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Blind, Per-Jonas
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Publications (6 of 6) Show all publications
Winsö, O., Kral, J., Wang, W., Kralova, I., Abrahamsson, P., Johansson, G. & Blind, P.-J. (2018). Thoracic epidural anaesthesia reduces insulin resistance and inflammatory response in experimental acute pancreatitis. Upsala Journal of Medical Sciences, 123(4), 207-215
Open this publication in new window or tab >>Thoracic epidural anaesthesia reduces insulin resistance and inflammatory response in experimental acute pancreatitis
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2018 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 4, p. 207-215Article in journal (Refereed) Published
Abstract [en]

AIMS: The activity of the sympathetic nervous system (SNS) is crucial at an early stage in the development of an inflammatory reaction. A study of metabolic events globally and locally in the early phase of acute pancreatitis (AP), implying hampered SNS activity, is lacking. We hypothesized that thoracic epidural anaesthesia (TEA) modulates the inflammatory response and alleviates the severity of AP in pigs.

MATERIAL AND METHODS: The taurocholate (TC) group (n = 8) had only TC AP. The TC + TEA group (n = 8) had AP and TEA. A control group (n = 8) underwent all the preparations, without having AP or TEA. Metabolic changes in the pancreas were evaluated by microdialysis and by histopathological examination.

RESULTS: The relative increase in serum lipase concentrations was more pronounced in the TC group than in TC + TEA and control groups. A decrease in relative tissue oxygen tension (PtiO2) levels occurred one hour later in the TC + TEA group than in the TC group. The maintenance of normoglycaemia in the TC group required a higher glucose infusion rate than in the TC + TEA group. The relative decrease in serum insulin concentrations was most pronounced in the TC + TEA group.

CONCLUSION: TEA attenuates the development of AP, as indicated by changes observed in haemodynamic parameters and by the easier maintenance of glucose homeostasis. Further, TEA was associated with attenuated insulin resistance and fewer local pathophysiological events.

Place, publisher, year, edition, pages
Abingdon: Taylor & Francis, 2018
Keywords
Acute pancreatitis, epidural anaesthesia, insulin, microdialysis, sodium-taurocholic acid, sympathetic nervous system
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
urn:nbn:se:umu:diva-153672 (URN)10.1080/03009734.2018.1539054 (DOI)000455702800003 ()30468105 (PubMedID)
Available from: 2018-11-26 Created: 2018-11-26 Last updated: 2019-02-25Bibliographically approved
Abrahamsson, P., Johansson, G., Åberg, A.-M., Winsö, O. & Blind, P. J. (2016). Outcome of microdialysis sampling on liver surface and parenchyma. Journal of Surgical Research, 200(2), 480-487
Open this publication in new window or tab >>Outcome of microdialysis sampling on liver surface and parenchyma
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2016 (English)In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 200, no 2, p. 480-487Article in journal (Refereed) Published
Abstract [en]

Background: To investigate whether surface microdialysis (μD) sampling in probes covered by a plastic film, as compared to noncovered and to intraparenchymatous probes, would increase the technique's sensitivity for pathophysiologic events occurring in a liver ischemia-reperfusion model. Placement of μD probes in the parenchyma of an organ, as is conventionally done, may cause adverse effects, e.g., bleeding, possibly influencing outcome.

Methods: A transient ischemia-reperfusion model of the liver was used in six anesthetized normoventilated pigs. μD probes were placed in the parenchyma and on the liver surface. Surface probes were either left uncovered or were covered by plastic film.

Results: Lactate and glucose levels were significantly higher in plastic film covered probes than in uncovered surface probes throughout the ischemic period. Glycerol levels were significantly higher in plastic film covered probes than in uncovered surface probes at 30 and 45 min into ischemia.

Conclusions: Covering the μD probe increases the sensibility of the μD–technique in monitoring an ischemic insult and reperfusion in the liver. These findings confirm that the principle of surface μD works, possibly replacing need of intraparenchymatous placement of μD probes. Surface μD seemingly allows, noninvasively from an organ's surface, via the extracellular compartment, assessment of intracellular metabolic events. The finding that covered surface μD probes allows detection of local metabolic changes earlier than do intraparenchymatous probes, merit further investigation focusing on μD probe design.

Keywords
Microdialysis, Liver, Ischemia, Reperfusion, Surface probe, Metabolism
National Category
Physiology Biomedical Laboratory Science/Technology Surgery
Identifiers
urn:nbn:se:umu:diva-112153 (URN)10.1016/j.jss.2015.09.009 (DOI)000366841500010 ()26505659 (PubMedID)
Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2018-06-07Bibliographically approved
Åkesson, O., Abrahamsson, P., Johansson, G. & Blind, P.-J. (2016). Surface microdialysis on small bowel serosa in monitoring of ischemia. Journal of Surgical Research, 204(1), 39-46
Open this publication in new window or tab >>Surface microdialysis on small bowel serosa in monitoring of ischemia
2016 (English)In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 204, no 1, p. 39-46Article in journal (Refereed) Published
Abstract [en]

Background: Ischemic injury of an organ causes metabolic change from aerobic to anaerobic metabolism. It has been shown in experimental studies on the heart and liver that such conversion may be detected by conventional microdialysis probes placed intraparenchymatously, as well as on organ surfaces, by assaying lactate, pyruvate, glucose, and glycerol in dialysate. We developed a microdialysis probe (S-mu D) intended for use solely on organ surfaces. The aim of this study was to assess whether the newly developed S-mu D probe could be used for detection and monitoring of small bowel ischemia. Methods: In anesthetized normoventilated pigs, a control S-mu D probe was applied on the jejunal serosa 50 cm downstream from the duodenojejunal junction (DJJ). Starting 100 cm from DJJ, a 100-cm long ischemic segment was created by division of all mesenteric vessels. S-mu Ds were applied at 2.5, 5, 20, and 50 cm from the starting point of ischemia by serosal sutures. A standard mu D probe was placed in the abdominal cavity as a further control. Dialysate was harvested before inducing ischemia and subsequently every 20 min for 4 h. Central venous blood was drawn every hour to monitor systemic lactate, C-reactive protein, and white blood cell count. Results: Microdialysis lactate levels were significantly higher than baseline from 20 min on into protocol time in the ischemic segment and in the control S-mu D probe. The peritoneal cavity probe showed no significant elevation. Lactate levels from the ischemic segment reached a plateau at 60 min. Courses of pyruvate, glucose, and glycerol levels were in accordance with transition from an aerobic to anaerobic metabolism in the bowel wall. No statistically significant changes in hemoglobin, white blood cell count, or lactate values in central venous blood were recorded. Conclusions: Assaying the aforementioned compounds in dialysate, harvested by the newly developed S-mu D probe, allowed detection and monitoring of small bowel ischemia from 20 min on following its onset.

Keywords
Surface microdialysis, Bowel, Ischemia, Pig, Experimental surgery
National Category
Surgery Anesthesiology and Intensive Care Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-125597 (URN)10.1016/j.jss.2016.04.001 (DOI)000380750000008 ()27451866 (PubMedID)
Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2018-06-07Bibliographically approved
Blind, P.-J., Andersson, B., Tingstedt, B., Bergenfeldt, M., Andersson, R., Lindell, G. & Sturesson, C. (2014). Fast-track program for liver resection: factors prolonging length of stay. Hepato-Gastroenterology, 61(136), 2340-2344
Open this publication in new window or tab >>Fast-track program for liver resection: factors prolonging length of stay
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2014 (English)In: Hepato-Gastroenterology, ISSN 0172-6390, Vol. 61, no 136, p. 2340-2344Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/AIMS: Fast-track programs involving multi-modal measures to enhance recovery after surgery, reduce morbidity and decrease hospital length of stay (LOS) are used for different major surgical procedures. For liver resections, factors influencing LOS within a fast-track program have been studied only to a limited extent, which was the aim of the present study.

METHODOLOGY: The present study comprises the first 64 patients included in a fast-track program for liver resections introduced in March 2012. Patient outcomes were compared to a historical cohort of patients (n=62) operated in 2009. Factors prolonging LOS was analyzed by uni- and multivariate analysis.

RESULTS: Median LOS was 6 days (range 3-42 days) within the fast-track program as compared with 8 days (range 5-47 days) in the historical cohort (P=0.004). On multivariate analysis, factors increasing LOS in the fast-track group were found to be the presence of complication (P=0.018), extent of resection (major as compared to minor) (P=0.001) and inability to drink > 1250 ml on the day after surgery (P=0.002).

CONCLUSION: Patients who can only drink limited amounts of fluid the day after liver resection represent a subset of patients that should be given special attention within a fast-track program.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-102772 (URN)10.5754/hge13687 (DOI)000346326500039 ()25699379 (PubMedID)
Available from: 2015-05-04 Created: 2015-05-04 Last updated: 2018-11-28Bibliographically approved
Nilsson, J., Eriksson, S., Blind, P.-J., Rissler, P. & Sturesson, C. (2014). Microcirculation changes during liver resection: a clinical study. Microvascular Research, 94, 47-51
Open this publication in new window or tab >>Microcirculation changes during liver resection: a clinical study
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2014 (English)In: Microvascular Research, ISSN 0026-2862, E-ISSN 1095-9319, Vol. 94, p. 47-51Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In this study we aimed to evaluate effects of liver resection on hepatic microcirculation. In addition we wanted to study if histological liver damage could be detected intra-operatively.

PATIENTS AND METHODS: 40 patients undergoing hepatic resection were included and grouped according to if they were operated with a major or minor resection. Hepatic microcirculation measurements were made intra-operatively before and after liver resection with sidestream dark-field (SDF) imaging. Red blood cell velocity (RBCV), sinusoidal diameter and functional sinusoidal density were determined.

RESULTS: After hepatic resection RBCV increased in both the minor and major groups (44 μm/s, P=0.016 and 121 μm/s, P=0.002). RBCV in patients with histological damages was 225 (148-464) μm/s vs. 161 (118-329) μm/s in patients with no damage (P=0.016).

CONCLUSION: A hepatic resection leads to an increase of sinusoidal RBCV. SDF imaging could potentially be used to intraoperatively identify histological damages.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-102773 (URN)10.1016/j.mvr.2014.05.002 (DOI)000339858000007 ()24840670 (PubMedID)
Available from: 2015-05-04 Created: 2015-05-04 Last updated: 2018-06-07Bibliographically approved
Blind, P. J. (1994). Carboxylic ester hydrolase in acute pancreatitis: a clinical and experimental study. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Carboxylic ester hydrolase in acute pancreatitis: a clinical and experimental study
1994 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Diagnosis of acute pancreatitis (AP) is erroneous in up to one third of patients when based on clinical criteria and elevated serum amylase values. Furthermore, according to autopsy reports fatal pancreatitis remains clinically undiagnosed in 22 to 86 % of hospitalised patients. Consequently, search for better methods for the diagnosis of AP seems not only justified but urgent. The pancreas secretes an nonspecific lipase, the carboxylic ester hydrolase (CEH) with molecular properties different from other pancreatic secretory enzymes. These differences may imply that sites and rates of clearances from blood of pancreatic enzymes differ. Except for the pancreas this enzyme is secreted from the lactating mammary gland with milk.

A sensitive and reproducible sandwich-ELISA for quantitative determination of CEH was developed. When establishing referent values it was noted that in individuals aged 20 to 65 years serum concentrations of CEH did not depend on age, gender, the time of the day or duration from food intake to blood sampling, or use of nicotine. The mammary gland did not contribute significantly to basal serum levels of CEH; enzyme levels in lactating women or women with mammary tumours were identical to those of the reference population.

Seventy percent of patients with the diagnosis AP, based on elevated serum amylase levels and abdominal pain, had elevated CEH values. Among the patients with elevated amylase alone a probable cause of pancreatitis was lacking in the majority of patients. Contrastingly, a likely cause of AP could be identified in all patients presenting with abdominal pain and elevated CEH levels alone. These findings suggested that an elevated CEH level indicated AP more reliably than an elevated amylase level.

In patients with AP diagnosed by contrast enhanced computed tomography (CECT) alone, or combined with histopathological diagnosis, serum CEH levels were elevated on admission in all but one patient, and in all within the next 24 h. Furthermore, in patients with severe pancreatitis CEH levels remained at a raised level from the second to at least the 10:th day following admission, whereas a significant decrease was noted in patients with mild pancreatitis. In contrast, serum amylase values were higher in patients with mild pancreatitis during the observation period than in those with severe pancreatitis. CEH levels were higher in patients with three or more Ranson signs than in those with less than three signs from the first day after admission. CEH levels were within referent range in 164 patients without known pancreatic disease admitted due to abdominal emergency conditions, or due to planned surgery for chronic extrapancreatic gastrointestinal diseases, and 16 patients having CECT without pathological findings in the pancreas. This suggests that AP can be excluded with very high degree of probability in presence of non-elevated CEH levels.

A sandwich ELISA for determination of Guinea pig CEH and a model for graded pancreatitis in the same species were developed. CEH levels showed proportional to severity of inflammation, thus confirming previous clinical observations. CEH levels in bile were proportional to inflammation, while it was absent in urine. Amylase levels in urine were identical regardless of severity of inflammation, but low in bile. These results suggested differences in sites and rates of clearance between the two enzymes.

Seemingly elevated CEH levels allowed identification of clinically significant pancreatitis following ERCP, which amylase levels did not.

The presented studies have shown that quantitative determination in serum of CEH by the described method is a more reliable test for the diagnosis of AP than determination of amylase activity. The differences between CEH and amylase are, at least partly, due to differences in molecular properties determining rates and routes of clearances of the two enzymes from serum.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 1994. p. 32
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 411
Keywords
Pancreatitis, carboxylic ester hydrolase, bile salt-stimulated lipase, lipase, amylase, endoscopic retrograde choledochopancreatography, Guinea pig
National Category
Pediatrics Surgery
Identifiers
urn:nbn:se:umu:diva-102564 (URN)91-7174-935-7 (ISBN)
Public defence
1994-09-28, sal B, 9 tr, Norrlands Universitetssjukhus, Umeå universitet, Umeå, 09:00
Projects
digitalisering@umu.se
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 1994, härtill 5 uppsatser.

Available from: 2015-04-29 Created: 2015-04-28 Last updated: 2018-06-07Bibliographically approved
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