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  • 1. Antonsson, J B
    et al.
    Engström, L
    Rasmussen, I
    Wollert, S
    Haglund, U H
    Changes in gut intramucosal pH and gut oxygen extraction ratio in a porcine model of peritonitis and hemorrhage.1995In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 23, no 11, p. 1872-81Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To establish the relationship between gut intramucosal pH and blood flow to the gut, gut oxygen delivery, and gut oxygen extraction ratio in a porcine model of peritonitis and hemorrhage.

    DESIGN: Prospective, controlled study.

    SETTING: Experimental laboratory in a university teaching hospital.

    SUBJECTS: Thirty pigs of both sexes, weighing 15 to 22 kg.

    INTERVENTIONS: Animals were anesthetized, intubated, and mechanically ventilated. A flow probe was placed around the superior mesenteric artery for registration of blood flow. A tonometer was placed in the lumen of midileum for calculation of gut intramucosal pH. Hourly, for 5 hrs, blood samples were taken from mixed venous, mesenteric venous, and arterial blood. Five animals served as controls, ten animals had peritonitis induced by fecal instillation in the abdominal cavity, five were bled stepwise, five were bled rapidly (to a mean arterial pressure of 30 mm Hg), and five were bled rapidly and reinfused after 3 hrs.

    MEASUREMENTS AND MAIN RESULTS: Both peritonitis and hemorrhage caused decreases in gut blood flow and intramucosal pH. In mild peritonitis, the intramucosal pH decrease preceded that of blood flow. In all experimental groups, oxygen delivery decreased over time; in both mild and severe peritonitis, this decrease was preceded by a decrease of intramucosal pH. Intramucosal pH correlated well with gut oxygen extraction ratio in peritonitis (r2 = .86). In hemorrhage, there was a correlation of r2 = .66, but in intramucosal pH of < 7.12, a further decrease was accompanied only by minor changes in extraction ratio.

    CONCLUSIONS: Since a reduction in blood flow was preceded by a decrease in intramucosal pH, low intramucosal pH in peritonitis cannot be explained by low flow alone. Gut oxygen delivery proved to be a poor indicator of gut acidosis (i.e., low intramucosal pH). In peritonitis, a decreasing intramucosal pH was associated with an increasing oxygen extraction ratio. In hemorrhage, this association had a sharp deflection point below which a further decrease in intramucosal pH occurred concomitantly with an unchanged gut oxygen extraction ratio. Increased extraction ratio was not sufficient, not even initially, to maintain aerobic metabolism (i.e., unchanged intramucosal pH).

  • 2.
    Antonsson, J
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Engstrom, L
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Wollert, S
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Haglund, U
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Changes in gut intramucosal pH and gut oxygen extraction ratio in a porcine model of peritonitits and hemorrhage1995In: Critical Care Medicine, Vol. 23, p. 1872-Article in journal (Refereed)
    Abstract
  • 3. Arvidsson, D
    et al.
    Rasmussen, I
    [Laparoscopic surgery. A shift in paradigm?].1993In: Nordisk Medicin, ISSN 0029-1420, Vol. 108, no 10, p. 247-50Article in journal (Refereed)
    Abstract [sv]

    Since it was first introduced at the beginning of the century, laparoscopy has been developed by pioneers in the field of gynaecological surgery from a diagnostic aid to a high tech tool for use in various branches of surgery. In the near future, this rapidly developing technique, with three-dimensional video and robot-assisted surgery, will require well planned theoretical and practical training.

  • 4. Arvidsson, D
    et al.
    Rasmussen, I
    Almqvist, P
    Niklasson, F
    Haglund, U
    Splanchnic oxygen consumption in septic and hemorrhagic shock.1991In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 109, no 2, p. 190-7Article in journal (Refereed)
    Abstract [en]

    Oxygen consumption (VO2) is dependent on oxygen delivery (DO2) in septic shock. Local hypoxia with later secondary organ failure may develop, however, despite an often hyperdynamic circulation. The splanchnic organs seem to be of vital importance in this context. In experiments performed in pigs we compared total body VO2 and DO2 with oxygen consumption and delivery in the gastrointestinal organs and the liver in two different shock states: (1) septic shock induced by peritonitis (n = 6) and (2) hemorrhagic shock (n = 6). Another group of six animals not in shock served as controls. Total, gastrointestinal, and liver DO2 decreased in a similar pattern in both septic and hemorrhagic shock. Gastrointestinal and liver VO2 increased in sepsis, whereas it was unchanged in hemorrhage. In the later phase of sepsis, liver VO2, but not gastrointestinal VO2, again decreased, because liver oxygen extraction was almost total and liver DO2 decreased further. The development of flow-dependent liver hypoxia was reflected in a decrease in liver lactate turnover (increased liver lactate release) during late sepsis. Early hypoxia in the splanchnic region is suggested as a plausible mechanism behind the development of secondary organ failure, especially in sepsis.

  • 5.
    Bjorck, M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Piehl, E
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Haglund, U
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    An experimental porcine model of partial ischaemia of the distal colon[see comments]1997In: Eur J Surg, Vol. 163, p. 843-Article in journal (Refereed)
    Abstract
  • 6. Björck, M
    et al.
    Bergqvist, D
    Rasmussen, I
    Piehl, E
    Haglund, U
    An experimental porcine model of partial ischaemia of the distal colon.1997In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 163, no 11, p. 843-50Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Ischaemia of the colon is a major challenge in aortoiliac surgery. The aim was to establish an animal model of partial distal colonic ischaemia to study interventional strategies.

    DESIGN: Randomised experiment.

    SETTING: University Hospital. Department of Experimental Research.

    MATERIAL: 19 pigs.

    INTERVENTIONS: 11 Pigs were subjected to ischaemia consisting of total occlusion of the inferior mesenteric artery and partial occlusion of the superior mesenteric artery. Eight animals were sham controls. Dextran was given.

    MAIN OUTCOME MEASURES: Haemodynamic measurements, intramucosal pH-measurements (pHi) and histological grading.

    RESULTS: Both ischaemic animals and controls remained haemodynamically stable. It was possible to maintain stable ischaemia in the distal colon in the pHi-range of 6.9-7.1. There was histological mucosal damage of the distal colon in ischaemic animals but not in controls.

    CONCLUSIONS: The model could be of value when studying interventional strategies to reduce or reverse ischaemia.

  • 7.
    Dahlstrand, Ursula
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Sandblom, Gabriel
    Eriksson, Lars-Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Nyman, Rickard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Rasmussen, Ib Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Primary patency of percutaneously inserted self-expanding metallic stents in patients with malignant biliary obstruction2009In: HPB : the official journal of the International Hepato Pancreato Biliary Association, ISSN 1365-182X, Vol. 11, no 4, p. 358-63Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Effective bile duct drainage is crucial to the health-related quality of life of patients with jaundice caused by obstruction of the bile duct by inoperable malignant tumours. METHODS: All patients who were treated at Uppsala University Hospital, Sweden with percutaneous stenting between 2000 and 2005 were identified retrospectively. Data on the location of the obstruction and type of stent used, date and cause of death and date of stent failure were abstracted from the patients' notes. Stent patency was defined as the duration from the insertion of the stent to the date of failure. In cases in which the cause of death was directly related to failure of the stent, the date of death was defined as the patency endpoint. RESULTS: A total of 64 patients (34 women, 30 men) were identified. Their mean age was 71 years (standard deviation 11 years). The median length of patency was 11.4 months. Stent diameter >10 mm and distal stricture were found to be associated with significantly longer patency time in univariate Cox proportional hazard analysis. In multivariate Cox proportional hazard analysis, only location of the stricture was found to be independently and significantly associated with patency time. DISCUSSION: Percutaneous stenting is a good alternative for patients with obstructive jaundice and a life expectancy /=10 mm. However, patency time was found to be lower for hilar tumours.

  • 8. Darkahi, Bahman
    et al.
    Sandblom, Gabriel
    Liljeholm, Hakan
    Videhult, Per
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Rasmussen, Ib Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Biliary Microflora in Patients Undergoing Cholecystectomy2014In: Surgical Infections, ISSN 1096-2964, E-ISSN 1557-8674, Vol. 15, no 3, p. 262-265Article in journal (Refereed)
    Abstract [en]

    Background: The management of acute cholecystitis requires a sound knowledge of the biliary microflora. Methods: Bile samples were taken for culture according to a standard routine during all cholecystectomies performed from April 2007 to February 2009 in the Department of Surgery at Enkoping Hospital. The use of antibiotics within the 3-mo period before surgery, indication for surgery, prophylactic antibiotics, and post-operative complications were recorded prospectively. Results: Altogether, 246 procedures were performed during the study period, of which 149 (62%) were done on women. The mean (SD) age of the study subjects was 49 +/- 16y. Bacterial growth was seen in cultures from 34 (14%) of the subjects. The mean age of subjects with positive cultures was 64y and that of subjects with negative cultures was 47y (p<0.001). Positive culture was seen in 16 (31%) of the 51 patients who underwent operations for acute cholecystitis, whereas positive cultures were obtained in 18 of 195 patients without acute cholecystitis (9%) (p<0.001). Resistance to ampicillin was recorded in three of 34 (9%) of the cultures with bacterial growth, to co-trimoxazole in one of the 34 (3%) cultures, to fluoroquinolones in one of the 34 (3%) cultures, and to cephalosporins in one of the 34 (3%) cultures. Resistance to piperacillin-tazobactam was not observed in any of the cultures. In multivariable logistic regression analysis, a positive culture was the only factor significantly associated with risk for post-operative infectious complications (p<0.05). Discussion: Bacterial growth in the bile is observed more often in patients undergoing surgery for acute cholecystitis. The microflora of the bile is probably important for the outcome of surgery, but further studies are required for assessing the effectiveness of measures for preventing infectious post-operative complications.

  • 9. Darkahi, Bahman
    et al.
    Videhult, Per
    Sandblom, Gabriel
    Liljeholm, Haakan
    Ljungdahl, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Rasmussen, Ib Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Effectiveness of antibiotic prophylaxis in cholecystectomy: a prospective population-based study of 1171 cholecystectomies2012In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 47, no 10, p. 1242-1246Article in journal (Refereed)
    Abstract [en]

    Background.

    The aim of this study was to assess the benefit from antibiotic prophylaxis (AP) during cholecystectomy in a population-based cohort study.

    Methods.

    All cholecystectomies performed in Uppsala County, 2003-2005, were registered prospectively according to a standardized protocol. High-risk procedures (HP) were defined as operations for acute cholecystitis and procedures including exploration of the common bile duct. Infections requiring surgical or percutaneous drainage and non-surgical infections that prolonged hospital stay were defined as major infectious complications (IC).

    Results.

    Altogether 1171 patients underwent cholecystectomy. AP was given to 130 of 867 (15%) of the patients undergoing low-risk procedures (LP) and 205 of 304 (67%) of those undergoing H-R P. Major IC were seen in 6 of 205 (3%) of the patients undergoing H-R P with AP and 1 of 99 of the patients undergoing H-R P without AP. No major IC was seen after L-R P. Minor IC were seen after 5 of 205 (2%) HP with AP, 1 of 99 (1%) HP without AP, 0 of 130 (0%) LP with AP, and 2 of 737 (0.3%) LP without AP. In univariate logistic analysis, the overall risk for IC was found to be higher with AP (p < 0.05), but the increase did not remain significant if adjusting for age, gender, ASA class, H-R P/L-R P and surgical approach or limiting the analysis to major IC.

    Conclusion.

    There is no benefit from AP in uncomplicated procedures. The effectiveness of antibiotic prophylaxis in complicated cholecystectomy must be evaluated in randomized controlled trials.

  • 10.
    Eklund, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rudberg, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Montgomery, Agneta
    Rasmussen, Ib
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sandbu, Rune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Low Recurrence Rate After Laparoscopic (TEP) and Open (Lichtenstein) Inguinal Hernia Repair A Randomized, Multicenter Trial With 5-year Follow-up Reply2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 250, no 2, p. 355-355Article in journal (Refereed)
    Abstract
  • 11.
    Eklund, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rudberg, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Montgomery, Agneta
    Rasmussen, Ib
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sandbue, Rune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Laparoscopic Versus Open Mesh Repair for Inguinal Hernia Reply2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 250, no 2, p. 354-354Article in journal (Refereed)
    Abstract
  • 12.
    Eklund, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Montgomery, Agneta K.
    Rasmussen, Ib C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sandbue, Rune P.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Bergkvist, Leif A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rudberg, Claes R.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Low Recurrence Rate After Laparoscopic (TEP) and Open(Lichtenstein) Inguinal Hernia RepairA Randomized, Multicenter Trial With 5-Year Follow-Up2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 249, no 1, p. 33-38Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence.

    Summary Background Data: Laparoscopic hernia repair has been introduced as an alternative to open repair. Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques; ie, less postoperative pain and a shorter convalescence period. Long-term results, however, are less well known.

    Methods: The study was conducted as a multicenter randomized trial with a 5-year follow-up. A total of 1512 men aged 30 to 70 years, with a primary unilateral inguinal hernia, were randomized to either TEP or Lichtenstein repair.

    Results: Overall, 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable. The cumulative recurrence rate was 3.5% in the TEP group and 1.2% in the Lichtenstein group (P = 0.008). Test for heterogeneity revealed significant differences between individual surgeons. The exclusion of 1 surgeon, who was responsible for 33% (7 of 21) of all recurrences in the TEP group, lowered the cumulative recurrence rate to 2.4% in this group, which was not statistically different from that of the Lichtenstein group.

    Conclusions: The recurrence rate for both TEP and Lichtenstein repair was low. A higher cumulative recurrence rate in the TEP group was seen at 5 years. Further analysis revealed that this could be attributable to incorrect surgical technique.

  • 13.
    Eklund, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rudberg, C.
    Leijonmarck, C-E.
    Rasmussen, Ib Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Spangen, L.
    Wickbom, G.
    Wingren, U.
    Montgomery, A.
    Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair2007In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 21, no 4, p. 634-640Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The optimal treatment for recurrent inguinal hernia is of concern due to the high frequency of recurrence. METHODS: This randomized multicenter study compared the short- and long-term results for recurrent inguinal hernia repair by either the laparoscopic transabdominal preperitoneal patch (TAPP) procedure or the Lichtenstein technique. RESULTS: A total of 147 patients underwent surgery (73 TAPP and 74 Lichtenstein). The operating time was 65 min (range, 23-165 min) for the TAPP group and 64 min (range, 25-135 min) for the Lichtenstein group. Patients who underwent TAPP reported significantly less postoperative pain and shorter sick leave (8 vs 16 days). The recurrence rate 5 years after surgery was 19% for the TAPP group and 18% for the Lichtenstein group. CONCLUSION: The short-term advantage for patients who undergo the laparoscopic technique is less postoperative pain and shorter sick leave. In the long term, no differences were observed in the chronic pain or recurrence rate.

  • 14. Granlund, A
    et al.
    Karlson, B M
    Elvin, A
    Rasmussen, I
    Ultrasound-guided percutaneous cholecystostomy in high-risk surgical patients.2001In: Langenbeck's archives of surgery (Print), ISSN 1435-2443, E-ISSN 1435-2451, Vol. 386, no 3, p. 212-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: In critically ill patients, cholecystectomy is associated with a high mortality rate. The aim of this study was to evaluate the safety, efficacy and long-term outcome of ultrasound-guided percutaneous cholecystostomy (USGPC) in critically ill patients with acute cholecystitis.

    MATERIALS AND METHODS: Clinical records of 51 patients, all considered high-risk surgical patients, with acute cholecystitis treated with USGPC between 1987 and 1999, were retrospectively reviewed. Response was defined as improvement in clinical symptoms and signs, and/or reduction in c-reactive protein and white blood count levels within 72 h. Long-term results were evaluated by means of clinical records and written correspondence.

    RESULTS: Gallbladder stones were seen in 28 patients whereas 23 had acalculous cholecystitis. Ninety percent showed clinical improvement after USGPC. Cholecystectomy was performed in 16%, of which 6% after recurrent cholecystitis. Recurrence of cholecystitis occurred in 22%. Hospital mortality was 16%. None of the deaths was procedure related or related to acute cholecystitis alone. Major complications relating to the USGPC were rare (4%), while minor catheter-related complications were quite common.

    CONCLUSIONS: USGPC is a procedure with few complications and a high success rate. In patients with acalculous cholecystitis as well as in many patients with calculous cholecystitis, no further treatment was needed.

  • 15.
    Haglund, U
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Norlen, K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Flowers, J L
    Complications related to pneumoperitoneum1995In: Complications of Laparoscopic Surgery, Quality Medical Publishing Inc., St. Louis, Missouri , 1995, p. 26-Chapter in book (Other academic)
    Abstract
  • 16.
    Haglund, U
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Failing organs in shock - the small intestine1996In: SHOCK, From Molecular and Cellular Level to Whole Body; Proceedings of the Third International Shock Congress - Shock '95, Elsevier Science B.V. , 1996, p. 243-Chapter in book (Other academic)
    Abstract
  • 17. Haglund, U
    et al.
    Rasmussen, I
    Oxygenation of the gut mucosa.1993In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 80, no 8, p. 955-6Article in journal (Refereed)
  • 18.
    Haglund, Ulf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rasmussen, Ib
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Acute Cholecystitis2001In: In: M Schein, L Wise (Eds), Controversis in Surgery, Springer Verlag, Berlin , 2001, p. 109-Chapter in book (Other academic)
    Abstract
  • 19. Lindberg, F
    et al.
    Bergqvist, D
    Björck, M
    Rasmussen, I
    Renal hemodynamics during carbon dioxide pneumoperitoneum: an experimental study in pigs.2003In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 17, no 3, p. 480-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Laparoscopic living donor nephrectomy is increasingly being performed, although the effects of carbon dioxide pneumoperitoneum (CO2 PP) on renal function and hemodynamics and the levels of vasopressin are not well studied.

    METHODS: Renal blood flow, renal venous pressure, urine output, and vasopressin concentrations in renal venous blood were measured in pigs subjected to 12 mmHg of CO2 PP for 150 min.

    RESULTS: Renal blood flow was decreased at induction of PP and increased during the first 30 min after exsufflation. Renal venous pressure was increased during PP. There was indirect evidence of a decrease in urine output during PP. No changes in renal venous vasopressin concentrations were seen.

    CONCLUSION: A CO2 PP of 12 mmHg causes changes in renal hemodynamics and urine output. No changes in vasopressin levels were seen in this pig model, suggesting that other explanations for the observed changes must be sought.

  • 20. Lindberg, F
    et al.
    Bergqvist, D
    Rasmussen, I
    Incidence of thromboembolic complications after laparoscopic cholecystectomy: review of the literature.1997In: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, ISSN 1051-7200, E-ISSN 2331-2254, Vol. 7, no 4, p. 324-31Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to quantify the risk of thromboembolic complications after laparoscopic cholecystectomy by a survey of the literature. We reviewed 60 laparoscopic cholecystectomy series consisting of 153,832 patients. The average mortality was 0.08%. The average rate of fatal pulmonary embolism was 0.02% and total pulmonary embolism 0.06%. The average rate of reported deep vein thrombosis was 0.03%. We conclude that laparoscopic cholecystectomy is a safe procedure, and the rate of clinically evident postoperative thromboembolic complications is probably lower than after conventional cholecystectomy. A lingering bias due to the overrepresentation of young and healthy patients early in the era of laparoscopic cholecystectomy could, however, still affect these figures. An underreporting of the lesser complications is likely. The risk is not negligible, though, and some authors have recommended thromboembolism prophylaxis, although further studies are necessary to find the optimal prophylaxis strategy. The true incidence is possible to establish only by using objective diagnostic methods for surveillance.

  • 21. Lindberg, F
    et al.
    Bergqvist, D
    Rasmussen, I
    Haglund, U
    Hemodynamic changes in the inferior caval vein during pneumoperitoneum. An experimental study in pigs.1997In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 11, no 5, p. 431-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Laparoscopic procedures of increasing difficulty and duration are becoming more and more common. This may cause significant challenges to the circulatory system and possibly influence thrombogenicity.

    METHODS: Experimental study of carbon dioxide pneumoperitoneum in pigs.

    RESULTS: Inferior caval vein blood flow remained unchanged, whereas inferior caval vein pressure increased during pneumoperitoneum. Inferior caval vein, pulmonary, and systemic vascular resistance increased during pneumoperitoneum and remained increased after exsufflation.

    CONCLUSIONS: Pneumoperitoneum leads to an increased inferior caval vein pressure, which could cause a dilation of peripheral veins. The similar patterns of vascular resistance in the inferior caval vein, pulmonary artery, and systemic arteries (a gradual increase remaining elevated after exsufflation) suggest a common humoral factor or increased sympathetic nerve activity.

  • 22.
    Lindberg, F
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bjorck, M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Renal hemodynamics during carbon dioxide pneumoperitoneum.2003In: Surg Endosc, Vol. 17, p. 480-Article in journal (Refereed)
    Abstract
  • 23.
    Lindberg, F.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rasmussen, Ib Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Current use of thromboembolism prophylaxis for laparoscopic cholecystectomy patients in Sweden2005In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 19, no 3, p. 386-388Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The need for thromboembolism (TE) prophylaxis during laparoscopic surgery is not well established. The aim of this study was to investigate current TE prophylaxis in patients undergoing laparoscopic cholecystectomy (LC) in Sweden. METHODS: Mail questionnaire to all Surgical Departments in Sweden about the current use of thromboembolism prophylaxis in patients undergoing laparoscopic cholecystectomy. RESULTS: The response rate was 78 of 80 departments of surgery (98%). Seventy reported performing LC. Thirty-six percent used thromboembolism prophylaxis in all patients, 17% in most, 9% in half their patients and 39% only rarely. The current use of thromboembolism prophylaxis ranged from low-molecular-weight heparin for 7 days + stockings in all patients to no prophylaxis at all in the majority of patients. CONCLUSIONS: The use of thromboembolism prophylaxis in LC patients is highly variable, even in the small and homogenous country of Sweden. Further studies concerning the risk of TE complications after laparoscopic surgery are warranted.

  • 24. Lindberg, F
    et al.
    Rasmussen, I
    Siegbahn, A
    Bergqvist, D
    Coagulation activation after laparoscopic cholecystectomy in spite of thromboembolism prophylaxis.2000In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 14, no 9, p. 858-61Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to determine whether laparoscopic cholecystectomy (LC), in spite of its minimally invasive nature, causes coagulation activation.

    METHODS: Sixty-four patients undergoing LC were included prospectively. All received either dextran or low-molecular-weight heparin (LMWH). Blood samples taken the morning of the operation and the following morning were analyzed for TAT, FM, fragment 1+2, tPA, PAI-1, vWf, D-dimer, Hb, hematocrit, and APC resistance.

    RESULTS: Significant increases in TAT, FM, fragment 1+2, and D-dimer were seen, whereas APC resistance, Hb, and hematocrit decreased significantly. Dextran led to a decrease in vWf and no change in tPA, whereas LMWH led to an increase in both these parameters.

    CONCLUSIONS: Laparoscopic cholecystectomy causes coagulation activation. There are differences in the response between patients receiving dextran and LMWH as thromboembolism prophylaxis. Since most patients are discharged the day after the operation, there could be practical as well as theoretical advantages to using dextran.

  • 25. Lindberg, F
    et al.
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Siegbahn, A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Coagulation activation after laparoscopic cholecystectomy in spite ofthromboembolism prophylaxis.2000In: Surg Endosc, Vol. 14, p. 858-Article in journal (Refereed)
    Abstract
  • 26. Lindberg, Fredrik
    et al.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Rasmussen, Ib
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Nyman, Rickard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Low frequency of phlebographic deep vein thrombosis after laparoscopic cholecystectomy: a pilot study2006In: Clinical and applied thrombosis/hemostasis, ISSN 1076-0296, E-ISSN 1938-2723, Vol. 12, no 4, p. 421-426Article in journal (Refereed)
    Abstract [en]

    To investigate the rate of deep vein thrombosis (DVT) after laparoscopic surgery, 50 patients underwent bilateral phlebography 7-11 days after laparoscopic cholecystectomy (LC). All received thromboembolism prophylaxis, either low molecular weight heparin (LMWH) or dextran. Three patients were converted to open cholecystectomy. D-dimer was investigated preoperatively, on day 1 and on the day of phlebography. One asymptomatic DVT was found. One phlebogram was incomplete. Seven phlebograms were not optimal but of sufficient quality to rule out DVT. The frequency of DVT was thus 1 of 49 or 2.0% (95% confidence interval, 0-6.0%). No anticoagulants were prescribed after discharge. No patient developed late thromboembolic complications. D-dimer values increased significantly at day 1 and were further increased at the time of phlebography. The frequency of phlebographical DVTs thus seems to be low despite prophylaxis of questionable efficacy. The D-dimer values, however, suggest that the effects of LC on coagulation/fibrinolysis have a duration of longer than 1 week.

  • 27. Ljungdahl, M
    et al.
    Lundholm, M
    Katouli, M
    Rasmussen, I
    Engstrand, L
    Haglund, U
    Bacterial translocation in experimental shock is dependent on the strains in the intestinal flora.2000In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 35, no 4, p. 389-97Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Enteric microorganisms are responsible for a significant proportion of post-surgical infections. Intestinal mucosal injury may permit translocation of bacteria and endotoxin. This study investigates translocation in peritonitis and ischemia/reperfusion by inoculating different bacterial species into the small intestine.

    METHODS: Twenty-five pigs were monitored hemodynamically and divided into three groups: controls (C), ischemia/reperfusion (I/R), and peritonitis (P). Intramucosal pH (pHi) was calculated tonometrically. A perfusion tube was positioned in the ileum for inoculation of the bacterial strains. In a first study period a non-pathogenic bacterium was used, whereas Escherichia coli strains with known ability to translocate were used in a second. Blood and mesenteric lymph nodes (MLNs) were obtained for bacterial culture and endotoxin analyses.

    RESULTS: Mesenteric arterial blood flow and pHi decreased in groups I/R and P. Endotoxin levels increased in these groups in period 1, whereas in period 2 an increase over time was only observed in group P. No bacterial translocation to blood or MLNs occurred in period 1. In period 2 bacteria translocated to MLNs in all animals, including controls. Translocation to central and/or mesenteric venous blood was found in all groups, but mainly in I/R and P. The incidence of mucosal injury was similar in the two periods.

    CONCLUSIONS: Since positive blood and MLN samples were only found in period 2, we conclude that translocation of bacteria seems to be more dependent on the presence of translocating strains in the intestinal bacterial flora than on the mucosal insult.

  • 28. Ljungdahl, M
    et al.
    Rasmussen, I
    Haglund, U
    Intestinal blood flow and intramucosal pH in experimental peritonitis.1999In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 11, no 1, p. 44-50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Experimental peritonitis causes gut intramucosal acidosis indicating intramucosal ischemia. However, tissue acidosis may reflect other conditions than ischemia. An increased mucosal-arterial Pco2 difference ( Pco2-gap) is suggested to be a more adequate measure of tissue ischemia than intramucosal pH (pHi). This study was performed to elucidate whether keeping cardiac index (CI) and splanchnic blood flow normal or supranormal by administration of colloids and an inotropic drug could prevent the acidosis as well as reduce the Pco2-gap. A secondary aim was to study to what degree the low pHi in peritonitis really reflects ischemia.

    SUBJECTS: 24 anesthetized pigs (18-27 kg) divided into four groups.

    MODELS: A Swan-Ganz catheter, transonic flow meters and catheters for blood sampling were applied. pHi was calculated using tonometry. Standardized fecal peritonitis was induced, except in controls. One peritonitis group was given dextran (Group P(DEX)) and another in addition dobutamine (Group PDOB) to keep CI normal or supranormal, respectively.

    RESULTS: After 4 h, a significant drop in pHi was found in all peritonitis groups, most pronounced in untreated peritonitis (to 7.09+/-.02). Corresponding values in Group P(DEX) and Group P(DOB) were 7.22+/-.03 and 7.22+/-.01, respectively, and in controls 7.30+/-.02. The Pco2-gap and the mucosal-arterial [H+] difference ([H+]-gap) increased significantly in untreated peritonitis but did not increase in groups given dextran and dextran + dobutamine.

    CONCLUSION: Maintaining CI in peritonitis attenuated the reduction in pHi and prevented the increased Pco2- and [H+]-gap. It seems justified from these data to conclude that the somewhat reduced pHi in treated peritonitis groups did not reflect tissue ischemia.

  • 29. Ljungdahl, M
    et al.
    Rasmussen, I
    Raab, Y
    Hillered, L
    Haglund, U
    Small intestinal mucosal pH and lactate production during experimental ischemia-reperfusion and fecal peritonitis in pigs.1997In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 7, no 2, p. 131-8Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate mucosal pH and lactate production in a porcine model of ischemia/reperfusion and sepsis using both tonometry and a technique for segmental intestinal perfusion. Eighteen pigs (17-23 kg) were anesthetized and mechanically ventilated. They were divided into three groups and followed for 4 h. Group C (n = 6) served as controls. In the ischemia/reperfusion group (I/R; n = 6), the superior mesenteric artery was totally occluded for 60 min. In group P (n = 6), sepsis was induced by fecal peritonitis. Cardiac index (CI) was determined by thermodilution and blood flow in the superior mesenteric artery (QSMA), using a Transonic flow probe. Intramucosal pH (pHi) was calculated using tonometry. A special balloon tube for segmental perfusion was introduced in the midileum for lactate measurement. Lactate and oxygen saturation were measured in arterial blood and in the superior mesenteric vein. CI, QSMA, pHi, and lactate in blood and perfusate remained unchanged in controls. Occlusion of intestinal blood flow induced a fall in pHi from 7.28 +/- .02 to 6.76 +/- .04, a marked rise in lactate in the perfusate, and an increased arteriovenous lactate difference. During reperfusion, pHi tended to return to baseline values. Lactate in the perfusate and the arteriovenous lactate difference decreased. In sepsis there was a continuous reduction in CI and QSMA to 45 +/- 13% and 40 +/- 20% of baseline, respectively. pHi decreased moderately from 7.22 +/- .09 to 6.98 +/- .25. Lactate remained unchanged in blood and perfusate. Microscopic mucosal injury was observed in all animals subjected to ischemia/reperfusion and in three of six pigs in group P. A good association between pHi and lactate production was seen in ischemia/reperfusion. However, in sepsis, lactate in superior mesenteric venous blood or in intestinal perfusate did not increase, despite the fall in pHi. The mechanism causing ischemic mucosal injury has different characteristics in sepsis and in ischemia caused by arterial occlusion.

  • 30. Ljungdahl, M
    et al.
    Rasmussen, I
    Ronquist, G
    Haglund, U
    Intramucosal pH and pCO(2) do not strictly correlate with intestinal energy metabolism in experimental peritonitis.2000In: European Surgical Research, ISSN 0014-312X, E-ISSN 1421-9921, Vol. 32, no 3, p. 182-90Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate tissue hypoxia on the cellular level in sepsis. Eighteen pigs weighing 18-27 kg were studied. Intramucosal-arterial PCO(2) gradient (PCO(2)-gap) and intramucosal pH (pH(i)) were calculated using tonometry. A blind loop of the small intestine was constructed for repeated tissue biopsies to measure intestinal energy-related metabolites and lactate concentration. Six animals served as controls. In 12 animals, faecal peritonitis was induced. Six of these animals were studied without further interventions, while the others were resuscitated with dextran to maintain cardiac index at baseline level. Untreated peritonitis caused an increase in PCO(2)-gap and a drop in pH(i). The intestinal energy metabolism was not disturbed until the end of the experimental period, with a decreased energy charge value and a moderately increased lactate concentration. In peritonitis-dextran animals, PCO(2)-gap and pH(i) remained at baseline level and the energy metabolism was not disturbed. We conclude that in peritonitis, PCO(2)-gap - like pH(i) - can be influenced by other factors than strictly anaerobic tissue metabolism.

  • 31.
    Nyman, Rickard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Eklöf, Hampus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Eriksson, Lars-Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Karlsson, Britt-Marie
    Rasmussen, Ib
    Lundgren, Dan
    Thomsen, Peter
    Soft-tissue-anchored transcutaneous port for long-term percutaneous transhepatic biliary drainage2005In: Cardiovascular and Interventional Radiology, ISSN 0174-1551, E-ISSN 1432-086X, Vol. 28, no 1, p. 53-59Article in journal (Refereed)
    Abstract [en]

    PURPOSE: A transcutaneous port (T-port) has been developed allowing easy exchange of a catheter, which was fixed inside the device, using the Seldinger technique. The objective of the study was to test the T-port in patients who had percutaneous transhepatic biliary drainage (PTBD).

    METHODS: The T-port, made of titanium, was implanted using local anesthesia in 11 patients (mean age 65 years, range 52-85 years) with biliary duct obstruction (7 malignant and 4 benign strictures). The subcutaneous part of the T-port consisted of a flange with several perforations allowing ingrowth of connective tissue. The T-port allowed catheter sizes of 10 and 12 Fr.

    RESULTS: All wounds healed uneventfully and were followed by a stable period without signs of pronounced inflammation or infection. It was easy to open the port and to exchange the drainage tube. The patient's quality of life was considerably improved even though several patients had problems with repeated bile leakage due to frequent recurrent obstructions of the tubes. The ports were implanted for a mean time of 9 months (range 2-21 months). Histologic examination in four cases showed that the port was well integrated into the soft tissue. Tilting of the T-port in two cases led to perforation of the skin by the subcutaneous part of the ports, which were removed after 7 and 8 months.

    CONCLUSION: The T-port served as an excellent external access to the biliary ducts. The drainage tubes were well fixed within the ports. The quality of life of the patients was considerably improved. Together with improved aesthetic appearance they found it easier to conduct normal daily activities and personal care. However, the problem of recurrent catheter obstruction remained unsolved.

  • 32. Osterberg, J
    et al.
    Bergqvist, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Haglund, U
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    [Abdominal sarcomas--rare tumors requiring multidisciplinary approach.Evaluation of surgical management in a sarcoma team]2002In: Lakartidningen, Vol. 99, p. 490-Article in journal (Other academic)
    Abstract
  • 33. Osterberg, Johanna
    et al.
    Bergqvist, David
    Haglund, Ulf
    Rasmussen, Ib
    [Abdominal sarcomas--rare tumors requiring multidisciplinary approach. Evaluation of surgical management in a sarcoma team].2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, no 6, p. 490-4Article in journal (Refereed)
    Abstract [sv]

    Retroperitoneal sarcomas and gastrointestinal stromal tumors are rare malignant tumors with a high recurrence rate. Due to their localization, and to the fact that they give rise to non-specific symptoms, these tumors are usually large at diagnosis. From 1990 to 1998 thirty-one patients (16 men and 15 women, mean age 45 years; range 15-77 years) went through surgical treatment. Patients were evaluated by a team consisting of an oncologist, a pathologist, a radiologist and a surgeon both pre- and postoperatively. Forty-five operations were performed (23 for primary tumors and 22 for recurrences). The resectability and radical resection rate were 89% and 59% respectively in primary tumors (4 patients with benign histological diagnoses were excluded) and 68% and 47% respectively in local recurrences. Other organs were removed in 50% of the procedures. Vascular and orthopedic surgeons participated when necessary. Morbidity and in-hospital mortality were 18% and 7% respectively. The overall recurrence rate was 70%. It is our belief that a multidisciplinary approach is mandatory for optimal treatment in these patients.

  • 34. Párniczky, Andrea
    et al.
    Abu-El-Haija, Maisam
    Husain, Sohail
    Lowe, Mark
    Oracz, Grzegorz
    Sahin-Tóth, Miklós
    Szabó, Flóra K
    Uc, Aliye
    Wilschanski, Michael
    Witt, Heiko
    Czakó, László
    Grammatikopoulos, Tassos
    Rasmussen, Ib Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sutton, Robert
    Hegyi, Péter
    EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis.2018In: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 18, no 2, p. 146-160, article id S1424-3903(18)30001-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pediatric pancreatitis is an underdiagnosed disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has increased, it is now 3.6-13.3 cases per 100,000 children. Up-to-date evidence based management guidelines are lacking for the pediatric pancreatitis. The European Pancreatic Club, in collaboration with the Hungarian Pancreatic Study Group organized a consensus guideline meeting on the diagnosis and management of pancreatitis in the pediatric population.

    METHODS: Pediatric Pancreatitis was divided into three main clinical categories: acute pancreatitis, acute recurrent pancreatitis and chronic pancreatitis. Fifteen relevant topics (acute pancreatitis: diagnosis; etiology; prognosis; imaging; complications; therapy; biliary tract management; acute recurrent pancreatitis: diagnosis; chronic pancreatitis: diagnosis, etiology, treatment, imaging, intervention, pain, complications; enzyme replacement) were defined. Ten experts from the USA and Europe reviewed and summarized the available literature. Evidence was classified according to the GRADE classification system.

    RESULTS: Within fifteen topics, forty-seven relevant clinical questions were defined. The draft of the updated guideline was presented and discussed at the consensus meeting held during the 49th Meeting of European Pancreatic Club, in Budapest, on July 1, 2017.

    CONCLUSIONS: These evidence-based guidelines provides the current state of the art of the diagnosis and management of pediatric pancreatitis.

  • 35. Pålsson, Simon Henry
    et al.
    Rasmussen, Ib
    Lundström, Patrik
    Osterberg, Johanna
    Sandblom, Gabriel
    Registration of health-related quality of life in a cohort of patients undergoing cholecystectomy.2011In: ISRN Gastroenterology, ISSN 2090-4398, E-ISSN 2090-4401, Vol. 2011, article id 507389Article in journal (Refereed)
    Abstract [en]

    Background. Assessment of gallstone surgery's impact on quality of life (QoL) requires a reliable instrument with sufficient responsiveness. The instrument should also enable estimation of each individual's expected condition in an unaffected state. Materials and Methods. The Swedish Register for Gallstone Surgery and ERCP (GallRiks) registers indications, complications, results, and QoL-outcome of gallstone surgery. In 2008, 68 hospitals were registered in GallRiks. Between 2007 and 2008, SF-36 (a short form health survey) was filled in 1-2 weeks pre- and 6-9 months postoperatively at five of the units. Expected scores were determined from an age- and gender-matched Swedish population (AGMSP). Results. Of the 330 patients, 212 responded to SF36 pre- and postoperatively (RR = 64%; 212/330). Standardized response means ranged from 0.20 to 0.93 for the SF-36 subscores. Highest responsiveness was seen for bodily pain. Preoperatively, all subscores were significantly lower than in the AGMSP (all P < .05). Six months postoperatively, there was no significant difference between any of the observed and expected quality of life subscales. Conclusion. SF-36 is a useful instrument for measuring the impact of gallstone surgery on QoL. The postinterventional health status equalled or even exceeded the AGMSP for all subscales.

  • 36. Raab, Y
    et al.
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Odenholt, I
    Påhlman, L
    Trimethoprim-sulphamethoxazole and metronidazole as prophylaxis in colorectal surgery: a study of bioavailability after an oral single dose.2001In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 167, no 1, p. 46-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate oral single dose prophylaxis in colorectal surgery.

    DESIGN: Prospective study.

    SETTING: University hospital, Sweden.

    SUBJECTS: 24 patients (13 women; 11 men; mean age 57 years, range 27-81) listed for elective colorectal operations.

    INTERVENTION: At 0630 on the day of the operation all patients were given an oral dose of trimethoprim-sulphamethoxazole (TMP 160 mg and SMZ 800 mg) and metronidazole (2 g). The serum concentrations of TMP and SMZ were analysed in venous samples taken at the start and end of each operation.

    RESULTS: The earliest operation started at 0830 and the last finished at 1700. The median (range) serum concentrations of TMP were 1.4 (0.7-2.6) mg/L (start) and 1.3 (1.0-2.8) mg/L (end), and of SMZ 35 (15-65) mg/L (start) and 33 mg (13-70) mg/L (end). The individual values were above or equal to the minimal inhibitory concentration (TMP 0.8 mg/L; SMZ 15.2 mg/L) for relevant gram-negative species.

    CONCLUSION: Oral TMP/SMZ in the morning gives satisfactory serum concentrations independently of when the operation is done during the day. The regimen is simple and has the potential for being an effective alternative to intravenous prophylaxis.

  • 37.
    Rasmussen, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Chemotherapy in cancer of the liver, pancreas and bile ducts. Consensus statement of a workshop at the Swedish Society for Upper Abdominal Surgery, sponsored by the Swedish Cancer Society1998Other (Other academic)
    Abstract
  • 38. Rasmussen, I
    et al.
    Arvidsson, D
    Zak, A
    Haglund, U
    Splanchnic and total body oxygen consumption in experimental fecal peritonitis in pigs: effects of dextran and iloprost.1992In: Circulatory shock, ISSN 0092-6213, Vol. 36, no 4, p. 299-306Article in journal (Refereed)
    Abstract [en]

    Tissue oxygenation in the gastrointestinal tract and in the liver was studied in a porcine model where septic shock was induced by fecal peritonitis. The effects of different fluid regimes were compared. In one group (n = 8) a moderate amount of crystalloid fluids was given, in another (n = 7) crystalloids and colloids, and in a third group (n = 6) iloprost, a prostacyclin analogue, was administered intra-arterially (10 ng x kg-1 b.w. x min-1) in combination with the crystalline and colloid fluid regime. Septic shock induced by fecal peritonitis reduced cardiac index and oxygen supply to splanchnic organs. Iloprost improved the hepatic arterial blood flow, and tended to attenuate the reduction in liver oxygen delivery. Oxygen consumption (VO2) in the gastrointestinal tract and the liver was significantly increased in the group given crystalloids. These animals developed a hypovolemic/hypodynamic septic shock. Liver VO2 in these animals became flow dependent reflected by increasing hepatic venous lactate values and inversion of lactate turnover by the liver. In the two other groups gastrointestinal and liver VO2 remained constant during the observation period. Oxygen extraction over the liver increased when oxygen delivery decreased. The increased liver VO2 is suggested to be secondary to impaired microcirculation and accumulation of macrophages and leukocytes in the septic liver.

  • 39. Rasmussen, I
    et al.
    Enblad, P
    Acute solitary diverticulitis of the caecum. Case report.1988In: Acta chirurgica Scandinavica, ISSN 0001-5482, Vol. 154, no 5-6, p. 399-401Article in journal (Refereed)
    Abstract [en]

    In two cases of suspected appendicitis, laparotomy revealed an inflammatory mass medially in the caecum. Colonic resection was performed in both cases and the final diagnosis was solitary caecal diverticulitis. When inflammation of a caecal diverticulum is recognized at laparotomy, simple diverticulectomy is the procedure of choice, but colonic resection is recommended if malignancy cannot be excluded or inflammatory changes are severe.

  • 40.
    Rasmussen, I
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Garden, O J
    Benign tumours of the liver. In: Garden J (Ed), A Companion to Specialist Surgical Practice. Vol III - Hepatobiliary and Pancreatic Surgery1997Chapter in book (Other academic)
    Abstract
  • 41. Rasmussen, I
    et al.
    Garden, O J
    The management of liver cell cancer.1996In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 8, no 9, p. 861-7Article in journal (Refereed)
    Abstract [en]

    Hepatocellular carcinoma (HCC) is a highly malignant tumour. It presents a considerable management problem. In this review the natural history of HCC is summarized. Surgical and non-surgical treatment modalities are reviewed. Finally, combined treatments are described.

  • 42. Rasmussen, I
    et al.
    Haglund, U
    Early gut ischemia in experimental fecal peritonitis.1992In: Circulatory shock, ISSN 0092-6213, Vol. 38, no 1, p. 22-8Article in journal (Refereed)
    Abstract [en]

    Tissue oxygenation in the gastrointestinal tract was studied in a porcine model in which septic shock was induced by fecal peritonitis. The oxygen delivered was estimated by measuring the portal venous blood flow and the calculated arterial oxygen saturation. The oxygen consumption of the gut, including the pancreas and spleen, was monitored by measuring the portal venous blood flow and the difference between the calculated arterial oxygen and the measured portal venous oxygen saturation. In addition, the oxygenation of the gut mucosa was followed via the tonometric technique. Furthermore, lactate was measured in arterial and portal blood. The experimental animals were divided into two groups, one control (n = 6) and one experimental (n = 6). Peritonitis was introduced by installation of a standardized amount of autologous feces into the abdominal cavity. The animals were followed for 5 hr. Very early during the course of sepsis there was a fall in gut intramucosal pH (pHi), and this was evident before any reduction in splanchnic DO2. Furthermore, an early increase in splanchnic VO2 was evident simultaneously with the fall in pHi. Arterial pH and lactate were not able to detect the inadequate regional tissue oxygenation. It is concluded that pHi measured with the tonometric technique is sensitive in detecting gut mucosal ischemia, and it is therefore highly likely that tonometry would be a valuable method in monitoring severe ill patients.

  • 43. Rasmussen, I
    et al.
    Hillered, L
    Ungerstedt, U
    Haglund, U
    Detection of liver ischemia using microdialysis during experimental peritonitis in pigs.1994In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 1, no 1, p. 60-6Article in journal (Refereed)
    Abstract [en]

    The liver oxygen delivery (DO2) and consumption (VO2) were measured in a porcine model of septic shock induced by fecal peritonitis. Lactate and hypoxanthine were simultaneously monitored in hepatic extracellular fluid and in central venous blood using a microdialysis technique. Animals were divided into a control group (n = 6) and a peritonitis group (n = 6). Peritonitis was induced by installation of a standardized amount of autologous feces into the abdominal cavity. The animals were followed for 5 h. The changes in the liver during peritonitis were, a decreased DO2, a increased, maintained, or decreased VO2, an increased oxygen extraction, and a loss of net hepatic lactate uptake. Parallel to these changes, systemic lactic acidosis developed. Intrahepatic lactate and hypoxanthine increased during peritonitis reflecting liver ischemia. The increase of these metabolites was seen concomitantly in the liver and in central venous blood. There was a wide variability of the individual response to the septic challenge among the animals. The limited hepatic oxygen delivery, and the increased needs for oxygen led to flow-dependent oxygen consumption, and signs of liver ischemia in severe sepsis. Intrahepatic and intravenous microdialysis may be useful for monitoring of the individual time course of hepatic and systemic ischemia in sepsis.

  • 44.
    Rasmussen, I
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Lebel, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical and Physiological Chemistry.
    Arvidsson, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Haglund, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Laurent, T C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Gerdin, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Hepatic extraction of hyaluronic acid in porcine peritonitis1995In: European Surgical Research, ISSN 0014-312X, E-ISSN 1421-9921, Vol. 27, no 1, p. 1-10Article in journal (Refereed)
    Abstract [en]

    The hepatic extraction of hyaluronic acid (HA) was studied in porcine fecal peritonitis in two groups of animals given various amounts of volume substitution. There was a progressive decrease in hepatic blood flow (QH) and a corresponding increase in the plasma concentration of HA in arterial blood over a 5-hour observation period, less pronounced in animals given more volume substitution. While hepatic clearance of HA decreased, the extraction ratio over the liver was not altered. The extracted amount of HA, which at steady state reflects the turnover of HA, was also unchanged. There was a significant correlation between QH and arterial HA concentration (r = 0.57; p < 0.05). The data suggest that the arterial HA concentration in sepsis reflects QH rather than an altered ability of the liver to eliminate HA.

  • 45. Rasmussen, I
    et al.
    Lundgren, E
    Osterberg, J
    Arvidsson, D
    Haglund, U
    Spilled gallstones: a complication of laparoscopic cholecystectomy.1997In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 163, no 2, p. 147-50Article in journal (Refereed)
  • 46.
    Rasmussen, I
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Odenholt, Inga
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Raab, Y
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Peroral antibiotikaprofylax vid övre gastrointestinal kirurgi2000In: Läkartidningen, Vol. 97, p. 3156-Article in journal (Other academic)
    Abstract
  • 47. Rasmussen, I
    et al.
    Rane, A
    Haglund, U
    Hepatic oxygen consumption and cytochrome P450 activity in experimental faecal peritonitis.1993In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 159, no 4, p. 201-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study hepatic oxygen consumption and cytochrome P450 activity in pigs with septic shock induced by faecal peritonitis.

    DESIGN: Controlled experimental study.

    ANIMALS: 12 pigs weighing 19-27 kg.

    INTERVENTION: The animals were divided into a control group (n = 6) and a peritonitis group (n = 6). Peritonitis was induced by intraperitoneal instillation of a standard amount of autologous faeces. The animals were then observed for 300 minutes. Liver biopsy specimens were taken at 0 and 300 minutes.

    MAIN OUTCOME MEASURES: Hepatic oxygen delivery (DO2) and consumption (VO2). Cytochrome P450 activity was studied by measuring O- and N-demethylation of codeine at 0 and 300 minutes.

    RESULTS: Hepatic DO2 was reduced, whereas VO2 was increased during sepsis. There were no significant changes in the N- and O-demethylation of codeine.

    CONCLUSIONS: Hepatic VO2 did increase during sepsis, possibly because of the increased metabolic demand. Cytochrome P450 activity was unaffected by the septic challenge.

  • 48.
    Rasmussen, I
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Sörensen, J
    Långström, B
    Haglund, U
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Is positron emission tomography using 18F-fluorodeoxyglucose and 11C-acetate valuable in diagnosing indeterminate pancreatic masses?2004In: Scand J Surg, ISSN 1457-4969, Vol. 93, no 3, p. 191-7Article in journal (Refereed)
  • 49.
    Rasmussen, Ib
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Berggren, U
    Arvidsson, D
    Ljungdahl, M
    Haglund, U
    Effects of pneumoperitoneum on splanchnic hemodynamics: an experimental study in pigs.1995In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 161, no 11, p. 819-26Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the effects on splanchnic haemodynamics of pneumoperitoneum induced by carbon dioxide insufflation.

    DESIGN: Controlled experimental study.

    ANIMALS: 11 Pigs weighing 19-30 kg.

    INTERVENTION: The animals were divided into a control group (n = 4) and a experimental group (n = 7). Experimental animals were subjected to stepwise increasing intra-abdominal pressure from 0 mm Hg to 25 mm Hg by carbon dioxide insufflation.

    MAIN OUTCOME MEASURES: Portal venous blood flow, portal venous blood pressure, portal/hepatic vascular resistance, and gastrointestinal vascular resistance.

    RESULTS: At 25 mm Hg portal venous blood flow was reduced (66% of baseline), and portal venous blood pressure and portal/hepatic vascular resistance were increased (360% and 650% of baseline, respectively). The increase in gastrointestinal vascular resistance was less pronounced.

    CONCLUSIONS: Increased intra-abdominal pressure caused significant changes in the splanchnic haemodynamics. The risk was greater if the intra-abdominal pressure exceeded 15 mm Hg.

  • 50.
    Rasmussen, Ib Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Measurements of blood flow in animal research1998In: Animal Modelling in Surgical Research / [ed] Bengt Jeppsson, Harwood Academic, 1998Chapter in book (Other academic)
12 1 - 50 of 64
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