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Biomedical subjects

K Thor

Publications and source records attributed to K Thor.

At least 19 recordsLinked to original sources
PubMed2000

Long-term management of gastro-oesophageal reflux disease with omeprazole or open antireflux surgery: results of a prospective, randomized clinical trial. The Nordic GORD Study Group.

BACKGROUND AND AIM: The efficacy of antireflux surgery (ARS) and omeprazole treatment in the control of gastrooesophageal reflux disease (GORD) are well established. We have compared these two therapeutic options in a randomized, clinical trial. PATIENTS AND METHODS: Three hundred and ten patients with erosive oesophagitis were enrolled into the trial. After a run-in period when all patients had < or = 40 mg of omeprazole daily to heal the oesophagitis and relieve symptoms, 155 patients were randomized to continuous omeprazole therapy and 155 to open antireflux surgery, of whom 144 later had an operation. One hundred and thirty-nine and 129 in the omeprazole and antireflux surgery groups, respectively, completed the 3-year follow-up. Symptoms, 24-h pH monitoring and endoscopy were used to document the outcome. Quality of life was evaluated by the psychological general well-being (PGWB) index and the gastrointestinal symptom rating scale (GSRS). RESULTS: Analysis of time to treatment failure (defined as moderate to severe GORD symptoms for > or = 3 days during the last 7 days, oesophagitis or changed therapy) revealed a significant difference in favour of antireflux surgery (P = 0.0016). Seventeen patients originally submitted to antireflux surgery experienced symptom relapse alone, 14 had oesophagitis at endoscopy and another six had omeprazole for different reasons, leaving 97 patients in clinical remission after 3 years. The corresponding figures in the omeprazole arm were 50 relapses, 18 with oesophagitis, two had surgery, leaving 77 patients in remission. Allowing a dose adjustment in the case of relapse in those on omeprazole therapy to either 40 or 60 mg, the curves describing the failure rates were not significantly different from each other. Quality of life assessment showed a comparable outcome in the two study groups. CONCLUSION: In this randomized multicentre trial we found antireflux surgery to be very efficacious in controlling GORD, a level of control which could also be achieved by omeprazole provided that advantage was taken of the opportunity of adjusting the dose.

Adult↗
PubMed1999

Lack of effect of acid suppression therapy on gastric atrophy. Nordic Gerd Study Group.

BACKGROUND & AIMS: A hypothesis suggesting that profound acid inhibition therapy facilitates and hastens the development of gastric glandular atrophy in patients infected with Helicobacter pylori was investigated in this randomized study comparing omeprazole therapy with antireflux surgery (ARS) for chronic gastroesophageal reflux disease (GERD). METHODS: Patients with esophagitis and/or chronic GERD were enrolled; 155 patients were randomized to ARS and 155 to long-term omeprazole therapy. Baseline data were obtained and repeated after 3 years in 131 ARS patients and in 139 omeprazole-treated patients. Histopathologic status of the oxyntic mucosa was assessed according to the Sydney system. RESULTS: Forty omeprazole-treated patients were infected with H. pylori compared with 53 in the ARS group. Basal gastrin levels were significantly higher in H. pylori-infected patients, particularly in the omeprazole group. No further increases in serum gastrin levels were observed during 3 years. Despite 3 years of therapy, only slight changes were found in the prevalence of inflammation in the corpus mucosa of H. pylori-infected subjects. A slow progression of gastric glandular atrophy was observed in these patients irrespective of therapy with no obvious difference between treatment regimens. Intestinal metaplasia (all of type I) was only exceptionally observed with no difference between the treatment arms. CONCLUSIONS: Acid-suppressive therapy in the form of omeprazole maintained for 3 years facilitates neither the development of gastric glandular atrophy of the corpus mucosa nor the occurrence of intestinal metaplasia in H. pylori-infected GERD patients.

Adolescent↗
PubMed1998

Comprehensive 1-year cost analysis of open antireflux surgery in Nordic countries. Nordic GORD Study Group. Gastro-oesophageal reflux disease.

BACKGROUND: Antireflux surgery is a highly effective treatment option in patients with severe gastro-oesophageal reflux disease. However, because of the increasing pressure of cost containment within health care, cost aspects must also be added to the decision-making process. METHODS: The aim of this analysis was to assess the total cost of open antireflux surgery during the first year after operation in 178 patients with chronic reflux, who were recruited into a controlled, prospective clinical trial. The study was carried out in 17 hospitals in the Nordic countries. RESULTS: The cost of the operation represented more than 90 per cent of the direct medical costs which amounted to approximately US $5700. For a patient in the work force the indirect cost, i.e. loss of production, represented 47 per cent of the total cost, which was about US $10800. CONCLUSION: The total cost profile of open antireflux surgery has now been established prospectively and can form a basis for future comparisons.

Adolescent↗
PubMed1998

Outcome of open antireflux surgery as assessed in a Nordic multicentre prospective clinical trial. Nordic GORD-Study Group.

OBJECTIVE: To evaluate the outcome of antireflux surgery in various hospitals in Scandinavian countries. DESIGN: Partly randomised controlled study, and partly open study. SETTING: Hospitals throughout Norway, Sweden, Denmark and Finland. SUBJECTS: 310 patients with chronic reflux disease and oesophagitis who were initially entered into a randomised controlled study of omeprazole and antireflux surgery. INTERVENTIONS: Total fundic wrap, partial fundoplication, or omeprazole. MAIN OUTCOME MEASURES: Control of symptoms at one year. RESULTS: 154 patients who had their symptoms of reflux completely controlled with omeprazole were initially randomised to have an open operation but 10 refused, leaving 144 for analysis. 34 patients who had only a partial response were also offered operation; 120/178 (68%) had a total fundic wrap, and 53 (30%) partial fundoplication. 6 patients had postoperative complications that required reoperation and 123 made a completely uneventful recovery. Reflux was controlled in most patients, and only 10 (6%) required further treatment with omeprazole. The outcome in those patients who only responded partially to omeprazole was similar to that in patients who had a complete response. CONCLUSION: The outcome of antireflux surgery throughout Norway, Sweden, Denmark, and Finland is good.

Adolescent↗
PubMed1997

Intravenous cholangiography before 1000 consecutive laparoscopic cholecystectomies.

BACKGROUND: The advent of laparoscopic cholecystectomy has resulted in an increase in common bile duct (CBD) injuries. Routine intraoperative cholangiography has been advocated to prevent these injuries. This study describes an alternative management strategy applied to a consecutive series of 1000 patients having laparoscopic cholecystectomy. METHODS: In patients with no history of contrast allergy and no suspicion of CBD stones, preoperative intravenous cholangiography (i.v.c.) was performed routinely. Patients with suspected or detected CBD stones were referred for endoscopic retrograde cholangiography. This strategy was supplemented by selective intraoperative cholangiography. RESULTS: Overall 782 of the 1000 patients had successful preoperative i.v.c., allowing detection of 30 CBD stones and providing useful information about anatomical variation in CBD anatomy. Patients with inconclusive i.v.c. studies, or those with a history of contrast allergy, had intraoperative cholangiography, which demonstrated a further 19 CBD stones. There were no contrast reactions and no damage to the biliary system which might have been obviated by intraoperative cholangiography. In the 724 patients who did not require complimentary intraoperative cholangiography, there has been no clinical evidence of missed CBD stones. CONCLUSION: Routine preoperative i.v.c., with reservation of intraoperative cholangiography for indeterminate i.v.c. examinations or the need for anatomical clarification, is a safe strategy for laparoscopic cholecystectomy.

Cholangiography↗
PubMed1996

Gastroesophageal reflux in obese patients is not reduced by weight reduction.

BACKGROUND: The present study tested the hypothesis that weight reduction improves the subjective and objective manifestations of gastroesophageal reflux. METHODS: Twenty obese patients with gastroesophageal reflux as shown by 24-h pH measurement and with symptoms requiring daily medication were studied. The patients were randomized into a group (A) treated with very low-caloric diet (VLCD) and a control group (B). Objective measurements were repeated after 6 months. Group B was then treated with VLCD and reexamined. RESULTS: Patients in group A lost 10.8 +/- 1.4 kg whereas group B gained 0.6 +/- 0.7 kg (P < 0.001). There was no reduction in reflux according to pH measurement. Furthermore, there were no significant changes in reflux symptoms. After VLCD treatment, group B lost 9.7 +/- 1.6 kg, but reflux indicators remained unchanged. All patients except one in group B remained dependent on daily anti-reflux medication. CONCLUSION: Weight reduction does not improve the subjective or objective manifestations of reflux.

Body Mass Index↗
PubMed1995

The Ersta procedure, a hemifundoplication for the treatment of gastro-oesophageal reflux disease.

Symptoms of gastro-oesophageal reflux and gastro-oesophageal reflux disease (GERD) are common in the population and are a frequent reason for consulting physicians and surgeons. If complications of reflux occur or if the problem cannot be managed without medication such as H2 blockers or proton pump inhibitors, surgery should be considered. In the majority of cases GERD is caused by a surgically correctable anatomical defect affecting the angle of His and the flap valve mechanism. Patients should be carefully evaluated prior to surgery, and for maintaining good long-term results the antireflux procedure should be performed by surgeons with special interest in the field. We present our experience with a hemifundoplication performed both by open technique and through laparoscopy.

Adolescent↗
PubMed1992

Evaluation of p53 protein expression in Barrett's esophagus by two-parameter flow cytometry.

Barrett's esophagus is a condition in which the normal stratified squamous epithelium is replaced by metaplastic columnar epithelium that predisposes to the development of esophageal adenocarcinoma. Neoplastic progression in Barrett's esophagus occurs by a multistep process associated with genomic instability and the development of aneuploid cell populations. p53 protein overexpression and allelic deletions on chromosome 17p have been shown to be present in some Barrett's adenocarcinomas, but the stage in neoplastic progression at which p53 protein overexpression develops has not been investigated. To determine the stages in neoplastic progression at which p53 protein overexpression could be detected, biopsy specimens from patients with Barrett's esophagus at all stages of histological progression from Barrett's metaplasia negative for dysplasia to esophageal adenocarcinoma were investigated using a multiparameter flow-cytometric assay. p53 protein overexpression was found in 1 of 21 patients (5%) with Barrett's metaplasia negative for dysplasia, 2 of 13 patients (15%) with Barrett's metaplasia with abnormalities in the indefinite/low-grade dysplasia range, 5 of 11 patients (45%) with high-grade dysplasia, and 8 of 15 patients (53%) with Barrett's adenocarcinoma (P less than 0.01). p53 protein overexpression was found in 9% of patients with Barrett's esophagus who had neither high-grade dysplasia nor adenocarcinoma. Whether or not patients whose biopsy specimens show p53 protein overexpression are at increased risk for progression to adenocarcinoma can be determined by prospective endoscopic surveillance.

Adenocarcinoma↗
PubMed1991

Monoclonal antibody L6-daunomycin conjugates constructed to release free drug at the lower pH of tumor tissue.

Measurements in cancer patients showed that the pH of tumors averages 0.8 unit lower than that of the surrounding normal tissues, confirming published work. Based on this, the anti-carcinoma monoclonal antibody (mAb) L6 was used to prepare immunoconjugates with daunomycin (DM), the drug being released at the acidic pH of the tumor. A direct linking of the aconitic derivative of DM (AcoDM) to mAb L6 led to conjugates that either had a low drug/antibody ratio (less than 5:1) or precipitated in vitro. In order to increase the drug load and avoid precipitation, several biopolymers were tested as spacers between the drug and the L6. To attach the polymer derivative to the mAb, the former was maleimidized and the mAb was thiolated. The AcoM/mAb ratio obtained was 20, and the mAb retained its highly specific binding to tumor cells. At pH 6 the AcoDM-L6 conjugate was toxic to cultured C-3347 carcinoma cells with an inhibitory concentration (IC50) of 5 micrograms/ml. The conjugate was less effective than the free DM with an IC50 of 0.2 micrograms/ml. The L6 alone was not toxic. At a tumor pH of 6.5, 15% of the AcoDM was released. The amount of released drug reached a maximum 24-48 h after exposure to the acidic medium. In vivo localization studies demonstrated a similar tumor uptake of the conjugate and mAb L6 with 18% of the injected dose/g tumor and a maximum uptake in tumor 48 h after injection. Our data indicate that it is possible to construct conjugates based on a pH-sensitive linker that can be targeted successfully to a tumor with release of a portion of the drug at the tumor site, but testing is needed to establish whether such release has anti-tumor activity in vivo and offers an advantage over treatment with unconjugated drug.

Aged↗
PubMed1990

Mechanisms underlying the recovery of urinary bladder function following spinal cord injury.

Micturition in cats and rats with an intact neuraxis is dependent upon a spinobulbospinal reflex activated by A delta bladder afferents. This report describes changes in micturition reflexes 2 h to 14 weeks following spinal cord transection at the lower thoracic level. In acute spinal cats micturition reflexes were blocked, however, several weeks after transection, a long latency (180-200 ms) spinal reflex could be activated by C-fiber bladder afferents. This reflex was blocked by capsaicin in doses (20-30 mg/kg, s.c.) that did not affect micturition reflexes in intact cats. Micturition reflexes were unmasked in acute spinal and facilitated in chronic spinal cats by naloxone, an opioid antagonist. Spinal neurons and axons containing opioid peptides were more prominent below the level of transection in chronic spinal cats. VIP, a putative neurotransmitter in C-fiber bladder afferents, inhibited micturition reflexes when injected intrathecally (2-10 micrograms) in intact cats but facilitated micturition reflexes in spinal cats (doses 0.1-1 micrograms, i.t.). VIP-containing C-fiber afferent projections to lamina I of the sacral spinal cord expanded in spinal cats. Thus VIP afferents may have an important role in the recovery of bladder reflexes after spinal injury. Paraplegic animals also exhibit bladder-sphincter dyssynergia, which causes functional outlet obstruction. Studies in rats have revealed that outlet obstruction induced by partial urethral ligation facilitates spinal micturition reflex pathways and causes an expansion of HRP-labelled bladder afferent projections in the spinal cord. These findings raise the possibility that the alterations in central reflex connections in paraplegic animals may be induced in part by changes in peripheral afferent input secondary to outlet obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Afferent Pathways↗