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Biomedical subjects

S Nordgren

Publications and source records attributed to S Nordgren.

At least 37 records · Page 2Linked to original sources
PubMed1997

Neuropeptides in idiopathic chronic constipation (slow transit constipation).

Tissue specimens from the large bowel of 18 patients with long-standing slow transit constipation were investigated to determine the distribution and density of several neuropeptides and amines in the enteric nerve system, and also of endocrine cells in comparison to normal individuals. CGRP (calcitonin gene-related peptide), galanin, glucagon, GRP (gastrin-releasing peptide), metenkephalin, motilin, neuropeptide Y (NPY), PACAP, peptide YY (PYY), serotonin, somatostatin, substance P and VIP were studied by immunohistochemistry. Tissue concentrations of VIP, substance P and galanin were also measured by radioimmunoassay. Significantly increased VIP, SP and galanin contents were found in specimens from the ascending colon. Levels of VIP and galanin were also increased in the transverse colon. Immunohistochemistry revealed only marginal changes with an increased density of PACAP nerve fibres in the smooth muscle and of VIP and PACAP nerves in the myenteric plexus of the transverse colon. In the descending colon substance P and NPY immunoreactivity were also increased in the myenteric plexus while the density of VIP nerve fibres was reduced in the mucosa/submucosa. The frequency of PYY-containing cells and the 5-HT-containing cells in the ascending colon was significantly increased in the constipated patients.

Adult↗
PubMed1997

Low-dose recombinant human growth hormone increases body weight and lean body mass in patients with short bowel syndrome.

OBJECTIVE: The authors investigate the effects of low dose recombinant human growth hormone (rhGH) on body composition and absorptive capacity in patients with short bowel syndrome from Crohn's disease. SUMMARY BACKGROUND DATA: Patients with short bowel syndrome usually are malnourished because of malabsorption. The anabolic effects of high doses of rhGH have been tested in different clinical catabolic conditions, recently including patients with short bowel syndrome. The authors have investigated the effects of low-dose rhGH in short bowel syndrome in a placebo-controlled crossover clinical trial. METHODS: Ten patients were treated with daily subcutaneous doses of rhGH/placebo (0.5 international units/kg-1 per week-1 = 0.024 mg/kg-1 per day-1) for 8 weeks in a randomized, double-blind, placebo-controlled crossover clinical trial with a minimum of 12 weeks wash-out. Absorptive capacity and biochemical parameters were investigated in a metabolic ward before treatment and during first and last week of treatment. Body composition was determined by DEXA-Scan (Lunar DPX, Scanexport Medical, Helsingborg, Sweden), impedance analysis, and whole body potassium counting. RESULTS: Low-dose rhGH doubled serum levels of insulin-like growth factor-1 (IGF-1) and increased body weight, lean body mass, and total body potassium by 5% (p < 0.05). Fat-free mass and total body water increased by 6% (p = 0.008). Increases in IGF-1 levels correlated with increases in fat-free mass (r = 0.77, p < 0.02). No significant changes in absorptive capacity of water, energy, or protein were detected. CONCLUSION: Eight weeks of low-dose rhGH treatment leads to increases in body weight, lean body mass, and fat-free mass in patients with short bowel syndrome, correlated to increases in IGF-1 levels.

Adult↗
PubMed1997

Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery.

INTRODUCTION: This randomized controlled study evaluated the clinical benefit and physiological effects of prophylactic chest physiotherapy in open major abdominal surgery. METHODS: A group of 174 patients received chest physiotherapy including breathing with pursed lips, huffing and coughing, and information about the importance of early mobilization. In addition high-risk patients were given resistance training on inspiration and expiration with a mask. The resistance used during inspiration was -5 cmH2O and that during expiration +10 cmH2O. The control group (194 patients) received no information or treatment unless a pulmonary complication occurred. RESULTS: Oxygen saturation on postoperative days 1-3 was significantly greater in the treatment group. Treated patients were mobilized significantly earlier. No difference was noted in peak expiratory flow rate or forced vital capacity. Postoperative pulmonary complications occurred in 6 per cent of patients in the treatment group and in 27 per cent of controls (P < 0.001). In high-risk patients the numbers with pulmonary complications were six of 40 and 20 of 39 respectively. Pulmonary complications were particularly common in patients with morbid obesity. CONCLUSION: Preoperative chest physiotherapy reduced the incidence of postoperative pulmonary complications and improved mobilization and oxygen saturation after major abdominal surgery.

Abdomen↗
PubMed1996

The effect of pelvic nerve stimulation on recto-anal motility in the cat.

Rectal and anal motility responses to pharmacological manipulation of neuro-transmission and graded efferent electrical pelvic nerve stimulation were investigated in alpha-1-chloralose anaesthetized cats. N omega-nitro-L-arginine (L-NNA), a competitive inhibitor of nitric oxide synthase, did not influence spontaneous rectal and anal motility. No significant change in anal pressure or rectal tone was observed after sectioning the pelvic nerves in animals pretreated with L-NNA. The effect of pelvic nerve stimulation on anal tone was varying and depended upon the intensity of stimulation and the prevailing anal tone. A reduction of anal tone on pelvic nerve stimulation was consistently converted to an increase of anal tone after pretreatment with L-NNA. The rectal response to pelvic nerve stimulation was unchanged by L-NNA. Residual increase of anal tone observed on pelvic nerve stimulation after L-NNA and noradrenergic blockade was partly sensitive to hexamethonium and abolished by atropine. The results suggest that there is no tonic influence on rectal and anal motility via nitric oxide mechanisms. On the other hand, the reduction of anal tone on high intensity pelvic nerve stimulation seemed to be dependent on the release of nitric oxide. An excitatory cholinergic component of the smooth muscle contractility of the feline anal canal, partly sensitive to hexamethonium, was demonstrated to be conveyed in the pelvic nerves.

Adrenergic Antagonists↗
PubMed1996

The role of nitric oxide in the acetylcholine-induced relaxation of the feline internal anal sphincter, in vitro.

BACKGROUND: The relaxatory effect of acetylcholine was investigated on the feline internal anal sphincter (IAS), in vitro. RESULTS: Acetylcholine (10, 30, 100, and 1000 microM) caused a concentration-dependent relaxation of the same magnitude in strips from the proximal and distal IAS. The antagonist of nitric oxide synthase, N omega-nitro-L-arginine (L-NNA; 1, 10, and 100 microM), in a concentration-dependent and stereospecific manner, blocked the acetylcholine-induced relaxation, leaving a residual response of 10-30%. The blocking effect of L-NNA (100 microM) could not be shown in tissues that had been incubated with the substrate for nitric oxide synthase, L-arginine (1 mM). CONCLUSIONS: The present results suggest that the acetylcholine-induced relaxation of the IAS to a major extent is due to an activation of nitrergic, inhibitory motor neurons to the IAS.

Acetylcholine↗
PubMed1995

Reflex interaction from the urinary bladder and the rectum on anal motility in the cat.

The intrinsic recto-anal inhibitory reflex (RAIR) and the extrinsic vesico-anal excitatory reflex were studied in anaesthetized cats in order to explore the nervous components of anal pressure regulation. The magnitude of the RAIR was documented at varying levels of anal pressure. Minimal anal pressure during RAIR was positively correlated to anal pressure immediately prior to rectal distension. It was possible to elicit the vesico-anal excitatory reflex concomitantly with an ongoing RAIR. It was also possible to elicit a RAIR during the vesico-anal excitatory reflex. The magnitude of the pressor reflex response was not changed by concomitant activation of the inhibitory reflex and vice versa. This suggests an independent action on the internal anal sphincter (IAS) of the two reflexes. Spontaneous detrusor contractions were abolished by rectal distension. However, an escape phenomenon from this inhibition was observed, suggesting a spinal, associative, connection. The results support the concept of a direct action of both extrinsic and intrinsic nervous mechanisms on the smooth muscle of the IAS.

Anal Canal↗
PubMed1995

Exercise capacity in patients undergoing proctocolectomy and small bowel resection for Crohn's disease.

The effect of proctocolectomy and small bowel resection on working capacity has not been assessed objectively in previous research. Twenty-nine patients with Crohn's disease were investigated with cycle ergometry and a questionnaire, following proctocolectomy with and without small bowel resection. Maximal exercise load is known to correspond well with working capacity, particularly when account is taken of body composition and metabolic variables. Maximal exercise load was reduced marginally (by 9 per cent) in patients without small bowel resection and by 22 per cent in patients with moderate small bowel resection (15-30 per cent resection). Patients with extensive bowel resection (more than 50 per cent) had a 40 per cent reduction in the maximal exercise load. This reduction in maximal exercise load was greater than predicted when accounting for reduction in muscle mass. All patients had a normal oxygen uptake including resting energy expenditure. Urinary sodium and magnesium excretion was low in the group with moderate bowel resection, whereas the extensively resected patients were malnourished and had a reduced body cell mass. The authors conclude that the significantly reduced working capacity was of multifactorial origin secondary to malabsorption. However, the patients seemed unaware of the degree of their diminished working capacity. This reduced capacity makes it unlikely that they would be able to perform any labour involving high energy consumption at the level of 500-700 W, and this inability was reflected by a high rate of unemployment among the patients.

Adult↗
PubMed1995

Adhesins of Escherichia coli associated with extra-intestinal pathogenicity confer binding to colonic epithelial cells.

Escherichia coli adhesins are virulence factors in intestinal and extra-intestinal infections, but their role in normal intestinal colonization has not been defined. We investigated the intestinal adherence of E. coli with Dr hemagglutinin, S fimbriae, CFA/I or CFA/II, using freshly isolated ileal or colonic enterocytes and cells from the human colonic cell line HT-29. E. coli with S-fimbrial adhesins (Sfa I or Sfa II), P or type 1 fimbriae, adhered in a non-polarized manner, and in similar numbers to colonic and ileal enterocytes. S fimbriae of the variety Sfa II (originating from a meningitis isolate), mediated a stronger binding than Sfa I (of uropathogenic origin). Strains expressing Dr hemagglutinin adhered preferentially to the brush borders, slightly better to colonic than ileal enterocytes. Strains expressing CFA/I or II adhered to colonic and ileal enterocytes, although brush border adherence was predominantly observed with ileal cells. Binding to HT-29 cells paralleled binding to colonic enterocytes for all adhesin specificities except CFA/I. The results suggest that Dr hemagglutinin, P-, type 1- and S-fimbrial adhesins mediate binding to both colonic and ileal enterocytes. These specificities may contribute to the establishment of E. coli in the intestinal microflora, which precedes their spread to extra-intestinal sites.

Adhesins, Escherichia coli↗
PubMed1995

Anal and rectal motility responses to distension of the urinary bladder in man.

Recto-anal motility response to bladder distension was studied under general anaesthesia in 12 patients undergoing intestinal resection for Crohn's disease of the small intestine or colonic cancer. The effect of epidural anaesthesia on anal tone and on the motility response to bladder distension was studied in six of these patients. An anal pressure increase on bladder distension was observed in all individuals. No motility response was noted in the rectum. The anal pressure response to bladder distension was abolished by epidural anaesthesia. It was concluded that anal pressure in man under general anaesthesia was tonically influenced by the thoracolumbar sympathetic outflow. An excitatory vesico-anal reflex was demonstrated. It appears as this reflex is mediated via the spinal cord.

Adult↗
PubMed1994

Abdominal rectopexy for rectal prolapse. Influence of surgical technique on functional outcome.

PURPOSE: The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex mesh abdominal rectopexy. METHODS: The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment were performed before and at 3, 6, and 12 months after operation. RESULTS: Improvement of continence was similar. Bowel regulation problems which were unchanged after the Ripstein procedure increased significantly after the Wells procedure (P < 0.01). Rectal volume became reduced in the group who received the Wells procedure (225 ml vs. 115 ml, P < 0.05 at one year), but remained unchanged after receiving the Ripstein procedure. The pressure thresholds required to elicit sensation of rectal filling and defecation urge were increased after the Wells procedure (15 cm of H2O vs. 25 cm of H2O, P < 0.05 and 25 cm of H2O vs. 45 cm of H2O, P < 0.05, respectively). In the Ripstein group there was only a slight increase of the threshold for urge (P < 0.05). CONCLUSION: The Wells procedure was followed by severe rectal dysfunction accompanied by increased constipation and evacuation problems. The Ripstein procedure, preserving the lateral ligaments, appears not to affect such symptoms adversely. On the other hand, improvement is not likely to occur.

Defecation↗
PubMed1994

Loperamide improves anal sphincter function and continence after restorative proctocolectomy.

The physiological and clinical effects of loperamide treatment versus placebo were investigated in a randomized, double-blind, crossover study in patients operated with restorative proctocolectomy. Sixteen patients operated with endoanal mucosectomy and a handsewn ileal pouch-anal anastomosis and 14 patients operated with abdominal proctocolectomy and stapling of the pouch to the top of the anal canal were studied. While loperamide treatment increased resting anal pressure in both groups of patients by approximately 20% (P < 0.05), squeeze pressure was not affected. Loperamide did not affect pouch volume or contractility. Sensory thresholds and the recto/pouch-anal inhibitory reflex were not influenced by loperamide treatment. Clinical function was improved, with a reduced bowel frequency and an improved nighttime continence, with less soiling (P < 0.05) as well as need to wear a protective pad.

Adult↗
PubMed1994

Anal and rectal motility responses to distension of the urinary bladder in the cat.

The neural pathways and possible transmission mechanisms of the integrated autonomic nervous control of the urinary bladder and anorectum, were investigated in chloralose anaesthetized cats. Bladder distension and spontaneous detrusor contractions increased internal anal sphincter-tone, a response which was blocked by an alpha-adrenoceptor antagonist. Moreover, a nicotinic transmission step was present. Both the afferent and efferent limbs of the reflex were conveyed in the postganglionic hypogastric nerves and the preganglionic lumbar splanchnic nerves. Intact connection with the central nervous system was therefore essential. Contrasting to the specific reflex response in the internal anal sphincter, bladder distension also elicited a nociceptive vaso-pressor response. Rectal motility appeared to be unaffected by bladder distension.

Adrenal Glands↗
PubMed1994

Early diagnosis of colorectal cancer.

It is reasonable to suggest that survival in colorectal cancer is closely linked to the anatomical stage of the tumour, implying that detection and removal of less advanced cancers will lead to a prolongation of survival. Early diagnosis of colorectal cancer therefore should be an important goal to strive for. An effort to achieve early diagnosis may be based on identification of high risk patients, and screening of groups at intermediate risk of developing colorectal cancer. Patients with well defined precancerous conditions should be included in surveillance programme. Prophylactic surgical treatment should be considered in longstanding ulcerative colitis and familial polyposis syndrome. Improved methods of genetic mapping and identification of the genetic defects that predisposed to cancer will probably be of great importance in the future. To reach groups of the population for early diagnosis of colorectal cancer large-scale screening is probably necessary. A change towards less advanced cancers is likely to be the result of mass screening. Improved survival with acceptable cost-benefit ratio remains to be shown.

Adenomatous Polyposis Coli↗
PubMed1993

Possible role of the autonomic nervous system in sphincter impairment after restorative proctocolectomy.

Peroperative manometry was performed in 12 patients operated on with endoanal proctectomy and a hand-sewn pouch-anal anastomosis and in 12 in whom proctectomy was performed entirely from above, with the ileal pouch stapled to the top of the anal canal. Results from both groups showed that division of the superior rectal artery reduced the median (95 per cent confidence interval (c.i.)) resting anal pressure from 77.5 (69.9-83.3) mmHg to 64.5 (55.2-70.0) mmHg (P < 0.01). Complete rectal mobilization to the pelvic floor decreased resting pressure by an additional 22 per cent, to a median of 50.0 (95 per cent c.i. 40.1-53.5) mmHg (P < 0.01). After completion of anastomosis, irrespective of the operative technique used, a further decline in median pressure to 35.0 (95 per cent c.i. 26.0-47.7) mmHg could be demonstrated (P < 0.05). This study indicates that anal sphincter pressure is reduced to a similar extent after hand-sewn and stapled anastomoses. Injury to the autonomic nervous supply to the anal sphincter mechanism might be the major cause for this reduction.

Adult↗