Search PubMed⌕ Search

Biomedical subjects

M Lempinen

Publications and source records attributed to M Lempinen.

At least 55 records · Page 3Linked to original sources
PubMed1986

Microcirculatory changes in visceral organs during slowly progressing hypovolaemia in pigs.

The loss of 30% of the blood volume, reported in early experimental haemorrhagic pancreatitis, was simulated in anaesthetized piglets by inducing slowly progressive haemorrhage leading to the loss of one third of the blood volume during five hours. Cardiac output, determined by thermodilution, was measured hourly as was mean blood pressure and pulse rate. Organ blood flow was determined before and at the end of the experiment with the reference sample method using radioactive microspheres. During the experiment cardiac output decreased by 33% (p less than 0.001) and mean blood pressure by 21% (p less than 0.005), the decrease being almost linear in both parameters. However, pulse rate increased only slightly. Organ blood flow decreased roughly in proportion to the decrease in cardiac output in almost all organs the decrease being significant in the spleen, antral mucosa and kidneys. Blood flow to the spleen, however, decreased significantly more while blood flow to the adrenal glands increased insignificantly. According to the results, it is obvious, that some form of vasoregulation took place during the experiment, since no frank hypovolaemic shock was observed. The present results closely resemble those observed earlier during experimental haemorrhagic pancreatitis, with the exception of greater cardiac output related decrease in organ blood flow in experimental haemorrhagic pancreatitis, suggesting that the circulatory changes during experimental haemorrhagic pancreatitis are mainly due to secondary hypovolaemia.

Animals↗
PubMed1985

Partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after Nissen fundoplication.

The results of partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication in six patients were analysed. There were no postoperative deaths. Postoperative complications (pneumonia and atelectases, postoperative ileus) developed in three patients. The results were evaluated by clinical and endoscopic examination 1 to 3.5 years after the operation. Clear clinical and endoscopic improvement was observed in five of the six patients. In the remaining patient the procedure failed to prevent progression of the oesophagitis with development of a Barrett's oesophagus. The results suggest that a partial gastrectomy with Roux-en-Y reconstruction is an effective and safe procedure in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication.

Aged↗
PubMed1985

Pancreatic blood flow and contrast enhancement in computed tomography during experimental pancreatitis.

The pancreatic blood flow and contrast enhancement in computed tomography (CT) were studied in 10 piglets weighing 17-25 kg with experimental pancreatitis. Each animal served as its own control. CT and blood flow measurements were made both before induction of pancreatitis and 5-6 h after the onset of the disease. Cardiac output was measured by thermodilution, and was kept constant throughout the study by infusion of dextran and saline. Although the pancreatic blood flow remained constant in this experiment, CT showed a significant decrease in contrast enhancement.

Animals↗
PubMed1985

Biliary dyskinesia.

It has not been firmly established whether dysfunction of the sphincter of Oddi, biliary dyskinesia, exists as a distinct clinical entity. Improved diagnostic methods, such as ERCP and different manometric studies combined with provocation tests, have provided objective evidence that, in some patients with what is termed the postcholecystectomy syndrome, a spastic sphincter of Oddi is a cause of their complaints. Controlled randomised clinical studies are lacking, but previous results have shown that either operative or endoscopic papillotomy might be indicated in some patients with sphincter Oddi dyskinesia.

Biliary Dyskinesia↗
PubMed1985

Significance of extrapancreatic findings in computed tomography (CT) of acute pancreatitis.

Computed tomography (CT) has proven reliable in the early detection of acute haemorrhagic pancreatitis. In the present study the extrapancreatic changes at CT were studied in 60 patients with acute pancreatitis. The CT findings were correlated to the early "prognostic signs" by Ranson and the clinical course of the disease. All the patients with minor extrapancreatic changes recovered without complications. When moderate to severe extrapancreatic changes were seen the incidence of haemorrhagic pancreatitis and the risk of development of pseudocyst or abscess was high. In these patients a dynamic contrast enhanced CT should be done in order to select the patients with haemorrhagic pancreatitis.

Acute Disease↗
PubMed1985

Total pancreatectomy for chronic pancreatitis.

Ten instances of total pancreatectomy performed for chronic alcohol induced pancreatitis are reported. There was no hospital mortality, and all of the patients were free of pain. The most difficult problem was labile insulin sensitive diabetes in these patients who were chronic alcoholics. In addition, steatorrhea with weight loss, bleeding marginal ulcers and general weakness diminished working ability. The present data suggest that this procedure should be considered as the last resort in the treatment of severe instances of chronic pancreatitis.

Adult↗
PubMed1985

Glycemic control and serum lipoproteins after total pancreatectomy.

Carbohydrate and lipid metabolism were studied in 10 patients who had undergone total pancreatectomy. The results were compared with Type I diabetic patients and normal subjects, all of whom were matched for age, sex and weight. At the same level of glycemic control, the daily need for insulin was significantly lower in the patients with pancreatogenic diabetes than in those with Type I diabetes. Concentrations of serum total VLDL and HDL triglyceride were higher in the pancreatectomized patients than in the diabetic or normal controls, whereas concentrations of serum total and LDL cholesterol were significantly lower. The composition of the VLDL, LDL and HDL particles was abnormal in the totally pancreatectomized patients as all three lipoprotein fractions were enriched in triglyceride. HDL2 cholesterol was similar in the totally pancreatectomized patients to that in the other two groups but HDL3 cholesterol was lower. Postheparin plasma lipoprotein lipase and hepatic lipase activities were normal. It is concluded that in totally pancreatectomized patients the changes in the lipoprotein profile on reflect more the action of various confounding factors, i.e. malabsorption, continuance of alcohol abuse and dietary changes than the impact of the diabetes itself.

Adult↗
PubMed1984

A new method for the diagnosis of acute hemorrhagic-necrotizing pancreatitis using contrast-enhanced CT.

Twenty-eight consecutive patients with a first attack of alcohol-induced pancreatitis were studied using contrast-enhanced CT. The findings on CT were then related to the course of the disease. The patients with acute hemorrhagic-necrotizing pancreatitis showed significantly lower enhancement values of the pancreatic parenchyma than those with milder forms of the disease. The next 20 patients with severe pancreatitis were scanned using a slightly modified procedure. The enhancement values were calculated and plotted on the graphs for the 2 former groups. Two categories of pancreatic enhancement were found: "low enhancement" and "high enhancement." In all 10 patients with "low-enhancement" values surgery revealed hemorrhagic-necrotizing pancreatitis. In the 10 patients with "high-enhancement" values conservative treatment was continued, and the clinical course was nonfulminant in all of them.

Acute Disease↗
PubMed1984

Pancreatic resection versus peritoneal lavation for acute fulminant pancreatitis. A randomized prospective study.

Thirty-five patients with acute fulminant (hemorrhagic) pancreatitis, verified at laparotomy, were allocated to either pancreatic resection (18 patients) or peritoneal lavation (17 patients) therapy groups. Pancreatic resection was carried out by removing the distal pancreas well cephalad to the portal vein. For peritoneal lavation, two inlet silicone catheters were inserted at laparotomy around the pancreas and an outlet catheter was inserted in the lower abdomen, and the peritoneal cavity was thereafter lavated (1000 ml/hr) with a standard peritoneal dialysis fluid for 7 to 12 days (or until death if met earlier). In other respects, the postoperative care was similar, including intravenous fluids with total parenteral nutrition until oral intake of food was resumed, prophylactic antibiotics (tobramycin and clindamycin) and stress ulcer prophylaxis (cimetidine and antacids). In the resection group, four of the 18 patients (22.2%) died, while in the lavation group eight of the 17 patients (47.1%) died. The most common cause of death was septic complications with multiple organ failure, but one patient in each group died accidentally of airway complications. There was no difference in the incidence of septic complications (sepsis and/or intra-abdominal abscesses), but the incidence and severity of pulmonary and renal complications were greater in the lavation group. However, these complications accumulated to patients who ultimately died. Also, the need for reoperation was greater in the lavation group (20 reoperations/10 patients versus 12 reoperation/eight patients). Yet, the length of overall hospital stay was equal in the two groups. Six of the 14 survivors in the resection group developed diabetes, whereas none of the nine survivors in the lavation group got this complication. The results suggest that pancreatic resection is superior to peritoneal lavation in the management of acute fulminant (hemorrhagic) pancreatitis, decreasing mortality and affording smoother postoperative course. However, these benefits are gained at the expense of higher incidence of postoperative diabetes.

Acute Disease↗
PubMed1984

Endotoxaemia and acute pancreatitis: correlation between the severity of the disease and the anti-enterobacterial common antigen antibody titre.

Enterobacterial common antigen is a highly immunogenic component of the Gram negative bacterial cell wall that is common to all enteric bacteria. In the present study, the humoral antibody response against enteric bacteria was investigated by measuring antibodies to enterobacterial common antigen in paired serum samples in 38 patients with acute pancreatitis and in 31 healthy subjects. In mild pancreatitis (11 patients), no changes in anti-enterobacterial common antigen titres were observed as compared with healthy controls. Nine of the 10 patients had a significant increase (greater than or equal to 8 times) in anti-enterobacterial common antigen titres during the disease. Similarly, in patients with fulminant (haemorrhagic) pancreatitis who survived, a significant increase in anti-enterobacterial common antigen titres occurred during the course of the disease (in nine of the 11 patients). Paradoxically, only one of the six patients with fulminant pancreatitis with fatal outcome showed a significant increase in his anti-enterobacterial common antigen titre. The results suggest that Gram negative bacterial components escape into the systemic circulation in acute pancreatitis. This may have pathophysiologic significance in this disease.

Abscess↗
PubMed1984

Serum phospholipase A2 in diet-induced pancreatitis.

Serum activities of amylase, lipase, phospholipase A2 and transaminases were measured in mice with diet-induced acute pancreatitis. To study the role of choline deficiency, one control group received only a choline-deficient diet (CD diet), another group received the choline-deficient diet with 0.5% DL-ethionine (CDE), and a third group received the choline-deficient diet and was given ethionine intraperitoneally. Serum amylase activities increased after 1 day of treatment in all experimental groups. In contrast, lipase activity rose later in the groups receiving ethionine either in the diet or intraperitoneally. In the CDE group there were significant changes in phospholipase A2 on the fourth day after test feeding was started, but no rise was seen in the other groups. Correspondingly, in the group receiving the CD diet alone and the group receiving intraperitoneal ethionine the mortality was significantly lower than in the group receiving ethionine in the diet. In all experimental groups there was a significant rise in serum transaminases (ASAT, ALAT). The rise in ALAT on day 4 was significantly higher in the CDE group than in the other two groups. The mortality rate in the CDE diet group on day 4 was 91%. In the animals to which ethionine was given intraperitoneally the corresponding mortality was 21%. In the CD diet group all animals survived for more than 4 days. The present results suggest that serum lipase and phospholipase A2 activities correlate better with the severity of diet-induced pancreatitis than do serum amylase levels. The most severe cases of the disease seemed to be associated with a rise in serum phospholipase A2 activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1984

Time-courses of hepatocellular hyperpolarization and cyclic adenosine 3',5'-monophosphate accumulation after partial hepatectomy in the rat. Effects of fasting for 48 hours and intravenous injection of glucose.

Hepatic cell membrane potentials, hepatic cyclic adenosine 3',5'-monophosphate concentrations, and blood glucose levels were measured in anesthetized rats before, and at various times after, partial hepatectomy. In fed rats, hyperpolarization became evident 1-3 h postoperatively, reached its first peak at 4 h, and was maintained for approximately 36 h. The early phase of hyperpolarization was preceded by depletion of glycogen from the liver remnant and occurred during a decline of blood glucose concentrations below the level in sham-operated rats. Preoperative exhaustion of glycogen stores by fasting for 48 h resulted in marked hyperpolarization within 15 min after partial hepatectomy. In fasted rats, an intravenous injection of glucose (10 mmol X kg-1) caused a delay in hyperpolarization when given 30 min before partial hepatectomy, or a transient normalization of the membrane potentials when given 30 min after partial hepatectomy. Liver tissue cyclic adenosine 3',5'-monophosphate concentrations in fed rats remained largely unchanged 2 h after partial hepatectomy but increased greatly at 4 h. On the other hand, in fasted rats a significant increase was seen within 30 min. Glucose administration to fasted rats depressed cyclic adenosine 3',5'-monophosphate concentrations in the liver remnant. The results suggest that intensified gluconeogenesis, partly mediated by cyclic adenosine 3',5'-monophosphate, could be the event underlying early hepatocellular hyperpolarization induced by partial hepatectomy.

Animals↗
PubMed1984

Elective operations in chronic alcohol induced pancreatitis.

The role of surgical treatment in the management of chronic pancreatitis has increased, mainly because of improved diagnostic methods. In the present study, 83 consecutive patients who were operated upon for chronic alcohol induced pancreatitis between 1970 and 1980 are reviewed. The results indicate that the best results with regard to pain relief were achieved with lateral drainage operation in patients with dilated pancreatic ducts. A sufficient pancreatic resection gives satisfactory results in patients with nondilated ducts. Patients with severe pancreatic changes and a long history of alcoholism are best treated by extended pancreatic resections with regard to pain relief; however, most of the patients are still unable to work after the operation. A constant follow-up and active surgical attitude at the early stage of the disease before the circulus vitiosus of pain, drugs, inability to work and disturbances in social life are of paramount importance.

Adult↗
PubMed1984

Acute haemorrhage associated with pancreatic pseudocyst and chronic pancreatitis.

The present study reports 18 patients operated on for chronic pancreatitis complicated by bleeding in the upper gastrointestinal tract, the peritoneal cavity or the retroperitoneal space. Damage to the splenic artery by a pancreatic pseudocyst was the most common reason for the bleeding (10 patients, 56%) and the most common site was the duodenum (10 patients, 56%). Eleven patients were treated by transcystic multiple suture ligations combined with external drainage of the pseudocyst, and seven by pancreatic resection or total pancreatectomy. Hospital mortality was 33% (6 patients); two patients had undergone transcystic suture ligation, and four pancreatic resection. Five patients needed a reoperation because of further bleeding, four of them having been treated initially by transcystic suture ligation. Our results suggest that haemostasis by suture ligation is a method to be recommended if the patient's condition has been exacerbated by severe haemorrhage.

Adult↗
PubMed1984

Long-term outcome after jejunoileal bypass for morbid obesity.

Long-term results after jejunoileal bypass operation for morbid obesity in 47 patients are presented. Two patients died postoperatively and a reanastomosis was made in three. Forty-one patients were re-examined on average 4.7 years after operation. Mean weight loss was 43 kg or 31 per cent of original weight. Increased stool frequency and abdominal discomfort were common postoperative symptoms. Abnormalities in serum electrolytes, serum vitamin levels and in liver function were relatively uncommon and in none serious. The net effect of the operation on joint and back symptoms was positive. In most patients the quality of life was clearly improved and all except two were satisfied with the results. Our experience suggests that jejunoileal bypass is still an alternative in the treatment of morbid obesity.

Adolescent↗
PubMed1984

The clinical significance of contrast enhanced computed tomography in acute pancreatitis.

58 patients with alcohol-induced acute pancreatitis were studied by contrast enhanced computed tomography (CT). The patients were divided into groups both on the basis of the clinical course and the prognostic signs. The contrast enhancement curves were then plotted for these patients. All patients with uncomplicated pancreatitis had increased or normal contrast enhancement, whereas all those with fulminant pancreatitis had decreased contrast enhancement of the pancreas. The patients with three, or more prognostic signs had lower enhancement values than those with fewer prognostic signs, but the prognostic signs did not correlate as well with the clinical course as did the contrast enhancement.

Acute Disease↗
PubMed1984

Haemodynamics after distal splenorenal shunt.

Haemodynamic studies were made both preoperatively and 7--62 months after the operation in 17 cirrhotic patients subjected to distal splenorenal shunt. Patent shunt was demonstrated in all patients. Preoperatively all patients had hepatopetal portal flow. Postoperatively portography through percutaneous transhepatic portal vein cannulation demonstrated hepatopetal flow in nine patients and reversed flow in eight patients. Portal pressure was significantly decreased in both groups after the shunt (p less than 0.01). However, no differences in pre- and post-operative portal pressure were observed in the two patient groups. In patients with hepatopetal flow, minimal new collaterals without clear connection to gastroesophageal region could be demonstrated. Collateral formation in patients with reversed flow was more abandoned but, even in these cases, no connection to gastroesophageal region could be demonstrated. The results indicate that a continuous increase in liver resistance due to the progression of the liver disease is the main cause of changes in portal circulation.

Adult↗