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Biomedical subjects

P Kirkegaard

Publications and source records attributed to P Kirkegaard.

At least 55 records · Page 3Linked to original sources
PubMed1994

Postoperative electrolyte and mineral balance after restorative proctocolectomy with ileoanal reservoir.

Postoperative electrolyte and mineral balance was studied in nine patients with ulcerative colitis who underwent restorative proctocolectomy with ileoanal reservoir (J-pouch). The study was carried out during the first seven days of bowel function after construction of the reservoir and temporary ileostomy, and again after the ileostomy was closed and bowel continuity re-established. Stool volume and intestinal sodium excretion were reduced by respectively 40 and 45% after ileostomy was closed (p < 0.05), but potassium excretion was unchanged. The concentration of sodium was higher in ileostomy effluents, whereas the concentration of potassium was higher in stools after the ileostomy was closed (p < 0.05). Significant changes in blood and urinary electrolytes or minerals were not recorded. It is concluded that a major reduction in stool volume and intestinal excretion of sodium is already present in the early postoperative period after bowel continuity has been re-established.

Adult↗
PubMed1993

[Pouchitis: acute inflammation in the pelvic ileal reservoir. Diagnostic criteria, frequency, possible etiological factors and treatment].

Pouchitis is a significant long-term complication of restorative proctocolectomy. Pouchitis is characterized by diarrhoea, fever, malaise, abdominal pain and in few a patients a worsening of already present extraintestinal manifestations may occur. The estimated probability of pouchitis occurring within five years is approximately 35%. Standard diagnostic criteria have not yet been established, but clinical symptoms, endoscopic and histological features should be included. The cause of pouchitis is unknown, bacterial over-growth, faecal stasis, oxygen free radicals, secondary and deconjugated bile acids, shortchain fatty acids, gastrointestinal hormones and an immunologically-mediated reaction have all been suggested as possible etiological factors. Metronidazole is the most commonly used treatment and has prompt effect in more than 90% of the patients. Steroids and 5-aminosalicylic acid derivatives also seem to be effective. A diverting ileostomy is necessary in only five to seven percent of the patients, and in less than one percent does pouchitis result in excision of the pouch. Controlled trials with uniform diagnostic criteria are required to assess the effectiveness of the individual regimens.

Acute Disease↗
PubMed1993

[Early complications of enterostomy. Importance of the type of suture].

The frequency and character of early complications following creation of enterostomies, and their relation to the type of suture material used were studied in 50 consecutive patients. The stomas were matured by muco-cutaneous eversion, and were fixated with Maxon 4-0 and Vicryl 3-0 sutures. Half the stoma circumference was sutured with the one suture type, and the other half with the other. No statistically significant correlation was found between enterostomy type or surgical procedure and complications. The incidence of muco-cutaneous complications was significantly higher following fixation with Vicryl as compared to Maxon sutures. The cause of this difference is uncertain, however, the physical configuration of the sutures seems important, Maxin being monofile versus Vicryl being braided. Whether the chemical structure is significant as well remains undetermined at present.

Adult↗
PubMed1993

[Liver transplantation in Denmark. First-year experiences].

During the first 12 months of the Danish Liver Transplantation program, which began in October 1990, 21 transplantations were performed in 11 women, six men and three children. One patient required a retransplant. Fourteen operations were performed electively and six patients were transplanted for acute and subacute fulminant liver failure and coma, two patients had reduced size livers because of large donor liver. There were no peroperative deaths. One of the elective patients died after three weeks from multiorgan failure and sepsis. Two of the emergency patients died after 20 and 22 days. One from graft dysfunction due to stenosis of the celiac trunk and the other of exudative pericarditis. One patient died from chronic rejection and CMV-infection after seven months. Complications were relatively few and acute rejection occurred in 40% of the patients. Fifteen patients are discharged with normal liver function and 11 of these were back at work, school or previous functions in the home. It is concluded that these results are comparable to the best results from other centres but that 21 transplants in 12 months must be a minimum activity.

Adolescent↗
PubMed1993

[Plasmapheresis as life-saving treatment in acute hepatic failure].

Emergency liver transplantation is the treatment of choice in acute liver failure without signs of spontaneous regeneration. However, many patients rapidly contract irreversible neurological complications before transplantation can be performed. We used high-volume plasmapheresis to increase the time span to obtain a donor liver. Four patients with acute liver failure of unknown cause and a galactose elimination capacity indicative of a virtually extinct liver function were assigned maximum priority for liver transplantation. Plasmapheresis were performed daily until transplantation. Each time 8-10 liters of patient plasma were replaced with an equal volume of fresh donor plasma. There were no major complications. None of the patients developed irreversible neurological complications for 48-144 h at which time liver transplantation was performed. High volume plasmapheresis increases the time to obtain a donor liver for emergency liver transplantation and optimizes the condition for the surgical procedure.

Acute Disease↗
PubMed1993

[Partial orthotopic liver transplantation].

From October 1990 to May 1992, nine of 38 patients with liver transplants (24%) had partial orthotopic liver transplantation on account of lack of size-matching donor livers. The preliminary results have presented very few problems; there was no per- or postoperative mortality and no surgical complications. Four patients had episodes of acute rejection which responded to anti-rejection therapy, and two patients were treated for CMV infection. All patients are discharged with normal liver function 4-9 weeks after transplantation (median 5 weeks). The method seems to be safe and can be used in centers with limited activity, where there is a problem of having the correct liver at the correct time.

Adolescent↗
PubMed1993

Pancreatic beta-cell function and glucose metabolism in human segmental pancreas and kidney transplantation.

beta-Cell function and glucose metabolism were studied in eight insulin-dependent diabetic recipients of combined segmental pancreas and kidney transplant with peripheral insulin delivery (Px), in eight nondiabetic kidney-transplant individuals (Kx), and in eight normal subjects (Ns) after three consecutive mixed meals. All subjects had normal fasting plasma glucose, but increased basal levels of C-peptide were demonstrated in the transplant groups (P < 0.05 relative to Ns). Postprandial hyperglycemia was increased 14% in Kx and 32% in Px (P < 0.05), whereas compared with Ns postprandial C-peptide levels were increased three- and twofold, respectively, in Kx and Px (P < 0.05). Compared with Ns basal insulin secretion rate (combined model) was increased 2-fold in Kx and 1.4-fold in Px (P < 0.05). Maximal insulin secretion rate was reduced 25% in Px compared with Kx (P < 0.05) but not different from that of Ns (P NS). Also, maximal insulin secretion rate occurred later in Px than in controls (Tmax: Px 50 min, Kx 30 min, and Ns 32 min; P < 0.05). The total integrated insulin secretion was increased 1.4-fold in Px compared with Ns (P < 0.05) but decreased 1.4-fold compared with Kx (P < 0.05). Fasting and postprandial proinsulin-to-C-peptide molar ratios were inappropriately increased in Px compared with Kx and Ns. Basal hepatic glucose production was increased 43% in Px and 33% in Kx compared with Ns (P < 0.05). Postprandial total systemic glucose appearance was similar in all three groups, whereas peripheral glucose disposal was 15% reduced in Px (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Complications after J-pouch ileoanal anastomosis: stapled compared with handsewn anastomosis.

OBJECTIVE: To compare the morbidity after stapled compared with handsewn J-pouch ileoanal anastomoses. DESIGN: Retrospective study. SETTING: University Hospital, Copenhagen, Denmark. SUBJECTS: 144 consecutive patients who underwent either handsewn or stapled J-pouch ileoanal anastomosis between November 1983 and December 1991. MAIN OUTCOME MEASURES: Length of operation; operative blood loss; incidence of anastomotic breakdown, fistula and stenosis; and number of pouches that were excised as a result of complications. RESULTS: Ninety-six patients had handsewn, and 48 patients had stapled, anastomoses. There were no differences between the groups except in the length of operation (median (range) 270 (155-420) in the handsewn group compared with 197 (135-300) in the stapled group, p < 0.001), and the incidence of later stenosis of the anastomosis (22/96, 23%, compared with 3/48, 6%, p = 0.02). Patients who developed anastomotic breakdown lost significantly more blood during operation (median 2300 ml, range 1100-7500, compared with 1600 ml, range 600-6000, p = 0.02), and women were more likely to develop anastomotic leaks than men (15/70 compared with 3/74, p = 0.009). CONCLUSION: We conclude that so far the stapled anastomoses have given superior results, but it remains to be seen whether other differences will emerge as length of follow up increases.

Adolescent↗
PubMed1992

Early local stoma complications in relation to the applied suture material: comparison between monofilament and multifilament sutures.

The frequency and character of early complications following creation of enterostomies, and their relation to the applied suture material, were studied in 50 consecutive patients. The stomas were matured by mucocutaneous eversion and were fixated with Maxon (Davis & Geck, Pearl River, NY) 4-0 and Vicryl (Ethicon, Inc., Somerville, NJ) 3-0 sutures. Half of the stoma circumference was sutured with one suture type, and vice versa. Three patients died within 10 days. Of the remaining 47 patients, 34 (72 percent) had one or more complications diagnosed. Four (9 percent) suffered major complications (one total stoma loosening and three partial stoma necroses), and 30 (64 percent) had mucocutaneous affections only. There was no statistically significant correlation between enterostomy type or surgical procedure and complications, whereas the incidence of mucocutaneous complications was significantly higher following fixation with Vicryl as compared with Maxon sutures. The cause of this difference is uncertain; however, the physical configuration of the sutures, Maxon being monofile vs. Vicryl being braided, seems important. Whether the chemical structure is significant as well remains undetermined at present.

Adult↗
PubMed1992

Stimulatory effect of epidermal growth factor on liver regeneration after partial hepatectomy in rats.

The effect of epidermal growth factor (EGF) on liver regeneration was investigated in rats subjected to partial hepatectomy. In a dose-response study EGF in doses of 6 and 24 nmol/kg x day increased liver regeneration after treatment for 48 h compared with controls, whereas a dose of 48 nmol/kg x day had no effect. In a subsequent study EGF, 6 nmol/kg x day, accelerated liver regeneration significantly after 36, 48, and 72 h of treatment. A possible influence of EGF on other hepatotrophic factors was investigated. No changes in the concentration of gastrin, insulin, or glucagon was found in portal venous blood. This study has shown that EGF in small doses can stimulate liver regeneration, whereas higher doses are ineffective. The study suggests that EGF should be regarded as a hepatotrophic factor.

Animals↗
PubMed1991

Hepatic metabolism of vasoactive intestinal polypeptide during liver transplantation in the pig.

In order to investigate hepatic clearance of vasoactive intestinal polypeptide we measured its concentration in blood from the common carotid artery, right atrium and portal vein during orthotopic liver transplantation in six pigs. Just after laparotomy we found a significantly higher concentration of vasoactive intestinal polypeptide in portal plasma compared to that of the right atrium (p less than 0.05). This difference was soon eliminated by a fall in portal concentration, and, apart from fluctuations in portal concentration, no significant gradient between portal and atrial blood was recorded during the remaining part of the operation. When portal concentrations exceeded 30 pmol/l, the median reduction after transhepatic passage was 29% (range 16.8%-63.9%), while portal concentrations less than 30 pmol/l had a median reduction of only 6.3% (range 1.4%-16.5%) (p less than 0.05). No gradient between right atrial and systemic arterial blood was recorded. We suggest that a concentration-dependent clearance of splanchnic vasoactive intestinal polypeptide takes place in the porcine liver.

Animals↗