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L Perbeck

Publications and source records attributed to L Perbeck.

At least 19 recordsLinked to original sources
PubMed2003

Orally delivered antibiotics which lower bacterial numbers decrease experimental intra-abdominal adhesions.

BACKGROUND: Postsurgical adhesion formation is a common occurrence after most surgical procedures and is still a major cause of postoperative morbidity because no satisfactory treatment or prophylaxis has yet been developed. Further elucidation of the basic mechanisms of postsurgical adhesion formation is needed. Recent studies using germfree rats have found the indigenous bowel flora to be important in the adhesive response. The present study examined whether antibiotic treatment affects intra-abdominal adhesion formation. METHODS: Using the cecal crush model to inflict adhesions, groups of rats ( n=12) were treated with placebo or amoxicillin/clavulanic acid in the drinking water. Treatment started 3 days before operation and continued until evaluation. Adhesion scores were recorded after 7 days. Bacterial counts were made from cultures of fecal samples on operation day and at termination. RESULTS: Amoxicillin/clavulanic acid decreased adhesion score compared to placebo. Adhesion incidence was 50% in the treatment group and 92% in the placebo group. Bacterial numbers were lower in the treatment group. CONCLUSIONS: Antibiotic treatment which lowers bacterial numbers can decrease adhesions.

Abdomen↗
PubMed2002

Value of MR imaging in clinical evaluation of breast lesions.

PURPOSE: To evaluate the value of dynamic MR imaging as an adjunctive tool to triple diagnosis (TD) (physical examination, mammography and fine needle aspiration cytology) in diagnosing breast lesions. MATERIAL AND METHODS: Ninety-three consecutive patients with 114 palpable or mammographically detected breast lesions were examined with TD and MR imaging. The MR examination was performed dynamically using a dedicated breast coil. Five diagnostic groups were defined on a scale from 1=normal, to 5 = malignant, where groups 1-3 were defined as benign and groups 4-5 as malignant. All lesions were histopathologically examined. The sensitivity and specificity were calculated for mammography alone, TD, MR and the combination of MR and TD. RESULTS: Histopathology revealed 32 benign and 82 malignant lesions (73 invasive and 9 cancer in situ). The sensitivity/specificity was 84%/59% for mammography, 93%/41% for TD, 94%/47% for MR and 99%/19% for TD + MR. In the 32 mammographically dense breasts, mammography/TD/MR/TD + MR had a sensitivity of 72%/94%/94%/100% and a specificity of 79%/57%/36%/29%, respectively. CONCLUSION: MR imaging might be of value as an additive method to TD by increasing the sensitivity, but at the cost of decreasing specificity. Patients with mammographically dense parenchyma might have more benefit of the additive value, as the decrease in specificity in these patients was less pronounced in our study.

Adult↗
PubMed2001

The intestinal flora influences adhesion formation around surgical anastomoses.

BACKGROUND: Postsurgical adhesion formation is still a cause of postoperative morbidity because no satisfactory treatment or prophylaxis has yet been developed. The present study was designed to investigate the influence of the gastrointestinal flora on adhesion formation around surgical anastomoses. METHODS: Anastomoses were constructed in germfree, conventional, ex-germfree and mono- contaminated rats (Escherichia coli X7 and Lactobacillus acidophilus La5), and adhesion formation was recorded. RESULTS: The germfree group had a significantly lower adhesion score than all other groups (P < 0.05) apart from the lactobacillus group, which had a significantly lower score than the conventional group (P < 0.05). CONCLUSION: The bacterial flora of the gastrointestinal tract enhances adhesion formation around surgical anastomoses.

Anastomosis, Surgical↗
PubMed2001

Efficacy of subcutaneous and topical local anaesthesia for pain relief after resection of malignant breast tumours.

OBJECTIVE: Infiltration and topical application of local anaesthetics close to the surgical wound may be used to prevent postoperative pain. We evaluated the efficacy of these treatments after breast surgery for cancer. DESIGN: Double-blind randomised trial with two treatment groups and one control group. SETTING: University hospital, Sweden. INTERVENTIONS: Patients were allocated to treatment with bupivacaine infiltration (n = 29), topical application of lignocaine/prilocaine (n = 31), or no local treatment (n = 30). MAIN OUTCOME MEASURES: Difference and time related patterns in pain scores measured on a visual analogue scale (VAS), and morphine consumption. RESULTS. None of the local anaesthetics significantly reduced the VAS score or morphine consumption. However, fewer patients in the anaesthetic groups had high VAS scores than controls, the 75 centile for the mean score after operation being 2.7, 2.0 and 2.1 for the controls, infiltration, and topical anaesthetic groups, respectively. The controls had higher scores from 6 hours postoperatively onwards. The corresponding median morphine consumption was 24.5, 18.5, and 16.2 mg. CONCLUSIONS. Local anaesthesia slightly reduced the overall pain scores and the morphine consumption, but was of potential clinical value only in the patients who had the highest pain scores.

Administration, Topical↗
PubMed1999

HIV-1 exposed dendritic cells show increased pro-inflammatory cytokine production but reduced IL-1ra following lipopolysaccharide stimulation.

OBJECTIVES: Dendritic cells (DC) are potential first target cells in sexually transmitted HIV-1 infection. They are also considered to be central in the activation of naive T cells, which thereupon can become permissive for HIV-1. In addition, activated DC express effector molecules, which likely contribute to the direction of T helper (Th1/Th2)-specific immune responses. METHODS: The capacity of cytokine and chemokine production in in vitro DC infected and uninfected with HIV-1 was assessed by enzyme-linked immunosorbent assay (ELISA) and by in situ immunocytochemical detection at the single cell level. Fluorescent in situ 5'-nuclease assay (FISNA) was used for quantitative evaluation of HIV-1 gag-positive cells. RESULTS: Macrophage-tropic HIV-1 effectively infected 20-40% of in vitro cultured DC. However, this activity alone did not induce detectable cytokine or chemokine protein expression in DC. In contrast, lipopolysaccharide (LPS) stimulation of these HIV-1-infected DC resulted in a significantly increased level of cells producing tumour necrosis factor alpha (TNF-alpha) and interleukin (IL) 1beta but reduced frequencies of cells producing IL-1 receptor antagonist (IL-1ra) compared with the LPS-stimulated but uninfected DC cultures (P < 0.05). Furthermore, an extensive production of the beta-chemokines [RANTES, macrophage inflammatory proteins (MIP) 1alpha and 1beta] was detected in DC in response to both LPS and HIV-1 plus LPS. CONCLUSIONS: These findings indicate that HIV-1 infected DC may have an increased proinflammatory activity. Elevated production of cytokines such as TNF-alpha and IL-1beta and reduced IL-1ra may contribute to enhanced replication of HIV-1 in bystander T cells. Gram-negative bacterial infection and gut-associated bacterial translocation in HIV-1-infected individuals may also result in endotoxin-mediated reactivation of HIV-1 in bystander CD4 CD45RO T cells caused by the increased production of proinflammatory cytokines in DC.

Cells, Cultured↗
PubMed1999

The influence of radiotherapy on skin circulation of the breast after subcutaneous mastectomy and immediate reconstruction.

The skin circulation was measured in 43 breast cancer patients following subcutaneous mastectomy and immediate reconstruction with a prosthesis, at least 1 year after radiotherapy (46 Gy) following surgery (19 patients) or if no radiotherapy was given, at least 1 year postoperatively (24 patients). The skin circulation was measured by laser Doppler fluxmetry (LDF) and fluorescein flowmetry within three areas: 2 cm above the border of the areola, within the nipple-areola complex, and 2 cm below the border of the areola. The results show that there was no reduction in skin circulation. On the contrary LDF and fluorescein flowmetry showed in the operated breast an increased circulation in the nipple-areola complex in the irradiated breast compared with the non-irradiated by 26% and 30%, respectively (P < 0.05). The results indicate that radiotherapy following subcutaneous mastectomy and immediate reconstruction with a prosthesis does not lead to long-term reduction in basal skin circulation in the breast.

Adult↗
PubMed1999

Evaluation of planar scintimammography with 99mTc-MIBI in the detection of axillary lymph node metastases of breast carcinoma.

PURPOSE: The aim of our prospective study was to evaluate the role of planar scintimammography with 99mTc-MIBI in detecting axillary lymph node metastases in women with primary breast carcinoma. MATERIAL AND METHODS: Fifty-eight patients underwent scintimammography rior to axillary lymph node dissection. Ten minutes after injection of 700 MBq 99mTc-MIBI, two prone lateral projections were obtained, followed by a supine anterior projection. Sixty-one axillae (3 bilateral) were operated upon and the status of the lymph nodes verified with histopathology. The scintigraphic result was compared to the histopathologic findings. RESULTS: A sensitivity of 67% and a specificity of 80% of planar scintimammography in detecting axillary lymph node metastases were achieved. CONCLUSION: Scintimammography with 99mTc-MIBI is not recommended as a routine method for the detection of axillary lymph node metastases in patients with breast carcinoma.

Axilla↗
PubMed1998

Presence of thyrotropin receptor in infant adipocytes.

In healthy infants, the levels of TSH are known to peak at 50-100 times adult values during the first days of life. In studies of isolated human infant adipocytes, we have earlier shown that bovine TSH (bTSH) has a strong lipolytic effect, accompanied by a blunted response of adipocytes to catecholamines. In this study, we used human recombinant TSH (hTSH), and incubation of adipocytes with hTSH induced a lipolytic response similar to that obtained with the beta-adrenergic receptor agonist isoprenaline in adipocytes isolated from three infants. The lipolytic effect of hTSH was completely blocked by inhibitory TSH receptor (TSHR) antibodies. The TSHR mediates the effects of TSH in the thyroid, and it has been detected in some extrathyroid tissues, but not in isolated human adipocytes or childhood adipose tissue. In this study, we found TSHR RNA in infant and adult adipose tissues and isolated adipocytes with reverse transcriptase-PCR. The sequence of the amplified PCR product agreed with the published sequence. Northern blot hybridization on RNA prepared from infant adipose tissue showed a transcript of the expected size, and the expression of TSHR seemed higher in infant than in adult adipose tissue. In conclusion, this study indicates that TSH plays an active role in the metabolic adaptation after birth.

Adipocytes↗
PubMed1998

[Angiogenesis-inhibiting drugs--a future therapeutic option].

In order to grow beyond 2-3 mm in size, a primary tumour or metastasis must induce angiogenesis, the formation of new blood vessels. Tumour capillary content is an independent prognostic factor, usually measured as the mean of three counts in capillary-rich areas of the histological section. Either as single drugs or in combination with other treatment, angiostatic agents probably represent the future of cancer treatment.

Capillaries↗
PubMed1997

Touch sensibility in the breast after subcutaneous mastectomy and immediate reconstruction with a prosthesis.

Touch sensibility was assessed with von Frey's monofilaments in the breasts of 10 healthy women (controls) and of 80 women with breast cancer who at least 1 year previously had undergone subcutaneous mastectomy and immediate reconstruction with a prosthesis. Touch thresholds were measured at nine positions on each breast. Low threshold values (< 3.2 mN) and good reproducibility were found in the controls. In the patients' surgically treated breasts normal (< 3.2 mN) or subnormal (< 20 mN) median threshold values were found outside the areola. Higher median values were noted on the areola and nipple; on the nipple, however, one third of the patients had normal sensibility while 14% lacked sensibility. The only factors found to influence the results were simultaneous subcutaneous reduction mammaplasty (lower touch thresholds) and the localisation of the incision (slightly lower thresholds for lazy-S than inframammary incision). These results confirm the clinical impression that touch sensibility is substantially retained after subcutaneous mastectomy and immediate reconstruction with a prosthesis.

Aged↗
PubMed1997

Diagnostic accuracy of mammography and contrast-enhanced MR imaging in 238 histologically verified breast lesions.

PURPOSE: To determine the sensitivity and specificity of X-ray mammography and of MR imaging in 238 consecutively operated breasts, and to correlate the findings to histopathological diagnosis. MATERIAL AND METHODS: Over 15 months, 220 patients scheduled for breast surgery were examined consecutively, before surgery, by means of both mammography and MR imaging. Of the 220 patients, 18 underwent bilateral breast surgery. The entire breast was examined by means of T1-weighted transversal images using a 3D fast low-angle shot (FLASH) sequence. One pre- and 2 post-contrast scans were performed. Each breast was examined by means of mammography and 3 views were applied as routine. All palpable and mammographically suspect lesions were examined on additional images as microfocus magnification or spot compression. The two methods were evaluated independently of each other. RESULTS: In total, 145 malignant and 93 benign lesions were found at histopathological examination. The sensitivity of mammography was 89% and MR imaging 92%. The specificity was 72% in both methods. When the results of the 2 methods were combined, a sensitivity of 99% and a specificity of 55% was achieved. CONCLUSION: Mammography and MR imaging seemed to complement each other to produce a high sensitivity. Unfortunately it is impossible at present to supplement mammography with MR imaging in each patient as a routine owing to the current technical and financial limitations.

Breast↗
PubMed1996

Sensitivity and specificity of MR mammography with histopathological correlation in 250 breasts.

PURPOSE: The aim of our prospective study was to determine the diagnostic accuracy of MR mammography (MRM) in detecting malignant disease. MATERIAL AND METHODS: In 231 consecutive patients scheduled for surgery because of mammographic or palpable lesions suspected of malignancy, the breasts were examined with T1-weighted transversal images using a 3-D fast low angle shot (FLASH) sequence. One pre- and 2 post-contrast images were obtained. Histological examination of the surgical specimens showed carcinoma in 155 breasts, of which 138 were invasive and 17 in situ. RESULTS: MRM detected 144 of the 155 malignancies and was false-negative in 11 cases. Eight of these MRM-missed tumours were invasive and 3 were in situ cancers. Benign lesions were found at microscopy in 95 breasts, of which MRM correctly diagnosed 69. The cellular composition of the 26 false-positive lesions (myxomatous stromal change, high vascularity, and epithelial or apocrine hyperplasia) might explain the false positivity. The sensitivity and specificity of MRM were 93% and 73% respectively. CONCLUSION: MRM should be interpreted with caution, and supplemented with e.g. mammography and ultrasonography.

Breast Neoplasms↗
PubMed1995

Contrast-enhanced MR imaging of the breast in patients with breast implants after cancer surgery.

The purpose of the study was to determine the value of contrast-enhanced MR imaging in the assessment of local recurrence in breast cancer patients who underwent mastectomy and breast reconstruction with an implant. Eighty-three patients have been evaluated by semidynamic contrast-enhanced MR imaging. The T1-weighted FLASH 3-D sequence was repeated twice postcontrast for evaluation of the entire breast bilaterally. The findings were compared to physical examination, mammography and histopathology. Recurrence verified by histopathology occurred in 14 of 83 patients (17%). Contrast-enhanced MR imaging was superior to palpation and mammography in revealing recurrences, especially when these were located close to the chest wall. MR was also more sensitive in detecting multiple foci of cancers. Our study revealed that MR imaging was influenced by size, type and composition of the tumor, as illustrated by the false-negative results. Therefore, the use of all 3 investigation methods is necessary for detecting recurrence at an early stage during the postoperative follow-up.

Breast↗
PubMed1994

Effect of exposure to heat and intake of ethanol on the skin circulation and temperature in ischaemic limbs.

The question of whether alcohol intake increases skin circulation is controversial. The study described here was undertaken to examine the effect on skin circulation and skin temperature in ischaemic limbs of exposure to external heat, and of alcohol intake together with such exposure. Fourteen patients with occlusive arterial disease, mean age of 65 years (range 47-80), underwent measurements of blood flow by laser Doppler flowmetry (LDF) and of skin temperature 1-2 days before and 8-10 days after vascular reconstruction. LDF and skin temperature were measured in the plantar region of the mid-forefoot with the subject supine. After 30 min of exposure to external heat, the measurements were repeated. Each subject then drank 15 ml of 50% alcohol and after a further 30 min of heat exposure the same measurements were performed again. Similarly, fourteen healthy subjects, mean age 33 years (range 21-43), were studied. In the patients there was no increase in skin blood flow or skin temperature after heat exposure alone or after combined heat exposure and alcohol intake, either before or after vascular reconstruction. In the healthy subjects LDF showed a 126% increase (P < 0.01) in skin blood flow after 30 min of exposure to external heat and a further increase by 81% after alcohol intake and an additional 30 min of heat exposure (P < 0.01). The corresponding increases in skin temperature were 3.0 degrees C (P < 0.05) and 2.9 degrees C (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Skin microcirculatory and thermal changes in elderly subjects with early stage of pressure sores.

Elderly subjects are prone to develop pressure sores over the sacrum area mainly due to external pressure and shear effects which negatively affect the skin microcirculation. The aim of the study described here was to measure skin microcirculatory and thermal changes in twelve elderly patients with an early stage of pressure sore and in ten elderly subjects without pressure sore. The total skin microcirculation at a damaged risk area, the sacrum, and a reference area of undamaged skin over the gluteal region, was evaluated using the laser Doppler fluxmetry. The nutritive transport of small solutes, characterized by the transcapillary exchange of sodium fluorescein, was evaluated using the fluorescein flowmetry technique. The skin temperature was measured with a thermoelement. The skin microcirculation at the area with an early stage of pressure sore was significantly higher than at undamaged skin as measured by both techniques. The total microcirculatory blood flow increased > 16 times (P < 0.001) and the nutritive transport approximately 5 times (P < 0.01) compared to the reference value, and the calculated blood flow of subpapillary tissue layers increased 17-19 times (P < 0.001). However, the skin temperatures in damaged and undamaged skin did not differ significantly. These results show an increased skin microcirculation in the early stage of pressure sores but no increase in skin temperature. The more strongly increased skin blood flow in subpapillary tissue layers effectively conducts away the heat caused by the damage and the increased metabolic activity.

Aged↗
PubMed1993

Reoperation for suspected primary hyperparathyroidism.

A retrospective analysis of 93 patients undergoing 128 re-explorations for persistent or recurrent hypercalcaemia is presented. Seventy-six patients (82 per cent) became normocalcaemic after between one and five reoperations. Nine patients had hypercalcaemia caused by sarcoidosis, familial hypocalciuric hypercalcaemia or metastatic disease, and two had parathyroid carcinoma. Fifteen patients (16 per cent) developed permanent hypoparathyroidism requiring vitamin D and/or calcium therapy and nine had permanent recurrent laryngeal nerve paralysis. Undetected adenomas (41 cases) and inadequate resection in hyperplastic disease (28) were the predominant causes of initial failure. Reoperation for persistent or recurrent hyperparathyroidism restored normocalcaemia in the majority of patients. This 'cure' was achieved at the cost of considerable morbidity and a careful risk-benefit analysis of each patient is recommended before performing reoperative parathyroid surgery.

Adenoma↗