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  • 1.
    Hultman, Lena
    et al.
    n/a.
    Järhult, Johannes
    Ryhov Hosp, Dept Surg, S-55185 Jonkoping, Sweden.
    Akut ortopedi2010 (ed. 1)Book (Other academic)
    Abstract [sv]

    Akut ortopedi beskriver hur man handlägger patienter som kommer till akutmottagningen med skador eller sjukdomstillstånd i rörelseapparaten. För varje tillstånd beskrivs kortfattat vad läsaren ska och kan göra själv, men också när det är lämpligt att konsultera en mer erfaren kollega.Boken inleds med att kort beskriva undersökningsmetodik, preoperativ bedömning, ortopediska skador och smärttillstånd samt praktiska råd rörande smärtlindring, injektioner/punktioner och gipsteknik. Därefter följer huvudavsnittet som omfattar alla de skador, smärttillstånd och infektioner som kan drabba respektive kroppsdel. Boken avslutas med ett avsnitt om posttraumatiska och postoperativa tillstånd.Akut ortopedi är skriven främst för medicinstudenter, AT-läkare och nyblivna jourhavande i ortopedi, men är också lämplig för övrig personal som är verksam på landets akutmottagningar. Boken vänder sig också till läkare och sjuksköterskor inom primärvården liksom till sjukgymnaster och arbetsterapeuter som arbetar med patienter med ortopediska besvär. Priset gäller för varje separat artikel i serien.

  • 2.
    Järhult, Johannes
    et al.
    Ryhov Hosp, Dept Surg, S-55185 Jonkoping, Sweden.
    Ander, S
    NAL Trollhattan, Dept Surg, Trollhattan, Sweden.
    Askling, B
    Ryhov Hosp, Dept Surg, S-55185 Jonkoping, Sweden.
    Jansson, S
    Sahlgrens Univ Hosp, Dept Surg, Gothenburg, Sweden.
    Meehan, A
    Sahlgrens Univ Hosp, Dept Surg, Gothenburg, Sweden.
    Krisoffersson, A
    Umea Univ Hosp, Dept Surg, S-90185 Umea, Sweden.
    Nordenström, J
    Karolinska Univ Hosp, Dept Breast & Endocrine Surg, Stockholm, Sweden.
    Long-term results of surgery for lithium-associated hyperparathyroidism2010In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 97, no 11, p. 1680-1685Article in journal (Refereed)
    Abstract [en]

     Background: Lithium therapy for affective bipolar disease is frequently associated with hyperparathyroidism (HPT), but the results of surgical treatment are virtually unknown. The aim of this retrospective review was to analyse the long-term outcome after surgery for lithium-induced HPT in a large series of patients.

    Methods: Seventy-one patients on chronic lithium therapy who underwent surgery in three university and three district hospitals in Sweden were followed for a median of 6.3 years. Histopathology, complications of surgery and normocalcaemia at 6 months after surgery and last follow-up were analysed.

    Results: The primary histopathological diagnoses were adenoma (45 per cent), double adenomas (3 per cent) and hyperplasia (52 per cent). No permanent paresis of the recurrent laryngeal nerve was recorded but 13 per cent of the patients suffered from permanent hypoparathyroidism. At follow-up, the rate of persistent and recurrent HPT was 42 per cent regardless of the histopathological diagnosis.

    Conclusion: The results of conventional surgery for lithium-associated HPT are poor. The surgical approach should be adjusted for the multiglandular disease that is usually the cause of HPT in patients on chronic lithium therapy.

  • 3.
    Järhult, Johannes
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Landerholm, Kalle
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Falkmer, Sture E.
    Department of Clinical Pathology, Ryhov Hospital, Jönköping, Sweden.
    Nordenskjöld, Magnus
    Karolinska Institute, Department of Molecular Medicine and Surgery, Clinical Genetic Unit, Stockholm, Sweden.
    Sundler, Frank
    Lund University, Department of Experimental Medical Sciences, Lund, Sweden.
    Wierup, Nils
    Lund University, Department of Experimental Medical Sciences, Lund, Sweden.
    First Report on Metastasizing Small Bowel Carcinoids in First-Degree Relatives in Three Generations2010In: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 91, no 4, p. 318-323Article in journal (Refereed)
    Abstract [en]

    Background/Aims: There is an established association between the multiple endocrine neoplasia type 1 (MEN 1) syndrome and foregut carcinoids. Some registry studies also indicate that offspring to carcinoid patients run an increased risk of developing a carcinoid tumor themselves. However, there are only scattered reports of gastrointestinal carcinoids in two generations. The aim of this study was to describe the clinical characteristics as well as the histopathological, immunohistochemical (IHC) and genetic data of metastasizing ileal carcinoids in three consecutive first-degree relatives. Methods: The histopathological and IHC analyses were performed on newly cut sections of the tumor specimens and included growth pattern, proliferation index (Ki67) as well as expression of established neuroendocrine markers and recently introduced cocaine-amphetamine-regulated transcript (CART). The genetic analyses were focused on establishing whether a connection with the MEN 1 syndrome existed in this family, by means of mutation screening using polymerase chain reaction, multiple ligation-dependent probe amplification, and genotyping using fluorescent-labeled microsatellite markers. Results: Histopathology and IHC revealed that the tumors were virtually identical, with only minor differences in proliferation index and expression of CART. Genetic analyses indicated that the inheritance of the small bowel carcinoids in the family was not linked to the MEN1 gene. Conclusion: Metastasizing small bowel carcinoids have been found in first-degree relatives in three consecutive generations. All three tumors were very similar when characterized by histopathology and IHC. Based on clinical findings and genetic analyses, it seems unlikely, although not completely excluded, that inheritance was linked to the MEN 1 syndrome

  • 4.
    Landerholm, Kalle
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Falkmer, Sture
    Department of Clinical Pathology, Ryhov Hospital, Jönköping, Sweden.
    Järhult, Johannes
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Epidemiology of Small Bowel Carcinoids in a Defined Population2010In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 34, no 7, p. 1500-1505Article in journal (Refereed)
    Abstract [en]

    Background: This retrospective study describes the epidemiology of small bowel carcinoids in a geographically defined population, with no other selection bias.

    Methods: All patients (n = 145) resident in Jönkoping County when diagnosed with carcinoid in the jejunum or ileum from 1960 to 2005 were included. Medical records were reviewed in detail, and tumor specimens were histopathologically and immunohistochemically reexamined when required (n = 44).

    Results: The annual age-adjusted incidence of small bowel carcinoids was 1.12 (95% confidence interval 0.95-1.31) per 100,000 persons. Median age at diagnosis was 69 years. The predominating presenting symptom was uncharacteristic abdominal pain (50%), whereas a smaller number suffered from typical flushes (13%). Surprisingly, 14% presented with overt gastrointestinal hemorrhage. Most of the patients diagnosed based on their symptoms had metastases at diagnosis (44% regional, 40% distant). Metastasized tumors by definition belong to World Health Organization (WHO) histopathologic group 2; and when reexamined, most (83%) of the localized tumors were also found to belong to WHO group 2.

    Conclusions: In comparison to previous reports, a higher age-adjusted incidence of small bowel carcinoids was observed, and the patients were clearly older at the time of diagnosis. Even with metastatic disease, the presenting symptoms were usually uncharacteristic, and the carcinoid syndrome was infrequently seen.

  • 5.
    Landerholm, Kalle
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Shcherbina, Liliya
    Lund University, Department of Clinical Sciences in Malmö, Sweden.
    Falkmer, Sture E
    Department of Clinical Pathology, Ryhov Hospital, Jönköping, Sweden.
    Järhult, Johannes
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Wierup, Nils
    Lund University, Department of Clinical Sciences in Malmö, Sweden.
    Expression of Cocaine- and Amphetamine-Regulated Transcriptis Associated with Worse Survival in Small Bowel Carcinoid Tumors2012In: Clinical Cancer Research, ISSN 1078-0432, E-ISSN 1557-3265, Vol. 18, no 13, p. 3668-3676Article in journal (Refereed)
    Abstract [en]

    Purpose: Cocaine- and amphetamine-regulated transcript (CART) peptide exerts several regulatory functions acting both as neurotransmitter and hormone. We recently showed that CART is expressed in various neuroendocrine tumors, including small bowel carcinoid. The main objective of the present study was to examine whether CART expression is associated with survival in small bowel carcinoid patients. Secondary aims were to assess if CART expression is associated with other tumor characteristics or clinical symptoms.

    Experimental Design: Specimens from 97 patients with small bowel carcinoids were examined for CART expression using immunohistochemistry and in situ hybridization. A CART score was introduced based on the proportion of CART immunoreactive cells. On inclusion, specimens were examined by routine histopathological methods and detailed clinical patient data were retrieved. The effect of CART on cell viability was assessed in vitro using an enteroendocrine cell line.

    Results: Expression of CART (P = 0.011), and increasing CART score (P = 0.033) were associated with worse disease-specific survival. Adjusting for age, disease stage and tumor grade in multivariable analysis, CART expression was still associated with worse survival (Low CART hazard ratio (HR) 5.47, 95% confidence interval (CI) 0.71 to 42.46; and High CART HR 9.44, 95% CI 1.14 to 78.14). Expression of CART correlated with higher tumor grade, but not with age or disease stage, neither with weight loss or any other symptom. Supporting our clinical data, we found that CART promoted tumor cell viability in vitro.

    Conclusion: Expression of CART in small bowel carcinoid tumors is associated with worse survival.

  • 6.
    Landerholm, Kalle
    et al.
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Zar, N
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Andersson, R E
    Department of Clinical Surgery, Ryhov Hospital, Jönköping, Sweden.
    Falkmer, Sture E
    Department of Pathology, Ryhov Hospital, Jönköping, Sweden.
    Järhult, Johannes
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Survival and prognostic factors in patients with small bowel carcinoid tumour2011In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 98, no 11, p. 1617-1624Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies of small bowel carcinoid tumours usually presented overall or relative survival. This study, in addition, evaluated disease-specific survival in a cohort of patients in a geographically defined population.

    METHODS: Patients diagnosed with carcinoid of the jejunum or ileum in Jönköping County between 1960 and 2005 were eligible for inclusion. Available tumour specimens were re-examined to confirm the diagnosis. Medical records and pathology reports were reviewed in detail.

    RESULTS: A total of 145 patients were included in the study. One hundred and thirty-five patients underwent surgery in connection with the diagnosis. Resection was considered complete (R0) in 74 patients (54·8 per cent). Only two localized tumours recurred, whereas no patient with distant metastases was cured. Patients with regional metastases who underwent R0 resection had a better survival than patients with incomplete resection (P = 0·005), and a majority of patients remained recurrence-free. Median overall survival was 7·2 years and median disease-specific survival 12·3 years. In multivariable analysis, age 61-74 years (hazard ratio (HR) 3·78, 95 per cent confidence interval 1·86 to 7·68), age 75 years or more (HR 3·96, 1·79 to 8·74), distant metastases (HR 14·44, 1·59 to 131·36) and incomplete tumour resection (HR 2·71, 1·11 to 6·61) were associated with worse disease-specific survival. Later time period of diagnosis (HR 0·45, 0·24 to 0·84) was associated with better disease-specific survival.

    CONCLUSION: Age, disease stage and complete resection were identified as independent prognostic factors for survival in patients with small bowel carcinoid tumours. The importance of achieving R0 resection is therefore emphasized.

  • 7.
    Malterling, R R
    et al.
    Ryhov Hospital.
    Andersson, Roland E
    Ryhov Hospital.
    Falkmer, S
    Ryhov Hospital.
    Falkmer, U
    Ryhov Hospital.
    Niléhn, E
    Ryhov Hospital.
    Järhult, J
    Ryhov Hospital.
    Differentiated thyroid cancer in a Swedish county--long-term results and quality of life.2010In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 49, no 4, p. 454-459Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is still no complete agreement about the proper treatment of differentiated thyroid cancer (DTC).

    MATERIAL AND METHODS: All patients (n=130) with DTC in a defined population, treated with surgery between 1985 and 1999, were carefully followed up (median 13.1 years). Fifty three were operated with subtotal and 77 with total thyroidectomy. Twenty seven percent of the patients in the subtotal group and 56% of those in the total thyroidectomy group had postoperative radioiodine ablation. Thirty nine patients had papillary cancers incidentally detected during surgery for benign disorders (median size 7 (1-30) mm). Living patients answered the Swedish version of the SF-36 health survey.

    RESULTS: Eleven of 106 patients considered tumour-free after primary surgery developed recurrences during follow-up. Fifteen patients (12%) died from DTC but only one within stage I-II (1.2%). No patient below 50 years of age at diagnosis died from DTC. Only three of 29 patients with isolated loco-regional spreading of their disease at the time of diagnosis have died from thyroid cancer. There was no statistically significant difference in the 10 year cancer-specific survival rate between those operated with subtotal or total thyroidectomy--irrespective of stage. Survival rate was significantly better for papillary than for follicular cancer. Mental and physical quality of life among patients treated for DTC were similar to the healthy Swedish population.

    CONCLUSIONS: Patients with DTC stage I-II (according to TNM) or low-risk (according to AMES) have an excellent prognosis. Treatment as well as follow-up should not be exaggerated.

  • 8.
    Oscarsson Tibblin, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Gupta, Anil
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Järhult, Johannes
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nyström, Matti
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Pettersson, Eva
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Darvish, Bijan
    Department of Anaesthesia & Intensive Care University Hospital, Örebro, Sweden.
    Krook, Helena
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Eintrei, Christina
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Intensive Care UHL.
    To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial2010In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 104, no 3, p. 305-312Article in journal (Refereed)
    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.

     

  • 9.
    Winbladh, A
    et al.
    Highland Hospital, Eksjö.
    Järhult, Johannes
    Highland Hospital, Eksjö.
    Fate of the non-operated, non-toxic goitre in a defined population2008In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 3, p. 338-343Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is lack of consensus in Europe regarding the management of patients with benign goitre. This study evaluated the long-term results of recommending no surgery for clinically and cytologically benign goitre. METHODS: Some 261 patients (median age 56 years) referred for surgical evaluation for goitre were followed prospectively for a median of 130 months. All hospital and primary care charts were reviewed and living patients interviewed by telephone. RESULTS: During follow-up, 36.4 per cent of patients were re-referred for a new surgical evaluation, mainly because of growth of the goitre and/or worsening of local symptoms. Fifty-seven (21.8 per cent) of the patients had surgery, and 13 developed thyrotoxicosis. Five patients (1.9 per cent) were diagnosed with thyroid carcinoma, three of whom (all elderly women) died from the disease. Some 95.0 per cent of patients were satisfied with the expectant policy, but 13.1 per cent had been worried about thyroid cancer despite the reassurance of a benign diagnosis. CONCLUSION: Patients with benign goitre can be treated conservatively with good results. However, there is a small risk that aggressive carcinoma will develop and about a quarter of patients may need surgery within 10 years of the decision to wait and see. 

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