Search PubMed⌕ Search

Biomedical subjects

L Lundell

Publications and source records attributed to L Lundell.

At least 127 records · Page 7Linked to original sources
PubMed1990

Effects of partial resection of acid-secreting mucosa on plasma gastrin and enterochromaffin-like cells in the rat stomach.

Female rats were subjected to various degrees (50, 75, 90 and 100%) of fundectomy, i.e. resection of the acid-producing part of the stomach, to compare the effects of different degrees of reduction of the amount of acid reaching the antrum. Plasma gastrin was monitored for 10 weeks after the operation. Histidine decarboxylase (HDC) activity, histamine concentration and density of enterochromaffin-like (ECL) cells in the remaining oxyntic mucosa were determined in the rats subjected to 50 or 75% fundectomy. There was a close correlation between the amount of acid-producing mucosa removed and the plasma gastrin levels, the highest gastrin level being observed in the rats subjected to 100% fundectomy. HDC activity, histamine concentration and ECL cell density seemed to reflect plasma gastrin concentration. These findings indicate that hypergastrinemia induced by surgical removal of acid-producing mucosa in the rat has the same effects on oxyntical mucosal HDC activity, histamine concentration and ECL cell density as hypergastrinemia induced by continuous gastrin infusion or by long-term treatment with effective antisecretagogues.

Animals↗
PubMed1990

Effect of parietal cell vagotomy and cholinergic blockade on gastrin release in man induced by gastrin-releasing peptide.

The influence of cholinergic blockade as well as vagal denervation of the oxyntic gland mucosa on the gastrin response to gastrin-releasing peptide (GRP) have been studied in patients with duodenal ulcer disease. The gastric luminal content was neutralized during the experiments. GRP induced a substantial increase in gastrin levels with a peak response already after 15 min of infusion. Vagal denervation of the parietal cell area induced a significant increase in basal gastrin concentrations and a significant enhancement of the GRP response. Two different doses of benzilonium bromide were studied and neither influenced the basal concentrations of gastrin. A significantly increased gastrin response to GRP was, however, observed after administration of both a high and a very low dose of the anticholinergic drug. Our results delineate a vagal, noncholinergic inhibitory influence on the basal gastrin release. In addition a vagally dependent oxyntopyloric mechanism inhibits the gastrin release stimulated by GRP. This inhibitory mechanism may hypothetically be a cholinergic reflex mechanism.

Bombesin↗
PubMed1990

Prevention of relapse of reflux oesophagitis after endoscopic healing: the efficacy and safety of omeprazole compared with ranitidine.

The prognosis for the acute healing of patients with persistent, erosive or ulcerative reflux oesophagitis depends upon the choice of drug treatment as well as the severity of the initial oesophagitis. The results of this study show that omeprazole, 40 mg once daily (n = 51), is more effective than ranitidine, 300 mg b.i.d. (n = 47), in the acute healing of reflux oesophagitis (90 and 47% healing, respectively; p less than 0.0001). Omeprazole, 20 mg o.m., is also far more effective than ranitidine, 150 mg b.i.d., in the maintenance treatment of these patients; 67% of the omeprazole-treated patients remained in clinical and endoscopic remission throughout the 12-month study period compared with only 10% of those given ranitidine (p less than 0.0001). This therapeutic advantage was achieved without adverse events and without significant abnormalities in the endocrine or exocrine cell population of the oxyntic mucosa. Basal serum gastrin levels were modestly raised after 4 weeks of omeprazole treatment (the change being from 8.6 to 16.9 pmol/l; p less than 0.05), and remained at this level throughout the study period.

Double-Blind Method↗
PubMed1990

In vivo catabolism of histamine in the human stomach.

The importance of the stomach in the magnitude of excreted amounts of the major histamine metabolite in the urine was studied during total parenteral nutrition in five patients before and after total gastrectomy. In all subjects, a reduction in the 24-h urinary excretion of methylimidazoleacetic acid was observed. No corresponding effect was seen after an operation because of abdominal aortic aneurysm. In patients with duodenal ulcer disease and those submitted to a cholecystectomy because of cholecystolithiasis, we studied the catabolism of histamine in the stomach by injecting 14C-histamine directly into the portal vein and, simultaneously, 3H-histamine intra-arterially to the corpus fundus region of the stomach and subsequently determining the urinary excretion of 14C. 3H-histamine and their basic and acid metabolites, respectively. We found no apparent difference in the pattern of excreted 14C and 3H metabolites between the two patients groups, indicating that the catabolism of histamine in the stomach of patients with duodenal ulcer disease is similar to that in 'healthy' controls.

Aged↗
PubMed1990

Terlipressin (triglycyl-lysine vasopressin) controls acute bleeding oesophageal varices. A double-blind, randomized, placebo-controlled trial.

The haemostatic effect of terlipressin (triglycyl-lysine vasopressin; Glypressin) on bleeding from oesophageal varices was evaluated in a placebo-controlled, double-blind, randomized clinical trial. Patients with clinically suspected liver cirrhosis were included in the study if they had been admitted to hospital with an extensive haemorrhage within the last 24h before diagnostic endoscopy. The patients randomized after stratification for severity of liver disease. Terlipressin or placebo was administered as intravenous bolus injections every 4th h during a period of 24 to 36 h or until the clinical course necessitated active intervention (failure or withdrawal). Sixty patients entered the study; 31 patients were allocated to receive terlipressin, and 29 patients to receive placebo. Bleeding from varices was arrested in 28 of the 31 receiving terlipressin, as compared with 17 of the 29 receiving placebo (p less than 0.01). Patients receiving active drug required significantly fewer blood transfusions (p less than 0.05). Most of the side effects were classified as mild and were registered in the terlipressin group.

Acute Disease↗
PubMed1990

Evaluation of propranolol for prevention of recurrent bleeding from esophageal varices between sclerotherapy sessions.

Forty-one patients admitted with first episode of bleeding from esophageal varices were enrolled in a trial of the efficacy of oral propranolol to prevent rebleeding during the course of endoscopic sclerotherapy until obliteration. Single-blind randomization to sclerotherapy alone or with propranolol was used. At monthly endoscopy the varices were injected with 1% Aethoxysclerol until obliteration. If bleeding recurred, additional sclerotherapy was given. There was no intergroup difference in time to eradication of varices (8.1 vs. 7.7 months). The cumulative number of bleedings from varices and from distal esophageal ulcerations was identical in the two study groups. Five patients in the control group but only one in the propranolol group died of bleeding in the study period, a difference of only borderline significance (chi 2 = 4.08, df = 1). There were no specific side effects of propranolol. Thus propranolol did not significantly reduce the frequency of rebleeding until variceal obliteration, but could have had some influence on the gravity of rebleeding.

Esophageal and Gastric Varices↗
PubMed1990

Alterations in body composition after gastroplasty for morbid obesity.

Body compositional changes during rapid weight loss and after weight stabilization were prospectively studied in morbidly obese patients undergoing gastroplasty operations. Body composition was studied preoperatively and 6 and 24 months postoperatively in 23 patients by use of a total body counter (40K) and an isotope dilution technique. The mean fat mass, cell mass, and intracellular water (ICW) decreased during the first 6 months (p less than 0.001) and remained unchanged at the 24-month test. However, the mean liters of extracellular water (ECW) did not change. Consequently, the ECW/ICW ratio, high in states of malnutrition, rose above postoperative levels. A strong correlation was found between decreases in cell mass and increases in the ECW/ICW ratio.

Adult↗
PubMed1989

Influence of age, fat cell weight, and obesity on O2 consumption of human adipose tissue.

The oxygen consumption of human adipose tissue (AT) was determined in 53 adults, lean and obese, and in nine lean boys. The oxygen consumption was positively related to fat cell weight and negatively to age and degree of obesity. Men and women did not differ with respect to oxygen consumption of AT. The positive relationship between oxygen consumption per cell and fat cell size was also demonstrated in size-separated cells from the same donors. Expressed per cell the oxygen consumption was higher in fat cells from obese than in cells from lean subjects, but expressed per gram of tissue the opposite result was found. The oxygen consumption of the total AT organ was higher in obese than in lean subjects. The energy expenditure of AT constituted approximately 4% of the estimated 24-h energy expenditure in both groups. It is concluded that obese subjects do not maintain their obesity because of a reduced energy expenditure of the total AT (or of the total body). After a partial weight reduction in five subjects, the energy metabolism tended to change in direction toward the conditions seen in lean subjects. However, it is still an open question whether the observed energy metabolic aberrations of obese human AT are only secondary to the obese state or partly primary and thus of etiological importance.

Adipose Tissue↗
PubMed1989

Histamine metabolism of the human gastric mucosa--a study on the regional distribution of the amine and enzyme activities.

Histamine content, histidine decarboxylase activity and histamine methyl transferase activity of the human gastric mucosa have been studied in healthy subjects. Histamine content was evenly distributed over the gastric mucosa and no significant difference could be observed between the oxyntic and pyloric gland area. A 'specific' histidine decarboxylase was found in the human gastric mucosa and the enzyme activity was significantly higher in the corpus compared to the antral mucosa. We found no difference in enzyme activity of the mucosa obtained from three defined areas of the corpus region of the stomach. Histamine methyl transferase activity was of the same magnitude in the corpus as in the antral mucosa. In addition, with regard to histamine methyl transferase activity, we were unable to demonstrate any difference in activity in the mucosal specimens obtained from the defined areas of the stomach. The presented technique to obtain gastric mucosal tissue specimens during routine fibreoptic endoscopy of the stomach, allows studies over gastric mucosal histamine metabolism in health as well as in disease states.

Carboxy-Lyases↗
PubMed1989

Studies of the release of gastrin from the human duodenum induced by gastrin-releasing peptide.

In the present study the influence of duodenal exclusion and vagotomy on basal release of gastrin from extra-antral stores has been investigated in addition to the consequences of these procedures on the gastrin response to gastrin-releasing peptide (GRP) infusion. Basal gastrin concentrations and the response to GRP were measured in seven patients after a Whipple operation, in seven patients after antrectomy combined with selective gastric vagotomy and B I reconstruction, in seven patients operated on with antrectomy, selective gastric vagotomy, and Roux-en-Y reconstruction, and finally in seven patients after antrectomy, truncal vagotomy, and Roux-en-Y reconstruction. Gastrin was measured by a highly specific radioimmunoassay. Very low concentrations were obtained after a Whipple operation, and no increase followed GRP infusion. The basal gastrin concentrations were slightly higher in antrectomized patients, irrespective of whether a selective gastric vagotomy had been added. However, in these patients a significant gastrin response followed GRP infusion. Duodenal exclusion seemed not to influence the response to GRP. On the other hand, extragastric vagotomy was followed by low gastrin concentrations in the basal state and only a marginal response to GRP administration. These results strongly suggest that GRP releases gastrin from the human duodenal mucosa and that duodenal exclusion does not alter the response of the duodenal gastrin cells to GRP stimulation. Vagal denervation of the duodenal mucosa seems to suppress the gastrin response to GRP, indicating an excitatory influence of the vagus nerve.

Adult↗
PubMed1989

Palliative endoscopic dilatation in carcinoma of the esophagus and esophagogastric junction.

The palliative effect of repeated endoscopic dilatation of malignant strictures of the esophagus and esophagogastric junction was prospectively evaluated in 41 patients. Dilatation was performed with Eder-Puestow technique in brief general anesthesia. Substantial improvement in swallowing ability was experienced after each treatment. The dysphagia recurred, however, and the dilatations were repeated at intervals of about 4 weeks. Most patients required less than or equal to three treatments during their remaining lifespan. There were few complications, the most prominent being perforation (in 5% of 128 sessions). Only short hospital stay was required, and 18 patients remained at home during the periods between dilatations. Endoscopic dilation of the esophagus and esophagogastric junction gives good palliation. The technique is simple, cheap and safe. It is suitable for lesions at any site, not time-consuming, available at almost all endoscopy units, and consequently to be recommended in this clinical setting.

Adenocarcinoma↗
PubMed1988

Gastrin and somatostatin in the rat antrum. The effect of removal of acid-secreting mucosa.

Female rats were subjected to operations aimed at reducing the amount of oxyntic gland mucosa draining its acid secretion to the antrum. The rats were provided either with Heidenhain or Pavlov pouches reducing the oxyntic mucosa draining its secretion to the antrum by about 50% or subjected to various degrees (75, 90 and 100%) of fundectomy. Ten weeks following surgery, plasma levels of gastrin and somatostatin were assayed. At the same time, antral mucosal content of gastrin and somatostatin was determined as well as the mucosal density of these hormone-producing cells. There was a relationship between the amount of acid-secreting mucosa removed and the ensuring plasma concentration of gastrin. Thus, a stepwise increase in plasma gastrin was found with the highest levels obtained in rats subjected to 90 or 100% fundectomy. The somatostatin concentration in plasma was reduced only in rats subjected to fundectomy with the most sustained decrease in animals in which all oxyntic gland mucosa had been removed. There was also a relationship between the amount of acid-secreting mucosa removed and the gastrin content of the antral mucosa. An inverse relationship seemed to exist between antral gastrin and somatostatin concentrations. However, a significant decrease in somatostatin concentration of the antral mucosa was seen only in rats subjected to a fundectomy. The number of gastrin cells in the antral mucosa was increased in fundectomized rats only, with the largest density seen in rats deprived of all oxyntic mucosa. A corresponding decrease in the number of somatostatin cells was noticed. Our results would suggest an apparent functional relationship between antral gastrin and somatostatin cells, where the antral acid load (or pH) appears to be the major factor of physiological significance.

Animals↗
PubMed1988

The benefit of pancreatic enzyme substitution after total gastrectomy.

The aim of the present study was to evaluate the effect of the pancreatic enzyme preparation Kreon on abdominal symptoms, bowel habits, faecal fat excretion and oro-caecal transit time in patients after total gastrectomy for carcinoma of the stomach with Roux-en-Y anastomosis. A hydrogen breath test was carried out in each patient to detect bacterial overgrowth. In a double-blind crossover trial, 15 patients were treated with either Kreon or placebo (3.6 g/day) in two test-periods each of seven days. During treatment with the active substance, the stool consistency became more solid (P less than 0.05). The number of bowel movements and the abdominal symptoms, however, remained statistically unchanged. Treatment with Kreon did not influence the oro-caecal transit time. Faecal fat excretion did not significantly decrease in the whole group of patients. However, in those patients with massive steatorrhoea (free and esterified fatty acids greater than 350 mmol/72 h; upper reference limit 60 mmol/72 h) a significant (P less than 0.05) reduction from a median excretion of 643 mmol/72 h to 501 mmol/72 h was seen. Such a decrease in faecal fat excretion did not occur in patients with steatorrhoea below this limit. Bacterial overgrowth or rapid upper intestinal transit were not over-represented in patients with a high-degree of steatorrhoea. We conclude that after total gastrectomy pancreatic enzyme substitution reduces massive steatorrhoea and improves stool consistency.

Aged↗
PubMed1988

Endocrine cells in the human oxyntic mucosa. A histochemical study.

The oxyntic mucosa of the human stomach harbors at least five different endocrine cell types (ECL cells, A-like or X cells, somatostatin cells (D), enterochromaffin (EC) cells, and D1 or P cells). Little is known about their functional roles, and of the hormones they produce only somatostatin has been identified. The relative frequency and regional distribution of the different endocrine cell populations were studied in 13 adults with no manifest gastrointestinal disease. From each of them at least three biopsy specimens were taken at seven fixed locations within the oxyntic mucosa. The specimens were examined for the different endocrine cell types by means of immunocytochemistry (staining with antisera against chromogranin A,5-hydroxytryptamine, and somatostatin) and silver staining techniques (demonstration of argyrophil cells by the methods of Grimelius or Sevier-Munger). Chromogranin-positive cells included all endocrine cells identified by the other staining techniques. Grimelius-positive cells included all endocrine cells except the somatostatin cells. Sevier-Munger-positive cells, finally, included the ECL cells and the EC cells. The frequency of ECL cells could be calculated by subtracting the number of EC cells from the number of Sevier-Munger-positive cells. The ECL cells represented 35% of the total endocrine number, somatostatin cells 26%, and EC cells 25%. The remaining 14% consisted of A-like cells, D1 cells, and P cells. Generally, the endocrine cells predominated in the basal portion of the glands, but the various populations of endocrine cells were not uniformly distributed in the various regions of the oxyntic mucosa. However, representative specimens could be obtained from the main body of the stomach, and the results indicate that the examination of a fairly small number of specimens from the main body of the stomach may be sufficient for assessing the frequency of endocrine cells in the oxyntic mucosa of individual patients.

Adult↗
PubMed1988

The effect of omeprazole or ranitidine treatment on 24-hour esophageal acidity in patients with reflux esophagitis.

Twenty-two consecutive patients with gastroesophageal reflux and erosive or ulcerative esophagitis entered a double-blind, randomized study comparing the effect of 20 mg omeprazole once daily with that of 150 mg ranitidine twice daily on esophageal acidity. Ambulatory 24-h esophageal pH measurements were performed within 1 month before inclusion and after 3 weeks of medication. Omeprazole significantly (p less than 0.05) reduced the number of reflux (pH less than 4) episodes, the number of refluxes lasting greater than 5 min, and the total reflux time. In contrast, ranitidine significantly reduced only the total reflux time. When the two treatment groups were compared, a significant difference in favor of omeprazole was found for daytime and total reflux values, except for the longest reflux and the number of reflux episodes lasting greater than 5 min. Substantial differences, also in favor of omeprazole, were found with regard to the effect on endoscopic healing of the esophagitis.

Adolescent↗
PubMed1988

A criterion for completeness of vagotomy based on basal and vagally stimulated gastric acid secretion after esophagectomy or proximal gastric vagotomy.

The variation in basal acid secretion was determined in 10 patients after resection of the esophagus, an operation resulting in a total transection of all vagal nerves to the abdomen. After recording basal acid secretion over a 3-h period, a 15-min modified sham feeding procedure was performed, and the acid output was studied for an additional hour. The mean basal acid output +2 SD was 0.27 mmol/15 min. The difference between the highest and lowest recorded 15-min output--that is, the oscillation of basal acid output--was calculated for each patient. The mean oscillation of basal acid output +2 SD was 0.58 mmol/15 min. Vagal stimulation accomplished by sham feeding produced no significant increase in acid output above this level. The variation in basal acid secretion was also investigated in 20 duodenal ulcer patients after proximal gastric vagotomy. These patients were insulin-negative and remained asymptomatic during a 7- to 10-year follow-up study. Shortly after the vagotomy, measurement of basal acid secretion over 3 h showed a mean basal acid output +2 SD of 0.58 mmol/15 min. The mean oscillation of basal acid output +2 SD was 0.66 mmol/15 min. On the basis of the oscillation in basal acid secretion after complete vagotomy we propose a new criterion for completeness of vagotomy, namely a response to physiologic vagal stimulation which does not exceed the lowest basal level by more than 0.6 mmol/15 min.

Adult↗