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  • 1.
    Aanestad, Øystein
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Quantitative electromyographic studies of the perineal muscles in normal subjects and patients suffering from anal or urinary incontinence1998Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of the study were to characterize the interference pattern in perineal muscles in healthy subjects with the use of quantitative EMG techniques, to evaluate if prostatic surgery had any effect on the interference pattern and furthermore to examine the interference pattern in the perineal muscles in patients suffering from urinary or anal incontinence.

    The interference pattern in the perineal muscles was examined with a computerized analysis, the Turns and Amplitude (T/A) analysis, and the innervation pattern of the muscles was examined with single fiber electromyography measuring the fiber density. Reference values were collected from 30 normal subjects. The patient material consisted of 20 males subjected to transurethral prostatectomy (TUR-P), 10 males who underwent radical retropubic prostatectomy (RRP), 20 patients suffering from anal incontinence and 24 women withurinary incontinence.

    T/A analysis of the interference pattern in the perineal muscles in normal subjects showed a significant increase in number of turns/sec and mean amplitude correlating to increasing force but no age-related changes.

    TUR-P and RRP did effect the innervation of the distal urethral sphincter muscle as shown by increased fiber density indicating a peripheral nerve lesion. T/A analysis did not shown any increased activation of the distal urethral sphincter as a compensation for the loss in bladder neck sphincter function but rather signs of decreasedcentral activation.

    Patients with idiopathic faecal incontinence showed signs of impaired innervation of the external anal sphincter muscle. A decreased interference pattern at maximal contraction indicated a reduced central activation of perineal muscles, in particular for patients with partial rupture of the external anal sphincter muscle. The reduced central activation could play a role for the aetiology of faecal incontinence.

    Patients with urinary stress incontinence also showed signs of impaired innervation of the external anal sphincter muscle as well as reduced interference pattern at maximal contraction and during continuous recording of the EMG activity during cystometry. A reduced central activation of the motor units was predicted as one factor involved in the aetiology.

  • 2.
    Abadie, V.
    et al.
    Hop Univ Necker, Paris, France..
    Bohorquez, D.
    Vall Hebron, Barcelona, Spain..
    Bulstrode, N. W.
    Great Ormond St Hosp Sick Children, London, England..
    Davies, Gareth
    Hakelius, Malin
    Uppsala Univ Hosp, Uppsala, Sweden..
    Ong, J.
    Great Ormond St Hosp Sick Children, London, England..
    Mathijssen, I. M. J.
    Erasmus MC, Rotterdam, Netherlands..
    Matos, E.
    Santa Maria Hosp, Lisbon, Portugal..
    Mazzoleni, F.
    San Gerardo Hosp, Monza, Italy..
    van der Molen, A. Mink
    Utrecht Med Ctr, Utrecht, Netherlands..
    Muradin, M.
    Utrecht Med Ctr, Utrecht, Netherlands..
    Neovius, E.
    Karolinska Hosp, Stockholm, Sweden..
    Piacentile, K.
    San Bortolo Hosp Vicenza, Vicenza, Italy..
    Redondo, M.
    Hosp 12 Octobre, Madrid, Spain..
    Vuola, P.
    Helsinki Univ Hosp, Helsinki, Finland..
    Wolvius, E. B.
    Erasmus MC, Rotterdam, Netherlands..
    Reinert, Siegmar
    Plast Operationen, Klin & Poliklin Mund Kiefer & Gesichtschirurg, Tubingen, Germany..
    Murray, Dylan
    Childrens Univ Hosp, Craniofacial Team, Temple St, Dublin, Ireland.;Karolinska Inst, Plast Surg & ENT, Stockholm, Sweden..
    Peterson, Petra
    Hens, Greet
    Katholieke Univ Leuven, Dept Neurowetenschappen, Leuven, Belgium..
    Schachner, P.
    Sivertsen, A.
    Irvine, W. F. E.
    Qualicura, Breda, Netherlands..
    Welling-van Overveld, L. F. J.
    Qualicura, Breda, Netherlands..
    van Breugel, M.
    Utrecht Med Ctr, Utrecht, Netherlands..
    van Schalkwijk, K.
    Utrecht Med Ctr, Utrecht, Netherlands..
    Verhey, E.
    Utrecht Med Ctr, Utrecht, Netherlands..
    Khan, A.
    Great Ormond St Hosp Sick Children, London, England..
    Baillie, L.
    Great Ormond St Hosp Sick Children, London, England..
    Bishop, N.
    Great Ormond St Hosp Sick Children, London, England..
    Hillyar, C. R. T.
    Great Ormond St Hosp Sick Children, London, England..
    Koudstaal, M. J.
    Erasmus MC, Rotterdam, Netherlands..
    van de lande, L.
    Great Ormond St Hosp Sick Children, London, England..
    Nibber, A.
    Great Ormond St Hosp Sick Children, London, England..
    Panciewicz, N.
    Great Ormond St Hosp Sick Children, London, England..
    Ramjeeawan, A.
    Great Ormond St Hosp Sick Children, London, England..
    Bouter, A.
    Erasmus MC, Rotterdam, Netherlands..
    El Ghoul, K.
    Erasmus MC, Rotterdam, Netherlands..
    Logjes, B.
    Erasmus MC, Rotterdam, Netherlands..
    van der Plas, P.
    Erasmus MC, Rotterdam, Netherlands..
    Kats, J.
    Erasmus MC, Rotterdam, Netherlands..
    Weissbach, E.
    Erasmus MC, Rotterdam, Netherlands..
    van Veen-van der Hoek, M.
    Erasmus MC, Rotterdam, Netherlands..
    Bittermann, A. J. N.
    Utrecht Med Ctr, Utrecht, Netherlands..
    van den Boogaard, M-JH.
    Coenraad, S.
    Utrecht Med Ctr, Utrecht, Netherlands..
    Dulfer, K.
    Erasmus MC, Rotterdam, Netherlands..
    Joosten, K.
    Erasmus MC, Rotterdam, Netherlands..
    Lachmeijer, A. M. A.
    Utrecht Med Ctr, Utrecht, Netherlands..
    Muradin, M. S. M.
    Utrecht Med Ctr, Utrecht, Netherlands..
    Peters, N. C. J.
    Erasmus MC, Rotterdam, Netherlands..
    Pleumeekers, M.
    Erasmus MC, Rotterdam, Netherlands..
    de Veye, H. Swanenburg
    Utrecht Med Ctr, Utrecht, Netherlands..
    European Guideline Robin Sequence An Initiative From the European Reference Network for Rare Craniofacial Anomalies and Ear, Nose and Throat Disorders (ERN-CRANIO)2024In: The Journal of Craniofacial Surgery, ISSN 1049-2275, E-ISSN 1536-3732, Vol. 35, no 1, p. 279-361Article in journal (Refereed)
    Abstract [en]

    A European guideline on Robin Sequence was developed within the European Reference Network for rare and/ or complex craniofacial anomalies and ear, nose, and throat disorders. The guideline provides an overview of optimal care provisions for patients with Robin Sequence and recommendations for the improvement of care.

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  • 3. Abdelhalim, Mohamed A.
    et al.
    Tenorio, Emanuel R.
    Oderich, Gustavo S.
    Haulon, Stephan
    Warren, Gasper
    Adam, Donald
    Claridge, Martin
    Butt, Talha
    Abisi, Said
    Dias, Nuno V.
    Kölbel, Tilo
    Gallitto, Enrico
    Gargiulo, Mauro
    Gkoutzios, Panos
    Panuccio, Giuseppe
    Kuzniar, Marek
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mees, Barend M.
    Schurink, Geert W.
    Sonesson, Björn
    Spath, Paolo
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Schanzer, Andres
    Beck, Adam W.
    Schneider, Darren B.
    Timaran, Carlos H.
    Eagleton, Matthew
    Farber, Mark A.
    Modarai, Bijan
    Multicenter trans-Atlantic experience with fenestrated-branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms2023In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 78, no 4, p. 854-862.e1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This multicenter international study aimed to describe outcomes of fenestrated-branched endovascular aortic repairs (FB-EVAR) in a cohort of patients treated for chronic post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs).

    METHODS: We reviewed the clinical data of all consecutive patients treated by FB-EVAR for repair of extent I to III PD-TAAAs in 16 centers from the United States and Europe (2008-2021). Data were extracted from institutional prospectively maintained databases and electronic patient records. All patients received off-the-shelf or patient-specific manufactured fenestrated-branched stent grafts. Endpoints were any cause mortality and major adverse events at 30 days, technical success, target artery (TA) patency, freedom from TA instability, minor (endovascular with <12 Fr sheath) and major (open or ≥12 Fr sheath) secondary interventions, patient survival, and freedom from aortic-related mortality (ARM).

    RESULTS: A total of 246 patients (76% male; median age, 67 years [interquartile range, 61-73 years]) were treated for extent I (7%), extent II (55%), and extent III (35%) PD-TAAAs by FB-EVAR. The median aneurysm diameter was 65 mm (interquartile range, 59-73 mm). Eighteen patients (7%) were octogenarians, 212 (86%) were American Society of Anesthesiologists class ≥3, and 21 (9%) presented with contained ruptured or symptomatic aneurysms. There were 917 renal-mesenteric vessels targeted by 581 fenestrations (63%) and 336 directional branches (37%), with a mean of 3.7 vessels per patient. Technical success was 96%. Mortality and rate of major adverse events at 30 days was 3% and 28%, including disabling complications such as new onset dialysis in 1%, major stroke in 1%, and permanent paraplegia in 2%. Mean follow-up was 24 months. Kaplan-Meier (KM) estimated patient survival at 3 and 5 years was 79% ± 6% and 65% ± 10%. KM estimated freedom from ARM was 95% ± 3% and 93% ± 5% at the same intervals. Unplanned secondary interventions were needed in 94 patients (38%), including minor procedures in 64 (25%) and major procedures in 30 (12%). There was one conversion to open surgical repair (<1%). KM estimated freedom from any secondary intervention was 44% ± 9% at 5 years. KM estimated primary and secondary TA patency were 93% ± 2% and 96% ± 1% at 5 years, respectively.

    CONCLUSIONS: FB-EVAR for chronic PD-TAAAs was associated with high technical success and a low rate of mortality (3%) and disabling complications at 30 days. Although the procedure is effective in the prevention of ARM, patient survival was low at 5 years (65%), likely due to the significant comorbidities in this cohort of patients. Freedom from secondary interventions at 5 years was 44%, although most procedures were minor. The significant rate of reinterventions highlights the need for continued patient surveillance.

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    fulltext
  • 4.
    Abdulcadir, Jasmine
    et al.
    Outpatient Clinic for Women with FGM/C, Department of Obstetric and Gynecology, Geneva University Hospitals.
    Abdulcadir, Omar
    Referral Centre for Preventing and Curing Female Genital Mutilation, Department of Maternal and Child Health, Careggi University Hospital, Florence, Italy.
    Caillet, Martin
    Outpatient Clinic for Women with FGM/C, Department of Obstetric and Gynecology, Geneva University Hospitals.
    Catania, Lucrezia
    Referral Centre for Preventing and Curing Female Genital Mutilation, Department of Maternal and Child Health, Careggi University Hospital, Florence, Italy.
    Cuzin, Béatrice
    Division of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Foldès, Pierre
    Institute of Reproductive Health, Saint Germain en Laye, Paris, France.
    Johnsdotter, Sara
    Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Johnson-Agbakwu, Crista
    Refugee Women's Health Clinic, Obstetrics & Gynecology, Maricopa Integrated Health System.
    Nour, Nawal
    Global Ob/Gyn and African Women's Health Center, Ambulatory Obstetrics, Office for Multicultural Careers, Division of Global Obstetrics and Gynecology, Brigham and Women's Hospital.
    Ouedraogo, Charlemagne
    University Hospital Yalgado Ouedraogo of Ouagadougou, Ouagadougou, Burkina Faso.
    Warren, Nicole
    Department of Community Public Health Nursing, John Hopkins School of Nursing, Baltimore, MD, USA.
    Wylomanski, Sophie
    Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France.
    Clitoral Surgery After Female Genital Mutilation/Cutting2017In: Aesthetic surgery journal, ISSN 1090-820X, E-ISSN 1527-330X, Vol. 37, no 9, p. NP113-NP115Article in journal (Other academic)
  • 5. Aboyans, Victor
    et al.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Brodmann, Marianne
    Collet, Jean-Philippe
    Czerny, Martin
    De Carlo, Marco
    Naylor, A Ross
    Roffi, Marco
    Tendera, Michal
    Vlachopoulos, Charalambos
    Ricco, Jean-Baptiste
    Document Reviewers,
    Widimsky, Petr
    Kolh, Philippe
    Dick, Florian
    de Ceniga, Melina Vega
    Piepoli, Massimo Francesco
    Sievert, Horst
    Sulzenko, Jakub
    Esc Committee For Practice Guidelines Cpg,
    Windecker, Stephan
    Aboyans, Victor
    Agewall, Stefan
    Barbato, Emanuele
    Bueno, Héctor
    Coca, Antonio
    Collet, Jean-Philippe
    Coman, Ioan Mircea
    Dean, Veronica
    Delgado, Victoria
    Fitzsimons, Donna
    Gaemperli, Oliver
    Hindricks, Gerhard
    Iung, Bernard
    Jüni, Peter
    Katus, Hugo A
    Knuuti, Juhani
    Lancellotti, Patrizio
    Leclercq, Christophe
    McDonagh, Theresa
    Piepoli, Massimo Francesco
    Ponikowski, Piotr
    Richter, Dimitrios J
    Roffi, Marco
    Shlyakhto, Evgeny
    Simpson, Iain A
    Zamorano, Jose Luis
    Questions and Answers on Diagnosis and Management of Patients with Peripheral Arterial Diseases: A Companion Document of the 2017 ESC Guidelines for the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS).2018In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 55, no 4, p. 457-464, article id S1078-5884(17)30516-6Article in journal (Refereed)
  • 6. Aboyans, Victor
    et al.
    Ricco, Jean-Baptiste
    Bartelink, Marie-Louise
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Brodmann, Marianne
    Cohner, Tina
    Collet, Jean-Philippe
    Czerny, Martin
    De Carlo, Marco
    Debus, Sebastian
    Espinola-Klein, Christine
    Kahan, Thomas
    Kownator, Serge
    Mazzolai, Lucia
    Naylor, Ross
    Roffi, Marco
    Röther, Joachim
    Sprynger, Muriel
    Tendera, Michal
    Tepe, Gunnar
    Venermo, Maarit
    Vlachopoulos, Charalambos
    Desormais, Ileana
    [2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)]2017In: Kardiologia polska, ISSN 0022-9032, E-ISSN 1897-4279, Vol. 75, no 11, p. 1065-1160Article in journal (Refereed)
  • 7. Aboyans, Victor
    et al.
    Ricco, Jean-Baptiste
    Bartelink, Marie-Louise E L
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Brodmann, Marianne
    Cohnert, Tina
    Collet, Jean-Philippe
    Czerny, Martin
    De Carlo, Marco
    Debusa, Sebastian
    Espinola-Klein, Christine
    Kahan, Thomas
    Kownator, Serge
    Mazzolai, Lucia
    Naylora, A Ross
    Roffi, Marco
    Rotherb, Joachim
    Sprynger, Muriel
    Tendera, Michal
    Tepe, Gunnar
    Venermoa, Maarit
    Vlachopoulos, Charalambos
    Desormais, Ileana
    2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS).2018In: Revista espanola de cardiologia (English ed.), ISSN 1885-5857, Vol. 71, no 2, article id 111Article in journal (Refereed)
  • 8.
    Abrahamsson, Niclas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Postprandial Normoglycemic Hypokalemia-an Overlooked Complication to Gastric Bypass Surgery?2021In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 31, no 7, p. 3369-3371Article in journal (Refereed)
    Abstract [en]

    Obesity is one of the major health problems of the world, and one of the most common surgical treatments is the Roux-en-Y gastric bypass surgery. This can however lead to problems with postprandial hypoglycemia, but sometimes, the meal test does not render any signs of hypoglycemia. Here, 3 cases are presented with postprandial normoglycemic hypokalemia.

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    FULLTEXT01
  • 9.
    Abrahamsson, Niclas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Response to Postprandial Hyperinsulinemic Normoglycemic Hypokalemic Response After Roux-en-Y Gastric Bypass Surgery2022In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 32, no 7, p. 2468-2468Article in journal (Other academic)
  • 10. Abreu, Phillipe
    et al.
    Ivanics, Tommy
    Jiang, Keruo
    Chen, Kui
    E. Hansen, Bettina
    Sapisochin, Gonzalo
    Ghanekar, Anand
    Novel biomarker for hepatocellular carcinoma: high tumoral PLK-4 expression is associated with better prognosis in patients without microvascular invasion2021In: HPB, ISSN 1365-182X, E-ISSN 1477-2574Article in journal (Refereed)
  • 11.
    Acosta, Rafael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Warren M.
    Whitaker, Iain S.
    Banking of the DIEP Flap: A "Previously Described New Technique" Reply2010In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 126, no 4, p. 1407-1409Article in journal (Refereed)
  • 12.
    Acosta, Rafael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Warren M.
    Whitaker, Iain S.
    Probing Questions on Implantable Probes Reply2010In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 126, no 5, p. 1790-1791Article in journal (Refereed)
  • 13.
    Acosta, S.
    et al.
    Lund Univ, Dept Clin Sci, Vasc Ctr, Malmo, Sweden..
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery2017In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, no 2, p. E75-E84Article, review/survey (Refereed)
    Abstract [en]

    BackgroundIndications for negative-pressure wound therapy (NPWT) in vascular surgical patients are expanding. The aim of this review was to outline the evidence for NPWT on open and closed wounds. MethodsA PubMed, EMBASE and Cochrane Library search from 2007 to June 2016 was performed combining the medical subject headings terms wound infection', abdominal aortic aneurysm (AAA)', fasciotomy', vascular surgery' and NPWT' or VAC'. ResultsNPWT of open infected groin wounds was associated with shorter duration of wound healing by 47 days, and was more cost-effective than alginate dressings in one RCT. In one RCT and six observational studies, NPWT-related major bleeding and graft preservation rates were 0-10 and 83-100 per cent respectively. One retrospective comparative study showed greater wound size reduction per day, fewer dressing changes, quicker wound closure and shorter hospital stay with NPWT compared with gauze dressings for lower leg fasciotomy. NPWT and mesh-mediated fascial traction after AAA repair and open abdomen was associated with high primary fascial closure rates (96-100 per cent) and low risk of graft infection (0-7 per cent). One retrospective comparative study showed a significant reduction in surgical-site infection, from 30 per cent with standard wound care to 6 per cent with closed incisional NPWT. ConclusionNPWT has a central role in open and infected wounds after vascular surgery; the results of prophylactic care of closed incisions are promising.

  • 14.
    Acosta, Stefan
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    On Acute Thrombo-Embolic Occlusion of the Superior Mesenteric Artery2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods.

    Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease.

    Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor.

    A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions.

    Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated from clinical series. The patients were often nursed in non-surgical wards.

    List of papers
    1. Preliminary study of D-dimer as a possible marker of acute bowel ischaemia
    Open this publication in new window or tab >>Preliminary study of D-dimer as a possible marker of acute bowel ischaemia
    2001 In: Br J Surg, Vol. 88, p. 385 - 388Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-91561 (URN)
    Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
    2. D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery
    Open this publication in new window or tab >>D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery
    2004 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 91, no 8, p. 991-994Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    There is no accurate non-invasive method available for the diagnosis of acute thromboembolic occlusion of the superior mesenteric artery (SMA). The aim of this study was to assess the diagnostic properties of the fibrinolytic marker D-dimer.

    METHODS:

    From September 2000 to April 2003 consecutive patients aged over 50 years admitted to hospital with acute abdominal pain were studied. Patients with possible acute SMA occlusion at presentation had blood samples taken within 24 h of the onset of the pain for analysis of D-dimer, plasma fibrinogen, activated partial thromboplastin time, prothrombin time and antithrombin. The value of D-dimer testing to diagnose SMA occlusion was assessed by means of likelihood ratios.

    RESULTS:

    Nine of 101 patients included had acute SMA occlusion. The median D-dimer concentration was 1.6 (range 0.4-5.6) mg/l, which was higher than that in 25 patients with inflammatory disease (P = 0.007) or in 14 patients with intestinal obstruction (P = 0.005). The combination of a D-dimer level greater than 1.5 mg/l, atrial fibrillation and female sex resulted in a likelihood ratio for acute SMA occlusion of 17.5, whereas no patient with a D-dimer concentration of 0.3 mg/l or less had acute SMA occlusion.

    CONCLUSION:

    D-dimer testing may be useful for the exclusion of patients with suspected acute SMA occlusion.

    Keywords
    Abdominal Pain/*etiology, Aged, Aged; 80 and over, Female, Fibrin Fibrinogen Degradation Products/*analysis, Humans, Male, Mesenteric Artery; Superior, Mesenteric Vascular Occlusion/*diagnosis, Middle Aged, Sensitivity and Specificity, Thromboembolism/*diagnosis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-91562 (URN)10.1002/bjs.4645 (DOI)15286959 (PubMedID)
    Available from: 2004-04-14 Created: 2004-04-14 Last updated: 2017-12-14Bibliographically approved
    3. Acute thrombo-embolic occlusion of the superior mesenteric artery: A prospective study in a well defined population
    Open this publication in new window or tab >>Acute thrombo-embolic occlusion of the superior mesenteric artery: A prospective study in a well defined population
    2003 In: Eur J Vasc Endovasc Surg, Vol. 26, p. 179-183Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-91563 (URN)
    Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
    4. Revascularization of the superior mesenteric artery after acute thromboembolic occlusion
    Open this publication in new window or tab >>Revascularization of the superior mesenteric artery after acute thromboembolic occlusion
    Show others...
    2002 In: Br J Surg, Vol. 89, p. 923-927Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-91564 (URN)
    Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
    5. Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery - a population-based study
    Open this publication in new window or tab >>Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery - a population-based study
    Show others...
    2004 In: Eur J Vasc Endovasc Surg, Vol. 27, p. 145 - 150Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-91565 (URN)
    Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
    6. Autopsy findings in 213 patients with fatal acute thrombo-embolic occlusion of the superior mesenteric artery
    Open this publication in new window or tab >>Autopsy findings in 213 patients with fatal acute thrombo-embolic occlusion of the superior mesenteric artery
    Show others...
    (English)Article in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-91566 (URN)
    Available from: 2004-04-14 Created: 2004-04-14 Last updated: 2013-08-14Bibliographically approved
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    FULLTEXT01
  • 15. Acosta, Stefan
    et al.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Acute and Chronic Mesenteric Vascular Disease2017In: Vascular Surgery:: Principles and Practice / [ed] Wilson SE; Jimenez JC; Veith FJ; Naylor AR; Buckels JAC, CRC Press, 2017, 4, p. 603-617Chapter in book (Refereed)
  • 16. Acosta, Stefan
    et al.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Petersson, Ulf
    Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy: a systematic review2017In: Anaesthesiology intensive therapy, ISSN 1731-2515, Vol. 49, no 2, p. 139-145Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this paper was to review the literature on vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies.

    METHODS: A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure".

    RESULTS: Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias.

    CONCLUSIONS: A high primary fascial closure rate can be achieved with the vacuum-assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-trauma patients, in need of prolonged open abdomen therapy.

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  • 17. Acosta, Stefan
    et al.
    Seternes, Arne
    Venermo, Maarit
    Vikatmaa, Leena
    Sörelius, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Svensson, Mats
    Djavani, Khatereh
    Department of Surgery, Gävle Hospital, Gävle, Sweden.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study2017In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 6, p. 697-705Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    Open abdomen therapy may be necessary to prevent or treat abdominal compartment syndrome (ACS). The aim of the study was to analyse the primary delayed fascial closure (PDFC) rate and complications after open abdomen therapy with vacuum and mesh mediated fascial traction (VACM) after aortic repair and to compare outcomes between those treated with open abdomen after primary versus secondary operation.

    METHODS:

    This was a retrospective cohort, multicentre study in Sweden, Finland, and Norway, including consecutive patients treated with open abdomen and VACM after aortic repair at six vascular centres in 2006-2015. The primary endpoint was PDFC rate.

    RESULTS:

    Among 191 patients, 155 were men. The median age was 71 years (IQR 66-76). Ruptured abdominal aortic aneurysm (RAAA) occurred in 69.1%. Endovascular/hybrid and open repairs were performed in 49 and 142 patients, respectively. The indications for open abdomen were inability to close the abdomen (62%) at primary operation and ACS (80%) at secondary operation. Duration of open abdomen was 11 days (IQR 7-16) in 157 patients alive at open abdomen termination. The PDFC rate was 91.8%. Open abdomen initiated at primary (N=103), compared with secondary operation (N=88), was associated with less severe initial open abdomen status (p=.006), less intestinal ischaemia (p=.002), shorter duration of open abdomen (p=.007), and less renal replacement therapy (RRT, p<.001). In hospital mortality was 39.3%, and after entero-atmospheric fistula (N=9) was 88.9%. Seven developed graft infection within 6 months, 1 year mortality was 28.6%. Intestinal ischaemia (OR 3.71, 95% CI 1.55-8.91), RRT (OR 3.62, 95% CI 1.72-7.65), and age (OR 1.12, 95% CI 1.06-1.12), were independent factors associated with in hospital mortality, but not open abdomen initiated at primary versus secondary operation.

    CONCLUSIONS:

    VACM was associated with a high PDFC rate after prolonged open abdomen therapy following aortic repair. Patient outcomes seemed better when open abdomen was initiated at primary, compared with secondary operation but a selection effect is possible.

  • 18.
    Adalberth, Gunnar
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Total knee arthroplasty: Alternative aspects on fixation, design and postoperative treatment2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Total knee arthroplasty as a treatment of severe gonarthrosis has become a great success, but tibial component loosening is still a major reason for failure. When total knee arthroplasty was introduced, only all-polyethylene (AP) tibial components were available. Based on mostly theoretical data, AP components were more or less abandoned during the 1980:ies in favor of metal-backed (MB) tibial components. The aim of the present study was to evaluate whether insufficient fixation would result, using an all-polyethylene tibial component instead of a more costly metal-backed prosthesis. Further, to compare different antibiotic loaded bone cements, and to investigate whether post- operative drainage is beneficial in total knee arthroplasty. Radiostereometric analysis (RSA) was used to obtain accurate and standardized evaluations facilitating comparison between prosthetic designs.

    Magnitude and pattern of migration of a moderately conforming AP tibial component was analyzed in 22 patients. Migration was on par with a more conforming previously used frequently, AP component, indicating a favorable prognosis regarding future aseptic loosening. Another 34 arthroplasties with a flat on flat (non-conforming) articulating geometry were randomized to an AP or MB cemented tibial component. There were no differences in migration between the groups. None of the AP implants displayed any continuous migration between 1 and 2 years postoperative. In a similar randomized series of 38 arthroplasties with a semiconstrained articulation, fixation measured with RSA was not inferior for AP implants compared with MB. Both studies indicate a good long-term prognosis using an AP component. A new antibiotic loaded bone cement was prospectively randomized against a more commonly used bone cement in a series of 51 arthroplasties. Neither fixation of the tibial component nor the radiographic and clinical results differed between the cements, indicating a good prognosis for the new cement. Postoperative drainage of knee arthroplasty is widely used. 90 patients were prospectively randomized into three groups: no drain, ordinary drain system and a retransfusable drain system. Postoperative drainage in knee arthroplasty has no adverse clinical consequences but seems not to be necessary.

  • 19.
    Adwall, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Hultin, Hella
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Norlén, Olov
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Prospective Evaluation of Complications and Associated Risk Factors in Breast Cancer Surgery2022In: Journal of Oncology, ISSN 1687-8450, E-ISSN 1687-8469, Vol. 2022, article id 6601066Article in journal (Refereed)
    Abstract [en]

    Background; Surgical site infection (SSI) is a well-known complication after breast cancer surgery. The primary aim was to assess risk factors for SSI. Risk factors for other wound complications were also studied.

    Materials and Methods: In this prospectively registered cohort study, patients who underwent breast-conserving surgery (BCS) or mastectomy between May 2017 and May 2019 were included. Data included patient and treatment characteristics, infection, and wound complication rates. Risk factors for SSI and wound complications were analyzed with simple and multiple logistic regression.

    Results: The study cohort consisted of 592 patients who underwent 707 procedures. There were 66 (9.3%) SSI and 95 (13.4%) wound complications. "BMI > 25, " "oncoplastic BCS, " "reoperation within 24 hour, " and "prolonged operative time " were risk factors for SSI with simple analysis. BMI 25-30 and > 30 remained as significant risk factors for SSI with adjusted analysis. Risk factors for "any wound complication " with adjusted analysis were "mastectomy with/without reconstruction " in addition to "BMI 25-30 " and "BMI > 30. "

    Conclusion: The only significant risk factor for SSI on multivariable analysis were BMI 25-30 and BMI > 30. Significant risk factors for "any wound complication " on multivariable analysis were "mastectomy with/without reconstruction " as well as "BMI 25-30 " and "BMI > 30. "

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    FULLTEXT01
  • 20.
    Adwall, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Pantiora, Eirini
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Hultin, Hella
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Norlén, Olov
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Association of postoperative infection and oncological outcome after breast cancer surgery2021In: BJS Open, E-ISSN 2474-9842, Vol. 5, no 4, article id zrab052Article in journal (Refereed)
    Abstract [en]

    Background: Surgical-site infection (SSI) is a well known complication after breast cancer surgery and has been reported to be associated with cancer recurrence. The aim of this study was to investigate the association between SSI and breast cancer recurrence, adjusting for several known confounders. The secondary aim was to assess a possible association between any postoperative infection and breast cancer recurrence.

    Method: This retrospective cohort study included all patients who underwent breast cancer surgery from January 2009 to December 2010 in the Uppsala region of Sweden. Data collected included patient, treatment and tumour characteristics, infection rates and outcome. Association between postoperative infection and oncological outcome was examined using Kaplan-Meier curves and Cox regression analysis.

    Results: Some 492 patients (439 with invasive breast cancer) with a median follow-up of 8.4 years were included. Mean(s.d.) age was 62(13) years. Sixty-two (14.1 per cent) of those with invasive breast cancer had an SSI and 43 (9.8 per cent) had another postoperative infection. Some 26 patients had local recurrence; 55 had systemic recurrence. Systemic recurrence was significantly increased after SSI with simple analysis (log rank test, P = 0.035) but this was not observed on adjusted analysis. However, tumour size and lymph node status remained significant predictors for breast cancer recurrence on multiple regression. Other postoperative infections were not associated with recurrence.

    Conclusion: Neither SSI nor other postoperative infections were associated with worse oncological outcome in this study. Rather, other factors that relate to both SSI and recurrence may be responsible for the association seen in previous studies.

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    fulltext
  • 21.
    Afshari, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Surgical Aspects and Prognostic Factors in the Management of Rectal Cancer2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Survival among patients with stage IV rectal cancer is poor and surgical treatment for this disease is associated with morbidities such as small bowel obstruction, complications with a diverting loop ileostomy, and functional bowel disturbances. The overall aim of this thesis was to assess risk factors and morbidity after surgery for rectal cancer and to evaluate factors affecting survival in patients with stage IV rectal cancer.

    Paper I a prospective study on patients with rectal cancer with loop ileostomy who underwent stoma closure in a 23-hour hospital stay setting. Results were compared with a group who underwent standard in-hospital stoma closure prior to the start of the study, selected retrospectively as controls. No differences were found in the number of complications or the frequency of re-hospitalization or re-operation, indicating that ileostomy closure in a 23-hour hospital stay setting in these selected patients was feasible and safe with high patient satisfaction.

    Paper II a population-based study with data gathered prospectively. In total, 11% of the patients developed small bowel obstruction (SBO), mostly during the first year after rectal cancer surgery. Surgical treatment for SBO was performed in 4.2% of the patients, and the mechanism was stoma-related in one-fourth. Rectal resection without anastomoses, age, morbidity, and previous radiotherapy (RT) was not associated with admission to the hospital or surgery for SBO. Re-laparotomy due to complications after rectal cancer surgery was an independent risk factor for admission for treating SBO.

    Paper III a population-based study with data gathered prospectively on bowel function at 1 year after anterior resection or stoma reversal. No associations were found between any defecatory dysfunction and the part of the colon used for anastomosis, the level of the vascular tie, or gender. An association was observed between higher anastomotic level and a lower risk of incontinence and clustering. At 1 year after loop ileostomy closure, the risks of incontinence, clustering, and urgency increased by up to fourfold.

    Paper IV a case-control study aiming to identify patient-, tumor-, and treatment-related prognostic factors for 5-year survival in patients with rectal cancer with synchronous stage IV disease. Patient-related factors did not differ between groups. Among the tumor-related factors, multiple site metastases, bilobar liver metastases, and increasing numbers of liver metastases were associated with poor survival. Prognostic treatment-related factors were preoperative RT, metastasectomy, and radical resection of the primary tumor. The most important prognostic factor for long-term survival was metastasectomy.

    List of papers
    1. Loop-ileostomy reversal in a 23-h stay setting is safe with high patient satisfaction
    Open this publication in new window or tab >>Loop-ileostomy reversal in a 23-h stay setting is safe with high patient satisfaction
    2021 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 56, no 9, p. 1126-1130Article in journal (Refereed) Published
    Abstract [en]

    Introduction: This study aimed to determine whether day-case closure of loop ileostomy with discharge within 23 h was both feasible and accepted by patients.

    Materials and methods: We conducted a prospective pilot study where selected rectal cancer patients with diverting loop ileostomy underwent stoma closure in a 23-h stay setting. Patients were followed up on the third, seventh, and 30th postoperative day and phoned daily during the first week. A comparable group of 30 patients who underwent standard in-hospital stoma closure prior to the start of the study were selected retrospectively as historical controls.

    Results: In total, 30 patients (median age, 67 years; range, 41-79 years) were included. All patients met discharge criteria and were discharged within 23 h of surgery, except one. In total, seven patients (23%) were admitted. Two of these patients underwent laparotomy because of anastomotic leakage and small bowel obstruction, respectively. The mean total length of stay was 1.7 days. Most patients (87%) were satisfied with the treatment without feeling neglected or anxious and preferred the 23-h stay setting. In the control group, the mean length of stay was 5 days. Seven patients (23%) were readmitted. Two of these patients underwent laparotomy because of small bowel obstruction and abscess, respectively.

    Conclusion: Ileostomy closure in a 23-h stay setting in selected patients with meticulous follow up is feasible and safe with high patient satisfaction.

    Place, publisher, year, edition, pages
    Taylor & Francis Group, 2021
    Keywords
    Ileostomy closure, ileostomy reversal, day-case, ·23-h stay, diverting ileostomy closure, patient experience
    National Category
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-449442 (URN)10.1080/00365521.2021.1947367 (DOI)000669733700001 ()34224302 (PubMedID)
    Funder
    Region Västmanland, LTV-943053
    Available from: 2021-07-26 Created: 2021-07-26 Last updated: 2022-04-27Bibliographically approved
    2. Risk factors for small bowel obstruction after open rectal cancer resection
    Open this publication in new window or tab >>Risk factors for small bowel obstruction after open rectal cancer resection
    2021 (English)In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 21, no 1, article id 63Article in journal (Refereed) Published
    Abstract [en]

    Background: Small bowel obstruction (SBO) is observed in around 10% of patients with prior open abdominal surgery. Rectal resection causes the highest readmission rates. The aim of this study was to investigate risk factors for readmission for SBO and causes for SBO in patients who needed surgery following rectal cancer surgery.

    Methods: A population-based registry with prospectively gathered data on 752 consecutive patients with rectal cancer who underwent open pelvic surgery between January 1996 and January 2017 was used. Univariable and multivariable regression analysis was performed, and the risk of SBO was assessed.

    Results: In total, 84 patients (11%) developed SBO after a median follow-up time of 48 months. Of these patients, 57% developed SBO during the 1st year after rectal cancer surgery. Surgery for SBO was performed in 32 patients (4.3%), and the cause of SBO was stoma-related in one-fourth of these patients. In the univariable analysis previous RT and re-laparotomy were found as risk factors for readmission for SBO. Re-laparotomy was an independent risk factor for readmission for SBO (OR 2.824, CI 1.129-7.065, P = 0.026) in the multivariable analysis, but not for surgery for SBO. Rectal resection without anastomoses, splenic flexors mobilization, intraoperative bleeding, operative time were not found as risk factors for SBO.

    Conclusions: One-tenth of rectal cancer patients who had open surgery developed SBO, most commonly within the 1st postoperative year. The risk of SBO is greatest in patients with complications after rectal cancer resection that result in a re-laparotomy.

    Place, publisher, year, edition, pages
    BioMed Central (BMC)BMC, 2021
    Keywords
    Small bowel obstruction, Rectal cancer, Surgery, Admission, Risk factors
    National Category
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-435183 (URN)10.1186/s12893-021-01072-y (DOI)000613227000001 ()33509187 (PubMedID)
    Available from: 2021-02-26 Created: 2021-02-26 Last updated: 2024-01-15Bibliographically approved
    3. Risk factors for developing Anorectal dysfunction after Anterior Resection
    Open this publication in new window or tab >>Risk factors for developing Anorectal dysfunction after Anterior Resection
    Show others...
    2021 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 36, no 12, p. 2697-2705Article in journal (Refereed) Published
    Abstract [en]

    Anterior resection (AR) may result in defecatory dysfunction and the cause is multifactorial. The aim was to explore if dysfunction could be related to the part of the colon used for anastomosis (sigmoid or descending) and to identify other possible risk factors for bowel dysfunction after AR.

    This is a retrospective study based on prospectively registered data from a regional registry at the surgical department in Västmanland 1996–2019. Bowel function was registered at 1 year after AR or after stoma reversal. In total, 470 stage I–III rectal cancer patients had AR whereof 412 were included in this study.

    Clustering was seen in 57%, incontinence 29%, urgency 22%, and evacuatory dysfunction 16%. The part of the colon used for anastomosis, level of vascular tie, and gender were not significantly associated with defecatory dysfunction. The higher the anastomotic level, the lower the risk of incontinence (OR 0.75; CI 0.63–0.90; p < 0.001) and clustering (OR 0.78; CI 0.67–0.90; p < 0.001). Compared with patients without a loop-ileostomy, an increased risk of clustering (OR 1.89; 1.08–3.31; p = 0.03), incontinence (OR 2.48; 1.29–4.77; p < 0.01), and urgency (OR 4.61; CI 2.02–10.60; p < 0.001) was seen after loop-ileostomy closure. Preoperative radiotherapy had a negative impact on continence and clustering seen mainly in the unadjusted analysis.

    The part of the colon used for anastomosis was not a significantly associated functional outcome after anterior resection. Low anastomotic level and having had a diverting ileostomy were independent risk factors associated with negative functional outcomes.

    Place, publisher, year, edition, pages
    Springer Nature, 2021
    Keywords
    anorectal dysfunction; anterior resection syndrome; functional bowel disturbance; anterior resection; bowel disturbance; functional outcome; bowel dysfunction
    National Category
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-449964 (URN)10.1007/s00384-021-04024-3 (DOI)000691949300001 ()34471965 (PubMedID)
    Available from: 2021-08-18 Created: 2021-08-18 Last updated: 2023-07-13Bibliographically approved
    4. Prognostic factors for survival in stage IV rectal cancer: A Swedish nationwide case-control study
    Open this publication in new window or tab >>Prognostic factors for survival in stage IV rectal cancer: A Swedish nationwide case-control study
    Show others...
    2019 (English)In: Surgial oncology, ISSN 0960-7404, E-ISSN 1879-3320, Vol. 29, p. 102-106Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim was to identify patient-, tumor- and treatment-related prognostic factors for five-year survival in rectal cancer patients with synchronous stage IV disease. Material and methods: This nationwide case-control study was based on the Swedish Colorectal Cancer Registry with supplementary information from medical records and the Swedish Inpatient Registry during the period 2000-2008. All resected rectal cancer patients with synchronous metastases that survived more than five years were included as cases. The control group consisted of corresponding patients who lived less than five years, matched in a 1:2 based on gender, age, resection of the rectal tumor, and the study period. Results: A total of 405 patients were identified; 99 long-term survivors (LTS) and 182 short-term survivors (STS). Patient-related factors of symptoms and comorbidity did not differ between LTS and STS. Among the treatment-related factors, multiple site metastases (p = 0.007), bilobar liver metastasis (p = 0.002), and increasing number of liver metastasis (p < 0.001) were associated with STS. Prognostic treatment-related factors were preoperative radiotherapy (p = 0.001), metastasectomy (p < 0.001), and radical resection of the primary tumor (p = 0.014). In the multivariable analysis, the single most important factor for becoming a LTS was a metastasectomy (hazard ratio: 8.474, 95% confidence interval: 4.098-17.543). Conclusions: The most important prognostic factor for long-term survival in patients with stage IV rectal cancer was metastasectomy, especially liver surgery. With thorough selection of patients for metastasectomy more patients with metastasized rectal cancer may survive beyond five years.

    Place, publisher, year, edition, pages
    Elsevier, 2019
    Keywords
    Rectal cancer, Stage IV, Prognostic factor, Metastases
    National Category
    Cancer and Oncology
    Identifiers
    urn:nbn:se:uu:diva-389816 (URN)10.1016/j.suronc.2019.04.005 (DOI)000470833100016 ()31196471 (PubMedID)
    Available from: 2019-07-30 Created: 2019-07-30 Last updated: 2021-08-18Bibliographically approved
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  • 22.
    Afshari, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, 72189, Västerås, Sweden.
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, 72189, Västerås, Sweden.
    Smedh, Kennet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, 72189, Västerås, Sweden.
    Nikberg, Maziar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, 72189, Västerås, Sweden.
    Risk factors for small bowel obstruction after open rectal cancer resection2021In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 21, no 1, article id 63Article in journal (Refereed)
    Abstract [en]

    Background: Small bowel obstruction (SBO) is observed in around 10% of patients with prior open abdominal surgery. Rectal resection causes the highest readmission rates. The aim of this study was to investigate risk factors for readmission for SBO and causes for SBO in patients who needed surgery following rectal cancer surgery.

    Methods: A population-based registry with prospectively gathered data on 752 consecutive patients with rectal cancer who underwent open pelvic surgery between January 1996 and January 2017 was used. Univariable and multivariable regression analysis was performed, and the risk of SBO was assessed.

    Results: In total, 84 patients (11%) developed SBO after a median follow-up time of 48 months. Of these patients, 57% developed SBO during the 1st year after rectal cancer surgery. Surgery for SBO was performed in 32 patients (4.3%), and the cause of SBO was stoma-related in one-fourth of these patients. In the univariable analysis previous RT and re-laparotomy were found as risk factors for readmission for SBO. Re-laparotomy was an independent risk factor for readmission for SBO (OR 2.824, CI 1.129-7.065, P = 0.026) in the multivariable analysis, but not for surgery for SBO. Rectal resection without anastomoses, splenic flexors mobilization, intraoperative bleeding, operative time were not found as risk factors for SBO.

    Conclusions: One-tenth of rectal cancer patients who had open surgery developed SBO, most commonly within the 1st postoperative year. The risk of SBO is greatest in patients with complications after rectal cancer resection that result in a re-laparotomy.

    Download full text (pdf)
    FULLTEXT01
  • 23.
    Afshari, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Nikberg, Maziar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Smedh, Kennet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Loop-ileostomy reversal in a 23-h stay setting is safe with high patient satisfaction2021In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 56, no 9, p. 1126-1130Article in journal (Refereed)
    Abstract [en]

    Introduction: This study aimed to determine whether day-case closure of loop ileostomy with discharge within 23 h was both feasible and accepted by patients.

    Materials and methods: We conducted a prospective pilot study where selected rectal cancer patients with diverting loop ileostomy underwent stoma closure in a 23-h stay setting. Patients were followed up on the third, seventh, and 30th postoperative day and phoned daily during the first week. A comparable group of 30 patients who underwent standard in-hospital stoma closure prior to the start of the study were selected retrospectively as historical controls.

    Results: In total, 30 patients (median age, 67 years; range, 41-79 years) were included. All patients met discharge criteria and were discharged within 23 h of surgery, except one. In total, seven patients (23%) were admitted. Two of these patients underwent laparotomy because of anastomotic leakage and small bowel obstruction, respectively. The mean total length of stay was 1.7 days. Most patients (87%) were satisfied with the treatment without feeling neglected or anxious and preferred the 23-h stay setting. In the control group, the mean length of stay was 5 days. Seven patients (23%) were readmitted. Two of these patients underwent laparotomy because of small bowel obstruction and abscess, respectively.

    Conclusion: Ileostomy closure in a 23-h stay setting in selected patients with meticulous follow up is feasible and safe with high patient satisfaction.

  • 24.
    Afshari, Kevin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Västmanland’s Sjukhus Västerås, Kirurgkliniken.
    Smedh, Kenneth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Västmanland’s Sjukhus Västerås, Kirurgkliniken.
    Wagner, Philippe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Chabok, Abbas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Västmanland’s Sjukhus Västerås, Kirurgkliniken.
    Nikberg, Maziar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Västmanland’s Sjukhus Västerås, Kirurgkliniken.
    Risk factors for developing Anorectal dysfunction after Anterior Resection2021In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 36, no 12, p. 2697-2705Article in journal (Refereed)
    Abstract [en]

    Anterior resection (AR) may result in defecatory dysfunction and the cause is multifactorial. The aim was to explore if dysfunction could be related to the part of the colon used for anastomosis (sigmoid or descending) and to identify other possible risk factors for bowel dysfunction after AR.

    This is a retrospective study based on prospectively registered data from a regional registry at the surgical department in Västmanland 1996–2019. Bowel function was registered at 1 year after AR or after stoma reversal. In total, 470 stage I–III rectal cancer patients had AR whereof 412 were included in this study.

    Clustering was seen in 57%, incontinence 29%, urgency 22%, and evacuatory dysfunction 16%. The part of the colon used for anastomosis, level of vascular tie, and gender were not significantly associated with defecatory dysfunction. The higher the anastomotic level, the lower the risk of incontinence (OR 0.75; CI 0.63–0.90; p < 0.001) and clustering (OR 0.78; CI 0.67–0.90; p < 0.001). Compared with patients without a loop-ileostomy, an increased risk of clustering (OR 1.89; 1.08–3.31; p = 0.03), incontinence (OR 2.48; 1.29–4.77; p < 0.01), and urgency (OR 4.61; CI 2.02–10.60; p < 0.001) was seen after loop-ileostomy closure. Preoperative radiotherapy had a negative impact on continence and clustering seen mainly in the unadjusted analysis.

    The part of the colon used for anastomosis was not a significantly associated functional outcome after anterior resection. Low anastomotic level and having had a diverting ileostomy were independent risk factors associated with negative functional outcomes.

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  • 25.
    Aho, Sonja
    et al.
    Tampere Univ Hosp, Tays Canc Ctr, Dept Oncol, Elamanaukio 2, Tampere 33520, Finland.;Tampere Univ, Fac Med & Hlth Technol, Arvo Ylpon Katu 23, Tampere 33520, Finland.;Tampere Univ, Fac Med & Hlth Technol, TUNI Palliat Care Res Grp, Arvo Ylpon Katu 23, Tampere 33520, Finland.;Tampere Univ Hosp, Palliat Care Ctr, Elamanaukio 2, Tampere 33520, Finland..
    Österlund, Emerik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Cancer precision medicine. Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Haartmaninkatu 4, Helsinki 00290, Finland..
    Ristimäki, Ari
    Helsinki Univ Hosp, Dept Pathol, HUS Diagnost Ctr, HUSLAB, Haartmaninkatu 3, Helsinki 00290, Finland.;Univ Helsinki, Fac Med, Res Programs Unit, Appl Tumor Genom Res Program, Haartmaninkatu 8, Helsinki 00290, Finland..
    Nieminen, Lasse
    Tampere Univ Hosp, Dept Obstet & Gynecol, Elamanaukio 2, Tampere 33520, Finland.;Univ Tampere, Dept Pathol, Arvo Ylpon Katu 23, Tampere 33520, Finland..
    Sundström, Jari
    Turku Univ Hosp, Dept Pathol, Kiinanmyllynkatu 4-8, Turku 20520, Finland.;Univ Turku, Inst Biomed, Kiinanmyllynkatu 10, Turku 20520, Finland..
    Mäkinen, Markus J.
    Oulu Univ Hosp, Dept Pathol, Kajaanintie 50, Oulu 90220, Finland.;Univ Oulu, Dept Pathol, Translat Med Res Unit, Pentti Kaiteran Katu 1, Oulu 90570, Finland.;Med Res Ctr Oulu, Pentti Kaiteran Katu 1, Oulu 90570, Finland..
    Kuopio, Teijo
    Hosp Nova, Dept Pathol, Hoitajantie 3, Jyvaskyla 40620, Finland.;Univ Jyvaskyla, Dept Biol & Environm Sci, Seminaarinkatu 15, Jyvaskyla 40014, Finland..
    Kytölä, Soili
    Helsinki Univ Hosp, HUS Diagnost Ctr, Dept Genet, HUSLAB, Haartmaninkatu 3, Helsinki 00290, Finland.;Univ Helsinki, Dept Genet, Haartmaninkatu 8, Helsinki 00290, Finland..
    Ålgars, Annika
    Turku Univ Hosp, Dept Oncol, Hameentie 11, Turku 20520, Finland..
    Ristamäki, Raija
    Turku Univ Hosp, Dept Oncol, Hameentie 11, Turku 20520, Finland..
    Heervä, Eetu
    Turku Univ Hosp, Dept Oncol, Hameentie 11, Turku 20520, Finland..
    Kallio, Raija
    Oulu Univ Hosp, Dept Oncol, Kajaanintie 50, Oulu 90220, Finland.;Univ Oulu, Dept Oncol, Pentti Kaiteran Katu 1, Oulu 90570, Finland..
    Halonen, Päivi
    Helsinki Univ Hosp, Dept Oncol, Haartmaninkatu 4, Helsinki 00290, Finland.;Univ Helsinki, Dept Oncol, Haartmaninkatu 8, Helsinki 00290, Finland..
    Soveri, Leena-Maija
    Univ Helsinki, Dept Oncol, Haartmaninkatu 8, Helsinki 00290, Finland.;Joint Municipal Author Hlth Care & Social Serv Kes, Home Care, Sairaalakatu 1, Hyvinkaa 05850, Finland..
    Nordin, Arno
    Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Haartmaninkatu 4, Helsinki 00290, Finland.;Univ Helsinki, Dept Surg, Haartmaninkatu 8, Helsinki 00290, Finland..
    Uutela, Aki
    Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Haartmaninkatu 4, Helsinki 00290, Finland.;Univ Helsinki, Dept Surg, Haartmaninkatu 8, Helsinki 00290, Finland..
    Salminen, Tapio
    Tampere Univ Hosp, Tays Canc Ctr, Dept Oncol, Elamanaukio 2, Tampere 33520, Finland.;Tampere Univ, Fac Med & Hlth Technol, Arvo Ylpon Katu 23, Tampere 33520, Finland..
    Stedt, Hanna
    Kuopio Univ Hosp, Dept Oncol, Puijonlaaksontie 2, Kuopio 70210, Finland.;Univ Eastern Finland, Fac Hlth Sci, Yliopistonranta 1A, Kuopio 70210, Finland..
    Lamminmäki, Annamarja
    Kuopio Univ Hosp, Dept Oncol, Puijonlaaksontie 2, Kuopio 70210, Finland.;Univ Eastern Finland, Fac Hlth Sci, Yliopistonranta 1A, Kuopio 70210, Finland..
    Muhonen, Timo
    Univ Helsinki, Dept Oncol, Haartmaninkatu 8, Helsinki 00290, Finland.;South Carel Cent Hosp, Dept Oncol, Valto Kakelan Katu 1, Lappeenranta 53130, Finland..
    Kononen, Juha
    Docrates Hosp, Docrates Canc Ctr, Saukonpaadenranta 2, Helsinki 00180, Finland.;Hosp Nova, Dept Oncol, Hoitajankatu 3, Jyvaskyla 40620, Finland..
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Cancer precision medicine.
    Isoniemi, Helena
    Helsinki Univ Hosp, Dept Transplantat & Liver Surg, Haartmaninkatu 4, Helsinki 00290, Finland.;Univ Helsinki, Dept Surg, Haartmaninkatu 8, Helsinki 00290, Finland..
    Lehto, Juho T.
    Tampere Univ, Fac Med & Hlth Technol, TUNI Palliat Care Res Grp, Arvo Ylpon Katu 23, Tampere 33520, Finland.;Tampere Univ Hosp, Palliat Care Ctr, Elamanaukio 2, Tampere 33520, Finland..
    Lehtomäki, Kaisa
    Tampere Univ Hosp, Tays Canc Ctr, Dept Oncol, Elamanaukio 2, Tampere 33520, Finland.;Tampere Univ, Fac Med & Hlth Technol, Arvo Ylpon Katu 23, Tampere 33520, Finland..
    Österlund, Pia
    Tampere Univ Hosp, Tays Canc Ctr, Dept Oncol, Elamanaukio 2, Tampere 33520, Finland.;Tampere Univ, Fac Med & Hlth Technol, Arvo Ylpon Katu 23, Tampere 33520, Finland.;Helsinki Univ Hosp, Dept Oncol, Haartmaninkatu 4, Helsinki 00290, Finland.;Univ Helsinki, Dept Oncol, Haartmaninkatu 8, Helsinki 00290, Finland.;Karolinska Univ Sjukhuset, Dept Gastrointestinal Oncol, Eugeniavagen 3, S-17176 Solna, Sweden.;Karolinska Inst, Dept Oncol Pathol, Solnavagen 1, S-17177 Solna, Sweden..
    Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)2024In: Cancers, ISSN 2072-6694, Vol. 16, no 5, article id 1052Article in journal (Refereed)
    Abstract [en]

    Simple Summary The location of the primary tumor in the right colon, left colon, or rectum affects the efficacy of biological drugs used in the treatment of metastatic colorectal cancer, but how? We examined how the primary tumor location affects disease characteristics, treatability, quality of life, and outcome in a real-life study population of 1080 Finnish patients in the RAXO study. The primary tumor location correlates with the location of metastases, the frequency of gene mutations, how often metastases can be operated upon, long-term survival after curative surgery or palliative chemotherapy, and the quality of life during the disease trajectory. The primary tumor location is a helpful surrogate for clinicians working with metastatic colorectal cancer patients in estimating the clinical course of the disease. This study cannot identify the reasons for the associations, i.e., whether it is the primary location per se, the different mutations, or other reasons.Abstract The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression were used to compare the groups. The PTL was in the right colon in 310 patients (29%), the left colon in 396 patients (37%), and the rectum in 375 patients (35%). The PTL was associated with distinct differences in metastatic sites during the disease trajectory. The resectability, conversion, and resection rates were lowest in the right colon, followed by the rectum, and were highest in the left colon. Overall survival was shortest for right colon compared with left colon or rectal PTL (median 21 vs. 35 vs. 36 months), with the same trends after metastasectomy or systemic therapy only. PTL also remained statistically significant in a multivariable model. The distribution of symptoms varied according to PTL, especially between the right colon (with general symptoms of metastases) and rectal PTL (with sexual- and bowel-related symptoms). mCRC, according to PTL, behaves differently regarding metastatic sites, resectability of the metastases, outcomes of treatment, and HRQoL.

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  • 26.
    Ahonen, Matti
    et al.
    Univ Helsinki, Dept Pediat Surg Orthoped & Traumatol, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland.;Univ Helsinki, Dept Pediat Surg Orthoped & Traumatol, Stenbackinkatu 9, Helsinki 00029, Finland.;Helsinki Univ Hosp, Stenbackinkatu 9, Helsinki 00029, Finland..
    Syvanen, Johanna
    Univ Turku, Dept Pediat Orthoped, Turku, Finland.;Turku Univ Hosp, Turku, Finland..
    Helenius, Linda
    Turku Univ Hosp, Turku, Finland.;Univ Turku, Dept Anesthes & Intens Care, Turku, Finland..
    Mattila, Mikko
    Univ Helsinki, Dept Pediat Surg Orthoped & Traumatol, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Perokorpi, Tanja
    Univ Helsinki, Dept Pediat Surg Orthoped & Traumatol, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Diarbakerli, Elias
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Reconstruct Orthoped, Stockholm, Sweden..
    Gerdhem, Paul
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Uppsala Univ Hosp, Dept Orthoped & Hand Surg, Uppsala, Sweden..
    Helenius, Ilkka
    Helsinki Univ Hosp, Helsinki, Finland.;Univ Helsinki, Dept Orthoped & Traumatol, Helsinki, Finland..
    Back Pain and Quality of Life 10 Years After Segmental Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis2023In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 48, no 10, p. 665-671Article in journal (Refereed)
    Abstract [en]

    Study Design.Comparative cohort study. Objective.The aim of the present study was to evaluate pain and health-related quality of life (HRQoL) in surgically managed patients with a minimum follow-up of 10 years compared with patients with untreated adolescent idiopathic scoliosis (AIS) and a healthy control group. Summary of Background Data.Posterior spinal fusion with pedicle screws is the standard treatment for AIS, although it remains unclear whether this procedure results in improved long-term HRQoL compared with untreated patients with AIS. Patients and Methods.Sixty-four consecutive patients at a minimum follow-up of 10 years, who underwent posterior pedicle screw instrumentation for AIS were prospectively enrolled. Fifty-three (83%) of these patients completed Scoliosis Research Society (SRS) 24 questionnaires, clinical examination, and standing spinal radiographs. Pain and HRQoL were compared with age and sex-matched patients with untreated AIS and healthy individuals. Results.The mean major curve was 57 degrees preoperatively and 15 degrees at the 10-year follow-up. SRS-24 self-image domain score showed a significant improvement from preoperative to 2 years and remained significantly better at the 10-year follow-up (P < 0.001). Patients fused to L3 or below had lower pain, satisfaction, and total score than patients fused to L2 or above (P < 0.05), but self-image, function, and activity scores did not differ between groups at 10-year follow-up. Pain, self-image, general activity, and total SRS domains were significantly better at 10-year follow-up in the surgically treated patients as compared with untreated patients (all P < 0.05). Healthy controls had significantly higher total scores than those surgically treated at 10-year follow-ups (P < 0.001). Conclusion.Patients undergoing segmental pedicle screw instrumentation for AIS maintain high-level HRQoL during a 10-year follow-up. Their HRQoL was significantly better than in the untreated patients with AIS, except for the function domain. However, HRQoL remained at a lower level than in healthy controls.

  • 27.
    Akerlund, Emma
    et al.
    Inst för Experimentell och Klinisk medicin, Linköping.
    Huss, Fredrik R M
    Inst för Experimentell och Klinisk medicin, Linköping.
    Sjöberg, Folke
    Inst för Experimentell och Klinisk medicin, Linköping.
    Burns in Sweden: an analysis of 24,538 cases during the period 1987-2004.2007In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 33, no 1, p. 31-6Article in journal (Refereed)
    Abstract [en]

    Burn care is always progressing, but there is little epidemiological information giving a clear picture of the current number of treated burns in Sweden. This study was conducted to provide an update of patients admitted to hospital with burns in Sweden. Data were obtained for all patients who were admitted to hospitals with a primary or secondary diagnosis of burns (ICD-9/10 codes) from 1 January 1987 to 31 December 2004; 24,538 patients were found. Most of the patients were male (69%), giving a male:female ratio of 2.23:1. Children in the age-group 0-4 years old predominated, and accounted for 27% of the study material. The median length of stay was 3 days. Throughout the period 740 patients (3%) died of their burns. Significant reductions in mortality, incidence, and length of stay were seen during the study, which correlates well with other studies. However, most of the reductions were in the younger age-groups. Men accounted for the improved mortality, as female mortality did not change significantly. We think that the improvement in results among patients admitted to hospital after burns is a combination of preventive measures, improved treatment protocols, and an expanding strategy by which burned patients are treated as outpatients.

  • 28.
    Al Ani, Amer
    et al.
    Ajman Univ, Coll Med, Ajman, U Arab Emirates..
    Tahtamoni, Rafeef
    Sharjah Univ, Coll Med, Sharjah, U Arab Emirates..
    Mohammad, Yara
    Sharjah Univ, Coll Med, Sharjah, U Arab Emirates..
    Al-Ayoubi, Fawzi
    Sheikh Khalifa Med City, Ajman, U Arab Emirates..
    Haider, Nadeem
    Sheikh Khalifa Med City, Ajman, U Arab Emirates..
    Al-Mashhadi, Ammar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatric Surgery. Sheikh Khalifa Med City Ajman, Ajman, U Arab Emirates..
    Impacts of severity of Covid-19 infection on the morbidity and mortality of surgical patients2022In: Annals of Medicine and Surgery, E-ISSN 2049-0801, Vol. 79, article id 103910Article in journal (Refereed)
    Abstract [en]

    Introduction: One of the challenges of surgery on patients with active SARS-CoV-2(severe acute respiratory syndrome coronavirus 2) infection is the increased risk of postoperative morbidity and mortality. Aim: This study will describe and compare the postoperative morbidity and mortality in asymptomatic patients or those with mild infection with those with severe COVID-19 infection undergoing elective or and emergency surgery. Materials and methods: This is a retrospective study of 37 COVID19 patients who had the infection 7 days prior to and 30 days after emergency or elective surgery. Patients were divided to two groups. Group1: the asymptomatic or those with mild infection that is diagnosed just before surgery (14 patients). Group 2: those who were admitted to the hospital because of severe COVID-19 and were operated for COVID-19 related complications (23 patients). Morbidity and mortality of both groups was studied. Results: There was no significant difference in gender between the two groups. There were 5 females (2 in group 1, and 3 in group 2) and 32 males (12 in group 1, and 20 in group 2). Mean age for all patients was 49.8years (38 for group 1 and 57 for group2). Median age for all patients was 50 years (37.5 for group 1 and 57 years for group 2). Sepsis developed in 7 patients (1 patient in group 1 and in 6 patients in group 2). Statistically there was no significant difference in occurrence of sepsis between the two groups. There was a significant difference in the intensive care stay between the two groups (higher in group 2). Four deaths were reported in group 1 and fourteen in group 2. Eighteen out of thirty-seven patients died. Conclusion: Severity of COVID-19 infection will prolong the hospitalization and ICU stay in surgical patients with no significant effect on mortality.

  • 29.
    Albåge, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    An important piece of the puzzle for understanding the benefits of concomitant ablation of atrial fibrillation in cardiac surgery2018In: Annals of Translational Medicine, ISSN 2305-5839, E-ISSN 2305-5847, Vol. 6, no 11, article id 223Article in journal (Other academic)
  • 30.
    Albåge, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Postoperative chylothorax: a cause for concern2017In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 159, no 10, p. 2023-2024Article in journal (Other academic)
  • 31.
    Albåge, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Montibello, Marco
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Surgical aspects of valve replacement in carcinoid heart disease2021In: Journal of cardiac surgery, ISSN 0886-0440, E-ISSN 1540-8191, Vol. 36, no 1, p. 290-294Article in journal (Refereed)
    Abstract [en]

    Tricuspid and pulmonary valve replacement in patients with advanced carcinoid heart disease (CaHD) reduces right heart failure and improves prognosis. The surgical literature is limited concerning description of technical aspects of valve replacement in CaHD. Although a dedicated multidisciplinary care is required for these frail patients, optimization of surgical technique is important and may lead to better postoperative outcomes.

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  • 32.
    Albåge, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Sartipy, Ulrik
    Kenneback, Goran
    Johansson, Birgitta
    Schersten, Henrik
    Jidéus, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Long-Term Risk of Ischemic Stroke After the Cox-Maze III Procedure for Atrial Fibrillation2017In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 104, no 2, p. 523-529Article in journal (Refereed)
    Abstract [en]

    Background. The long-term risk of stroke after surgical treatment of atrial fibrillation is not well known. We performed an observational cohort study with long follow-up after the "cut-and-sew" Cox-maze III procedure (CM-III), including left atrial appendage excision. The aim was to analyze the incidence of stroke/transient ischemic attack (TIA) and the association to preoperative CHA(2)DS(2)-VASc (age in years, sex, congestive heart failure history, hypertension history, stroke/TIA, thromboembolism history, vascular disease history, diabetes mellitus) score. Methods. Preoperative and perioperative data were collected in 526 CM-III patients operated in four centers 1994 to 2009, 412 men, mean age of 57.1 +/- 8.3 years. The incidence of any stroke/TIA was identified through analyses of the Swedish National Patient and Cause-ofDeath Registers and from review of individual patient records. The cumulative incidence of stroke/TIA and association with CHA(2)DS(2)-VASc score was estimated using methods accounting for the competing risk of death. Results. Mean follow-up was 10.1 years. There were 29 patients with any stroke/TIA, including 6 with intracerebral bleedings (2 fatal) and 4 with perioperative strokes (0.76%). The remaining 13 ischemic strokes and six TIAs occurred at a mean of 7.1 +/- 4.0 years postoperatively, with an incidence of 0.36% per year (19 events per 5,231 patient-years). In all CHA(2)DS(2)-VASc groups, observed ischemic stroke/TIA rate was lower than predicted. A higher risk of ischemic stroke/TIA was seen in patients with CHA(2)DS(2)-VASc score 2 or greater compared with score 0 or 1 (hazards ratio 2.15, 95% confidence interval: 0.87 to 5.32) but no difference by sex or stand-alone versus concomitant operation. No patient had ischemic stroke as cause of death. Conclusions. This multicenter study showed a low incidence of perioperative and long-term postoperative ischemic stroke/TIA after CM-III. Although general risk of ischemic stroke/TIA was reduced, patients with CHA(2)DS(2)-VASc score 2 or greater had a higher risk compared with score 0 or 1. Complete left atrial appendage excision may be an important reason for the low ischemic stroke rate. (C) 2017 by The Society of Thoracic Surgeons

  • 33.
    Aldenbäck, Erica
    et al.
    Falun Cent Hosp, Dept Surg, Bariatr Clin, Falun, Sweden..
    Johansson, Hans-Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Falun Cent Hosp, Dept Surg, Bariatr Clin, Falun, Sweden..
    Anthropometric Measurements and Correlations to Glucometabolic and Cardiovascular Risk in Obese Patients Undergoing Gastric Bypass Surgery2021In: Journal of Obesity, ISSN 2090-0708, E-ISSN 2090-0716, Vol. 2021, article id 6647328Article in journal (Refereed)
    Abstract [en]

    Abdominal obesity is associated with hypertension, increased fasting glucose, HbA1c, and cholesterol. Body mass index (BMI) is frequently used to measure and define obesity and as inclusion criteria for bariatric surgery. Sagittal abdominal diameter (SAD) has been suggested to predict the amount of visceral fat, metabolic traits, and cardiometabolic risk superior to BMI. The aim was to test whether SAD has stronger correlations to glucometabolic traits compared to BMI. One hundred and fifty-five (108 women, 47 men) morbidly obese patients undergoing bariatric surgery were evaluated before (baseline), 6 and 12 months after Roux-en-Y gastric bypass (RYGBP). BMI was reduced from 43.7 kg/m2 (baseline) to 31.3 kg/m2 (12 months) and SAD from 32.6 to 23.2 cm (both p < 0.001). SAD correlated with CRP (p=0.04), fasting glucose (p=0.008), HbA1c (p=0.016), triglycerides (p=0.017), systolic blood pressure (p=0.032), and vitamin D (p=0.027). BMI correlated with CRP (p=0.006), triglycerides (p=0.016), vitamin D (p=0.002), and magnesium (p=0.037). Despite RYGBP surgery, vitamin D was significantly increased. Liver enzymes were significantly lowered after RYGBP and the change over time in SAD correlated with gamma-glutamyltransferase. SAD was superior to BMI to predict glucose disturbance and dyslipidemia implying increased use of SAD as it is cost effective and simple to perform in the clinic and could be of value when considering patients for bariatric surgery.

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  • 34.
    Alexandersson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Nyköping Hosp, Dept Orthoped, Nyköping, Sweden.
    Wang, Eugen Yu-Hui
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Eriksson, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Umeå Univ, Dept Community Med & Rehabil, Physiotherapy, Umeå, Sweden.
    A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 4, p. 1035-1042Article in journal (Refereed)
    Abstract [en]

    Purpose: When a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.

    Methods: 81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.

    Results: ANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.

    Conclusions: The hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.

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  • 35.
    Alim, Md Abdul
    et al.
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Domeij-Arverud, Erica
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Gunnar
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Edman, Gunnar
    Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden.
    Ackermann, Paul W
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 7, p. 2021-2029Article in journal (Refereed)
    Abstract [en]

    PURPOSE AND HYPOTHESIS: Adjuvant intermittent pneumatic compression (IPC) during leg immobilization following Achilles tendon rupture (ATR) has been shown to reduce the risk of deep venous thrombosis. The purpose of this study was to investigate whether IPC can also promote tendon healing.

    METHODS: One hundred and fifty patients with surgical repair of acute ATR were post-operatively leg immobilized and prospectively randomized. Patients were allocated for 2 weeks of either adjuvant IPC treatment (n = 74) or treatment-as-usual (n = 74) in a plaster cast without IPC. The IPC group received 6 h daily bilateral calf IPC applied under an orthosis on the injured side. At 2 weeks post-operatively, tendon healing was assessed using microdialysis followed by enzymatic quantification of tendon callus production, procollagen type I (PINP) and type III (PIIINP) N-terminal propeptide, and total protein content. 14 IPC and 19 cast patients (control group) consented to undergo microdialysis. During weeks 3-6, all subjects were leg-immobilized in an orthosis without IPC. At 3 and 12 months, patient-reported outcome was assessed using reliable questionnaires (ATRS and EQ-5D). At 12 months, functional outcome was measured using the validated heel-rise test.

    RESULTS: At 2 weeks post-rupture, the IPC-treated patients exhibited 69% higher levels of PINP in the ruptured Achilles tendon (AT) compared to the control group (p = 0.001). Interestingly, the IPC-treated contralateral, intact AT also demonstrated 49% higher concentrations of PINP compared to the non-treated intact AT of the plaster cast group (p = 0.002). There were no adverse events observed associated with IPC. At 3 and 12 months, no significant (n.s.) differences between the two treatments were observed using patient-reported and functional outcome measures.

    CONCLUSIONS: Adjuvant IPC during limb immobilization in patients with ATR seems to effectively enhance the early healing response by upregulation of collagen type I synthesis, without any adverse effects. Whether prolonged IPC application during the whole immobilization period can also lead to improved long-term clinical healing response should be further investigated. The healing process during leg immobilization in patients with Achilles tendon rupture can be improved through adjuvant IPC therapy, which additionally prevents deep venous thrombosis.

    LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

  • 36.
    Al‐Kurd, Abbas
    et al.
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Kitajima, Toshihiro
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Delvecchio, Khortnal
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Tayseer Shamaa, Mhd
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Ivanics, Tommy
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Yeddula, Sirisha
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Yoshida, Atsushi
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Rizzari, Michael
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Collins, Kelly
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Abouljoud, Marwan
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Nagai, Shunji
    Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Henry Ford Transplant Institute Detroit MI USA.
    Short recipient warm ischemia time improves outcomes in deceased donor liver transplantation2021In: Transplant International, ISSN 0934-0874, E-ISSN 1432-2277Article in journal (Refereed)
  • 37.
    Almby, Kristina E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Akademiska Sjukhuset.
    Edholm, David
    Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Anastomotic Strictures After Roux-en-Y Gastric Bypass: a Cohort Study from the Scandinavian Obesity Surgery Registry2019In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 1, p. 172-177Article in journal (Refereed)
    Abstract [en]

    Background

    Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure worldwide. Anastomotic stricture is a known complication of RYGB. The aim was to explore the incidence and outcomes of strictures within the Scandinavian Obesity Surgery Registry (SOReg).

    Method

    SOReg included prospective data from 36,362 patients undergoing bariatric surgery in the years 2007–2013. Outcomes were recorded at 30-day and at 1-year follow-up according to the standard SOReg routine. The medical charts of patients suffering from stricture after RYGB were requested and assessed.

    Setting

    National bariatric surgery registry

    Results

    Anastomotic stricture within 1 year of surgery was confirmed in 101 patients representing an incidence of 0.3%. Risk factors for stricture were patient age above 60 years (odds ratio (OR), 6.2 95% confidence interval (CI) 2.7–14.3), circular stapled gastrojejunostomy (OR 2.7, 95% CI 1.4–5.5), postoperative anastomotic leak (OR 8.9 95%, CI 4.7–17.0), and marginal ulcer (OR 30.0, 95% CI 19.2–47.0). Seventy-five percent of the strictures were diagnosed within 70 days of surgery. Two dilatations or less was sufficient to successfully treat 50% of patients. Ten pecent of patients developed perforation during dilatation, and the risk of perforating at each dilatation was 3.8%. Perforation required surgery in six cases but there was no mortality. Strictures in SOReg may be underreported, which could explain the low incidence in the study.

    Conclusion

    Most strictures present within 2 months and are successfully treated with two dilatations or less. Dilating a strictured gastrojejunostomy entails a risk of perforation (3.8%).

  • 38.
    Almqvist Terán, Nicolas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Neurosurgery.
    Loayza, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Neurosurgery.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Ericson, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Neurosurgery.
    Abu Hamdeh, Sami
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Neurosurgery.
    Svedung-Wettervik, Teodor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Neurosurgery.
    In Reply to the Letter to the Editor Regarding "Posterior Fossa Volume and Dimensions: Relation to Pathophysiology and Surgical Outcomes in Classical Trigeminal Neuralgia"2023In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 180, article id 268Article in journal (Other academic)
  • 39.
    Al-Shamkhi, Nasrin
    et al.
    Örebro Univ Hosp, Dept Internal Med, Örebro, Sweden.;Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden.;Uppsala Univ Hosp, Dept Endocrinol & Diabetol, Uppsala, Sweden.;Akadem Sjukhuset, Endokrin & Diabetesmottagningen, S-75185 Uppsala, Sweden..
    Berinder, Katarina
    Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Borg, Henrik
    Lund Univ, Skane Univ Hosp, Dept Endocrinol, Lund, Sweden..
    Burman, Pia
    Lund Univ, Skane Univ Hosp, Dept Endocrinol, Malmö, Sweden..
    Dahlqvist, Per
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå, Sweden..
    Hoybye, Charlotte
    Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Olsson, Daniel S.
    Sahlgrens Univ Hosp, Dept Endocrinol, Gothenburg, Sweden.;Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Gothenburg, Sweden.;AstraZeneca, BioPharmaceut R&D, Cardiovasc Renal & Metab CVRM, Gothenburg, Sweden..
    Ragnarsson, Oskar
    Sahlgrens Univ Hosp, Dept Endocrinol, Gothenburg, Sweden.;Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Gothenburg, Sweden.;Univ Gothenburg, Wallenberg Ctr Mol & Translat Med, Gothenburg, Sweden..
    Ekman, Bertil
    Linköping Univ, Dept Endocrinol Linköping & Norrköping, Linköping, Sweden.;Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden..
    Edén Engström, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish Pituitary Register2023In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 189, no 2, p. 217-224Article in journal (Refereed)
    Abstract [en]

    Objective: Data on pre- and postoperative pituitary function in nonfunctioning pituitary adenomas (NFPA) are not consistent. We aimed to investigate pituitary function before and up to 5 years after transsphenoidal surgery with emphasis on the hypothalamic-pituitary-adrenal axis (HPA).

    Design and methods: Data from the Swedish Pituitary Register was used to analyze anterior pituitary function in 838 patients with NFPA diagnosed between 1991 and 2014. Patients who were reoperated or had received radiotherapy were excluded.

    Results: Preoperative ACTH, TSH, LH/FSH, and GH deficiencies were reported in 31% (236/755), 39% (300/769), 51% (378/742), and 28% (170/604) of the patients, respectively. Preoperative median tumor volume was 5.0 (2.4-9.0) cm(3). Among patients with preoperative, 1 year and 5 years postoperative data on the HPA axis (n = 428), 125 (29%) were ACTH-deficient preoperatively. One year postoperatively, 26% (32/125) of them had recovered ACTH function while 23% (70/303) patients had developed new ACTH deficiency. Thus, 1 year postoperatively, 163 (38%) patients were ACTH-deficient (P < .001 vs. preoperatively). No further increase was seen 5 years postoperatively (36%, P = .096). At 1 year postoperatively, recoveries in the TSH and LH/FSH axes were reported in 14% (33/241) and 15% (46/310), respectively, and new deficiencies in 22% (88/403) and 29% (83/288), respectively.

    Conclusions: Adrenocorticotrophic hormone deficiency increased significantly at 1 year postoperatively. Even though not significant, some patients recovered from or developed new deficiency between 1 and 5 years postoperatively. This pattern was seen in all axes. Our study emphasizes that continuous individual evaluations are needed during longer follow-up of patients operated for NFPA.

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  • 40.
    Altreuther, Martin
    et al.
    St Olavs Hosp, Dept Vasc Surg, Trondheim, Norway.;NTNU, Inst Circulat & Med Imaging, Trondheim, Norway..
    Grima, Matthew J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Mater Dei Hosp, Dept Surg, Vasc Unit, Msida, Malta; Univ Malta, Fac Med & Surg, Msida, Malta.
    Lattmann, Thomas
    Kantonsspital Winterthur, Dept Vasc Surg, Winterthur, Switzerland.;Swiss Soc Vasc Surg, Lausanne, Switzerland..
    International Validation Of Vascular Registries: The VASCUNET Validation Template2023In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 66, no 3, p. 438-439Article in journal (Other academic)
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  • 41.
    An, Feng-Wei
    et al.
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Yuan, Hu
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Guo, Weiwei
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Hou, Zhao-Hui
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Cai, Jian-Ming
    Chinese Peoples Liberat Army Gen Hosp, Dept Radiol, Beijing, Peoples R China.
    Luo, Chun-Cai
    Chinese Peoples Liberat Army Gen Hosp, Dept Radiol, Beijing, Peoples R China.
    Yu, Ning
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Jiang, Qing-Qing
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Cheng, Wei
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Liu, Wei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Yang, Shi-Ming
    Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Establishment of a Large Animal Model for Eustachian Tube Functional Study in Miniature Pigs2019In: Anatomical Record Part A-discoveries in Molecular Cellular and Evolutionary Biology, ISSN 1552-4884, E-ISSN 1932-8494, Vol. 302, no 6, p. 1024-1038Article in journal (Refereed)
    Abstract [en]

    This study was performed to investigate whether miniature pigs are a suitable animal model for studies of the Eustachian tube (ET). Sixteen Chinese experimental miniature pigs were used in this investigation. Ten animals were used for anatomical and morphometric analyses to obtain qualitative and quantitative information regarding the ET. Three animals were used for histological analysis to determine the fine structure of ET cross-sections. Three animals were used to investigate the feasibility of balloon dilation of the Eustachian tube (BDET). The anatomical study indicated that the pharyngeal orifice and tympanic orifice of the miniature pig ET are located at the posterior end of the nasal lateral wall and anterior wall of the middle ear cavity, respectively. The cartilaginous tube was seen to pass through the whole length of the ET, the length of the cartilaginous part of the ET and the diameter of the isthmus were similar between humans and miniature pigs. The inclination of the ET in miniature pigs was larger than that in humans. The gross histology seemed to be slightly different between miniature pig and human, but the fine structures were essentially the same in both species. BDET experiments verified that the miniature pig model is suitable as a model for clinical operations. The miniature pig ET corresponds very well to that of humans. In addition, the miniature pig ET is suitable as a model for clinical operations. Therefore, the miniature pig is a valid animal model for ET study. 

  • 42.
    Analatos, Apostolos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogsvag 1, S-61139 Nyköping, Sweden.
    Hakanson, Bengt S.
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp, Dept Surg & Anaesthesiol, Stockholm, Sweden.
    Ansorge, Christoph
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogsvag 1, S-61139 Nyköping, Sweden.
    Lindblad, Mats
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Upper Abdominal Surg, Stockholm, Sweden.
    Lundell, Lars
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark.
    Thorell, Anders
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.
    Clinical Outcomes of a Laparoscopic Total vs a 270 degrees Posterior Partial Fundoplication in Chronic Gastroesophageal Reflux Disease: A Randomized Clinical Trial2022In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 157, no 6, p. 473-480Article in journal (Refereed)
    Abstract [en]

    Importance The efficacy of fundoplication operations in the management of gastroesophageal reflux disease (GERD) has been documented. However, few prospective, controlled series report long-term (>10 years) efficacy and postfundoplication concerns, particularly when comparing various types of fundoplication.

    Objective To compare long-term (>15 years) results regarding mechanical complications, reflux control, and quality of life between patients undergoing posterior partial fundoplication (PF) or total fundoplication (TF) (270 degrees vs 360 degrees) in surgical treatment for GERD.

    Design, setting and participants A double-blind randomized clinical trial was performed at a single center (Ersta Hospital, Stockholm, Sweden) from November 19, 2001, to January 24, 2006. A total of 456 patients were recruited and randomized. Data for this analysis were collected from August 1, 2019, to January 31, 2021.

    Interventions Laparoscopic 270 degrees posterior PF vs 360 degrees TF.

    Main Outcomes and Measures The main outcome was dysphagia scores for solid and liquid food items after more than 15 years. Generic (36-Item Short-Form Health Survey) and disease-specific (Gastrointestinal Symptom Rating Scale) quality of life and proton pump inhibitor consumption were also assessed.

    Results Among 407 available patients, relevant data were obtained from 310 (response rate, 76%; mean [SD] age, 66 [11.2] years; 184 [59%] men). A total of 159 were allocated to a PF and 151 to a TF. The mean (SD) follow-up time was 16 (1.3) years. At 15 years after surgery, mean (SD) dysphagia scores were low for both liquids (PF, 1.2 [0.5]; TF, 1.2 [0.5]; P = .58) and solids (PF, 1.3 [0.6]; TF, 1.3 [0.5]; P = .97), without statistically significant differences between the groups. Reflux symptoms were equally well controlled by the 2 types of fundoplications as were the improvements of quality-of-life scores.

    Conclusions and Relevance The long-term findings of this randomized clinical trial indicate that PF and TF are equally effective for controlling GERD and quality of life in the long term. Although PF was superior in the first years after surgery in terms of less dysphagia recorded, this difference did not prevail when assessed a decade later.

  • 43.
    Analatos, Apostolos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Nyköping, Sweden..
    Håkanson, B. S.
    Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden.;Karolinska Inst, Danderyds Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lundell, L.
    Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark..
    Lindblad, M.
    Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden..
    Thorell, A.
    Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden.;Karolinska Inst, Danderyds Hosp, Dept Clin Sci, Stockholm, Sweden..
    Author response to: Tension-free mesh versus suture-alone cruroplasty in antireflux surgery: a randomized, double-blind clinical trial2021In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 108, no 11, p. E390-E390Article in journal (Other academic)
  • 44.
    Analatos, Apostolos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden; Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Nyköping Hosp, Dept Surg, Nyköping, Sweden.
    Håkanson, B. S.
    Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden.;Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Danderyd, Sweden..
    Lundell, L.
    Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark..
    Lindblad, M.
    Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden..
    Thorell, A.
    Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden.;Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Danderyd, Sweden..
    Tension-free mesh versus suture-alone cruroplasty in antireflux surgery: a randomized, double-blind clinical trial2020In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 107, no 13, p. 1731-1740Article in journal (Refereed)
    Abstract [en]

    Background

    Antireflux surgery is effective for the treatment of gastro-oesophageal reflux disease (GORD) but recurrence of hiatal hernia remains a challenge. In other types of hernia repair, use of mesh is associated with reduced recurrence rates. The aim of this study was to compare the use of mesh versus sutures alone for the repair of hiatal hernia in laparoscopic antireflux surgery.

    Methods

    Patients undergoing laparoscopic Nissen fundoplication for GORD between January 2006 and December 2010 were allocated randomly to closure of the diaphragmatic hiatus with crural sutures or non-absorbable polytetrafluoroethylene mesh (CruraSoft®). The primary outcome was recurrence of hiatal hernia, as determined by barium swallow study 12 months after surgery. Secondary outcomes were: intraoperative and postoperative complications, use of antireflux medication, postoperative oesophageal acid exposure, quality of life, dysphagia and duration of hospital stay.

    Results

    Some 77 patients were randomized to the suture technique and 82 patients underwent mesh repair. At 1 year, the hiatal hernia had recurred in six of 64 patients (9 per cent) in the mesh group and two of 64 (3 per cent) in the suture group (P = 0·144). Reflux symptoms, use of proton pump inhibitors and oesophageal acid exposure did not differ between the groups. At 3 years, recurrence rates were 13 and 10 per cent in the mesh and suture groups respectively (P = 0·692). Dysphagia scores decreased in both groups, but more patients had dysphagia for solid food after mesh closure (P = 0·013). Quality-of-life scores were comparable between the groups.

    Conclusion

    Tension-free crural repair with non-absorbable mesh does not reduce the incidence of recurrent hiatal hernia compared with use of sutures alone in patients undergoing laparoscopic fundoplication. NCT03730233 (http://www.clinicaltrials.gov).

  • 45.
    Analatos, Apostolos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogs Vag 1, Nyköping, Sweden..
    Lindblad, Mats
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Upper Abdominal Surg, Stockholm, Sweden..
    Ansorge, Christoph
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogs Vag 1, Nyköping, Sweden..
    Lundell, Lars
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark..
    Thorell, Anders
    Ersta Hosp Stockholm, Danderyds Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp Stockholm, Dept Surg & Anaesthesiol, Stockholm, Sweden..
    Hakanson, Bengt S.
    Ersta Hosp Stockholm, Danderyds Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp Stockholm, Dept Surg & Anaesthesiol, Stockholm, Sweden..
    Total versus partial posterior fundoplication in the surgical repair of para-oesophageal hernias: randomized clinical trial2022In: BJS Open, E-ISSN 2474-9842, Vol. 6, no 3, article id zrac034Article in journal (Refereed)
    Abstract [en]

    Background: Fundoplication is an essential step in para-oesophageal hernia (POH) repair, but which type minimizes postoperative mechanical complications is controversial.

    Methods: This was a randomized, double-blind clinical trial conducted between May 2009 and October 2018. Patients with symptomatic POH were allocated to either a total (Nissen) or a posterior partial (Toupet) fundoplication after hernia reduction and crural repair. The primary outcome was dysphagia (Ogilvie dysphagia scores) at 6 months postoperatively. Secondary outcomes were peri- and postoperative complications, swallowing difficulties assessed by the Dakkak dysphagia score, gastro-oesophageal reflux, quality of life (QoL), and radiologically confirmed hernia recurrence.

    Results: A total of 70 patients were randomized to a Nissen (n = 32) or a Toupet (n = 38) fundoplication. Compared with baseline, Ogilvie dysphagia scores were stable at the 3- and 6-month follow-up in the Nissen group (P = 0.075 and 0.084 respectively) but significantly improved in the Toupet group (from baseline mean (s.d.): 1.4 (1.1) to 0.5 (0.8) at 3 months, and 0.5 (0.6) at 6 months; P= 0.003 and P = 0.001 respectively). At 6 months, Dakkak dysphagia scores were significantly higher in the Nissen group than in the Toupet group (mean (s.d.): 10.4 (7.9) versus 5.1(7.2); P = 0.003). QoL scores improved throughout the follow-up. However, at 3 and 6 months postoperatively, the absolute median improvement (A) from preoperative values in the mental component scores of the Short Form-36 QoL questionnaire was significantly higher in the Toupet group (median (i.q.r.): 7.1 (-0.6 to 15.2) versus 1.0 (-5.4 to 3.3) at 3 months, and 11.2 (1.4 to 18.3) versus 0.4 (-9.4 to 7.5) at 6 months; (P =0.010 and 0.003 respectively)). At 6 months, radiologically confirmed POH recurrence occurred in 11 of 24 patients (46 per cent) of the Nissen group and in 15 of 32 patients (47 per cent) of the Toupet group (P = 1.001).

    Conclusions: A partial posterior wrap (Toupet fundoplication) showed reduced obstructive complications and improved QoL compared with a total (Nissen) fundoplication following POH repair.

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  • 46.
    Analatos, Apostolos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden; Nykoping Hosp, Dept Surg, Nykoping, Sweden.
    Lindblad, Mats
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Rouvelas, Ioannis
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Elbe, Peter
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Lundell, Lars
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Nilsson, Magnus
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Tsekrekos, Andrianos
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Tsai, Jon A.
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Evaluation of resection of the gastroesophageal junction and jejunal interposition (Merendino procedure) as a rescue procedure in patients with a failed redo antireflux procedure. A single-center experience2018In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 18, article id 70Article in journal (Refereed)
    Abstract [en]

    Background: Primary antireflux surgery has high success rates but 5 to 20% of patients undergoing antireflux operations can experience recurrent reflux and dysphagia, requiring reoperation. Different surgical approaches after failed fundoplication have been described in the literature. The aim of this study was to evaluate resection of the gastroesophageal junction with jejunal interposition (Merendino procedure) as a rescue procedure after failed fundoplication.

    Methods: All patients who underwent a Merendino procedure at the Karolinska University Hospital between 2004 and 2012 after a failed antireflux fundoplication were identified. Data regarding previous surgical history, preoperative workup, postoperative complications, subsequent investigations and re-interventions were collected retrospectively. The follow-up also included questionnaires regarding quality of life, gastrointestinal function and the dumping syndrome.

    Results: Twelve patients had a Merendino reconstruction. Ten patients had undergone at least two previous fundoplications, of which one patient had four such procedures. The main indication for surgery was epigastric and radiating back pain, with or without dysphagia. Postoperative complications occurred in 8/12 patients (67%). During a median follow-up of 35 months (range 20-61), four (25%) patients had an additional redo procedure with conversion to a Roux-en-Y esophagojejunostomy within 12 months, mainly due to obstructive symptoms that could not be managed conservatively or with endoscopic techniques. Questionnaires scores were generally poor in all dimensions.

    Conclusions: In our experience, the Merendino procedure seems to be an unsuitable surgical option for patients who require an alternative surgical reconstruction due to a failed fundoplication. However, the small number of patients included in this study as well as the small number of participants who completed the postoperative workout limits this study.

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  • 47.
    Anderberg, Leif
    et al.
    Lunds universitet.
    Aldskogius, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neuroanatomy.
    Holtz, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Spinal cord injury: scientific challenges for the unknown future2007In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 112, no 3, p. 259-288Article, review/survey (Other academic)
    Abstract [en]

    The history of spinal cord injuries starts with the ancient Egyptian medical papyrus known as the Edwin Smith Surgical Papyrus. The papyrus, written about 2500 B. C. by the physician and architect of the Sakkara pyramids Imhotep, describes "crushed vertebra in his neck" as well as symptoms of neurological deterioration. An ailment not to be treated was the massage to the patients at that time. This fatalistic attitude remained until the end of World War II when the first rehabilitation centre focused on the rehabilitation of spinal cord injured patients was opened. Our knowledge of the pathophysiological processes, both the primary as well as the secondary, has increased tremendously. However, all this knowledge has only led to improved medical care but not to any therapeutic method to restore, even partially, the neurological function. Neuroprotection is defined as measures to counteract secondary injury mechanisms and/or limit the extent of damage caused by self-destructive cellular and tissue processes. The co-existence of several distinctly different injury mechanisms after trauma has provided opportunities to explore a large number of potentially neuroprotective agents in animal experiments such as methylprednisolone sodium succinate. The results of this research have been very discouraging and pharmacological neuroprotection for patients with spinal cord injury has fallen short of the expectations created by the extensive research and promising observations in animal experiments. The focus of research has now, instead, been transformed to the field of neural regeneration. This field includes the discovery of regenerating obstacles in the nerve cell and/or environmental factors but also various regeneration strategies such as bridging the gap at the site of injury as well as transplantation of foetal tissue and stem cells. The purpose of this review is to highlight selected experimental and clinical studies that form the basis for undertaking future challenges in the research field of spinal cord injury. We will focus our discussion on methods either preventing the consequences of secondary injury in the acute period ( neuroprotection) and/or various techniques of neural regeneration in the sub-acute and chronic phase and finally expose some thoughts about future avenues within this scientific field.

  • 48. Andersen, Lise Geisler
    et al.
    Ängquist, Lars
    Gamborg, Michael
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Bengtsson, Calle
    Canoy, Dexter
    Eriksson, Johan G.
    Eriksson, Marit
    Järvelin, Marjo-Riitta
    Lissner, Lauren
    Nilsen, Tom I.
    Osler, Merete
    Overvad, Kim
    Rasmussen, Finn
    Salonen, Minna K.
    Schack-Nielsen, Lene
    Tammelin, Tuija H.
    Tuomainen, Tomi-Pekka
    Sørensen, Thorkild I. A.
    Baker, Jennifer L.
    Birth weight in relation to leisure time physical activity in adolescence and adulthood: meta-analysis of results from 13 nordic cohorts2009In: PloS one, ISSN 1932-6203, Vol. 4, no 12, p. e8192-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Prenatal life exposures, potentially manifested as altered birth size, may influence the later risk of major chronic diseases through direct biologic effects on disease processes, but also by modifying adult behaviors such as physical activity that may influence later disease risk. METHODS/PRINCIPAL FINDINGS: We investigated the association between birth weight and leisure time physical activity (LTPA) in 43,482 adolescents and adults from 13 Nordic cohorts. Random effects meta-analyses were performed on categorical estimates from cohort-, age-, sex- and birth weight specific analyses. Birth weight showed a reverse U-shaped association with later LTPA; within the range of normal weight the association was negligible but weights below and above this range were associated with a lower probability of undertaking LTPA. Compared with the reference category (3.26-3.75 kg), the birth weight categories of 1.26-1.75, 1.76-2.25, 2.26-2.75, and 4.76-5.25 kg, had odds ratios of 0.67 (95% confidence interval: 0.47, 0.94), 0.72 (0.59, 0.88), 0.89 (0.79, 0.99), and 0.65 (0.50, 0.86), respectively. The shape and strength of the birth weight-LTPA association was virtually independent of sex, age, gestational age, educational level, concurrent body mass index, and smoking. CONCLUSIONS/SIGNIFICANCE: The association between birth weight and undertaking LTPA is very weak within the normal birth weight range, but both low and high birth weights are associated with a lower probability of undertaking LTPA, which hence may be a mediator between prenatal influences and later disease risk.

  • 49.
    Andersen, Mikkel Österheden
    et al.
    Reg Southern Denmark, Ctr Spine Surg & Res, Middelfart, Denmark;Univ Southern Denmark, Odense, Denmark.
    Fritzell, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Capio St Goran Hosp, Stockholm, Sweden;Qulturum Ctr Learning & Innovat Healthcare, Jonkoping, Sweden.
    Eiskjaer, Sören Peter
    Aalborg Univ Hosp, Aalborg C, Denmark.
    Lagerbäck, Tobias
    Karolinska Univ Hosp, Huddinge, Sweden;Karolinska Inst, Huddinge, Sweden.
    Hägg, Olle
    Spine Ctr Goteborg, Gothenburg, Sweden.
    Nordvall, Dennis
    Qulturum Ctr Learning & Innovat Healthcare, Jonkoping, Sweden.
    Lönne, Greger
    Innlandet Hosp Trust, Lillehammer, Norway;Trondheim Reg & Univ Hosp, St Olavs Hosp, Trondheim, Norway.
    Solberg, Tore
    Univ Hosp Northern Norway, Tromso, Norway;Arctic Univ Norway, Tromso, Norway.
    Jacobs, Wilco
    van Hooff, Miranda
    Sint Maartenskliniek, Nijmegen, Netherlands;Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands.
    Gerdhem, Paul
    Karolinska Univ Hosp, Huddinge, Sweden;Karolinska Inst, Huddinge, Sweden.
    Gehrchen, Martin
    Univ Copenhagen, Rigshosp, Copenhagen, Denmark.
    Surgical Treatment of Degenerative Disk Disease in Three Scandinavian Countries: An International Register Study Based on Three Merged National Spine Registers2019In: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, Vol. 9, no 8, p. 850-858Article in journal (Refereed)
    Abstract [en]

    Study Design: Observational study of prospectively collected data.

    Objectives: Patients with chronic low back pain resistant to nonoperative treatment often face a poor prognosis for recovery. The aim of the current study was to compare the variation and outcome of surgical treatment of degenerative disc disease in the Scandinavian countries based on The International Consortium for Health Outcomes Measurement core spine data sets.

    Methods: Anonymized individual level data from 3 national registers were pooled into 1 database. At the time of surgery, the patient reports data on demographics, lifestyle topics, comorbidity, and data on health-related quality of life such as Oswestry Disability Index, Euro-Qol-5D, and back and leg pain scores. The surgeon records diagnosis, type of surgery performed, and complications. One-year follow-ups are obtained with questionnaires. Baseline and 1-year follow-up data were analyzed to expose any differences between the countries.

    Results: A total of 1893 patients were included. At 1-year follow-up, 1315 (72%) patients responded. There were statistically significant baseline differences in age, smoking, comorbidity, frequency of previous surgery and intensity of back and leg pain. Isolated fusion was the primary procedure in all the countries ranging from 84% in Denmark to 76% in Sweden. There was clinically relevant improvement in all outcome measures except leg pain.

    Conclusions: In homogenous populations with similar health care systems the treatment traditions can vary considerably. Despite variations in preoperative variables, patient reported outcomes improve significantly and clinically relevant with surgical treatment.

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  • 50.
    Andersson, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Nursing Research.
    Ajanovic, Elma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Patientens upplevelse av de första timmarna på en kirurgisk vårdavdelning efter ankomst från akutmottagningen: En intervjustudie2023Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
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