Biomedical subjects
Publications and source records attributed to T Ihre.
Cholecystokinin (CCK) was used in a randomized double-blind trial to evaluate its effect on post-operative paralytic ileus. Sixty patients were admitted to the study. The return of postoperative intestinal motility was registered with subjective and/or objective methods. No differences were found between the CCK group and the placebo group.
Forty-three patients who were papillotomied according to Doubilet were followed up for 20-25 years after the papillotomy in an attempt to predict the long-term effects of endoscopic papillotomy (EPT). The indications for the initial papillotomy was common bile duct stones in 20 patients, and elevated serum amylase in 23. The papillotomy was performed in conjunction with a cholecystectomy. No negative effects were found at follow-up, and this study therefore seems to show that the long-term risks of EPT are minimal.
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A widely used classification of pancreatitis is the one proposed in Marseilles in 1963, which distinguishes among acute, acute relapsing, chronic relapsing, and chronic pancreatitis. The diagnostic criteria in chronic pancreatitis are permanent damage of morphology and/or function of the pancreas after clinical symptoms of pancreatitis. In clinical practice, however, it can be difficult to find the suitable and comparable diagnosis in accordance with the Marseilles classification. In the present study the exocrine and endocrine function and the morphology of the pancreas have been thoroughly investigated in 54 patients who have been treated for various diagnoses of pancreatitis. The results show that the above diagnostic criteria often are difficult to interpret. We consider that the prevailing classification of pancreatitis needs to be revised in the light of progress in investigative techniques. A proposal for a modified classification is presented.
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A retrospective study of 314 patients hospitalized for pancreatitis in the period 1972-1973, showed that 74 (24%) had died in the course of five years. The aim of the study was to elucidate the etiology and the course of the pancreatitis and the immediate cause of death in the 61 cases where an autopsy was performed. There were three types of histopathological findings at autopsy concerning the pancreas: acute hemorrhagic pancreatitis, chronic pancreatitis and one group with no or minimal changes in the pancreas. The last group had had typical clinical symptoms of pancreatitis with abdominal pain and elevated urine and/or serum amylase, in many patients a very marked rise. Alcoholism was the dominant predisposing factor, regardless of the type of histopathological findings, but when the first attack of pancreatitis appeared at advanced age, biliary tract disease and cancer were the dominant causes. Liver damage was a common finding in alcoholic pancreatitis.
Acute haemorrhagic and/or necrotizing pancreatitis is a most serious condition. A retrospective account is presented of the clinical course, treatment and results in 61 patients with the diagnosis confirmed at laparotomy and/or autopsy. Forty-eight patients (79%) died while in hospital. Of the 13 surviving patients, 10 were followed up for periods ranging from 1.5 to 9 years. They were reinvestigated with respect to morphologic and exocrine and endocrine functional changes in the pancreas. The aetiology of the acute condition was biliary tract disease in 33% of the total series and alcoholism in 59%. Neither cause of the disease nor type of treatment (surgery with or without peritoneal lavage) had statistically significant effect on survival. At the follow-up examination the endocrine and exocrine pancreatic functions were satisfactory in many patients. In almost half of the surviving patients, endoscopic retrograde pancreatography showed openly minor changes.
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In patients with massive upper gastrointestinal bleeding the results of endoscopic control by coagulation with YAG-laser have been compared with the results of an active surgical approach with early operation in a controlled randomized study. The laser coagulation was done at admission in patients in whom an actively bleeding lesion was diagnosed at endoscopy. Of the 66 patients belonging to the laser group, 23 were bleeding at admission and endoscopy, and in 15 of these coagulation was attempted and initial haemostasis was achieved in 14. Seven of the latter rebled and five of them were then operated upon with on postoperative death. Two patients died from bleeding oesophageal varices and hepatic failure. In the patient in whom haemostasis was not achieved, an operation was done for a duodenal ulcer. She died postoperatively. Of the 43 patients belonging to the laser group and not bleeding at endoscopy, nine patients rebled and three of them were operated upon, the with on postoperative death. An additional four patients died in this group, three of bleeding oesophageal varices in combination with hepatic failure and one of bleeding from an unknown source. Sixty-nine patients belonged to the control group and in 19 of these patients bleeding lesions were diagnosed at endoscopy. Five of these were operated upon, with two postoperative deaths. An additional three patients died of bleeding oesophageal varices and hepatic failure. Of the 50 patients belonging to the control group and not bleeding at endoscopy, eight later showed signs of recurrent bleeding. Four of them had oesophageal varices and two died. The other four with recurrent bleeding were operated upon with no postoperative mortality. Thus nine patients (five with oesophageal varices) died in the laser group and seven (five with oesophageal varices) in the control group. There was no statistically significant difference between the two groups regarding mortality, need of blood transfusion or time of treatment in the hospital. However, the material is too small to make any definite conclusions, and further studies are necessary in which laser treatment is compared with an aggressive surgical policy with early operations.
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In 12 non-icteric patients, changes in the pancreatic duct indicative of carcinoma were found during endoscopic retrograde cholangio-pancreatography (ERCP). Percutaneous fine-needle biopsy was positive for cancer in six cases. Nine of the 12 patients were later proved to have carcinoma of the pancreas. There was one falsely negative biopsy but no false positives. In two cases no pancreatic cells were found in the smear. It seems that percutaneous fine-needle aspiration biopsy during ERCP is a feasible procedure and can be recommended in ductal changes indicative of carcinoma.
The Mallory-Weiss syndrome is defined as bleeding from longitudinal tears in the gastro-oesophageal junction. The characteristic history consists of repeated vomiting followed by sudden haematemesis. During the past 4 1/2 years, 23 patients, 17 males and 6 females with the diagnosis of Mallory-Weiss syndrome were treated in our institution. An aetiological factor has been sought for. In a review of the case-records, we discovered that many patients had coagulation defects on admission. This was verified with extended coagulation tests at later follow-up. It is proposed that non-bleeding lacerations in the cardiac orifice in conjunction with vomiting is a common occurence, and that the Mallory-Weiss syndrome may be regarded as a complication occuring predominantly in patients with some coagulation defect.