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BETA
Halldestam, Ingvar
Alternative names
Publications (10 of 11) Show all publications
Bahlmann, H., Halldestam, I. & Nilsson, L. (2019). Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial. European Journal of Anaesthesiology, 36(2), 153-161
Open this publication in new window or tab >>Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial
2019 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 36, no 2, p. 153-161Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications.

OBJECTIVES: The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care.

DESIGN: A randomised controlled study.

SETTING: Two Swedish university hospitals, between October 2011 and October 2015.

PATIENTS: Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency.

INTERVENTION: A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min m and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg.

MAIN OUTCOME MEASURE: The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list.

RESULTS: Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P < 0.01) and dobutamine more frequently (27/30 vs. 9/29, P < 0.01). The median [interquartile range, IQR] incidence of complications per patient 5 days after surgery was 2 [0 to 3] in the intervention group and 1 [0 to 2] in the control group (P = 0.10), and after 30 days 4 [2 to 6] in the intervention group and 2 [1 to 4] in the control group (P = 0.10).

CONCLUSION: Goal-directed therapy during oesophageal resection did not result in a reduction of the incidence of postoperative complications.

TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01416077.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-156264 (URN)10.1097/EJA.0000000000000908 (DOI)000462763800010 ()30431499 (PubMedID)2-s2.0-85059795456 (Scopus ID)
Note

Funding agencies: Linkoping Medical Society

Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-18Bibliographically approved
Halldestam, I. (2010). Incidensen av gallsten: symtom och riskfaktorer. Läkartidningen, 107(7), 425
Open this publication in new window or tab >>Incidensen av gallsten: symtom och riskfaktorer
2010 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 7, p. 425-Article in journal (Refereed) Published
Abstract [en]

[No abstract available]

Place, publisher, year, edition, pages
Lakartidningen, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-57025 (URN)
Available from: 2010-06-14 Created: 2010-06-09 Last updated: 2017-12-12
Halldestam, I., Kullman, E. & Borch, K. (2009). Incidence of and potential risk factors for gallstone disease in a general population sample. BRITISH JOURNAL OF SURGERY, 96(11), 1315-1322
Open this publication in new window or tab >>Incidence of and potential risk factors for gallstone disease in a general population sample
2009 (English)In: BRITISH JOURNAL OF SURGERY, ISSN 0007-1323, Vol. 96, no 11, p. 1315-1322Article in journal (Refereed) Published
Abstract [en]

Background: Several epidemiological studies have been published, but there are few reports on relations between gallstone incidence, symptomatology and risk factors. Methods: Of 621 randomly selected individuals aged 35-85 years in a general population who been screened previously, with ultrasonography and found to have no gallbladder stones, 503 (81.0 per cent) were re-examined after a minimum interval of 5 years. At baseline and re-examination, heredity for gallstone disease was explored and body mass index, digestive symptoms including abdominal pain, quality of life, alcohol and smoking habits, use of non-steroidal anti-inflammatory drugs and oestrogen, parity and blood lipid levels were recorded. Results: Forty-two (8.3 per cent) of the 503 subjects developed stones. Subjects were followed for a total of 3025.8 person-years, yielding an incidence for newly developed gallstones of 1.39 per 100 person-years. A positive association for gallstone development,was found only for length of follow-up and plasma low-density lipoprotein-cholesterol levels at baseline. Weekly alcohol consumption was inversely related to gallstone development. Conclusion: The incidence of gallstones in this population was 1.39 per 100 person-years. Gallstone development was related to length of follow-up and LDL-cholesterol levels, and inversely related to alcohol consumption.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-51895 (URN)10.1002/bjs.6687 (DOI)
Available from: 2009-11-23 Created: 2009-11-23 Last updated: 2009-11-23
Halldestam, I., Kullman, E. & Borch, K. (2008). Defined indications for elective cholcystectomy for gallstone disease. British Journal of Surgery, 95(5), 620-626
Open this publication in new window or tab >>Defined indications for elective cholcystectomy for gallstone disease
2008 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 5, p. 620-626Article in journal (Refereed) Published
Abstract [en]

Background: This study examined symptomatology and quality of life following elective cholecystectomy for symptomatic gallstone disease with defined indications for surgery.

Methods: In this prospective study of 200 consecutive patients (161 women; median age 46·5 (range 24-79) years), strict indications for elective cholecystectomy were stipulated. Digestive symptoms and quality of life were recorded with a self-administered questionnaire before and at 3 and 12 months after surgery.

Results: Of 149 patients who experienced abdominal pain with typical location before surgery, 136 (91·3 per cent) reported total remission or reduced frequency of that type of pain 12 months later. Of 35 patients who reported atypical or multiple pain location before operation, 27 (77 per cent) experienced reduced frequency or disappearance of that type of pain. Frequency of pain episodes, atypical or multiple pain location, specific food intolerance and frequency of disturbing abdominal gas at baseline correlated positively with the frequency of abdominal pain episodes at 12 months after surgery. There was a tendency towards an inverse relation to age.

Conclusion: The frequency of persistent abdominal pain after elective cholecystectomy was low among patients with typical pain location before surgery. Atypical pain location, and frequent pain episodes before operation significantly reduced the chance of becoming pain-free.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13294 (URN)10.1002/bjs.6020 (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2017-12-13Bibliographically approved
Halldestam, I. (2008). Gallstone disease: Population based studies on risk factors, symptomatology and complications. (Doctoral dissertation). Linköping University Electronic Press
Open this publication in new window or tab >>Gallstone disease: Population based studies on risk factors, symptomatology and complications
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background & aims: Gallstone disease is common, costly and its complications are sometimes life threatening. The aim of this thesis is to determine the prevalence and incidence in relation to putative risk factors in the general population. Furthermore, to identify individuals with asymptomatic gallstones who are at risk of developing complications and, finally, to identify those who are at risk of an unsatisfactory outcome after cholecystectomy.

Material & methods: A sample of the adult (35-85 y.) general population was screened with ultrasound examination, blood tests and a questionnaire regarding digestive symptoms, life-style and quality of life. After excluding 115 subjects, who previously had a cholecystectomy, 739 participated. The examination was repeated after a minimum of five years. The individuals who were shown to have gallstones were followed in order to identify risk factors for developing complications. 200 consecutive symptomatic patients were operated with cholecystectomy on defined indications. They completed a questionnaire regarding digestive symptoms, life-style and quality of life before and three and twelve months after surgery.

Results: The crude prevalence of gallstone disease was 17.2 % for women and 12.4% for men. It increased with age and was higher among women. Symptoms did not differ between subjects with and without gallstones, but those previously operated with cholecystectomy did worse both regarding symptoms and quality of life. The estimated crude annual gallstone incidence was 1.5%. This increased with age, but did not differ between the sexes. Gallstone development was positively related to elevated blood lipids and negatively related to alcohol consumption. Fourteen of 120 subjects with gallstones at the primary screening developed a complication demanding treatment during a follow-up interval of 87 (3-146) months. In the patient series operated on strict indications, 91.3 % of those who had reported typical gallstone related pain preoperatively, experienced total or partial pain relief 3 months postoperatively. With atypical pain preoperatively, the corresponding figure was 77.1 %. The findings 12 months postoperatively were similar. In the logistic regression analysis, young age, frequency of pain episodes, atypical pain, specific food intolerance and disturbing abdominal gas were positively related to the frequency of abdominal pain 12 months after surgery.

Conclusion: The prevalence of gallstones was positively related to age and female gender. Previous cholecystectomy was associated with more symptoms and worse quality of life. The annual gallstone incidence of 1.5 % was high in comparison with other studies, but our population was older. In general, neither prevalent nor incident gallstones in the general population were associated with specific symptoms. The cumulative risk of developing a complication to gallstone disease during a 5-year followup interval was 7.6 % with no tendency to level off.

Patients with typical pain had a better outcome after cholecystectomy. Young age, atypical pain and frequent pain episodes before surgery were major risk factors for a worse outcome in terms of persistent pain.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2008. p. 69
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1065
Keywords
Epidemiology, gallstone disease, symptomatology, complications, risk factors
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-11801 (URN)978-91-7393-896-9 (ISBN)
Public defence
2008-05-28, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2015-11-19
Halldestam, I., Kullman, E. & Borch, K. (2008). Incidence of gallstone disease in a general population sample: relations to symptomatology and potential risk factors.
Open this publication in new window or tab >>Incidence of gallstone disease in a general population sample: relations to symptomatology and potential risk factors
2008 (English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13293 (URN)
Available from: 2008-05-13 Created: 2008-05-13
Redéen, S., Engström, H., Erikson, S., Haldestam, I., Leinsköld, T. & Johansson, K.-E. (2005). Abdominell tuberkulos - en nygammal diagnostisk utmaning. Läkartidningen, 102(30-31), 2151-2153
Open this publication in new window or tab >>Abdominell tuberkulos - en nygammal diagnostisk utmaning
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2005 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 30-31, p. 2151-2153Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-33243 (URN)19242 (Local ID)19242 (Archive number)19242 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Halldestam, I., Enell, E.-L., Kullman, E. & Borch, K. (2004). Development of symptoms and complications in individuals with asymptomatic gallstones. British Journal of Surgery, 91(6), 734-738
Open this publication in new window or tab >>Development of symptoms and complications in individuals with asymptomatic gallstones
2004 (English)In: British Journal of Surgery, ISSN 0007-1323, Vol. 91, no 6, p. 734-738Article in journal (Refereed) Published
Abstract [en]

Background: Gallbladder stones are common in the developed world. Complications of gallstones contribute substantially to healthcare costs and may be life threatening. The identification of individuals likely to develop complications would be of benefit in clinical practice as elective cholecystectomy could then be performed.

Methods: Seven hundred and thirty-nine subjects aged 35-85 years from the general population were screened for gallbladder problems by ultrasonography and questionnaire assessment of putative risk factors and digestive symptoms. Gallstones, cholesterolosis or sludge in the gallbladder were diagnosed in 123 (16·3 per cent) of 739 subjects, 120 of whom were followed for a median of 87 (range 3-146) months to May 2003 or until treatment was required.

Results: Fourteen patients were admitted to hospital and treated for gallstone-related complications or symptoms. The cumulative risk of being treated during the first 5 years after detection of asymptomatic gallstones was 7·6 per cent and there was no indication of this risk levelling off. There were no significant differences between treated and untreated subjects with regard to digestive symptoms or any of the risk factors monitored at the initial screening, although treated subjects were significantly younger than those who were not treated.

Conclusion: Nearly one in ten individuals with asymptomatic gallbladder stones in the general population may be expected to develop symptoms or complications that require treatment within 5 years. Age may be inversely related to the incidence of complications.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13292 (URN)10.1002/bjs.4547 (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2009-08-18
Haldestam, I. (2004). Skilj på gallstensförekomst och gallstenssjukdom. Läkartidningen, 101, 3054-3054
Open this publication in new window or tab >>Skilj på gallstensförekomst och gallstenssjukdom
2004 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 3054-3054Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28159 (URN)12974 (Local ID)12974 (Archive number)12974 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
Andersson, P., Kullman, E., Halldestam, I., Einarsson, C. & Borch, K. (2000). Bouveret's syndrome followed by gallstone entrapment in the stomach: An uncommon cause of upper gastrointestinal bleeding and gastric retention. European Journal of Surgery, 166(2), 183-185
Open this publication in new window or tab >>Bouveret's syndrome followed by gallstone entrapment in the stomach: An uncommon cause of upper gastrointestinal bleeding and gastric retention
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2000 (English)In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 2, p. 183-185Article in journal (Refereed) Published
Abstract [en]

[No abstract available]

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24875 (URN)9277 (Local ID)9277 (Archive number)9277 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
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