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Biomedical subjects

R Olsson

Publications and source records attributed to R Olsson.

215 records · Page 12Linked to original sources
PubMedDate not supplied

Solid-state computerized manometry improves diagnostic yield in pharyngeal dysphagia: simultaneous videoradiography and manometry in dysphagia patients with normal barium swallows.

OBJECTIVE: Dynamic barium radiology with cine- or video recording has been the most frequently used technique for assessing patients with pharyngeal dysphagia. Although the diagnostic yield of the barium swallow has been high, many patients with pharyngeal dysphagia have normal dynamic barium radiology and remain a diagnostic dilemma. Could manometry add important diagnostic information in these patients? MATERIAL AND METHODS: We examined 19 patients (12 men and 7 women, mean age 47 years, range 19-69 years) with pharyngeal dysphagia but a normal barium swallow with simultaneous videoradiography and pharyngeal manometry and compared their manometry to that found in 24 normal volunteers (11 men and 13 women, mean age 37 years, range 23-59 years). RESULTS: Comparing mean values, the patient group showed statistically significant differences from the control group for eight of 10 manometric parameters. Fourteen of 19 patients showed at least one (five patients) and in most cases multiple (nine patients) manometric abnormalities (values exceeding normal mean by +/- 2SD) which might have contributed to their dysphagia: five patients with high upper esophageal sphincter (UES) resting pressures, five with high UES residual pressures, three with weak pharyngeal contractions, three with pharyngeal "spasms," seven with prolonged contraction/relaxation times, five with reduced compliance, and seven with UES/P incoordination. CONCLUSIONS: Solid-state computerized manometry is a useful adjunct to videoradiography and can provide potentially important additional information in the diagnosis of dysphagia patients.

Adult↗
PubMedDate not supplied

High AST/ALT ratio may indicate advanced alcoholic liver disease rather than heavy drinking.

AIMS: To assess the place of AST/ALT ratio (the ratio of serum aspartate aminotransferase to serum alanine aminotransferase) as a diagnostic marker in medical populations. METHODS: Laboratory tests were viewed retrospectively in three groups of patients: 313 patients with alcohol dependence, consecutively admitted to an alcohol and drug treatment unit for treatment of withdrawal (W) symptoms, 78 patients with alcohol abuse or dependence consecutively admitted to surgical or medical wards with various primary somatic (S) diagnoses (e.g. respiratory, gastrointestinal and metabolic), and 48 consecutive patients with alcohol abuse or dependence admitted to surgical or medical wards for treatment of alcohol-related liver cirrhosis and its complications (C). Comparison between groups was made of the pattern of patients' AST/ALT ratios using, for Groups S and C, laboratory data from patients' first admission for their condition. RESULTS: There was a significant rise in the AST/ALT ratio from the W to the S patients, and from the S to the C patients. In the W group, the ratio was < or = 1.0 in 64% of the patients, and only exceptionally > or = 2. In the C group, 69% had a ratio > or = 2, and 8% a ratio < or = 1.0. The mean ratio was midway in the S group. In the C group, there was a progressive decline in aspartate (AST/ALT) ratios after admission. CONCLUSIONS: Most patients with high alcohol consumption but without severe liver disease do not have an AST/ALT ratio above 1. High AST/ALT ratio suggests advanced alcoholic liver disease.

Adult↗
PubMedDate not supplied

Pharmacokinetics of metoprolol in patients with hepatic cirrhosis.

The selective beta 1-adrenoceptor antagonist metoprolol is eliminated primarily by hepatic metabolism and usually less than 5% of an oral dose is excreted unchanged in the urine. The effects of impaired liver function on the pharmacokinetics of metoprolol were studied in 10 patients with hepatic cirrhosis. All subjects were given single doses of 20mg intravenously and 50mg orally on separate days. The mean fraction of the drug available systematically was 84 +/- 10% in patients and 50 +/- 11% in a control group of 6 healthy subjects (p less than 0.05). The total body clearance of metoprolol in the cirrhotics was 0.61 +/- 0.13L/min and in the controls 0.80 +/- 0.11L/min. These values correspond to elimination half-lives of 7.2 +/- 1.2 and 4.2 +/- 1.1 hours, respectively. The differences were not statistically significant. Impaired liver function had no effect on the volume of distribution of metoprolol. Total clearance was weakly but linearly related to galactose clearance (r2 = 0.52; p less than 0.05), and the half-life was related to serum bilirubin (r2 = 0.74; p less than 0.01).

Administration, Oral↗
PubMedDate not supplied

Spontaneous course of symptoms in primary sclerosing cholangitis: relationships with biochemical and histological features.

An analysis was made of the symptom diaries of 65 patients with primary sclerosing cholangitis (PSC) who recorded their symptoms of itching, pain and fever during a 3 year period. Symptoms occurred in 84% of the patients, with considerable individual variations in symptom load. Symptoms were usually intermittent. "Itching only" and "pain only" were the most frequent episode features. Most episodes lasted only 1-2 days. Fever seemed to be the most embarrassing symptom. Apart from close correlations between pruritus and serum ALP levels, there were no significant correlations between the symptom load and serum biochemistry or eleven different histological features. Even daily symptoms over a period of several months could disappear spontaneously. We conclude that most symptom episodes in PSC are mono-symptomatic and brief. Biochemical or histological data do not predict the appearance of symptoms.

Alanine Transaminase↗
PubMedDate not supplied

Metronidazol as a probable cause of severe liver injury.

Metronidazol, a commonly used antibiotic drug, has been very rarely associated with hepatotoxicity. In particular, no reports have appeared in the literature about cases of metronidazol-associated severe hepatotoxicity, leading to liver transplantation or death. We report on a case of acute fulminant liver failure in a young woman, who had, two years previously, developed jaundice after intake of metronidazol. During the current hospitalization, metronidazol treatment had been undertaken two weeks previously and also this time the patient developed severe hepatocellular injury and cholestasis. A viral etiology was ruled out as well as vascular, metabolic and malignant etiology. Although, the cause of the liver injury in this case is not proven, the relationship between this drug and two occasions of severe liver damage, suggests a positive challenge as well as rechallenge. An International algorithm was used for the assessment of the causality of a drug in this case of acute liver injury and a "probable" classification was obtained.

Adult↗
PubMedDate not supplied

Small bowel barium examination in children. Diagnostic accuracy and clinical value as evaluated from 331 enteroclysis and follow-through examinations.

The indications for small bowel barium examination, the radiologic findings, and the clinical outcome were compared retrospectively in 331 children, aged 0 to 15 years. Sixty examinations (18%) were pathologic, which is in accordance with adult materials. The most common indications for referral were inflammatory bowel disease (48%) and small bowel obstruction (25%). The examinations were positive in 19 per cent and 17 per cent, respectively. Indications for referring patients with non-specific symptoms led to a low frequency of pathologic findings. A therapeutic or diagnostic procedure was performed in 38 of the 60 pathologic radiologic examinations (63%). In 18 patients (30%) a pathologic finding caused no change in therapy. No consistent difference in sensitivity, specificity or predictive values of a positive or negative result was found concerning enteroclysis or elective follow-through examination. For screening purposes of the small bowel in children follow-through examinations give adequate radiologic information and should be used instead of enteroclysis.

Adolescent↗