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  • 1.
    Abdiu, Avni
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Ohannessian, Peter
    Östergötlands Läns Landsting, Reconstruction Centre, Department of Oral Surgery UHL.
    Berggren, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    The nasal alar elevator: A new device that may reduce the need for primary operation of the nose in patients with cleft lip2009In: SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY, ISSN 0284-4311, Vol. 43, no 2, p. 71-74Article in journal (Refereed)
    Abstract [en]

    To improve the shape of the cleft lip nose preoperatively, we have developed the nasal alar elevator. This has been used routinely since 1996 on all our cleft lip patients who have an asymmetrical nose, from the first week after birth until the date of primary lip surgery. We present our 11-year-long experience of using the device on patients born with complete, unilateral cleft lip. In this study 56 children, born between 1996 and 2006 inclusive, with complete unilateral cleft lip, had preoperative treatment with the elevator. During this 11-year period, continuous evaluation during the preoperative period, and its effects on the cleft lip nose, were evaluated, both preoperatively and postoperatively. Our results show that the preoperative use of the device has led to less need for primary nasal surgery. Instead of having to have a primary rhinoplasty (McComb) together with a lip plasty, as a routine, now only about 30% of the patients need primary surgical correction of the nose. If nasal correction is needed, a rather limited undermining of skin over the ala on the cleft side will often be sufficient. The use of a nasal elevator reduces both the length and the extent of the primary intervention, without compromising the final result.

  • 2. Abu-Zidan, FM
    et al.
    Siosteen, AK
    Wang, Jianpu
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery.
    Al-Ayoubi, Fawzi
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology.
    Establishment of a teaching animal model for sonographic diagnosis of trauma2004In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 56, no 1, p. 99-104Article in journal (Refereed)
    Abstract [en]

    Background: Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intraabdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. Methods: Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. Results: The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. Conclusion: The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

  • 3.
    Adell, Gunnar
    et al.
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Boeryd, B.
    Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Frånlund, B.
    Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Sjödahl, Rune
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Håkansson, L.
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes' B colorectal carcinoma: an immunohistochemical study1996In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 162, no 8, p. 637-642Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the incidence and prognostic importance of micrometastatic disease in regional lymph nodes from Dukes' B colorectal carcinomas.

    DESIGN: Retrospective study.

    SETTING: University hospital, Sweden.

    SUBJECTS: 100 patients operated on for primary colorectal carcinoma, classified as Dukes' B lesions.

    INTERVENTIONS: The regional lymph nodes were re-examined immunohistochemically using monoclonal antibodies against cytokeratin.

    OUTCOME MEASURES: Incidence and prognostic importance of micrometastases.

    RESULTS: Micrometastases were found in 39% (39/100) of the patients. The number of positive cells in the lymph nodes examined varied from 1 to over 100. They appeared as single cells or small clusters of cells located within the capsule or in the peripheral sinus of the lymph node. At least three sections from each of three lymph nodes had to be examined to identify 95% of the patients with lymph node micrometastases. The outcome of the patients with micrometastases was not significantly different from that of patients with no epithelial cells in the lymph nodes.

    CONCLUSION: Micrometastases in regional lymph nodes are a interesting phenomenon but clinically seem to be of only weak prognostic value.

  • 4. Adolfsson, L.E.
    et al.
    Nettelblad, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Radial nerve entrapment in the upper arm as a cause of lateral arm pain: A report of four cases2001In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 35, no 2, p. 217-220Article in journal (Refereed)
    Abstract [en]

    Four patients with no history of trauma presented with lateral arm pain, local tenderness, and a tingling sensation at the distal end of the arm when the radial nerve was percussed in the mid-third of the upper arm (Tinel's sign), but no clinical or subjective signs of muscular weakness. They were treated by decompression of the radial nerve in the fibrous canal proximal to the lateral intermuscular septum. Three of the patients had a complete or pronounced reduction in pain, while the fourth had only a slight improvement. Non-traumatic radial nerve entrapment in the upper arm may be the cause of lateral arm pain without clinical signs of muscular weakness.

  • 5.
    Al-Ayoubi, Fawzi
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Eriksson, Helene
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Myrelid, Pär
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Wallon, Conny
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Andersson, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Uneven distribution of emergency operations and lack of trauma: a call for reorganization of acute surgical care?2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20Article in journal (Refereed)
    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.

  • 6.
    Amasheh, Maren
    et al.
    Charite.
    Grotjohann, Ingo
    Charite.
    Amasheh, Salah
    Charite.
    Fromm, Anja
    Charite.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Zeitz, Martin
    Charite.
    Fromm, Michael
    Charite.
    Schulzke, Joerg-Dieter
    Charite.
    Regulation of mucosal structure and barrier function in rat colon exposed to tumor necrosis factor alpha and interferon gamma in vitro: A novel model for studying the pathomechanisms of inflammatory bowel disease cytokines2009In: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, ISSN 0036-5521, Vol. 44, no 10, p. 1226-1235Article in journal (Refereed)
    Abstract [en]

    Objective. In Inflammatory bowel disease (IBD), elevated cytokines are responsible for disturbed intestinal transport and barrier function. The mechanisms of cytokine action have usually been studied in cell culture models only; therefore the aim of this study was to establish an in vitro model based on native intestine to analyze distinct cytokine effects on barrier function, mucosal structure, and inherent regulatory mechanisms. Material and methods. Rat colon was exposed to tumor necrosis factor alpha (TNF alpha) and interferon gamma (IFN gamma) in Ussing chambers. Transepithelial resistance (R-t) and H-3-mannitol fluxes were measured for characterization of the paracellular pathway. Transcellular transport was analyzed by horseradish peroxidase (HRP) flux measurements. Expression and distribution of tight junction proteins were characterized in immunoblots and by means of confocal laser-scanning microscopy (LSM). Results. Colonic viability could be preserved for 20 h in a specialized in vitro set-up. This was sufficient to alter mucosal architecture with crypt surface reduction. R-t was decreased (101 +/- 10 versus 189 +/- 10 Omega . cm(2)) with a parallel increase in mannitol permeability after cytokine exposure. Tight junction proteins claudin-1, -5, -7, and occludin decreased (45 +/- 10%, 16 +/- 7%, 42 +/- 8%, and 42 +/- 13% of controls, respectively), while claudin- 2 increased to 208 +/- 32%. Occludin and claudin- 1 translocated from the plasma membrane to the cytoplasm. HRP flux increased from 0.73 +/- 0.09 to 8.55 +/- 2.92 pmol . h(-1) . cm(-2). Conclusions. A new experimental IBD model with native colon in vitro is presented. One-day exposure to TNFa and IFNg alters mucosal morphology and impairs epithelial barrier function by up-regulation of the paracellular pore-former claudin-2 and down-regulation of the barrier-builders claudin-1, -5, and -7. These alterations resemble changes seen in IBD and thus underline their prominent role in IBD pathogenicity.

  • 7.
    Andersson, Erik
    et al.
    Karolinska Institute.
    Walen, Christian
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Hallberg, Jonas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Paxling, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Dahlin, Mats
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Almlöv, Jonas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Källström, Reidar
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Carlbring, Per
    Umeå University, Department Psychol, S-90187 Umeå, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    A Randomized Controlled Trial of Guided Internet-delivered Cognitive Behavioral Therapy for Erectile Dysfunction2011In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 8, no 10, p. 2800-2809Article in journal (Refereed)
    Abstract [en]

    Introduction. Men with erectile dysfunction are often worried about their condition, have interpersonal difficulties, and have a reduced quality of life. Internet-delivered cognitive behavior therapy (ICBT) has been shown effective for a number of health problems but evidence is limited concerning the treatment of erectile dysfunction. less thanbrgreater than less thanbrgreater thanAim. The study investigated the effects of ICBT for erectile dysfunction. less thanbrgreater than less thanbrgreater thanMethods. Seventy-eight men were included in the study and randomized to either ICBT or to a control group, which was an online discussion group. Treatment consisted of a 7-week Web-based program with e-mail-based therapist support. Each therapist spent an average of 55 minutes per participant. less thanbrgreater than less thanbrgreater thanMain Outcome Measure. The International Index of Erectile Functioning five-item version was administered via the telephone at pretreatment, post-treatment, and 6 months after receiving ICBT. less thanbrgreater than less thanbrgreater thanResults. At post-treatment, the treatment group had significantly greater improvements with regard to erectile performance compared with the control group. Between-group differences at post-treatment were small (d = 0.1), but increased at the 6-month follow-up (d = 0.88). less thanbrgreater than less thanbrgreater thanConclusions. This study provides support for the use of ICBT as a possible treatment format for erectile dysfunction.

  • 8.
    Andersson, M.
    et al.
    Kirurgiska kliniken, Universitetssjukhuset, Örebro, Sweden.
    Andersson, P.
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Bohe, M.
    Kirurgiska kliniken, Universitetssjukhuset MAS, Malmö, Sweden.
    Borjesson, L.
    Kirurgiska kliniken, Sahlgrenska Universitetssjukhuset/Östra, Göteborg, Sweden.
    Graf, W.
    Kirurgiska kliniken, Akademiska sjukhuset, Uppsala, Sweden.
    Jeppsson, B.
    Kirurgiska kliniken, Universitetssjukhuset MAS, Malmö, Sweden.
    Torkvist, L.
    Gastrocentrum kirurgi, Karolinska universitetssjukhuset, Huddinge, Sweden.
    Akerlund, J.-E.
    Kirurgiska kliniken, Danderyds sjukhus, Danderyd, Sweden.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kirurgi - Omistligt komplement till medicinsk behandling2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 45, p. 3003-3009Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 9.
    Andersson, M.
    et al.
    Department of Surgery, County Hospital Ryhov, 551 85 Jönköping, Sweden.
    Andersson, Rolland E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    The appendicitis inflammatory response score: A tool for the diagnosis of acute appendicitis that outperforms the Alvarado score2008In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 32, no 8, p. 1843-1849Article in journal (Refereed)
    Abstract [en]

    Background: The clinical diagnosis of appendicitis is a subjective synthesis of information from variables with ill-defined diagnostic value. This process could be improved by using a scoring system that includes objective variables that reflect the inflammatory response. This study describes the construction and evaluation of a new clinical appendicitis score. Methods: Data were collected prospectively from 545 patients admitted for suspected appendicitis at four hospitals. The score was constructed from eight variables with independent diagnostic value (right-lower-quadrant pain, rebound tenderness, muscular defense, WBC count, proportion neutrophils, CRP, body temperature, and vomiting) in 316 randomly selected patients and evaluated on the remaining 229 patients. Ordered logistic regression was used to obtain a high discriminating power with focus on advanced appendicitis. Diagnostic performance was compared with the Alvarado score. Results: The ROC area of the new score was 0.97 for advanced appendicitis and 0.93 for all appendicitis compared with 0.92 (p = 0.0027) and 0.88 (p = 0.0007), respectively, for the Alvarado score. Sixty-three percent of the patients were classified into the low- or high-probability group with an accuracy of 97.2%, leaving 37% for further investigation. Seventy-three percent of the nonappendicitis patients, 67% of the advanced appendicitis, and 37% of all appendicitis patients were correctly classified into the low- and high-probability zone, respectively. Conclusion: This simple clinical score can correctly classify the majority of patients with suspected appendicitis, leaving the need for diagnostic imaging or diagnostic laparoscopy to the smaller group of patients with an indeterminate scoring result. © 2008 Société Internationale de Chirurgie.

  • 10.
    Andersson, Manne
    et al.
    County Hospital Ryhov, Sweden .
    Andersson, Roland
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Correction: The Appendicitis Inflammatory Response Score: A Tool for the Diagnosis of Acute Appendicitis that Outperforms the Alvarado Score (vol 32, pg 1843–1849, 2008, DOI 10.1007/s00268-008-9649-y2012In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 36, no 9, p. 2269-2270Article in journal (Refereed)
    Abstract [en]

    n/a

  • 11.
    Andersson, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Jansson, Anna
    Institutionen för medicinsk epidemiologi och biostatistik Karolinska institutet, Stockholm.
    Surgery--important part of the humanitarian assistance. Physicians Without Borders in Somalia2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 20, p. 1476-1479Article in journal (Refereed)
    Abstract [en]

      

  • 12.
    Andersson, Peter
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sjödahl, Rune
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Continent Ileostomy2008In: Seminars in Colon and Rectal Surgery, ISSN 1043-1489, Vol. 19, no 3, p. 124-131Article in journal (Other academic)
    Abstract [en]

    Continent ileostomy reservoir is today still an alternative to a standard (conventional) ileostomy in patients where ileal pouch-anal anastomosis is contraindicated or malfunctioning. It eliminates a protruding stoma, obviates the need for a stoma bag, and permits controlled evacuation of bowel contents. A well-functioning continent ileostomy also is entirely continent for gas and feces in the elderly. The reservoir is emptied three to five times a day. Obvious benefits are improved sexual life and facilitated leisure activities. The main drawbacks are frequent complications requiring reoperations in about 50% of the patients. Slippage of the nipple valve occurs in about one-third but in the majority of patients reoperations are successful in the long run. Other complications are pouchitis, enterocutaneous fistula, and stomal stricture. Modifications of the original Kock pouch have been developed as the Barnett pouch and the T-pouch to reduce complications associated with dysfunction of the nipple valve. Cancer of a continent ileostomy reservoir has been reported only in one patient and there seems to be no risk of high-grade dysplasia even after long-term follow-up. At present there are few indications for creating a continent ileostomy reservoir but it is still recommended in very select patients. © 2008 Elsevier Inc. All rights reserved.

  • 13.
    Andersson, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Crohn´s Disease2008In: Coloproctology / [ed] Alexander Herold, Paul-Antoine Lehur, Klaus E. Matzel, P. Ronan O'Connell., Berlin: Springer , 2008, 1, p. 145-158Chapter in book (Other academic)
    Abstract [en]

    EMM: Coloproctology presents the state-of-the-art in coloproctology. The topics covered include anatomy, physiology, anal disorders, dermatology, functional disorders, inflammatory bowel disease, benign and malignant tumours, endoscopy, emergencies and pain syndromes. All chapters give a comprehensive overview of aetiology, incidence, epidemiology, diagnostics, medical and surgical treatment, complications and individual special considerations. This work presents surgical trainees with a comprehensive and condensed guide to the core knowledge required for the European Board of Surgery Qualification (EBSQ) examination. The manual will also be of assistance to practising coloproctologists across Europe and beyond who have an interest in continued professional development. Written by an international team of experts who have each made noteworthy contributions in their field, the coverage of most aspects of coloproctology in an easy-to-follow format also makes this manual valuable to other specialists.

  • 14.
    Andersson, Peter
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Surgery in ulcerative colitis: indication and timing.2009In: Digestive diseases (Basel, Switzerland), ISSN 1421-9875, Vol. 27, no 3, p. 335-340Article in journal (Refereed)
    Abstract [en]

    Surgery continues to play an important role in the therapeutic arsenal in ulcerative colitis. In acute colitis, close collaboration between the gastroenterologist and the surgeon is pertinent. Absolute indications for surgery include toxic megacolon, perforation, and severe colorectal bleeding. In addition, surgery should always be considered upon deterioration during medical therapy. The recommended operation in acute colitis is colectomy and ileostomy, with the rectum left in situ; reconstruction is not an option in the acute setting. In chronic continuous colitis, often with long-term steroid therapy, healing conditions are poor. A staged procedure is preferred also in these cases. In cases with dysplasia, surgery should be done after verifying the dysplasia since these patients often have little symptoms from their colitis. The proctocolectomy should in these cases include total mesorectal excision. Ileal pouch-anal anastomosis is the standard bowel reconstruction in ulcerative colitis. The various options should, however, always be thoroughly discussed, considering the pros and cons in each individual patient, before a choice is made. Ileorectal anastomosis is a temporary alternative in select cases (e.g. young women not having had children). Reconstructive surgery is best done approximately 6 months after primary surgery. Surgery for ulcerative colitis should be seen as complementary to medical treatment and may prevent complications, improve the patients' quality of life and occasionally be life-saving. Correct assessment and optimised medical treatment are prerequisites for surgery on accurate indications and good surgical results. Therefore, close interactions between gastroenterologists and colorectal surgeons are mandatory for optimal patient outcome.

  • 15.
    Andersson, Roland
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Antibiotics versus surgery for appendicitis2011In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 378, no 9796, p. 1067-1067Article in journal (Other academic)
    Abstract [en]

    n/a

  • 16.
    Andersson, Roland
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Short and Long-Term Mortality After Appendectomy in Sweden 1987 to 2006. Influence of Appendectomy Diagnosis, Sex, Age, Co-morbidity, Surgical Method, Hospital Volume, and Time Period. A National Population-Based Cohort Study2013In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, no 5, p. 974-981Article in journal (Refereed)
    Abstract [en]

    Avoiding mortality is the ultimate goal when managing patients with suspected appendicitis. Previous studies have shown high mortality after negative appendectomy. This national cohort study analyzes short- and long-term mortality after appendectomy in relation to appendectomy diagnosis, age, co-morbidity, surgical method, hospital volume, and time period. less thanbrgreater than less thanbrgreater thanA total of 223,543 appendectomy patients treated from 1987 to 2006 were identified from the Swedish National Patient Register and followed up via the Swedish Cause of Death Register. Analysis of mortality was conducted as Standardized Mortality Ratio (SMR) and by Cox multivariate regression. less thanbrgreater than less thanbrgreater thanNegative appendectomy was followed by a higher mortality in the short term (30-day Standardized Mortality Ratio (SMR30d) 8.95, confidence interval (CI) 6.68-12.61) than after perforated appendicitis (SMR30d 6.39, CI 5.44-7.48), and remained increased for up to 5 years (SMR5yr 1.31, CI 1.16-1.47). Non-perforated appendicitis had a lower than expected long-term mortality (SMR5yr 0.72, CI 0.68-0.76). These differences remained after adjustment for covariates. Laparoscopic appendectomy had similar short-term mortality as open appendectomy but lower than expected long-term morality (SMR5yr 0.70, CI 0.62-0.78). Mortality was decreasing during the study period. Hospital volume had no influence on mortality. less thanbrgreater than less thanbrgreater thanNegative appendectomy is associated with excess short- and long-term mortality that remains after adjustment for known confounders, suggesting an association with underlying undetected morbidity. This motivates an improved preoperative diagnosis to avoid the additional trauma from unnecessary surgical interventions, but further studies are needed to investigate the cause of the increased long-term mortality and if this can be prevented by an improved follow-up of patients with negative appendectomy. Laparoscopic and open appendectomy have similar short-term mortality. The lower long-term mortality after non-perforated appendicitis and laparoscopic appendectomy suggest selection of healthier patients for these interventions. This possibility should be taken into account when comparing mortality after open and laparoscopic appendectomy.

  • 17.
    Andersson, Roland E
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Letter: Resolving appendicitis is common2008In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, no 3, p. 553-553Article in journal (Other academic)
    Abstract [en]

    n/a

  • 18.
    Andersson, Roland
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Hugander, AP
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Ghazi, SH
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Ravn, H
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Offenbartl, SK
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Olaison, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Why does the clinical diagnosis fail in suspected appendicitis?2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 10, p. 796-802Article in journal (Refereed)
    Abstract [en]

    Objective: To identify systematic errors in surgeons' estimations of the importance of diagnostic variables in the decision to explore patients with suspected appendicitis. Design: Prospective case series. Setting: Two emergency departments, Sweden. Patients: 496 patients with suspected appendicitis on admission, of whom 194 had a correct operation for appendicitis and 59 had a negative exploration. Main outcome measures: Predictors of a negative exploration expressed as the odds ratio (OR) for negative exploration. Variables influence on the decision to operate, expressed as the OR for operation, compared with the true diagnostic importance, expressed as the OR for appendicitis. Results: Predictors of negative explorations were high ratings in variables describing pain and tenderness (patient's perceived pain, abdominal tenderness, rebound tenderness, guarding or rectal tenderness), weak or absent inflammatory response, female sex, long duration of symptoms and absence of vomiting, with OR of 1.8-3.0. Pain and tenderness had too strong an influence on the decision to operate whereas the lack of an inflammatory response, no vomiting, and long duration of symptoms were not given enough attention. There was no sex difference in the proportion of patients with non-surgical abdominal pain (NSAP) who were operated on, but NSAP was more common and appendicitis less common among women, leading to a larger proportion of negative appendicectomies among women. Conclusion: Negative explorations in patients with suspected appendicitis are related to systematic errors in the clinical diagnosis with too strong an emphasis on pain and tenderness, and too little attention paid to duration of symptoms and objective signs of inflammation. Rectal tenderness is not a sign of appendicitis. The risk of diagnostic errors is similar in men and women.

  • 19.
    Angelidis, Ioannis K
    et al.
    Stanford University Medical Center.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Connolly, Ian D
    Stanford University Medical Center.
    Lindsey, Derek
    Stanford University Medical Center.
    Pham, Hung M
    Stanford University Medical Center.
    Chang, James
    Stanford University Medical Center.
    Tissue Engineering of Flexor Tendons: The Effect of a Tissue Bioreactor on Adipoderived Stem Cell-Seeded and Fibroblast-Seeded Tendon Constructs2010In: JOURNAL OF HAND SURGERY-AMERICAN VOLUME, ISSN 0363-5023, Vol. 35A, no 9, p. 1466-1472Article in journal (Refereed)
    Abstract [en]

    Purpose Tissue-engineered flexor tendons could eventually be used for reconstruction of large tendon defects. The goal of this project was to examine the effect of a tissue bioreactor on the biomechanical properties of tendon constructs seeded with adipoderived stem cells (ASCs) and fibroblasts (Fs). Methods Rabbit rear paw flexor tendons were acellularized and seeded with ASCs or Fs. A custom bioreactor applied a cyclic mechanical load of 1.25 N at 1 cycle/minute for 5 days onto the tendon constructs. Three additional groups were used as controls: fresh tendons and tendons reseeded with either ASCs or Fs that were not exposed to the bioreactor treatment and were left in stationary incubation for 5 days. We compared the ultimate tensile stress (UTS) and elastic modulus (EM) of bioreactor-treated tendons with the unloaded control tendons and fresh tendons. Comparison across groups was assessed using one-way analysis of variance with the significance level set at pandlt;.05. Pairwise comparison between the samples was determined by using the Tukey test. Results The UTS and EM values of bioreactor-treated tendons that were exposed to cyclic load were significantly higher than those of unloaded control tendons. Acellularized tendon constructs that were reseeded with ASCs and exposed to a cyclic load had a UTS of 66.76 MPa and an EM of 906.68 MPa; their unloaded equivalents had a UTS of 47.90 MPa and an EM of 715.57 MPa. Similar trends were found in the fibroblast-seeded tendon constructs that were exposed to the bioreactor treatment. The bioreactor-treated tendons approached the UTS and EM values of fresh tendons. Histologically, we found that cells reoriented themselves parallel to the direction of strain in response to cyclic strain. Conclusions The application of cyclic strain on seeded tendon constructs that were treated with the bioreactor helped achieve a UTS and an EM comparable with those of fresh tendons. Bioreactor pretreatment and alternative cell lines, such as ASCs and Fs, might therefore contribute to the in vitro production of strong tendon material.

  • 20.
    Anlauf, Martin
    et al.
    Department of Pathology, University of Kiel, Kiel, Germany.
    Enosawa, Tetsuji
    Department of Pathology, University of Kiel, Germany / First Department of Pathology, Showa University, Japan.
    Henopp, Tobias
    Department of Pathology, University of Kiel, Germany.
    Schmitt, Anja
    Department of Pathology, University of Zurich, Switzerland.
    Gimm, Oliver
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Department of General, Visceral, and Vascular Surgery, Halle/Saale, Germany.
    Brauckhoff, Michael
    Department of General, Visceral, and Vascular Surgery, Halle/Saale, Germany.
    Dralle, Henning
    Department of General, Visceral, and Vascular Surgery, Halle/Saale, Germany.
    Musil, Anette
    Department of Pathology, University of Halle, Halle, Germany.
    Hauptmann, Steffen
    Department of Pathology, University of Halle, Halle, Germany.
    Perren, Aurel
    Department of Pathology, Technische Universitat Munchen, Klinikum Rechts der Isar, Germany.
    Klöppel, Günter
    Department of Pathology, University of Kiel, Kiel, Germany.
    Primary lymph node gastrinoma or occult duodenal microgastrinoma with lymph node metastases in a MEN1 patient: the need for a systematic search for the primary tumor.2008In: American Journal of Surgical Pathology, ISSN 0147-5185, E-ISSN 1532-0979, Vol. 32, no 7, p. 1101-5Article in journal (Refereed)
    Abstract [en]

    Gastrinoma tissue has been found frequently in lymph nodes located near the duodenum without a known primary tumor. Therefore, it has been suggested that a primary lymph node gastrinoma exists. We report on a 38-year-old woman suffering from multiple endocrine neoplasia type 1 (MEN1) confirmed by menin gene mutation analysis. MEN1 disease started with primary hyperparathyroidism followed by Cushing disease, the detection of tumors of the pituitary, adrenal cortex, and the pancreas and also an elevated serum gastrin level. An octreotide scan revealed 4 tumors in the upper abdomen. A selective arterial calcium stimulation test located the source of the hypergastrinemia to the area of the gastroduodenal and the superior mesenteric arteries. Total pancreatoduodenectomy was performed and conventional histopathologic examination revealed a well-differentiated cystic neuroendocrine tumor of the pancreas expressing glucagon and accompanied by several microadenomas. In addition, 3 suprapancreatic lymph nodes with gastrin-positive endocrine tissue were found. None of the pancreatic microadenomas expressed gastrin and no duodenal endocrine tumor was found despite careful macroscopic examination. Only after complete embedding of the duodenal and pancreatic tissue in 65 paraffin blocks, 2 microgastrinomas (0.45 and 0.8 mm in diameter) were identified in the duodenum. It is concluded that duodenal gastrinomas that give rise to lymph node metastases may be so tiny that they are easily overlooked in a routine examination and that systematic tissue monitoring is required to identify them.

  • 21.
    Ansaloni, Luca
    et al.
    1st Unit of General Surgery, Ospedali Riuniti di Bergamo, Italy .
    Andersson, Roland E.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Bazzoli, Franco
    Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
    Catena, Fausto
    Unit of General, Emergency and Transplant Surgery, St Orsola-Malpighi University Hospital, Bologna, Italy.
    Cennamo, Vincenzo
    Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
    Di Saverio, Salomone
    Acute Care and Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna, Italy.
    Fuccio, Lorenzo
    Department of Internal Medicine and Gastroenterology, University of Bologna, Italy .
    Jeekel, Hans
    Department of Surgery, ZNA Middelheim, Antwerp, Belgium.
    Leppaniemi, Ari
    Department of Surgery, Helsinki University Hospital, Helnsiki, Finland.
    Moore, Ernest
    Department of Surgery, Denver Health Medical Center, University of Colorado Denver, CO, USA.
    Pinna, Antonio D.
    Unit of General, Emergency and Transplant Surgery, St Orsola-Malpighi University Hospital, Bologna, Italy.
    Pisano, Michele
    1st Unit of General Surgery, Ospedali Riuniti di Bergamo, Italy.
    Repici, Alessandro
    Department of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milano, Italy.
    Sugarbaker, Paul H.
    The Washington Cancer Institute, Washington Hospital Center.
    Tuech, Jean-Jaques
    Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
    Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society2010In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 5, p. 29-Article, review/survey (Refereed)
    Abstract [en]

    Background: Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods: The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results: Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B). Conclusions: Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A.

  • 22.
    Antepohl, Wolfram
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Dahle, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Interleukin-8 is elevated in cerebrospinal fluid following high-voltage electrical injury with late-onset paraplegia suggesting neuronal damage at the microlevel as causative factor2010In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 36, no 3, p. e7-e9Article in journal (Refereed)
    Abstract [en]

    The patient, a 31-year-old male, sustained an electric burn injury (16 kV, AC/DC) while working with electric power lines. He was acutely admitted to a national burn center in Southeast Sweden, where burns equalling 29% of the total body surface area were noted. The burns were located at the front of the abdomen, upper arms bilaterally, and the left hip region, and the lesions were estimated to be mainly of the dermal type, what was believed initially to be caused mainly by an electric flash. There were no obvious entry or exit sites of the electric current. However, myoglobin in plasma was elevated as a sign of muscular degradation, suggesting that at least some current had passed through the tissues. According to the paramedic report there was an episode of a few minutes of unconsciousness immediately after the injury, but the patient was fully awake and alert on admission. There was no concomitant trauma.

  • 23.
    Barral, Anna-Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Källström, Reidar
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Sander, B.
    Rosén, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Thioredoxin, thioredoxin reductase and tumour necrosis factor-alpha expression in melanoma cells: correlation to resistance against cytotoxic attack2000In: Melanoma research, ISSN 0960-8931, Vol. 10, no 4, p. 331-343Article in journal (Refereed)
    Abstract [en]

    Although malignant melanomas are often associated with cytotoxic lymphocyte infiltration, these cells are largely ineffective in inducing tumour cell kill, indicating that the melanoma cells have protective mechanisms. These mechanisms are not fully understood, but cytokines and redox-active antioxidant proteins such as catalase, superoxide dismutase, thioredoxin (Trx) and Trx reductase (TrxR) present in the tumour cells constitute part of this protection. In this study firstly we investigated the constitutive intracellular expression of Trx, TrxR, the cytokines interleukin (IL)-1alpha, IL1beta, IL2, IL4, IL6, IL8, IL10, tumour necrosis factor-alpha (TNFalpha) and interferon-gamma (IFNgamma) in normal melanocytes and ten primary and metastatic malignant melanoma cell lines. Secondly, we analysed whether redox stimulation by Trx alone or in combination with the phorbol ester PMA affected the expression and release of TNFalpha. Thirdly, we explored the possible correlation between Trx/TrxR expression and resistance to exogenous TNFalpha. All the cultured cells showed intracellular overexpression of Trx and TrxR, which was not always the case for melanoma cells in vivo (tissue sections). The predominant intracellular cytokines found were TNFalpha, IL1alpha and IL1beta. In spite of its presence in the Golgi apparatus, none of the cell lines secreted TNFalpha constitutively, and only one melanoma, FM3, released detectable amounts after stimulation. In contrast, U-937 monocyte control cells released high amounts of TNFalpha on identical stimulation. All the melanoma cell lines were relatively resistant against exogenous TNFalpha, and there was a significant correlation (P < 0.01) between intracellular Trx/TrxR expression and TNFalpha resistance (IC50). In conclusion, Trx and TrxR, as well as TNFalpha, IL1alpha and IL1beta, were highly expressed in cultured normal skin melanocytes and malignant melanoma cell lines. In contrast to U-937 monocytic cells, TNFalpha showed a secretory block in these cells, suggesting a cytoprotective and possible autocrine role for TNFalpha. The intracellular expression of Trx and TrxR together with endogenous TNFalpha was correlated with the resistance to TNFalpha-induced cytotoxicity.

  • 24.
    Bauhofer, A.
    et al.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Lorenz, W.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Stinner, B.
    Department of General Surgery, Philipps-University Marburg, Germany.
    Rothmund, M.
    Department of General Surgery, Philipps-University Marburg, Germany.
    Koller, M.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Sitter, H.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Celik, I.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Farndon, J.R.
    Department of Surgery, Bristol Royal Infirmary, Bristol, United Kingdom.
    Fingerhut, A.
    Department of Surgery, Centre Hospitalier Intercommunal, Poissy, France.
    Hay, J.M.
    Department of Surgery, Hopital Louis Mourier, Colombes, France.
    Lefering, R.
    2nd Department of Surgery, University of Cologne, Germany.
    Lorijn, R.
    AMGEN Europe, Lucerne, Switzerland.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Schafer, H.
    Schäfer, H., Institute of Medical Biometrics and Epidemiology, Philipps-University Marburg, Germany.
    Schein, M.
    Department of Surgery, New York Methodist Hospital, Cornell University, United States.
    Solomkin, J.
    Department of Surgery, University of Cincinnati, College of Medicine, United States.
    Troidl, H.
    2nd Department of Surgery, University of Cologne, Germany.
    Volk, H.-D.
    Institute of Medical Immunology, Humboldt-University Berlin, Germany.
    Wittmann, D.H.
    Department of Surgery, Medical College of Wisconsin, Milwaukee, United States.
    Wyatt, J.
    School of Public Policy, University College London, United Kingdom.
    Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). Protocol for a controlled clinical trial developed by consensus of an international study group: Part two2001In: Inflammation Research, ISSN 1023-3830, E-ISSN 1420-908X, Vol. 50, no 4, p. 187-205Article, review/survey (Refereed)
    Abstract [en]

    General design: Presentation of a new type of a study protocol for evaluation of the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and of sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4) This part describes the design of the randomised, placebo controlled, double-blinded, single-centre study performed at an university hospital (n = 40 patients for each group). Objective: The trial design includes the following elements for a prototype protocol: - The study population is restricted to patients with colorectal cancer, including a left sided resection and an increased perioperative risk (ASA 3 and 4). - Patients are allocated by random to the control or treatment group. - The double blinding strategy of the trial is assessed by psychometric indices - An endpoint construct with quality of life (EORTC QLQ-C30) and a recovery index (modified Mc Peek index) are used as primary endpoints Qualitative analysis of clinical relevance of the endpoints is performed by both patients and doctors. - Statistical analysis uses an area under the curve (AUC) model for improvement of quality of life on leaving hospital and two and six months after operation. A confirmatory statistical model with quality of life as the first primary endpoint in the hierarchic test procedure is used. Expectations of patients and surgeons and the negative affect are analysed by social psychological scales. Conclusion: This study design differs from other trials on preoperative prophylaxis and postoperative recovery, and has been developed to try a new concept and avoid previous failures.

  • 25.
    Biancone, Livia
    et al.
    University of Roma Tor Vergata.
    Michetti, Pierre
    CHU Vaudois.
    Travis, Simon
    John Radcliffe Hospital.
    Escher, Johanna C
    Sophia Childrens University Hospital.
    Moser, Gabriele
    University Hospital Vienna.
    Forbes, Alastair
    University College London Hospital.
    Hoffmann, Joerg C
    St Marien Hospital.
    Dignass, Axel
    University of Frankfurt.
    Gionchetti, Paolo
    University of Bologna.
    Jantschek, Guenter
    University Klinikum Schleswig Holstein.
    Kiesslich, Ralf
    Johannes Gutenberg University.
    Kolacek, Sanja
    Childrens Hospital Zagreb.
    Mitchell, Rod
    European Federat Crohns & Ulcerat Colitis Association.
    Panes, Julian
    Barcelona.
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Vucelic, Boris
    University Hospital Rebro.
    Stange, Eduard
    Robert Bosch Krankenhaus.
    European evidence-based Consensus on the management of ulcerative colitis: Special situations2008In: JOURNAL OF CROHNS and COLITIS, ISSN 1873-9946, Vol. 2, no 1, p. 63-92Article in journal (Refereed)
  • 26.
    Björkman, Ida
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Karlsson, Frida
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Lundberg, Ann
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Gastroenterology. Linköping University, Faculty of Health Sciences.
    Hollman Frisman, Gunilla
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Gastroenterology. Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Gender differences when using sedative music during colonoscopy2013In: Gastroenterology Nursing, ISSN 1042-895X, E-ISSN 1538-9766, Vol. 36, no 1, p. 14-20Article in journal (Refereed)
    Abstract [en]

    Colonoscopy is a procedure often experienced as uncomfortable and worrying. Music has been reported to reduce discomfort during colonoscopy; however, no study in a Swedish setting has been found. The purpose of this randomized controlled trial was to analyze the effects of sedative music on patients' experience of anxiety, pain, relaxation, and well-being during colonoscopy. Prior to colonoscopy, adult patients (n = 120), aged 18–80 years, were randomly assigned to either an intervention group (n = 60) who listened to sedative instrumental music with 60–80 beats per minute during the colonoscopy or a control group. After the colonoscopy, both groups completed a questionnaire on anxiety, the State Trait Anxiety Inventory, and an anxiety Visual Analogue Scale. Pain, relaxation, and well-being were also measured with Visual Analogue Scales. Women in the intervention group had a lower level of anxiety during the colonoscopy than those in the control group (p = .007) and well-being was significantly higher in the intervention group, especially among men, than in the controls (p = .006 and p = .025, respectively). Men in the intervention group were more relaxed during the colonoscopy than those in the control group (p = .065). Listening to sedative music decreased anxiety among women and increased well-being among men during colonoscopy.

  • 27.
    Björnsson, Bergthor
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Winbladh, Anders
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Bojmar, Linda
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Trulsson, Lena
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Olsson, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Molecular and Immunological Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Gullstrand, Per
    Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery UHL.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Remote or Conventional Ischemic Preconditioning -Local Liver Metabolism in Rats Studied with Microdialysis2012In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 176, no 1, p. 55-62Article in journal (Refereed)
    Abstract [en]

    Background. Ischemic preconditioning (IPC) of the liver decreases liver injury secondary to ischemia and reperfusion. An attractive alternative to IPC is remote ischemic preconditioning (R-IPC), but these two methods have not previously been compared. Material and Methods. Eighty-seven rats were randomized into four groups: sham operated (n = 15), 1 h segmental ischemia (IRI, n = 24), preceeded by IPC (n = 24), or R-IPC (n = 24) (to the left hindleg). IPC and R-IPC were performed with 10 min ischemia and 10 min of reperfusion. Analyses of liver microdialysate (MD), serum transaminase levels, and liver histology were made. Results. Rats treated with IPC and R-IPC had significantly lower AST, 71.5 (19.6) IU/L respective 96.6 (12.4) at 4 h reperfusion than those subjected to IRI alone, 155 (20.9), P = 0.0004 and P = 0.04 respectively. IPC also had lower ALT levels, 41.6 (11.3) IU/L than had IRI 107.4 (15.5), P = 0.003. The MD glycerol was significantly higher during ischemia in the R-IPC = 759 (84) mu M] and the IRI = 732 (67)] groups than in the IPC 514 (70) group, P = 0.022 and P = 0.046 respectively. The MD glucose after ischemia was lower in the IPC group 7.1 (1.2) than in the IRI group 12.7 (1.6), P = 0.005. Preconditioning to the liver caused an direct increase in lactate, glucose and glycerol in the ischemic segment compared with the control segment an effect not seen in the R-IPC and IRI groups. Conclusions. IPC affects glucose metabolism in the rat liver, observed with MD. IPC reduces liver cell injury during ischemic and reperfusion in rats. R-IPC performed over the same length of time as IPC does not have the same effect as the latter on ALT levels and MD glycerol; this may suggest that R-IPC does not offer the same protection as IPC in this setting of rat liver IRI.

  • 28. Blomquist, L.
    et al.
    Dizdar, N.
    Linköping University, Department of Biomedicine and Surgery.
    Karlsson, M.
    Kågedal, Bertil
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemestry. Linköping University, Faculty of Health Sciences.
    Ossowicki, H.
    Pettersson, A.
    Smeds, Staffan
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Microdialysis of 5-S-cysteinyldopa from interstitial fluid in cutaneous human melanoma transplanted to athymic mice1991In: Melanoma Research, ISSN 0960-8931, Vol. 1, no 1, p. 23-32Article in journal (Refereed)
    Abstract [en]

    Microdialysis was investigated as a tool for the determination of the extracellular concentration of the pigment metabolite 5-S-cysteinyldopa in human melanoma transplanted to athymic mice. Histology of the tumour with the microdialysis probes in situ showed no tissue damage. With probes equipped with polycarbonate membranes (20 kD) extraction (relative recovery) was approximately 50% at pH 4.0 and flow rates of 1 microliter/min, but at pH 7.0 recoveries were markedly lower, particularly from serum. In a first series of human melanomas transplanted to athymic mice low concentrations of 5-S-cysteinyldopa were detected in only two out of ten dialysates and were not detected in the other eight. Utilizing devices constructed for comparison of membrane characteristics in vitro we found about 4-fold higher recoveries with cuprophane and polyamide membranes than with polycarbonate membranes. Therefore newly constructed microdialysis probes (CMA/11) with cuprophane membranes were tested in vitro and gave recoveries of 38-48% from Ringer-Acetate solutions and 22-31% from serum, and the pH effects were low. When these probes were utilized in a second series of melanomas transplanted to athymic mice, 5-S-cysteinyldopa could easily be quantified in 10/10 experiments. A steady-state level of the dialysate 5-S-cysteinyldopa concentration was reached after 45 min.

  • 29.
    Borch, Kurt
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Jönsson, K.-A.
    Zdolzek, J.
    Halldestam, Ingvar
    Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Kullman, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Prevalence of gallstone disease in a Swedish population sample: Relations to occuption, childbirth, health status, life style, medications and blood lipids1998In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 33, no 11, p. 1219-1225Article in journal (Refereed)
    Abstract [en]

    Background: There are only a few Swedish studies on the prevalence of gallstone disease in selected age groups, and none including possible risk factors. Methods: Of a population sample of 1200 individuals (age, 35-85 years), 857 participated in the study. The study subjects were asked to answer a questionnaire about potential risk factors (occupation, childbirth, life style, and so forth), symptoms, and quality of life. Cholecystectomy had previously been done in 115 subjects, leaving 742 for ultrasound examination of the gallbladder. Results: The prevalence of gallstone disease increased with age, and at 75 years or more, 53% of the women and 32% of the men either had gallstones or had previously undergone cholecystectomy (32% and 13%, respectively). When comparing subjects with and without gallstones, there were no differences with regard to any variable, including blood lipid levels. The odds ratio of previous cholecystectomy was increased in subjects with an occupation requiring no specific education and reduced in subjects using wine or spirits every week. The odds ratio of abdominal pain was increased after previous cholecystectomy. Women in this group also experienced a lower quality of life. Conclusions: The age and sex distribution of gallstone disease was in the order of the magnitude seen in other Scandinavian countries. None of the studied variables differed between subjects with and without gallstones. Subjects previously operated on with cholecystectomy did worse with regard to symptoms and quality of life.

  • 30.
    Borch, Kurt
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Skarsgard, J
    Franzén, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology . Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Mårdh, Sven
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Cell Biology.
    Rehfeld, JF
    Benign gastric polyps - Morphological and functional origin2003In: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568, Vol. 48, no 7, p. 1292-1297Article in journal (Refereed)
    Abstract [en]

    The most common types of benign gastric polyps are fundic gland polyps, hyperplastic polyps, and adenomas. The aim of this study was to determine on which morphological and functional background benign gastric polyps develop. The study includes 85 consecutive patients with gastric polyps and sex and age-matched controls without polyps selected at random from a general population sample. The type of polyp was hyperplastic in 52 (61%), fundic gland in 18 (21%), adenoma in 10 (12%), carcinoid in 2 (2%), hamartoma in 2 ( 2%), and inflammatory fibroid in 1 (1%) of the cases. Routine biopsies from the gastric corpus and antrum were examined for presence of gastritis and H. pylori. Blood samples were analyzed for H. pylori antibodies, H+, K+-ATPase antibodies, gastrin, and pepsinogen I. Patients with hyperplastic polyps had increased P-gastrin concentrations and S-H+, K+-ATPase antibody titers and decreased S-pepsinogen I concentrations with a high prevalence of atrophic corpus gastritis or pangastritis. A similar pattern was observed among patients with adenomas, whereas patients with fundic gland polyps had normal serology and a lower prevalence of gastritis and H. pylori infection than controls. In conclusion, hyperplastic polyps and adenomas are generally associated with atrophic gastritis. Patients with fundic gland polyps seem to have a sounder mucosa than controls. Whereas the risk of malignant gastric neoplasia is increased in patients with hyperplastic polyps or adenomas, this does not seem to be the case in patients with fundic gland polyps.

  • 31.
    Brauckhoff, Michael
    et al.
    University Halle Wittenberg.
    Machens, Andreas
    University Halle Wittenberg.
    Hess, Soeren
    University Halle Wittenberg.
    Lorenz, Kerstin
    University Halle Wittenberg.
    Gimm, Oliver
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Surgery UHL. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Brauckhoff, Katrin
    University Halle Wittenberg.
    Sekulla, Carsten
    University Halle Wittenberg.
    Dralle, Henning
    University Halle Wittenberg.
    Premonitory symptoms preceding metastatic medullary thyroid cancer in MEN 2B: An exploratory analysis2008In: SURGERY, ISSN 0039-6060, Vol. 144, no 6, p. 1044-1050Article in journal (Refereed)
    Abstract [en]

    Background. More than 90% of M918T carriers with multiple endocrine neoplasia type 2B (MEN 2B) harbor de novo mutations in the REarranged during Transfection (RET) protooncogene. DNA-based screening for RET germline mutations is rarely useful for early diagnosis, which thus is contingent on the clinical ascertainment of MEN 2B-specifitc symptoms as soon as they emerge. Little information exists about the presence of these symptoms in infancy.

    Methods. Detailed information was gathered regarding the development of MEN 2B-associated symptoms from the parents of 25 M918T RET carriers and 50 age- and sex-matched, controls with the use of a disease-specific questionnaire.

    Results. Until the end of the study, at a median age of 16 2 (range, 0.5-34.9 years), all 25 M918T RET carriers had developed medullary thyroid cancer. By that time, 96%, 91%, 71%, 75%, and 28% Of carriers displayed oral manifestations, ocular abnormalities, intestinal symptoms, musculoskeletal malformations, and pheochromocytoma, respectively. During the first year of life, fewer than 20% of carriers were found to express the typical MEN 2B phenotype, whereas 86% and 61% of these children, but none of the controls, were noted for their inability to cry tears and for constipation.

    Conclusion. Because the classic MEW 2B phenotype is rare during the first year of life, more emphasis should be placed on the more subtle features of the syndrome. Additional studies are needed to validate the usefulness of the symptoms "inability to cry" and "constipation" for earlier diagnosis of MEAT 2B.

  • 32.
    Bringman, S.
    et al.
    Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
    Ek, A.
    Ek, Å., Department of Surgery, Karlskoga Hospital, Karlskoga, Sweden.
    Haglind, E.
    Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Heikkinen, T.
    Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kylberg, F.
    Department of Surgery, Karlskoga Hospital, Karlskoga, Sweden.
    Ramel, S.
    Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
    Wallon, Conny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Anderberg, B.
    Department of Surgery, Karolinska Institute, Huddinge University Hospital, S-141 86 Stockholm, Sweden.
    Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study2001In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 15, no 3, p. 266-270Article in journal (Refereed)
    Abstract [en]

    Background: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation. Methods: A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon. Results: In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8). Conclusion: The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.

  • 33.
    Bringman, S
    et al.
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Ek, Anna-Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Haglind, E
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Heikkinen, TJ
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kylberg, F
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Ramel, S
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Wallon, Conny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Anderberg, B
    Huddinge Univ Hosp, Karolinska Inst, Dept Surg, S-14186 Huddinge, Sweden Karlskoga Hosp, Dept Surg, Karlskrona, Sweden Sahlgrens Univ Hosp, Dept Surg, S-41345 Gothenburg, Sweden Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study2001In: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, ISSN 1051-7200, E-ISSN 2331-2254, Vol. 11, no 5, p. 322-326Article in journal (Refereed)
    Abstract [en]

    Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to gain the initial working space in totally extraperitoneal endoscopic (TEP) hernioplasty, but this increases its cost. Forty-four men with bilateral, primary or recurrent inguinal hernias were randomized to undergo TEP with or without dissection balloon, There were two conversions to transabdominal preperitoneal hernioplasty, or open herniorrhaphy, in the group with balloon and four in the group without balloon. There was no difference in the postoperative morbidity or operation time between the two groups, and there were no major complications in either group. The recurrence rate was 4.3% in the group with the balloon and 7.1% in the group without the balloon. There were no statistically significant differences between the groups, Although our study population is too small to detect small differences between the groups, it seems that the use of a dissection balloon is not beneficial in a bilateral TEP.

  • 34.
    Bäck, Karolina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Wahlström, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Gasslander, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Arnqvist, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Endocrinology and Gastroenterology UHL.
    Differential expression of insulin and IGF-I receptors in human tissuesManuscript (preprint) (Other academic)
    Abstract [en]

    Insulin and IGF-I are related peptides with similar structure. They both signal via their cognate receptors, the insulin receptor (IR) and the insulin-like growth factor (IGF)-I receptor (IGF-IR).

    Our aim was to simultaneously measure the amount of insulin and IGF-I receptors in different human tissues and also the IR-A and IR-B isoforms to study tissue specific expression

    Renal artery intima-media, myometrium, skeletal muscle or liver tissue samples were obtained from patients undergoing surgery. IR, IGF-IR, IR-A and IR-B gene expression was investigated with real-time RT-PCR and expression of IR and IGF-IR protein was examined by Western blot and ELISA.

    Renal arteries and myometrium expressed the IGF-IR gene to a higher extent than the IR gene, liver expressed more IR than IGF-IR and skeletal muscle expressed almost equal amounts of both receptors. IR-B was the most abundant isoform in all tissues. With Western blot we could detect IR in skeletal muscle, liver and myometrium. With ELISA we found that, normalized to total protein, the highest levels of IGF-IR were found in renal arteries and myometrium and low levels in skeletal muscle and liver. The highest levels of IR were found in liver.

    In conclusion there is a large variation in the quantity and ratio of insulin receptors and IGF-I receptors expressed in different tissues, the extremes being arterial intima media with predominantly IGF-I receptors and liver with predominantly insulin receptors. This suggests that differential expression of insulin and IGF-I receptors is a key mechanism in regulation of growth and metabolism.

  • 35.
    Cederbrant, Karin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Hultman, Per
    Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan A.
    Department of Dermatology, Huddinge Hospital, Huddinge.
    Tibbling, Lita
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    In vitro Lymphocyte Proliferation as Compared to Patch Test Using Gold, Palladium and Nickel1997In: International Archives of Allergy and Immunology, ISSN 1018-2438, E-ISSN 1423-0097, Vol. 112, no 3, p. 212-217Article in journal (Refereed)
    Abstract [en]

    Background: A conventional lymphocyte transformation test (LTT) was compared to the commercially available MELISA® (memory lymphocyte immuno-stimulation assay), a lymphoproliferative assay that has been suggested to be a valuable instrument for the diagnosis of metal allergy. Sensitivity and specificity of the two assays were calculated using a patch test as a reference method.

    Methods: 34 patients were patch-tested for gold sodium thiosulfate, palladium chloride and nickel sulfate, and the lymphocyte proliferation to these metals was tested in vitro using mononuclear cells from peripheral blood.

    Results: No significant differences regarding sensitivity and specificity were found between MELISA and conventional LTT. The sensitivity varied between 55 and 95% and the specificity between 17 and 79%.

    Conclusions: The low specificity of the two in vitro assays suggests that they are not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.

  • 36.
    Chassaing, Benoit
    et al.
    University Auvergne.
    Rolhion, Nathalie
    University Auvergne.
    de Vallee, Amelie
    University Auvergne.
    Salim, Sa´ad
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Prorok-Hamon, Maelle
    University of Liverpool.
    Neut, Christel
    University Lille 2.
    Campbell, Barry J
    University of Liverpool.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Hugot, Jean-Pierre
    University of Paris Diderot.
    Colombel, Jean-Frederic
    University Lille 2.
    Darfeuille-Michaud, Arlette
    University Auvergne.
    Crohn disease-associated adherent-invasive E. coli bacteria target mouse and human Peyers patches via long polar fimbriae2011In: JOURNAL OF CLINICAL INVESTIGATION, ISSN 0021-9738, Vol. 121, no 3, p. 966-975Article in journal (Refereed)
    Abstract [en]

    Crohn disease (CD) is a multifactorial disease in which an abnormal immune response in the gastrointestinal (GI) tract leads to chronic inflammation. The small intestine, particularly the ileum, of patients with CD is colonized by adherent-invasive E. coil (AIEC) a pathogenic group of E. coil able to adhere to and invade intestinal epithelial cells. As the earliest inflammatory lesions are microscopic erosions of the epithelium lining the Peyers patches (PPs), we investigated the ability of AIEC bacteria to interact with PPs and the virulence factors involved. We found that AIEC bacteria could interact with mouse and human PPs via long polar fimbriae (LPF). An LPF-negative AIEC mutant was highly impaired in its ability to interact with mouse and human PPs and to translocate across monolayers of M cells, specialized epithelial cells at the surface of PPs. The prevalence of AIEC strains harboring the lpf operon was markedly higher in CD patients compared with controls. In addition, increased numbers of AIEC, but not LPF-deficient AIEC, bacteria were found interacting with PPs from Nod2(-/-) mice compared with WT mice. In conclusion, we have identified LPF as a key factor for AIEC to target PPs. This could be the missing link between AIEC colonization and the presence of early lesions in the PPs of CD patients.

  • 37.
    Chatzikokkinou, P.
    et al.
    Department of Dermatology and Venereology, University of Trieste, Ospedale Maggiore, Via Stuparich 1, I-34100 Trieste, Italy.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Angelidis, I.K.
    Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Palo Alto, CA 94305, United States.
    Papa, G.
    University Department of Plastic and Reconstructive Surgery, University of Trieste, Cattinara Hospital Trieste, Strada di Fiume 447, I-34100 Trieste, Italy.
    Trevisan, G.
    Department of Dermatology and Venereology, University of Trieste, Ospedale Maggiore, Via Stuparich 1, I-34100 Trieste, Italy.
    Spontaneous endometriosis in an umbilical skin lesion2009In: Acta Dermatovenerologica Alpina, Pannonica et Adriatica, ISSN 1318-4458, Vol. 18, no 3, p. 126-130Article in journal (Refereed)
    Abstract [en]

    Cutaneous endometriosis of the umbilicus is an unusual condition with unclear pathogenetic mechanisms that might be mistaken for a malignant condition. A 46-year-old woman presented with a cutaneous black mass in the umbilicus. The lesion was removed surgically and histological analyses revealed that it consisted of endometrial tissue. There was no recurrence at 18-month follow-up. Endometriosis of the umbilicus is a rare condition and the pathogenesis is not completely elucidated. According to one theory, intraperitoneal endometrial tissue is translocated during endoscopic surgery or other surgical procedures that involve the umbilicus. However, in this case there was no history of abdominal wall surgery. We conclude that endometriosis is important to consider in cases of unclear skin lesions of the umbilicus, even in cases with no previous abdominal surgery. Moreover, umbilical endometriosis of the skin can have different appearances that resemble malignant tumors, and radical surgery with histology is therefore indicated.

  • 38.
    Cheetham, MJ
    et al.
    St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Mortensen, NJM
    St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kamm, MA
    St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Phillips, RKS
    St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Persistent pain and faecal urgency after stapled haemorrhoidectomy2000In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 356, no 9231, p. 730-733Article in journal (Refereed)
    Abstract [en]

    Introduction Haemorrhoidectomy usually cures haemorrhoids. Day surgery is feasible, and is associated with high patients' satisfaction and few complications, but patients take an average of 2 weeks off work after surgery. Stapled haemorrhoidectomy has the potential to decrease postoperative pain and time off work. However, data on longterm efficacy and function are lacking. Methods 22 patients underwent stapled haemorrhoidectomy: seven in a pilot study, and 15 in a randomised controlled trial to compare the new stapled operation with diathermy haemorrhoidectomy in a day-case setting. All operations were done by one consultant surgeon. Results 16 patients were followed up for longer than 6 months, five of whom (31% [95% CI 8.5-54.0%]) developed symptoms of pain and faecal urgency which persisted for up to 15 months postoperatively. The randomised trial was suspended, and patients were investigated with endoanal ultrasonography, anorectal physiology, and examination under anaesthetic. All five affected patients were reviewed by two independent surgeons experienced in the stapled operation. In one patient, a fibroepithelial polyp was found adjacent to an anodermal ulcer, in the other patients, no abnormality was found. Four of the five affected patients had some muscle incorporated into the doughnut, compared with only one of 11 of the unaffected patients (p=0.012, Fisher's exact test). No other significant differences in operative variables were identified between patients with and without symptoms, Interpretation Persistent severe pain and faecal urgency has been found in a disturbingly high proportion of patients after stapled haemorrhoidectomy. The mechanism behind this phenomenon is unclear, although muscle incorporation in the doughnut may have a role, Other groups who have studied stapled haemorrhoidectomy urgently need to audit their long-term results to assess the frequency of this problem.

  • 39.
    Christerson, Utrika
    et al.
    University of Kalmar.
    Keita, Åsa
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Gustafson-Svard, Christina
    University of Kalmar.
    Increased expression of protease-activated receptor-2 in mucosal mast cells in Crohns ileitis2009In: JOURNAL OF CROHNS and COLITIS, ISSN 1873-9946, Vol. 3, no 2, p. 100-108Article in journal (Refereed)
    Abstract [en]

    Background and aims: Activation of protease-activated receptor-2 (PAR-2) may stimulate various events of importance in inflammatory processes, including release of inflammatory mast cell mediators. PAR-2 is frequently up-regulated during inflammatory conditions, but it is not known if the expression is altered in Crohns disease. The aim of the present study was to investigate the ileal mucosal PAR-2 expression in Crohns ileitis, with particular emphasis on the expression in ileal mucosal mast cells. Methods: Surgical specimens from the distal ileum were collected from patients with Crohns ileitis and patients with colonic cancer as controls. The overall expression of PAR-2 was investigated by Western blot, and the presence of PAR-2 expressing mucosal mast cells by immunohistochemistry and cell counting. The effect of tumor necrosis factor-alpha (TNF-alpha) on the PAR-2 expression in a human mast cell tine (HMC-1) was investigated by RT-PCR and immunocytochemistry. Results: In Crohns specimens, the fraction of PAR-2-expressing mucosal. mast cells was increased about 2.5 times (P andlt; 0.001; n = 14) compared with specimens from control patients (n = 6). No difference was found between inflamed (n = 6) and uninflamed Crohns specimens (P andgt; 0.05; n = 8). Exposure to TNF-alpha for 48 h up-regulated PAR-2 mRNA and protein expression in the HMC-1 cell line. Conclusion: PAR-2 is up-regulated on ileal mucosal mast cells in Crohns ileitis, possibly due to the action of inflammatory cytokines, such as TNF-alpha. This may contribute to perpetuating the inflammatory process in the intestinal mucosa in Crohns ileitis.

  • 40.
    Christerson, Utrika
    et al.
    Kalmar University .
    Keita, Åsa
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Gustafson-Svard, Christina
    Kalmar University .
    Potential role of protease-activated receptor-2-stimulated activation of cytosolic phospholipase A(2) in intestinal myofibroblast proliferation: Implications for stricture formation in Crohns disease2009In: JOURNAL OF CROHNS and COLITIS, ISSN 1873-9946, Vol. 3, no 1, p. 15-24Article in journal (Refereed)
    Abstract [en]

    Background and aims: Myofibroblast hyperplasia contributes to muscularis mucosae thickening and stricture formation in Crohns disease (CD). Protease-activated receptor-2 (PAR-2) and cytosolic phospholipase A(2) (cPLA(2)) are known regulators of cell growth, but their significance in intestinal myofibroblast proliferation remain to be elucidated. The principle aims of the present study were to investigate if PAR-2 is expressed in the expanded muscularis mucosa in ileal CD specimens, if inflammatory cytokines may stimulate PAR-2 expression in intestinal myofibroblasts, and if PAR-2 and cPLA(2). may regulate intestinal myofibroblast growth.

    Methods: Immunohistochemistry was used for detection of PAR-2 in ileal CD specimens. Studies on PAR-2 expression, PLA(2) activation and cell growth were performed in a human intestinal myofibroblast cell tine, CCD-18Co. PAR-2 expression was investigated by RT-PCR and immunocytochemistry. PLA(2) activity was analyzed by quantification of released C-14-arachidonic acid (C-14-AA). Cell growth was examined by H-3-thymidine incorporation and cell counting.

    Results: The thickened muscularis mucosae of the CD specimens showed strong PAR-2 expression. In cultured myofibroblasts, tumor necrosis factor-alpha (TNF-alpha) up-regulated PAR-2 mRNA and protein, and potentiated PAR-2-stimutated C-14-AA release by two known PAR-2 activators, trypsin and SLIGRL-NH2. The release of C-14-AA was dependent on cPLA(2). Trypsin stimulated the proliferation of serum-starved cells, and inhibition of cPLA(2) reduced normal cell growth and abolished the growth-promoting effect of trypsin.

    Conclusions: The results suggest that PAR-2-mediated cPLA(2) activation might be of importance in intestinal myofibroblast proliferation. The results also point to the possibility that PAR-2 upregulation by inflammatory cytokines, like TNF-alpha, may modulate this effect.

  • 41.
    Cohn-Cedermark, G
    et al.
    Karolinska Hosp, Radiumhemmet, Dept Oncol Pathol, S-17176 Stockholm, Sweden Karolinska Hosp, Ctr Oncol, Dept Oncol Pathol, S-10401 Stockholm, Sweden Univ Umea Hosp, Dept Radiat Sci, S-90185 Umea, Sweden Orebro Reg Hosp, Dept Oncol, Orebro, Sweden Univ Lund Hosp, Dept Surg, S-22185 Lund, Sweden Helsingborg Hosp, Dept Surg, Helsingborg, Sweden Linkoping Univ Hosp, Dept Hand Surg Plast Surg & Burns, S-58185 Linkoping, Sweden Ryhov Cty Hosp, Dept Oncol, Jonkoping, Sweden.
    Rutqvist, LE
    Karolinska Hosp, Radiumhemmet, Dept Oncol Pathol, S-17176 Stockholm, Sweden Karolinska Hosp, Ctr Oncol, Dept Oncol Pathol, S-10401 Stockholm, Sweden Univ Umea Hosp, Dept Radiat Sci, S-90185 Umea, Sweden Orebro Reg Hosp, Dept Oncol, Orebro, Sweden Univ Lund Hosp, Dept Surg, S-22185 Lund, Sweden Helsingborg Hosp, Dept Surg, Helsingborg, Sweden Linkoping Univ Hosp, Dept Hand Surg Plast Surg & Burns, S-58185 Linkoping, Sweden Ryhov Cty Hosp, Dept Oncol, Jonkoping, Sweden.
    Andersson, R
    Breivald, M
    Karolinska Hosp, Radiumhemmet, Dept Oncol Pathol, S-17176 Stockholm, Sweden Karolinska Hosp, Ctr Oncol, Dept Oncol Pathol, S-10401 Stockholm, Sweden Univ Umea Hosp, Dept Radiat Sci, S-90185 Umea, Sweden Orebro Reg Hosp, Dept Oncol, Orebro, Sweden Univ Lund Hosp, Dept Surg, S-22185 Lund, Sweden Helsingborg Hosp, Dept Surg, Helsingborg, Sweden Linkoping Univ Hosp, Dept Hand Surg Plast Surg & Burns, S-58185 Linkoping, Sweden Ryhov Cty Hosp, Dept Oncol, Jonkoping, Sweden.
    Ingvar, C
    Karolinska Hosp, Radiumhemmet, Dept Oncol Pathol, S-17176 Stockholm, Sweden Karolinska Hosp, Ctr Oncol, Dept Oncol Pathol, S-10401 Stockholm, Sweden Univ Umea Hosp, Dept Radiat Sci, S-90185 Umea, Sweden Orebro Reg Hosp, Dept Oncol, Orebro, Sweden Univ Lund Hosp, Dept Surg, S-22185 Lund, Sweden Helsingborg Hosp, Dept Surg, Helsingborg, Sweden Linkoping Univ Hosp, Dept Hand Surg Plast Surg & Burns, S-58185 Linkoping, Sweden Ryhov Cty Hosp, Dept Oncol, Jonkoping, Sweden.
    Johansson, H
    Jonsson, PE
    Krysander, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Lindholm, C
    Ringborg, U
    Karolinska Hosp, Radiumhemmet, Dept Oncol Pathol, S-17176 Stockholm, Sweden Karolinska Hosp, Ctr Oncol, Dept Oncol Pathol, S-10401 Stockholm, Sweden Univ Umea Hosp, Dept Radiat Sci, S-90185 Umea, Sweden Orebro Reg Hosp, Dept Oncol, Orebro, Sweden Univ Lund Hosp, Dept Surg, S-22185 Lund, Sweden Helsingborg Hosp, Dept Surg, Helsingborg, Sweden Linkoping Univ Hosp, Dept Hand Surg Plast Surg & Burns, S-58185 Linkoping, Sweden Ryhov Cty Hosp, Dept Oncol, Jonkoping, Sweden.
    Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8-2.0 mm2000In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 89, no 7, p. 1495-1501Article in journal (Refereed)
    Abstract [en]

    BACKGROUND. Large, prospective, randomized trials with long term follow-up are required to obtain an unbiased evaluation of the significance of resection margins in patients with cutaneous melanoma. METHODS, The Swedish Melanoma Study Group performed a prospective, randomized, multicenter study of patients with primary melanoma located on trunk or extremities and with a tumor thickness > 0.8 mm and less than or equal to 2 mm. Patients were allocated randomly to a 2-cm excision margin or a 5-cm excision margin. In total, 989 patients were recruited during the period 1982-1991. The median follow-up, was 11 years (range, 7-17 years) for estimation of survival and 8 years (range, 0-17 years) for evaluation of recurrent disease. RESULTS. The crude rate of local recurrence, defined as a recurrence in the scar or transplant, was < 1% (8 of 989 patients). Twenty percent of the patients (194 of 989 patients) experienced any disease recurrence, and 15% (146 of 989 patients) died of melanoma. There were no statistically significant differences between the two treatment arms. In a multivariate Cox analysis with patients allocated to wide excision as the reference group, the estimated relative hazards for overall survival and recurrence free survival among those allocated to a 2-cm resection margin were 0.96 (95% confidence interval, 0.75-1.24), and 1.02 (95% confidence interval, 0.80-1.30), respectively. CONCLUSIONS. In this long term follow-up study, local recurrences were found to be rare among patients with tumors > 0.8 mm thick and less than or equal to 2.0 mm thick. Mo difference in recurrence rate or survival between the two treatment groups was found. Patients in this category can be treated with a resection margin of 2 cm as safely as with a resection margin of 5 cm. Cancer 2000,89:1495-501. (C) 2000 American Cancer Society.

  • 42.
    Crafoord, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hallböök, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery UHL.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Pelvic organ prolapse and anorectal manometry: a prospective study2012In: Urogynaecologia International Journal, ISSN 1121-3086, E-ISSN 2038-8314, Vol. 26, no 1, p. 12-16Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate associations between anal sphincter pressure and stage of prolapse and bowel and prolapse symptoms among women undergoing prolapse surgery and to determine whether anal sphincter pressure could predict symptomatic and anatomical outcomes of prolapse surgery. Fortytwo women with pelvic organ prolapse (POP) stage 2-3 were included in this prospective longitudinal study. Pre- and postoperative evaluation by means of a symptom questionnaire, clinical examination and anorectal manometry. The vaginal prolapse surgery included at the very least posterior colporrhaphy. Analysis of variance and covariance and logistic regression models were used for statistical analyses. The anal sphincter pressure at rest and squeeze was significantly lower in women with the symptom vaginal protrusion than in the women without the symptom. No associations were found between anal sphincter pressure and the extent or degree of prolapse or subjective and anatomical outcomes of POP surgery. The prolapse symptom vaginal protrusion is associated with a low anal sphincter pressure but the anal sphincter pressure does not seem to predict the outcome of POP surgery, neither regarding symptoms nor anatomy.

  • 43.
    Crafoord, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    The predictive value of anorectal manometry on subjective and objective findings and outcome of pelvic organ prolapse surgery: A prospective studyManuscript (Other academic)
    Abstract [en]

    The objectives were to evaluate associations between anal sphincter pressure and a) stage of prolapse and b) bowel and prolapse symptoms; and to determine the predictive value of the manometric measurements on symptomatic and anatomical outcomes of prolapse surgery-. Forty two women with prolapse stage 2-3 participated in the study. Pre- and postoperative evaluation of the patients was done by using a symptom questionnaire and doing clinical examinations and anorectal manometry. The vaginal prolapse surgery always included at the very least posterior colporrhaphy. Median follow-up time was 6.4 years. The symptoms vaginal protrusion and feeling of incomplete bowel emptying were associated with levels of anal sphincter pressure. Anorectal manometric measurements could not predict the subjective and anatomical outcomes of POP surgery. Symptoms of prolapse and bowel emptying “sensations” were significantly reduced. The cure rates of rectocele and apical descensus were high, whereas the cure rate was low for cystocele.

  • 44.
    Dahlqvist Leinhard, Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Dahlström, Nils
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Brismar, T
    Sandström, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kihlberg, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Smedby, Örjan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Medical Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Lundberg, Peter
    Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medicine and Health Sciences, Radiation Physics . Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.
    A liver function test based on measurement of liver-specific contrast agent uptake2008In: Proceedings 16th Scientific meeting, ISMRM,2008, 2008Conference paper (Other academic)
    Abstract [en]

      

  • 45.
    Dahlqvist Leinhard, Olof
    et al.
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Dahlström, Nils
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Kihlberg, Johan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Sandström, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery.
    Brismar, Torkel
    Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
    Smedby, Örjan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Lundberg, Peter
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study2012In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 22, no 3, p. 642-653Article in journal (Refereed)
    Abstract [en]

    Objectives   To develop and evaluate a procedure for quantifying the hepatocyte-specific uptake of Gd-BOPTA and Gd-EOB-DTPA using dynamic contrast-enhanced (DCE) MRI. Methods   Ten healthy volunteers were prospectively recruited and 21 patients with suspected hepatobiliary disease were retrospectively evaluated. All subjects were examined with DCE-MRI using 0.025 mmol/kg of Gd-EOB-DTPA. The healthy volunteers underwent an additional examination using 0.05 mmol/kg of Gd-BOPTA. The signal intensities (SI) of liver and spleen parenchyma were obtained from unenhanced and enhanced acquisitions. Using pharmacokinetic models of the liver and spleen, and an SI rescaling procedure, a hepatic uptake rate, K Hep, estimate was derived. The K Hep values for Gd-EOB-DTPA were then studied in relation to those for Gd-BOPTA and to a clinical classification of the patient’s hepatobiliary dysfunction. Results   K Hep estimated using Gd-EOB-DTPA showed a significant Pearson correlation with K Hep estimated using Gd-BOPTA (r = 0.64; P < 0.05) in healthy subjects. Patients with impaired hepatobiliary function had significantly lower K Hep than patients with normal hepatobiliary function (K Hep = 0.09 ± 0.05 min-1 versus K Hep = 0.24 ± 0.10 min−1; P < 0.01). Conclusions   A new procedure for quantifying the hepatocyte-specific uptake of T 1-enhancing contrast agent was demonstrated and used to show that impaired hepatobiliary function severely influences the hepatic uptake of Gd-EOB-DTPA. Key Points   • The liver uptake of contrast agents may be measured with standard clinical MRI.Calculation of liver contrast agent uptake is improved by considering splenic uptake.Liver function affects the uptake of the liver-specific contrast agent Gd-EOB-DTPA.Hepatic uptake of two contrast agents (Gd-EOB-DTPA, Gd-BOPTA) is correlated in healthy individuals.This method can be useful for determining liver function, e.g. before hepatic surgery

  • 46.
    Dahlström, Nils
    et al.
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Dahlqvist Leinhard, Olof
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kihlberg, Johan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Brismar, Torkel
    Karolinska Huddinge.
    Lundberg, Peter
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Smedby, Örjan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Quantified hepatobiliary Gd-EOB-DTPA uptake rate reflects hepatobiliary function in patients2011Conference paper (Refereed)
  • 47.
    Danielsson, Pär
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Fredriksson, Camilla
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Huss, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    A Novel Concept for Treating Large Necrotizing Fasciitis Wounds With Bilayer Dermal Matrix, Split-thickness Skin Grafts, and Negative Pressure Wound Therapy2009In: Wounds (King of Prussia, Pa.), ISSN 1044-7946, E-ISSN 1943-2704, Vol. 21, no 8, p. 215-220Article in journal (Refereed)
    Abstract [en]

    Treatment of necrotizing fasciitis (NF) includes radical surgical debridement often resulting in large wounds that need to be closed with methods including split-thickness skin grafts (STSG), local flaps, or guided tissue regeneration procedures. In this case report, a 45 year-old Caucasian male was surgically treated for a benign left groin hernia, developed NF, and was transferred to the authors burn unit. The wound was treated initially with wide debridement and with a brief delay before finally closing the wound. A collagen matrix such as Integra (R) Dermal Regeneration Template (Integra LifeSciences, Plainsboro, NJ) in combination with STSG and negative pressure wound treatment, can provide fast recovery resulting in pliable, functional skin.

  • 48.
    Derwinger, Kristoffer
    et al.
    Sahlgrens University Hospital.
    Kodeda, Karl
    Sahlgrens University Hospital.
    Gerjy, Roger
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Age Aspects of Demography, Pathology and Survival Assessment in Colorectal Cancer2010In: ANTICANCER RESEARCH, ISSN 0250-7005, Vol. 30, no 12, p. 5227-5231Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to assess how age is related to differences in stage, tumour differentiation and treatment in colorectal cancer. Patients and Methods: A retrospective study in a consecutive series of colorectal cancer patients (n=2220) where age was related to demography, stage, tumour characteristics, treatment and outcome (OS/CSS) both as a continuous variable and grouped by high/low 10th percentiles, as young/old groups, with a third median reference group. Results: Young patients had more advanced cancer stages (p=0.012), higher N-status (p=0.011) and more frequent T4/G4 tumours. Old patients had higher postoperative mortality and were less likely to receive chemotherapy. The proportion of cancer-related deaths was stage-dependent and decreased with age. Conclusion: Cancer stage, tumour characteristics, treatment and outcome can vary with age in colorectal cancer. The increasing proportion of non-cancer deaths at a higher age can affect the use of overall survival as an outcome parameter, which may be of importance in evaluating clinical and translational research.

  • 49.
    Dignass, A
    et al.
    Markus Krankenhaus.
    Van Assche, G
    University Hospital Gasthuisberg.
    O Lindsay, J
    Barts and London NHS Trust.
    Lemann, M
    Hospital St Louis, Paris, France .
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    F Colombel, J
    Hospital Huriez, Lille, France .
    Danese, S
    Ist Clin Humanitas, Milan, Italy .
    DHoore, A
    University Hospital Gasthuisberg.
    Gassull, M
    Germans Trias and Pujol Fdn, Badalona, Spain .
    Gomollon, F
    Hospital Clin University, Zaragoza, Spain .
    W Hommes, D
    Leiden University.
    Michetti, P
    Gastroenterol La Source Beaulieu, Lausanne, Switzerland .
    OMorain, C
    Adelaide and Meath Hospital, Dublin, Ireland .
    Oresland, T
    Akershus University Hospital.
    Windsor, A
    University Coll London Hospital.
    F Stange, E
    Robert Bosch Krankenhaus.
    P L Travis, S
    John Radcliffe Hospital.
    The second European evidence-based Consensus on the diagnosis and management of Crohns disease: Current management2010In: JOURNAL OF CROHNS and COLITIS, ISSN 1873-9946, Vol. 4, no 1, p. 28-62Article in journal (Refereed)
    Abstract [en]

    n/a

  • 50.
    Dizdar (Dizdar Segrell), Nil
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences.
    Kågedal, Bertil
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Smeds, Staffan
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Årstrand, Kerstin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    A high-sensitivity fluorometric high-performance liquid chromatographic method for determination of glutathione and other thiols in cultured melanoma cells, microdialysis samples from melanoma tissue, and blood plasma.1991In: Melanoma Research, ISSN 0960-8931, Vol. 1, no 1, p. 33-42Article in journal (Refereed)
    Abstract [en]

    A high-performance liquid chromatographic method with fluorometric detection is described which is suitable for determination of glutathione in small samples. Reduced glutathione (GSH) and total glutathione obtained as GSH after reduction with glutathione reductase is derivatized with N-(7-dimethylamino-4-methyl-3-coumarinyl) maleimide (DACM) and subjected to chromatography. The detection limit for the GSH-DACM derivative was 5-10 fmol/injection, and analytical recovery was quantitative. The method is suitable for determination of both reduced and total glutathione in samples from microdialysis of melanoma tumours, and cysteine can be quantified in the same chromatogram. Application is shown also for glutathione determinations in cultured melanoma cells, melanoma homogenates and plasma.

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