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Biomedical subjects

L Perbeck

Publications and source records attributed to L Perbeck.

53 records · Page 3Linked to original sources
PubMed1986

Saccular dilation of the small intestine in Crohn's disease.

A saccular dilation of the small intestine, 15 X 15 cm2 large, blocked by a hard introitus was seen in a patient with a one-year history of diarrhea. Histopathological examination showed inflammatory infiltration with ulceration between the normal and distended intestine within a length of 1 cm. The mucosa, submucosa and muscularis layers were thicker than normal with infiltration of monocytes. The histological diagnosis was Crohn's disease.

Crohn Disease↗
PubMed1986

The possible advantage of keeping the uterine and intestinal serosa irrigated with saline to prevent intraabdominal adhesions in operations for fertility. An experimental study in rats.

In an attempt to find out whether a constant irrigation of the abdominal cavity with saline, as advocated in operations for fertility, is an adjuvant in the prevention of postoperative adhesions or not an experimental study was performed in 52 rats. The influence of a constant drying and irrigation with saline, respectively, on the exudation of an intact and of an injured serosa of the uterus and of the caecum was assessed after intravenous administration of fluoreisothiocyanate-dextran (FITC-dextran) in 12 rats. The influence of constant drying and constant irrigation with saline, respectively, on the postoperative adhesion formation on an intact and on an injured serosa was evaluated in all 52 animals. The results of this study imply that there was no significant difference in exudation of the intact serosa of the uterus and the caecum irrespective of constant drying or irrigation with saline. Subsequent to a certain trauma, however, the exudation increased with approximately 80 per cent in the uterus and 70 percent in the caecum. Moreover, constant irrigation of the abdominal serosa did not inhibit the increase of the exudation. The adhesion formation on the injured and intact abdominal serosa, respectively, was furthermore not influenced by irrigation with saline or drying, but seemed solely associated with a trauma to the serosa.

Animals↗
PubMed1986

Nonresectable malignant bile duct obstruction. Surgical bypass or endoprosthesis?

Forty-one patients with malignant obstructive jaundice, not amenable to radical surgery, had biliary decompression by either surgical bypass or endoscopically introduced endoprosthesis. The two treatment groups were statistically comparable with reservation for age, which was significantly lower in the operated group. Judged by the effect on bilirubin and alkaline phosphatase levels the two methods were equally efficient. Major complications were more common and initial hospital stay was significantly longer in the surgical bypass group. Neither early mortality nor survival differed between the groups. Implications of these data in the management of patients with unresectable malignancy are discussed.

Aged↗
PubMed1985

The mucosal blood flow in pelvic pouches in man. A methodologic study of fluorescein flowmetry.

Fluorescein flowmetry implies the measurement of capillary blood flow, expressed as an index between the maximum fluorescence after the first circulatory passage of sodium fluorescein (NaF) and the rise time, defined as the time interval between ten and 90 percent of the maximum fluorescence. A mathematic model based on fluorescein flowmetry was deduced to distinguish a mucosal and muscular blood flow in an intact (unopened) intestine during surgery in man. The hypothesis was that if, at a certain point in time, there is a fixed relationship between the seromuscular fluorescence and the mucosal maximum fluorescence, obtained during the first circulatory passage of NaF, and if the rise times were equal, then a mucosal blood flow could be calculated based on the seromuscular fluorescence. The model was tested in intestinal anastomoses on 16 patients. A fixed relationship between the numeric value of the mucosal maximum fluorescence and the seromuscular fluorescence was found. After five minutes, the ratio was 1:1 and the correlation coefficient at its highest (0.97). It was also found that the rise times were practically identical (r = 0.92). The validity of the model was then tested by comparing it with fluorescein flowmetry, and the correlation coefficient was 0.85. The model was therefore accepted and named indirect mucosal fluorescein flowmetry. Indirect mucosal fluorescein flowmetry was applied to measure blood flow in pelvic pouches in 14 patients, and fluorescein flowmetry in the ileoanal anastomoses in eight patients. The mucosal blood flow in the reservoir, compared with the normal intestine, was reduced to 58 percent if the ileocolic artery or distal branches of the mesenteric artery were ligated, and to 88 percent if the vessels were left intact (P less than 0.05). In the ileoanal anastomosis the mucosal blood flow was reduced to 23 percent compared with the normal intestine (P less than 0.01). The results suggest that stretching and compressing the mesentery might be critical for circulation in the ileoanal anastomoses.

Capillaries↗
PubMed1985

Transport of sodium fluorescein between the mucosal and muscular layers in man, possibly indicating functional serially-coupled exchange vessels.

In sixteen patients subjected to intestinal surgery, the transport of sodium fluorescein (Na-F) was measured between the mucosal and serosal-muscular layers. Experiments were carried out in intestinal anastomosis by fluorescein flowmetry (FF). The blood-flow index of the mucosal layer was about twice the serosal-muscularis, per unit tissue volume. The temporal changes in fluorescence pattern from the two layers showed that more than 90% of Na-F, eliminated from the mucosal layer, was transported to the serosal-muscular layers. In six patients, in whom Na-F was instilled intraluminarily, fluorescence was seen on the outside of the intestine after 3 min. However, when the circulation was stopped before Na-F was instilled, no fluorescence was seen, this suggests that the transport was not only due to diffusion but also to convection. The results suggest that functional serially-coupled exchange vessels may exist within the intestinal wall, and that Na-F is transported both by convection and diffusion.

Biological Transport↗
PubMed1985

Correlation between fluorescein flowmetry, 133Xenon clearance and electromagnetic flow measurement: a study in the intestine of the pig.

The purpose of the present study was to compare fluorescein flowmetry as a technique for measuring changes in intestine blood flow with electromagnetic blood flowmetry and the 133Xenon clearance technique. In eight anaesthetized pigs the blood flow in the superior mesenteric artery was reduced to 20-75% of basal flow as defined by electromagnetic flowmetry. The change in blood flow as calculated by fluorescein flowmetry correlated well with that obtained by electromagnetic blood flowmetry (correlation coefficient 0.86) and 133Xenon clearance technique (correlation coefficient 0.94). These findings indicate that fluorescein flowmetry can be considered a quantitative method for measurements of a relative blood flow.

Animals↗
PubMed1985

Fluorescein flowmetry: a method for measuring relative capillary blood flow in the intestine.

The present work represents an attempt to develop a method for measuring relative blood flow in intestinal capillaries, by the use of sodium fluorescein (Na-F) as an indicator substance. The method is called fluorescein flowmetry (FF). A mathematical model was developed; blood flow was expressed as an index between the maximum fluorescence obtained during the first circulatory passage of Na-F and the rise time, defined as the time interval between 10 and 90% of the maximum fluorescence. The prerequisites for the mathematical model were tested in experiments in animals and man. The extraction of Na-F in the intestinal capillaries was found to be more than 99%. The ratio between the tissue clearance and uptake was found to be 0.0051, indicating no back flux. Experiments in man revealed that the rise time was proportional to the mean transit time and the mean transversal time of the bolus proper. The accuracy of FF was confirmed in man where the ratio between mucosal and serosal-muscular capillary blood flow was 2:1. From the results obtained, it appears that FF can be used as a method for measuring relative capillary blood flow in the intestine.

Animals↗
PubMed1985

Intestinal capillary blood flow studied with fluorescein flowmetry in hemorrhagically shocked rats.

The intestinal capillary blood flow in hemorrhagic shock was studied in 32 rats by fluorescein flowmetry (FF). FF implies the measurement of relative intestinal capillary blood flow, expressed as an index. Exsanguination to 35 mmHg for 180 min resulted in a heterogeneous fluorescence pattern with 51% difference in blood flow index between the areas with most and those with least fluorescence, compared with 14% in the control group. Following retransfusion of the shed blood, the difference in blood flow index between areas with most and least fluorescence was 54%, suggesting that the heterogeneous blood flow was not improved by retransfusion. Heterogeneity of the capillary blood flow in the intestines seems to be a phenomenon of hemorrhagic shock and FF to be a suitable method for studying this condition.

Animals↗
PubMed1984

Comparison between fluorescein angiography and fluorescein microscopy.

Fluorescein angiography (FA), which implies that the tissue is reproduced in natural size, and fluorescence microscopy was compared in anesthetized normovolemic and hypovolemic rats in order to define the microscopic background to the fluorescence pattern obtained by FA. It was found that the fluorescence detected by FA by the use of sodium fluorescein as an indicator substance was emitted from the interstitial and intracellular compartments, including the intranuclear. Microscopy showed that sodium fluorescein was located extravascularly in the small intestine within 4 seconds after an intravenous injection. There was a 4 second interval between corresponding microscopic and macroscopic fluorescence pattern.

Angiography↗
PubMed1982

Blood pressure responses associated with hemorrhagic shock in anesthetized rats.

Blood pressure responses to noradrenaline were studied in anesthetised rats subjected to hypovolemia by a constant pressure--open reservoir technique. Hypovolemia resulted in a decrease of the noradrenaline response, which correlated well to the length of the hypovolemic period and to the arterial perfusion pressure when lower than 60 mmHg. Early after retransfusion of the shed blood the pressure response to noradrenaline continued to decrease and began to recover only after additional 30-60 min. The decline in blood pressure response to noradrenaline during hemorrhagic shock was not significantly altered by adrenalectomy, infusion of various metabolic substrates, such as fat emulsion, Na-pyruvate or ATP-MgCl2, or by protection against respiratory and metabolic acidosis. The results imply that high levels of circulating catecholamines, substrate exhaustion and acidosis may be regarded as secondary factors rather than primary causes of decreased blood pressure response and development of irreversible hemorrhagic shock, and they stress the importance of adequate tissue perfusion in the protection against these disorders.

Acidosis, Respiratory↗
PubMed1980

Varicose veins. Do not do phlebography unnecessarily; preserve the great saphenous vein!

Phlebography should be performed only on special indications, chiefly for the diagnosis of thrombosis. A non-invasive method such as venous plethysmography is valuable in assessing deep venous insufficiency. Local exstirpation of varices and perforants and percutaneous paired sutures round superficial varices are recommended instead of stripping, as the saphenous vein may be needed for arterial reconstruction in risk groups, e.g. all male smokers. Peripheral arterial pulsations should always be checked to ascertain that the symptoms are not due to arteriosclerotic occlusion.

Humans↗
PubMed1980

Prostaglandins E1 and E2 antagonize indomethacin-induced decrease in survival rate of haemorrhagically shocked rats.

Indomethacin treatment (15 mg/kg) reduced bleeding volume and diminished the survival rate in haemorrhagically shocked rats. These effects of indomethacin were prevented by a continuous infusion of prostaglandin E1 or E2 (0,1 microgram x min--1). Without indomethacin treatment, prostaglandin E1 in this concentration had no effect on bleeding volume or survival rate. The results are consistent with the possibility that indomethacin decreases the survival rate in haemorrhagically shocked rats by inhibiting prostaglandin synthesis, and that endogenous prostaglandins might counteract the development of irreversible haemorrhagic shock.

Animals↗
PubMedDate not supplied

Sensory and sympathetic block during interpleural analgesia.

BACKGROUND AND OBJECTIVES: Interpleural analgesia is an effective method for pain relief after upper abdominal surgery. To examine whether the analgesic effect is obtained by block of the intercostal nerves, we assessed the analgesic efficacy of the block, the skin sensitivity, and indices of sympathetic outflow over the trunk. METHODS: Interpleural analgesia was instituted at the end of open cholecystectomy in 20 patients 24-81 years of age (mean, 42 years). After a washout period of 8 hours, the analgesic effect was tested 5-12 times during the postoperative follow-up period by using a visual analogue scale before and 20 minutes after injection of 20 mL of bupivacaine 0.25%. Temperature and pain sensations were tested on the day after surgery, and in nine of the patients, the cutaneous blood flow over the trunk was studied by an electronic thermometer, laser Doppler flowmetry, and fluorescein flowmetry. In addition, the conduction velocity in the phrenic nerve was studied in four of the patients. RESULTS: Interpleural analgesia significantly reduced the median visual analogue score from of 5.7 (range 2-10) to 1.1 (range, 0-4). Although the analgesic effect was very good in all patients, half of them still showed skin sensitivity to pain and temperature. Cutaneous blood flow did not change, which showed than block of the intercostal nerves was incomplete. The phrenic nerve was not affected. CONCLUSION: The incomplete cutaneous sensory and sympathetic block indicates that the analgesic effect of interpleural analgesia cannot be explained by retrograde diffusion of the local anesthetic solution into the intercostal nerves alone.

Adult↗
PubMedDate not supplied

Correlation between the uptake of sodium fluorescein in the tissue and xenon-133 clearance and laser Doppler fluxmetry in measuring changes in skin circulation.

We have measured the plantar forefoot skin circulation by the uptake of sodium fluorescein (fluorescein flowmetry), 133Xe clearance and laser Doppler fluxmetry in 24 healthy subjects and correlated measurements under basal conditions and after provocation by alcohol intake and application of external heat. To assess the change in skin circulation between the initial measurement at rest and the second measurement after provocation, the coefficient of correlation (r) of the fluorescein flowmetry to the fast slope of the 133Xe elimination curve was 0.46 (p < 0.05), to the slow slope of the 133Xe elimination curve 0.66 (p < 0.001) and to laser Doppler fluxmetry 0.86 (p < 0.001). The coefficient of correlation (r) of the fluorescence appearance time to fluorescein flowmetry was 0.65 (p < 0.001), to the fast slope of the 133Xe elimination curve 0.14 (p = 0.42), to the slow slope of the 133Xe elimination curve 0.47 (p < 0.05) and to laser Doppler fluxmetry 0.63 (p < 0.001). The uptake of sodium fluorescein as measured by fluorescein fluxmetry correlates well with both 133Xe clearance and laser Doppler fluxmetry in assessing a change in skin circulation in healthy humans. The fluorescence appearance time also correlates to the slow slope of the 133Xe elimination curve and to laser Doppler fluxmetry though to a lesser extent.

Adult↗
PubMedDate not supplied

Blood flow measurements in rabbit sinus mucosa. A comparison between fluorescein flowmetry and blood flow measurements with microspheres and Rb86Cl.

The blood flow of the sinus mucosa was studied in 14 rabbits of the New Zealand White strain. The blood flow was determined by fluorescein flowmetry and the values were compared with those obtained from the same sinus mucosa with use of Sn113 radioactively labelled microspheres and with Rb86Cl. One sinus cavity in each animal received nose drops prior to the blood flow measurement. The blood flow index in the sinus mucosa was 0.039 +/- 0.019 density units Xs-1 and was significantly reduced to 0.016 +/- 0.011 density units Xs-1 by administration of nose drops. Blood flow in the sinus mucosa was 1.0 +/- 0.53 ml X min-1 X g-1 as measured with microspheres and 0.52 +/- 0.12 ml X min-1 X g-1 with the Rb86Cl method. Following administration of nose drops the values were reduced to 0.29 +/- 0.13 and 0.22 +/- 0.07 ml X min-1 X g-1 respectively. There was a significant difference in blood flow obtained with the Rb86Cl and microsphere methods in the sinus mucosa without decongestion. This might be explained by possible shunting of blood in the mucosa due to hyperaemia caused by the surgical trauma to the sinus.

Animals↗
PubMedDate not supplied

Fluorescein flowmetry in human nasal mucosa.

In sixteen patients a relative blood flow, expressed as an index, in the nasal mucosa was measured by fluorescein flowmetry (FF) using an endoscope technique. Duplicate determination showed slightly lower values in the second measurement performed 5 min after the first one. This difference might be due to a too high background fluorescence in the tissue. The blood flow index was reduced to 1/3 of the original blood flow index by the administration of nose drops. These changes in man due to decongestion are comparable to the changes in blood flow index observed in a previous work (2) in rabbit sinus mucosa, using the corresponding technique.

Adolescent↗