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  • 1.
    Alkaissi, Aidah
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Evertsson, Karin
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Johnsson, Vivi-Ann
    Department of Anaesthesiology and Intensive Care, Västervik Hospital .
    Ofenbartl, Lilli
    Department of Anaesthesiology and Intensive Care, Eksjö Hospital, Linköping, Sweden.
    Kalman, Sigga
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women2002Inngår i: Canadian Journal of Anesthesia, ISSN 0832-610X, Vol. 49, nr 10, s. 1034-1039Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To investigate the effect of sensory stimulation of the P6 point on postoperative nausea and vomiting (PONV) after gynecological surgery in the everyday clinical setting (effectiveness study).

    Methods: Four hundred and ten women undergoing general anesthesia for elective gynecological surgery were included in a prospective, consecutive, randomized, multicentre, placebo-controlled, double-blind clinical trial with a reference group. One group was given bilateral P6 acupressure (n = 135), a second group similar pressure on bilateral non-acupressure points (n = 139), and a third group (n = 136) served as reference group. Nausea (scale 0–6), vomiting, pain, and satisfaction with the treatment were recorded. Primary outcome was complete response, i.e., no nausea, vomiting or rescue medication for 24 hr. Results were analyzed by applying logistic regression with indicators of treatments, type of operation and risk score for PONV as explanatory variables.

    Results: Complete response was more frequent in the P6 acupressure group than in the reference group (P = 0.0194) Conversely, the incidence of PONV was 46% in the reference group, 38% after pressure on a non-acupoint and 33% after P6 acupressure. The decrease from 46% to 33% was statistically significant. When considering vaginal cases separately, the decrease in PONV was from 36% to 20% (P = 0.0168). The corresponding decrease from 59% to 55% in the laparoscopic surgery group was not statistically significant.

    Conclusion: P6 acupressure is a non-invasive method that may have a place as prophylactic antiemetic therapy during gynecological surgery.

  • 2.
    Alkaissi, Aidah
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Gunnarsson, H.
    Department of Anesthesiology, Västervik Hospital, Sweden.
    Evertsson, Karin
    Department of Anesthesiology, Västervik Hospital, Sweden.
    Johnsson, V.
    Department of Anesthesiology, Västervik Hospital, Sweden.
    Ofenbartl, L.
    Department of Anesthesiology, Eksjö Hospital, Sweden.
    Kalman, Sigga
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Disturbing postoperative symptoms are not reduced by prophylactic antiemetric treatment in patients at high risk for post-operative nausea and vomiting2004Inngår i: Acta anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 48, nr 6, s. 761-71Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: To give prophylactics or timely treatment for post-operative nausea and vomiting (PONV) is the question. We compared the intensity and number of disturbing post-operative symptoms (i.e. pain, PONV, headache, fatigue, etc.) after prophylactic antiemetic treatment in a group of patients with >30% risk for post-operative vomiting. METHODS: Four hundred and ninety-five patients, from three hospitals, planned for gynaecological surgery were randomized double blind. They were given granisetron 3 mg, droperidol 1.25 mg or no prophylactic antiemetic. Post-operative symptoms were followed for 24 h using a questionnaire. Symptoms were analyzed both according to their intensity and in a dichotomous fashion. RESULTS: The intensity of different symptoms differed depending on whether droperidol, granisetron or no antiemetic had been given (P = 0.005) but the overall incidence of moderate to very severe symptoms was similar in all groups. No group fared better in general. The total number of symptoms was higher in the groups given prophylactic treatment (P < 0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis was 27%[95% confidence interval (CI) 8-43] and 22% (2-38), respectively. The NNT (number needed to treat) for granisetron (0-24 h) was 7 and for droperidol 8. The NNH (number needed to harm) (0-24 h) for headache and visual disturbances was 6 and 13 (NS) for granisteron and, 50 (NS) and 6 for droperidol. CONCLUSION: The intensity of symptoms or the total number of disturbing symptoms did not decrease after prophylactic antiemetic treatment in a group of patients, but the profile of disturbing symptoms changed. The relevance of post-operative symptoms in terms of patients' well-being needs to be addressed.

  • 3.
    Alkaissi, Aidah
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Ledin, Torbjörn
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    Ödkvist, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    Kalman, Sigga
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    P6 acupressure increases tolerance to nausogenic motion stimulation in women with high risk for PONV2005Inngår i: Canadian Journal of Anesthesia, ISSN 1496-8975, Vol. 52, s. 703-709Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: In a previous study we noticed that P6 acupressure decreased postoperative nausea and vomiting (PONV) more markedly after discharge. As motion sickness susceptibility is increased by, for example, opioids we hypothesized that P6 acu-pressure decreased PONV by decreasing motion sickness susceptibility. We studied time to nausea by a laboratory motion challenge in a group of volunteers, during P6 and placebo acupressure.

    Methods: 60 women with high and low susceptibilities for motion sickness participated in a randomized and double-blind study with an active P6 acupressure, placebo acupressure, and a control group (n = 20 in each group). The risk score for PONV was over 50%. The motion challenge was by eccentric rotation in a chair, blindfolded and with chin to chest movements of the head. The challenge was stopped when women reported moderate nausea. Symptoms were recorded.

    Results: Mean time to moderate nausea was longer in the P6 acu-pressure group compared to the control group. P6 acupressure = 352 (259–445), mean (95% confidence interval) in seconds, control = 151 (121–181) and placebo acupressure = 280 (161–340); (P = 0.006). No difference was found between P6 and placebo acupressure or placebo acupressure and control groups. Previous severity of motion sickness did not influence time to nausea (P = 0.107). The cumulative number of symptoms differed between the three groups (P < 0.05). Fewer symptoms were reported in the P6 acupressure compared to the control group P < 0.009. Overall, P6 acupressure was only marginally more effective than placebo acupressure on the forearms.

    Conclusion: In females with a history of motion sickness P6 acu-pressure increased tolerance to experimental nauseogenic stimuli, and reduced the total number of symptoms reported.

  • 4.
    Alkaissi, Aidah
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Stålnert, Monica
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Kalman, Sigga
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatientgynaecological surgery1999Inngår i: Acta anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 43, nr 3, s. 270-274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Acupuncture and acupressure have previously been reported to possess antiemetic effect. We wanted to investigate the "true" and placebo effect of acupressure in prevention of postoperative nausea and vomiting (PONV). PATIENTS AND METHODS: Sixty women undergoing outpatient minor gynaecological surgery were entered into a double-blind and randomised study. One group received acupressure with bilateral stimulation of P6 (A), a second group received bilateral placebo stimulation (P) and a third group received no acupressure wrist band and served as a reference group (R). PONV was evaluated as number of patients with complete response (no PONV), nausea only or vomiting. In addition, the need for rescue antiemetic medication and nausea after 24 h was registered. RESULTS: Complete response was obtained in 11, 11 and 9 patients in groups, A, P and R, respectively. Nine, 7 and 6 patients had nausea before discharge home, and 1, 1 and 8 patients were nauseated (8 vs 1 patient: P < 0.05) 24 h after operation in A, P and R groups, respectively. When compared to placebo acupressure (2 patients vomited and 5 needed rescue), significantly (P < 0.05) fewer needed rescue antiemetic medication after acupressure at P6 (no vomiting or rescue medication). When compared to the observation group (5 vomited and 4 needed rescue antiemetics), significantly fewer vomited after acupressure (P < 0.05) CONCLUSION: In patients undergoing brief gynaecological surgery, placebo effect of acupressure decreased nausea after 24 h but vomiting and need of rescue antiemetics was reduced only by acupressure with the correct P6 point stimulation.

  • 5.
    Backstrom, D.
    et al.
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Al-Ayoubi, Fawzi
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Yrkes- och miljömedicin. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    Letter: Outcome of trauma patients2010Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, nr 7, s. 902-903Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    n/a

  • 6.
    Bartha, Erzsébet
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Carlsson, Per
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery2006Inngår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 96, nr 1, s. 111-117Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. The outcome of different treatment strategies for postoperative pain has been an issue of controversy. Apart from efficacy and effectiveness a policy decision should also consider cost-effectiveness. Since economic analyses on postoperative pain treatment are rare we developed a decision model in a pilot cost-effectiveness analysis (CEA) comparing epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) after major abdominal surgery in routine care. Methods. Using a decision-tree model, treatment with EDA (ropivacaine and morphine) was compared with PCIA (morphine). Effects and costs of treatment were established. The number of pain-free days at rest (pain intensity <30 using visual analogue scale 1-100 mm) was the primary measure of effect. An incremental cost-effectiveness ratio (ICER) was calculated as the difference in direct costs divided by the difference in effect. A database on 644 patients collected for the purpose of quality control during the period of 1997 to 1999 was the main data source. Sensitivity analysis was used to test uncertain data. Results. EDA was more effective in terms of pain-free days but more expensive. The additional cost for each pain-free day was 5652 Euros. Conclusion. It is a judgement of value if the additional cost is reasonable. When the cost of around 55 000 Euros per gained life-year with full health for other interventions is debated, our result indicates poor cost-effectiveness for EDA. Before any conclusion can be drawn concerning policy recommendations the difference in costs has to be related to other outcome measures as length of hospital stay, morbidity and mortality are required. © The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved.

  • 7.
    Bartha, Erzsébet
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Kalman, Sigga
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Postoperativ smärtlindring - till vilket pris?: En hälsoekonomisk modellanalys av två smärtlindringsmetoder2006Rapport (Annet vitenskapelig)
    Abstract [sv]

    Utgångspunkten för denna rapport var en kvalitetskontroll av rutiner för postoperativ smärtlindring vid Anestesikliniken på US i Linköping under 1997-1999. Vid denna kontroll upptäckte vi en del svagheter i rutiner, bl.a. att epiduralsmärtlindring avslutades tidigare än avsetts i högre frekvens än väntat. Under denna period registrerades en mängd uppgifter om aktuell behandling och olika utfall i en databas. Resultatet pekade på att den mest använda metoden i praktiken var förenad med extrainsatser som bidrog till högre kostnader. Denna kunskap ledde fram till en vidare frågeställning än vad som traditionellt diskuterats i dessa sammanhang nämligen hur de aktuella metoderna förhåller sig till varandra när även kostnader för behandlingen tas i beaktande. Det första steget att besvara denna fråga var ett projektarbete i kursen om Klinisk Utvärderingsvetenskap (KLUV) som anordnades av Linköpings universitet med stöd av Forskningsrådet i Sydvästra Sjukvårdsregionen. Studien har sedan vidareutvecklats och färdigställts vid CMT med ekonomiskt stöd från Landstinget i Östergötland.

    Syftet med rapporten är att belysa hur två metoder för postoperativ smärtlindring (epiduralbedövning och intravenös opioidbehandling med patientkontrollerad pump) fungerar i vardagssjukvård med hänsyn tagen till både kostnader och effekten på smärta. Frågan om vilken metod som är den bättre av dessa har diskuterats under senaste decenniet. Epiduralbedövning tycks ge bättre smärtlindring, men det är oklart vilket mervärde som den skillnaden i smärtintensitet ger oavsett om den mäts som patientupplevd, medicinsk eller samhällelig nytta. Frågan om vilken behandlingsform som är mest kostnadseffektiv är intressant eftersom den här typen av smärtlindring är vanlig och berör ett stort antal patienter i sjukvården. Vår förhoppning är att vi med hjälp av denna hälsoekonomiska modellanalys av beslutsproblemet kan bidra till ett bättre beslutsunderlag men också väcka ett intresse för att göra hälsoekonomiska utvärderingar av smärtlindringsmetoder vilket hittills varit relativt ovanligt.

    Studien har genomförts i samarbete mellan CMT och AnOp Centrum vid US i Linköping. Flera personer har bidragit till denna rapport och vi vill tacka Mona Lindblad och Lilian Adamsson som var ansvariga för databasen under åren 1997-1999. Vi vill vidare tacka Martin Henriksson vid CMT för värdefulla synpunkter.

  • 8.
    Berkius, J
    et al.
    Västervik, Sweden .
    Engerström, L
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Orwelius, Lotti
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    HEALTH RELATED QUALITY OF LIFE IN COPD PATIENTS FOLLOWED 24 MONTHS AFTER ICU CARE in INTENSIVE CARE MEDICINE, vol 36, issue , pp S228-S2282010Inngår i: INTENSIVE CARE MEDICINE, Springer Science Business Media , 2010, Vol. 36, s. S228-S228Konferansepaper (Fagfellevurdert)
    Abstract [en]

    n/a

  • 9.
    Fornander, Lotta
    et al.
    Karolinska Institute.
    Nyman, Torbjörn
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Hansson, Thomas
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Ragnehed, Mattias
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk radiologi. Linköpings universitet, Hälsouniversitetet.
    Brismar, Tom
    Karolinska Institute.
    Age- and time-dependent effects on functional outcome and cortical activation pattern in patients with median nerve injury: a functional magnetic resonance imaging study Clinical article2010Inngår i: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 113, nr 1, s. 122-128Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Object. The authors conducted a study to determine age- and time-dependent effects on the functional outcome after median nerve injury and repair and how such effects are related to changes in the pattern of cortical activation in response to tactile stimulation of the injured hand. Methods. The authors studied 11 patients with complete unilateral median nerve injury at the wrist repaired with epineural suture. In addition, 8 patients who were reported on in a previous study were included in the statistical analysis. In the entire study cohort, the mean age at injury was 23.3 +/- 13.4 years (range 7-57 years) and the time after injury ranged from 1 to 11 years. Sensory perception was measured with the static 2-point discrimination test and monofilaments. Functional MR imaging was conducted during tactile stimulation (brush strokes) of Digits II-III and IV-V of both hands, respectively. Results. Tactile sensation was diminished in the median territory in all patients. The strongest predictor of 2-point discrimination was age at injury (p less than 0.0048), and when this was accounted for in the regression analysis, the other age- and time-dependent predictors had no effect. The activation ratios (injured/healthy hand) for Digit II-III and Digit IV-V stimulation were positively correlated (rho 0.59, p less than 0.011). The activation ratio for Digit II-III stimulation correlated weakly with time after injury (p less than 0.041). The activation ratio of Digits IV-V correlated weakly with both age at injury (p less than 0.048) and time after injury (p less than 0.033), but no predictor reached significance in the regression model. The mean ratio of ipsi- and contralateral hemisphere activation after stimulation of the injured hand was 0.55, which was not significantly different from the corresponding ratio of the healthy hand (0.66). Conclusions. Following a median nerve injury (1-11 years after injury) there may be an initial increase in the volume of the cortical representation, which subsequently declines during the restoration phase. These dynamic changes may involve both median and ulnar nerve cortical representation, because both showed negative correlation with time after injury. These findings are in agreement with animal studies showing that cortical plasticity is an important mechanism for functional recovery after peripheral nerve injury and repair.

  • 10.
    Hahn, Robert G
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård.
    Volume Kinetics for Infusion Fluids2010Inngår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 113, nr 2, s. 470-481Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Volume kinetics is a method for analyzing and simulating the distribution and elimination of infusion fluids. Approximately 50 studies describe the disposition of 0.9% saline, acetated and lactated Ringer´s solution, based on repeated measurements of the hemoglobin concentration and (sometimes) the urinary excretion.

    The slow distribution to the peripheral compartment results in a 50-75% larger plasma dilution during an infusion of crystalloid fluid than would be expected if distribution had been immediate. A drop in the arterial pressure during induction of anesthesia reduces the rate of distribution even further.

    The renal clearance of the infused fluid during surgery is only 10-20% compared to conscious volunteers. Some of this temporary decrease can be attributed to the anesthesia and probably also to preoperative psychological stress and/or dehydration. 

    Crystalloid fluid might be allocated to “non-functional” fluid spaces where it is unavailable for excretion. This amounts to approximately 20-25% during minor (thyroid) surgery.

  • 11.
    Hultcrantz, Elisabeth
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    Harder, Lena
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    Zetterlund, Eva-Lena
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Roberg, Karin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Öronkliniken US.
    To treat snoring with nasal steroids - effects on more than one level?2010Inngår i: ACTA OTO-LARYNGOLOGICA, ISSN 0001-6489, Vol. 130, nr 1, s. 124-131Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Conclusion. An inflammatory swelling in the uvula and nose due to vibration might be a contributing factor in snoring. The presence of corticosteroid receptors in the uvula indicates the possibility for treatment with local steroids. Use of mometasone furoate (MF) for 3 months reduced snoring and related symptoms in some patients. Objective. To investigate the effect of a nasal steroid, MF, on snoring and related discomfort. Subjects and methods. In the first part of the study, uvular and nasal biopsies from six patients with social snoring were examined using immunohistochemistry to evaluate whether corticosteroid receptors were present. Then 100 snoring patients were invited to participate in the second part of the study. In all, 72 men and 22 women with a mean age of 47 years and BMI 27 answered a questionnaire about symptoms, had ENT status assessed and reported sleep and related variables for a 7 day period. After randomization to placebo or MF, they used a nasal spray for 3 months at a dosage of 200 mu g. Thereafter the procedure was repeated. Results. Corticosteroid receptors were present in the mucous membranes and around the blood vessels in all uvulas examined. A total of 84 patients were evaluated. No decrease in mean snoring score was seen. Daytime sleepiness showed a slight improvement in the MF group and partners were less disturbed. Minor side effects were equal for both groups.

  • 12.
    Johansson, Anders
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Nilsson, Lena
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Öberg, Åke
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Respiratory monitoring using photoplethysmography - evaluation in the postoperative care unit1998Inngår i: Annual International Conference of th IEEE Engineering in Medicine and Biology Society,1998, 1998Konferansepaper (Fagfellevurdert)
  • 13.
    Kalman, Sigga
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Ekbäck, Gustav
    Örebro.
    Nilsson, Lena
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Metcalf, Kerstin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Ranklev Twetman, Eva
    Anestesiläkarnas arbetsmiljö kan förbättras. Slutrapport från ett arbetsmiljöprojekt2006Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, s. 1603-1610Artikkel i tidsskrift (Fagfellevurdert)
  • 14.
    Kalman, Sigga
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Linderfalk, C
    Wårdell, Karin
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Eintrei, Christina
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Lisander, Björn
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Differential effect on vasodilatation and pain after intradermal capsaicin in humans during decay of intravenous regional anesthesia with mepivacaine1998Inngår i: Regional anesthesia and pain medicine, ISSN 1098-7339, E-ISSN 1532-8651, Vol. 23, nr 4, s. 402-408Artikkel i tidsskrift (Fagfellevurdert)
  • 15.
    Laurent, Claes
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Jönsson, Björn
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kärlkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Vegfors, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Eneling, M
    Lindberg, Lars-Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Nonivasive monitoring of systolic blood pressuire on the arm utilizing photoplethysmpgraphy (PPG)2004Inngår i: Proceedings of SPIE jfr 1998-2000 SPIE proceedings ISSN 1017-2653, ISSN 1605-7422, s. 99-107Artikkel i tidsskrift (Fagfellevurdert)
  • 16.
    Laurent, Claes
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Jönsson, Björn
    Linköpings universitet, Institutionen för medicin och vård, Kärlkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken. Linköpings universitet, Hälsouniversitetet.
    Vegfors, Magnus
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN. Linköpings universitet, Hälsouniversitetet.
    Lindberg, Lars-Göran
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Non-invasive measurement of systolic blood pressure on the arm utilising photoplethysmography: development of the methodology2005Inngår i: Medical and Biological Engineering and Computing, ISSN 0140-0118, E-ISSN 1741-0444, Vol. 43, nr 1, s. 131-135Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Photoplethysmography (PPG) can be used to measure systolic blood pressure at the brachial artery. With a specially designed probe, positioned in the most distal position beneath a pressure cuff on the upper arm, this is possible. The distance between the light source (880 nm) and the photodetector was 20 mm. A test was performed on neuro-intensive care patients by determining blood pressure from the PPG curves, and, when it was compared with systolic blood pressure obtained from inserted indwelling arterial catheters, a correlation factor of r=0.95 was achieved. The difference between blood pressure obtained using PPG and invasive blood pressure measurement was 3.9±9.1 mmHg (mean±SD), n=19. The depth to the brachial artery was 13.9±4.1 mm (mean±SD), n=18. A digital PPG system utilising pulsating light was also developed.

  • 17.
    Laurent, Claes
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Jönsson, Björn
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kärlkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Vegfors, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Lindberg, Lars-Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Non-invasive monitoring of systolic blood preassure on arm utilizing photoplethysmography (PPG)2000Inngår i: World Congress of Medical Physics and Biomedical Engineering,2000, Springer-Verlag , 2000, s. 131-135Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Photoplethysmography (PPG) can be used to measure systolic blood pressure at the brachial artery. With a specially designed probe, positioned in the most distal position beneath a pressure cuff on the upper arm, this is possible. The distance between the light source (880 nm) and the photodetector was 20 mm. A test was performed on neuro-intensive care patients by determining blood pressure from the PPG curves, and, when it was compared with systolic blood pressure obtained from inserted indwelling arterial catheters, a correlation factor of r=0.95 was achieved. The difference between blood pressure obtained using PPG and invasive blood pressure measurement was 3.9±9.1 mmHg (mean±SD), n=19. The depth to the brachial artery was 13.9±4.1 mm (mean±SD), n=18. A digital PPG system utilising pulsating light was also developed.

  • 18.
    Lindberg, Lars-Göran
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Lennmarken, Claes
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Vegfors, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Pulse oximetry-clinical implications and recent technical developments1995Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 39, s. 279-287Artikkel i tidsskrift (Fagfellevurdert)
  • 19.
    Lindberg, Lars-Göran
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Vegfors, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Lennmarken, Claes
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Öberg, Åke
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Pulse oximeter signal at various blood flow conditions in an In vitro model1995Inngår i: Medical & Biological Engineering & Computing, ISSN 0140-0118, Vol. 33, s. 87-91Artikkel i tidsskrift (Fagfellevurdert)
  • 20.
    Lindholm, Maj-Lis
    et al.
    Karolinska Institute.
    Traff, Stefan
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Granath, Fredrik
    Karolinska Institute.
    Greenwald, Scott D
    Aspect Medical Systems.
    Ekbom, Anders
    Karolinska Institute.
    Lennmarken, Claes
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Sandin, Rolf H
    Karolinska Institute.
    Mortality Within 2 Years After Surgery in Relation to Low Intraoperative Bispectral Index Values and Preexisting Malignant Disease2009Inngår i: ANESTHESIA AND ANALGESIA, ISSN 0003-2999, Vol. 108, nr 2, s. 508-512Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A correlation between deep anesthesia (defined as time with Bispectral Index (BIS) &lt;45; T-BIS &lt;45 and death within 1. yr after surgery has previously been reported. In order to confirm or refute these findings, we evaluated T-BIS (&lt;45) as an independent risk factor for death within I and 2 yr after surgery and also the impact of malignancy, the predominant cause of death in the previous report.

    METHODS: Mortality within 2 yr after surgery, causes of death and the occurrence of malignant disease at the time of surgery were identified in a cohort of 4087 BIS-monitored patients. Statistically significant univariate predictors of mortality were identified. In order to allow for comparison with previous data, the following multivariate analysis was first done without, and thereafter with, preexisting malignancy status, the predominant cause of death.

    RESULTS: One-hundred-seventy-four (4.3%) patients died within I yr and another 92 during the second year (totaling 6.5% in 2 yr). T-BIS &lt;45 was a significant predictor of 1- and 2-yr mortality when preexisting malignant disease was not among the co-variates (hazard ratio [HR] 113 [1.01-1.27] and 1.18 [1.08-1.29], respectively). Further exploration confined the significant relation between postoperative mortality and T-BIS &lt;45 to Patients with preexisting malignant diagnoses associated with extensive Surgery and less favorable prognosis. The most powerful predictors of 2-yr mortality in the model, including preexisting malignancy, were ASA physical score class IV (HR 19.3 [7.31-51.1]), age &gt;80 yr (HR 2.93 [1.79-4.79]), and preexisting malignancy associated with less favorable prognosis (HR 9.30 [6.60-13.1]). When the initial multivariate regression was repeated using preexisting malignancy status among the co-variates in the model, the previously significant relation between 1, and 2-yr mortality and T-BIS &lt;45 did not reach statistical significance.

    CONCLUSION: Using a similar set of co-variates as in previous work, we confirmed the statistical relation between 1-yr mortality and T-BIS &lt;45, and we extended this observation to 2-yr mortality. However, this relation is sensitive to the selection of co-variates in the statistical model, and a randomized study is required to demonstrate that there really is a causal impact from and T-BIS (&lt;45) on postoperative mortality and, if it does, the effect is probably very weak in comparison with co-morbidity as assessed by ASA physical score, the preexisting malignancy status at surgery and age.

  • 21.
    Naredi, S.
    et al.
    Dept. Anaesthesia and Intensive Care.
    Koskinen, L.-O.
    Department of Neurosurgery, Umeå University Hospital, Sweden.
    Grande, P.-O.
    Grände, P.-O., Dept. Anaesthesia and Intensive Care.
    Nordstrom, C.-H.
    Nordström, C.-H., Department of Neurosurgery, Lund University Hospital, Sweden.
    Nellgard, B.
    Nellgård, B., Dept. Anaesthesia and Intensive Care.
    Rydenhag, B.
    Department of Neurosurgery, Shalgrens University Hospital, Gothenbourg, Sweden.
    Vegfors, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Treatment of Traumatic Head Injury - U.S./European Guidelines or the Lund Concept [1]2003Inngår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 31, nr 11, s. 2713-2714Annet (Annet vitenskapelig)
    Abstract [en]

    [No abstract available]

  • 22.
    Nilsson, Lena
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Goscinski, T.
    Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden.
    Kalman, S.
    Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden.
    Lindberg, Lars-Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Combined photoplethysmographic monitoring of respiration rate and pulse: A comparison between different measurement sites in spontaneously breathing subjects2007Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, nr 9, s. 1250-1257Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The non-invasive photoplethysmographic (PPG) signal reflects blood flow and volume in a tissue. The PPG signal shows variation synchronous with heartbeat (PPGc), as used in pulse oximetry, and variations synchronous with breathing (PPGr). PPGr has been used for non-invasive monitoring of respiration with promising results. Our aim was to investigate PPG signals recorded from different skin sites in order to find suitable locations for parallel monitoring of variations synchronous with heartbeat and breathing. Methods: PPG sensors were applied to the forearm, finger, forehead, wrist and shoulder on 48 awake healthy volunteers. From these sites, seven PPG signals were simultaneously recorded during normal spontaneous breathing over 10 min. Capnometry served as respiration and electrocardiogram (ECG) as pulse reference signals. PPG signals were compared with respect to power spectral content and squared coherence. Results: Forearm PPG measurement showed significantly higher power within the respiratory region of the power spectrum [median (quartile range) 42 (26)%], but significantly lower power within the cardiac region [9 (10)%] compared with the other skin sites. PPG finger measurement showed the opposite, in transmission mode, the power within the respiratory region was significantly lower [4 (10)%] and within the cardiac region significantly higher [45 (25)%] than the other sites. PPGc coherence values were generally high [>0.96 (0.08)], and PPGr coherence values lower [0.83 (0.35)-0.94 (0.17)]. Conclusion: Combined PPG respiration and pulse monitoring is possible, but there are significant differences between the respiratory and cardiac components of the PPG signal at different sites. © 2007 Acta Anaesthesiol Scand.

  • 23.
    Nilsson, Lena
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Goscinski, Tomas
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Lindberg, Lars-Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Detection of breaths by photoplethysmography is independent of age and sex2005Inngår i: Congress of the Scandinavian Society of Anaesthesiology and intensive care,2005, 2005, s. 19-Konferansepaper (Fagfellevurdert)
  • 24.
    Nilsson, Lena
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Goscinski, Tomas
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Lindberg, Lars-Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Photoplethysmography for central and obstructive apnea detection2005Inngår i: Congress of the Scandinavian Society of Anaesthesiology and intensive care,2005, 2005, s. 19-Konferansepaper (Fagfellevurdert)
  • 25.
    Nilsson, Lena
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Goscinski, Tomas
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi.
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Lindberg, Lars-Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Time relation between respiratory signals can be analysed by automated algorithms2005Inngår i: Congress of the Scandinavian Society of Anaesthesiology and intensive care,2005, 2005, s. 19-Konferansepaper (Fagfellevurdert)
  • 26.
    Nilsson, Lena
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Den andningssynkrona kompenenten av den fotopletysmorgrafiska signalen hos sövda påverkas inte av övertrycksandning2004Inngår i: Programbok SFAI-veckan 2004,2004, 2004, s. 149-19Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

       

  • 27.
    Nilsson, Lena
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    The phase of the respiratory variation in the photoplethysmographic signal is not affected by sympathetic tone2004Inngår i: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 21, s. 76-77Artikkel i tidsskrift (Fagfellevurdert)
  • 28.
    Nilsson, Lena
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Svanerudh, Johan
    Kalman, Sigga
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Is the respiratory component of the photoplethysmographic signal of venous origin?1999Inngår i: Medical & Biological Engineering & Computing, ISSN 0140-0118, Vol. 37, s. 912-913Artikkel i tidsskrift (Fagfellevurdert)
  • 29.
    Nilsson, Lena
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US. Östergötlands Läns Landsting, Anestesi- och operationscentrum.
    Juhlin, Claes
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Krook, H.
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Rutberg, H.
    Östergötlands Läns Landsting, Patientsäkerhetsenheten.
    Strukturerad journalgranskning kan öka patientsäkerheten2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 35, s. 2125-2128Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    [No abstract available]

  • 30.
    Oscarsson, Anna
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Juhas, M.
    Department of Laboratory Medicine, Lund University, Malmö University Hospital, Malmö, Sweden.
    Sjolander, A.
    Sjölander, A., Department of Laboratory Medicine, Lund University, Malmö University Hospital, Malmö, Sweden.
    Eintrei, Christina
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    The effect of propofol on actin, ERK-1/2 and GABAA receptor content in neurones2007Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, nr 9, s. 1184-1189Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: Interaction with the ?-aminobutyric acid receptor (GABA AR) complex is recognized as an important component of the mechanism of many anaesthetic agents, including propofol. The aims of this study were to investigate the effect of propofol on GABAAR, to determine whether exposure of neurones to propofol influences the localization of GABA AR within the cell and to look for cytoskeletal changes that may be connected with activation, such as the mitogen-activated protein kinase (MAPK) pathway. Methods: Primary cortical cell cultures from rat, with and without pre-incubation with the GABAAR antagonist bicuculline, were exposed to propofol. The cells were lysed and separated into membrane and cytosolic fractions. Immunoblot analyses of filamentous actin (F-actin), the GABA A ß2-subunit receptor and extracellular signal-regulated kinase-1/2 (ERK-1/2) were performed. Results: Propofol triggers an increase in GABAAR, actin content and ERK-1/2 phosphorylation in the cytosolic fraction. In the membrane fraction, there is a decrease in GABAA ß2-subunit content and an increase in both actin content and ERK-1/2 phosphorylation. The GABAAR antagonist bicuculline blocks the propofol-induced changes in F-actin, ERK and GABA A ß2-subunit content, and ERK-1/2 phosphorylation. Conclusion: We believe that propofol triggers a dose-dependent internalization of the GABAA ß2-subunit. The increase in internal GABAA ß2-subunit content exhibits a close relationship to actin polymerization and to an increase in ERK-1/2 activation. Actin contributes to the internalization sequestering of the GABAA ß2-subunit. © 2007 Acta Anaesthesiol Scand.

  • 31.
    Oscarsson, Anna
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Massoumi, R.
    Department of Laboratory Medicine, Lund University, Malmö University Hospital, Malmö, Sweden.
    Sjolander, A.
    Sjölander, A., Department of Laboratory Medicine, Lund University, Malmö University Hospital, Malmö, Sweden.
    Eintrei, Christina
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Reorganization of actin in neurons after propofol exposure2001Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 45, nr 10, s. 1215-1220Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: It has previously been shown that propofol in clinically relevant concentrations induces a calcium-dependent conformational change in the cytoskeleton. The aim of this study was to further clarify the effect of propofol on the actin cytoskeleton and to determine if this conformational change is mediated by the interaction between the GABAA-receptor and propofol. Methods: Primary cultured cortical neurons from newborn rats were treated with propofol 3 µg·ml-1 in a time-response titration, with and without preincubation with the GABAA-receptor antagonist, bicuculline. Actin-protein content was detected by Western blot analysis and the cellular content of F-actin measured by a spectrophotometric technique. Results: Propofol triggers a relatively slow statistically significant increase in the intracellular F-actin content, maximum after 20-min incubation (160%±16.3) (mean±SEM) P

  • 32. Bestill onlineKjøp publikasjonen >>
    Oscarsson Tibblin, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Perioperative myocardial damage and cardiac outcome in patients-at-risk undergoing non-cardiac surgery2009Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Despite increasingly sophisticated perioperative management, cardiovascular complications continue to be major challenges for the clinician. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing non-cardiac surgery, cardiovascular complications will remain a significant clinical problem in the future.

    The overall objective of this thesis was to study the incidence of myocardial damage and perioperative adverse cardiac events, to determine predictors of poor outcome and to assess the effect of a medical intervention in patients at risk undergoing non-cardiac surgery.

    The studies in this thesis were conducted on a total of 952 patients undergoing non-cardiac surgery. Studies I and IV were multicenter studies; whereas the patients included in studies II and III underwent non-cardiac surgery at Linkoping University Hospital, Sweden.

    The correlation between postoperative myocardial damage and short- and long-term outcome were studied in 546 patients, aged 70 years or older undergoing non-cardiac surgery of at least 30 minutes duration. This study showed a close correlation between postoperative myocardial damage and poor short- as well as long-term outcome. Elevated Troponin T was a strong independent predictor of mortality within one year of surgery. In 186 patients with ASA physical status classification III or IV undergoing non-elective surgery, the incidence of myocardial damage was 33%. In this study preoperative myocardial damage was an independent predictor of major adverse cardiac events in the postoperative period. In 69 patients with ASA physical status classification III & IV undergoing acute hip surgery, we found a close correlation between elevated NT-proBNP value prior to surgery and cardiac complications in the postoperative period. To study the effect of acetylsalicylic acid on postoperative myocardial damage and cardiovascular events, 220 patients at risk were randomized to receive 75 mg of acetylsalicylic acid or placebo 7 days prior to surgery until the third postoperative day. This study showed that treatment with acetylsalicylic acid resulted in an 8% (95% CI 1-15%) absolute risk reduction of having a postoperative major adverse cardiac event. No statistically significant differences of bleeding complications were seen between the groups.

    In conclusion, this thesis contributes to the understanding of the clinical relevance of elevated cardiac markers (with or without clinical or ECG signs of myocardial damage) in patients undergoing elective or emergency surgery. Moreover, we have identified predictors of poor outcome in the perioperative period that could be used as tools for identifying patients at risk. Finally, we have shown that continuing acetylsalicylic acid in the perioperative period reduced the risk of major adverse cardiac events within 30 days of surgery.

    Delarbeid
    1. Troponin T-values provide long-term prognosis in elderly patients undergoing non-cardiac surgery.
    Åpne denne publikasjonen i ny fane eller vindu >>Troponin T-values provide long-term prognosis in elderly patients undergoing non-cardiac surgery.
    Vise andre…
    2004 (engelsk)Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, nr 9, s. 1071-9Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BACKGROUND: The aim of this study was to evaluate the significance of elevated postoperative Troponin T (TnT) levels in an elderly population undergoing non-cardiac surgery. METHODS: Five hundred and forty-six consecutive patients aged 70 years or older undergoing non-cardiac surgery of >30-min duration were enrolled in this prospective, observational study. A postoperative TnT measurement was obtained on the 5th to 7th postoperative day. Troponin T values greater than 0.02 ng ml(-1) were considered positive. Patients were followed over a 1-year period, and mortality and non-fatal cardiac events (acute myocardial infarction and coronary interventions) were recorded. RESULTS: Troponin T concentrations greater than 0.02 ng ml(-1) were detected in 53 of the study subjects (9.7%). Eleven per cent of the patients with elevated TnT had electrocardiographic or clinical signs of myocardial ischemia. One year after surgery, 17 (32%) of the patients with abnormal TnT concentrations had died. In a multivariate Cox regression analysis adjusting for baseline and perioperative data, a TnT value >0.02 ng ml(-1) was an independent correlate of the mortality adjusted hazard ratio (HR): 14.9 (95% CI 3.7-60.3). Other independent predictors of death were tachycardia (HR, 14.9 95% CI 3.45-64.8), ASA 4 (HR, 8.1 95% CI 1.3-50.0), reoperation (HR, 6.4 95% CI 1.1-36.9), and use of diuretics (HR, 4.2 95% CI 1.3-13.8). CONCLUSION: We conclude that elevated TnT levels in the postoperative period confer a 15-fold increase in mortality during the first year after surgery. Our findings also provide evidence that silent myocardial ischemia is common in an elderly population. Routine perioperative surveillance for TnT might therefore be of use in detecting patients at an increased risk of mortality during the first postoperative year.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-20245 (URN)10.1111/j.1399-6576.2004.00463.x (DOI)15352951 (PubMedID)
    Tilgjengelig fra: 2009-08-31 Laget: 2009-08-31 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    2. Predictors of cardiac events in high-risk patients undergoing emergency surgery
    Åpne denne publikasjonen i ny fane eller vindu >>Predictors of cardiac events in high-risk patients undergoing emergency surgery
    Vise andre…
    2009 (engelsk)Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, nr 8, s. 986-994Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: The aim of this study was to determine the incidence of myocardial damage and left ventricular myocardial dysfunction and their influence on outcome in high-risk patients undergoing non-elective surgery.

    Methods: In this prospective observational study, 211 patients with American Society of Anesthesiologists classification III or IV undergoing emergent or urgent surgery were included. Troponin I (TnI) was measured pre-operatively, 12 and 48 h post-operatively. Pre-operative N-terminal fragment of B-type natriuretic peptide (NT-proBNP), as a marker for left ventricular systolic dysfunction, was analyzed. The diagnostic thresholds were set to TnI andgt; 0.06 mu g/l and NT-proBNP andgt; 1800 pg/ml, respectively. Post-operative major adverse cardiac events (MACE), 30-day and 3-months mortality were recorded.

    Results: Elevated TnI levels were detected in 33% of the patients post-operatively. A TnI elevation increased the risk of MACE (35% vs. 3% in patients with normal TnI levels, P andlt; 0.001) and 30-day mortality (23% vs. 7%, P=0.003). Increased concentrations of NT-proBNP were seen in 59% of the patients. Elevated NT-proBNP was an independent predictor of myocardial damage post-operatively, odds ratio, 6.2 [95% confidence interval (CI) 2.1-18.0] and resulted in an increased risk of MACE (21% vs. 2.5% in patients with NT-proBNP andlt; 1800 pg/ml, P andlt; 0.001).

    Conclusion: Myocardial damage is common in a high-risk population undergoing unscheduled surgery. These results suggest a close correlation between myocardial damage in the post-operative period and increased concentration of NT-proBNP before surgery. The combinations of TnI and NT-proBNP are reliable markers for monitoring patients at risk in the peri-operative period as well as useful tools in our risk assessment pre-operatively in emergency surgery.

    sted, utgiver, år, opplag, sider
    Wiley-Blackwell, 2009
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-20010 (URN)10.1111/j.1399-6576.2009.01971.x (DOI)000268789300002 ()19388892 (PubMedID)
    Tilgjengelig fra: 2009-08-24 Laget: 2009-08-24 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    3. N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery
    Åpne denne publikasjonen i ny fane eller vindu >>N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery
    Vise andre…
    2009 (engelsk)Inngår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, ISSN 0007-0912, Vol. 103, nr 2, s. 206-212Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The aim of this investigation was to assess the incidence of elevated N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) and its relation to outcome defined as perioperative adverse cardiac events and all-cause mortality in high-risk patients undergoing non-elective surgery for hip fracture. A cohort of patients with hip fractures were extracted from a prospective observational study of high-risk patients (ASA class III or IV) undergoing emergency surgery. NT-proBNP and troponin I were measured before operation. An NT-proBNP greater than= 3984 ng litre(-1) was set as the cut-off level for significance. Perioperative adverse cardiac events and 30 day and 3 month mortality were recorded. Sixty-nine subjects were included. Thirty-four subjects (49%) had an NT-proBNP greater than= 3984 ng litre(-1) before surgery. Thirty-four subjects (49%) had a perioperative adverse cardiac event. Of these, 22 subjects (65%) had NT-proBNP above the diagnostic threshold compared with 12 subjects (34%) who had an NT-proBNP below the diagnostic threshold (P=0.01). Preoperative NT-proBNP greater than= 3984 ng litre(-1) [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.0-8.9] and congestive heart failure (OR 3.0; 95% CI 1.0-9.0) were independent predictors of perioperative adverse cardiac events. A total of eight subjects (12%) died within 30 days after operation. There is a high incidence of elevated NT-proBNP in subjects undergoing non-elective hip fracture surgery. Preoperative NT-proBNP is a valuable predictor of cardiac complications in the perioperative period.

    sted, utgiver, år, opplag, sider
    Oxford University Press, 2009
    Emneord
    complications; morbidity; heart; myocardial function; surgery; non-cardiac; surgery; orthopaedic
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-20147 (URN)10.1093/bja/aep139 (DOI)000268107800009 ()19525507 (PubMedID)
    Tilgjengelig fra: 2009-09-01 Laget: 2009-08-31 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    4. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial
    Åpne denne publikasjonen i ny fane eller vindu >>To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial
    Vise andre…
    2010 (engelsk)Inngår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 104, nr 3, s. 305-312Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: Major adverse cardiac events (MACEs) are a common cause of deathafter non-cardiac surgery. Despite evidence for the benefitof aspirin for secondary prevention, it is often discontinuedin the perioperative period due to the risk of bleeding.

    Methods: We conducted a randomized, double-blind, placebo-controlledtrial in order to compare the effect of low-dose aspirin withthat of placebo on myocardial damage, cardiovascular, and bleedingcomplications in high-risk patients undergoing non-cardiac surgery.Aspirin (75 mg) or placebo was given 7 days before surgery andcontinued until the third postoperative day. Patients were followedup for 30 days after surgery.

    Results: A total of 220 patients were enrolled, 109 patients receivedaspirin and 111 received placebo. Four patients (3.7%) in theaspirin group and 10 patients (9.0%) in the placebo group hadelevated troponin T levels in the postoperative period (P=0.10).Twelve patients (5.4%) had an MACE during the first 30 postoperativedays. Two of these patients (1.8%) were in the aspirin groupand 10 patients (9.0%) were in the placebo group (P=0.02). Treatmentwith aspirin resulted in a 7.2% absolute risk reduction [95%confidence interval (CI), 1.3–13%] for postoperative MACE.The relative risk reduction was 80% (95% CI, 9.2–95%).Numbers needed to treat were 14 (95% CI, 7.6–78). No significantdifferences in bleeding complications were seen between thetwo groups.

    Conclusions: In high-risk patients undergoing non-cardiac surgery, perioperativeaspirin reduced the risk of MACE without increasing bleedingcomplications. However, the study was not powered to evaluatebleeding complications.

     

    Emneord
    analgesics non-opioid, aspirin; complications, haemorrhage; heart, ischaemia; surgery, non-cardiac
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-20759 (URN)10.1093/bja/aeq003 (DOI)000274485900006 ()
    Merknad
    This is a pre-copy-editing, author-produced PDF of an article accepted for publication in British Journal of Anaesthesia following peer review. The definitive publisher-authenticated version: Anna Oscarsson Tibblin, Anil Gupta, Mats Fredrikson, Johannes Järhult, Matti Nyström, Eva Pettersson, Bijan Darvish, Helena Krook, Eva Swahn and Christina Eintrei, To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial, 2010, British Journal of Anaesthesia, (104), 3, 305-312. is available online at: http://dx.doi.org/doi:10.1093/bja/aeq003 Copyright: Oxford University Press http://www.oxfordjournals.org/ Tilgjengelig fra: 2009-09-18 Laget: 2009-09-18 Sist oppdatert: 2017-12-13bibliografisk kontrollert
  • 33.
    Oscarsson Tibblin, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Eintrei, Christina
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Anskär, S
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Engdahl, Olle
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Fagerström, Lena
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Blomqvist, Per
    Anestesikliniken, Ryhov.
    Fredriksson, M
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Yrkes- och miljömedicin. Linköpings universitet, Hälsouniversitetet.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Troponin T-values provide long-term prognosis in elderly patients undergoing non-cardiac surgery.2004Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, nr 9, s. 1071-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The aim of this study was to evaluate the significance of elevated postoperative Troponin T (TnT) levels in an elderly population undergoing non-cardiac surgery. METHODS: Five hundred and forty-six consecutive patients aged 70 years or older undergoing non-cardiac surgery of >30-min duration were enrolled in this prospective, observational study. A postoperative TnT measurement was obtained on the 5th to 7th postoperative day. Troponin T values greater than 0.02 ng ml(-1) were considered positive. Patients were followed over a 1-year period, and mortality and non-fatal cardiac events (acute myocardial infarction and coronary interventions) were recorded. RESULTS: Troponin T concentrations greater than 0.02 ng ml(-1) were detected in 53 of the study subjects (9.7%). Eleven per cent of the patients with elevated TnT had electrocardiographic or clinical signs of myocardial ischemia. One year after surgery, 17 (32%) of the patients with abnormal TnT concentrations had died. In a multivariate Cox regression analysis adjusting for baseline and perioperative data, a TnT value >0.02 ng ml(-1) was an independent correlate of the mortality adjusted hazard ratio (HR): 14.9 (95% CI 3.7-60.3). Other independent predictors of death were tachycardia (HR, 14.9 95% CI 3.45-64.8), ASA 4 (HR, 8.1 95% CI 1.3-50.0), reoperation (HR, 6.4 95% CI 1.1-36.9), and use of diuretics (HR, 4.2 95% CI 1.3-13.8). CONCLUSION: We conclude that elevated TnT levels in the postoperative period confer a 15-fold increase in mortality during the first year after surgery. Our findings also provide evidence that silent myocardial ischemia is common in an elderly population. Routine perioperative surveillance for TnT might therefore be of use in detecting patients at an increased risk of mortality during the first postoperative year.

  • 34.
    Oscarsson Tibblin, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Yrkes- och miljömedicin. Linköpings universitet, Hälsouniversitetet.
    Sorliden, M.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Anskär, Stefan
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Eintrei, Christina
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery2009Inngår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, ISSN 0007-0912, Vol. 103, nr 2, s. 206-212Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this investigation was to assess the incidence of elevated N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) and its relation to outcome defined as perioperative adverse cardiac events and all-cause mortality in high-risk patients undergoing non-elective surgery for hip fracture. A cohort of patients with hip fractures were extracted from a prospective observational study of high-risk patients (ASA class III or IV) undergoing emergency surgery. NT-proBNP and troponin I were measured before operation. An NT-proBNP greater than= 3984 ng litre(-1) was set as the cut-off level for significance. Perioperative adverse cardiac events and 30 day and 3 month mortality were recorded. Sixty-nine subjects were included. Thirty-four subjects (49%) had an NT-proBNP greater than= 3984 ng litre(-1) before surgery. Thirty-four subjects (49%) had a perioperative adverse cardiac event. Of these, 22 subjects (65%) had NT-proBNP above the diagnostic threshold compared with 12 subjects (34%) who had an NT-proBNP below the diagnostic threshold (P=0.01). Preoperative NT-proBNP greater than= 3984 ng litre(-1) [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.0-8.9] and congestive heart failure (OR 3.0; 95% CI 1.0-9.0) were independent predictors of perioperative adverse cardiac events. A total of eight subjects (12%) died within 30 days after operation. There is a high incidence of elevated NT-proBNP in subjects undergoing non-elective hip fracture surgery. Preoperative NT-proBNP is a valuable predictor of cardiac complications in the perioperative period.

  • 35.
    Oscarsson Tibblin, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Yrkes- och miljömedicin. Linköpings universitet, Hälsouniversitetet.
    Sorliden, M
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Anskär, Stefan
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Gupta, Anil
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Eintrei, Christina
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Intensivvårdskliniken US.
    Predictors of cardiac events in high-risk patients undergoing emergency surgery2009Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, nr 8, s. 986-994Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The aim of this study was to determine the incidence of myocardial damage and left ventricular myocardial dysfunction and their influence on outcome in high-risk patients undergoing non-elective surgery.

    Methods: In this prospective observational study, 211 patients with American Society of Anesthesiologists classification III or IV undergoing emergent or urgent surgery were included. Troponin I (TnI) was measured pre-operatively, 12 and 48 h post-operatively. Pre-operative N-terminal fragment of B-type natriuretic peptide (NT-proBNP), as a marker for left ventricular systolic dysfunction, was analyzed. The diagnostic thresholds were set to TnI andgt; 0.06 mu g/l and NT-proBNP andgt; 1800 pg/ml, respectively. Post-operative major adverse cardiac events (MACE), 30-day and 3-months mortality were recorded.

    Results: Elevated TnI levels were detected in 33% of the patients post-operatively. A TnI elevation increased the risk of MACE (35% vs. 3% in patients with normal TnI levels, P andlt; 0.001) and 30-day mortality (23% vs. 7%, P=0.003). Increased concentrations of NT-proBNP were seen in 59% of the patients. Elevated NT-proBNP was an independent predictor of myocardial damage post-operatively, odds ratio, 6.2 [95% confidence interval (CI) 2.1-18.0] and resulted in an increased risk of MACE (21% vs. 2.5% in patients with NT-proBNP andlt; 1800 pg/ml, P andlt; 0.001).

    Conclusion: Myocardial damage is common in a high-risk population undergoing unscheduled surgery. These results suggest a close correlation between myocardial damage in the post-operative period and increased concentration of NT-proBNP before surgery. The combinations of TnI and NT-proBNP are reliable markers for monitoring patients at risk in the peri-operative period as well as useful tools in our risk assessment pre-operatively in emergency surgery.

  • 36.
    Oscarsson Tibblin, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Gupta, Anil
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och operationkliniken US.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Yrkes- och miljömedicin. Linköpings universitet, Hälsouniversitetet.
    Järhult, Johannes
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Nyström, Matti
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Pettersson, Eva
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Darvish, Bijan
    Department of Anaesthesia & Intensive Care University Hospital, Örebro, Sweden.
    Krook, Helena
    Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Eintrei, Christina
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Intensivvårdskliniken US.
    To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial2010Inngår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 104, nr 3, s. 305-312Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Major adverse cardiac events (MACEs) are a common cause of deathafter non-cardiac surgery. Despite evidence for the benefitof aspirin for secondary prevention, it is often discontinuedin the perioperative period due to the risk of bleeding.

    Methods: We conducted a randomized, double-blind, placebo-controlledtrial in order to compare the effect of low-dose aspirin withthat of placebo on myocardial damage, cardiovascular, and bleedingcomplications in high-risk patients undergoing non-cardiac surgery.Aspirin (75 mg) or placebo was given 7 days before surgery andcontinued until the third postoperative day. Patients were followedup for 30 days after surgery.

    Results: A total of 220 patients were enrolled, 109 patients receivedaspirin and 111 received placebo. Four patients (3.7%) in theaspirin group and 10 patients (9.0%) in the placebo group hadelevated troponin T levels in the postoperative period (P=0.10).Twelve patients (5.4%) had an MACE during the first 30 postoperativedays. Two of these patients (1.8%) were in the aspirin groupand 10 patients (9.0%) were in the placebo group (P=0.02). Treatmentwith aspirin resulted in a 7.2% absolute risk reduction [95%confidence interval (CI), 1.3–13%] for postoperative MACE.The relative risk reduction was 80% (95% CI, 9.2–95%).Numbers needed to treat were 14 (95% CI, 7.6–78). No significantdifferences in bleeding complications were seen between thetwo groups.

    Conclusions: In high-risk patients undergoing non-cardiac surgery, perioperativeaspirin reduced the risk of MACE without increasing bleedingcomplications. However, the study was not powered to evaluatebleeding complications.

     

  • 37.
    Samuelson, K.
    et al.
    Lund University Hospital.
    Persfalk, B-M
    Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Linden, M.
    Walther, Sten
    Linköpings universitet, Institutionen för medicin och hälsa, Fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Validation of the nursing care recording system 20082009Inngår i: in ACTA ANAESTHESIOLOGICA SCANDINAVICA, vol 53, 2009, Vol. 53, s. 73-73Konferansepaper (Fagfellevurdert)
    Abstract [en]

    n/a

  • 38. Bestill onlineKjøp publikasjonen >>
    Samuelsson, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Anestesi- och intensivvårdskliniken VIN.
    Effects of burns and vasoactive drugs on human skin: Clinical and Experimental studies using microdialysis2010Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Patients who require critical care, including those with burns, are affected by a systemic inflammatory reaction, which at times has consequences such as multiple organ dysfunction and failure. It has become increasingly evident that other factors important in the development of organ dysfunction are disturbances at the tissue level, in the microcirculation. Such disturbances activate cascade systems including stress hormones, all of which have local effects on organ function.

    Despite this knowledge, monitoring and treatment in critical illness today relies mainly on central haemodynamics and blood sampling.

    Microdialysis is a minimally invasive technique that enables us to study the chemical composition and changes in biochemistry in the extracellular, extravascular space in living tissues. Most of our current experience is from animal models, but the technique has also been used in humans and has become routine in many neurosurgical intensive care units to monitor brain biochemistry after severe injury. In skin, this experience is limited. During the first half of this thesis we studied the injured and uninjured skin of severely burned patients. The results show that there are severe local metabolic disturbances in both injured and uninjured skin. Most interesting is a sustained tissue acidosis, which is not detectable in systemic (blood) sampling. We also recorded considerable alterations in the glucose homeostasis locally in the skin, suggesting a cellular or mitochondrial dysfunction. In parallel, we noted increased tissue glycerol concentrations, which indicated appreciable traumainduced lipolysis.

    We also examined serotonin kinetics in the same group of patients, as serotonin has been claimed to be a key mediator of the vasoplegia and permeability disturbances found in patients with burns. We have shown, for the first time in humans to our knowledge, that concentrations of serotonin in skin are increased tenfold, whereas blood and urine concentrations are just above normal. The findings support the need for local monitoring of substances with rapid local reabsorption, or degradation, or both. The results also indicate that serotonin may be important for the systemic response that characterises burn injuries.

    In the second half of the thesis we evaluated the effects of microdosing in skin on metabolism and blood flow of vasoactive, mainly stress-response-related, drugs by the microdialysis system. The objectives were to isolate the local effects of the drugs to enable a better understanding of the complex relation between metabolic effects and effects induced by changes in local blood flow. In the first of these two studies we showed that by giving noradrenaline and nitroglycerine into the skin of healthy subjects we induced anticipated changes in skin metabolism and blood flow. The results suggest that the model may be used to examine vascular and metabolic effects induced locally by vasoactive compounds. Data from the last study indicate that conventional pharmacodynamic models (Emax) for time and dose response modelling may be successfully used to measure the vascular and metabolic response in this microdosing model.

    We conclude that the microdialysis technique can be successfully used to monitor skin metabolism and iso late a mediator (serotonin) of the local skin response in burned patients. It was also feasible to develop a vascular model in skin based on microdialysis to deliver vasoactive substances locally to the skin of healthy volunteers. This model provided a framework in which the metabolic effects of hypoperfusion and reperfusion in skin tissues could be examined further.

    Delarbeid
    1. Microdialysis shows metabolic effects in skin during fluid resuscitation in burn-injured patients
    Åpne denne publikasjonen i ny fane eller vindu >>Microdialysis shows metabolic effects in skin during fluid resuscitation in burn-injured patients
    2006 (engelsk)Inngår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 10, nr 6, s. Art.no: R172-Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Introduction: Established fluid treatment formulas for burn injuries have been challenged as studies have shown the presence of tissue hypoxia during standard resuscitation. Such findings suggest monitoring at the tissue level. This study was performed in patients with major burn injuries to evaluate the microdialysis technique for the continuous assessment of skin metabolic changes during fluid resuscitation and up to four days postburn. Methods: We conducted an experimental study in patients with a burn injury, as represented by percentage of total body surface area burned (TBSA), of more than 25% in a university eight-bed burns intensive care unit serving about 3.5 million inhabitants. Six patients with a median TBSA percentage of 59% (range 33.5% to 90%) and nine healthy controls were examined by intracutaneous MD, in which recordings of glucose, pyruvate, lactate, glycerol, and urea were performed. Results: Blood glucose concentration peaked on day two at 9.8 mmol/l (6.8 to 14.0) (median and range) and gradually declined on days three and four, whereas skin glucose in MD continued to increase throughout the study period with maximum values on day four, 8.7 mmol/l (4.9 to 11.0). Controls had significantly lower skin glucose values compared with burn patients, 3.1 mmol/l (1.5 to 4.6) (p < 0.001). Lactate from burn patients was significantly higher than controls in both injured and uninjured skin (MD), 4.6 mmol/l (1.3 to 8.9) and 3.8 mmol/l (1.6 to 7.5), respectively (p < 0.01). The skin lactate/pyruvate ratio (MD) was significantly increased in burn patients on all days (p < 0.001). Skin glycerol (MD) was significantly increased at days three and four in burn patients compared with controls (p < 0.01). Conclusion: Despite a strategy that fulfilled conventional goals for resuscitation, there were increased lactate/pyruvate ratios, indicative of local acidosis. A corresponding finding was not recorded systemically. We conclude that MD is a promising tool for depicting local metabolic processes that are not fully appreciated when examined systemically. Because the local response in glucose, lactate, and pyruvate metabolism seems to differ from that recorded systemically, this technique may offer a new method of monitoring organs. © 2006 Samuelsson et al., licensee BioMed Central Ltd.

    sted, utgiver, år, opplag, sider
    London, UK: BioMed Central, 2006
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-37628 (URN)10.1186/cc5124 (DOI)000247718500020 ()17166287 (PubMedID)36806 (Lokal ID)36806 (Arkivnummer)36806 (OAI)
    Tilgjengelig fra: 2009-10-10 Laget: 2009-10-10 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    2. Serotonin kinetics in patients with burn injuries: A comparison between the local and systemic responses measured by microdialysis-A pilot study
    Åpne denne publikasjonen i ny fane eller vindu >>Serotonin kinetics in patients with burn injuries: A comparison between the local and systemic responses measured by microdialysis-A pilot study
    2008 (engelsk)Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, nr 5, s. 617-622Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objectives: To investigate serotonin (5HT) locally in burned and uninjured skin (intracutaneous) by microdialysis, and simultaneously record urinary and blood values in the same subjects. For comparison, serotonin values were also measured in skin of healthy controls. Design and setting: An experimental study in burned patients with of more than 25% TBSA (total burn surface area) % in an 8-bed tertiary burns unit, serving about 3.5 million persons. Patients and methods: Six subjects with a median TBSA% of 59% (range 33.5-90), and five healthy controls were examined by intracutaneous microdialysis of the skin. Results: 5HT was increased in burned patients, compared with controls. This increase was tenfold in skin and was noted both in uninjured and burned skin. The highest values were recorded on day 1 (median 16.1 nmol in uninjured and 9.5 nmol in burned skin) and day 2 (15.6 nmol in uninjured and 13.4 nmol in burned skin). A rapid reduction was noted on day 3 (4.9 nmol in uninjured and 3.8 nmol in burned skin). The corresponding value for control subjects was 1.3 nmol. The 5HT in blood was twice normal on day 2, and gradually reduced on days 3 and 4 (3189, 3035 and 2573 nmol, respectively). Urinary 5HT concentrations were increased only on day 2 at 1755 nmol and thereafter returned to the normal range on days 3 and 4 (1248 and 1344 nmol, respectively). Conclusions: We showed that microdialysis may be used in the critical care of burns, and local skin serotonin concentrations examined continuously for several days. The findings of significantly raised tissue serotonin concentrations, compared to that in blood and urine, suggests that serotonin may be important in local vascular control and formation of oedema. © 2007 Elsevier Ltd and ISBI.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-43419 (URN)10.1016/j.burns.2007.08.003 (DOI)73800 (Lokal ID)73800 (Arkivnummer)73800 (OAI)
    Tilgjengelig fra: 2009-10-10 Laget: 2009-10-10 Sist oppdatert: 2017-12-13
    3. Implications for critical care of a new in vivo human vascular microdosing technique for giving noradrenaline and nitroglycerine by microdialysis
    Åpne denne publikasjonen i ny fane eller vindu >>Implications for critical care of a new in vivo human vascular microdosing technique for giving noradrenaline and nitroglycerine by microdialysis
    Vise andre…
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Introduction: Skin has a large dynamic capacity for alterations in blood flow, and is therefore often used for recruitment of blood during states of hypoperfusion. Little is known, however, about the metabolic consequences seen in skin secondary to hyporperfusion, particularly when the effects of vasoactive drugs are involved. The aims of this study were: to develop an in vivo, human microdosing model based on microdialysis in skin; and to investigate the effects on blood flow and metabolism of administering noradrenaline and nitroglycerine locally.

    Method: Nine healthy volunteers each had two or three microdialysis catheters placed intradermally in the volar surface of the lower arm. After a stabilisation period, the catheters were perfused with buffers containing noradrenaline 0.5 or 5 μg/ml for 60 minutes, and after a second period of equilibrium of 60 minutes, all catheters were perfused with buffer containing nitroglycerine (0.5mg/ml). Changes in the blood flow in the skin were measured by laser Doppler imaging urea and ethanol clearance. Simultaneous changes in tissue glucose, lactate, and pyruvate concentrations were recorded.

    Results: Perfusing skin with noradrenaline and nitroglycerine induced appreciable changes in all variables studied, depending on time and dose. The changes in glucose and lactate concentrations correlated with the change in blood flow assessed by either laser Doppler imaging or urea clearance. The changes in glucose and lactate that were induced by vasoconstriction (noradrenaline) continued until vasodilatation was induced by nitroglycerine.

    Conclusion: Noradrenaline given by microdialysis in healthy volunteers induced reproducible and dose-dependent hypoperfusion and ischaemia with simultaneous metabolic consequences. Among these, we particularly note that: tissue glucose concentrations responded rapidly to hypoperfusion but remained considerably higher than zero, which suggests an energy-dependent deficiency in cellular uptake; and vasoconstriction remained after cessation of the noradrenaline perfusion, implicating vasospasm and a lack of autoregulatory (recovery) capacity in skin. These findings are particularly interesting from the critical care perspective, where noradrenaline is used extensively for circulatory support. The metabolic consequences may be underestimated and our results suggest that further investigations are warranted.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-59517 (URN)
    Tilgjengelig fra: 2010-09-17 Laget: 2010-09-17 Sist oppdatert: 2010-09-17bibliografisk kontrollert
    4. A human vascular model based on microdialysis for the assessment of the vasoconstrictive dose-response effects of noradrenaline and vasopressin in skin: in JOURNAL OF VASCULAR RESEARCH, vol 48, pp 320-320
    Åpne denne publikasjonen i ny fane eller vindu >>A human vascular model based on microdialysis for the assessment of the vasoconstrictive dose-response effects of noradrenaline and vasopressin in skin: in JOURNAL OF VASCULAR RESEARCH, vol 48, pp 320-320
    Vise andre…
    2011 (engelsk)Inngår i: JOURNAL OF VASCULAR RESEARCH, Karger , 2011, s. 320-320Konferansepaper, Publicerat paper (Fagfellevurdert)
    Abstract [en]

    Microdialysis is a well-established technique for continuous sampling of small, water-soluble molecules within the extracellular fluid space in vivo. It also allows the use of microdoses of drugs, and the simultaneous evaluation of their related effects at the site of action. The present study was an experimental, randomized microdose trial to develop a human vascular model of dose response. We aimed to evaluate a microdialysis dosing method using urea clearance as a marker of druginduced changes in dermal blood flow and metabolism (glucose and lactate) in 12 healthy volunteers. We found that asymptomatic vasoconstriction can be detected by continuous microdialysis measurements of urea clearance in dermal tissue. More importantly, dose-effect relations using the Emax model could be constructed using the corresponding data on drug doses and both the urea clearance-based flow estimates and the changes in concentrations of tissue metabolites. This in vivo human experimental skin model offers an interesting tool with which both the dose-response effects on blood flow and concentrations of tissue metabolites of potent vasoactive substances can be evaluated.

    sted, utgiver, år, opplag, sider
    Karger, 2011
    Emneord
    Microdialysis; Urea; Skin; Noradrenalin; Vasopressin; micro dose; dose-response; pharmacodynamics; human; vasoconstriction
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-59518 (URN)000294760800317 ()
    Tilgjengelig fra: 2010-09-17 Laget: 2010-09-17 Sist oppdatert: 2012-03-21bibliografisk kontrollert
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