[What is in the heart comes out of the mouth].
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Breast Neoplasms↗
Biomedical subjects
N Krarup
Publications and source records attributed to N Krarup.
[One foreman, two caps].
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Breast Neoplasms↗
Bilateral pyogenic sacroiliitis following uncomplicated pregnancy and labor.
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Adult↗
[Open tension-free hernioplasty using mesh in the treatment of inguinal hernia in adults].
Open tension-free inguinal mesh repair is a new operative procedure in Denmark. During 1993 the author performed 20 procedures in 19 men with inguinal hernias, of which seven were direct and 13 indirect. Five of the hernias were recurrent and one patient had bilateral hernias. The median operation time was 30 minutes from skin incision to closure. The recovery time was short and the complications were few and insignificant. No infections occurred. One patient operated for an indirect hernia complained of recurrency. Reoperation was performed laparoscopically and a femoral hernia, obviously overlooked at the primary operation, was found. There were no other recurrencies. Thus, tension-free open inguinal hernial repair seems to be a safe and easy procedure with few complications and no early recurrency.
Adult↗
Propranolol may prevent recurrence of oesophageal varices after obliteration by endoscopic sclerotherapy.
In 29 patients admitted with their first bleeding episode from oesophageal varices the varices were obliterated within 6 months by treatment with serial endoscopic sclerotherapy and propranolol or with sclerotherapy only. The patients were checked regularly during 18 months after the varices had been obliterated. Variceal recurrence was found in 11 patients (73%; 95% confidence limits, 45-92%) treated with sclerotherapy only and in 2 patients (15%; 95% confidence limits, 2-43%; p less than 0.01) treated with sclerotherapy and propranolol. In nine patients (69%) with recurrence significant variceal bleeding occurred. All recurrences were observed within 12 months after the initial obliteration. Variceal recurrence occurred in 3 Child A patients and in 10 Child B or C patients. All bleeding occurred in Child B or C patients. It is concluded that obliteration of oesophageal varices by endoscopic sclerotherapy and propranolol may be more effective in the long-term control of variceal recurrence than treatment with sclerotherapy only.
Adult↗
Endoscopic, portographic, and hemodynamic evaluation of prolonged propranolol administration in pigs with experimental portal hypertension and esophageal varices.
The effect of long-term propranolol administration on esophageal varices, portocollateral shunting, portal pressure, hepatosplanchnic hemodynamics, and liver function was studied in a pig model with experimentally induced prehepatic portal hypertension and esophageal varices. Five pigs were treated with 160 mg propranolol daily from week 5 to week 24 after portal-vein banding, and five pigs served as nontreated controls. Administration of propranolol caused an initial, significant reduction (20%) of portal venous pressure, followed by a gradual increase to levels not different from control pressures. In contrast, a marked reduction of the caliber of the coronary vein and size of the esophageal varices was noticed. Twenty weeks of propranolol treatment did not change liver blood flow or liver function. We conclude that the size of the varices rather than portal venous pressure depicts the effect of propranolol treatment and suggest that the beneficial effect of propranolol on variceal bleeding can be explained by a reduction in the wall tension of the varices, initiated and maintained by a diminution of splanchnic blood flow.
Animals↗
Propranolol in prevention of rebleeding from oesophageal varices during the course of endoscopic sclerotherapy.
Thirty-one patients admitted with the first bleeding episode from oesophageal varices were randomized in a double-blind manner to receive oral propranolol, 160 mg daily, for 6 months (n = 15) or matching placebo (n = 16) for the same period. Endoscopy was performed each month during the 6 months and additionally after a further 3 months. The oesophageal varices were injected paravariceally with 2% aethoxysclerol until obliteration. If rebleeding occurred, additional sclerotherapy was performed. In the group treated with sclerotherapy and propranolol 3 patients rebled (20%; 95% confidence limits, 4%-48%), whereas 12 patients treated with sclerotherapy and placebo rebled (75%; 95% confidence limits, 48%-93%; p less than 0.05). There were no side effects to treatment in either of the groups, and it is concluded that administration of propranolol reduces the frequency of variceal rebleeding before variceal obliteration during a course of endoscopic sclerotherapy.
Adult↗
A prospective study of circulating immune complexes in patients with breast cancer.
Levels of circulating immune complex (cIC) and complement split product C3d were studied in 86 patients with breast cancer (BC), 22 patients with benign breast disease (BD), and 72 age- and sex-matched blood-bank donors (NC), using solid-phase Clq-protein A RIA, Clq-anti-IgG RIA, anti-C3d anti-IgG RIA, and polyclonal IgM-rheumatoid factor ELISA for clC detection. No significant differences in cIC and C3d levels were found between the groups. The incidence of raised cIC levels varied from 4.9 to 8.2% in the BC group and from 4.5 to 22.7% in the BD group in comparison with 2.9 to 3.0% in the NC group. Using the solid-phase polyclonal IgM-rheumatoid factor ELISA we found that the cIC levels of patients with stage-III cancer were significantly higher than those of patients with stage-I or stage-II cancer. However, the other tests showed no relationship to tumor burden. Likewise, an effect of mastectomy on the cIC levels was also only detectable by one of the assays, i.e., the post-mastectomy levels of cIC as measured by the solid-phase anti-C3d anti-IgG RIA were significantly lower than the pre-mastectomy levels. Serial analyses of cIC and C3d levels were performed pre-operatively, one month post-operatively and every 3 months during the first year after mastectomy in 46 of the patients. During a I-year observation period, 7 patients developed metastatic disease. The occurrence of metastatic disease was not, however, preceded by characteristic changes in serially determined cIC and C3d levels.
Adult↗
Endoscopic sclerotherapy or selective embolisation of esophageal varices. An endoscopic and portographic study in an experimental model.
In an experimental animal model with portal hypertension and esophageal varices, endoscopic sclerotherapy of the varices with Aethoxysclerol was compared with selective embolisation of the coronary vein with absolute ethanol. After 4 courses of endoscopic sclerotherapy the varices were permanently obliterated, as documented by portography and endoscopy. Selective embolisation also caused obliteration of the coronary vein and varices, but early and repeated recanalisation occurred, and permanent obliteration was only obtained when embolisation was combined with endoscopic sclerotherapy. Portal vein thrombosis occurred when embolisation was repeated more than 3 times. Hepatic blood flow was significantly higher in animals treated by endoscopic sclerotherapy than in nontreated controls and animals treated by selective embolisation alone.
Animals↗
Chronic portal venous hypertension. The effect on liver blood flow and liver function and the development of esophageal varices.
Portal venous hypertension was induced in Göttingen minipigs by banding the portal vein. The pigs were checked repeatedly during the following 24 weeks. Portal pressure increased immediately on banding, from 8.4 +/- 0.7 mm Hg to 19.4 +/- 0.7 mm Hg, and remained constant throughout the observation period. Within 5 weeks all pigs developed esophageal varices, as demonstrated by portal angiography and endoscopy. The experimentally induced portal hypertension was accompanied by a 65% decrease in hepatic blood flow, most probably caused by almost complete shunting of portal venous blood. The hepatic arterial flow appeared to be within normal limits and sufficient to cover the oxygen demand of the liver; to judge from the splanchnic elimination rate of galactose, the hemodynamic changes did not affect the functional capacity of the liver.
Animals↗
Effect of endoscopic sclerotherapy of esophageal varices on liver blood flow and liver function. An experimental study.
In 10 Göttingen mini-pigs esophageal varices developed after banding of the portal vein. In five pigs the varices were treated by paravariceal injection of polidocanol, and the rest served as controls. As judged from endoscopy and portography, the varices disappeared after four sclerotherapy sessions within 4 weeks, and at the same time portal venous pressure rose from 19 to 38 mm Hg. No changes were seen in the control group. After 24 weeks of observation the hepatic blood flow in the untreated group was 10 ml/kg/min, and portal angiography showed that nearly all the portal blood bypassed the liver. In the pigs treated with sclerotherapy the hepatic blood flow increased to 28 ml/kg/min, angiography showed a normal hepatogram, and no filling of the collaterals was seen. Sclerotherapy induced only a few changes in liver function, and these may be related to the concomitant increase in liver blood flow.
Animals↗
Effect of acute portal hypertension on hepatosplanchnic hemodynamics and liver function.
Acute prehepatic portal hypertension was mechanically induced in Göttingen minipigs. A 125% increase in portal pressure resulted in a significant decrease in estimated hepatic blood flow. The decrease in blood flow was accompanied by a 25% reduction in the 'true' clearance of indocyanine green and an 18% decrease in splanchnic oxygen consumption. Judged from the splanchnic elimination rate of galactose, the functional liver cell mass was not altered by portal banding, and an unaltered lactate to pyruvate ratio in hepatic venous blood indicated that no functional parts of the liver became severely hypoxic.
Animals↗
[Peroral premedication before anesthesia. A comparison between diazepam and dixyrazine].
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Administration, Oral↗
The effect of glucagon, dibutyrylic cyclic AMP and theophylline on bile production in the cat.
The effect of glucagon, dibutyrylic cyclic AMP and theophylline on bile production and liver metabolism was studied in fasting, chloralose anesthetized cats. After 45 min infusion of glucagon (0.1 mug/kg/min) total bile flow started to increase and finally reached a level 32% above control bile flow. The rise in flow was accompanied by a parallel increase in the biliary clearance of erythritol and the rate of biliary excretion of inorganic ions, whereas the bile acid excretion remained constant. Glucagon therefore appears to stimulate selectively the bile acid-independent canalicular production of bile. In contrast to the delayed action on bile production, glucagon caused an immediate change in liver metabolism as judged from the elimination rate of ethanol and the rise in plasma glucose concentration. Dibutyrylic cyclic AMP or theorphylline also caused similar immediate changes in liver metabolism but neither substance influenced bile production or the biliary excretion of electrolytes or bile acids. It thus appears that glucagon choleresis in the cat is either independent of cAMP release or that an increase in intracellular cAMP is not in itself sufficient to influence bile secretion. The results also seem to exclude that an increase in insulin production induced by hyperglycemia, or hemodynamic changes in the liver, can explain glucagon choleresis.
Animals↗
The effect of secretin on bile production, splanchnohepatic hemodynamics and liver function in cats.
The effect of secretin on bile flow, biliary clearance of 14C-erythritol and bile composition was studied in fasting, chloralose anesthetized cats. Secretin (2 U.kg-1 . h-1) increased from values below the values above the erythritol clearance, which did not change significantly. It is therefore concluded that secretin altered ductular transfer of fluid from a net reabsorption to a net secretion of a bicarbonate rich fluid. Secretin did not affect the sphlanchno-hepatic hemodynamics or the overall function of the liver and Indomethacin did not significantly alter the response to secretin.
Animals↗
Liver hemodynamics and liver function in cats during graded hypoxic hypoxemia.
In 15 cats, anesthetized with chloralose and curarized, liver hemodynamics and liver function were followed during graded hypoxic hypoxemia. Hepatic arterial and intrahepatic portal venous conductance were not influenced by hypoxia, whereas severe hypoxemia increased gastrointestinal conductance. Total liver blood flow remained constant and hypoxemia was compensated for by an increase in hepatic extraction of oxygen approaching 100%. Only when the hepatic venous pO2 fell below 5-10 mmHg did hypoxemia decrease liver function. The results indicate that the sinusoidal perfusion is homogeneous.
Animals↗
Secretin-like choleretic effect of prostaglandins E1 and E2 in cats.
1. The effects of intraportal and hepatic arterial infusion of prostaglandins E1 and E2 on liver function and circulation was studied in fasting chloralose anaesthetized cats. 2. Infusion of the prostaglandins at rates of 0-1, 1-0 and 5-0 mug/kg.min caused a 35-40% increase in bile flow. This may be explained by a decrease in the reabsorption or a secretion of sodium ions by the ductular cells. The canalicular bile production and bile flow. This may be explained by a decrease in the reabsorption or a secretion of sodium ions by the ductular cells. The canalicular bile production and bile acid excretion was not affected by the prostaglandins. 3. Infused at rates of 1-0 and 5-0 mug/kg.min the prostaglandins caused a transient decrease in mean arterial blood pressure and mesenteric vascular resistance. The resistance in the intrahepatic arterioles and low-pressure vessels was not affected. 4. The prostaglandins did not influence the splanchnic uptake of oxygen and ethanol, whereas a slight increase in the splanchnic glucose output occurred. 5. The effects of the two prostaglandins were identical and not related to the route of administration.
Animals↗
The influence of dye infusion rate and hepatic plasma flow on indocyanine green clearance.
The plasma clearance and extraction ratio of indocyanine green (ICG) were followed in cats anesthesized with chloralose. In one series of experiments the ICG infusion rate was raised stepwise and in another the hepatic plasma flow was changed by replacing part of the blood volume with erythrocytes, plasma, or dextran (Macrodex). For unknown reasons blood replacement with Macrodex increased the ICG elimination. Both plasma clearance and extraction ratio were independent of ICG infusion rate but dependent on hepatic plasma flow. In contrast, a clearance calculated from the dye elimination rate and the estimated average hepatic plasma concentration of ICG was independent of changes in hepatic plasma flow. In conclusion, plasma clearance and extraction ratio of indocyanine green are not ideal for estimation of liver function. However, when clearance is calculated from the average hepatic plasma concentration of the dye, it becomes independent of hepatic plasma flow and thus a more reliable index of liver function.
Animals↗