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Smeds, Staffan
Publications (10 of 13) Show all publications
Kingsnorth, A., Gingell-Littlejohn, M., Nienhuijs, S., Schuele, S., Appel, P., Ziprin, P., . . . Smeds, S. (2012). Randomized controlled multicenter international clinical trial of self-gripping Parietex (TM) ProGrip (TM) polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months. Hernia, 16(3), 287-294
Open this publication in new window or tab >>Randomized controlled multicenter international clinical trial of self-gripping Parietex (TM) ProGrip (TM) polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months
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2012 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 16, no 3, p. 287-294Article in journal (Refereed) Published
Abstract [en]

To compare clinical outcomes following sutureless Parietex (TM) ProGrip (TM) mesh repair to traditional Lichtenstein repair with lightweight polypropylene mesh secured with sutures. less thanbrgreater than less thanbrgreater thanThis is a 3-month interim report of a 1-year multicenter international study. Three hundred and two patients were randomized; 153 were treated with Lichtenstein repair (L group) and 149 with Parietex (TM) ProGrip (TM) precut mesh (P group) with or without fixation. The primary outcome measure was postoperative pain using the visual analog scale (VAS, 0-150 mm); other outcomes were assessed prior to surgery and up to 3 months postoperatively. less thanbrgreater than less thanbrgreater thanCompared to baseline, pain score was lower in the P group at discharge (-10%) and at 7 days (-13%), while pain increased in the L group at discharge (+39%) and at 7 days (+21%). The difference between groups was significant at both time points (P = 0.007 and P = 0.039, respectively). In the P group, patients without fixation suffered less pain compared to those with single-suture fixation (1 month: -20.9 vs. -6.15%, P = 0.02; 3 months: -24.3 vs. -7.7%, P = 0.01). The infection rate was significantly lower in the P group during the 3-month follow-up (2.0 vs. 7.2%, P = 0.032). Surgery duration was significantly shorter in the P group (32.4 vs. 39.1 min; P andlt; 0.001). No recurrence was observed at 3 months in both groups. less thanbrgreater than less thanbrgreater thanSurgery duration, early postoperative, pain and infection rates were significantly reduced with self-gripping polyester mesh compared to Lichtenstein repair with polypropylene mesh. The use of fixation increased postoperative pain in the P group. The absence of early recurrence highlights the gripping efficiency effect.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2012
Keywords
Parietex (TM) ProGrip (TM), Lichtenstein, Polyester mesh, Polypropylene mesh, Lightweight mesh, Self-gripping mesh
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-78809 (URN)10.1007/s10029-012-0900-y (DOI)000304611700008 ()
Note
Funding Agencies|Sofradim Production/Covidien, Trevoux, France||Available from: 2012-06-21 Created: 2012-06-21 Last updated: 2017-12-07
Koch Frisén, A., Starck, J., Smeds, S., Nyström, P. & Kald, A. (2011). Analysis of outcome of Lichtenstein groin hernia repair by surgeons in training versus a specialized surgeon. Hernia, 15(3), 281-288
Open this publication in new window or tab >>Analysis of outcome of Lichtenstein groin hernia repair by surgeons in training versus a specialized surgeon
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2011 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 3, p. 281-288Article in journal (Refereed) Published
Abstract [en]

Purpose: Groin hernia repair is a common procedure in general surgery, and is taught to and performed by surgeons early in their training. The aim of this observational study was to compare hernia repair performance and results of surgical trainees with those of a specialized surgeon. The further aim sought to identify what factors may influence short and long-term outcome, and areas for improvement in surgical training.

Methods: A non-randomized parallel cohort study was designed to compare a specialized surgeon with surgical trainees, performing the Lichtenstein repair in adult males. Two hundred repairs were included, of which 96 were performed by surgical trainees. Patient characteristics, surgical experience, and operative data including duration of procedural parts and surgical complexity were noted at surgery. Postoperative complications, recurrence, chronic pain and residual symptoms were assessed at longterm follow-up after a median of 34.5 months.

Results: Surgical trainees had longer overall operative time consume, with an unproportionally longer time for mobilising the sac and cord. They perceived exposure and mobilisation as more difficult than the specialist, and also a greater demand on own experience during surgery. The trainee repairs had a higher rate of postoperative complications (14.7% versus 5.0%) but recurrence rate was the same as for specialist repairs. At long-term follow-up, specialist repairs had a higher symptom burden and more chronic pain.

Conclusions: Comparison of a specialized surgeon to surgical trainees in performance and outcome for inguinal hernia surgery shows it was more efficient, but not necessarily better to let a specialized surgeon perform the repairs. The better long-term outcome for surgical trainees stands in contrast to the prejudice that it is better to have an experienced surgeon to perform standard procedures. It seems likely that targeted training in dissection and mobilisation could decrease level of perceived complexity and shorten operative time consume for surgical trainees. We believe that adequately supervised hernia surgery should remain as a part of the surgical training.

Place, publisher, year, edition, pages
Springer, 2011
Keywords
Groin hernia, Surgical trainees, Lichtenstein, Pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63643 (URN)10.1007/s10029-010-0780-y (DOI)000291603300006 ()
Available from: 2010-12-29 Created: 2010-12-29 Last updated: 2017-12-11
Smeds, S., Kald, A. & Lofstrom, L. (2010). Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study. HERNIA, 14(3), 249-252
Open this publication in new window or tab >>Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study
2010 (English)In: HERNIA, ISSN 1265-4906, Vol. 14, no 3, p. 249-252Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to assess the variation of self-reported pain over a period of 2 years in three groups of patients with no, moderate and severe pain at 3 months after primary open inguinal hernia repair. In two cohorts of patients from 2004 (n = 272) and 2005 (n = 292) who had given a self-report of postoperative pain at 3 months, 79 randomly selected patients without pain (box visual analogue scale [VAS] level 10) and all patients with moderate (Box VAS level 7-9) and severe pain (Box VAS level 1-6), 91 and 9, respectively, were included in the case series. The self-assessments were repeated for all patients 1-1.5 and 2-2.5 years after surgery (November 2006). It was observed that moderate pain reappeared among the pain-free patients in 28 and 23% after 1-1.5 and 2-2.5 years, respectively. Of those patients with moderate pain at 3 months, 39 and 49% reported no pain at 1-1.5 and 2-2.5 years, respectively, after surgery. A worsening from moderate pain to severe pain was reported by 22% of patients after 1-1.5 years and by 15% of patients after 2-2.5 years. Hernia recurrence (n = 3) was observed only in patients with increased pain. All nine patients with severe pain at 3 months reported less pain, but only one was pain-free at 2-2.5 years after surgery. The study shows that a significant proportion of the patients developed pain later than 3 months after the operation. It further points to a difference in pain evolvement in patients with moderate pain and those with severe postoperative pain at 3 months. Pain can increase in intensity from moderate to severe, both with and without the presence of a clinical recurrence.

Place, publisher, year, edition, pages
Springer Science Business Media, 2010
Keywords
Inguinal hernia, Surgery, Postoperative pain, Open herniorraphy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-57172 (URN)10.1007/s10029-009-0615-x (DOI)000278153700004 ()
Available from: 2010-06-11 Created: 2010-06-11 Last updated: 2010-06-11
Smeds, S., Löfström, L. & Eriksson, O. (2010). Influence of nerve identification and the resection of nerves at risk on postoperative pain in open inguinal hernia repair. HERNIA, 14(3), 265-270
Open this publication in new window or tab >>Influence of nerve identification and the resection of nerves at risk on postoperative pain in open inguinal hernia repair
2010 (English)In: HERNIA, ISSN 1265-4906, Vol. 14, no 3, p. 265-270Article in journal (Refereed) Published
Abstract [en]

Surgical strategy regarding nerve identification and resection in relation to chronic postoperative pain remains controversial. A central question is whether nerves in the operation field, when identified, should be preserved or resected. In the present study, the hypotheses that the identification and consequent resection of nerves at risk have no influence on postoperative pain has been tested. A single-centre study was conducted in 525 patients undergoing Lichtenstein hernioplasty. One surgeon (364 operations, Group A) consequently resected nerves at risk for being injured and nine surgeons (161 operations, Group B) adhered to the general routine of nerve preservation. All cases were ambulatory surgery on anaesthetised patients and the groups were similar with regard to age, body mass index (BMI) and preoperative pain. Self-reported pain at 3 months was recorded on a 10-box visual analogue scale (VAS). The identification and resection of nerves were continuously registered. Statistical calculations were performed with Fishers exact test and ordinal logistic regression. There was no significant difference in the number of identified nerves in the two groups of patients (iliohypogastricus, P = 0.555; ilioinguinalis, P = 0.831; genital branch, P = 0.214). However, the number of resected nerves was significantly higher in Group A for the iliohypogastric nerve, P andlt; 0.001, but not for ilioinguinalis, P = 0.064, and genital branch, P = 0.362. Non-identification of the ilioinguinal nerve correlated to the highest level of self-reported postoperative pain at 3 months. Patients in Group A, who had nerves at risk resected from the operation field, reported significantly less postoperative pain at 3 months, P = 0.007. This register study confirms the importance of nerve identification. Nerve resection strategy with the consequent removal of nerves at risk gives a significantly better outcome in Lichtenstein hernioplasty.

Place, publisher, year, edition, pages
Springer Science Business Media, 2010
Keywords
Open herniorraphy, Nerve identification, Inguinal nerve resection, Postoperative pain
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-57173 (URN)10.1007/s10029-010-0632-9 (DOI)000278153700007 ()
Available from: 2010-06-11 Created: 2010-06-11 Last updated: 2010-06-11
Smeds, S., Löfström, L. & Kald, A. (2008). Not to hurt the patient--do we live up to this in hernia surgery? A self-assessment method tested to answer the question. Läkartidningen, 105(21), 1582-1584
Open this publication in new window or tab >>Not to hurt the patient--do we live up to this in hernia surgery? A self-assessment method tested to answer the question
2008 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 21, p. 1582-1584Article in journal (Refereed) Published
Abstract [en]

   

Keywords
Age Factors Clinical Competence Follow-Up Studies Hernia, Inguinal/*surgery Humans Postoperative Complications/diagnosis/etiology Questionnaires Recurrence Risk Factors Self Concept Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43421 (URN)73821 (Local ID)73821 (Archive number)73821 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Koch Frisén, A., Bringman, S., Myrelid, P., Smeds, S. & Kald, A. (2008). Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh. British Journal of Surgery, 95(10), 1226-1231
Open this publication in new window or tab >>Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh
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2008 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 10, p. 1226-1231Article in journal (Refereed) Published
Abstract [en]

Background: Groin hernia repair is one of the commonest operations in general surgery. Existing techniques have very low and acceptable recurrence rates, but chronic pain and discomfort remain a problem for many patients. New mesh materials are being developed to increase biocompatibility, and the aim of this study was to compare a new titanium-coated lightweight mesh with a standard polypropylene mesh.

Methods: A randomized controlled single-centre clinical trial was designed, with the basic principle of one unit, one surgeon, one technique (Lichtenstein under general anaesthesia) and two meshes. Pain before and after surgery, and during convalescence (primary outcomes) was estimated in 317 patients. At 1-year clinical follow-up, recurrence, pain, discomfort and quality of life (secondary outcomes) were evaluated.

Results: Patients with the lightweight mesh returned to work after 4 days, compared with 6.5 days for the standard mesh (P = 0.040). The lightweight group returned to normal activity after 7 days, versus 10 days for the standard group (P = 0.005). There was no difference in postoperative pain or recurrence at the 1-year follow-up.

Conclusion: Patients with the lightweight mesh had a shorter convalescence than those with the standard heavyweight mesh. Registration number: ISRCTN36979348 (http://www.controlled-trials.com). Copyright © 2008 British Journal of Surgery Society Ltd Published by John Wiley & Sons Ltd.

Keywords
Adult Aged Hernia, Inguinal/*surgery Humans Male Middle Aged Pain Measurement Pain, Postoperative/etiology Polypropylenes/*therapeutic use Quality of Life Recurrence *Surgical Mesh Titanium/*administration & dosage Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43370 (URN)10.1002/bjs.6325 (DOI)73656 (Local ID)73656 (Archive number)73656 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Trulsson, L., Sandström, P., Sundqvist, T., Smeds, S., Gasslander, T. & Svanvik, J. (2004). The influence of a load of L-arginine on serum amino acids and pancreatic apoptosis/proliferation and ATP levels in the rat. Pancreas, 29(4), 113-120
Open this publication in new window or tab >>The influence of a load of L-arginine on serum amino acids and pancreatic apoptosis/proliferation and ATP levels in the rat
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2004 (English)In: Pancreas, ISSN 0885-3177, E-ISSN 1536-4828, Vol. 29, no 4, p. 113-120Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

Administration of high doses of amino acids like ethionine, methionine, and arginine causes pancreatic tissue damage. The initial mechanism behind these effects is not known. The aim of this study was to show the early effects of a load of L-arginine on programed cell death/proliferation and ATP levels in the pancreas.

METHODS:

We analyzed in rats the effects of intraperitoneal administration of L-arginine on serum amino acids, pancreatic cell apoptosis/proliferation, and ATP levels at 8, 16, and 24 hours. Serum amino acid concentrations were measured with HPLC, tissue ATP was measured fluorometrically, apoptosis was studied with caspase-3 activity and histone-associated DNA-fragments, and proliferation was studied with thymidine autoradiography.

RESULTS:

After a load of l-arginine, there were initially increased serum levels of L-arginine and L-citrulline, but these fell below control levels after 24 hours as well as amino acids in the glutamate family (ornithine, proline, histidine, and glutamine). Initially, increased ATP levels in the pancreatic tissue returned to control levels at 24 hours. The acinar cells proliferation was suppressed and the apoptosis rate strongly increased at 16 and 24 hours. Pancreatic histology showed vacuole formation in the acinar cells at 8 hours. At 16 hours, there was less vacuolization, but apoptotic bodies were seen, and at 24 hours there was cell degeneration but no necrosis.

CONCLUSIONS:

After a load of l-arginine, amino acid metabolism causes a high ATP production in the pancreatic tissue that may cause mitochondrial initiation of cell death.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-23748 (URN)15502637 (PubMedID)3258 (Local ID)3258 (Archive number)3258 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
Trulsson, L., Velin, Å., Herder, A., Söderkvist, P., Rüter, A. & Smeds, S. (2003). Telomerase activity in surgical specimens and fine-needle aspiration biopsies from hyperplastic and neoplastic human thyroid tissues. American Journal of Surgery, 186(1), 83-88
Open this publication in new window or tab >>Telomerase activity in surgical specimens and fine-needle aspiration biopsies from hyperplastic and neoplastic human thyroid tissues
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2003 (English)In: American Journal of Surgery, ISSN 0002-9610, E-ISSN 1879-1883, Vol. 186, no 1, p. 83-88Article in journal (Refereed) Published
Abstract [en]

Background: Telomerase activity (TA) indicates malignancy, but activated lymphocytes also express TA. Correlation between TA in thyroid tissues and fine-needle aspiration (FNA) samples and knowledge about TA in adjacent tissue are of importance. Methods: The telomeric repeat amplification protocol assay followed by enzyme-linked immunosorbent assay detection was performed on 78 thyroid cases including 53 suspected malignancies, preoperative and perioperative FNA specimens, and adjacent tissue. Results: Benign lesions in cancer-suspected cases were TA negative. Eight of 13 papillary (62%) and 4 of 5 follicular (80%) tumors were TA positive (TA+). Lower TA was observed in conventional papillary cancer than in follicular, tall cell variant of papillary and anaplastic cancers. Adjacent tissues with lymphocyte infiltration were TA+ in 9 of 17 cases (53%). Nine of 65 adjacent tissues (14%) were TA+. Three of 6 preoperative and 9 of 11 perioperative FNA samples from malignant tumors corresponded to the tissue TA. Conclusions: High TA may reflect more severe thyroid cancer. Telomerase activity in FNA biopsies does not add reliable diagnostic information, and presence of lymphocytes can give false-positive results.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25339 (URN)10.1016/S0002-9610(03)00119-3 (DOI)9781 (Local ID)9781 (Archive number)9781 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Velin, Å., Ander, S., Johansson, K., Trulsson, L. & Smeds, S. (2001). Inverse relation between mRNA synthesis and secretion of parathyroid hormone in athymic mice grafted with human parathyroid tissue. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 109(3), 235-240
Open this publication in new window or tab >>Inverse relation between mRNA synthesis and secretion of parathyroid hormone in athymic mice grafted with human parathyroid tissue
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2001 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 109, no 3, p. 235-240Article in journal (Refereed) Published
Abstract [en]

Parathyroid hormone (PTH) mRNA in original and transplanted human adenomatous parathyroid tissue and human serum intact PTH (S-iPTH) was measured in athymic mice at 4, 7, 14, and 28 days after transplantation. Parathyroid tissue was obtained during surgery for hyperparathyroidism and implanted subcutaneously. PTH mRNA detection was done with RT-PCR followed by membrane blot and hybridisation and S-iPTH was analysed using a human specific immunoradiometric method. At 4 days, PTH mRNA was 79.6 ▒ 5.3% (mean ▒ SE) of that in original tissue whereas S-iPTH was only 5.4 ng/l. At 28 days, PTH mRNA was significantly reduced to 60.7▒4.1% whereas S-iPTH was increased to 192 ng/l. The reduced PTH mRNA expression in the transplants at 28 days may be explained by an inhibited DNA transcription. The presence of human S-iPTH in transplanted mice at 4 days may be due to cell disintegration and diffusion. The gradual increase in S-iPH during the experimental period probably reflects increased transplant cell volume and improved graft revascularisation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25366 (URN)9809 (Local ID)9809 (Archive number)9809 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Velin, Å., Herder, A., Johansson, K., Trulsson, L. & Smeds, S. (2001). Telomerase is not activated in human hyperplastic and adenomatous parathyroid tissue. European Journal of Endocrinology, 145(2), 161-164
Open this publication in new window or tab >>Telomerase is not activated in human hyperplastic and adenomatous parathyroid tissue
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2001 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 145, no 2, p. 161-164Article in journal (Refereed) Published
Abstract [en]

Background: Telomerase is a specific enzyme that appears to have a key role in cellular senescence and the progression of neoplastic tissue. High telomerase activity has been found in several cancers, but not in most normal and benign tissue. Little is known about the influence of telomerase on the abnormal growth associated with hyperparathyroidism. Objective: To analyse telomerase activity in parathyroid tissue obtained from 29 patients undergoing surgery for primary hyperparathyroidism. Design: Tissue for telomerase activity measurements was collected from six hyperplastic, 20 adenomatous and 22 normal parathyroid glands. Methods: The highly sensitive PCR-based telomeric repeat amplification protocol, TRAP, combined with ELISA, was used to detect telomerase activity in tissue extracts containing 3.0 ╡g protein. Result: Telomerase was not activated in any of the analysed tissue by 3 ╡g protein. Reassay of 12 samples containing 6.0 ╡g protein verified these negative TRAP results. Conclusion: Our findings indicate that telomerase is not a part of the mechanism promoting parathyroid proliferation and the underlying conditions remain to be determined.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25367 (URN)9810 (Local ID)9810 (Archive number)9810 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
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