Somatostatin in the treatment of pancreatic ascites.
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Biomedical subjects
Publications and source records attributed to K Nygaard.
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In distal pancreatectomy, splenectomy has usually been an expedient component. In view of the recognized risk of overwhelming postsplenectomy septicaemia the current trend is splenic salvage whenever possible, in trauma surgery as well as in elective surgery. In order to emphasise this point we report a case of distal pancreatectomy with splenic salvage.
A research project initiated in 1978 comprised establishment of a national polyposis registry, a genetic linkage study using classical and DNA markers, an in vitro study of fibroblasts for transformation parameters and chromosome instability, and a comparative study of DNA-RFLPs in cancer and constitutional tissue. The linkage study (to be reported elsewhere) confirmed the recently reported close linkage between the polyposis gene locus APC and D5S71. No in vitro test for the presence of the APC gene has been confirmed or revealed, but we detected increased chromosomal instability on a statistical basis and also recorded abnormal DNA-repair. As per 1. January 1988 the prevalence of adenomatosis of colon and rectum in Norway was 1/43,500. Among patients born in the period 1931-1950 the incidence at birth of developing the disease is 1/20,000 and the mutation rate is 1/72,000 per gamete per generation. In Norway new mutants in healthy families will comprise 1/3-1/2 of all new cases in the coming two decades, or one of 36,000 births.
Single-dose doxycycline was compared with single-dose doxycycline + tinidazole in regard to prevention of septic complications after colorectal surgery, taking into account the type and level of surgery--right or left hemicolectomy, rectal operations and others. The study was performed as a prospective double-blind trial, with randomization in blocks. In colorectal surgery as a whole the combination was found to be more effective than doxycycline alone. When the four surgical blocks were separately considered, however, the difference between the two regimens was found to be mainly due to rectal operations, following which the incidence of abdominal and of perineal wound infections was significantly lower with the combined regimen than with doxycycline alone. The subgroups composed of right-sided or left-sided hemicolectomy or other operations were too small to permit definite conclusions.
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One hundred and forty-seven patients with splenic injury were entered in a prospective multicentre study including 18 hospitals. The diagnosis was made by scintigraphy in 55 patients, ultrasonography in 51 and computed axial tomography in 31. Exploratory laparotomy was performed in 52 patients, in 23 of these after a positive peritoneal lavage. Splenic injury was found in 33 per cent of the ultrasound examinations, indicated in another 20 per cent and not indicated in 16 per cent. In 31 per cent increased intraperitoneal effusion was the only finding. There was a tendency towards an underestimation of the injury by ultrasonography. Peritoneal lavage was positive in all examinations.
Ranitidine is used to treat symptomatic oesophageal reflux; its effect is probably to a great extent due to reduced gastric secretion. Whether it also affects oesophageal motility is a matter of controversy. In a randomized double-blind study oesophageal motility was recorded in 21 healthy individuals after 3 doses of 150 mg ranitidine or placebo given over 36 h. Ranitidine increased the pressure in the lower oesophageal sphincter from 14 to 18 mmHg (p = 0.05) but otherwise did not influence oesophageal motility.
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During the years 1981-85, 163 patients were treated with gastric banding for morbid obesity. Mean preoperative body weight (+/- s.e.m.) was 121.3 kg +/- 1.4, and mean overweight was 71.5% +/- 1.6 according to Broca's formula. Twenty-four patients had postoperative complications during the first 30 days, mostly minor. Four required reoperation and one of these died. Seventeen patients had late complications, six persistent vomiting necessitating reoperation, eight incisional hernia and three penetration of gastric wall by band. The weight loss was rapid during the first 6 months, and thereafter levelled off. After 2 years the weight loss was 33.4 kg +/- 2.4, corresponding to a mean weight loss of 27.6 percent +/- 1.9 of preoperative weight. There was no significant difference in weight loss expressed as a percentage of preoperative weight between patients operated with an outlet of 12 mm (45 patients) or 15 mm (118 patients), nor between males (37 patients) or females (126 patients). We conclude that our technique of gastric banding seems to be a relatively safe and reliable surgical treatment for morbid obesity. But our follow-up period has been limited to 2 years or less, and a longer follow-up is necessary before the method can be fully evaluated.
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Temporary reduction of the exocrine pancreatic secretion may be desirable in various experimental models. In the rat this can be achieved by obstructing the connection between the pancreas and the duodenum. A new, simple technique of pancreatic duct occlusion using metal hemostatic clips is described. The reduction of secretion produced by the procedure was assessed by measuring duodenal protein, amylase, and trypsin during stimulation with cholecystokinin. Stimulated duodenal amylase activity 1 and 4 weeks following duct occlusion was reduced by approximately 80% compared with sham-operated controls, whereas proteolytic activity was reduced by 96 and 60%, respectively. The magnitude and duration of pancreatic insufficiency achieved by this technique is equivalent to that achieved with more complicated methods.
To assess the predictive ability of various indicators of common bile duct calculi, 457 patients undergoing cholecystectomy for gallstone disease were prospectively screened for the presence of 11 predefined criteria of possible choledocholithiasis. The predictive ability of the criteria, individually and in combinations, was determined. For all criteria, except a history of pancreatitis, a significantly increased incidence of choledocholithiasis was found. The number of positive criteria correlated positively with the frequency of common bile duct calculi. The negative predictive value and sensitivity of the total set of criteria were 98% and 89.5%, respectively. Following common duct exploration, the number of complications and the duration of postoperative hospitalization were significantly increased as compared with simple cholecystectomy. Peroperative cholangiography with cholecystectomy is recommended in all patients, with one or more criteria of possible choledocholithiasis. Routine peroperative cholangiography in patients with no positive criteria does not seem to be necessary.
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In a randomized trial, irradiation alone (35 Gy) or irradiation (30 Gy) and bleomycin was given as preoperative treatment of esophageal cancer. In inoperable patients, a split course of irradiation alone (63 Gy) or irradiation (55 Gy) and bleomycin was given. Bleomycin doses were 5 mg i.m. 1/2-1 h before each irradiation dose. No benefit was obtained by addition of bleomycin to irradiation concerning survival or palliation of dysphagia. No benefit of bleomycin was seen either in any subgroup of patients according to different primary tumour classifications, histopathological gradings or localizations of tumour. In patients with advanced/metastatic disease, bleomycin and adriamycin treatment gave a significantly longer survival than bleomycin alone. It was shown that the presence of T1 tumours was a significant prognostic factor for long-term survival and that performing a radical operation was a significant advantage for a longer survival. Female patients treated with irradiation with or without bleomycin survived significantly longer than males, but in operable patients there was no significant difference between the two sexes with regard to survival.
Germfree rats were subjected to: (1) 90% jejunoileal resection (15 rats) or (2) 90% end-to-side jejunoileal bypass (20 rats). The mortality rate was 67 and 75%, respectively, which is markedly higher than after the same types of operation in conventional rats. Late mortality occurred only in the bypass group. Possible reasons for the high mortality rate are discussed. 5 rats in each group survived and were followed up for 6-12 weeks. At autopsy, the liver was normal, and except for lower serum concentration of albumin in the operated rats, the other liver function tests were normal. There did not seem to be any difference in body weight between the two groups of surviving rats which may indicate that the intestinal microflora is an important factor in causing the difference in body weight after resection and bypass of the small intestine in conventional rats. The number of surviving rats was small, however, and further studies are therefore necessary to give a definite answer to this question.
Of a series of 133 patients treated surgically for Crohn's disease during the years 1962-78, 21 had recurrence after previous operations in other hospitals. In addition, 40 of the patients underwent altogether 52 reoperations for recurrent disease; hence the total number of operations was 185. Five patients died in the postoperative period (2.7%). There were five late deaths related to Crohn's disease. The annual recurrence rate after all operations performed was rather constant, averaging 13.1%, and the cumulative recurrence rate after 10 years was 76.1%. The annual rate of reoperation tended to decline, with a cumulative reoperation rate of 35.8% after 10 years. The recurrence rate was not significantly different after primary operations and operations for recurrent disease. There was a higher risk of relapse during the first 2 years after non-radical excision of diseased gut than after radical excision. At follow-up examination in 108 patients most were in good general condition. Only eight patients had severe, disabling symptoms with reduced working capacity.