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Biomedical subjects

S Fasth

Publications and source records attributed to S Fasth.

At least 73 records · Page 4Linked to original sources
PubMed1983

Zinc depletion after small-bowel resections for Crohn's disease.

The serum concentration and the 24-h urinary excretion of zinc was studied in 87 consecutive out-patients with distal small-bowel resections (mean 104 cm) because of Crohn's disease. Muscle zinc concentration was determined in 55 of the patients. The 24-h urinary excretion decreased with increasing resection length. It was abnormally low in 13 per cent of the patients with resections shorter than 100 cm and in 44 per cent of the patients with major resections. Compared to healthy controls the concentration of zinc in fat-free dry muscle was significantly lower both in patients with moderate and extensive resections. The muscle zinc concentration was below normal in one-third of the patients with a distal small-bowel resection exceeding 100 cm. The concentration of zinc in serum was below normal range in 34 per cent and did not correlate to the zinc content in muscle.

Adult↗
PubMed1982

Autosuture of low colorectal anastomosis.

The safety of low colorectal anastomosis constructed with autosuture technique (U.S. EEA-stapling device, USSC) and the functional results were assessed in consecutive series of patients operated upon for rectal carcinoma. The operative procedure was greatly facilitated and certainly, many of the patients would otherwise have been subjected to abdominoperineal resection with permanent colostomy. Clinical leaks were observed in 4 of the 25 patients (16%) and another 4 patients were shown to have subclinical leaks, as demonstrated by endoscopy and/or X-ray. The total incidence of leaks was therefore 32% (8/25). Even when constructed with the autosuture technique a low anastomosis should probably be protected by a proximal enterostomy. There was a general tendency to anastomic narrowing during the initial period but in most patients stenosis disappeared with time after closure of the enterostomy. Frequent endoscopic examinations and dilatation of the anastomosis during the early postoperative period may be advantageous. The immediate functional results were unsatisfactory with increased frequency and varying grades of incontinence. Although these disturbances improved with time the results at six months after surgery were still not satisfactory and for confidence many patients wore a pad.

Aged↗
PubMed1981

Loop ileostomy for protection of the newly constructed ileostomy reservoir.

Sixteen patients submitted to reservoir ileostomy were at the same time given a proximal loop ileostomy to defunction the reservoir for 2-3 months. All made smooth recoveries in the immediate postoperative period both before and after the closure of the loop ileostomy. During follow-up of at least 12 months the function of the reservoir ileostomy has been excellent except in one patient who developed dysfunction of the nipple valve requiring reoperation. On the basis of this experience, it is suggested that a temporary defunction loop ileostomy is a wise precaution in connection with reservoir ileostomy, which may lessen the incidence of complications and reduce the risks of later valve extrusion.

Adult↗
PubMed1981

Adverse reactions to intravenous administration of fusidic acid.

To study adverse reactions associated with intravenous administration of fusidic acid 6 patients were treated with fusidic acid intravenously in association with a major large bowl operation, and 9 patients were treated in the same way because of staphylococcal infections. The main adverse reaction was thrombophlebitis, which occurred in as many as 12 of 14 patients who were treated for 2 days or longer. Three surgical patients developed postoperative hyperbilirubinaemia, but studies of liver function before and during treatment in 6 of the patients with staphylococcal disease revealed no adverse liver reactions. Intravenous administration of fusidic acid into a peripheral vein for 24 h or more involves an extremely high risk of developing thrombophlebitis.

Adult↗
PubMed1981

Studies on the atropine-resistant sacral parasympathetic vascular and motility responses in the cat colon.

1. Pelvic nerve stimulation in atropinized cats elicits a sustained contraction of the proximal colon and a relaxation of the rectum. Concomitantly there is an immediate but transient vasodilatation which is followed by recurrent increases and a slight post-stimulatory hyperaemia. Direct stimulation of the pelvic nerve produces secretion of colonic kallikrein and activation of the plasma kinin system. The present study examines whether Trasylol, which inhibits the kinin system, affects the atropine-resistant responses observed on pelvic nerve stimulation. 2. After I.V. or close I.A. administration of Trasylol, the initial vasodilatation on pelvic nerve stimulation was markedly reduced and in a few experiments completely blocked. The recurrent blood flow increases and the post-stimulatory hyperaemia observed on prolonged stimulation were completely abolished. In contrast the proximal colonic contraction and the rectal relaxation appeared unchanged after Trasylol. 3. The reactivity of the vascular bed after Trasylol injection was studied by recording the changes of vascular resistance following sympathetic vasoconstrictor fibre activation and infusion of bradykinin before and after Trasylol injection. The responses were quantitatively unchanged excluding an unspecific interference with nervous transmission or vascular smooth muscle reactivity. 4. The results show that the atropine-resistant vasodilatation in the cat colon as elicited by pelvic nerve stimulation is partly abolished by a kallikrein inhibitor. This observation lends further support to the hypothesis that kinins might be involved in this response. The motor response, however, appears not be dependent on such a mechanism.

Animals↗
PubMed1981

Effects of regional vasopressin infusion of intestinal series-coupled vascular sections.

The effects induced by infusion of vasopressin into the superior mesenteric artery on the small intestinal series-coupled vascular sections were studied in cats and compared to those evoked by stimulation of the regional sympathetic nerves. The doses used were similar to those recommended for clinical purposes. Vasopressin induced an increase in intestinal resistance to blood flow, which at higher doses was biphasic with an initial pronounced effect followed after a few min by a less marked steady state response. Vasopressin induced no effect on the intestinal capillary filtration coefficient, did not change the isovolumetric equilibrium and evoked only a minor decrease in regional blood volume. When compared with sympathetic nerve stimulation the latter induced a less marked steady state increase in intestinal blood flow resistance but a more pronounced decrease in regional blood volume and a decrease in capillary filtration coefficient. The effects following vasopressin infusion were in the doses used not that pronounced that they could be considered potentially harmful for the small intestinal tissue.

Animals↗
PubMed1981

Vascular responses of small intestine and liver to regional infusion of vasopressin.

The vascular responses of the small intestine and liver to regional infusion of vasopressin were measured continuously and synchronously in anaesthetized cats. When infused into the superior mesenteric artery there was a marked initial blood flow reduction (peak response) followed by a sustained but moderately reduced flow (steady state). Corresponding to the peak response the portal pressure fell significantly. This reduction was only transient, however. Vasopressin infused into the hepatic artery caused if anything only a shortlasting decrease of hepatic flow. Concomitantly there was also a transient decrease of portal pressure. The findings indicate that continuous regional infusion of vasopressin causes a considerable reduction of intestinal blood flow without interfering with hepatic arterial circulation.

Animals↗
PubMed1980

Adjustments of hepatic and small intestine blood flow on selective vasoconstrictor fibre stimulation.

The mutual changes in hepatic and small intestinal blood flow on selective nervous stimulation of the periarterial vasoconstriction fibres, were studied in anaesthetized cats. Occlusion of the hepatic artery did not change portal blood flow, whereas occlusion of superior mesenteric blood flow caused a significant increase in hepatic arterial flow. Stimulation of the hepatic sympathetic nervous supply caused a phasic blood flow response with a marked transient peak flow reduction of hepatic arterial blood flow. The magnitude of the peak response varied with the frequency of the stimulation. Despite continuous stimulation the first phase went over into a second phase of less pronounced vasoconstriction. This "steady state" blood flow, was maintained at about 20% below the control level, irrespective of stimulation frequency. Corresponding in time with the peak vasoconstriction there was a transient increase of portal pressure. Sympathetic nerve stimulation increased portal pressure even on occlusion of the hepatic artery. Stimulation of the mesenteric sympathetic nerves evoked the characteristic transient peak vasoconstrictor response consisting of two phases, a brief intense peak resistance response followed by a second phase of less pronounced but generally well maintained constriction. Simultaneously a slight reduction of portal pressure and hepatic arterial vascular resistance was regularly seen. In contrast to the observations in the hepatic arterial circuit the magnitude of this "steady state" blood flow in the small intestine was dependent on the rate of the stimulation, however. On simultaneous stimulation of the hepatic and mesenteric sympathetic nerves the hemodynamic responses were largely the same as when these nerves were stimulated separately. The portal pressure affecting mean capillary pressure in the intestine differed, however. Small and variable pressure changes were followed by rapid return towards control and during steady state it did not differ from the prestimulatory level.

Adrenergic Fibers↗
PubMed1980

Evidence for a dual pelvic nerve influence on large bowel motility in the cat.

1. The effects of efferent electric pelvic nerve stimulation on colorectal motility and blood flow with emphasis on the motor responses in consecutive colonic and rectal segments were studied in anaesthetized cats. It was considered of particular interest to explore whether selective pharmacological blockade and graded nerve stimulations might reveal the presence of functionally differentiated efferent fibres controlling colonic motility.2. Pelvic nerve stimulation induced immediate and sustained colorectal contractions and a simultaneous increase of the over-all colonic blood flow. The excitatory responses declined immediately on cessation of a shortlasting stimulation (< 2 min); after a longlasting one, however, the rectal contraction was maintained for several min.3. The colonic contraction on pelvic nerve stimulation remained unchanged after atropine but was delayed in onset. Moreover, in the transverse and distal colon it was preceded by a relaxation which was most pronounced in the distal part. The vasodilator response was unchanged.4. After atropine the rectal segment showed a purely relaxatory response. Despite continuous pelvic nerve stimulation the relaxation vanished, however, and rectal volume returned to resting level with 3-5 min. On cessation of such a prolonged stimulation there was a marked rectal ;after-contraction'.5. The excitation thresholds for the efferent nerve fibres eliciting these different responses could not be separated. The motility and the vasodilator responses were not influenced by adrenergic or by serotoninergic blockade.6. The results indicate that direct preganglionic stimulation of the cat pelvic nerves activates intramural cholinergic excitatory neurones as well as non-cholinergic excitatory neurones and furthermore, non-adrenergic non-cholinergic inhibitory neurones, which together result in most complex colonic and rectal motor responses. From a functional point of view these centrally controlled responses may well be independently controlled by separate preganglionic neurones though they do not differ concerning excitation thresholds.7. The effects are consistent with a dual function of the distal colon and rectum. Such a dual parasympathetic influence on the large bowel simulates the vagal control of the stomach, where specific vagal relaxatory fibres convey a reflex widening of the corpus-fundus reservoir during food intake.

Animals↗
PubMed1980

Early complications after surgical treatment for Crohn's disease with particular reference to factors affecting their development.

Early postoperative mortality and morbidity and factors that might be of importance in this respect were studied in a series of consecutive patients resected for classical Crohn's disease (IPI) or mainly colonic disease (CPC). The operative mortality was comparatively low after surgery for both primary and recurrent disease (1.5 and 2.0% respectively). The complication rate was marked, particularly so after primary surgery for colonic disease. Weight loss, abnormally low serum albumin or TIBC referred to as nutritional markers, appeared to have no predictive value in determining patients at risk for postoperative complications. Steroid treatment prior to operation was not associated with increased postoperative complication rate. The important factor influencing postoperative complication rate was the occurrence of preoperative septic complications and surgery performed for urgency was associated with an increased complication rate only when associated with pre-existing septic complications. The observations would appear to speak in favour of surgery at an earlier stage in patients with Crohn's disease who do not respond to medical treatment.

Crohn Disease↗
PubMed1980

Loop ileostomy--an attractive alternative to a temporary transverse colostomy.

Right-sided transverse colostomy and loop ileostomy when temporary used for protecting a new-constructed colorectal anastomosis were compared in two matched series of patients. The relative safety of the methods as expressed in complication rate on construction and subsequent closure and any difficulties associated with stoma care were assessed. The results indicate that a loop ileostomy, when properly constructed is well born even in elderly patients and is followed by a remarkably swift convalescence. Construction and closure appeared not to be associated with more difficulties or complications than transverse colostomy. As far as stoma care is concerned, transverse colostomy offered, if anything, more difficulties than the loop ileostomy. With modern appliances a loop ileostomy presents no more problems than a well-established conventional end ileostomy, and since a loop ileostomy is a more reliable defunctioning stoma than the transverse colostomy, it should probably be preferred when the primary purpose is to protect a colorectal anastomosis.

Aged↗
PubMed1979

Faecal excretion of intravenously injected 14C-cholic acid in patients with conventional ileostomy and in patients with continent ileostomy reservoir.

Bile salt absorption, as determined by the faecal excretion in i.v. injected 14C-cholic acid (FBS) was studied in 13 ileostomy patients before and after conversion to Kock's continent ileostomy reservoir. The result was compared with that obtained in 8 ileostomy patients in whom about 50 cm of the terminal ileum has also been removed. As compared with 16 healthy controls, FBS was moderately increased in the conventional ileostomy patients, but still within normal limits. After conversion to ileostomy reservoir all patients had pathological FBS, although less severe than in the ileostomy patients with ileal resection. Bacterial contamination probably contributes more than the structural mucosal changes to the bile malabsorption in the pouch, whereas reduced mucosal surface and short small-intestinal transit time are the main causes of malabsorption in ileostomy patients in whom an appreciable amount of the terminal ileum has been resected.

Adult↗
PubMed1978

Mobilization of colonic kallikrein following pelvic nerve stimulation in the atropinized cat.

1. Pelvic nerve stimulation (p.n.s.) in cats induces atropine-resistant colonic vasodilatation and colonic contraction. The effects of this on cat colon are mimicked by synthetic bradykinin infusions. The present study examines the effect of p.n.s. on the activation of kallikrein, the kinin-forming enzyme present in colonic tissue and its effects on the plasma kinin system in the atropinized cat.2. Mean level (+/- S.D.) of mucosal kallikrein was found to be about 37 times higher in unstimulated colonic mucosa (300 +/- 100 ng bradykinin equivalents min(-1)g(-1)) than in the underlying muscle (8.2 +/- 6.3 ng bradykinin equiv min(-1)g(-1)).3. After a p.n.s. of 5 min, mean kallikrein level in colonic muscle was 7.3 +/- 3.5 ng bradykinin equiv min(-1)g(-1), which was not significantly different from the control muscle kallikrein. However, there was an 86% fall in mucosal kallikrein to 41.3 +/- 34.7 ng bradykinin equiv min(-1)g(-1) after 5 min p.n.s., indicating a rapid activation and secretion of mucosal kallikrein.4. Secretion of mucosal kallikrein was paralleled by specific depletion of plasma kininogen, the precursor of active kinin in blood draining the colon. The mean plasma kininogen level fell to 79 and 68% of the prestimulated value (3.1 +/- 1.1 S.D. mug bradykinin equiv per ml. plasma) after 5 and 10 min p.n.s. respectively. Total plasma protein and haematocrit remained unaltered excluding non-specific changes due to protein extravasation or haemodilution and indicating utilization of the plasma kinin precursor.5. Following 2 hr p.n.s., raised levels of kallikrein were detected in both colonic muscle (28 +/- 2.0 bradykinin equiv min(-1)g(-1)) and mucosa 434 +/- 118 ng bradykinin equiv min(-1)g(-1)). Preliminary studies using a kallikrein inhibitor indicated that the increased kallikrein levels originated from plasma.6. Direct stimulation of the parasympathetic pelvic nerve in the atropinized cat thus produced activation of the plasma kinin system in the colon and formation of free kinins may be responsible for the mucosal vasodilatation and strong motor contraction which is not blocked by large doses of atropine. The observation that prolonged stimulation causes extravasation of plasma kallikrein, a potential inflammatory mediator, into the tissues may be of clinical significance.

Animals↗
PubMed1978

Intramural oesophageal cyst with massive mediastinal bleeding. A case report.

Intramural oesophageal cysts lined by ciliated columnar epithelium are considered to be lesions which are not prone to serious complications except infection. In contrast to this view, a case of intramural oesophageal cyst recently operated upon by us, in which severe mediastinal bleeding developed, is described.

Adult↗
PubMed1978

Sexual dysfunction following proctocolectomy.

122 patients, 66 men and 56 women, operated upon by proctocolectomy were interviewed by means of a detailed questionaire regarding any significant change in sexual function. In the majority of the patients (70% of the men and 87% of the women) the sexual relationships were considered to be unchanged or even enhanced. Impaired function was reported by 19 men (29%) and seven women (12%). Male sexual dysfunction consisted of impotence and abolition of ejaculation. True impotence occurred in five men, all above 40 years of age, corresponding to an incidence of 25%. Loss of ejaculation occurred even in young people (about 7%) but was more common in elderly patients (15%). Female dysfunction consisted of dyspareunia and/or inability to achieve orgasm. On the basis of the present results it appears unlikely that impotence is caused by the operative trauma per se. On the other hand loss of ejaculation is probably due to injury of the presacral nerves. Postoperative impotence might probably be improved by medical information and encouragement. Particular precautions during operation might reduce ejaculatory disorders. Careful handling and proper treatment of the perineal wound might prevent scarring and stricture of the posterior aspect of the vulva, a condition that appears to be a common cause of dyspareunia.

Adult↗
PubMed1978

Blood pressure changes in the marginal artery of the colon following occlusion of the inferior mesenteric artery.

The perfusion pressure in the marginal artery of the descending colon was measured continuously at laparotomy in eight patients and the effect of sudden occlusion of the inferior mesenteric artery recorded. Three patients with ulcerative colitis, all in their early 30s, and five elderly patients with colonic or rectal carcinoma were studied. In all patients occlusion caused an initial and marked pressure drop, which remained reduced at a critically low level in two of the elderly patients. Such a reduction in perfusion pressure is probably still insufficient to interfere with the nourishment of the terminal part of the colon provided that the systemic pressure is kept at a normal level. However, since in many patients there is a sharp drop in systemic blood pressure during the recovery phase after surgery, it appears likely that the perfusion pressure in the marginal artery may in those cases be insufficient to maintain an adequate blood flow to the colon despite the inherent tendency of "auto-regulation" in this vascular bed. The results of the present study indicate that, contrary to previous belief, ligation of the inferior mesenteric artery may increase the risk of ischaemia in the terminal part of the descending colon, leading to anastomotic dehiscence after anterior resection, or sloughing after a "pull-through" operation. This complication could probably be prevented by a more generous resection of the sigmoid and descending colon, thus reducing the length of the anastomosis formed by the arc of Riolan and by careful maintenance of an adequate blood pressure during the recovery phase.

Adult↗