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Biomedical subjects

K L Wiechel

Publications and source records attributed to K L Wiechel.

At least 19 recordsLinked to original sources
PubMed2000

The laparoscopic finding of pericholedochitis at cholecystectomy predicts the presence of unsuspected bile duct stones.

Routine laparoscopic cholangiography and sonography have been recommended for identification of unsuspected bile duct stones in laparoscopic cholecystectomy. The increased prevalence of retained stones seems, however, to confirm that cholangiography has been used rather selectively. The aim of this study was to investigate the kind and extent of a possible correlation between inflammatory changes in the bile duct mucosa and the hepatoduodenal ligament in patients with and without unsuspected bile duct stones. Sixty-eight patients, without symptoms or signs of bile duct stones in their case histories, laboratory findings, and preoperative sonography results, underwent laparoscopic cholecystectomy for symptomatic gallstone disease and diagnostic transcystic cholangiography and cholangioscopy. The initial step at laparoscopy revealed edema of the periductal loose tissue, vascular dilation, and petechiae on the external surface of the distal portion of the extrahepatic bile duct in 47 of 68 patients. Cholangioscopy revealed inflammatory changes in the mucosa of the distal and sphincteric portions of the extrahepatic bile duct in 45 of 47 patients, and unsuspected ductal stones were identified in 41 of these 45 patients. Neither the external surface of the bile duct nor its mucosa exhibited any signs of inflammation in the 21 remaining patients (controls), all of whom showed stone-free bile ducts. Inflammatory changes in the bile duct mucosa, occurring along with unsuspected mobile ductal stones in this study, were reflected on the external surface of the bile duct with a specificity of 87%. The changes in the external surface of the bile duct can be recognized at the initial inspection in laparoscopic cholecystectomy, as in this study, and indicate that more accurate diagnostic procedures to identify unsuspected ductal stones should be used.

Bile Ducts, Extrahepatic↗
PubMed1999

Why is it necessary to retrieve small bile duct stones at cholecystectomy?

Recovery of gallstones from the stool demonstrates that gallstones pass into the duodenum due to antegrade sphincter of Oddi (SO) activity. However, retrograde SO peristalsis occurs in three-fourths of patients with bile duct stones as shown by SO manometry. The aim of this study was to investigate, by comparing patients with and without bile duct stones, whether reversed SO activity would retain even small stones. Thirty-nine patients with gallbladder stones < or = 3 mm in diameter underwent cholecystectomy, 22 of them with concomitant biliary stones. The remaining 17 patients served as controls. The diameters of the cystic duct and the small stones in the gallbladder and bile duct were measured. The case histories of the controls indicated previous passage of gallstones into the duodenum, i.e., a normal antegrade SO activity. Biliary stones < or = 3 mm in diameter were recovered in three-fourths of the patients with ductal stones, a sign of retrograde SO activity. SO dysfunction seems to occur in three-fourths of patients with bile duct stones and should be suspected when stones < or = 3 mm are present, as, under these circumstances, it is necessary to retrieve even such small stones.

Adult↗
PubMed1998

How often might a trans-cystic-duct stone extraction be feasible?

BACKGROUND: Although the sizes of the cystic duct and concomitant bile duct stones are fundamental in evaluating the possibility of a trans-cystic-duct approach as an alternative to cholangiotomy, no conclusive data are supplied in the reports on laparoscopic cholecystectomy. METHOD: The narrowest inner diameter of the cystic duct and the diameter of the largest concomitant bile duct stone are compared in a prospective study of 30 consecutive patients. RESULTS: The bile duct stones were smaller than the cystic duct in 14 patients, 47%, and of equal size in nine, 30%. They were larger than the cystic duct in the remaining seven patients, 23%, with a difference of only 1 mm in five patients and of 2 and 4 mm, respectively, in two. CONCLUSIONS: Physical conditions allowing a trans-cystic-duct stone extraction were present in 23 of 30 patients and an attempt might have been possible after, for example, cystic duct dilatation in a further five.

Adult↗
PubMed1994

Sphincter of Oddi function studied by radioimmunoassay of biliary trypsin in patients with bile duct stones and in controls.

The trypsin level in bile was studied by radioimmunoassay in a prospective series of 63 patients with gallstone disease but without signs or symptoms of cholecystitis or pancreatitis in order to find indirect evidence of a retrograde flow of pancreatic juice. Mobile duct stones were present in 18 patients and impacted stones in 12. The remaining 33 patients had stones only in the gallbladder and served as controls. The average intraoperative trypsin level of the ductal bile was normal, both in the control group and in the group with stones occluding a potential retrograde reflux of pancreatic juice. After removal of the impacted stones, the bile showed a significantly higher trypsin level. The average intraoperative trypsin level for the group with mobile stones was significantly higher than that of the control group, and was further increased 10 days postoperatively. The trypsin level of ductal bile from 23 of the 30 patients (77%) with bile duct stones exceeded that of the 33 patients with stone-free bile ducts, indicating an inflow of pancreatic juice to the bile ducts of patients with bile duct stones. The present results correspond well to those in a previous report on retrograde phasic contractions of the sphincter of Oddi in the majority of patients with bile duct stones. This dysfunction of the sphincter, which persisted for 10 days after surgical stone removal, may be the primary disorder, probably consisting of a retrograde propulsive activity of the sphincter of Oddi.

Adult↗
PubMed1993

Bile duct pressure, hormonal influence and recurrent bile duct stones.

An obstacle to the outflow from the bile duct not only increases bile duct pressure but also facilitates the formation of primary bile duct stones. The bile duct pressure, an indicator of the balance between bile inflow and outflow, was studied postoperatively under similar conditions in 123 patients, who had been operated on for bile duct stones. Secondary bile duct stones had been present in 86 patients (group CC) and primary stones in 26 (group C), while 11 without sphincter of Oddi function were used as a control group. The basal bile duct pressure was similar in groups CC and C, but significantly lower in the controls. Intraductal injection of saline solution caused a similar increase in bile duct pressure in groups CC and C, but not in the controls. Intravenous administration of secretin and somatostatin increased the bile duct pressure in groups CC and C, while a "normal" response to cholecystokinin, a decrease in bile duct pressure, was observed only in group CC. The "abnormal" response to cholecystokinin found in group C indicates a motor dysfunction of the sphincter of Oddi, which may have been responsible for, or at least contributed to, the formation of recurrent bile duct stones in this group.

Adult↗
PubMed1992

Clinical relevance of tumour markers CA 19-9 and CA-50 in sera from patients with pancreatic duct carcinoma.

Serum levels of the tumour antigens CA 19-9 and CA-50 and their relation to the extent of the disease were studied in 97 patients with carcinoma of the pancreas. Of 13 patients with normal serum concentrations of CA 19-9, 11 (84.6%) had irresectable disease, whereas 87.5% of the patients with resectable disease expressed antigen levels above cut-off. Following attempted radical surgery, preoperatively elevated serum levels decreased in eight patients (50%). Unchanged and high levels were associated with residual disease and early death. Clinical signs of recurrence were preceded by elevated serum levels of both tumour antigens.

Aged↗
PubMed1991

Measurements of cytoplasmic free Ca2+ concentration in human pancreatic islets and insulinoma cells.

In human pancreatic islets an increase in the glucose concentration from 3 to 20 mM raised the free cytoplasmic Ca2+ concentration [( Ca2+]i), an effect being reversible upon withdrawal of the sugar. Depolarization with a high concentration of K+ or the sulphonylurea tolbutamide also raised [Ca2+]i. Addition of extracellular ATP produced a transient rapid rise in [Ca2+]i. Oscillations in [Ca2+]i were observed in the presence of 10 mM glucose. Insulinoma cells responded to glucose and tolbutamide with increases in [Ca2+]i, whereas the sulphonamide diazoxide caused a decrease in [Ca2+]i. These findings confirm previous results obtained in rodent beta-cells.

Adult↗
PubMed1991

Duodenal varicose veins.

Duodenal varices (DV) are rare. We present a review of published cases with emphasis on the management and outcome, as illustrated by our own cases, which reflects the experience reported in the literature. The diagnosis of DV must be considered in patients with gastrointestinal bleeding. Two-thirds of all reported cases have portal venous hypertension caused by hepatic cirrhosis. In the remaining one-third prehepatic portal hypertension as a consequence of either a compromised portal venous circulation (caused by perivenous tumor or inflammation) or a primary haematological disease is the underlying cause. Previously, duodenoscopy has often failed to detect and correctly interpret DV, and was similarly unsuccessful in our case. This case report demonstrates the problems and shortcomings in the management of DV and documents a hither to unreported cause. Treatment depends on the severity of bleeding. When conservative measures cannot control the haemorrhage, emergency laparotomy may be indicated. The type of surgery should be chosen according to the aetiology, site and extent of the bleeding DV. Among 112 reported cases of DV, information on outcome exists for only 35 patients who presented with haemorrhage. The aetiology was liver cirrhosis in 26 of these patients, 10 of whom had a fatal outcome, and prehepatic portal hypertension in the remaining 9, 1 of whom had a fatal outcome.

Adult↗
PubMed1990

Endoluminal ultrasound of the bile ducts.

Miniaturization of ultrasound probes has made possible endoluminal investigation of small duct systems. We have used a 360 degree transaxial real-time sector-scan imaging system with a field of view of 3-5 cm. It operates at ultra-high frequencies, which allows very high resolution. Ten jaundiced patients, aged 35-73 years, were investigated. Malignant bile-duct obstructive disease was present in eight and benign strictures in the remaining two. In all of them the intrahepatic bile ducts had undergone percutaneous transhepatic cannulation for diagnostic and therapeutic purposes. The resolution capacity has been sufficient to allow studies of the bile duct wall and adjacent tissues, and it has thus been possible to study the papilla of Vater, biliary-enteric anastomoses, and adjoining portions of the pancreatic and cystic ducts. Adjacent vessels have been identified. This preliminary study indicates that the character of strictures and the extent of tumour growth may be evaluated, thereby demonstrating the clinical potential of these miniature transducers. Endoluminal ultrasound evaluation of the bile ducts may also be possible intraoperatively and as a supplement to duodenoscopy.

Adult↗
PubMed1988

Tumor markers carbohydrate antigens CA 19-9 and CA-50 and carcinoembryonic antigen in pancreatic cancer and benign diseases of the pancreatobiliary tract.

Sera from patients with diseases in the pancreas, gallbladder, and bile duct were analyzed for the tumor markers CA 19-9, CA-50, and carcinoembryonic antigen. In particular CA 19-9 and CA-50 appear to be valuable in differentiating malignant from benign disease in these organs. Our sample of 72 patients with pancreatic cancer also indicates that CA 19-9 and CA-50 complement each other in 21% of the cases. They are also shown to be reliable for monitoring disease: following radical surgery for pancreatic cancer low levels of CA 19-9 and CA-50 were noted, while progressive rises of these tumor markers were related to disease progression.

Antigens, Neoplasm↗
PubMed1988

The effect of glipizide on extraction of insulin by the human cirrhotic and noncirrhotic liver.

The effect of glipizide on hepatic uptake of insulin was studied in five patients with liver cirrhosis and five patients with varying diseases in the biliary system and pancreas. All patients had portal catheters for diagnostic purposes. The hepatic uptake of insulin was estimated from the clearance rate for insulin obtained after a constant rate infusion into a peripheral vein and the portal vein. Each patient was examined on two consecutive mornings, the second investigation carried out one hour after oral glipizide administration. The fractional hepatic uptake was significantly lower in cirrhotic patients (17% +/- 6%) than in the other patients (52% +/- 7%; P less than .01). After glipizide, an increase in the estimated uptake of insulin occurred in cirrhotic patients (from 17% +/- 6% to 39% +/- 6%; P less than .01), whereas an insignificant decrease was observed in the other patients (from 52% +/- 7% to 43% +/- 11%).

Adult↗
PubMed1987

Basal and meal-induced somatostatin-like immunoreactivity in healthy subjects and in IDDM and totally pancreatectomized patients. Effects of acute blood glucose normalization.

We investigated the impact of blood glucose normalization on plasma levels of somatostatin-like immunoreactivity (SLI) in subjects with C-peptide-negative insulin-dependent diabetes mellitus (IDDM) and in totally pancreatectomized patients. Patients were studied during hyperglycemia and during normoglycemia, which was attained by Biostator-directed feedback insulin infusion. The experiments were performed in the fasted state and after a standardized breakfast. In IDDM (n = 6), basal levels of SLI were significantly higher than in nondiabetic subjects (n = 18). In IDDM, normalization of hyperglycemia was followed by a 40% decline in basal SLI (P less than .05). After the meal, SLI increased to the same absolute levels with or without feedback insulin treatment; however, the incremental response was 60% higher during feedback insulin treatment (P less than .05). Treatment also suppressed fasting and postprandial levels of glucagon, whereas gastric inhibitory polypeptide (GIP) levels were unaltered. In four pancreatectomized patients, normoglycemia tended to lower plasma levels of SLI by 50% (P less than .1). After breakfast, an SLI response was noted during normoglycemia, whereas no significant effect of the meal was seen during hyperglycemia. We conclude that in IDDM and in totally pancreatectomized patients, administration of insulin with subsequent normalization of blood glucose is accompanied by a decline in plasma levels of SLI in the fasted state, whereas the apparent response to a meal is enhanced. These effects on plasma levels of SLI probably reflect to a major extent release of somatostatin from the gastrointestinal tract.

Adolescent↗
PubMed1986

Diet and pancreatic cancer: a case-control study.

In a population-based case-control study carried out in Sweden in 1982-1984, the authors examined the association of pancreatic cancer with several dietary factors, coffee, alcohol, and tobacco. Analyses were based on 99 cases, 138 population controls, and 163 hospital controls. The cases were persons aged 40-79 years diagnosed with cancer of the exocrine pancreas at three surgical departments in Stockholm and Uppsala. The risk increased with higher consumption frequency of fried and grilled meat in the comparison with each series of controls (e.g., relative risk (RR) = 1.7 (90% confidence interval (CI) = 1.1-2.7) for weekly intake and RR = 13.4 (90% CI = 2.4-74.7) for almost daily intake, in the comparison with population controls). Furthermore, associations were found with other fried or grilled foods, but not with meat other than fried or grilled. The risk also increased with the intake of margarine (e.g., RR = 9.7 (90% CI = 3.1-30.2) for 15+ g of margarine on a slice of bread, in the comparison with population controls). In contrast, no excess risk was associated with high intake of butter. A low risk was associated with frequent consumption of fruits and vegetables, particularly carrots (RR = 0.3 (90% CI = 0.2-0.7)) and citrus fruits (RR = 0.5 (90% CI = 0.3-0.9)) for almost daily intake. No consistent associations were found with coffee, artificial sweeteners or alcohol consumption, but a threefold increase in risk was associated with smoking at least one pack of cigarettes per day.

Adult↗
PubMed1986

Occupational factors and pancreatic cancer.

The relation between occupational factors and pancreatic cancer has been studied by two different approaches: a population based case-control study with two series of controls and a retrospective cohort study based on register data. With both approaches, some support was found for an association with occupational exposure to petroleum products. Associations were also indicated with exposure to paint thinner (case-control study) and work in painting and in paint and varnish factories (cohort study), for exposure to detergents, floor cleaning agents, or polish (case-control study) and with floor polishing or window cleaning (cohort study), and for exposure to refuse (case-control study) and work in refuse disposal plants (cohort study).

Adult↗
PubMed1985

Insulin uptake by the human alcoholic cirrhotic liver.

Insulin uptake by the human cirrhotic liver was studied in six patients with Laennec's cirrhosis, and the result was compared with that found in ten control patients with varying diseases affecting the biliary system. All patients had portal catheters for diagnostic purposes. The fractional hepatic uptake of insulin was calculated from the clearance rates for insulin obtained after a constant rate infusion into a peripheral vein and the portal vein in each patient. The fractional hepatic extraction of insulin was 13% +/- 5 in cirrhotic patients and differed significantly from the fractional hepatic extraction found in controls (51% +/- 5;P less than 0.001).

Adult↗
PubMed1985

Oesophageal motility after sclerotherapy for bleeding varices.

Endoscopic injection sclerotherapy (ST) has gained wide acceptance as emergency and definitive treatment of bleeding oesophageal varices. The long-term effects of serial ST on oesophageal motility were studied in 19 patients with cirrhosis and prior variceal bleeding. A control group of 14 patients with compensated cirrhosis has been conservatively treated for major variceal haemorrhage a median of 5 months previously. In the ST group, eradication of the varices by serial ST had been completed a median of 7 months prior to manometry. The manometric results did not differ between the controls and 11 ST patients without dysphagia (SA). In eight ST patients with dysphagia (SB), the percentage of deglutitive peristaltic contractions (DPC) in the lower oesophagus was less than in the controls (31.4 vs. 98.6%) and in the SA patients (84%). Nonpropulsive contractions instead dominated in the lower oesophagus, but were frequent also in the upper part, resembling the motility pattern seen in patients with sclerodermal involvement of the oesophagus. When seven SB patients were reinvestigated after a median of 11.5 months (without further ST), the DPC value had increased to 74.2% and the dysphagia had decreased. The lower oesophageal sphincter pressure did not differ between the controls and the subgroups of ST patients.

Adult↗