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Andersson, Peter
Publications (10 of 29) Show all publications
Abdalla, M., Norblad, R., Olsson, M., Landerholm, K., Andersson, P., Söderholm, J. D., . . . Myrelid, P. (2019). Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients. Digestive Diseases and Sciences
Open this publication in new window or tab >>Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients
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2019 (English)In: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: With a lifelong perspective, 12% of ulcerative colitis patients will need a colectomy. Further reconstruction via ileo-rectal anastomosis or pouch can be affected by patients' perspective of their quality of life after surgery.

AIM: To assess the function and quality of life after restorative procedures with either ileo-rectal anastomosis or ileal pouch-anal anastomosis in relation to the inflammatory activity on endoscopy and in biopsies.

METHOD: A total of 143 UC patients operated with subtotal colectomy and ileo-rectal anastomosis or pouches between 1992 and 2006 at Linköping University Hospital were invited to participate. Those who completed the validated questionnaires (Öresland score, SF-36, Short Health Scale) were offered an endoscopic evaluation including multiple biopsies. Associations between anorectal function and quality of life with type of restorative procedure and severity of endoscopic and histopathologic grading of inflammation were evaluated.

RESULTS: Some 77 (53.9%) eligible patients completed questionnaires, of these 68 (88.3%) underwent endoscopic evaluation after a median follow-up of 12.5 (range 3.5-19.4) years after restorative procedure. Patients with ileo-rectal anastomosis reported better overall Öresland score: median = 3 (IQR 2-5) for ileo-rectal anastomosis (n = 38) and 10 (IQR 5-15) for pouch patients (n = 39) (p < 0.001). Anorectal function (Öresland score) and endoscopic findings (Baron-Ginsberg score) were positively correlated in pouch patients (tau: 0.28, p = 0.006).

CONCLUSION: Patients operated with ileo-rectal anastomosis reported better continence compared to pouches. Minor differences were noted regarding the quality of life. Ileo-rectal anastomosis is a valid option for properly selected ulcerative colitis patients if strict postoperative endoscopic surveillance is carried out.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2019
Keywords
Ileal pouch-anal anastomosis, Ileo-rectal anastomosis, Quality of life, Ulcerative colitis
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-160247 (URN)10.1007/s10620-019-05757-6 (DOI)31372911 (PubMedID)2-s2.0-85070104240 (Scopus ID)
Available from: 2019-09-13 Created: 2019-09-13 Last updated: 2019-09-18Bibliographically approved
Abdalla, M., Landerholm, K., Andersson, P., Andersson, R. & Myrelid, P. (2017). Risk of Rectal Cancer After Colectomy for Patients With Ulcerative Colitis: A National Cohort Study. Clinical Gastroenterology and Hepatology, 15(7), 1055-1060, Article ID e2.
Open this publication in new window or tab >>Risk of Rectal Cancer After Colectomy for Patients With Ulcerative Colitis: A National Cohort Study
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2017 (English)In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 15, no 7, p. 1055-1060, article id e2Article in journal (Refereed) Published
Abstract [en]

BACKGROUND amp; AIMS: Patients with ulcerative colitis (UC) have an increased risk of rectal cancer, therefore reconstruction with an ileal pouch-anal anastomosis (IPAA) generally is preferred to an ileorectal anastomosis (IRA) after subtotal colectomy. Similarly, completion proctectomy is recommended for patients with ileostomy and a diverted rectum, although this approach has been questioned because anti-inflammatory agents might reduce cancer risk. We performed a national cohort study in Sweden to assess the risk of rectal cancer in patients with UC who have an IRA, IPAA, or diverted rectum after subtotal colectomy.

METHODS: We collected data from the Swedish National Patient Register for a cohort of 5886 patients with UC who underwent subtotal colectomy with an IRA, IPAA, or diverted rectum from 1964 through 2010. Patients who developed rectal cancer were identified from the Swedish National Cancer Register. The risk of rectal cancer was compared between this cohort and the general population by standardized incidence ratio analysis.

RESULTS: Rectal cancer occurred in 20 of 1112 patients (1.8%) who received IRA, 1 of 1796 patients (0.06%) who received an IPAA, and 25 of 4358 patients (0.6%) with a diverted rectum. Standardized incidence ratios for rectal cancer were 8.7 in patients with an IRA, 0.4 in patients with an IPAA, and 3.8 in patients with a diverted rectum. Risk factors for rectal cancer were primary sclerosing cholangitis in patients with an IRA (hazard ratio, 6.12), and colonic severe dysplasia or cancer before subtotal colectomy in patients with a diverted rectum (hazard ratio, 3.67).

CONCLUSIONS: In an analysis of the Swedish National Patient Register, we found that the risk for rectal cancer after colectomy in patients with UC is low, in relative and absolute terms, after reconstruction with an IPAA. An IRA and diverted rectum are associated with an increased risk of rectal cancer, compared with the general population, but the absolute risk is low. Patients and their health care providers should consider these findings in making decisions to leave the rectum intact, perform completion proctectomy, or reconstruct the colon with an IRA or IPAA.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
SIR; Surgery; IBD Treatment; Patient Management
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-138873 (URN)10.1016/j.cgh.2016.11.036 (DOI)000403327600022 ()28013111 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Futurum Academy for Health and Care (Region Jonkoping County, Sweden)

Available from: 2017-06-27 Created: 2017-06-27 Last updated: 2019-09-18
Myrelid, P., Salim, S., Darby, T., Almer, S., Melgar, S., Andersson, P. & Söderholm, J. D. (2015). Effects of anti-inflammatory therapy on bursting pressure of colonic anastomosis in murine dextran sulfate sodium induced colitis. Scandinavian Journal of Gastroenterology, 50(8), 991-1001
Open this publication in new window or tab >>Effects of anti-inflammatory therapy on bursting pressure of colonic anastomosis in murine dextran sulfate sodium induced colitis
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2015 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, no 8, p. 991-1001Article in journal (Refereed) Published
Abstract [en]

Background. The aim of this study was to examine the effect of colitis and anti-inflammatory therapies on the healing of colonic anastomoses in mice. Methods. Female C57BL/6 mice were randomized into eight groups; four groups receiving plain tap-water and four groups receiving dextran sulfate sodium. Intra-peritoneal treatment was given therapeutically for 14 days with placebo, prednisolone, azathioprine, or infliximab (IFX). Colonic anastomoses were performed and bursting pressure (BP) measurements were recorded and the inflammation evaluated with histology and zymography. Results. The mice with colitis had a more active inflammation based on histology and bowel weight compared with the tap water group, 8.3 (7.6-9.5) mg/mm and 5.5 (4.8-6.2) mg/mm respectively (p less than 0.0001). Similarly mice with colitis receiving placebo had a more active inflammation, 12.8 (10.6-15.0) mg/mm, which differed significantly from all the other therapy arms among the colitic mice; prednisolone 8.1 (7.5-9.1) mg/mm (p = 0.014), azathioprine 8.2 (7.0-8.5) mg/mm (p = 0.0046), IFX 6.7 (6.4-7.9) mg/mm (p = 0.0055). BP for the placebo group was 90.0 (71.5-102.8) mmHg and did not differ from azathioprine or IFX groups, 84.4 (70.5-112.5) and 92.3 (75.8-122.3) mmHg respectively. In contrast BP for the prednisolone group was significantly decreased compared to placebo, 55.5 (42.8-73.0) mmHg (p = 0.0004). Conclusions. All therapies had a beneficial effect on the colitis. An impaired BP of colonic anastomoses was noted after preoperative steroids but not after azathioprine or IFX in this model.

Place, publisher, year, edition, pages
TAYLOR and FRANCIS LTD, 2015
Keywords
anastomosis; colitis; dextran sulfate sodium; inflammatory bowel disease; postoperative complications; surgical
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-121927 (URN)10.3109/00365521.2014.964760 (DOI)000361323200008 ()25861827 (PubMedID)
Note

Funding Agencies|Science Foundation Ireland (SFI) by SFI [02/CE/B124, 07/CE/B1368]

Available from: 2015-10-13 Created: 2015-10-12 Last updated: 2017-12-01
Andersson, P., Norblad, R., Söderholm, J. D. & Myrelid, P. (2014). Ileorectal anastomosis in comparison with ileal pouch anal anastomosis in reconstructive surgery for ulcerative colitis - a single institution experience. Journal of Crohn's & Colitis, 8(7), 582-589
Open this publication in new window or tab >>Ileorectal anastomosis in comparison with ileal pouch anal anastomosis in reconstructive surgery for ulcerative colitis - a single institution experience
2014 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 8, no 7, p. 582-589Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

Ileal pouch anal anastomosis (IPAA) is the standard procedure for reconstruction after colectomy for ulcerative colitis (UC). However, ileorectal anastomosis (IRA) as an alternative has, recently experienced a revival. This study from a single center compares the clinical outcomes of these procedures.

METHODS:

From 1992 to 2006, 253 patients consecutively underwent either IRA (n=105) or IPAA (n=148). Selection to either procedure was determined on the basis of rectal inflammation, presence of dysplasia/cancer or patient preferences. Patient-records were retrospectively evaluated. Mean follow-up time was 5.4 and 6.3 years respectively.

RESULTS:

Major postoperative complications occurred in 12.4% of patients after IRA and in 12.8% after IPAA (ns). Complications of any kind after IRA or IPAA, even including subsequent stoma-closure, occurred in 23.8% and 39.9% respectively (p<0.01). Estimated cumulative failure rates after 5 and 10 years were 10.1% and 24.1% for IRA and 6.1% and 18.6% for IPAA respectively (ns). The most common cause for failure was intractable proctitis (4.8%) and unspecified dysfunction (4.8%) respectively. At follow-up 76.9% of patients with IRA had proctitis and 34.1% with IPAA had pouchitis. Estimated cumulative cancer-risk after 10, 20 and 25 year duration of disease was 0.0%, 2.1% and 8.7% for IRA. Figures for IPAA were 0.7%, 1.8% and 1.8% (ns).

CONCLUSION:

Failure-rates did not significantly differ between patients operated with IRA or IPAA. Patients operated with IPAA had a higher cumulative number of postoperative complications. The high long-term cancer-risk after IRA indicates that this procedure should be an interim solution in younger patients.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Ulcerative colitis; IRA; IPAA; Complications; Failure
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-109174 (URN)10.1016/j.crohns.2013.11.014 (DOI)000337867700003 ()24315777 (PubMedID)
Available from: 2014-08-12 Created: 2014-08-11 Last updated: 2017-12-05
Myrelid, P., Druvefors, P. & Andersson, P. (2014). Recurrent volvulus of an ileal pouch requiring repeat pouchopexy: a lesson learnt.. Case Reports in Surgery, 2014, 807640
Open this publication in new window or tab >>Recurrent volvulus of an ileal pouch requiring repeat pouchopexy: a lesson learnt.
2014 (English)In: Case Reports in Surgery, ISSN 2090-6919, E-ISSN 2090-6900, Vol. 2014, p. 807640-Article in journal (Refereed) Published
Abstract [en]

Introduction. Restorative surgery for ulcerative colitis with ileal pouch anal anastomosis (IPAA) is frequently accompanied by complications. Volvulus of the ileal pouch is one of the most rarely reported late complications and to our knowledge no report exists on reoperative surgery for this condition. Case Report. A 58-year-old woman who previously had undergone restorative proctocolectomy due to ulcerative colitis with an IPAA presented with volvulus of the pouch. She was operated with a single row pouchopexy to the presacral fascia. Two months later she returned with a recurrent volvulus. At reoperation, the pouch was found to have become completely detached from the fascia. A new pexy was made by firmly anchoring the pouch with two rows of sutures to the presacral fascia as well as with sutures to the lateral pelvic walls. At follow-up after five months she was free of symptoms. Conclusion. This first report ever on reoperative surgery for volvulus of a pelvic pouch indicates that a single row pouchopexy might be insufficient for preventing retwisting. Several rows seem to be needed.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2014
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-115299 (URN)10.1155/2014/807640 (DOI)25110603 (PubMedID)
Available from: 2015-03-12 Created: 2015-03-12 Last updated: 2017-12-04Bibliographically approved
Sjödahl, R., Schulz, C., Myrelid, P. & Andersson, P. (2012). Long-term quality of life in patients with permanent sigmoid colostomy. Colorectal Disease, 14(6), E335-E338
Open this publication in new window or tab >>Long-term quality of life in patients with permanent sigmoid colostomy
2012 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 14, no 6, p. E335-E338Article in journal (Refereed) Published
Abstract [en]

Aim The study aimed to assess quality of life (QoL) in patients with a sigmoid colostomy using a simple general and disease-specific instrument. A subgroup not doing well was identified and examined further. Method The Short Health Scale (SHS) is a four-item instrument exploring severity of symptoms, function in daily life, worry, and general well-being, using visual analogue scales ranging from 0 to 100 where 100 is the worst possible situation. The SHS was delivered to 206 patients with a sigmoid colostomy. It was returned by 181 (87.9%) patients [88 men; median age 73 (3391) years]. Follow-up was 61 (10484) months for 178 (86.4%) patients returning usable questionnaires. A subgroup of 16 patients scoring more than 50 in all four items of the SHS was further examined with StomaQOL where 100 is best possible. Results The median score for severity of symptoms was 18 (295), function in daily life 21 (095), worry 17 (398) and general well-being 22 (099). A score of andlt; 50 in the SHS was recorded in 84.9%, 82.1%, 79.9% and 70.5% respectively. In the group scoring more than 50 in all four items patients diagnosed with irritable bowel syndrome constituted 43.8% to compare with 5.6% in the entire study group (P andlt; 0.001). Median score for StomaQOL was 37 (2262) in this group. Conclusion Most patients with a permanent sigmoid colostomy have a good QoL consistent with previous findings. However, this is reduced in a subgroup of patients diagnosed with irritable bowel syndrome.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
Sigmoid colostomy, quality of life, Short Health Scale, StomaQOL, irritable bowel syndrome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-77860 (URN)10.1111/j.1463-1318.2012.02941.x (DOI)000303798700008 ()
Available from: 2012-05-31 Created: 2012-05-31 Last updated: 2017-12-07
Myrelid, P., Söderholm, J. D., Sjödahl, R. & Andersson, P. (2012). Split Stoma in Resectional Surgery of High Risk Patients with Ileocolonic Crohn’s Disease. Colorectal Disease, 14(2), 188-193
Open this publication in new window or tab >>Split Stoma in Resectional Surgery of High Risk Patients with Ileocolonic Crohn’s Disease
2012 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 14, no 2, p. 188-193Article in journal (Refereed) Published
Abstract [en]

Objectives: Surgery for Crohn’s disease (CD) is at high risk of anastomotic complications, with severe postoperative morbidity and even mortality. This retrospective study of high risk CD patients compared the outcome of primary anastomosis (PA) with that of split stoma (SS) and delayed anastomosis (DA).

Methods: We performed 146 operations for ileocolonic CD from 1995-2006. Patient data were obtained from a prospectively registered data base. Patients with ≥2 preoperative risk factors (n=76) constituted high risk patients. Outcomes following PA or SS with DA were assessed.

Results: The number of risk factors (mean) was 2.4 in the PA group and 3.5 in the SS group at time of resection and 0.2 (p<0.0001) at time of DA after 5.0 (2.3-12.6) months. Anastomotic complications occurred in 19 % (11/57) after PA compared with 0 % (0/19) after DA (p=0.038). The total number of operations and in-hospital time was 1.9 (±1.5) and 20.9 (±35.6) days after PA compared with 2.0 (±0.2) and 17.8 (±10.4) days after DA (p=0.70 and p=0.74).

Conclusions: SS in high risk ileocolonic resections for CD, reduces the number of risk factors at the time of DA and the risk for anastomotic complications, compared to PA, without adding inhospital time or number of operations.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
Crohn’s Disease; Stoma, Surgical; Surgery; Postoperative Complications; Anastomosis, Surgical
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54812 (URN)10.1111/j.1463-1318.2011.02578.x (DOI)000298944800019 ()
Available from: 2010-04-14 Created: 2010-04-14 Last updated: 2017-12-12Bibliographically approved
Al-Ayoubi, F., Eriksson, H., Myrelid, P., Wallon, C. & Andersson, P. (2012). Uneven distribution of emergency operations and lack of trauma: a call for reorganization of acute surgical care?. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 20
Open this publication in new window or tab >>Uneven distribution of emergency operations and lack of trauma: a call for reorganization of acute surgical care?
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2012 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. METHODS: Linkoping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. RESULTS: There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1%) were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures) 276 (60.9%) were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4%) required operation, of whom general surgeons operated on eight (3.1%). Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range) number of such operations done by each consultant was 6 (3--17) and 6 (1--22). Corresponding figures for senior registrars were 7 (0--11) and 8 (1--39). CONCLUSION: There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient with trauma. Further centralization of trauma care, long-term positions at units for emergency surgery and trauma, and subspecialisation in the fields of emergency surgery and trauma, might be options to solve problems of low volumes.

Place, publisher, year, edition, pages
BioMed Central, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87677 (URN)10.1186/1757-7241-20-66 (DOI)22985447 (PubMedID)
Available from: 2013-01-22 Created: 2013-01-21 Last updated: 2017-12-06
Escobar Kvitting, J.-P., Andersson, P. & Druvefors, P. (2009). A phytobezoar in the acute abdomen. American Journal of Surgery, 197(2), e21-e22
Open this publication in new window or tab >>A phytobezoar in the acute abdomen
2009 (English)In: American Journal of Surgery, ISSN 0002-9610, E-ISSN 1879-1883, Vol. 197, no 2, p. e21-e22Article in journal (Refereed) Published
Abstract [en]

A phytobezoar is a rare differential diagnosis in the acute abdomen. An 89-year-old woman presented with lower abdominal pain. A computed tomography scan and ultrasound suggested the presence of a bezoar. A phytobezoar was extracted surgically, and a resection was performed of the perforated small bowel segment. The etiology and management of phytobezoars are discussed.

Place, publisher, year, edition, pages
Elsevier, 2009
Keywords
Phytobezoar; Small intestinal perforation
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-18744 (URN)10.1016/j.amjsurg.2008.02.013 (DOI)18789409 (PubMedID)
Available from: 2009-06-03 Created: 2009-06-03 Last updated: 2017-12-13Bibliographically approved
Salim, S., Silva, M. A., Keita, Å., Larsson, M., Andersson, P., Magnusson, K.-E., . . . Söderholm, J. D. (2009). CD83(+)CCR7(-) Dendritic Cells Accumulate in the Subepithelial Dome and Internalize Translocated Escherichia coli HB101 in the Peyers Patches of Heal Crohns Disease. American Journal of Pathology, 174(1), 82-90
Open this publication in new window or tab >>CD83(+)CCR7(-) Dendritic Cells Accumulate in the Subepithelial Dome and Internalize Translocated Escherichia coli HB101 in the Peyers Patches of Heal Crohns Disease
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2009 (English)In: American Journal of Pathology, ISSN 0002-9440, E-ISSN 1525-2191, Vol. 174, no 1, p. 82-90Article in journal (Refereed) Published
Abstract [en]

Recurrent Crohns disease originates with small erosions in the follicle-associated epithelium overlying the Peyers patches. Animal studies have illustrated mucosal immune regulation by dendritic cells located in the subepithelial dome. The aim of this study was to characterize the dendritic cells at this specific site in patients with Crohns disease. Heal tissues were obtained after surgery performed on Crohns patients; ileal samples from noninflammatory bowel disease and ulcerative colitis served as standard and inflammatory controls, respectively. Flow cytometry of isolated intestinal mononuclear cells showed a larger subset of dendritic cells in Crohns samples compared with controls. This finding was corroborated by confocal microscopy, showing enhanced infiltrates of cells positive for the dendritic cell markers, DC-SIGN(+) and CD83(+), in the subepithelial dome. Moreover, the CD83(+) cells in Crohns tissues showed reduced expression of the lymph node migratory receptor, CCR7, possibly contributing to the high numbers of dendritic cells. After exposure to nonpathogenic Escherichia coli in Ussing chambers, dendritic cells in the subepithelial dome of Crohns disease demonstrated increased co-localization with translocated bacteria. Immunohistochemical results revealed that DC-SIGN(+) cells in Crohns tissues were found to express toll-like receptor 4 and produce tumor necrosis factor-a. In conclusion, nonmigrating dendritic cells that accumulate in the subepithelial dome and internalize nonpathogenic bacteria may be important for the onset and perpetuation of mucosal inflammation in Crohns disease.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16424 (URN)10.2353/ajpath.2009.080273 (DOI)
Available from: 2009-01-23 Created: 2009-01-23 Last updated: 2017-12-14Bibliographically approved
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