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Karlson, Britt-Marie
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Publications (10 of 11) Show all publications
Tingstedt, B., Andersson, B., Jonsson, C., Formichov, V., Bratlie, S.-O., Ohman, M., . . . Gasslander, T. (2019). First results from the Swedish National Pancreatic and Periampullary Cancer Registry. HPB, 21(1), 34-42
Open this publication in new window or tab >>First results from the Swedish National Pancreatic and Periampullary Cancer Registry
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2019 (English)In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 21, no 1, p. 34-42Article in journal (Refereed) Published
Abstract [en]

Background: Despite improvements in therapy regimens over the past decades, overall survival rates for pancreatic and periampullary cancer are poor. Specific cancer registries are set up in various nations to regional differences and to enable larger prospective trials. The aim of this study was to describe the Swedish register, including possibilities to improve diagnostic work-ups, treatment, and follow-up by means of the register.

Methods: Since 2010, all patients with pancreatic and periampullary cancer (including also patients who have undergone pancreatic surgery due to premalignant or benign lesions) have been registered in the Swedish National Periampullary and Pancreatic Cancer registry.

Results: In total 9887 patients are listed in the registry; 8207 of those have malignant periampullary cancer. Approximately one-third (3282 patients) have had resections performed, including benign/premalignant resections. 30-day and 90-day mortality after pancreatoduodenectomy is 1.5% and 3.5%, respectively. The overall 3-year survival for resected pancreatic ductal adenocarcinoma is 35%. Regional variations decreased over the studied period, but still exist.

Conclusion: Results from the Swedish National Registry are satisfactory and comparable to international standards. Trends over time show increasing resection rates and some improved results. Better collaboration and openness within pancreatic surgeons is an important side effect.

National Category
Cancer and Oncology Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-377375 (URN)10.1016/j.hpb.2018.06.1811 (DOI)000456821400004 ()30097413 (PubMedID)
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-25Bibliographically approved
Månsson, C., Brahmstaedt, R., Nygren, P., Nilsson, A., Urdzik, J. & Karlson, B.-M. (2019). Percutaneous Irreversible Electroporation as First Line Treatment of Locally Advanced Pancreatic Cancer. Anticancer Research, 39(5), 2509-2512
Open this publication in new window or tab >>Percutaneous Irreversible Electroporation as First Line Treatment of Locally Advanced Pancreatic Cancer
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2019 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 39, no 5, p. 2509-2512Article in journal (Refereed) Published
Abstract [en]

Background/Aim:

Irreversible electroporation (IRE) has recently been used as an experimental ablation treatment following systemic chemotherapy in locally advanced pancreatic cancer (LAPC). The primary aim of this study was to evaluate survival of LAPC patients after IRE prior to chemotherapy. The secondary aim was to examine the complication rates.

Patients and Methods:

Twenty-four patients with LAPC were included and treated with percutaneous ultrasound-guided IRE under general anesthesia. Survival data from the National Quality Registry for Pancreatic and Periampullary Cancer for LAPC during the same period were used for comparison.

Results:

The median survival after diagnosis was 13.3 months in the IRE group compared to 9.9 months in the registry group (p=0.511). Six patients had a severe complication after IRE treatment.

Conclusion:

No obvious gain in survival was observed with IRE as the first line treatment of LAPC and IRE was associated with severe complications. This study does not support percutaneous IRE in this setting.

Keywords
Pancreatic Neoplasms, Electroporation, Interventional Ultrasonography
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-365201 (URN)10.21873/anticanres.13371 (DOI)000469427800032 ()31092446 (PubMedID)
Available from: 2018-11-11 Created: 2018-11-11 Last updated: 2019-06-26Bibliographically approved
Langerth, A., Sandblom, G. & Karlson, B.-M. (2015). Long-term risk for acute pancreatitis, cholangitis, and malignancy more than 15 years after endoscopic sphincterotomy: a population-based study. Endoscopy, 47(12), 1132-1136
Open this publication in new window or tab >>Long-term risk for acute pancreatitis, cholangitis, and malignancy more than 15 years after endoscopic sphincterotomy: a population-based study
2015 (English)In: Endoscopy, ISSN 0013-726X, E-ISSN 1438-8812, Vol. 47, no 12, p. 1132-1136Article in journal (Refereed) Published
Abstract [en]

Background and study aims: It has been suggested that endoscopic sphincterotomy predisposes a patient to cholangitis, pancreatitis, and carcinoma in the pancreaticobiliary tract in the long term. Previous studies have shown an increased risk for acute cholangitis and pancreatitis but not for carcinoma. The aim of this study was to analyze these risks by conducting a long-term follow-up study of patients who underwent treatment for gallstone disease, comparing patients who underwent endoscopic sphincterotomy with those who did not. Patients and methods: A cohort of 1113 Swedish patients who were treated with endoscopic sphincterotomy between 1977 and 1990 for common bile duct stones was compared with two age-and sex-matched control groups with a history of cholecystectomy or cholecystectomy and cholangiotomy. Results: Over a median follow-up of more than 15 years after endoscopic sphincterotomy, the hazard ratio for endoscopic sphincterotomy versus cholecystectomy was 5.5 (95 % confidence interval [CI] 3.5 - 8.4) for cholangitis and 4.9 (95 %CI 2.8 - 8.6) for pancreatitis. The hazard ratio for endoscopic sphincterotomy versus cholangiotomy was 1.7 (95 %CI 1.3 - 2.4) for cholangitis and 1.5 (95 %CI 1.0 - 2.4) for pancreatitis. There was no significant increase in risk for malignant diagnoses. Conclusion: Patients who underwent endoscopic sphincterotomy for choledocholithiasis had an increased risk for acute pancreatitis and cholangitis in the long term compared with those not treated with endoscopic sphincterotomy. There was no increase in risk for malignancy in the pancreaticobiliary tract.

National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:uu:diva-266550 (URN)10.1055/s-0034-1392482 (DOI)000368414900008 ()26165737 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01Bibliographically approved
Månsson, C., Nilsson, A., Månsson, D. & Karlson, B.-M. (2015). Response from the authors of the original article. Comment to: Mansson C, Nilsson A, Karlson B-M. Severe complications with irreversible electroporation of the pancreas in the presence of a metallic stent: a warning of a procedure that never should be performed. ACTA RADIOLOGICA OPEN, 4(9), Article ID UNSP 2058460115603876.
Open this publication in new window or tab >>Response from the authors of the original article. Comment to: Mansson C, Nilsson A, Karlson B-M. Severe complications with irreversible electroporation of the pancreas in the presence of a metallic stent: a warning of a procedure that never should be performed
2015 (English)In: ACTA RADIOLOGICA OPEN, ISSN 2058-4601, Vol. 4, no 9, article id UNSP 2058460115603876Article in journal, Editorial material (Other academic) Published
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-276947 (URN)10.1177/2058460115603876 (DOI)000366018500004 ()
Available from: 2016-02-23 Created: 2016-02-16 Last updated: 2016-02-23Bibliographically approved
Wanjura, V., Lundstrom, P., Osterberg, J., Rasmussen, I., Karlson, B.-M. & Sandblom, G. (2014). Gastrointestinal Quality-of-Life After Cholecystectomy: Indication Predicts Gastrointestinal Symptoms and Abdominal Pain. World Journal of Surgery, 38(12), 3075-3081
Open this publication in new window or tab >>Gastrointestinal Quality-of-Life After Cholecystectomy: Indication Predicts Gastrointestinal Symptoms and Abdominal Pain
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2014 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 38, no 12, p. 3075-3081Article in journal (Refereed) Published
Abstract [en]

Despite the fact that cholecystectomy is a common surgical procedure, the impact on long-term gastrointestinal quality of life is not fully known. All surgical procedures for gallstone disease performed at Mora County Hospital, Sweden, between 2 January 2002 and 2 January 2005, were registered on a standard database form. In 2007, all patients under the age of 80 years at follow-up were requested to fill in a form containing the Gastrointestinal Quality-of-Life Index (GIQLI) questionnaire and a number of additional questions. The outcome was analysed with respect to age, gender, smoking, surgical technique, and original indication for cholecystectomy. A total of 627 patients (447 women, 180 men) underwent cholecystectomy, including laparoscopic cholecystectomy (N = 524), laparoscopic cholecystectomy converted to open cholecystectomy (N = 43), and open cholecystectomy (N = 60). The mean time between cholecystectomy and follow-up with the questionnaire was 49 months. The participation rate was 79 %. Using multivariate analysis in the form of generalised linear modelling, the original indication for cholecystectomy in combination with gender (p = 0.0042) was found to predict the GIQLI score. Female gender in combination with biliary colic as indication for cholecystectomy correlated with low GIQLI scores. Female gender also correlated with a higher risk for pain in the right upper abdominal quadrant after cholecystectomy (p = 0.028). We found the original indication for cholecystectomy, together with gender, to predict gastrointestinal symptoms and abdominal pain after cholecystectomy. Careful evaluation of symptoms is important before planning elective cholecystectomy.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-239764 (URN)10.1007/s00268-014-2736-3 (DOI)000345103900009 ()25189441 (PubMedID)
Available from: 2014-12-31 Created: 2014-12-30 Last updated: 2017-12-05Bibliographically approved
Sangfelt, P., Sundin, A., Wanders, A., Rasmussen, I., Karlson, B.-M., Bergquist, A. & Rorsman, F. (2014). Monitoring Dominant Strictures in Primary Sclerosing Cholangitis with Brush Cytology and FDG-PET. Journal of Hepatology, 61(6), 1352-1357
Open this publication in new window or tab >>Monitoring Dominant Strictures in Primary Sclerosing Cholangitis with Brush Cytology and FDG-PET
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2014 (English)In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 61, no 6, p. 1352-1357Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/AIMS: Despite high risk of cholangiocellular adenocarcinoma (CCA) it is unclear how surveillance of patients with primary sclerosing cholangitis (PSC) should be performed.

METHOD: We evaluated a follow-up algorithm of brush cytology and positron emission tomography/computed tomography with [18F]fluorodeoxyglucose ([18F]FDG-PET/CT), measured as the maximum standardized uptake values normalized to the liver background (SUVmax/liver) at 180 minutes, in PSC patients with dominant bile duct strictures.

RESULTS: Brush cytology with high grade dysplasia (HGD) was detected in 12/70 patients (17%), yielding diagnostic sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 56%, 89%, 75% and 88%, respectively. Preemptive liver transplantations due to repeated HGD before manifest CCA were performed in six patients. Receiver operating characteristic (ROC) analysis of [18F]FDG uptake showed that a SUVmax/liver quotient of 3.3 was able to discriminate between CCA and non-malignant disease with a sensitivity, specificity, PPV and NPV for CCA of 89%, 92%, 62%, 98%, respectively. A SUVmax/liver >3.3 detected CCA in 8/9 patients whereas a quotient < 2.4 excluded CCA. Combining brush cytology and quantitative [18F]FDG-PET/CT yielded a sensitivity for HGD and/or CCA of 100% and a specificity of 88%.

CONCLUSION: Early detection of HGD before manifest CCA is feasible with repeated brush cytology and may allow for preemptive liver transplantation. [18F]FDG-PET/CT has a high sensitivity for manifest CCA and a negative scan indicates a non-malignant state of the disease. Brush cytology and [18F]FDG-PET/CT are complementary in monitoring and managing PSC patients with dominant strictures.

National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-231471 (URN)10.1016/j.jhep.2014.07.032 (DOI)000345115600023 ()25111173 (PubMedID)
Available from: 2014-09-08 Created: 2014-09-08 Last updated: 2019-10-12Bibliographically approved
Månsson, C., Bergenfeldt, M., Brahmstaedt, R., Karlson, B.-M., Nygren, P. & Nilsson, A. (2014). Safety and Preliminary Efficacy of Ultrasound-guided Percutaneous Irreversible Electroporation for Treatment of Localized Pancreatic Cancer. Anticancer Research, 34(1A), 289-293
Open this publication in new window or tab >>Safety and Preliminary Efficacy of Ultrasound-guided Percutaneous Irreversible Electroporation for Treatment of Localized Pancreatic Cancer
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2014 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 34, no 1A, p. 289-293Article in journal (Refereed) Published
Abstract [en]

Background:

Irreversible electroporation (IRE) is a local tumor treatment. Thin needles are placed percutaneously around the tumor under ultrasound guidance. Short pulses of direct current sent through the tissue irreversibly increase cell membrane permeability leading to cell death. We report a phase I study assessing the safety of ultrasound guided percutaneous IRE in patients with localized pancreatic cancer (LPC).

Patients and Methods:

Five patients (three males) with LPC, judged unsuitable for surgery, chemotherapy, or non-resectable after standard oncological treatment, were treated with IRE. The treatment was given under general anesthesia with muscle relaxation.

Results:

No serious treatment-related adverse events were observed. There was no 30-day mortality. One patient went on to laparotomy and had a R0 pancreaticoduodenectomy with portal vein resection. Six months after the treatment, two patients had no signs of recurrence on computed tomography or contrast-enhanced ultrasound.

Conclusion:

IRE for LPC can be safely performed percutaneously under ultrasound guidance, with promising initial results regarding efficacy.

Keywords
Pancreatic cancer, tumor ablation, safety, irreversible electroporation, ultrasound guidance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-218956 (URN)000329765300037 ()24403476 (PubMedID)
Available from: 2014-02-20 Created: 2014-02-20 Last updated: 2018-11-15Bibliographically approved
Månsson, C., Nilsson, A. & Karlson, B.-M. (2014). Severe complications with irreversible electroporation of the pancreas in the presence of a metallic stent: a warning of a procedure that never should be performed.. Acta Radiologica Short Reports, 3(11)
Open this publication in new window or tab >>Severe complications with irreversible electroporation of the pancreas in the presence of a metallic stent: a warning of a procedure that never should be performed.
2014 (English)In: Acta Radiologica Short Reports, ISSN 0303-464X, E-ISSN 2047-9816, Vol. 3, no 11Article in journal (Refereed) Published
Abstract [en]

Irreversible electroporation (IRE) is an ablation technique that is being investigated as a potential treatment of pancreatic cancer. However, many of these patients have a metallic stent in the bile duct, which is recognized as a contraindication for IRE ablation. We report a case in which an IRE ablation in the region of the pancreatic head was performed on a patient with a metallic stent which led to severe complications. After the treatment, the patient suffered from several complications including perforation of the duodenum and transverse colon, and bleeding from a branch of the superior mesenteric artery which eventually lead to her death. Therefore, we believe it is important to be aware of this if an IRE ablation close to a metallic stent is considered.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-266551 (URN)10.1177/2047981614556409 (DOI)25535573 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01
Månsson, C. & Karlson, B.-m. (2012). An unusual presentation of a solid pseudopapillary pancreatic tumor. Journal of Surgical Case Reports (12)
Open this publication in new window or tab >>An unusual presentation of a solid pseudopapillary pancreatic tumor
2012 (English)In: Journal of Surgical Case Reports, ISSN 2042-8812, no 12Article in journal (Other academic) Published
Abstract [en]

Solid pseudopapillary pancreatic tumor (SPPT) is a rare tumor that constitutes 1–2% of all pancreatic tumors and most of the patients are young females. SPPT has low malignancy potential and radical resection is associated with good results and a high survival rate, even in cases with large tumors: the 5-year survival rate is estimated as 95%. This paper describes an unusual presentation of an SPPT discovered after blunt trauma to the abdomen during a basketball game. Computed tomography revealed a large tumor in the pancreatic head and the patient was operated by pylorus-preseving pancreaticoduodenectomy. The histopathologic examination indicated an SPPT with R0-resection and after 4 years there were no signs of recurrence.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-194100 (URN)10.1093/jscr/rjs022 (DOI)
Note

case report

Available from: 2013-02-08 Created: 2013-02-08 Last updated: 2013-02-20Bibliographically approved
Norén, A., Urdzik, J., Duraj, F., Ebeling Barbier, C., Karlson, B.-M. & Haglund, U. (2010). Longterm follow-up after transarterial chemotherapy for hepatocellular carcinoma in a Scandinavian centre. HPB, 12(9), 637-643
Open this publication in new window or tab >>Longterm follow-up after transarterial chemotherapy for hepatocellular carcinoma in a Scandinavian centre
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2010 (English)In: HPB, ISSN 1365-182X, Vol. 12, no 9, p. 637-643Article in journal (Refereed) Published
Abstract [en]

Background: Transarterial chemotherapy infusion (TAI) with lipiodol is a palliative treatment for hepatocellular carcinoma. The aim of this study was to describe the outcomes of TAI from a single scandinavian centre between 1995 to 2008. Methods: The study is a retrospective analyse of prospectively collected data. TAI (doxorubicin, 50 mg with lipiodol) was administrated every 6 weeks. After 5 treatments, a CT scan was performed, and if the disease was stable, (RECIST score) treatment was continued. Results: 57 patients with HCC were treated with TAI. Median age; 72 years (52-84), 41 (71%) men. 52 (91%) had Child-Pugh score A, and 5 (9%) had Child-Pugh B. Nine (16%) patients had a BCLC score A, 19 (33%) B, 29 (51%) C, while none was classified as BCLC D. Twenty nine (51%) patients had a tumour size ≥ 10 cm. In total 254 treatments were performed, a median of 4 (1-20) per patient. Treatment mortality was 0%. In 30 (53%) patients the treatment strategy was not completed due to deteriorating clinical conditions. Median survival was 17 months (2-108), 2, 3, and 5-years survival was 34%, 22%, and 13%, respectively. Patients that responded to treatment (n = 23) had a median survival of 26 (13-108) months compared to 8 (2-48) months for those not fulfilling the treatment plan, p < 0.05. Tumour size ≥ 10 cm, AFP ≥ 400 μg/l, and Child-Pugh class B or C were negative prognostic factors for survival, p < 0.05. Conclusions: The 5 year survival was 13%, and median survival 17 months. Treatment mortality was 0%. Patients that responded to treatment (40%) had a median survival of 26 months. TAI provides good palliation but selection of patients is crucial.

Keywords
transarterial chemotherapy, hepatocellular carcinoma < liver
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-133128 (URN)10.1111/j.1477-2574.2010.00210.x (DOI)000286438700007 ()20961372 (PubMedID)
Available from: 2010-11-02 Created: 2010-11-02 Last updated: 2013-05-07Bibliographically approved
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