| 11. |
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| 12. |
- Janunger, Karl-Gunnar, 1941-
(författare)
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Benign and malignant gastric mucosal changes after partial gastrectomy
- 1978
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The development of benign and malignant mucosal changes in the gastric remnant were studied early (1-3 years) postoperatively in 55 patients and late (10-24 years) postoperatively in 336 of 676 patients subjected to partial gastrectomy for ulcer disease.Chronic gastritis with atrophy, intestinal metaplasia and cystic dilatation of the gastric glands was found early postoperatively with the same prevalence in gastric and duodenal ulcer patients. Whereas the prevalence of atrophy, and of acute and chronic gastritis was the same both early and late postoperatively, the prevalence of intestinal metaplasia, cystic dilatation and lipid islands increased with time. The prevalence of inflammatory changes late postoperatively was not correlated to sex, age or type of anastomotic procedure.A significantly increased risk for stump carcinoma was found in male patients more than 12 years postoperatively. No difference correlated to type of ulcer disease or anastomotic procedure could be demonstrated. In duodenal ulcer patients the time interval between operation and diagnosis of carcinoma was independent of age at operation, while in gastric ulcer patients the interval was shorter with increasing age at operation.Gastric stump carcinomas were found in 12 of the 336 (3.6%) patients examined gastroscopically; four of these were early carcinomas. In four patients with stump carcinoma the correct diagnosis could not be established at the first examination.Gastric polyps and precancerous mucosal changes were the only macro- or microscopical findings in some cases with already existing non-visible carcinoma.The CEA immunohistochemical study of the gastric mucosa showed a positive reaction in 10 of 49 patients; 6 of the 10 had carcinoma, precancerous changes or adenomatous polyp. Three patients with diagnosed or later discovered carcinoma had CEA negative reactions. However, the results indicate that there is a correlation between demonstrated CEA content and increased risk for development of stump carcinoma. To evaluate whether this method can be used to identify patients at special risk for development of gastric carcinoma requires further study.Because of increased risk for stump carcinoma, gastric ulcer patients ought to be examined with gastroscopy from about 10 years after partial gastrectomy, and duodenal ulcer patients from about 15 years, irrespective of the type of anastomotic procedure. Re-examinations ought to be performed every two to four years. In patients with gastric polyps or precancerous mucosal changes re-examinations should be performed earlier, within 6-12 months.
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| 13. |
- Malmström, Per, et al.
(författare)
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Cholecystomy for acute choelcystitis
- 1973
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Ingår i: The American Journal of Surgery. - 1879-1883. ; 126:3, s. 397-402
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Tidskriftsartikel (refereegranskat)abstract
- During the decade 1957 through 1966, sixty-three cholecystostomies in sixty-two patients were performed in the Surgical Department, University of Lund. Fifty-five of these sixty-two patients were followed up. The mean age was seventy-one years for both sexes. The primary mortality was 20 per cent: a third died of circulatory and respiratory insufficiency; three quarters died of peritonitis, abscess, and renal failure; half of the surviving patients had delayed wound healing. The mean hospital stay for the survivors was nineteen days. During the follow-up period, sixteen later required cholecystectomy, nine electively and seven for a recurrence of acute cholecystitis. Nine had another attack of cholecystitis after cholecystostomy. Another four had continuous symptoms; five more died of the gallbladder disease.It is concluded that cholecystostomy should be restricted to very ill patients and should be planned and carried out with the patient under local anesthesia. In all other patients, early primary cholecystectomy should be performed with cholangiography performed during the operation.
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| 14. |
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| 15. |
- Reiz, Sebastian, 1942-
(författare)
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Hemodynamic and cardiometabolic studies in patients with distributive circulatory dysfunctions : with special reference to the effects of the beta-1-adrenoreceptor agonist prenalterol
- 1979
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A total of 49 patients were studied, using invasive hemodynamic techniques with systemic arterial, pulmonary artery and right atrial pressure recordings together with thermodilution cardiac output determinations. Sixteen of the patients were also subjected to cardiometabolic studies, using measurement of coronary sinus blood flow by the continuous thermodilution technique and analyses of oxygen content and lactate concentration in the systemic and coronary circulation. A common denominator in the five investigations was, that a distributive cardiovascular dysequilibrium was either induced (for surgical or anaesthesiological reasons) or already present due to a pathological condition.Thoracic epidural block from T 1 to T 12 induced marked decrease in systemic blood pressure due to vasodilation and impairment of cardiac performance. Prenalterol administration effectively abolished the low blood pressure by its marked inotropic action, having no effect on systemic vascular resistance. Myocardial oxygen consumption changed in parallel with the changes in cardiac work following both thoracic epidural block and prenalterol. Coronary vascular resistance was markedly decreased by the block and was not affected by prenalterol. It is suggested, that the critically low perfusion pressure is the main cause of the coronary vasodilation and that alpha-blockade induced by the thoracic epidural block is of less importance.The combination of a thoracic epidural block from T 1 to T 12 and selective ß1-stimulation with prenalterol was an effective way to modify the cardiovascular response to infrarenal aortic cross clamping. This treatment transferred the patients to a more favourable cardiac function curve and possibly facilitated the redistribution of blood flow in association with clamping.In association with declamping of the infrarenal aorta or the common iliac arteries, volume loading to a slightly elevated left ventricular filling pressure shortly before declamping was an effective way to counteract the expected blood pressure drop. A normal left ventricular filling pressure prior to declamping did not prevent the blood pressure drop following declamping. It is suggested, that mismatching between vascular volume and blood volume is the main cause of declamping hypotension.In patients with low resistance, distributive septic shock caused by gram negative bacteremias and signs of impaired cardiac function, prenalterol effectively reversed the hypotension and improved tissue perfusion by selectively increasing cardiac output. In parallel to the increased cardiac work, an increase in myocardial metabolic demand was demonstrated.
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