Joar Svanvik | Linköping University (original) (raw)
Papers by Joar Svanvik
Carcinogenesis is a sophisticated biological process consisting of a series of progressive change... more Carcinogenesis is a sophisticated biological process consisting of a series of progressive changes in somatic cells from premalignant to malignant phenotype. Despite the vast information available about cancer cells, the origin of cancer and cause of metastasis still remain enigmatic. The hypothesis of cell fusion is one of several models explaining the evolution of neoplasia into clinically significant cancer. This theory states that cancer cells through heterotypic fusion with host cells generate hybrids expressing traits from both parental cells, and acquire metastatic potentials and growth-promoting properties. The cell fusion theory is still unproven and speculative, but cell fusion is a common biological process in normal tissue. Accumulated evidence shows that macrophage-cancer cell fusion occurs in vitro and in vivo and produces hybrids with metastatic potential, but the clinical significant of cell fusion is unclear. The aim of this thesis is to test this hypothesis in clinical patient materials and to explore the clinical significance of macrophage phenotype traits in solid tumours. Paraffin-embedded cancer and normal tissue specimens from patients with breast cancer (n=133) and colorectal cancer (two different patient materials with totally 240 patients) were immunostained for the macrophage-specific antigen, CD163. The expression of CD163 was tested in relation to macrophage infiltration and tumour stage, survival time, irradiation, DNA ploidy, cancer cell proliferation and apoptosis. Phenotypic macrophage traits, such as the expression of CD163, were seen in both breast and colorectal cancers, and were correlated to advanced tumour stages and poor survival. CD163 expression was more frequent in rectal cancer after irradiation and was associated with decreased apoptosis. Cancer cell proliferation was correlated to both macrophage infiltration and CD163 expression. Multivariate analysis showed that CD163 is a significant prognostic factor in both breast and colorectal cancers. In an attempt to examine factors related to the function of macrophage fusion, the expression of the signalling adaptor protein DAP12 was tested and related to CD163 expression in breast cancers from 133 patients. DAP12 was shown to occur in breast cancer cells and was related to high histologic tumour grade, skeletal and liver metastasis, and poor prognosis. The findings in this thesis support the cell fusion theory and illustrate its clinical impact on tumour progression and metastasis.
Clinical Breast Cancer, 2013
Macrophages are an important cellular factor in breast cancer (BRC) progression and metastasis. D... more Macrophages are an important cellular factor in breast cancer (BRC) progression and metastasis. DNAX activating protein of 12 kD (DAP12) is essential factor for macrophage fusion function. This study was conducted to investigate the expression and significance of DAP12 expression in BRC. DAP12 is expressed in BRC cells and associated with poor survival, liver metastases, and bone metastases. These data provide new insight into the pathophysiology of macrophages in BRC. Background: The transmembrane adapter protein, DAP12, transduces activation signals for several arrays of receptors, including human signal-regulatory protein, DAP12-associating lectin-1, triggering receptor expressed on myeloid cells-1,-2, and-3, in natural killer cells, granulocytes, monocytes/macrophages, and dendritic cells. The macrophage-specific antigen, Cluster of Differentiation 163 (CD163), is expressed in breast and colorectal cancers and is associated with early cancer recurrence and poor prognosis. It was recently shown that fusion between intestinal tumor cells and macrophages results in nuclear reprogramming with hybrid transcripts from both cells of origin. The role of DAP12 in the fusion process is not known. This study investigates the expression of DAP12 in BRC cells, and its relation to other macrophage traits and to the clinical progression of disease. Materials and Methods: Immunostaining of DAP12 and CD163 was performed and evaluated in paraffin-embedded specimens from 132 patients with BRC. The outcomes were analyzed in relation to clinicopathological data. Results: DAP12 expression in cancer cells was positive in 66 percent of the cancers and was associated with high tumor grade (P ¼ .015), and with liver (P ¼ .047) and skeletal (P ¼ .067), but not with lung metastases (P ¼ 1.00). Patients with BRC expressing DAP12 had poor prognosis, with higher recurrence rates of skeletal (P ¼ .018) and liver metastases (P ¼ .047), and shorter survival time (P ¼ .0060). Conclusion: We suggest that macrophage traits in BRC cells facilitate the metastatic process and that DAP12 expression might promote metastatic homing to bone and liver tissues.
Digestive Surgery, 2008
Background/Aims: To assess the differences in outcome of acute and elective laparoscopic cholecys... more Background/Aims: To assess the differences in outcome of acute and elective laparoscopic cholecystectomy. Methods: Data from 630 consecutive patients who presented for laparoscopic cholecystectomy due to acute cholecystitis (n = 98) or non-acute gallstone disease (n = 532) were studied prospectively. Results: The conversion rate was significantly higher for acute cholecystitis (33%) than for non-acute gallstone disease (4%). For acute cholecystitis the timing of operation was crucial to the execution of a successful laparoscopic procedure. The existence of a learning curve was demonstrated by the fact that the mean operation room time for elective cholecystectomy decreased from 105 to 87 min between the first and the second half of the study time, whereas no significant decrease in operation room time was recorded for acute operations. For both acute and elective patients, complication rates were significantly higher among those over the age of 70 years. General complications, largely cardiopulmonary, were more frequent after acute operations (14%) than after elective operations (0.6%), whereas procedure-related complications were not significantly different between the 2 groups (8 and 6%, respectively). In addition, the overall postoperative morbidity increased significantly for both the acute and elective group if the laparoscopic procedure was converted to an open operation. Conclusion: It is too early to proclaim laparoscopic cholecystectomy as the procedure of choice in acute cholecystitis. However, a policy of reducing the delay of operation after the onset of symptoms may reduce the incidence of complications and conversion rate.Copyright © 1997 S. Karger AG, Basel
Digestive Surgery, 1995
Trends regarding symptomatic (pancreatitis, jaundice, cholangitis; 221 patients) and asymptomatic... more Trends regarding symptomatic (pancreatitis, jaundice, cholangitis; 221 patients) and asymptomatic (detected at cholecystectomy; 333 patients) common bile duct stones were studied by comparing the period 1970-1978 with the period 1979-1986. There was a significant increase in the population-based incidence of symptomatic stones (8-20 cases/100,000 inhabitants/year) and a slight decrease in the rate of asymptomatic stones diagnosed at cholecystectomy (12-10 cases/100 cholecystectomies/year). The proportion of patients aged 70 years or more increased from 31 to 60% in the symptomatic group. The proportion of patients undergoing cholecystectomy with choledocholithotomy as the primary procedure decreased from 75 to 44%. During the second period, endoscopic sphincterotomy accounted for 81 % of all primary procedures among patients with symptomatic stones. The type of treatment disregarded, the frequency of clinically overt retained or recurrent stones increased from 7 to 22%. Overall, the frequency of general complications decreased from 9.1 to 4.5%, mainly due to a decrease in the symptomatic group. The frequency of procedure-related complications also decreased in the symptomatic group (25.4-14.9%), whereas it increased in the asymptomatic group (13.5-23.4%). The mortality rate decreased in both groups (symptomatic 14.9-5.2%, asymptomatic 3.4-1.3%). The total duration of stay in hospital decreased by 48% for patients with symptomatic stones and by 23% for those with asymptomatic stones. Possible explanations for these changes are discussed.Copyright © 1995 S. Karger AG, Basel
Scandinavian Journal of Gastroenterology, 1995
The gallbladder mucosa normally absorbs fluid and secretes H+ ions. The fluid secretion in inflam... more The gallbladder mucosa normally absorbs fluid and secretes H+ ions. The fluid secretion in inflamed gallbladders is induced by prostaglandins and mediated by intramural vasoactive intestinal peptide (VIP)-ergic nerves. The influence of inflammation on gallblader contents due to secretion of H+ into the lumen. In animals with inflamed gallbladder this acid secretion was reduced; there was secretion of HCO3- and no evident acidification of the gallbladder contents. Injection of VIP antiserum or indomethacin restored H+ secretion and inhibited HCO3- and fluid secretion by the inflamed gallbladder mucosa. An impaired acidification of the gallbladder contents due to mucosal inflammation may reduce the solubility of calcium salts in gallbladder bile and increase the risk of their precipitation in the lumen. Mucosal inflammation reduces H+ secretion and impairs acidification of the gallbladder contents.
Acta Radiologica, 1996
Small pulmonary subpleural nodules are sometimes difficult to localise at thoracotomy. With the a... more Small pulmonary subpleural nodules are sometimes difficult to localise at thoracotomy. With the advent of minimal invasive surgery, thoracoscopic resection avoiding anterolateral thoracotomy is an attractive procedure. Since this technique does not allow manual palpation, preoperative indication of lesions is mandatory. A simple and cost-effective system for preoperative CT-guided localisation of small subpleural nodules before thoracoscopic resection is described. Material and Methods: The system consists of a 0.2-mrn steel wire 30-40 cm in length and a 0.9-mm biopsy needle. The tip of the wire is bent to a hook, and, guided by CT, it is placed in the vicinity of the lesion. The technique was tested in 8 cases. Results: The procedure was possible to perform in 7 patients. In all instances the wire remained in place when the lung was collapsed during the thoracoscopic procedure. The staple resected part of the lung also contained the lesion when examined extracorporeally. Conclusion: This simple and inexpensive system was found to be useful for indication of pulmonary lesions at thoracoscopic wedge resections.
Scandinavian Journal of Gastroenterology, 1990
... Diseases of the respiratory and digestive systems. In: Oral contraceptives and health. L,ondo... more ... Diseases of the respiratory and digestive systems. In: Oral contraceptives and health. L,ondon,Pitham Medical, 1974, 5759 J 1984. 288, 1795-1799 ... McSherry KC, Dietrick JE, May PS, et al. Biliary lipid metabolism in the pregnant baboon. Ann Surg 1971, 173, 569-577 12. ...
Pancreas, 2005
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > January ...
Läkartidningen, Jan 30, 1994
Woods, CM, Sandstrom, P., Bond, ME, Michael, MZ, Svanvik, J., Toouli, J., & Saccone, GT, 2007. Se... more Woods, CM, Sandstrom, P., Bond, ME, Michael, MZ, Svanvik, J., Toouli, J., & Saccone, GT, 2007. Selective iNOS inhibition enhances spontaneous gallbladder motility in the Australian possum. Neurogastroenterology and Motility, 19(6), 497-503.
The American Journal of Surgery, 1981
Biliary sludge is a frequent finding on abdominal sonography. It is most often found after prolon... more Biliary sludge is a frequent finding on abdominal sonography. It is most often found after prolonged stasis of gallbladder bile associated with other illness or mechanical obstruction of the common duct, and seldom indicates primary gallbladder disease. In most cases, sludge is a suspension of pigment precipitates in bile, and is at least in part calcium bilirubinate. Sludge may disappear with the return of normal gallbladder contractility. The ease with which this precipitate forms during stasis of gallbladder bile suggests a role for this process in the pathogenesis of cholelithiasis.
European Journal of Surgery, 2000
Laparoscopic cholecystectomy was introduced in 1985 and diffused within a few years throughout th... more Laparoscopic cholecystectomy was introduced in 1985 and diffused within a few years throughout the world. The avalanche-like spread resulted in this procedure not being scientifically supported by results of controlled clinical trials. By 1997 there were just 13 randomised controlled trials and 150 prospective studies that followed a research protocol, while there were more than 1500 retrospective analyses of series of operations in a country, in a specific hospital, or by a specific surgeon. Comparisons with the conventional laparotomy technique and with minilaparotomy techniques are complicated by the fact that the variables compared, such as operation times, complication rates, and costs, varied over time.
Digestive diseases and sciences, 1998
Gallbladder mucosal absorption of fluid during fasting is a well-known process. Indirect in vivo ... more Gallbladder mucosal absorption of fluid during fasting is a well-known process. Indirect in vivo and recent in vitro evidence for physiologically relevant gallbladder absorption of cholesterol and phospholipids from bile has been observed in humans. The present study explored and compared by indirect means the relative efficiences of human gallbladder mucosal absorption of fluid and lipids in health and disease. Biliary lipids and pigment content were measured in fasting gallbladder bile samples obtained from gallstone-free controls and from four study groups: multiple and solitary cholesterol gallstone patients, and morbidly obese subjects with and without gallstones. Bile salts and pigment content were significantly greater in gallstone-free controls than in all other disease study groups. This was interpreted as evidence of more effective gallbladder mucosal fluid absorption in nonobese gallstone-free controls compared to that in all other groups. Correlation plot analyses of bil...
Transplant International
Acute rejection, occurring with a reported frequency of 50-70%, is still a dominating problem aft... more Acute rejection, occurring with a reported frequency of 50-70%, is still a dominating problem after liver transplantation. Medication with ursodeoxycholic acid (UDCA) has beneficial effects in different cholestatic conditions and has also been shown to reduce HLA class I antigen expression on hepatocytes in patients with PBC. Since August 1989 we have consecutively treated all patients with primary graft function with UDCA (n = 41). Patients transplanted in the first half of 1989 served as a control group (n = 8). All patients in this study were given sequential quadruple drug immunosuppression. The treatment group were given oral UDCA 10 mg/kg per day. During the first postoperative month, 17% of the UDCA-treated patients had an episode of acute rejection compared with 75% of the control patients (P < 0.01). Liver biochemistry tests 1 month postoperatively were significantly better in patients treated with UDCA. The results suggest that adjuvant treatment with UDCA reduces acute...
Advances in Experimental Medicine and Biology, 2011
Macrophages are a heterogeneous cell population of the myeloid linage derived from monocytes. The... more Macrophages are a heterogeneous cell population of the myeloid linage derived from monocytes. These cells show two different polarization states, M1 and M2 macrophages in response to different micro environmental signals. Tumor associated macrophages (TAM) represent the M2 type and promote tumor progression. These cells express antigens that more or less are specific for macrophages like: CD14, CD68, MAC387, CD163, and DAP12. In a series of recent studies it is shown that cancer cells may express these antigens and CD163, MAC387 and DAP12 may be expressed by e.g. breast cancer cells. Thus, 48% of the breast cancers expressed CD163 that is a scavenger receptor normally expressed by macrophages alone. The corresponding figure for rectal cancer is 31%. The expression of CD163 is correlated to early distant recurrence in breast cancer and local recurrence in rectal cancer and reduced survival time in both conditions. Expression of macrophage antigens in breast- and colorectal-cancers may have a prognostic relevance in clinical praxis. One explanation to these findings is that resemblance with macrophages may indicate a more invasive phenotype due to genetic exchange between the primary tumor cells and associated macrophages. This is further supported by the finding that expression of DAP12, a macrophage fusion receptor, in breast cancer is associated with an advanced tumor grade and higher rates of skeletal and liver metastases and overall shorter distant recurrence free survival. Another explanation to the changed phenotype is a genetic exchange between the cells by exosome-mediated transfer.
Scandinavian Journal of Gastroenterology, 1983
The effects of electrical stimulation of the vagus nerves on the function of the feline gallbladd... more The effects of electrical stimulation of the vagus nerves on the function of the feline gallbladder and hepatic bile outflow were studied with a perfusion technique in vivo. After elimination of the muscarinic receptors with atropine, efferent stimulation of the cut vagus nerve in the neck relaxed the gallbladder, reduced the net water absorption rate across its wall, and increased the bile outflow from the liver. The results imply that the concentrating function of the gallbladder and the bile formation in the liver are under regulatory control by noncholinergic, nonadrenergic nerve fibres in the vagus nerves.
Scandinavian Journal of Gastroenterology, 1997
Despite solute dilution and reduced total lipid concentrations, an unexplained increase in protei... more Despite solute dilution and reduced total lipid concentrations, an unexplained increase in protein concentration has been reported to occur in the gallbladder bile of cholesterol gallstone patients. Solutes in gallbladder bile from gallstone-free controls and from four study groups were measured using standard methods. Total proteins were measured using amino acid analysis and a conventional fluorescamine method. Bile salts and pigment content were greater in gallstone-free controls than in all other study groups, including morbidly obese gallstone-free subjects. Total biliary protein concentration, as determined by amino acid analysis in the gallstone-free control group was higher than in non-obese gallstone patients with multiple stones and in morbidly obese gallstone-free subjects. Total biliary proteins as measured with fluorescamine, however, did not show intergroup differences. A major problem of the conventional fluorescamine assay is shown to be an artefact arising from the high pigment content of the more concentrated samples. Very dilute gallbladder bile samples are often found in the presence of gallstone disease. This also occurs in morbidly obese subjects, even in the absence of gallstones. Although the contribution of protein secretion/absorption by the gallbladder can also be relevant, especially in the presence of morbid obesity, the protein concentration in gallbladder bile, when accurately measured, generally parallels the concentrations of non-absorbed biliary solutes, reflecting the efficiency of fluid absorption. Measurement of biliary proteins by the conventional fluorescamine method is unreliable in clinical studies in which intergroup differences in pigment content are commonly present.
Scandinavian Journal of Gastroenterology, 1981
The effects of intra-arterial infusion of prostaglandin E2 on gallbladder concentrating function,... more The effects of intra-arterial infusion of prostaglandin E2 on gallbladder concentrating function, motility, and hepatic bile flow were studied simultaneously in the anesthetized cat by means of a perfusion technique. Prostaglandin E2 reversibly inhibited gallbladder net fluid absorption and in some cases reversed the direction of transport to a net fluid secretion. A contraction of the gallbladder and an increased flow of hepatic bile were seen during prostaglandin infusion. The results are discussed in relation to the role of prostaglandins in the pathophysiology of cholecystitis.
Carcinogenesis is a sophisticated biological process consisting of a series of progressive change... more Carcinogenesis is a sophisticated biological process consisting of a series of progressive changes in somatic cells from premalignant to malignant phenotype. Despite the vast information available about cancer cells, the origin of cancer and cause of metastasis still remain enigmatic. The hypothesis of cell fusion is one of several models explaining the evolution of neoplasia into clinically significant cancer. This theory states that cancer cells through heterotypic fusion with host cells generate hybrids expressing traits from both parental cells, and acquire metastatic potentials and growth-promoting properties. The cell fusion theory is still unproven and speculative, but cell fusion is a common biological process in normal tissue. Accumulated evidence shows that macrophage-cancer cell fusion occurs in vitro and in vivo and produces hybrids with metastatic potential, but the clinical significant of cell fusion is unclear. The aim of this thesis is to test this hypothesis in clinical patient materials and to explore the clinical significance of macrophage phenotype traits in solid tumours. Paraffin-embedded cancer and normal tissue specimens from patients with breast cancer (n=133) and colorectal cancer (two different patient materials with totally 240 patients) were immunostained for the macrophage-specific antigen, CD163. The expression of CD163 was tested in relation to macrophage infiltration and tumour stage, survival time, irradiation, DNA ploidy, cancer cell proliferation and apoptosis. Phenotypic macrophage traits, such as the expression of CD163, were seen in both breast and colorectal cancers, and were correlated to advanced tumour stages and poor survival. CD163 expression was more frequent in rectal cancer after irradiation and was associated with decreased apoptosis. Cancer cell proliferation was correlated to both macrophage infiltration and CD163 expression. Multivariate analysis showed that CD163 is a significant prognostic factor in both breast and colorectal cancers. In an attempt to examine factors related to the function of macrophage fusion, the expression of the signalling adaptor protein DAP12 was tested and related to CD163 expression in breast cancers from 133 patients. DAP12 was shown to occur in breast cancer cells and was related to high histologic tumour grade, skeletal and liver metastasis, and poor prognosis. The findings in this thesis support the cell fusion theory and illustrate its clinical impact on tumour progression and metastasis.
Clinical Breast Cancer, 2013
Macrophages are an important cellular factor in breast cancer (BRC) progression and metastasis. D... more Macrophages are an important cellular factor in breast cancer (BRC) progression and metastasis. DNAX activating protein of 12 kD (DAP12) is essential factor for macrophage fusion function. This study was conducted to investigate the expression and significance of DAP12 expression in BRC. DAP12 is expressed in BRC cells and associated with poor survival, liver metastases, and bone metastases. These data provide new insight into the pathophysiology of macrophages in BRC. Background: The transmembrane adapter protein, DAP12, transduces activation signals for several arrays of receptors, including human signal-regulatory protein, DAP12-associating lectin-1, triggering receptor expressed on myeloid cells-1,-2, and-3, in natural killer cells, granulocytes, monocytes/macrophages, and dendritic cells. The macrophage-specific antigen, Cluster of Differentiation 163 (CD163), is expressed in breast and colorectal cancers and is associated with early cancer recurrence and poor prognosis. It was recently shown that fusion between intestinal tumor cells and macrophages results in nuclear reprogramming with hybrid transcripts from both cells of origin. The role of DAP12 in the fusion process is not known. This study investigates the expression of DAP12 in BRC cells, and its relation to other macrophage traits and to the clinical progression of disease. Materials and Methods: Immunostaining of DAP12 and CD163 was performed and evaluated in paraffin-embedded specimens from 132 patients with BRC. The outcomes were analyzed in relation to clinicopathological data. Results: DAP12 expression in cancer cells was positive in 66 percent of the cancers and was associated with high tumor grade (P ¼ .015), and with liver (P ¼ .047) and skeletal (P ¼ .067), but not with lung metastases (P ¼ 1.00). Patients with BRC expressing DAP12 had poor prognosis, with higher recurrence rates of skeletal (P ¼ .018) and liver metastases (P ¼ .047), and shorter survival time (P ¼ .0060). Conclusion: We suggest that macrophage traits in BRC cells facilitate the metastatic process and that DAP12 expression might promote metastatic homing to bone and liver tissues.
Digestive Surgery, 2008
Background/Aims: To assess the differences in outcome of acute and elective laparoscopic cholecys... more Background/Aims: To assess the differences in outcome of acute and elective laparoscopic cholecystectomy. Methods: Data from 630 consecutive patients who presented for laparoscopic cholecystectomy due to acute cholecystitis (n = 98) or non-acute gallstone disease (n = 532) were studied prospectively. Results: The conversion rate was significantly higher for acute cholecystitis (33%) than for non-acute gallstone disease (4%). For acute cholecystitis the timing of operation was crucial to the execution of a successful laparoscopic procedure. The existence of a learning curve was demonstrated by the fact that the mean operation room time for elective cholecystectomy decreased from 105 to 87 min between the first and the second half of the study time, whereas no significant decrease in operation room time was recorded for acute operations. For both acute and elective patients, complication rates were significantly higher among those over the age of 70 years. General complications, largely cardiopulmonary, were more frequent after acute operations (14%) than after elective operations (0.6%), whereas procedure-related complications were not significantly different between the 2 groups (8 and 6%, respectively). In addition, the overall postoperative morbidity increased significantly for both the acute and elective group if the laparoscopic procedure was converted to an open operation. Conclusion: It is too early to proclaim laparoscopic cholecystectomy as the procedure of choice in acute cholecystitis. However, a policy of reducing the delay of operation after the onset of symptoms may reduce the incidence of complications and conversion rate.Copyright © 1997 S. Karger AG, Basel
Digestive Surgery, 1995
Trends regarding symptomatic (pancreatitis, jaundice, cholangitis; 221 patients) and asymptomatic... more Trends regarding symptomatic (pancreatitis, jaundice, cholangitis; 221 patients) and asymptomatic (detected at cholecystectomy; 333 patients) common bile duct stones were studied by comparing the period 1970-1978 with the period 1979-1986. There was a significant increase in the population-based incidence of symptomatic stones (8-20 cases/100,000 inhabitants/year) and a slight decrease in the rate of asymptomatic stones diagnosed at cholecystectomy (12-10 cases/100 cholecystectomies/year). The proportion of patients aged 70 years or more increased from 31 to 60% in the symptomatic group. The proportion of patients undergoing cholecystectomy with choledocholithotomy as the primary procedure decreased from 75 to 44%. During the second period, endoscopic sphincterotomy accounted for 81 % of all primary procedures among patients with symptomatic stones. The type of treatment disregarded, the frequency of clinically overt retained or recurrent stones increased from 7 to 22%. Overall, the frequency of general complications decreased from 9.1 to 4.5%, mainly due to a decrease in the symptomatic group. The frequency of procedure-related complications also decreased in the symptomatic group (25.4-14.9%), whereas it increased in the asymptomatic group (13.5-23.4%). The mortality rate decreased in both groups (symptomatic 14.9-5.2%, asymptomatic 3.4-1.3%). The total duration of stay in hospital decreased by 48% for patients with symptomatic stones and by 23% for those with asymptomatic stones. Possible explanations for these changes are discussed.Copyright © 1995 S. Karger AG, Basel
Scandinavian Journal of Gastroenterology, 1995
The gallbladder mucosa normally absorbs fluid and secretes H+ ions. The fluid secretion in inflam... more The gallbladder mucosa normally absorbs fluid and secretes H+ ions. The fluid secretion in inflamed gallbladders is induced by prostaglandins and mediated by intramural vasoactive intestinal peptide (VIP)-ergic nerves. The influence of inflammation on gallblader contents due to secretion of H+ into the lumen. In animals with inflamed gallbladder this acid secretion was reduced; there was secretion of HCO3- and no evident acidification of the gallbladder contents. Injection of VIP antiserum or indomethacin restored H+ secretion and inhibited HCO3- and fluid secretion by the inflamed gallbladder mucosa. An impaired acidification of the gallbladder contents due to mucosal inflammation may reduce the solubility of calcium salts in gallbladder bile and increase the risk of their precipitation in the lumen. Mucosal inflammation reduces H+ secretion and impairs acidification of the gallbladder contents.
Acta Radiologica, 1996
Small pulmonary subpleural nodules are sometimes difficult to localise at thoracotomy. With the a... more Small pulmonary subpleural nodules are sometimes difficult to localise at thoracotomy. With the advent of minimal invasive surgery, thoracoscopic resection avoiding anterolateral thoracotomy is an attractive procedure. Since this technique does not allow manual palpation, preoperative indication of lesions is mandatory. A simple and cost-effective system for preoperative CT-guided localisation of small subpleural nodules before thoracoscopic resection is described. Material and Methods: The system consists of a 0.2-mrn steel wire 30-40 cm in length and a 0.9-mm biopsy needle. The tip of the wire is bent to a hook, and, guided by CT, it is placed in the vicinity of the lesion. The technique was tested in 8 cases. Results: The procedure was possible to perform in 7 patients. In all instances the wire remained in place when the lung was collapsed during the thoracoscopic procedure. The staple resected part of the lung also contained the lesion when examined extracorporeally. Conclusion: This simple and inexpensive system was found to be useful for indication of pulmonary lesions at thoracoscopic wedge resections.
Scandinavian Journal of Gastroenterology, 1990
... Diseases of the respiratory and digestive systems. In: Oral contraceptives and health. L,ondo... more ... Diseases of the respiratory and digestive systems. In: Oral contraceptives and health. L,ondon,Pitham Medical, 1974, 5759 J 1984. 288, 1795-1799 ... McSherry KC, Dietrick JE, May PS, et al. Biliary lipid metabolism in the pregnant baboon. Ann Surg 1971, 173, 569-577 12. ...
Pancreas, 2005
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > January ...
Läkartidningen, Jan 30, 1994
Woods, CM, Sandstrom, P., Bond, ME, Michael, MZ, Svanvik, J., Toouli, J., & Saccone, GT, 2007. Se... more Woods, CM, Sandstrom, P., Bond, ME, Michael, MZ, Svanvik, J., Toouli, J., & Saccone, GT, 2007. Selective iNOS inhibition enhances spontaneous gallbladder motility in the Australian possum. Neurogastroenterology and Motility, 19(6), 497-503.
The American Journal of Surgery, 1981
Biliary sludge is a frequent finding on abdominal sonography. It is most often found after prolon... more Biliary sludge is a frequent finding on abdominal sonography. It is most often found after prolonged stasis of gallbladder bile associated with other illness or mechanical obstruction of the common duct, and seldom indicates primary gallbladder disease. In most cases, sludge is a suspension of pigment precipitates in bile, and is at least in part calcium bilirubinate. Sludge may disappear with the return of normal gallbladder contractility. The ease with which this precipitate forms during stasis of gallbladder bile suggests a role for this process in the pathogenesis of cholelithiasis.
European Journal of Surgery, 2000
Laparoscopic cholecystectomy was introduced in 1985 and diffused within a few years throughout th... more Laparoscopic cholecystectomy was introduced in 1985 and diffused within a few years throughout the world. The avalanche-like spread resulted in this procedure not being scientifically supported by results of controlled clinical trials. By 1997 there were just 13 randomised controlled trials and 150 prospective studies that followed a research protocol, while there were more than 1500 retrospective analyses of series of operations in a country, in a specific hospital, or by a specific surgeon. Comparisons with the conventional laparotomy technique and with minilaparotomy techniques are complicated by the fact that the variables compared, such as operation times, complication rates, and costs, varied over time.
Digestive diseases and sciences, 1998
Gallbladder mucosal absorption of fluid during fasting is a well-known process. Indirect in vivo ... more Gallbladder mucosal absorption of fluid during fasting is a well-known process. Indirect in vivo and recent in vitro evidence for physiologically relevant gallbladder absorption of cholesterol and phospholipids from bile has been observed in humans. The present study explored and compared by indirect means the relative efficiences of human gallbladder mucosal absorption of fluid and lipids in health and disease. Biliary lipids and pigment content were measured in fasting gallbladder bile samples obtained from gallstone-free controls and from four study groups: multiple and solitary cholesterol gallstone patients, and morbidly obese subjects with and without gallstones. Bile salts and pigment content were significantly greater in gallstone-free controls than in all other disease study groups. This was interpreted as evidence of more effective gallbladder mucosal fluid absorption in nonobese gallstone-free controls compared to that in all other groups. Correlation plot analyses of bil...
Transplant International
Acute rejection, occurring with a reported frequency of 50-70%, is still a dominating problem aft... more Acute rejection, occurring with a reported frequency of 50-70%, is still a dominating problem after liver transplantation. Medication with ursodeoxycholic acid (UDCA) has beneficial effects in different cholestatic conditions and has also been shown to reduce HLA class I antigen expression on hepatocytes in patients with PBC. Since August 1989 we have consecutively treated all patients with primary graft function with UDCA (n = 41). Patients transplanted in the first half of 1989 served as a control group (n = 8). All patients in this study were given sequential quadruple drug immunosuppression. The treatment group were given oral UDCA 10 mg/kg per day. During the first postoperative month, 17% of the UDCA-treated patients had an episode of acute rejection compared with 75% of the control patients (P < 0.01). Liver biochemistry tests 1 month postoperatively were significantly better in patients treated with UDCA. The results suggest that adjuvant treatment with UDCA reduces acute...
Advances in Experimental Medicine and Biology, 2011
Macrophages are a heterogeneous cell population of the myeloid linage derived from monocytes. The... more Macrophages are a heterogeneous cell population of the myeloid linage derived from monocytes. These cells show two different polarization states, M1 and M2 macrophages in response to different micro environmental signals. Tumor associated macrophages (TAM) represent the M2 type and promote tumor progression. These cells express antigens that more or less are specific for macrophages like: CD14, CD68, MAC387, CD163, and DAP12. In a series of recent studies it is shown that cancer cells may express these antigens and CD163, MAC387 and DAP12 may be expressed by e.g. breast cancer cells. Thus, 48% of the breast cancers expressed CD163 that is a scavenger receptor normally expressed by macrophages alone. The corresponding figure for rectal cancer is 31%. The expression of CD163 is correlated to early distant recurrence in breast cancer and local recurrence in rectal cancer and reduced survival time in both conditions. Expression of macrophage antigens in breast- and colorectal-cancers may have a prognostic relevance in clinical praxis. One explanation to these findings is that resemblance with macrophages may indicate a more invasive phenotype due to genetic exchange between the primary tumor cells and associated macrophages. This is further supported by the finding that expression of DAP12, a macrophage fusion receptor, in breast cancer is associated with an advanced tumor grade and higher rates of skeletal and liver metastases and overall shorter distant recurrence free survival. Another explanation to the changed phenotype is a genetic exchange between the cells by exosome-mediated transfer.
Scandinavian Journal of Gastroenterology, 1983
The effects of electrical stimulation of the vagus nerves on the function of the feline gallbladd... more The effects of electrical stimulation of the vagus nerves on the function of the feline gallbladder and hepatic bile outflow were studied with a perfusion technique in vivo. After elimination of the muscarinic receptors with atropine, efferent stimulation of the cut vagus nerve in the neck relaxed the gallbladder, reduced the net water absorption rate across its wall, and increased the bile outflow from the liver. The results imply that the concentrating function of the gallbladder and the bile formation in the liver are under regulatory control by noncholinergic, nonadrenergic nerve fibres in the vagus nerves.
Scandinavian Journal of Gastroenterology, 1997
Despite solute dilution and reduced total lipid concentrations, an unexplained increase in protei... more Despite solute dilution and reduced total lipid concentrations, an unexplained increase in protein concentration has been reported to occur in the gallbladder bile of cholesterol gallstone patients. Solutes in gallbladder bile from gallstone-free controls and from four study groups were measured using standard methods. Total proteins were measured using amino acid analysis and a conventional fluorescamine method. Bile salts and pigment content were greater in gallstone-free controls than in all other study groups, including morbidly obese gallstone-free subjects. Total biliary protein concentration, as determined by amino acid analysis in the gallstone-free control group was higher than in non-obese gallstone patients with multiple stones and in morbidly obese gallstone-free subjects. Total biliary proteins as measured with fluorescamine, however, did not show intergroup differences. A major problem of the conventional fluorescamine assay is shown to be an artefact arising from the high pigment content of the more concentrated samples. Very dilute gallbladder bile samples are often found in the presence of gallstone disease. This also occurs in morbidly obese subjects, even in the absence of gallstones. Although the contribution of protein secretion/absorption by the gallbladder can also be relevant, especially in the presence of morbid obesity, the protein concentration in gallbladder bile, when accurately measured, generally parallels the concentrations of non-absorbed biliary solutes, reflecting the efficiency of fluid absorption. Measurement of biliary proteins by the conventional fluorescamine method is unreliable in clinical studies in which intergroup differences in pigment content are commonly present.
Scandinavian Journal of Gastroenterology, 1981
The effects of intra-arterial infusion of prostaglandin E2 on gallbladder concentrating function,... more The effects of intra-arterial infusion of prostaglandin E2 on gallbladder concentrating function, motility, and hepatic bile flow were studied simultaneously in the anesthetized cat by means of a perfusion technique. Prostaglandin E2 reversibly inhibited gallbladder net fluid absorption and in some cases reversed the direction of transport to a net fluid secretion. A contraction of the gallbladder and an increased flow of hepatic bile were seen during prostaglandin infusion. The results are discussed in relation to the role of prostaglandins in the pathophysiology of cholecystitis.