Biomedical subjects
M Osnes
Publications and source records attributed to M Osnes.
[Adverse effects following piroxicam (Felden)].
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[Chronic pancreatitis as a cause to extrahepatic cholestasis].
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Stenosis of the common bile duct in chronic pancreatitis.
The incidence of common bile duct stenosis in patients with chronic pancreatitis was studied in a consecutive series of patients admitted for endoscopic retrograde cholangiopancreatography (ERCP). Thirty-six out of 79 patients (46 per cent) with moderate or advanced chronic pancreatitis as defined by radiological criteria were found to have a stenosis of the intrapancreatic portion of the common bile duct. There were no age or sex differences between the patients with and without biliary stenosis, but significantly more patients with stenosis had advanced chronic pancreatitis. In about two-thirds of the patients the stenosis was smooth, symmetrical and tapering. In the remaining cases, a shorter stricture of the hour-glass type was found. A complete obstruction was never seen. About one-half of the patients with bile duct stenosis were icteric at the time of the investigation. The jaundice resolved spontaneously in all but 1 patient in 3-42 (median 14) days. Stenosis of the common bile duct is a frequent complication of chronic pancreatitis, but biliary-enteric bypass operation seems to be unnecessary in the great majority of the patients.
Recurrent biliary calculi: duodenal diverticula as a predisposing factor.
Several studies indicate a causal relationship between duodenal diverticula and gallstone disease. The diverticula persist after biliary tract surgery, and it is therefore presumed that patients with diverticula have an increased disposition to develop new calculi in the bile ducts after cholecystectomy. To test this hypothesis, the occurrence of recurrent biliary calculi was studied in 101 patients who had cholecystectomy, all with an asymptomatic period of two years or more following the primary biliary surgery. All patients had symptoms, that indicated biliary tract or pancreatic diseases. The incidence of recurrent calculi in patients with diverticula was 87.5% (95% confidence interval, 66.9-95.8). In patients without diverticula, the incidence was 31.9% (95% confidence interval, 21.5-44.3). The difference is highly significant, and the results support the assumption tht diverticula in the area of the papilla of Vater dispose to gallstone disease.
Endoscopic sphincterotomy (EST) in patients with Billroth II Gastrectomy.
Methods for endoscopic sphincterotomy (EST) in patients with Billroth-II partial gastrectomy are described. The techniques have been successfully used in 13 out of 18 patients with common bile duct calculi (n = 12) and papillary carcinoma (n = 1). In all patients the calculi were EST. The patient was successfully treated with antibiotics. It is concluded that EST may be performed in most cases with a previous Billroth II operation using differentiated endoscopic techniques.
Plasma concentrations of gastric inhibitory polypeptide after intraduodenal infusion of cattle bile and synthetic bile salts in man.
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Biliary pigment and cholesterol calculi in patients with and without juxtapapillary duodenal diverticula.
The occurrence of pigment and cholesterol calculi was studied in 45 patients with concrements in the gallbladder but no calculi in the common or intrahepatic bile ducts. Twenty-one of the patients had juxtapapillary duodenal diverticula diagnosed by duodenoscopy. Twenty-four patients had no diverticula. The classification of the calculi as pigment stones or cholesterol stones was based on quantitative determination of the cholesterol contents. Calculi with a cholesterol content of less than 25% were classified as pigment stones; calculi with a cholesterol content of more than 25% were classified as cholesterol stones. All pigment stones had a cholesterol content of less than 20%. With the exception of four patients the cholesterol content was over 70% in all cholesterol stones. Twelve of the 21 patients with were classified as pigment stones; calculi with a cholesterol content of more than 25% were classified as cholesterol stones. All pigment stones had a cholesterol content of less than 20%. With the exception of four patients the cholesterol content was over 70% in all cholesterol stones. Twelve of the 21 patients with were classified as pigment stones; calculi with a cholesterol content of more than 25% were classified as cholesterol stones. All pigment stones had a cholesterol content of less than 20%. With the exception of four patients the cholesterol content was over 70% in all cholesterol stones. Twelve of the 21 patients with diverticula had pigment stones, whereas only 1 of the 24 patients without diverticula had pigment calculi, a difference that was statistically significant (p less than 0.01).
Normal and disturbed motility pattern in the duodenum of man. The effect of l-hyoscyamine, trimipramine and ranitidine on the maximal pressure waves.
Eight healthy subjects were examined in random order with an electronic capsule transducer, two capsules being mounted 8 cm from each other in the duodenum. At least two grade III maximal pressure waves were recorded following 0.6 mg l-hyoscyamine (Hässle), 50 mg trimipramine (Surmontil, Rhone Poulenc) or 150 mg ranitidine (Glaxo-Nyegaard & Co.) perorally. A significant prolonged cyclic length (Fig. 1) was observed on the day when l-hyoscyamine was given when compared to results on the day when placebo was given (Table I). No significant differences were observed between placebo and the other drugs given.
Incidence of malignancies of the Billroth II operated stomach. A prospective follow-up.
In 1976 endoscopy with at least 20 biopsies and cytology were performed in 108 patients 20-25 years after partial gastrectomy (Billroth II). In one patient advanced carcinoma and in three cases severe dysplasia or carcinoma in situ, were found. At the follow-study in 1979, 7 patients had died of causes other than gastric carcinoma. A re-examination with endoscopy, biopsies and cytology were performed in fifty-eight patients. The present study did not show a progress of dysplasia in the gastric remnant during the three years of follow-up. The observations may suggest that re-examinations with gastroscopy and multiple biopsies every 3-5 years may be satisfactory in detecting carcinoma of the gastric remnant.
Studies on recovery and variation of pancreatic juice obtained by endoscopic cannulation of the main pancreatic duct in man.
Recovery of pancreatic juice was studied by endoscopic cannulation of the main pancreatic duct, using a double-lumen catheter and infusion of a marker solution (57Co-labeled vitamin B12) into the pancreatic duct. Juice was collected by siphonage. Tracer amounts of 91Cr were infused into the duodenum through a separate catheter attached to the outside of the duodenoscope to determine contamination of duodenal juice. The recovery of the infused marker into the pancreatic duct was poor during the first 15 min of the study, probably because the volume infused merely filled the pancreatic ducts. After this initial period the recovery was slightly less than or exceeded the amount of marker infused per 5-min period. The overall recovery of infused marker was 84% (range 78%--96%). It is concluded that only small amounts of pancreatic juice will leak through the papilla of Vater during endoscopic cannulation under the conditions of this study. The variations in flow rate and concentrations of bicarbonate, amylase, and protein from time to time were studied. Unstimulated and bile-induced flow rate and protein secretion varied considerably within and between subjects. Less marked were the variations of concentrations of bicarbonate and amylase. It is suggested that the large variation may be physiological.
Duodenal diverticula and their relationship to age, sex, and biliary calculi.
The relationship between duodenal diverticula and age, sex, and biliary calculi was studied prospectively in 624 patients examines with endoscopic retrograde cholangiopancreatography (ERCP). The study showed that the incidence of biliary calculi was significantly higher in patients with diverticula (86%) than in patients without diverticula (38%). The difference was significant in all age groups above 40 years (p less than 0.01). The rate of diverticula found near the papilla of Vater was significantly higher in patients with biliary calculi than in patients without (p less than 0.01). A positive correlation was found between age and diverticula but not between sex and diverticula. An insufficient papillary sphincter together with an ascending bacterial infection is discussed as a possible explanation for the higher incidence of biliary calculi in patients with duodenal diverticula.
Does human bile stimulate the exocrine pancreas?
The exocrine pancreatic secretion of water and bicarbonate was studied by endoscopic cannulation of the main pancreatic duct. Intraduodenal infusions of human bile with high concentrations of bile acids were followed by increases in flow rate and bicarbonate secretion in three cases. When bile with low concentrations of bile acids was infused into the duodenum in two cases, no obvious change was found. The study indicates that bile may play a role in the regulation of the exocrine pancreatic secretion of water and bicarbonate in man.
[Endoscopy of colon and terminal ileum. Diagnostic and therapeutic purpose].
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[Malaria falciparum s. tropica. Direct infection from patient to a healthy person].
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Endoscopic retrograde cholangio-pancreatography in primary and secondary tumours of the pancreas.
Twelve of 69 histologically proven pancreatic malignancies were secondary tumours. The most common pattern in the pancreatogram was occlusion and stenosis of the main pancreatic duct. It was not possible radiologically to differentiate between primary and secondary lesions.
Studies of the choledocho-duodenal sphincter in patients with and without juxta-papillary duodenal diverticula.
The function of the choledocho-duodenal sphincter was studied in 16 patients, 8 with juxta-papillary duodenal diverticula. All patients had calculi in the gallbladder. The common bile duct was normal. At cholecystectomy two catheters were introduced into the common bile duct through the stump of the cystic duct and fixed in place. The examinations were performed when the patients had recovered from the operation. One catheter was connected to a pressure transducer, the other was used for saline infusions. Pressure in the common duct was recorded before infusion and at constant infusion rates of 3,6, and 12 ml/min. The muscular tone, the contractile activity, and the total rhythmic variations of the sphincter during infusions were all significantly less in patients with diverticula than in the controls without diverticula. The findings indicate that there is a dysfunction of the choledochoduodenal sphincter in patients with juxta-papillary duodenal diverticula. This may in part be responsible for the high incidence of biliary calculi in patients with duodenal diverticula.