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Biomedical subjects

S Granqvist

Publications and source records attributed to S Granqvist.

At least 37 records · Page 2Linked to original sources
PubMed1991

Mixed colorectal polyps. An immunohistologic and mucin-histochemical study.

The morphology of mixed colorectal polyps was analysed. Thirteen such polyps were found out of 2700 colorectal polyps (0.5%). Histology showed a spectrum of hyperplastic crypts from almost pure goblet cell population (two polyps) to hypermature serrated epithelium with scanty goblet cells (seven polyps). Tubular adenomas occurred in 12 polyps, and a tubulovillous adenoma was found in the largest polyp. Moderate dysplasia was seen in the five large polyps. The border between neoplastic and hyperplastic cells was usually sharp. Mucin histochemistry showed similarities between the mixed polyps and colorectal carcinomas--namely, the reduction/absence of sialomucin in both mature hyperplastic crypts and adenomatous glands. The expression of carcinoembryonic antigen within the hyperplastic crypts and within the neoplastic crypts showing moderate dysplasia was similar to that seen in colorectal carcinomas, whereas it was normal within the neoplastic crypts with low-grade dysplasia. IgA was reduced or absent in both components. Blood group antigen was found only within the adenomatous component of the largest polyp showing also moderate dysplasia.

Adenoma↗
PubMed1990

Two daily subcutaneous injections of fragmin as compared with intravenous standard heparin in the treatment of deep venous thrombosis (DVT).

In a prospective, randomized, open study 119 consecutive patients with phlebographically verified deep venous thrombosis (DVT) of the leg (36% distal and 64% proximal) were treated either with a low molecular weight heparin (Fragmin, Kabi-Vitrum) subcutaneously (120 anti-FXa U/kg) twice daily or standard heparin (SH) as continuous intravenous infusion (480 IU kg-1 day-1). The Fragmin doses were adjusted to achieve an anti-FXa activity of 0.2-0.4 U/ml before injection and not greater than 1.5 U/ml 4 h after the morning injection. The SH dose was modified to prolong the APTT 2-3 times. Repeat phlebography after 5-7 days showed improvement in 34/45 patients (76%) in the Fragmin group and in 30/49 patients (61%) in the SH group and progress in 2/45 (4%) and 3/49 (6%), respectively. The mean Marder scores decreased from 18.7 +/- 12.1 to 15.7 +/- 12.7 in the Fragmin group and from 16.9 +/- 12.0 to 14.4 +/- 11.8 in the SH group (ns). Two patients in the SH group and none in the Fragmin group had major bleedings. After 22 +/- 7 months follow up 6 rethromboses had occurred in the SH group and 4 in the Fragmin group. Postthrombotic signs and symptoms were similar in both groups. We conclude that two daily sc Fragmin doses seem as effective and safe as continuous SH in the treatment of DVT of the leg.

Adult↗
PubMed1990

Diverticular disease of the colon: a risk factor for peritonitis in continuous peritoneal dialysis.

To study the possible influence of colonic diverticula on the risk of peritonitis of enteral (intestinal) origin in patients undergoing continuous peritoneal dialysis, a barium enema was carried out as a pretreatment investigation in 129 consecutive patients starting CAPD over a 9-year period. In this prospective study comprising 3103 patient months, a total of 44 (15% of all) episodes of peritonitis with micro-organisms of enteral origin occurred in 30 of the 129 patients. The estimated probability of developing such an episode was 16% and 24%, respectively, within 1 or 2 years of treatment. Diverticula (greater than or equal to 1) were found in 54 (42%) of all patients. In all cases the following factors: greater than or equal to 10 diverticula, diverticular size of greater than or equal to 10 mm and diverticula in the ascending, transverse, or descending colon, significantly increased the risk of developing peritonitis of enteral origin (P less than 0.05). Neither diverticula in the sigmoid colon nor diverticulitis, as assessed by radiological findings, were identified as risk factors. Enteral episodes (as defined in this study) appear to represent mainly microperformations of existing diverticula; such episodes should probably be regarded as and handled differently from episodes due to major perforations of the colon secondary to diverticulitis. We conclude that diverticular disease of the non-sigmoid colon is a risk factor for peritonitis in CAPD.

Adult↗
PubMed1988

Long-term follow-up of the first successful bone marrow transplantation in Gaucher disease.

A 9-year-old girl with juvenile Gaucher disease underwent splenectomy and allogeneic bone marrow transplantation. Her HLA-identical brother with normal cerebroside-beta-glucosidase activity served as donor. One month after transplantation, cerebroside-beta-glucosidase activity in the lymphocytes were normal. Plasma glucosylceramide normalized already after splenectomy and further decreased after marrow transplantation. Glucosylceramide in the erythrocytes was normal around a year after transplantation. The enlarged liver normalized in size by 2 years. Gaucher cells were still present in the bone marrow 1 year after transplantation but had completely disappeared at 3 years. The patient has grown 29 cm during the 5 years that have passed after transplantation compared to 1 cm/year during 3 years before. The patient has a slight obstructive ventilatory impairment, and chest deformities have appeared. Wechsler intelligence scale performance has slowly decreased after transplantation. This may be caused by continued neuronal storage of glucosylceramide. Otherwise, this patient is active and healthy 5 years after bone marrow transplantation.

Bone Marrow↗
PubMed1988

Clinical experiences in the administration of a low molecular weight heparin (Fragmin, Kabi-Vitrum) to healthy volunteers and in the treatment of established deep venous thrombosis.

A low molecular weight heparin (Fragmin, Kabi-Vitrum) with a mean molecular weight of 4,000-5,000 D has been investigated in healthy volunteers and in patients with DVT. We found a T 1/2 of 4 hours and a high bioavailability after subcutaneous injection in volunteers. In a randomised study, patients with phlebographically verified DVT, 120 U(anti-FXa)/kg Fragmin injected twice daily was found to be as effective as 240 U/kg, 12 h standard heparin as continuous infusion in preventing DVT progress. No major bleedings were seen in the Fragmin group. We conclude that Fragmin administered subcutaneously twice daily results in adequate anticoagulation and is safe and practical in the treatment of DVT.

Biological Availability↗
PubMed1987

A pilot study; desmopressin (DDAVP) in the treatment of deep venous thrombosis.

In a pilot study on 9 patients with acute deep venous thrombosis of the leg the fibrinolytic response and the possible thrombolytic effect of desmopressin (DDAVP), when given supplementary to standard heparin treatment, was examined. Six injections of 0.3-0.4 microgram DDAVP/kg b.w. at 12 hours intervals were given. No serious side effects were observed. The fibrinolytic variables that followed showed that plasma levels of t-PA increased significantly and most pronounced after the first injection. Rephlebography 4-7 days after hospitalization showed partial thrombolysis in 7 out of 9 patients. The phlebographic score according to Marder was reduced from 22.7 +/- 12.1 to 18.4 +/- 10.1 (p = 0.018), corresponding to a thrombus size reduction of 19%. No correlation between the level of the fibrinolytic variables measured and the degree of thrombolysis in the individual patients, could be demonstrated in this small number of patients.

Antigens↗
PubMed1986

Long-term sequelae of calf vein thrombosis treated with heparin or low-dose streptokinase.

A prospective randomized study was performed to investigate the long-term sequelae of calf vein thrombosis (CVT) and correlate them to the success of the initial treatment. Thirty-six patients with symptomatic CVT, verified by venography, were treated with heparin or low-dose streptokinase (SK) combined with low-dose heparin. Venography was repeated after 1 week, and long-term follow-up was performed clinically and with foot volumetry after an average of 5 years. Since the low-dose SK regimen led to serious hemorrhagic side-effects in a parallel study, the present investigation was discontinued prematurely. The thrombolysis achieved was greater with SK but, since the initial thrombi were somewhat larger in this group, no significant difference in the average size of the thrombi after therapy could be displayed between the groups. The long-term sequelae and results of foot volumetry were also equal. Signs or symptoms of venous insufficiency were found in 37%, and foot volumetry showed deep venous insufficiency in 26% of the cases. There was a correlation between the hemodynamic change, as assessed by foot volumetry, and the venographic severity. This relation was stronger for the size of the thrombus after treatment than for the initial size. Thus, it seems important to limit the extent of a CVT in order to minimize the long-term sequelae, but administration of SK is not justified due to side-effects.

Acute Disease↗
PubMed1986

Intravenous and subcutaneous administration of Fragmin in deep venous thrombosis.

54 patients with venographically verified deep venous thrombosis (DVT) were randomized to treatment with either intravenous infusions of 240 anti-Xa U/kg/12 h unfractionated heparin (UFH) or 240 or 120 anti-Xa U/kg/12 h of the low molecular weight heparin Fragmin. Repeated venographies showed improvement in 48% of the UFH-treated patients and 50 and 77%, respectively, in the Fragmin-treated patients. Progression was seen only in the UFH-treated patients and was observed in 11%. Two bleeding complications were seen in the Fragmin group in 2 patients receiving the very high dose of 240 anti-Xa U/kg/12 h. Anti-Xa activity in plasma and activated partial thromboplastin time (APTT) does not correlate in the Fragmin-treated patients. Fragmin was as effective as UFH in preventing the progress of thrombosis in DVT. In another study 120 anti-Xa U/kg Fragmin given subcutaneously 2 times daily to 13 patients with DVT resulted in adequate anti-Xa activity but with a tendency for accumulation of the Fragmin-induced activity. Subcutaneous injections of Fragmin 2 times daily also appears to prevent the progression of thrombosis effectively.

Adult↗
PubMed1986

Endoscopic papillotomy in the management of choledocholithiasis.

Endoscopic papillotomy was attempted in 72 patients with common bile duct stones, 47 of whom previously had been cholecystectomized and 25 with their gallbladder still present. Papillotomy was successful in 69 patients (96%) and the duct was cleared of stones in 63 (88%). Nine patients thus needed elective surgery. There was no mortality following papillotomy and no grave complication occurred. On the follow-up, from 5 months to 10 years (mean 4 years), only one of the 63 patients with successful papillotomy has required operation. Endoscopic papillotomy is effective for treating many patients with choledocholithiasis, both in those following cholecystectomy and in those with gallbladders in situ.

Adult↗
PubMed1986

Nonresectable malignant bile duct obstruction. Surgical bypass or endoprosthesis?

Forty-one patients with malignant obstructive jaundice, not amenable to radical surgery, had biliary decompression by either surgical bypass or endoscopically introduced endoprosthesis. The two treatment groups were statistically comparable with reservation for age, which was significantly lower in the operated group. Judged by the effect on bilirubin and alkaline phosphatase levels the two methods were equally efficient. Major complications were more common and initial hospital stay was significantly longer in the surgical bypass group. Neither early mortality nor survival differed between the groups. Implications of these data in the management of patients with unresectable malignancy are discussed.

Aged↗
PubMed1985

A comparison between low molecular weight heparin (KABI 2165) and standard heparin in the intravenous treatment of deep venous thrombosis.

In order to study whether a low molecular weight heparin (LMWH) of mw 4000 D is effective in the treatment of deep venous thrombosis (DVT), patients with DVT verified by phlebography were randomized to treatment by continuous intravenous infusion of either unfractionated heparin (UFH) or LMWH. The initial dose was 240 U (anti F Xa)/kg/12 h. This study (study I) was stopped because of major bleeding in 2 newly operated patients in the LMWH group after 27 patients had been treated. The heparin activity measured as F Xa inhibition assayed in retrospect, was found to be much higher in the LMWH group (mean 1.6-2.0 anti F Xa U/ml) than in the UFH group (mean 0.5-0.8 anti F Xa U/ml). A second study was therefore initiated in which the DVT patients were randomly given UFH (240 U/kg/12 h) or LMWH only 120 U (anti F Xa)/kg/12 h, as initial doses (study II). In this study 27 patients could be evaluated, the mean heparin activity still being higher in the LMWH group (0.9-1.2 anti F Xa U/ml) than in the UFH group (0.5-0.7 anti F Xa U/ml). A second phlebographic investigation showed progression of thrombus size in 3 (11%) of the UFH patients of studies I and II (n = 29) and improvement in 14 (48%). There was no progression in any LMWH patient, 6 (50%) had improved in study I and 10 (77%) in study II. The mean decrease of thrombus size score (according to Marder) during treatment did not differ between the 3 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Thrombolysis and fibrinolytic parameters during heparin treatment of deep vein thrombosis.

Thirty-nine patients with symptomatic, venographically verified deep vein thrombosis (DVT) were studied during treatment with heparin in order to investigate the correlation between the venographic changes and parameters of heparin therapy or fibrinolytic components. Venograms were scored with a 40-grade scale, and after one week a significant improvement with an average reduction of the thrombi of 17% was observed. No statistically significant correlation was found between reduction of thrombus size and duration of heparin treatment, total amount of heparin administered, mean levels of APTT, plasmin-alpha 2-antiplasmin complex (PAP), tissue plasminogen activator (t-PA) antigen or t-PA-inhibitor. Only a short history of the thrombus was significantly correlated to thrombolysis. The concentrations of PAP and t-PA-inhibitor were not influenced, while that of t-PA antigen showed a significant increase during heparin infusion. Even if statistically significant correlations were not obtained, the patients with pronounced thrombolytic effect had high PAP-levels. Furthermore, patients with high t-PA-inhibitor levels had no lysis. The results suggest, that also other factors than plasminogen dependent fibrinolysis are of importance for the thrombolytic effect.

Blood Coagulation Tests↗
PubMed1985

Guaiac tests for detection of occult faecal blood loss in patients with endoscopically verified colonic polyps.

To evaluate the sensitivity of guaiac tests for colonic polyps, two tests were made on occult blood in faeces--Hemoccult II and Fecatwin-S--from 625 and 549 patients, respectively, referred for colonoscopy. Polyps were found in 212 and 194 patients, and these had one or more tests positive in 41% (Hemoccult II) and 48% (Fecatwin-S). The incidence of positive tests was greater for polyps situated in the transverse, descending, and sigmoid colon; for polyps with a stalk, villous elements, and dysplasia; and especially for large polyps. Although size was the most important factor for the bleeding tendency, at least one third of patients with polyps over 10 mm in diameter had no positive guaiac reactions. In patients at high risk of developing polyps, therefore, these tests cannot replace, but may well be supplementary to, radiography with double-contrast technique and colonoscopy.

Adolescent↗
PubMed1984

A comparative randomized trial of low-dose versus high-dose streptokinase in deep vein thrombosis of the thigh.

Fibrinolytic treatment of acute deep vein thrombosis (DVT) of the leg with high-dose streptokinase (SK) (100,000 U/h) in 39 cases, or low-dose SK (approx 10,000 U/h) in combination with low-dose heparin in 41 cases, was studied in a prospective randomized trial. The degree of thrombolysis was similar in both groups and did not correlate with age or size of the thrombus or with fibrinogen level. The degree of late recanalization was also similar in both groups. There were however significantly more patients with postthrombotic changes in the low-dose group than in the high-dose group after a mean follow-up time of 31 and 38 months respectively. In the low-dose group 2 intracranial hemorrhages occurred (one was fatal) and one patient died of pulmonary embolism, but there were significantly less allergic side effects to SK. There were no cases of such serious side effects in the highdose group. Although low-dose SK has equal thrombolytic effect it seems inferior to high-dose SK, since it probably causes more severe hemorrhagic side-effects.

Clinical Trials as Topic↗
PubMed1981

Distribution of polyps in the large bowel in relation to age. A colonoscopic study.

In a colonoscopic study of the anatomical distribution of 600 adenomas, polyps of all sizes in patients up to 55 years old were predominantly located distally. With advancing age of the patients a successively greater proportion of at first small and then also larger polyps was found in the intermediate and proximal parts of the colon. These findings support the assumption that polyps of the gut as a rule originate in the distal part of the large bowel, only later to appear proximally. This concept is important, since it might serve to explain conflicting experience with regard to the site of colorectal tumours.

Age Factors↗
PubMed1980

Colonoscopic biopsies and cytological examination in chronic ulcerative colitis.

Both multiple colonoscopic biopsies and brushing specimens for detection of any premalignant epithelial lesion were taken in 50 patients with long-standing ulcerative colitis. In 25 of the cases centrifuge sediment of enema return before the endoscopy was examined cytologically. The three methods were compared with respect to yield of colonic epithelium and occurrence of epithelial atypia. Enema return contained only a little glandular epithelium, which showed no atypical changes. Both biopsy and brushing yielded an abundance of epithelium. Biopsies showed a considerably higher frequency of epithelial atypia, especially of mild degree, and in two cases precancerous lesions were demonstrated only in the biopsies. In seven cases, on the other hand, moderate or severe atypia was found in brushing specimens when biopsies only revealed mild reactive changes.

Adolescent↗
PubMed1980

Precancerous lesions in the mucosa in ulcerative colitis. A radiographic, endoscopic, and histopathologic study.

A series of 150 patients with ulcerative colitis, 100 of which had had the disease more than 10 years, underwent colonoscopy on at least one occasion. 4700 biopsies of the mucosa of the gut were taken and examined histopathologically. 148 of the colonoscopies were performed within 12 months of the radiographic examination of the colon. Precancerous lesions were detected in 12 patients and moderate to severe reactive inflammatory changes in 39. One of the 12 patients with precancerous lesions was found to have a carcinoma in the same region at surgery 18 months later. No further cases of carcinoma in the series have been observed at follow-up surgery. Radiography and endoscopy demonstrated a higher rate of certain features of inflammation in the parts of colon with precancerous lesions, but no particular feature could be taken to indicate the presence of such lesions. All patients with precancerous lesions had on some occasion been radiologically and/or endoscopically judged to have total colitis, compared with 75% in the whole series. Analysis of clinical data in patients with and without precancerous lesions revealed no significant difference between the groups.

Adult↗