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  • 201. Radecka, E
    et al.
    Brekkan, E
    Juhlin, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Nilsson, L
    Sundin, A
    Magnusson, A
    An unusual case of tumor thrombus in the inferior vena cava. A case report.2003In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 44, p. 160-161Article in journal (Refereed)
  • 202.
    Ragnarsson, Eva Ge
    et al.
    Uppsala University.
    Schoultz, Ida
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Gullberg, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Carlsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Tafazoli, Farideh
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Lerm, Maria
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology .
    Magnusson, Karl-Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology .
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Artursson, Per
    Uppsala University.
    Yersinia pseudotuberculosis induces transcytosis of nanoparticles across human intestinal villus epithelium via invasin-dependent macropinocytosis2008In: Laboratory Investigation, ISSN 0023-6837, E-ISSN 1530-0307, Vol. 88, no 11, p. 1215-1226Article in journal (Refereed)
    Abstract [en]

    Crohns disease is characterized by a defect in intestinal barrier function, where bacteria are considered the most important inflammation-driving factor. Enteric bacteria, including E. coli and Yersinia spp, affect tight junctions in enterocytes, but little is known about bacterial effects on the transcellular pathway. Our objective was to study the short-term effects of Y. pseudotuberculosis on uptake of nanoparticles across human villus epithelium. Monolayers of human colon epithelium-derived Caco-2 cells and biopsies of normal human ileum were studied after 2 h exposure to Y. pseudotuberculosis expressing (inv+) or lacking (inv-) the bacterial adhesion molecule, invasin. Transepithelial transport of fluorescent nanoparticles (markers of transcytosis) was quantified by flow cytometry, and mechanisms explored by using inhibitors of endocytosis. Epithelial expressions of beta 1-integrin and particle uptake pathways were studied by confocal microscopy. The paracellular pathway was assessed by electrical resistance (TER), mannitol flux, and expression of tight junction proteins occludin and caludin-4 by confocal microscopy. Inv + Y. pseudotuberculosis adhered to the apical surface of epithelial cells and induced transcytosis of exogenous nanoparticles across Caco-2 monolayers (30-fold increase, P < 0.01) and ileal mucosa (268 +/- 47% of control; P < 0.01), whereas inv-bacteria had no effect on transcytosis. The transcytosis was concentration-, particle size-and temperature-dependent, and possibly mediated via macropinocytosis. Y. pseudotuberculosis also induced apical expression of beta 1-integrin on epithelial cells. A slight drop in TER was seen after exposure to inv+ Y. pseudotuberculosis, whereas mannitol flux and tight junction protein expression was unchanged. In summary, Y. pseudotuberculosis induced apical expression of beta 1-integrin and stimulated uptake of nanoparticles via invasin-dependent transcytosis in human intestinal epithelium. Our findings suggest that bacterial factors may initiate transcytosis of luminal exogenous particles across human ileal mucosa, thus presenting a novel mechanism of intestinal barrier dysfunction.

  • 203.
    Redéen, Stefan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Engström, Helena
    Erikson, Stina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Haldestam, Ingvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Leinsköld, Ted
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Johansson, Karl-Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Abdominell tuberkulos - en nygammal diagnostisk utmaning2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 30-31, p. 2151-2153Article in journal (Other academic)
  • 204.
    Redéen, Stefan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Petersson, F
    Jönsson, K-Å
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Borch, Kurt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Relationship of gastroscopic features to histological findings in gastritis and Helicobacter pylori infection in a general population sample2003In: Endoscopy, ISSN 0013-726X, E-ISSN 1438-8812, Vol. 35, no 11, p. 946-950Article in journal (Refereed)
    Abstract [en]

    Background and study aim: Various gastroscopic features may be interpreted as signs of gastritis, but the significance of such features in relation to histomorphology is uncertain. The aim of this study was to determine how macroscopic findings were related to histomorphological changes and the presence of Helicobacter pylori in the gastric mucosa, in a sample of the general population. Subjects and methods: 488 adult individuals, randomly selected from a general population, were screened with gastroscopy and biopsy. The macroscopic features recorded were erythema (diffuse, spotty, linear), erosions, absence of rugae in the gastric corpus, and presence of visible vessels. Gastritis was classified microscopically according to the Sydney system. The presence of H. pylori was determined histologically and using the urease test on fresh biopsy specimens. Results: The sensitivity and specificity of absence of rugae for moderate to severe atrophic gastritis in the gastric corpus were 67% and 85%, respectively. Corresponding valuers for severe atrophy were 90% and 84%. The sensitivity and specificity of the presence of visible vessels for moderate to severe atrophy in the corpus were 48% and 87%, and for severe atrophy the values were 80% and 87%, respectively. Considering the antrum, the sensitivity and specificity of the presence of visible vessels for moderate to severe atrophy was 14% and 91%, respectively. With regard to chronic inflammation (moderate to severe in the corpus or antrum), none of the features, alone or in combination, showed a sensitivity of more than 56%. No endoscopic features (alone or in combination) showed a sensitivity of more than 57 % for H. pylori infection. Conclusions: Except for the absence of rugae and visible vessels in the gastric corpus, macroscopic features as observed during gastroscopy are of very limited value in the evaluation of whether or not gastritis or H. pylori infection are present. This is in accordance with most previous studies in patient populations, and it must be emphasized that the diagnosis of gastritis should be based on histological examination of the gastric mucosa.

  • 205.
    Redéen, Stefan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Petersson, Fredrik
    National University Health System, Singapore.
    Kechagias, Stergios
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Mårdh, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Borch, Kurt
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Natural history of chronic gastritis in a population-based cohort2010In: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, ISSN 0036-5521, Vol. 45, no 5, p. 540-549Article in journal (Refereed)
    Abstract [en]

    Objective. To describe and explore the natural history of Helicobacter pylori infection and chronic gastritis in terms of gastric mucosal atrophy and ulcer development over time in a population-based cohort. Material and methods. A population-based cohort of 314 volunteers was re-screened (median follow-up interval of 8.4 years) with gastroduodenoscopy with biopsy, assessment of H. pylori status, analysis of pepsinogens, and monitoring of a nonsteroidal anti-inflammatory drug (NSAID) use and alcohol and smoking habits. Results. The incidence of duodenal or prepyloric ulcer was 0.45 per 100 person years and was associated with weekly NSAID use (odds ratios, OR 27.8), weekly alcohol consumption (OR 19.4) and smoking (OR 31.0), but not with H. pylori status. De novo infection with H. pylori was not observed, and the infection had disappeared in 11 of 113 subjects. Among subjects with chronic gastritis, the incidence of atrophy of the corpus mucosa was 1.4 per 100 person years. Atrophy development was related to age (OR 1.23) and to the severity of chronic inflammation in the corpus mucosa at baseline (OR 8.98). Substituting atrophy for subnormal S-pepsinogen I/S-pepsingen II gave similar results. Conclusions. In this cohort, the minimum incidence of ulcer was 0.45 per 100 person years. Smoking, alcohol, and NSAIDs, but not H. pylori infection were significant risk factors. The incidence of atrophy of the corpus mucosa was 1.4 per 100 person years with a positive relation to age and to the degree of chronic inflammation at baseline. Atrophy was stationary in advanced stages.

  • 206.
    Redéen, Stefan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Ryberg, Anna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Petersson, Fredrik
    Ryhov Hospital.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Nägga, Katarina
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Borch, Kurt
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Homocysteine Levels in Chronic Gastritis and Other Conditions: Relations to Incident Cardiovascular Disease and Dementia2010In: DIGESTIVE DISEASES AND SCIENCES, ISSN 0163-2116, Vol. 55, no 2, p. 351-358Article in journal (Refereed)
    Abstract [en]

    Background Homocysteine levels in circulation are determined by several factors and hyperhomocysteinemia is reportedly associated with cardiovascular diseases and dementia. The aim of this study is to determine the relation of chronic gastritis and other conditions to homocysteine levels and their relation to incident cardiovascular diseases and dementia. Methods An adult population-based cohort (N = 488) was screened for H. pylori infection, gastro-duodenitis ( endoscopic biopsies), disease history, and lifestyle factors. Blood samples were analyzed for pepsinogen I and II ( gastric function), vitamin B12, folate, homocysteine, and cystatin C ( renal function). The methylenetetrahydrofolate reductase C677T polymorphism reportedly associated with hyperhomocysteinemia was analyzed by pyrosequencing. Incident cardiovascular diseases and dementia were monitored during a median follow-up interval of 10 years. Results At baseline, there was a positive relation of S-homocysteine to male gender, age, S-cystatin C, methylenetetrahydrofolate reductase 677TT genotype and atrophic gastritis. During follow-up, cardiovascular diseases occurred in 101/438 and dementia in 25/488 participants, respectively. Logistic regression analysis ( adjusting for gender, age at baseline, follow-up interval, BMI, smoking, alcohol consumption, NSAID use, P-cholesterol, and P-triglycerides) showed an association of S-homocysteine higher than 14.5 mu mol/l to cardiovascular diseases (OR 2.05 [95% c.i. 1.14-3.70]), but not to dementia overall. Conclusions Gender, age, vitamin B12, folate, renal function, atrophic gastritis and the methylenetetrahydrofolate 677TT genotype were significant determinants of homocysteine levels, which were positively related to incident cardiovascular diseases.

  • 207.
    Ringberg, A.
    et al.
    Department of Plastic Surgery, Malmö University Hospital, Malmö, Sweden.
    Nordgren, H.
    Department of Pathology, University Hospital, Uppsala, Sweden.
    Thorstensson, S.
    Department of Pathology, Central Hospital, Kalmar, Sweden.
    Idvall, I.
    Department of Pathology, Malmö University Hospital, Malmö, Sweden.
    Garmo, H.
    Regional Oncologic Center, University Hospital, Uppsala, Sweden.
    Granstrand, B.
    Department of Surgery, Norrland University Hospital, Umeå, Sweden.
    Arnesson, Lars-Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sandelin, K.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Wallgren, A.
    Department of Oncology, Sahlgenska University Hospital, Gothenburg, Sweden.
    Anderson, H.
    Regional Oncologic Center, University Hospital, Lund, Sweden.
    Emdin, S.
    Department of Surgery, Norrland University Hospital, Umeå, Sweden.
    Holmberg, L.
    Regional Oncologic Center, University Hospital, Uppsala, Sweden.
    Histopathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast - Results from the Swedish randomised trial2007In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 43, no 2, p. 291-298Article in journal (Refereed)
    Abstract [en]

    Aim: The primary aims were to study risk factors for an ipsilateral breast event (IBE) after sector resection for ductal carcinoma in situ of the breast (DCIS) in a trial comparing adjuvant radiotherapy to no therapy and to assess predictive factors for response to radiotherapy. Secondary aims were to analyse reproducibility of the histopathological evaluation and to estimate correctness of diagnosis in the trial. Setting: A randomised trial in Sweden (the SweDCIS trial), including 1046 women with a median of 5.2 years of follow-up in a population, offered routine mammographic screening. Methods: A case-cohort design with a total of 161 cases of IBE (42 of those being members of the subcohort) and 284 sampled for the sub-cohort. Ninety five percent of the participants' slides could be retrieved and were re-evaluated by three experienced pathologists. Results: Low nuclear grade (NG 1-2) and absence of necrosis halves the risk of IBE in both irradiated and non-irradiated patients. Lesion size, margins of excision and age at diagnosis did not modify these associations. The presence of necrosis modified the effect of radiotherapy: relative risk was 0.40 with necrosis present and 0.07 with necrosis absent (p-value for interaction 0.068). In all subsets of prognostic factors, radiotherapy conferred a substantial benefit. The risk factors for in situ and invasive IBE were similar. The agreement between pathologists was moderate (? = 0.486). Correctness of diagnosis in the subcohort of SweDCIS was 84.8%. Conclusion: Although nuclear grade and necrosis carry prognostic information, we could not define a group with very low risk after sector resection alone. Radiotherapy has a protective effect in all substrata of risk factors studied. The interaction between the presence of necrosis and radiotherapy is a clinically and biologically relevant research area. © 2006 Elsevier Ltd. All rights reserved.

  • 208.
    Rubér, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Berg, A
    Ekerfelt, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology.
    Olaison, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Andersson, Roland
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis2006In: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249, Vol. 143, no 1, p. 117-124Article in journal (Refereed)
    Abstract [en]

    Appendicitis is one of the most common and costly acute abdominal states of illnesses. Previous studies suggest two types of appendicitis which may be different entities, one which may resolve spontaneously and another that progresses to gangrene and perforation. Gangrenous appendicitis has a positive association to states of Th1 mediated immunity whereas Th2 associated immune states are associated with lower risk of appendicitis. This study investigated the inflammatory response pattern in patients previously appendicectomized for gangrenous (n = 7), or phlegmonous appendicitis (n = 8) and those with a non-inflamed appendix (n = 5). Peripheral blood mononuclear cells were analysed with ELISPOT analysis for number of spontaneous or antigen/mitogen stimulated IFN-γ, IL-4, IL-10 and IL-12 secreting cells or with ELISA for concentration of spontaneous or antigen/mitogen stimulated IFN-γ, IL-5 and IL-10. Spontaneously IL-10 secreting cells/100 000 lymphocytes were increased in the gangrenous group compared to the phlegmonous group (P = 0.015). The median concentration of IL-10 secreted after Tetanus toxoid (TT)-stimulation were higher in the gangrenous group and the control group, than the phlegmonous group (P = 0.048 and P = 0.027, respectively). The median concentration of TT induced IFN-γ secretion was higher for the gangrenous group compared to both the phlegmonous group and the control group (P = 0.037 and P = 0.003). Individuals with a history of gangrenous appendicitis demonstrated ability to increased IL-10 and IFN-γ production. The increased IFN-γ may support the notion of gangrenous appendicitis as an uncontrolled Th1 mediated inflammatory response and increased IL-10 may speculatively indicate the involvement of cytotoxic cells in the progression to perforation. © 2005 British Society for Immunology.

  • 209.
    Ryberg, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Borch, Kurt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sun, Yi-Qian
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Monstein, Hans-Jürg
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology .
    Concurrent genotyping of Helicobacter pylori virulence genes and human cytokine SNP sites using whole genome amplified DNA derived from minute amounts of gastric biopsy specimen DNA2008In: BMC Microbiology, ISSN 1471-2180, E-ISSN 1471-2180, Vol. 8, p. 175-Article in journal (Refereed)
    Abstract [en]

    Background: Bacterial and cellular genotyping is becoming increasingly important in the diagnosis of infectious diseases. However, difficulties in obtaining sufficient amount of bacterial and cellular DNA extracted from the same human biopsy specimens is often a limiting factor. In this study, total DNA (host and bacterial DNA) was isolated from minute amounts of gastric biopsy specimens and amplified by means of whole genome amplification using the multiple displacement amplification (MDA) technique. Subsequently, MDA-DNA was used for concurrent Helicobacter pylori and human host cellular DNA genotyping analysis using PCR-based methods.

    Results: Total DNA was isolated from gastric biopsy specimens of 12 subjects with gastritis and 16 control subjects having a normal mucosa. The DNA was amplified using a multiple displacement amplification (MDA) kit. Next, concurrent genotyping was performed using H. pylori-specific virulence gene PCR amplification assays, pyrosequencing of bacterial 16S rDNA and PCR characterisation of various host genes. This includes Interleukin 1-beta (IL1B) and Interferon-gamma receptor (IFNGR1) SNP analysis, and Interleukin-1 receptor antagonist (IL1RN) variable tandem repeats (VNTR) in intron 2. Finally, regions of the vacA-gene were PCR amplified using M13-sequence tagged primers which allowed for direct DNA sequencing, omitting cloning of PCR amplicons. H. pylori specific multiplex PCR assays revealed the presence of H. pylori cagA and vacA genotypic variations in 11 of 12 gastritis biopsy specimens. Using pyrosequencing, 16S rDNA variable V3 region signatures of H. pylori were found in 11 of 12 individuals with gastritis, but in none of the control subjects. Similarly, IL1B and IFNGR1-SNP and IL1RN-VNTR patterns could be established in all individuals. Furthermore, sequencing of M13-sequence tagged vacA-PCR amplicons revealed the presence of highly diverse H. pylori vacA-s/i/m regions.

    Conclusion: The PCR-based molecular typing methods applied, using MDA-amplified DNA derived from small amounts of gastric biopsy specimens, enabled a rapid and concurrent molecular analysis of bacterial and host genes in the same biopsy specimen. The principles and technologies used in this study could also be applied to any situation in which human host and microbial genes of interest in microbial-host interactions would need to be sequenced.

  • 210.
    Rydén, Lisa
    et al.
    Department of Surgery, Helsingborgs Lasarett, Helsingborg, Sweden and Department of Laboratory Medicine, div of Pathology, University Hospital, Malmö.
    Jönsson, Per-Ebbe
    Department of Surgery, Helsingborgs Lasarett, Helsingborg, Sweden.
    Chebil, Gunilla
    Department of Pathology, Helsingborgs Lasarett, Helsingborg.
    Dufmats, Monika
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Fernö, Mårten
    Department of Oncology, University Hospital, Lund.
    Jirström, Karin
    Department of Laboratory Medicine, div of Pathology, University Hospital, Malmö.
    Källström, Ann-Christine
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Landberg, Göran
    Department of Laboratory Medicine, div of Pathology, University Hospital, Malmö.
    Stål, Olle
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Thorstenson, Sten
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Nordenskjöld, Bo
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Two years of adjuvant tamoxifen in premenopausal patients with breast cancer: a randomised, controlled trial with long-term follow-up2005In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 41, no 2, p. 256-264Article in journal (Refereed)
    Abstract [en]

    Adjuvant tamoxifen treatment increases recurrence-free survival (RFS) and overall survival (OS) in early breast cancer, although in premenopausal patients the number of studies comparing tamoxifen vs no treatment are limited. We report herein the effect on RFS of adjuvant tamoxifen treatment in a multicentre trial of premenopausal patients with stage II breast cancer patients randomised between 1986 and 1991 to 2 years of tamoxifen treatment (n = 276) or no treatment (n = 288). The receptor status of the tumour was known for 541 (96%) of the patients included. Tamoxifen treatment significantly increased RFS in patients with hormone receptor-positive (oestrogen receptor-positive (ER+) and/or progesterone receptor-positive (PR+)) tumours (Relative Risk (RR) 0.65; 95% Confidence Interval (CI): 0.48–0.89, P = 0.006), and the beneficial effect of tamoxifen was extended to patients with indicators of poor prognosis, such as young age and nodal-positivity. PR status was a significant predictor of response to tamoxifen in multivariate models with testing of interactions of hormone receptor status and adjuvant therapy.

  • 211.
    Salim, Sa'ad
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Silva, Manuel A
    McMaster University.
    Keita, Åsa
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Larsson, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Molecular Virology . Linköping University, Faculty of Health Sciences.
    Andersson, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Perdue, Mary H
    McMaster University.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    CD83(+)CCR7(-) Dendritic Cells Accumulate in the Subepithelial Dome and Internalize Translocated Escherichia coli HB101 in the Peyers Patches of Heal Crohns Disease2009In: American Journal of Pathology, ISSN 0002-9440, E-ISSN 1525-2191, Vol. 174, no 1, p. 82-90Article in journal (Refereed)
    Abstract [en]

    Recurrent Crohns disease originates with small erosions in the follicle-associated epithelium overlying the Peyers patches. Animal studies have illustrated mucosal immune regulation by dendritic cells located in the subepithelial dome. The aim of this study was to characterize the dendritic cells at this specific site in patients with Crohns disease. Heal tissues were obtained after surgery performed on Crohns patients; ileal samples from noninflammatory bowel disease and ulcerative colitis served as standard and inflammatory controls, respectively. Flow cytometry of isolated intestinal mononuclear cells showed a larger subset of dendritic cells in Crohns samples compared with controls. This finding was corroborated by confocal microscopy, showing enhanced infiltrates of cells positive for the dendritic cell markers, DC-SIGN(+) and CD83(+), in the subepithelial dome. Moreover, the CD83(+) cells in Crohns tissues showed reduced expression of the lymph node migratory receptor, CCR7, possibly contributing to the high numbers of dendritic cells. After exposure to nonpathogenic Escherichia coli in Ussing chambers, dendritic cells in the subepithelial dome of Crohns disease demonstrated increased co-localization with translocated bacteria. Immunohistochemical results revealed that DC-SIGN(+) cells in Crohns tissues were found to express toll-like receptor 4 and produce tumor necrosis factor-a. In conclusion, nonmigrating dendritic cells that accumulate in the subepithelial dome and internalize nonpathogenic bacteria may be important for the onset and perpetuation of mucosal inflammation in Crohns disease.

  • 212.
    Salim, Sa´ad
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Importance of Disrupted Intestinal Barrier in Inflammatory Bowel Diseases2011In: INFLAMMATORY BOWEL DISEASES, ISSN 1078-0998, Vol. 17, no 1, p. 362-381Article, review/survey (Refereed)
    Abstract [en]

    The current paradigm of inflammatory bowel diseases (IBD), both Crohns disease (CD) and ulcerative colitis (UC), involves the interaction between environmental factors in the intestinal lumen and inappropriate host immune responses in genetically predisposed individuals. The intestinal mucosal barrier has evolved to maintain a delicate balance between absorbing essential nutrients while preventing the entry and responding to harmful contents. In IBD, disruptions of essential elements of the intestinal barrier lead to permeability defects. These barrier defects exacerbate the underlying immune system, subsequently resulting in tissue damage. The epithelial phenotype in active IBD is very similar in CD and UC. It is characterized by increased secretion of chloride and water, leading to diarrhea, increased permeability via both the transcellular and paracellular routes, and increased apoptosis of epithelial cells. The main cytokine that seems to drive these changes is tumor necrosis factor alpha in CD, whereas interleukin (IL)-13 may be more important in UC. Therapeutic restoration of the mucosal barrier would provide protection and prevent antigenic overload due to intestinal "leakiness. Here we give an overview of the key players of the intestinal mucosal barrier and review the current literature from studies in humans and human systems on mechanisms underlying mucosal barrier dysfunction in IBD.

  • 213.
    Sandström, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Trulsson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Gasslander, Thomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sundqvist, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology .
    von Dobeln, U.
    Department of Laboratory Medicine Karolinska University Hospital Huddinge, Stockholm.
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Serum amino acid profile in patients with acute pancreatitis2008In: Amino Acids, ISSN 0939-4451, E-ISSN 1438-2199, Vol. 35, no 1, p. 225-231Article in journal (Refereed)
    Abstract [en]

    Patients in the early phase of acute pancreatitis (AP) have reduced serum levels of arginine and citrulline. This may be of patho-biological importance, since arginine is the substrate for nitric oxide, which in turn is involved in normal pancreatic physiology and in the inflammatory process. Serum amino acid spectrum was measured daily for five days and after recovery six weeks later in 19 patients admitted to the hospital for acute pancreatitis. These patients had abnormal levels of most amino acids including arginine, citrulline, glutamine and glutamate. Phenylalanine and glutamate were increased, while arginine, citrulline, ornithine and glutamine were decreased compared to levels after recovery. NO2/NO3 concentration in the urine, but not serum arginase activity, was significantly increased day 1 compared to day 5 after admission. Acute pancreatitis causes a disturbance of the serum amino acid spectrum, with possible implications for the inflammatory process and organ function both in the pancreas and the gut. Supplementation of selected amino acids could possibly be of value in this severe condition. © 2007 Springer-Verlag.

  • 214. Sayer, Brooke
    et al.
    Lu, Jun
    Green, Christina
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Akhtar, Mahmood
    McKay, Derek M
    Dextran sodium sulphate-induced colitis perturbs muscarinic cholinergic control of colonic epithelial ion transport2002In: British Journal of Pharmacology, ISSN 0007-1188, E-ISSN 1476-5381, Vol. 135, p. 1794-1800Article in journal (Refereed)
  • 215.
    Schoultz, Ida
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Carlsson, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Gullberg, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Almer, Sven
    Linköping University, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Endocrinology and Gastroenterology.
    Ström, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Endocrinology and Gastroenterology.
    Lerm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    McKay, Derek M.
    Department of Physiology and Biophysics, University of Calgary, Calgary, Canada.
    Rhodes, Jonathan M.
    Department of Medicine, Henry Wellcome Laboratory of Molecular and Cellular Gastroenterology, University of Liverpool, Liverpool, United Kingdom.
    Söderholm, Johan D.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Infliximab reduces bacterial uptake in mucosal biopsies of Crohn’s colitis viamicrotubule-dependent pathwayManuscript (preprint) (Other academic)
    Abstract [en]

    Background: A defective intestinal barrier, shown by increased paracellular permeability is an importantpathogenic factor in Crohn’s disease (CD). TNFα is a key mediator in the regulation of the intestinal barrierfunction. Treatment with antibodies directed against TNFα, such as infliximab, has been established as animportant part of the therapeutic arsenal in severe Crohn’s disease, but the mechanisms of action have yet tobe elucidated. Part of infliximab’s effect has been suggested to be reduced apoptosis of epithelial cells andthereby reduced paracellular permeability. Our aim was to study how infliximab affects uptake of adherent E.coli across the colonic mucosa in CD.

    Method: Seven patients with active CD colitis were examined before and after a four week treatment withinfliximab. Control biopsies were taken from healthy volunteers (4) and patients undergoing controlexamination for colonic polyps (4), aged 36 (range 25-81), coloscopy. Biopsies were taken from macroscopicallynon-inflamed descending colon and were mounted in Ussing chambers to study barrier function. Transmucosalpassage of green fluorescent protein (GFP) incorporated E. coli HM427, an adherent bacteria isolated from thecolon of a CD patient, was studied by quantifying the translocated fluorescent bacteria using flow cytometry.

    Results: Bacterial passage across the colonic mucosa was increased in CD (2500 ± 300 arb. units) comparedwith controls (960 ± 280; p<0.05), and was reduced to 500 ± 200 units after the infliximab treatment (p<0.05).In biopsies treated with colchicine (a microtubuline inhibitor) uptake of E. coli HM427 was reduced by 2/3compared to non-treated biopsies.

    Conclusion: Patients with active Crohn’s disease showed a defect in the barrier to adherent E. coli, which waspartly mediated through a microtubule dependent uptake. The four week treatment with infliximab improvedthe intestinal barrier to these bacteria. This may constitute an important part of infliximab’s mechanisms ofaction in active colitis.

  • 216.
    Schoultz, Ida
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Kufer, Thomas
    Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany.
    Jiang, Tieshan
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Jandu, Narveen
    University of Toronto, Toronto, Canada.
    Söderkvist, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Lerm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Söderholm, Johan D.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Ubiquitination and degradation of the Crohn’s Disease associated protein Nod2involves the E2 enzyme UBE2G2Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Mutations predisposing to Crohn’s disease (CD) have been mapped to the CARD15/Nod2 locus,which encodes a cytoplasmic receptor hereafter referred to as Nod2, a member of the NACHT-LRR (NLR) familyof pattern recognition receptors. The binding of bacterial muramyl dipeptide (MDP) to Nod2 triggers theactivation of the nuclear factor-κB (NFκB) pathway, thereby inducing a number of pro-inflammatory genes. Themost common variant of Nod2 associated with CD is the frame shift mutation L1007fs, which results in atruncated form of the protein unable to respond to MDP. Despite active research, little is known about howNod2 is regulated. The aim of this study was to investigate if the cellular Nod2 protein level is regulated by theubiquitin-proteasome pathway.

    Material and Methods/Results: Nod2 was shown to be subjected to rapid turnover in the colorectal cancer cellline SW480 as measured by immunoprecipitation following inhibition of protein synthesis with cyklohexamide.Immunoprecipitation of Nod2 also revealed co-precipitation of ubiquitin, suggesting that Nod2 wasubiquitinated. In line with this observation, inhibition of the proteasome using MG-132 or lactacystin, resultedin increased levels of Nod2 in the cells. UBE2G2, an E2 enzyme, thus conferring specificity of ubiquitin binding,was identified to have affinity for the CARD domain of Nod2. Activation of Nod2 with MDP enhanced itsubiquitination, and increasing amounts of UBE2G2 in the cells abrogated NFB-activation, suggesting thatubiquitination of Nod2 may be important for the resolution of the inflammatory signal.

    Conclusion: Taken together, our results show that the cellular level of Nod2 protein is regulated via theubiquitin-proteasome pathway, suggesting that Nod2-driven inflammation may be resolved through rapiddegradation of Nod2. Consequently, not only polymorphisms in Nod2 directly, but also in genes regulatingNod2 protein levels may contribute to the susceptibility to Crohn’s disease.

  • 217.
    Schoultz, Ida
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Verma, Deepti
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Halfvarsson, Jonas
    Örebro University Hospital.
    Torkvist, Leif
    Karolinska University Hospital.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Sjoqvist, Urban
    Karolinska University Hospital.
    Lordal, Mikael
    Karolinska University Hospital.
    Tysk, Curt
    Örebro University Hospital.
    Lerm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Söderkvist, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Söderholm, Johan D
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Combined Polymorphisms in Genes Encoding the Inflammasome Components NALP3 and CARD8 Confer Susceptibility to Crohns Disease in Swedish Men2009In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 104, no 5, p. 1180-1188Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES : Crohns disease (CD) is characterized by overproduction of proinflammatory cytokines like interleukin (IL)-1 beta. Production of mature IL-1 beta is dependent on a caspase-1-activating protein complex called the NALP3 inflammasome, composed of NALP3, ASC, and CARD8. NALP3 shares structural similarities with Nod2, and both of these proteins are required for bacteria-induced IL-1 beta secretion. The combination of the polymorphisms CARD8 (C10X) and NALP3 (Q705K) was recently shown to be associated with rheumatoid arthritis. Our aim was to investigate whether these combined polymorphisms play a role in the susceptibility to CD.

    METHODS: The study included 498 CD patients in two cohorts from different regions and 742 control individuals from a Swedish population. DNA was isolated from whole blood. Polymorphisms of (Q705K) NALP3 and (C10X) CARD8, as well as the Nod2 variants, R702W and G908R, were genotyped using the Taqman single nucleotide polymorphism assay. The Nod2 frameshift mutation, L1007fs, was detected by Megabace SNuPe genotyping.

    RESULTS: Our results show that men who have both the C10X and Q705K alleles in CARD8 and NALP3, and who express wild-type alleles of Nod2 are at an increased risk of developing CD (odds ratio, OR: 3.40 range: 1.32-8.76); P = 0.011). No association with these polymorphisms was found in women (OR: 0.89 (range: 0.44-1.77); P = 0.74).

    CONCLUSIONS: We suggest a role for combined polymorphisms in CARD8 and NALP3 in the development of CD in men, with obvious sex differences in the genetic susceptibility pattern. These findings give further support to the importance of innate immune responses in CD.

  • 218.
    Shabo, Ivan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Olsson, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Molecular and Immunological Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Sun, Xiao-Feng
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Svanvik, Joar
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Expression of the macrophage antigen CD163 in rectal cancer cells is associated with early local recurrence and reduced survival time.2009In: International journal of cancer. Journal international du cancer, ISSN 1097-0215, Vol. 125, no 8, p. 1826-1831Article in journal (Refereed)
    Abstract [en]

    Expression of the macrophage antigen CD163 in breast cancer cells is recently shown to be related to early distant recurrence and shortened survival. In this study, 163 patients with rectal cancer, included in the Swedish rectal cancer trial and followed up for a median of 71 months, were examined for the expression of CD163 in the primary tumors. The cancer cells expressed CD163 in the primary tumors in 23% (n = 32) of the patients. In pretreatment biopsies from 101 patients, 10 had CD163-positive cancers and these patients had earlier local recurrence (p < 0.044) and reduced survival time (p < 0.045) compared with those with CD163-negative tumors. When studying surgical specimens from 61 patients randomized to preoperative irradiation (5 x 5 Gy delivered in 1 week), it was found that 31% were CD163 positive whereas the corresponding figure was only 17% for 78 patients who were nonirradiated (p < 0.044), which tentatively may be consistent with X-rays inducing fusion. In CD163-positive tumors there was a reduced apoptotic activity as measured with the Termina deoxynucleotidyl Transferase Biotin-dUTP Nick End Labeling (TUNEL) technique (p = 0.018). There tended also to be an increased proliferation activity measured as an expression of Ki-67 non significant (NS). It is concluded that primary rectal cancers may express CD-163, and this phenotypic macrophage trait is related to early local recurrence, shorter survival time and reduced apoptosis. Furthermore, the expression of CD163 is more common after irradiation.

  • 219.
    Silva, M.A.
    et al.
    Department of Pathology and Molecular Medicine, McMaster University, Health Science Centre 3N5C, 1200 Main St. West, Hamilton, ON L8N 3Z5, Canada.
    Quera, R.
    Internal Medicine Department, University of Chile Clinical Hospital, Clínica Las Condes, Santiago, Chile.
    Valenzuela, J.
    Internal Medicine Department, University of Chile Clinical Hospital, Clínica Las Condes, Santiago, Chile.
    Salim, Sa´ad
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Perdue, M.H.
    Department of Pathology and Molecular Medicine, McMaster University, Health Science Centre 3N5C, 1200 Main St. West, Hamilton, ON L8N 3Z5, Canada.
    Dendritic cells and toll-like receptors 2 and 4 in the ileum of Crohn's disease patients2008In: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568, Vol. 53, no 7, p. 1917-1928Article in journal (Refereed)
    Abstract [en]

    We investigated myeloid-dendritic cell (DC) marker and Toll-like receptor (TLR)-2 and 4 distributions in ileal samples from Crohn's disease (CD) patients (n = 14) and controls (n = 13). In controls, no TLR-2+ cells were observed, and higher numbers of TLR-4+ and DC-SIGN+ cells (P < 0.01) were detected in ileal samples when compared versus colonic tissues. In non-inflamed CD ileum, TLR-4+ and DC-SGN+ cells were depleted from superficial areas of the villus, and a significant CD1a+ cell infiltration (P < 0.01) was observed when compared to ileal controls and non-inflamed colonic CD samples. In inflamed CD ileum, DC-SIGN+, CD1a+, TLR-4+ and few TLR-4 +DC-SIGN+ cells were detected as well as CD83 depletion. No correlation between TLR-2 and DC markers was detected in CD samples. A unique distribution of myeloid-DC markers characterized the CD ileum. Also, the presence of significant amounts of ileal CD1a+ cells may provide a relevant DC-mediated mechanism for antigen recognition in the pathogenesis of CD. © 2007 Springer Science+Business Media, LLC.

  • 220.
    Sjodahl, Rune
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Proposal: a score to select patients for fistulotomy2010In: COLORECTAL DISEASE, ISSN 1462-8910, Vol. 12, no 5, p. 487-489Article in journal (Refereed)
    Abstract [en]

    Traditionally the distance between the inner opening and the anal verge is considered when making the decision to lay open an anal fistula or not. In contrast to this, the score presented here includes the distance to the upper border of the puborectalis muscle or to the external sphincter (anteriorly). In addition this score also takes various aspects of bowel function into consideration.

  • 221.
    Sjödahl, Rune
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Hammarström, M
    Wiklund, L
    Larsson, LT
    Behndig, A
    Collective affiliation to the Medical Society is old-fashioned - time for renewal2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 218-219Article in journal (Other academic)
  • 222.
    Sjödahl, Rune
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Johansen, Lars
    Wallin, Göran
    Kirurgernas jourverksamhet måste förändras för att klara nyrekryteringen2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, p. 311-313Article in journal (Other academic)
  • 223.
    Sjödahl, Rune
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Myrelid, Pär
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Anal and rectal cancer in Crohn's disease2003In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 5, no 5, p. 490-495Article in journal (Refereed)
    Abstract [en]

    Several epidemiological studies have been published regarding the risk of Crohn's disease- associated colorectal cancer. The findings are, however, contradictory and it has been particularly difficult to obtain indisputable information on the incidence of cancer limited to the rectum and the anus. During 1987-2000 rectal or anal cancer was diagnosed in 335 patients in Sweden (153 males, 182 females). In other words, approximately 3 Crohn patients per million inhabitants were diagnosed with rectal or anal cancer every year during that time period which is 1% of the total number of cases. At diagnosis of cancer 36% were aged below 50 years and 58% below 60 years. Corresponding figures for all cases of anal and rectal cancer were 5% and 18%, respectively. Present knowledge from the literature implies that there is an increased risk of rectal and anal cancer only in Crohn's disease patients with severe proctitis or severe chronic perianal disease. However, the rectal remnant must also be considered a risk factor. Multimodal treatment is similar to that in sporadic cancer but proctectomy and total or partial colectomy is added depending on the extent of the Crohn's disease. The outcome is the same as in sporadic cancer at a corresponding stage but the prognosis is often poor due to the advanced stage of cancer at diagnosis. We suggest that six high-risk groups should be recommended annual surveillance after a duration of Crohn's disease of 15 years including extensive colitis, chronic severe anorectal disese, rectal remnant, strictures, bypassed segments and sclerosing cholangitis.

  • 224.
    Sjöstedt, Camilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Hannestad, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of clinical chemistry.
    Franzén, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Borch, Kurt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Atrophic gastritis is associated with increased sucrose permeability related to chronic inflammation2005In: Digestion, ISSN 0012-2823, E-ISSN 1421-9867, Vol. 72, no 4, p. 201-206Article in journal (Refereed)
    Abstract [en]

    Background: Different theories have been presented to explain how atrophic gastritis may lead to gastric cancer development. One contributing factor could be impaired function of the gastric mucosal barrier. The aim of this study was to investigate if there are changes in gastric mucosal permeability to sucrose in atrophic gastritis. Methods: The study comprised 22 patients with atrophic gastritis and 21 normal controls. Gastritis was classified according to the Sydney system from endoscopic biopsies of the gastric corpus and antrum. All subjects were exposed to oral sucrose load (100 g), and the fraction of sucrose excreted in urine was measured by gas chromatography-mass spectrometry. Results: The fraction of sucrose excreted in urine after oral load was significantly increased in atrophic gastritis compared with controls (median 0.08 vs. 0.04%, p = 0.003). Sucrose excretion was positively related to the degree of chronic inflammation (median fraction excreted: mild inflammation 0.06%, moderate inflammation 0.08%, severe inflammation 0.18%, p = 0.04) rather than to the degree of atrophy in the gastric mucosa. Occurrence of intestinal metaplasia was also associated with significantly higher sucrose excretion. However, in multivariate analysis, including intestinal metaplasia, only the degree of inflammation was positively related to sucrose excretion. Conclusion: Atrophic gastritis is associated with increased sucrose permeability, suggesting paracellular leakage of the gastric mucosa. This leakage seems to be related to the degree of inflammation rather than the degree of atrophy. The findings may have implications for the diseases and complications associated with atrophic gastritis. Copyright © 2005 S. Karger AG.

  • 225. Skarsgård, Constance
    et al.
    Berg, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Ekblad, G
    Wiklund, I
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Effects of estrogen therapy on well-being in postmenopausal women without vasomotor complaints2000In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 36, no 2, p. 123-130Article in journal (Refereed)
    Abstract [en]

    Objective: To establish whether estrogen treatment affects well-being in postmenopausal women without current or previous vasomotor symptoms. Design: Forty postmenopausal women, aged 45-59 years, without current or previous vasomotor complaints, were included. They were randomized to masked treatment with either transdermal 17▀-estradiol 50 ╡g/24 h or to placebo. At baseline and after 12 and 14 weeks of treatment, the women completed a questionnaire which reflects well-being, the Psychological General Well-Being (PGWB) Index. Results: The women scored high on the PGWB Index, both at baseline and after 12 and 14 weeks of treatment. There was no significant difference in well- being according to PGWB Index between the groups treated with estrogen and placebo, neither at baseline, nor after therapy. Furthermore, there was no difference in change during therapy between the treatment groups. Conclusion: There is a gradual decline in estrogen during the climacteric, and it is controversial to which extent this affects women's mental health. The PGWB scores in this study were high before therapy, reflecting that these women without previous or current vasomotor complaints represented a selected sample. Neither short-term estrogen treatment over 12 weeks nor addition with medroxyprogesterone acetate during 2 weeks improved well-being in postmenopausal women without vasomotor symptoms who had high well-being at baseline. (C) 2000 Elsevier Science Ireland Ltd.

  • 226. Skoglund, Johanna
    et al.
    Emterling, Anna
    Arbman, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Anglard, Patrick
    Sun, Xiao-Feng
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Oncology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Clinicopathological significance of stromelysin-3 expression in colorectal cancer2004In: Oncology, ISSN 0890-9091, Vol. 67, no 1, p. 67-72Article in journal (Refereed)
    Abstract [en]

    Objective: Stromelysin-3 (ST3) is a member of the matrix metalloproteinases and suggested to play a role in tissue remodeling observed in growth and metastasis of tumors. ST3 overexpression in breast cancer is associated with a worse outcome. Our aims were to analyze ST3 expression in primary colorectal tumors and metastases, and further to identify relationships of the expression to clinicopathological factors. Materials and Methods: ST3 expression was immunohistochemically analyzed in 200 primary colorectal adenocarcinomas and 36 corresponding lymph node metastases. Results: Scoring was performed by counting the percentages of positive cells and the percentages of positive areas. One hundred and one (51%) cases showed ≤5% positive cells and 99 (49%) >5% positive cells. One hundred and two (51%) cases showed ≤30% positive area and 98 (49%) >30% positive area. ST3 expression determined by both scoring methods was individually related to females, distally located tumors, infiltrative growth pattern and microsatellite stability. No relationship was found with age, Dukes' stage, differentiation and survival. Conclusions: These results suggest that ST3 protein was more involved in the pathway of colorectal cancer development in females, distal locations, infiltrative growth patterns and microsatellite stability. Copyright © 2004 S. Karger AG, Basel.

  • 227.
    Smeds, Staffan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kald, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Lofstrom, L
    Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study2010In: HERNIA, ISSN 1265-4906, Vol. 14, no 3, p. 249-252Article in journal (Refereed)
    Abstract [en]

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

  • 228.
    Smeds, Staffan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Löfström, L
    Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Influence of nerve identification and the resection of nerves at risk on postoperative pain in open inguinal hernia repair2010In: HERNIA, ISSN 1265-4906, Vol. 14, no 3, p. 265-270Article in journal (Refereed)
    Abstract [en]

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

  • 229.
    Smeds, Staffan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Löfström, Lars
    Sergelkliniken Linköping.
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Not to hurt the patient--do we live up to this in hernia surgery? A self-assessment method tested to answer the question2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 21, p. 1582-1584Article in journal (Refereed)
    Abstract [en]

       

  • 230.
    Spetz, Anna-Clara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Hot flushes in men: prevalence and possible mechanisms.2002In: Journal of the British Menopause Society, ISSN 1362-1807, p. 57-62Article in journal (Other academic)
  • 231.
    Spetz, Anna-Clara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Vasomotor symptoms in men - causes and mechanisms.2003In: British Journal of Sexual Medicine, ISSN 0301-5572, Vol. 27, p. 16-19Article in journal (Refereed)
  • 232.
    Spetz, Anna-Clara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Pettersson, W
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Urology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Varenhorst, Eberhard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Urology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Hot flushes and prostate cancer: pathogenesis and treatment2002In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 90, p. 476-476Article in journal (Refereed)
  • 233.
    Spetz, Anna-Clara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology.
    Zetterlund, Eva-Lena
    Varenhorst, Eberhard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Urology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Incidence and management of hot flashes in prostate cancer.2003In: The journal of supportive oncology, ISSN 1544-6794, Vol. 1, no 4Article in journal (Other academic)
    Abstract [en]

    Hot flashes are as common in men who have been castrated due to prostate cancer as hot flashes are in women after menopause. The symptom can cause significant discomfort for a considerable length of time. The hot flashes are most likely caused by a reduction in sex-hormone levels, which, in turn, causes an instability in the hypothalamic thermoregulatory center. Calcitonin gene-related peptide is involved in menopausal hot flashes in women and possibly also in castrated men. The mainstays of treatment for castrated men with hot flashes remain estrogens, progesterone, and cyproterone acetate, each of which has different side effects. Other treatments for hot flashes include clonidine and antidepressants and, according to one uncontrolled study, electrostimulated acupuncture. Nonetheless, there is a need for more effective and less toxic treatments. In this review, we will discuss the prevalence, duration, distress, physiology, and treatment options of hot flashes in men subjected to castration therapy due to prostate cancer.

  • 234.
    Steinvall, Ingrid
    et al.
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Bak, Zoltan
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Mortality After Thermal Injury: No Sex-Related Difference2011In: JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, ISSN 0022-5282, Vol. 70, no 4, p. 959-964Article in journal (Refereed)
    Abstract [en]

    Background: Young women have been reported to be more likely to survive than men after severe trauma. Girls also have less inflammation and hypermetabolism after major burns. Yet burned women have been found to have a twofold greater risk of death than men. Our aim was to find out if there is a sex-related difference in mortality after thermal injury, particularly in the age group between 16 years and 49 years, when hormonal differences would be most influential. Methods: All patients admitted to the Linkoping University Hospital Burn Unit with thermal injuries during the years 1993-2008 were included and the variables percentage burned total body surface area (TBSA%), age, type of burn, mechanical ventilation, and year were included in a multiple regression (Poisson log) model. Results: Of 1,119 patients with thermal injury, 792 (71%) were men. Crude mortality was 5% among men, and 8% among women (p = 0.04). After adjustment for age and TBSA%, there was no correlation between mortality and sex, in any age group. Eight men and four women died in the group of young adults (16-49 years) in which TBSA% correlated with mortality (p andlt; 0.01) but age did not. Mortality was 14% (32 of 221) among the men and 23% (23 of 102) of women in the group of older adults (50 years and older), and both age and TBSA% correlated with mortality (p andlt; 0.001). Conclusions: There is no relevant sex-related difference in survival after thermal injury. The conclusion is, however, tempered by the few deaths, particularly among younger adults.

  • 235. Stenquist, Monika
    et al.
    Juhlin, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Åström, Gunnar
    Friberg, Ulla
    Case Report. Fourth branchial pouch sinus with recurrent deep cervical abscesses successfully treated with trichloroacetic acid cauterization2003In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 123, p. 879-882Article in journal (Refereed)
  • 236. Stenquist, Monika
    et al.
    Juhlin, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Åström, Gunnar
    Friberg, Ulla
    Fallbeskrivning: Anomali i fjärde gälfickan med recidiverande halsabscesser. Etsning med triklorättiksyra tillslöt fistelmynning och botade patienten2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 1536-1539Article in journal (Other academic)
  • 237.
    Stinner, B
    et al.
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Bauhofer, A
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Lorenz, W
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Rothmund, M
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Plaul, U
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Torossian, A
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Celik, I
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Sitter, H
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Koller, M
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Black, A
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Duda, D
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Encke, A
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Greger, B
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    van Goor, H
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Hanisch, E
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Hesterberg, R
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Klose, KJ
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Lacaine, F
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Lorijn, RHW
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Margolis, C
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Neugebauer, E
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Reemst, PHM
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Schein, M
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Solovera, J
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4) - Protocol of a controlled clinical trial developed by consensus of an international study group Part three: individual patient, complication algorithm and quality management2001In: Inflammation Research, ISSN 1023-3830, E-ISSN 1420-908X, Vol. 50, no 5, p. 233-248Article, review/survey (Refereed)
    Abstract [en]

    General design: Presentation of a new type of a study protocol for evaluation of the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and of sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). A randomised placebo controlled, double-blinded, single-centre study is performed at an University Hospital (n = 40 patients for each group). This part presents the course of the individual patient and a complication algorithm for the management of anastomotic leakage and quality management. Objective: In part three of the protocol, the three major sections include: - The course of the individual patient using a comprehensive graphic display, including the perioperative period, hospital stay and post discharge outcome. - A center based clinical practice guideline for the management of the most important postoperative complication anastomotic leakage - including evidence based support for each step of the algorithm. - Data management, ethics and organisational structure. Conclusions: Future studies with immune modifiers will also fail if not better structured (reduction of variance) to achieve uniform patient management in a complex clinical scenario. This new type of a single-centre trial aims to reduce the gap between animal experiments and clinical trials or - if it fails - at least demonstrates new ways for explaining the failures.

  • 238.
    Styrud, J
    et al.
    Karolinska Institutet .
    Eriksson, S
    Karolinska Institutet .
    Nilsson, I
    Karolinska Institutet .
    Ahlberg, G
    Karolinska Institutet .
    Haapaniemi, Staffan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Neovius, G
    Kristianstad Central Hospital.
    Rex, L
    Borås Hospital.
    Badume, I
    Katrineholm Hospital.
    Granström, L
    Karolinska Institutet .
    Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial2006In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 30, no 6, p. 1033-1037Article in journal (Refereed)
    Abstract [en]

      Background  Appendectomy has been the treatment for acute appendicitis for over 120 years. Antibiotic treatment has occasionally been used in small uncontrolled studies, instead of operation, but this alternative has never before been tried in a multicenter randomized trial. Patients and Methods  Male patients, 18–50 years of age, admitted to six different hospitals in Sweden between 1996 and 1999 were enrolled in the study. No women were enrolled by decision of the local ethics committee. If appendectomy was planned, patients were asked to participate, and those who agreed were randomized either to surgery or to antibiotic therapy. Patients randomized to surgery were operated on with open surgery or laparoscopically. Those randomized to antibiotic therapy were treated intravenously for 2 days, followed by oral treatment for 10 days. If symptoms did not resolve within 24 hours, an appendectomy was performed. Participants were monitored at the end of 1 week, 6 weeks, and 1 year. Results  During the study period 252 men participated, 124 in the surgery group and 128 in the antibiotic group. The frequency of appendicitis was 97% in the surgery group and 5% had a perforated appendix. The complication rate was 14% in the surgery group. In the antibiotic group 86% improved without surgery; 18 patients were operated on within 24 hours, and the diagnosis of acute appendicitis was confirmed in all but one patient, and he was suffering from terminal ileitis. There were seven patients (5%) with a perforated appendix in this group. The rate of recurrence of symptoms of appendicitis among the 111 patients treated with antibiotics was 14% during the 1-year follow-up. Conclusions  Acute nonperforated appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy. 

  • 239.
    Sun, Xiao-Feng
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Oncology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Ahmadi, Ahmad
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology.
    Arbman, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Wallin, Åsa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Oncology.
    Asklid, Daniel
    Zhang, Hong
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology.
    Polymorphisms in sulfotransferase 1A1 and glutathione S-transferase P1 genes in relation to colorectal cancer risk and patients' survival2005In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 11, no 43, p. 6875-6879Article in journal (Refereed)
    Abstract [en]

    Aim: To examine whether polymorphisms in SULT1A1 and GSTP1 genes contribute to colorectal cancer development and whether they are associated with clinicopathological variables are not well identified. Methods: We examined the genotypes of 125 colorectal cancer patients and 666 healthy controls in a Swedish population by using PCR restriction fragment length polymorphism (RFLP). Results: SULT1A1 *2/*2 genotype (OR = 2.49, 95%CI = 1.48-4.19, P = 0.0002) and *2 allele (OR = 1.56, 95%CI = 1.16-2.10, P = 0.002) had an effect on colorectal cancer susceptibility, while GSTP1 genotype was without effect. However, GSTP1 G-type predicted a worse prognosis in the patients independently of gender, age, Dukes' stage, growth pattern, and differentiation (P = 0.03). Conclusion: Polymorphism in SULT1A1 may predispose to colorectal cancer and GSTP1 may be a biological indicator of prognosis in the patients. © 2005 The WJG Press and Elsevier Inc. All rights reserved.

  • 240.
    Sun, Yi-Qian
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Monstein, Hans-Jurg
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Molecular Biological Techniques.
    Ryberg, Anna
    Borch, Kurt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Multiple strand displacement amplification of DNA isolated from human archival plasma/serum: Identification of cytokine polymorphism by pyrosequencing analysis2007In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 377, no 1-2, p. 108-113Article in journal (Refereed)
    Abstract [en]

    Background: DNA isolation from formalin-fixed paraffin-embedded tissue appears to be problematic due to degradation caused by fixative. Our aim was to investigate if the isolated genomic DNA from archival plasma/serum, combined with multiple strand displacement amplification (MDA) can be used for genotyping. Methods: Nine archival plasma/serum samples and freshly frozen gastric biopsies from the same nine H. pylori-infected subjects were used for DNA isolation. Subsequently, MDA-DNA derived from the plasma/serum samples and DNA isolated from the antrum biopsies were analyzed by PCR amplification and pyrosequencing for the presence of interleukin-1beta gene (IL-1B) single nucleotide polymorphism (SNP). In addition, Southern blot and pyrosequencing analysis of H. pylori-specific PCR amplicons were performed. Results: IL-1B SNP profiles obtained from the plasma/serum MDA-DNA and antrum biopsy DNA were identical. A C/C genotype was observed in 7 of 9 samples, and 2 of 9 revealed a C/T genotype for IL-1B - 511. Similarly, 7 of 9 had a T/T, and 2 of 9 had a C/T genotype for IL-1B - 31, 4 of 9 had a C/C, 4 of 9 had a C/T, and 1 of 9 had a T/T genotype, respectively, for IL-1B + 3954. Moreover, pyrosequencing analysis revealed the presence of H. pylori 26695 and J99-like 16S rDNA variable V3 region sequence motifs in the antrum biopsies but not in the plasma/serum samples. Conclusions: We conclude that MDA combined with pyrosequencing enables a rapid and accurate molecular typing of cytokine single nucleotide polymorphisms from archival plasma/serum samples. © 2006 Elsevier B.V. All rights reserved.

  • 241.
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Laparoscopic cholecystectomy for acute cholecystitis2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 16-17Article in journal (Refereed)
    Abstract [en]

    Acute cholecystitis was initially considered a contra-indication for laparoscopic cholecystectomy, but today the laparoscopic route is generally used even for severe acute cholecystitis. Several studies have shown that this is possible, although the conversion and complication rates are high, but there are no randomised controlled trials that evaluate the complications and costs of this technique compared with conventional open techniques. The timing of a laparoscopic cholecystectomy for acute cholecystitis is also a matter of debate as well as its use in elderly patients with this condition.

  • 242.
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    ... och därför blev Kibor "hittad på vägen" läkare2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 34, p. 2320-2321Article in journal (Other academic)
  • 243.
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Patienten från Turkana [A patient from Turkana]2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 51-52, p. 4214-4215Article in journal (Other academic)
  • 244.
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Results of laparoscopic compared with open cholecystectomy2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 12-15Article in journal (Refereed)
    Abstract [en]

    Laparoscopic cholecystectomy was introduced in 1985 and diffused within a few years throughout the world. The avalanche-like spread resulted in this procedure not being scientifically supported by results of controlled clinical trials. By 1997 there were just 13 randomised controlled trials and 150 prospective studies that followed a research protocol, while there were more than 1500 retrospective analyses of series of operations in a country, in a specific hospital, or by a specific surgeon. Comparisons with the conventional laparotomy technique and with minilaparotomy techniques are complicated by the fact that the variables compared, such as operation times, complication rates, and costs, varied over time.

  • 245.
    Sydsjö, Adam
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Alexanderson, K
    Dastserri, M
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Gender differences in sick leave related to back pain diagnoses.2002In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 28, p. 385-389Article in journal (Refereed)
  • 246.
    Sydsjö, Adam
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Gravidas sjukfrånvaro ligger bakom ökat sjuktal för kvinnor i fertil ålder. Studie av gravida kvinnors sjukfrånvaro 1978-1997.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 3410-3414Article in journal (Other academic)
  • 247.
    Sydsjö, Adam
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Influence of pregnancy-related diagnoses on sick-leave data in women aged 16-442001In: Journal of Womens Health & Gender-Based Medicine, ISSN 1524-6094, E-ISSN 2168-7722, Vol. 10, no 7, p. 707-714Article in journal (Refereed)
    Abstract [en]

    Data on sickness absence frequently are used as a measure of morbidity and its social consequences in the employed population. The effects of sickness absence, as well as any possible differences in diagnoses among pregnant women as compared the sick leave data among the total population of women in fertile age have so far not been studied. The aim of this study was to investigate the relative contribution of pregnant women to the level of sickness absence, in general and in different diagnostic groups, as well as the extent to which sick-listed pregnant women can be identified through diagnoses on sickness certificates. In a cross-sectional study of all sick leave insured women aged 16-44 years (n=24,481) in Link÷ping, Sweden (117,000 inhabitants), data from two population-based research registers were used, one of sickness absence for the whole population, one of sickness absence among pregnant women in the same population and year. Pregnant women (5%) had a significantly higher cumulative incidence of sickness absence (0.64) compared with all women (0.18) and accounted for 20% of the women listed as absent because of sickness. The duration of the sickness absence was also significantly longer among pregnant women, 44.8 days compared with 9.7 days among all women. Practically all diagnoses among pregnant women were related to pregnancy or back pain (93%). When using diagnoses on the sickness certificates, only 46% of all sick-listed pregnant women could be identified, suggesting methodological difficulties in studies on sickness absence. Studies on sickness absence among women of fertile age should also contain information on the proportion of sick-listed pregnant women, as a small proportion of pregnant women may have a deep impact on the results and conclusions among all women.

  • 248.
    Sydsjö, Gunilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Newly delivered women's evaluation of personal health status and attitudes towards sickness absence and social benefits2002In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 81, no 2, p. 104-111Article in journal (Refereed)
    Abstract [en]

    Background. Unexpectedly high rates of sickness absence have been observed among pregnant women. No clear medical causes for illnesses reported as the basis for sick leave have yet been identified with certainty. An explanation proposed is the pregnant women's own attitudes towards their own states of well being during pregnancy. The aim of this study was to investigate the validity of this hypothesis. Methods. All of the 384 women who were delivered at the University Hospital during a 2-month period were asked to answer a questionnaire anonymously. Information was sought concerning sickness absence and the use of parental benefits. In addition, questions were asked about working conditions and about each mother's own estimate of her level of 'well being'. The women's attitudes towards work absence due to illness and towards social benefit programs were registered. Results. Forty-three per cent of the women stated that they had been on sick leave during pregnancy. The main reason for sick leave was reported back pain. Seventy-four per cent of the women who were on sick leave stated, nevertheless, that they had been in 'good' or 'excellent' health during pregnancy. Of the 149 women who did not take sick leave, 10 reported being in 'bad' or 'very bad' health during pregnancy. 4.3% of the women stated that they had considered themselves to be ill due to an obstetric condition. Conclusion. In addition to actual disease and severe discomfort, certain social conditions and attitudes as well, are likely to explain the increase of pregnant women on sick leave.

  • 249.
    Sydsjö, Gunilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Wijma, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Variations in sickness absence and use of social benefits among pregnant women in a Swedish community 1978-1997.1999In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 78, p. 383-387Article in journal (Refereed)
  • 250.
    Sydsjö, Gunilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Wadsby, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry.
    Period prevalence and types of psychosocial risk factors in pregnant women in an urban Swedish community2003In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 12, no 4, p. 302-306Article in journal (Refereed)
    Abstract [en]

    During a three-year period a total population of pregnant women attending antenatal clinics in Link÷ping, Sweden was screened for being at psychosocial risk. The prevalence of different psychosocial risk factors was compared with the corresponding prevalence in women referred to and accepting or declining to take part in a specialised training programme at a parent-baby clinic. In general, the present study showed that there was a constant proportion of about 4-5% of pregnant women with psychosocial risk factors. Psychiatric problems and social problems of relevance for pregnancies/parenthood were about equally frequent (i.e. 44 and 45%), while drug-addiction problems were at 11%. Only one in three women with risk factors were eventually referred to the parent-baby clinic, and every second woman referred finally took part in the programme. With the knowledge that an early intervention in families with psychosocial risk factors may alleviate some adverse or disadvantageous developments in children, it is a challenge to identify and to motivate these women to enrol in various support and training programmes. There are still too few pregnant women at risk who are ready to accept the further support that they may need, and the rationale for their reluctance must be better known.

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