Biomedical subjects

Magnus Sundbom

Publications and source records attributed to Magnus Sundbom.

10 recordsLinked to original sources

PubMed2006

Endoscopic marking with a metallic clip facilitates transcatheter arterial embolization in upper peptic ulcer bleeding.

PURPOSE: To enable accurate transcatheter arterial embolization (TAE) of the target vessel, a new technique to localize the exact position of a bleeding ulcer was tested that involves endoscopic marking of the ulcer with a metallic clip. MATERIALS AND METHODS: In 13 patients (mean age, 75 years) with acute bleeding ulcers (11 duodenal ulcers, two malignant ulcers), a metallic clip was placed at gastroscopy followed or preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. In 10 patients, TAE was indicated as a result of continued or recurrent bleeding. The artery was embolized with microcoils as close as possible to the clip. In three patients, there was no indication for TAE, so plain abdominal radiography was performed to determine whether the marking clip was still in place. RESULTS: In 11 patients, the clip was still in place on radiography; in two, it had disappeared. Hemostasis was achieved in eight of 10 patients after TAE. In six patients, the clip was essential to identify the bleeding vessel. CONCLUSION: Marking of the bleeding ulcer with a clip before TAE enhances the possibility that the correct vessel is embolized. This will most likely minimize the risk of recurrent bleeding after embolization, especially in patients who do not show contrast medium extravasation.

Adult↗

PubMed2006

Effects of gastric bypass on the GH/IGF-I axis in severe obesity--and a comparison with GH deficiency.

OBJECTIVE: Overfeeding suppresses GH secretion and makes evaluation of a suspected GH deficiency (GHD) difficult. In normal weight subjects, gender is known to influence GH concentrations, which is most apparent in the ambulatory, morning-fasted state. In this study, we examined the GH/IGF-I axis in obese men and women and the effect of surgically induced weight loss. DESIGN: Sixty-three subjects (body mass index (BMI) 45 +/- 6 kg/m2; 54 women, 9 men) were studied prior to, and 6 and 12 months following Roux-en-Y gastric bypass (RYGBP) surgery. Fifty-four patients with classic GHD (BMI 27 +/- 6 kg/m2; 35 men, 19 women) were included for comparison. METHODS: Hormones were analysed in fasting morning serum samples. RESULTS: RYGBP resulted in a decreased BMI to 35 +/- kg/m2 at 6 months and 32 +/- 6 kg/m2 at 12 months. GH and IGF-I increased at 6 months in the women and at 12 months in both sexes by > or = 300 and 11% respectively. Prior to RYGBP, GH concentrations were low in the obese men and similar to those of GHD men (mean 0.09 mU/l). Obese women had tenfold higher values than obese men and sevenfold higher than GHD women. IGF-I levels were in the low reference range in the obese and below -2 S.D. for age in 13%. CONCLUSIONS: Surgically induced weight loss partially restores GH secretion. Despite a marked suppression of GH values, a gender influence is maintained in severe obesity. In obese women, single morning GH and IGF-I values seem sufficient to exclude a suspicion of classic GHD.

Adult↗

PubMed2003

Ghrelin and adipose tissue regulatory peptides: effect of gastric bypass surgery in obese humans.

Presently surgery is the most effective way to obtain a controlled weight reduction in morbidly obese patients. Roux-en-Y gastric bypass (RYGBP) surgery is effective and used worldwide, but the exact mechanism of action is unknown. The effect of RYGBP on ghrelin, insulin, adiponectin, and leptin levels was investigated in 66 obese subjects; mean weight 127 kg (range, 96-195 kg) and mean body mass index (BMI) 45 kg/m(2) (range, 33-64) before and after surgery. Ghrelin levels were also compared in 10 nonoperated and 10 operated obese, BMI-matched women. RYGBP resulted in 22% and 30% weight loss at 6 and 12 months, respectively. Ghrelin increased by 44% and 62% and adiponectin by 36% and 98%, but insulin declined by 57% and 62% and leptin by 60% and 64%. The changes were all related to the reduction in BMI. In addition, ghrelin and insulin were inversely correlated at all time points as were changes of the peptides at 12 months (F = 4.9, P = 0.031), independent of the change in BMI. No evidence for RYGBP surgery per se having an effect on ghrelin levels, independent of weight loss, was obtained. The profound changes in the regulatory peptides are likely to reflect the new state of energy balance achieved. A close inverse association between ghrelin and insulin was observed, supporting an important role for ghrelin in glucose homeostasis.

Adiponectin↗

PubMed2003

Excellent weight result after Roux-en-Y gastric bypass in spite of gastro-gastric fistula.

A male patient (age 37 years, BMI 38 kg/m(2)) underwent a revisional gastric bypass after failed gastric banding. Unfortunately he developed a leak from the proximal pouch and subsequently a gastro-gastric fistula between the pouch and the main stomach. He recovered fully and could eat and drink without any restriction. Repeat examination with x-ray and endoscopy revealed that the fistula remained widely open. Remarkably, the patient lost weight to a BMI of 27 kg/m(2) (ie. lost 80% of his original excess body weight), thus challenging the widely held opinion that gastro-gastric fistulas inevitably lead to poor weight loss. In our patient the weight loss was stable for 2 years, when the fistula was closed surgically to avoid chronic proton pump inhibitor medication for stomal ulcer.

Adult↗

PubMed2002

[Hepatic trauma--a 10-year Swedish study. Conservative treatment generally the best option when the circulation is stable].

We studied retrospectively 60 patients with hepatic injuries, 30 of which were referrals. Blunt trauma dominated (90%). Twelve unstable patients had immediate surgery and 41 an initial CT-scan. The injury was graded according to the Liver Injury Scale (AAST). Moderate injuries (grade I-II) were seen in 40 patients, of which 29 had successful conservative treatment. Fifteen of the severe injuries required surgery. Minimally invasive techniques facilitated management of postoperative complications. In all, 16 died, 4 due to the hepatic injury. The material presented is small and heterogeneous, but our results are similar to those reported internationally. A multidisciplinary approach facilitates management.

Female↗

PubMed2002

Duodenogastric bile reflux after gastric bypass: a cholescintigraphic study.

In this exploratory study, we examined the occurrence of duodenogastric bile reflux to the excluded stomach after Roux-en-Y gastric bypass, a standard surgical therapy for morbid obesity. We studied 22 unselected patients (median age 44, 20 females) 18 months postoperatively. BMI at surgery and cholescintigraphy was 45 and 29 kg/m2, respectively. Mebrofenin labeled with 200 MBq 99mT was injected intravenously and the fate of radioactivity followed for 90 min. Bile flow was enhanced with cholecystokinin. We found scintigraphic evidence of duodenogastric bile reflux in 36% of the patients. The tracer remained in the excluded stomach throughout the study period. In conclusion, our investigation indicates that in more than one third of the patients undergoing gastric bypass, the gastric mucosa in the excluded stomach is exposed to the potential deleterious effects of bile.

Adolescent↗

PubMedDate not supplied

Bariatric surgery.

At present, surgery is necessary to counter extreme obesity. The outcomes in bariatric surgery have improved steadily and today most co-morbidities in the massively overweight can be improved or even resolved by surgery. The procedures work in one of two ways; by restricting the patient's ability to eat or by interfering with the ingested nutrient absorption. The operative treatment is in no way cosmetic. Drawbacks to the surgical therapy exist; major life-long rearrangement of the gastrointestinal tract, an operative mortality (<0.5%) and morbidity (about 10%). Surgically induced weight loss is currently the most effective treatment for the severely obese patient.

Body Mass Index↗

PubMedDate not supplied

Reduction in serum pepsinogen I after Roux-en-Y gastric bypass.

The excluded stomach after Roux-en-Y gastric bypass (RYGBP) cannot be readily examined by endoscopy for obvious anatomic reasons. Thus it is difficult to monitor possible changes in the gastric mucosa. However, the type and severity of gastritis can now be assessed by a combination of serologic tests: pepsinogen I and antibodies to Helicobacter pylori and H,K-ATPase. Morbidly obese patients were examined before and 1 to 4 years after surgery. A group of 34 patients (mean age 39 years, BMI 44 kg/m(2)) underwent RYGBP; another group of 30 patients (mean age 42 years, BMI 44 kg/m(2)) had simple gastric restriction and served as control subjects. All patients, except one in the control group, had normal titers of pepsinogen I before surgery. One year after RYGBP, pepsinogen I levels were significantly reduced, as compared to the control group (P<0.0001), and remained low throughout the study. The control group had stable pepsinogen I levels. In both groups, few patients had increased titers of H. pylori or H,K-ATPase antibodies, but these abnormalities remained unchanged. Low pepsinogen I levels, similar to those we observed in our RYGBP patients, have been linked to chronic atrophic gastritis. However, the absence of food stimulation in the excluded stomach could also be a reason for the low pepsinogen I levels.

Adult↗

PubMedDate not supplied

The proximal gastric pouch invariably contains acid-producing parietal cells in Roux-en-Y gastric bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is well tolerated and effective in ameliorating diseases common to morbidly obese patients. A potential drawback, however, is the risk for stomal ulcers, probably due to acid and peptic digestion of the mucosa in the proximal Roux limb. METHODS: In 23 RYGBP patients (mean BMI 45 kg/m(2), age 39 years), the gastro-jejunostomy was performed by circular stapler and the gastric suture ring retrieved for histological examination. 13 consecutive patients received our standard totally transected 4 x 3 cm proximal gastric pouch. The anvil was passed transgastricly and reference biopsies were taken from the gastrotomy in the corpus of the stomach. In the last 10 patients, the pouch size was reduced to 2 x 3 cm by a modified surgical technique. RESULTS: All suture rings from the standard pouches consisted of corpus-fundus mucosa with a large amount of parietal cells, histologically identical to the reference biopsies from the gastrotomy. Also, the 10 suture rings from the modified small pouches contained corpus-fundus mucosa. In 5 of these samples, cardiac mucosa was found, but only in a small segment (6 mm). In addition, 3 patients had esophageal epithelium in the suture ring. CONCLUSION: The proximal pouch invariably contains acid-producing parietal cells. In order to reduce acid production and, hence, the risk of stomal ulcers, the pouch has to be made as small as possible.

Adult↗

PubMedDate not supplied

Role of gastric acid in stomal ulcer after gastric bypass.

BACKGROUND: The pathogenetic mechanisms of stomal ulcer after Roux-en-Y gastric bypass (RYGBP) are unclear. In order to study the role of gastric acid, we measured acidity in the proximal pouch using a pH-sensitive probe. METHODS: 6 patients (5 females, mean age 45 years old at time of operation) with endoscopically confirmed stomal ulcer, were studied 2 to 6 years after RYGBP. All complained of epigastric pain that improved during proton pump inhibitor (PPI) therapy. Control subjects were 6 females (50 years old) who had had RYGBP at least 5 years earlier and denied symptoms of epigastric pain or heartburn. The pH-sensitive probe (Digitrapper-pH, Medtronic) was passed through the nose to the proximal pouch, guided by the calculated distance and pH response. The probe was left in place for 4 hours. The percentage of time with pH <4 was calculated. RESULTS: The probe could be accurately positioned in the proximal pouch both in symptomatic patients and in controls as evidenced by the acid pH reaction. The proximal pouches of patients with stomal ulcer were significantly more exposed to acid compared to controls. The median percentage of time with pH <4 was 69% and 20% in the stomal ulcer and the control group, respectively (P<0.01). Barium follow-through excluded gastro-gastric fistula in stomal ulcer patients. CONCLUSION: RYGBP patients with stomal ulcer have increased acid production in their proximal pouch in comparison with asymptomatic RYGBP patients. Gastric acid appears to have an important role in the pathogenesis of stomal ulcer.

Adult↗