge and signs of intestinal obstruction, but not against incontinence. In the absence of incontinence, palliation was excellent in patients with noncircumferential tumours and in four of the five with circumferential growth. In the latter group frequent treatment sessions were required for long tumours. There were no major complications. Endoscopic laser therapy is concluded to provide rapid, safe and excellent control of local symptoms in most patients with inoperable colorectal carcinoma, to be less useful when the tumour is large and circumferential and not effective in patients with incontinence.

Aged↗
PubMed1991

Tumor seeding occurring after fine-needle biopsy of abdominal malignancies.

Percutaneous fine-needle aspiration biopsy is a commonly used diagnostic procedure with a high accuracy and a low complication rate. However, tumor seeding in the biopsy tracts has been recorded with a frequency of one in 20,000-40,000 biopsies. We report 5 cases of percutaneous tumor seeding recorded after 5,000 fine-needle biopsies of abdominal malignancies at our institution. The risk of implantation metastases induced by fine-needle biopsy warrants consideration in patients with abdominal malignancies since it may compromise the outcome of radical surgery. It should only be performed when the result of the procedure has a direct impact on the choice of therapy.

Abdominal Neoplasms↗
PubMed1990

Repeated dearterialization of hepatic tumors with an implantable occluder.

A new implantable device for repeated hepatic dearterialization was evaluated in 13 patients with tumors of the liver. Eleven patients had colorectal secondaries and also received cyclic intraperitoneal infusion of 5-fluorouracil. Two patients had primary hepatocellular cancer (HCC). Four patients had a variant arterial supply. The hepatic artery was occluded repeatedly for 1 hour twice daily for 1 to 17 months (mean, 8.5 months). A complete transient occlusion was obtained in all but three patients, in whom minor collaterals were missed at the initial operation. Collaterals developed in two patients during therapy. Leakage from the balloon occurred in two patients after 5 and 12 months. Two patients developed thrombosis of the hepatic artery during therapy due to the cuff being placed too tightly around the vessel. A complete remission was demonstrated in one patient with HCC, a partial response in three patients (one HCC and two metastatic), stable disease in two patients, and progression in five patients. Median survival for colorectal lesions was 15 months (range, 2 to 23 months) from start of the occlusions. Four of nine patients developed calcifications of their lesions during therapy. One patient with HCC was alive and free of disease 18 months after the start of the occlusions. Both patients with HCC had an obstructed portal vein which may have contributed to the favorable outcome. The occluder was uniformly accepted by the patients who were able to do their occlusions at home.

Adult↗
PubMed1990

Roles of bile and bacteria in biliary peritonitis.

Bile is known to have an adverse effect in peritonitis but the mechanism(s) and site of action of bile are unknown, as are the relative roles of bile and bacteria. The present study was designed to answer some of these questions. Experiments in which rats were injected intraperitoneally and intravenously with bile, Escherichia coli or saline showed that bile had no systemic toxicity and that it increased the mortality rate only when introduced into the peritoneal cavity together with bacteria. Measurements of peritoneal fluid volumes and blood pressure did not confirm the theory that the increased mortality rate was a consequence of loss of plasma volume into the peritoneal cavity. The number of intraperitoneal bacteria decreased continuously in animals receiving intraperitoneal E. coli alone. When bile was added by intraperitoneal injection, the number of intraperitoneal bacteria started to rise at 2 h and then increased steadily with a consequent bacteraemia at 10 h. The number of bacteria per peritoneal phagocyte was significantly lower after intraperitoneal injection of E. coli and bile, when compared with injection of E. coli alone. It is concluded that bile exerts its detrimental effect within the peritoneal cavity in the presence of bacteria. Bile impairs local host defence in a way that remains unknown and may be related to the detergent-lytic effects of bile salts.

Animals↗