ABSTRACT. Because of frequently recurring haemarthrosis which could not be controlled by conserva... more ABSTRACT. Because of frequently recurring haemarthrosis which could not be controlled by conservative management 19 haemophiliacs were subjected to synovectomy on a total of 23 joints—17 knees, S elbows, and 1 hip. The patients were followed for an average of 23 months. Primary postoperative complications occurred, in the form of recurrent bleeding, in 8 joints. Rehabilitation was often difficult and long‐lasting, and the range of joint motion was essentially restricted in 4 cases. After a follow‐up period exceeding 6 months the findings in the remaining, mobile 19 synovectomized joints were: 12 had been relieved of haemorrhage, 5 had rare and two frequent haemorrhages. The reduction in the number of haemorrhages was significant (p<0.01). In the light of the complicated postoperative course it is concluded that synovectomy should be used only on strict indications, viz. only in otherwise intractable cases of progressing haemophilic arthropathy.
Peptic ulcer disease has undergone a significant change in incidence and modern medical and surgi... more Peptic ulcer disease has undergone a significant change in incidence and modern medical and surgical therapeutical modalities seems to change the history and outcome of the disease. The knowledge of the basic morphological and functional background of the entity is based on studies of ulcer formation and healing and of the influence of the gastroduodenal mucosa. Chronic gastritis is closely associated with peptic ulcer, and type, grade and dispersion of gastric changes are correlated to the activity and nature of the ulcer and the subsequent treatment, i.e. antrectomy. Parietal cell subpopulation shows a nearly unsusceptible numerical density during different phases of ulcer disease, only correlated to acid secretion in duodenal ulcer patients. The changes of gastric endocrine cells and morphological and subcellular changes of the parietal cells after medical and surgical treatment indicates a complex cellular regulation in the gastric mucosa.
We examined whether parietal cell vagotomy (PCV) changed the distribution between the different m... more We examined whether parietal cell vagotomy (PCV) changed the distribution between the different molecular forms of gastrin. Serum, antrum, and duodenum from PCV patients, unoperated duodenal ulcer (DU) patients and control subjects were studied. PCV was followed by a twofold increase in the serum gastrin concentration, while the distribution between small and large gastrins were unaffected. However, sulfation of antral gastrins was reduced from 45 percent in unoperated DU patients to 34 percent in PCV patients (p less than 0.01). We conclude that gastrin sulfation is diminished after PCV. Diminished sulfation seems to be correlated to hypergastrinaemia of antral origin and not to specific diseases.
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 2009
During gastroscopy biopsy specimens were taken from 4 different areas of gastric corpus mucosa in... more During gastroscopy biopsy specimens were taken from 4 different areas of gastric corpus mucosa in 51 patients with duodenal ulcer disease (DU) and 26 patients without ulcer disease and the patients underwent an acid stimulation test by injection of 6 μg 5‐gastrin/kg bodyweight. A parietal cell density study was carried out, using a direct counting of cell nuclei in a standardized lattice. The method was found fully acceptable when compared with stereological analysis of parietal cell density per unit volume (Nv) and was found having a low variation in and between observers. There was no significant variation of parietal cell density locally or regionally in the oxyntic mucosa. No correlation was found in DU group between Basic Acid Output (BAO), Peak Acid Output (PAO) and the parietal cell density, but in the non‐DU group a rather poor, but significantly positive correlation was demonstrated. We conclude that the parietal cell mass is not exactly correlated to acid production and th...
Acta Pathologica Microbiologica Scandinavica Section A Pathology, 2009
The rare, malignant Brenner tumour of the ovary was removed in a 67‐year old woman. The tumour wa... more The rare, malignant Brenner tumour of the ovary was removed in a 67‐year old woman. The tumour was of the epidermoid‐transitional‐cell type and is in particular remarkable because subcutaneous metastases occurred.
The concentrations of gastrin-releasing polypeptide, somatostatin (SS), and gastrin in extracts o... more The concentrations of gastrin-releasing polypeptide, somatostatin (SS), and gastrin in extracts of endoscopically obtained biopsies from the fundus, antrum, and duodenum of patients with uncomplicated bile stones (controls) or duodenal ulcer disease were measured with specific radioimmunoassays. The validity of the tissue sampling was confirmed by characteristic and significant differences between gastrin concentrations at the different biopsy sites. Gastrin-releasing polypeptide levels were at their highest in the fundic and duodenal bulb compared to the antrum in controls (p less than 0.01), whereas no differences in gastrin-releasing polypeptide content of the different parts of the stomach were found in duodenal ulcer patients. Compared to controls gastrin-releasing polypeptide in duodenal ulcer patients was reduced in fundic and duodenal bulb mucosa (p less than 0.01). SS levels were highest (p less than 0.05) in the first part of duodenum in controls. Compared to controls duod...
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 2009
In a prospective study, 20 patients with endoscopically proven duodenal ulcers were randomised to... more In a prospective study, 20 patients with endoscopically proven duodenal ulcers were randomised to be treated with cimetidine 1 g daily or with antacids 350 mmol daily. The duration of treatment was 30 days, but this was extended to three months in 3 patients in the cimetidine group and 4 patients in the antacid group. A morphological study of biopsies taken via a gastroscope from the corpus mucosa showed no change in mucosal height, parietal cell density per unit volume or changes in cellular infiltration after 30 and 90 days treatment in the two groups. Neither H‐2 receptor blockers nor antacids alter mucosal height or parietal cell density. Treatment was not found to induce gastritic changes in the mucosa.
The possibility that the gut peptide, neurotensin, may contribute to the dumping syndrome was inv... more The possibility that the gut peptide, neurotensin, may contribute to the dumping syndrome was investigated in 17 patients with a long history of dumping after a Billroth II gastrectomy for duodenal ulcer. After a test meal plasma levels of neurotensin were higher than in normal subjects, but no correlation to the severity of symptoms was found. In eight of the patients with meal-provoked dumping symptoms, intravenous infusion of neurotensin in relevant doses produced neither symptoms nor changes in blood glucose, blood pressure, or pulse rate. The apparent plasma half-life of neurotensin (t1/2 = 2.3 min) did not differ from that previously found in normal subjects. The results indicate that it is unlikely that neurotensin alone has a pathogenetic role in the dumping syndrome in gastrectomized patients.
ABSTRACT. Because of frequently recurring haemarthrosis which could not be controlled by conserva... more ABSTRACT. Because of frequently recurring haemarthrosis which could not be controlled by conservative management 19 haemophiliacs were subjected to synovectomy on a total of 23 joints—17 knees, S elbows, and 1 hip. The patients were followed for an average of 23 months. Primary postoperative complications occurred, in the form of recurrent bleeding, in 8 joints. Rehabilitation was often difficult and long‐lasting, and the range of joint motion was essentially restricted in 4 cases. After a follow‐up period exceeding 6 months the findings in the remaining, mobile 19 synovectomized joints were: 12 had been relieved of haemorrhage, 5 had rare and two frequent haemorrhages. The reduction in the number of haemorrhages was significant (p&lt;0.01). In the light of the complicated postoperative course it is concluded that synovectomy should be used only on strict indications, viz. only in otherwise intractable cases of progressing haemophilic arthropathy.
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 2009
Parietal cell density, mucosal height, grade of gastritis and pentagastrin‐stimulated acid produc... more Parietal cell density, mucosal height, grade of gastritis and pentagastrin‐stimulated acid production were assessed before and three months after parietal cell vagotomy (PCV) in 14 patients with duodenal ulcer. Parietal cell density was found to be unaltered after vagotomy and there was no difference in the parietal cell count in the neck and base of the glands. Both the basal acid production and the pentagastrin‐stimulated acid secretion were significantly reduced after PCV. No correlation could be shown between the stimulated acid production and the parietal cell count, either pre‐ or postoperatively, (r = 0,14 and r = 0,19). Mucosal height and grade of gastritic changes remained unchanged. It is concluded that PCV in duodenal ulcer patients causes no change in parietal cell density assessed at three months post‐operatively. Vagotomy causes no mucosal atrophy or gastritic changes within this period.
Background. Full thichness rectal prolapse is a disabling condition that is common in an ageing p... more Background. Full thichness rectal prolapse is a disabling condition that is common in an ageing population. Peri− neal operations are less traumatic than are abdominal procedures for the frail patient. Objectives. The aim of the study was to review the outcome with respect to control of the prolapse. Material and Methods. From 1985 to 2000 47 patients with rectal prolapse were treated with Altemeier’s proce− dure. The mean age was 75 years. Half of the patients suffered from medical diseases. Results. The recurrence rate was 15%. There were 2 postoperative deaths. 2 patients had anastomotic leaks. One patient had to be re−operated on because of bleeding. Conclusions. Altemeier’s procedure is a relatively easy and safe operation with a low recurrence rate (Adv. Clin. Exp. Med. 2003, 12, 4, 537–541).
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 2009
In a previous endoscopic follow-up examination of patients who 22-30 years before had undergone B... more In a previous endoscopic follow-up examination of patients who 22-30 years before had undergone Billroth II resection for duodenal ulcer the prevalence of dysplasia and carcinoma of the gastric remnant was 14.8 and 0%, respectively. In this second follow-up study five years later the figures had increased to 30.3 and 5.6%. It is uncertain whether these changes result from the higher number of biopsies taken at the re-examination or reflect a time-dependent rise in the morbidity. Although the observed prevalences may seem high, we do not find prophylactic endoscopic examination of such patients indicated, as other investigations by us have shown that the series of Billroth II resected patients under study does not show excess incidence or excess mortality of gastric carcinoma.
A double-blind, randomized study compared the healing of gastric ulcer during a twice-daily regim... more A double-blind, randomized study compared the healing of gastric ulcer during a twice-daily regimen of 2 g sucralfate or 400 mg cimetidine. The patients received the tablets one-half hour before breakfast and one-half hour before bedtime. The study included 76 patients with endoscopically proven gastric ulcer. Patients with ulcers less than 3 cm from the pyloric ring and patients with ulcers less than 3 mm in diameter were excluded from the study. Sixty-four patients completed the study. Healing was endoscopically assessed at four-week intervals for 12 weeks. After four, eight, and 12 weeks, the healing rates for cimetidine were 55, 81, and 94 percent, respectively; the healing rates for sucralfate were 52, 79, and 91 percent, respectively. No statistically significant difference was found between the two regimens. At 12 weeks, the risk of overlooking a difference in favor of one of the two dosage regimens was less than 20 percent. The results suggest that 2 g sucralfate twice daily is as effective in the healing of gastric ulcer as 400 mg cimetidine twice daily.
Pentagastrin-stimulated acid secretion and parietal cell density were studied in 51 patients with... more Pentagastrin-stimulated acid secretion and parietal cell density were studied in 51 patients with duodenal ulcer (DU) and 26 patients without ulcer disease (non-DU). Chronic gastritis was assessed for a comparative study between parietal cell density and grade as well as the extent of gastritis. Parietal cell density was estimated with a high degree of accuracy, since the difference in cell counts of two adjacent biopsies and the inter- and intra-observer variation never exceeded 10%. The density calculated from three regional biopsies was representative for the density of the entire corpus mucosa. Parietal cell density was similar in normal mucosa, superficial chronic gastritis and mild atrophic gastritis, while fewer parietal cells were found in severe chronic atrophic gastritis. Nonuniform distribution of chronic gastritis was more frequent in DU than in non-DU, and may explain the lack of correlation between acid secretion and parietal cell number. If severe chronic atrophic gastritis is found to be localized, parietal cell density investigations will require multiple biopsies.
ABSTRACT. Because of frequently recurring haemarthrosis which could not be controlled by conserva... more ABSTRACT. Because of frequently recurring haemarthrosis which could not be controlled by conservative management 19 haemophiliacs were subjected to synovectomy on a total of 23 joints—17 knees, S elbows, and 1 hip. The patients were followed for an average of 23 months. Primary postoperative complications occurred, in the form of recurrent bleeding, in 8 joints. Rehabilitation was often difficult and long‐lasting, and the range of joint motion was essentially restricted in 4 cases. After a follow‐up period exceeding 6 months the findings in the remaining, mobile 19 synovectomized joints were: 12 had been relieved of haemorrhage, 5 had rare and two frequent haemorrhages. The reduction in the number of haemorrhages was significant (p<0.01). In the light of the complicated postoperative course it is concluded that synovectomy should be used only on strict indications, viz. only in otherwise intractable cases of progressing haemophilic arthropathy.
Peptic ulcer disease has undergone a significant change in incidence and modern medical and surgi... more Peptic ulcer disease has undergone a significant change in incidence and modern medical and surgical therapeutical modalities seems to change the history and outcome of the disease. The knowledge of the basic morphological and functional background of the entity is based on studies of ulcer formation and healing and of the influence of the gastroduodenal mucosa. Chronic gastritis is closely associated with peptic ulcer, and type, grade and dispersion of gastric changes are correlated to the activity and nature of the ulcer and the subsequent treatment, i.e. antrectomy. Parietal cell subpopulation shows a nearly unsusceptible numerical density during different phases of ulcer disease, only correlated to acid secretion in duodenal ulcer patients. The changes of gastric endocrine cells and morphological and subcellular changes of the parietal cells after medical and surgical treatment indicates a complex cellular regulation in the gastric mucosa.
We examined whether parietal cell vagotomy (PCV) changed the distribution between the different m... more We examined whether parietal cell vagotomy (PCV) changed the distribution between the different molecular forms of gastrin. Serum, antrum, and duodenum from PCV patients, unoperated duodenal ulcer (DU) patients and control subjects were studied. PCV was followed by a twofold increase in the serum gastrin concentration, while the distribution between small and large gastrins were unaffected. However, sulfation of antral gastrins was reduced from 45 percent in unoperated DU patients to 34 percent in PCV patients (p less than 0.01). We conclude that gastrin sulfation is diminished after PCV. Diminished sulfation seems to be correlated to hypergastrinaemia of antral origin and not to specific diseases.
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 2009
During gastroscopy biopsy specimens were taken from 4 different areas of gastric corpus mucosa in... more During gastroscopy biopsy specimens were taken from 4 different areas of gastric corpus mucosa in 51 patients with duodenal ulcer disease (DU) and 26 patients without ulcer disease and the patients underwent an acid stimulation test by injection of 6 μg 5‐gastrin/kg bodyweight. A parietal cell density study was carried out, using a direct counting of cell nuclei in a standardized lattice. The method was found fully acceptable when compared with stereological analysis of parietal cell density per unit volume (Nv) and was found having a low variation in and between observers. There was no significant variation of parietal cell density locally or regionally in the oxyntic mucosa. No correlation was found in DU group between Basic Acid Output (BAO), Peak Acid Output (PAO) and the parietal cell density, but in the non‐DU group a rather poor, but significantly positive correlation was demonstrated. We conclude that the parietal cell mass is not exactly correlated to acid production and th...
Acta Pathologica Microbiologica Scandinavica Section A Pathology, 2009
The rare, malignant Brenner tumour of the ovary was removed in a 67‐year old woman. The tumour wa... more The rare, malignant Brenner tumour of the ovary was removed in a 67‐year old woman. The tumour was of the epidermoid‐transitional‐cell type and is in particular remarkable because subcutaneous metastases occurred.
The concentrations of gastrin-releasing polypeptide, somatostatin (SS), and gastrin in extracts o... more The concentrations of gastrin-releasing polypeptide, somatostatin (SS), and gastrin in extracts of endoscopically obtained biopsies from the fundus, antrum, and duodenum of patients with uncomplicated bile stones (controls) or duodenal ulcer disease were measured with specific radioimmunoassays. The validity of the tissue sampling was confirmed by characteristic and significant differences between gastrin concentrations at the different biopsy sites. Gastrin-releasing polypeptide levels were at their highest in the fundic and duodenal bulb compared to the antrum in controls (p less than 0.01), whereas no differences in gastrin-releasing polypeptide content of the different parts of the stomach were found in duodenal ulcer patients. Compared to controls gastrin-releasing polypeptide in duodenal ulcer patients was reduced in fundic and duodenal bulb mucosa (p less than 0.01). SS levels were highest (p less than 0.05) in the first part of duodenum in controls. Compared to controls duod...
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 2009
In a prospective study, 20 patients with endoscopically proven duodenal ulcers were randomised to... more In a prospective study, 20 patients with endoscopically proven duodenal ulcers were randomised to be treated with cimetidine 1 g daily or with antacids 350 mmol daily. The duration of treatment was 30 days, but this was extended to three months in 3 patients in the cimetidine group and 4 patients in the antacid group. A morphological study of biopsies taken via a gastroscope from the corpus mucosa showed no change in mucosal height, parietal cell density per unit volume or changes in cellular infiltration after 30 and 90 days treatment in the two groups. Neither H‐2 receptor blockers nor antacids alter mucosal height or parietal cell density. Treatment was not found to induce gastritic changes in the mucosa.
The possibility that the gut peptide, neurotensin, may contribute to the dumping syndrome was inv... more The possibility that the gut peptide, neurotensin, may contribute to the dumping syndrome was investigated in 17 patients with a long history of dumping after a Billroth II gastrectomy for duodenal ulcer. After a test meal plasma levels of neurotensin were higher than in normal subjects, but no correlation to the severity of symptoms was found. In eight of the patients with meal-provoked dumping symptoms, intravenous infusion of neurotensin in relevant doses produced neither symptoms nor changes in blood glucose, blood pressure, or pulse rate. The apparent plasma half-life of neurotensin (t1/2 = 2.3 min) did not differ from that previously found in normal subjects. The results indicate that it is unlikely that neurotensin alone has a pathogenetic role in the dumping syndrome in gastrectomized patients.
ABSTRACT. Because of frequently recurring haemarthrosis which could not be controlled by conserva... more ABSTRACT. Because of frequently recurring haemarthrosis which could not be controlled by conservative management 19 haemophiliacs were subjected to synovectomy on a total of 23 joints—17 knees, S elbows, and 1 hip. The patients were followed for an average of 23 months. Primary postoperative complications occurred, in the form of recurrent bleeding, in 8 joints. Rehabilitation was often difficult and long‐lasting, and the range of joint motion was essentially restricted in 4 cases. After a follow‐up period exceeding 6 months the findings in the remaining, mobile 19 synovectomized joints were: 12 had been relieved of haemorrhage, 5 had rare and two frequent haemorrhages. The reduction in the number of haemorrhages was significant (p&lt;0.01). In the light of the complicated postoperative course it is concluded that synovectomy should be used only on strict indications, viz. only in otherwise intractable cases of progressing haemophilic arthropathy.
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 2009
Parietal cell density, mucosal height, grade of gastritis and pentagastrin‐stimulated acid produc... more Parietal cell density, mucosal height, grade of gastritis and pentagastrin‐stimulated acid production were assessed before and three months after parietal cell vagotomy (PCV) in 14 patients with duodenal ulcer. Parietal cell density was found to be unaltered after vagotomy and there was no difference in the parietal cell count in the neck and base of the glands. Both the basal acid production and the pentagastrin‐stimulated acid secretion were significantly reduced after PCV. No correlation could be shown between the stimulated acid production and the parietal cell count, either pre‐ or postoperatively, (r = 0,14 and r = 0,19). Mucosal height and grade of gastritic changes remained unchanged. It is concluded that PCV in duodenal ulcer patients causes no change in parietal cell density assessed at three months post‐operatively. Vagotomy causes no mucosal atrophy or gastritic changes within this period.
Background. Full thichness rectal prolapse is a disabling condition that is common in an ageing p... more Background. Full thichness rectal prolapse is a disabling condition that is common in an ageing population. Peri− neal operations are less traumatic than are abdominal procedures for the frail patient. Objectives. The aim of the study was to review the outcome with respect to control of the prolapse. Material and Methods. From 1985 to 2000 47 patients with rectal prolapse were treated with Altemeier’s proce− dure. The mean age was 75 years. Half of the patients suffered from medical diseases. Results. The recurrence rate was 15%. There were 2 postoperative deaths. 2 patients had anastomotic leaks. One patient had to be re−operated on because of bleeding. Conclusions. Altemeier’s procedure is a relatively easy and safe operation with a low recurrence rate (Adv. Clin. Exp. Med. 2003, 12, 4, 537–541).
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 2009
In a previous endoscopic follow-up examination of patients who 22-30 years before had undergone B... more In a previous endoscopic follow-up examination of patients who 22-30 years before had undergone Billroth II resection for duodenal ulcer the prevalence of dysplasia and carcinoma of the gastric remnant was 14.8 and 0%, respectively. In this second follow-up study five years later the figures had increased to 30.3 and 5.6%. It is uncertain whether these changes result from the higher number of biopsies taken at the re-examination or reflect a time-dependent rise in the morbidity. Although the observed prevalences may seem high, we do not find prophylactic endoscopic examination of such patients indicated, as other investigations by us have shown that the series of Billroth II resected patients under study does not show excess incidence or excess mortality of gastric carcinoma.
A double-blind, randomized study compared the healing of gastric ulcer during a twice-daily regim... more A double-blind, randomized study compared the healing of gastric ulcer during a twice-daily regimen of 2 g sucralfate or 400 mg cimetidine. The patients received the tablets one-half hour before breakfast and one-half hour before bedtime. The study included 76 patients with endoscopically proven gastric ulcer. Patients with ulcers less than 3 cm from the pyloric ring and patients with ulcers less than 3 mm in diameter were excluded from the study. Sixty-four patients completed the study. Healing was endoscopically assessed at four-week intervals for 12 weeks. After four, eight, and 12 weeks, the healing rates for cimetidine were 55, 81, and 94 percent, respectively; the healing rates for sucralfate were 52, 79, and 91 percent, respectively. No statistically significant difference was found between the two regimens. At 12 weeks, the risk of overlooking a difference in favor of one of the two dosage regimens was less than 20 percent. The results suggest that 2 g sucralfate twice daily is as effective in the healing of gastric ulcer as 400 mg cimetidine twice daily.
Pentagastrin-stimulated acid secretion and parietal cell density were studied in 51 patients with... more Pentagastrin-stimulated acid secretion and parietal cell density were studied in 51 patients with duodenal ulcer (DU) and 26 patients without ulcer disease (non-DU). Chronic gastritis was assessed for a comparative study between parietal cell density and grade as well as the extent of gastritis. Parietal cell density was estimated with a high degree of accuracy, since the difference in cell counts of two adjacent biopsies and the inter- and intra-observer variation never exceeded 10%. The density calculated from three regional biopsies was representative for the density of the entire corpus mucosa. Parietal cell density was similar in normal mucosa, superficial chronic gastritis and mild atrophic gastritis, while fewer parietal cells were found in severe chronic atrophic gastritis. Nonuniform distribution of chronic gastritis was more frequent in DU than in non-DU, and may explain the lack of correlation between acid secretion and parietal cell number. If severe chronic atrophic gastritis is found to be localized, parietal cell density investigations will require multiple biopsies.
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