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Biomedical subjects

K Nygaard

Publications and source records attributed to K Nygaard.

At least 55 records · Page 3Linked to original sources

Antibiotic prophylaxis in colorectal surgery. Combined doxycycline-tinidazole vs. doxycycline alone.

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.

Adolescent↗

Splenic injury--a prospective multicentre diagnostic study.

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.

Adolescent↗

The effect of ranitidine on oesophageal motility.

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.

Administration, Oral↗

Gastric banding for morbid obesity: early results.

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.

Adult↗

Pancreatic duct occlusion in the rat: report and assessment of a new technique.

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.

Amylases↗

Predictive ability of choledocholithiasis indicators. A prospective evaluation.

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.

Cholangiography↗

Irradiation, chemotherapy and surgery in esophageal cancer: a randomized clinical study. The first Scandinavian trial in esophageal cancer.

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.

Aged↗

Comparison of bypass and resection of the small intestine in germfree rats.

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.

Animals↗

Crohn's disease. Results of excisional surgery in 133 patients.

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.

Adolescent↗

Intestinal bypass. Bacteriological studies from different parts of the small intestine in rats.

Forty-five rats were divided into four groups according to type of operation: 1) end-to-side jejunoileal bypass (ES), 10 rats; 2) end-to-end jejunoileal bypass (EE), 10 rats; 3) jejunoileal resection (R), 10 rats; and 4) no operation, 15 rats. The luminal contents from the proximal jejunum and distal ileum, in groups 1 and 2 also from the proximal and distal part of the excluded small intestine, were examined bacteriologically 5-11 months after operation. The total number of aerobic and anaerobic microbes in the jejunum was equal in all groups. The number of aerobic bacteria in the ileum was significantly higher in the ES group than in the R and U groups. The number of bacteria capable of producing gas in glucose-supplemented media was increased both in the jejunum and ileum after ES bypass. Enterobacteriaceae and Bacteroides were commonly present in the ileum after both types of bypass but were not cultured in jejunal contents. The proximal part of the excluded intestinal segment in groups 1 and 2 contained very low numbers of microbes, whereas the flora of its distal part was similar to that of the ileum in continuity in group 1. Thus, the most marked changes of the intestinal flora occurred after ES bypass in the region of the anastomosis and distal to this.

Animals↗

Late changes following single dose roentgen irradiation of rat small intestine.

In female Wistar rats a 10 cm long exteriorized mid small intestinal segment was roentgen irradiated with 17, 19, 21 and 23 Gy as single exposures. Animals were killed in groups of 3 at intervals of 6 weeks from 2 to 50 weeks following irradiation. Irradiation injury was assessed using 8 macroscopic and histopathologic parameters, and an injury score for each animal was calculated. The parameters used were divided in 2 subgroups, early and late alterations, showing different types of development. The score for the early alterations decreased from 2 to 20 weeks following irradiation and then remained constant. The late alterations increased and seemed to stabilize about 8 weeks following irradiation. After the initial 20 weeks there was no progression of irradiation injury.

Animals↗