| 1. |
- Andersson, Roland, et al.
(författare)
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Acute pancreatitis - from cellular signalling to complicated clinical course.
- 2007
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 9:6, s. 414-420
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Tidskriftsartikel (refereegranskat)abstract
- Acute pancreatitis (AP) is a common disease that has a mild to moderate course in most cases. During the last decade, a change in diagnostic facilities as well as improved intensive care have influenced both morbidity and mortality in AP. Still, however, a number of controversies and unresolved questions remain regarding AP. These include prognostic factors and how these may be used to improve outcome, diagnostic possibilities, their indications and optimal timing, and the systemic inflammatory reaction (systemic inflammatory response syndrome - SIRS) and its effect on the concomitant course of the disease and potential development of organ failure. The role of the gut has been suggested to be important in severe AP, but has recently been somewhat questioned. Despite extensive research, pharmacological and medical intervention of proven clinical value is scarce. Various aspects on surgical interventions, including endoscopic sphincterotomy, cholecystectomy and necrosectomy, as regards indications and timing, will be reviewed. Last, but not least, are the management of late complications and long-term outcome for patients with especially severe AP.
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| 2. |
- Andersson, Roland, et al.
(författare)
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Iatrogenic bile duct injury - a cost analysis.
- 2008
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 10:6, s. 416-419
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Iatrogenic bile duct lesions following cholecystectomy represent a feared complication occurring in up to 0.9%. The aim of the present study was to estimate the total cost associated with both minor and major bile duct injuries. Material and methods. Detailed information on 24 consecutive patients, out of which 14 were considered to have minor and 10 patients considered as having major bile duct injury, provided the underlying information that rendered calculations on average individual costs for both groups of injuries. Results and discussion. Calculating individual costs for minor and major bile duct injuries with actual incidences of cholecystectomies performed and the incidence of iatrogenic bile duct injury demonstrated that the total costs, including in-hospital cost, sick leave and loss of production, were substantial. For the management of minor bile duct injuries costs were within the range of 136,787-159,585 EUR and for the management of major bile duct injuries from 336,903-449,204 EUR per million inhabitants and year. The total costs for the management of all types of bile duct injuries were thus within the range of 473,690-608,789 EUR per million inhabitants annually for the society.
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| 3. |
- Andersson, Roland, et al.
(författare)
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Immunomodulation in surgical practise
- 2006
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 8:2, s. 116-123
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Tidskriftsartikel (refereegranskat)abstract
- Background. Immunomodulation may represent a potential way to improve surgical outcome. These types of interventions should be based on detailed knowledge of the underlying mechanisms involved. The aim of the present review is to summarize some experience on the acute phase response, potential ways of intervention and experiences from critical illness and HPB disease. Discussion. Mechanisms of the acute phase response are discussed including the individual parameters and local changes that take part. Mechanisms involved in failure of the gut barrier are presented and include changes in gut barrier permeability, effects on gut-associated immunocompetent cells, and systemic implications. As examples of HPB disease, mechanisms of the acute phase response and potential ways of intervention in obstructive jaundice and acute pancreatitis are discussed. Nutritional pharmacology and lessons learned from immunomodulation and immunonutrition in critical illness and major abdominal surgery, including upper GI and HPB surgery, are referred to. Overall, immunomodulation represents a potential tool to improve results but requires a thorough mapping of underlying mechanisms in order to achieve individualized treatment or prevention based on patients' specific needs.
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| 4. |
- Andersson, Roland, et al.
(författare)
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Pancreaticojejunostomy: A valid operation in chronic pancreatitis?
- 2008
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 43:8, s. 1000-1003
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Patients with chronic pancreatitis and intractable pain may be candidates for surgical intervention and various types of surgery have been described over time. The objective of this study was to describe long-term outcome following pancreaticojejunostomy in patients with chronic pancreatitis. Material and methods. Thirty-two patients with chronic pancreatitis underwent lateral pancreatiocojejunostomy and were then followed-up for 5 years. Results. The short-term results on relief of abdominal pain were good, but seemed to deteriorate at long-term follow-up (5 years), as did pancreatic exocrine and endocrine function. A substantial number of patients admitted to continued alcohol abuse at 5-year follow-up (31%). Conclusions. Pancreaticojejunostomy in patients with chronic pancreatitis renders good pain relief. In effect, the deterioration in abdominal pain at long-term follow-up was in parallel with a tendency towards a decline in both exocrine and endocrine function and a continued alcohol abuse.
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| 5. |
- Andersson, Roland, et al.
(författare)
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Pathogenesis of chronic pancreatitis: A comprehensive update and a look into the future.
- 2009
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 44, s. 661-663
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Tidskriftsartikel (refereegranskat)abstract
- Chronic pancreatitis is a relatively frequent condition usually caused by alcoholic abuse but also due to recurrent gallstone disease, metabolic endocrine disorders and haemochromatosis, among others. Specific types such as hereditary and autoimmune pancreatitis should be particularly kept in mind and emphasized, as they require specific treatment and attention. The possibility to identify gene mutations has also increased and this is likely to decrease the overall total number of "idiopathic" chronic pancreatitis cases. Pancreatic stellate cells have been identified as potential key players in the progression of chronic pancreatitis and the development of fibrogenesis, which are activated either during repeated attacks of necro-inflammation or directly by toxic factors. The inhibition or modulation of pancreatic stellate cells could represent a way of potential intervention in patients with chronic pancreatitis in the future.
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| 6. |
- Nehéz, Laszlo, et al.
(författare)
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Differently charged polypeptides in the prevention of post-surgical peritoneal adhesions.
- 2007
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 42:4, s. 519-523
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Peritoneal adhesions develop after almost all surgical interventions in the abdomen. We have developed an efficient treatment against post-surgical adhesions consisting of a combination of positively charged poly-L-lysine and negatively charged poly-L-glutamate. The aim of the present study was to further develop the concept of applying oppositely charged polypeptides in the prevention of adhesion formation, by evaluating different doses of the peptides, alterations in the way of administration, and also testing alternative components. Material and methods. Eighty-five NMRI mice were divided into six groups. A standardized peritoneal injury model was used. The groups received physiologic sodium chlorine, poly-L-lysine + poly-L-glutamate, low molecular weight poly-L-lysine + poly-L-glutamate, locally administered poly-L-lysine + poly-L-glutamate, in vitro mixed poly-L-lysine + poly-L-glutamate and poly-L-arginine + poly-L-glutamate, respectively. After 7 days, the extent of adhesion formation was determined during relaparotomy and was expressed as the mean percentage of the total wound length. Results. A significant decrease (p < 0.001) in the peritoneal adhesion rate was detected in all groups, with the exception of the group administered poly-L-arginine. Among those animals that received poly-L-lysine and poly-L-glutamate, the low dose of poly-L-lysine administration resulted in the most pronounced anti-adhesive effect. Conclusions. The most effective polypeptide combination was poly-L-lysine and poly-L-glutamate, also showing effectiveness when used at low doses and by local application. The differences in adhesion prevention and the possible underlying mechanisms are discussed and the key role of poly-L-lysine is elucidated.
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| 7. |
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| 8. |
- Nehéz, Laszlo, et al.
(författare)
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Prevention of postoperative peritoneal adhesions: Effects of lysozyme, polylysine and polyglutamate versus hyaluronic acid
- 2005
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 40:9, s. 1118-1123
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Intraperitoneal adhesions are an important cause of postoperative intestinal obstruction, abdominal discomfort and infertility. In the present study we hypothesized that a combination of polypeptides with different surface properties, resulting in fine disperse low-soluble complexes, could be of benefit in the prevention of abdominal adhesions. Material and methods. Various polypeptides including lysozyme, polyglutamate, polylysine and combinations of all three were evaluated as compared to hyaluronic acid. A standard wound on the parietal peritoneum in mice was used and the evaluated agents were administered immediately postoperatively. The extent of peritoneal adhesions to the injured area was measured and expressed as a percentage of the wound length as evaluated after 7 days. Flow cytometry was performed to evaluate the effect on peritoneal macrophage survival and phagocytic function and the Pick test was used to determine peroxide production in order to estimate toxicity and potential impairment of macrophage function caused by the chemicals. Results. Significant differences were seen among the treatment groups (p< 0.001). Both polyglutamate and lysozyme, and polyglutamate together with polylysine significantly decreased adhesion formation as compared to hyaluronic acid. The polylysine - polyglutamate combination was still visible macroscopically on the peritoneal surface after 1 week, though not after 1 month. The polyglutamate - lysozyme mixture was less effective than these individual components alone. The chemicals did not show any toxic effects or altered function in macrophage cell culture. Conclusions. Lysozyme, polyglutamate and, most effectively, a polyglutamate - polylysine combination significantly decreased experimental abdominal adhesion formation. A strong mechanical connection to the wound and prolonged attendance in the surface were noted. Peritoneal phagocyte function did not seem to be influenced by the chemicals.
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| 9. |
- Norrman, Gustav, et al.
(författare)
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Non-operative management of blunt liver trauma: feasible and safe also in centres with a low trauma incidence.
- 2009
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Ingår i: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 11:1, s. 50-56
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Non-operative management (NOM) of blunt liver trauma is currently, if possible, the preferred treatment of choice. The present study evaluates the experience of blunt liver injury in adults in a Swedish university hospital. MATERIAL AND METHODS: Forty-six patients with blunt liver trauma were treated from January 1994 through to December 2004. Patient charts were reviewed retrospectively to examine injury severity score (ISS), liver injury grade, diagnostics, treatment and outcome. RESULTS: Thirty-five patients (76%) were initially treated non-operatively and 11 (24%) patients had immediate surgery. In four (11%) patients, NOM failed and the patients required surgery 8-72 h after admission. Patients failing non-operative care had a significantly lower systolic blood pressure on admission as compared with patients with successful NOM (P = 0.001). Patients immediately operated upon had higher ISS (P < 0.001) and were haemodynamically unstable to a greater extent (P < 0.001) as compared with patients initially considered for NOM. Operated patients had increased transfusion requirements (P < 0.001), longer total hospital stay (P = 0.011) and stay in the intensive care unit (ICU) unit (P < 0.001) as compared with NOM. One immediately operated and one failed NOM died (total mortality 4%). Seventeen patients in the NOM group were successfully treated without surgery despite the presence of at least one described risk factor. CONCLUSIONS: Most patients with blunt liver trauma can be treated without surgery, and non-operative management may be performed even in the presence of established risk factors.
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| 10. |
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