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  • 51.
    Haapaniemi, Staffan
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Nilsson, Erik
    Motala Hospital, Motala, Sweden.
    Recurrence and pain three years after groin hernia repair: Validation of postal questionnaire and selective physical examination as a method of follow-up2002In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Objectives:

    To evaluate recurrence rate and chronic groin pain three years after hernia repair and to validate a postal questionnaire with selective physical examination as a method of follow-up.

    Design:

    Prospective cohort study.

    Setting:

    County hospital, Sweden.

    Patients:

    Prospective data were retrieved from the Swedish Hernia Register for patients aged 15–80 years at the time of groin hernia repair, operated on during 1994.

    Interventions:

    Three years after operation patients were mailed a three-item questionnaire and invited to have a physical examination. Those examined answered a detailed questionnaire about pain and functional impairment. When appropriate an extended physical examination was undertaken to find out the probable cause of the pain.

    Main outcome measures:

    Recurrence, pain, and functional impairment.

    Results:

    272 hernias were repaired in 264 patients. 24 patients had died and 16 had a recurrence before the follow-up examination. After a median observation time of 44 months, 218 patients with 223 repairs (96%) were examined. Depending on the definition of recurrence and completeness of physical examination (selective or all patients) the recurrence rate varied between 10% (25/239) and 15% (35/239) including recurrences diagnosed before follow-up. 40 patients (18%) reported groin pain at follow-up, which was considered to be caused by a previous hernia repair in 34 (15%), 12 of whom (5%) had moderate or severe pain. Postoperative complications were associated with an increased risk of chronic pain, whereas type of hernia and use of mesh had no influence.

    Conclusions:

    The incidence of recurrence and chronic pain after hernia repair requires continuous audit in non-specialised units. Participation in a register and follow-up by a three-item questionnaire and selective physical examination provides a solid basis for quality control.

  • 52.
    Hallböök, Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Colonic pouch anastomosis after rectal excision for cancer1996Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Anastomoses at the level of the pelvic floor will become increasingly more common in rectal cancer surgery when total mesorectal excision is used as a standard procedure to obtain local mdicality. A consequence of such low anastomoses is increased risk of healing disturbances and poor distal bowel function, The aim of this thesis was to focus on reconstruction after total mesorectal excision.

    A randomized trial comparing the conventional straight anastomosis (n=52) and the colonic pouch anastomosis (n=45) showed that the pouch patients had fewer bowel movements per 24 hours, less nocturnal evacuations, urgency and incontinence at one year after surgery. The superiority of colonic pouches could not, however, be verified by a general quality of life instrument, the Nottingham Health Profile. One disadvantage with the pouch reconstruction was that some patients experienced difficult evacuation.

    The trial also showed less anastomotic leakage in the pouches. This may partly be attributable to the concept of side-to-end reconstruction, which had a better preserved blood flow at the site of anastomosis than the straight (end-to-end) alternative, as shown by intraoperative laser Doppler flowmetry.

    In the search for specific mediators of the functional adaption after a restorative rectal excision two gut peptides, peptide YY and enteroglucagon, were sequentially measured in both plasma and neorectal mucosa after surgery. No major changes occurred.

    Manovolumetric investigation of the rectal substitute showed that construction of colonic pouches restores volume, improves compliance and sensory function compared with straight anastomoses. Compared with healthy rectum, pouches exhibit sensory deficits and decreased compliance despite adequate volume, factors which may partly explain why some pouch patients experience impaired evacuation. Maximum volume of the pouches was positively correlated with degree of evacuation difficulty. This association was verified by logistic regression with adjustment for confounding factors.

    Obviously colonic pouches cannot have the unique reservoir function of the healthy rectum. However, in-spite of physiological changes regarding sensory function, compliance, motility and reflex inhibition, patients having a colonic pouch anastomosis will usually experience satisfactory clinical bowel function.

  • 53.
    Hallböök, Olof
    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.
    Matthiessen, P
    Leinsköld, Ted
    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.
    Nyström, Per-Olof
    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.
    Sjödahl, Rune
    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.
    Safety of the temporary loop ileostomy2002In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 4, no 5, p. 361-364Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the complications of the temporary loop ileostomy. Method. A retrospective study of 222 consecutive patients with low anterior resection, ileal pouch-anal anastomosis or continent ileostomy and a diverting loop ileostomy routinely fashioned during the primary operation. The loop ileostomy was closed in 213 patients (96%) during the minimum follow-up period of 15 months. Results. Four patients (2%) required preterm closure of the ostomy due to stomal retraction (n = 3) or bowel obstruction (n = 1). Four patients were readmitted due to transient bowel obstruction that resolved without surgery. After closure of the loop ileostomy a total of 27 patients (13%) had complications. In 7 patients emergency re-operation was done due to small bowel obstruction (n = 5) or intra-abdominal abscess (n = 2). Elective re-operation was done in 5 patients for hernia at the site of the previous stoma. Despite the use of a loop ileostomy there was 1 postoperative death after the initial operation in consequence of anastomotic leakage. There was 1 death in consequence of closure of the loop ileostomy after 3 weeks due to intra-abdominal sepsis and heart failure. Conclusion. In this series closure of the ostomy was associated with one death (0.5%) and overall ostomy-related morbidity included the need to re-operate in 6%.

  • 54.
    Hallböök, Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Surgical approaches to obtaining optimal bowel function2000In: Seminars in surgical oncology, ISSN 8756-0437, E-ISSN 1098-2388, Vol. 18, no 3, p. 249-258Article in journal (Refereed)
    Abstract [en]

    Approximately 50% of patients have an unsatisfactory functional result after traditional restorative rectal resection, and an even higher percentage, at least in the early postoperative period, suffers from urgency, frequent bowel movements, and occasional faecal incontinence. The rectal reservoir function is disturbed after restorative surgery. This is related to the size of the rectal remnant, the viscero-elastic properties, and the motility pattern of the neorectal wall, because segments of the remaining colon can only substitute for the rectum to a limited extent. A straight anastomosis is recommended when the rectal remnant (measured from the anal verge) is at least 7 to 8 cm. The side-to-end anastomosis is probably preferable to the end-to-end anastomosis. In contrast, a straight anastomosis at the levator plane cannot be recommended. If straight anastomosis is still considered, the descending colon should be used rather than the sigmoid colon. The colonic pouch was introduced to increase the neorectal volume and eliminate some of the functional disturbance associated with the reduced neorectal volume occurring after a straight colo-anal anastomosis. To obtain optimal functional results soon after surgery, a pouch should be used when the anastomosis is located 3 to 5 cm from the anal verge. The size of the pouch should not be too small. A staple line of 6 to 7 cm is a fair compromise between the low anterior resection syndrome and problems with evacuation. Since the descending colon has a thinner wall and often is healthier than the sigmoid colon, it should be the first choice for the anastomosis.

  • 55. Harness, Jay K
    et al.
    van Heerden, Jon
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Rothmund, Matthias
    Barraclough, Bruce
    Goode, A W
    Rosen, Irving B
    Fujimoto, Hoshihide
    Proye, Charles
    Future of thyroid surgery and training surgeons to meet the expectations of 2000 and beyond2000In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 24, no 8, p. 976-982Article in journal (Refereed)
    Abstract [en]

    What is the future of thyroid surgery in the new millennium? How can surgeons keep abreast of advances in thyroid endocrinology, genetics surgical therapy, and other aspects of thyroid disease management? How should surgeons be trained to become highly competent in thyroid disease and to perform safe, effective thyroid operative procedures? Nine internationally recognized endocrine surgeons were asked to express their views on these and related subjects. They noted that advances in molecular biology, pathology, and genetics of thyroid disease should allow more tailored surgical approaches during the twenty-first century. Current training of general surgical residents in thyroid and other types of endocrine surgery is highly variable, which may contribute to increased complication rates and number of second operations. The leadership for addressing these deficiencies and promoting a more organized approach to thyroid disease management should come from national endocrine surgery associations and their leaders. It is incumbent upon endocrine surgeons to maintain their central role in the management of many aspects of thyroid disease. Organizing teams of specialists into thyroid centers (centers of excellence) can (1) increase efficiency, (2) increase quality of care, (3) decrease costs, (4) encourage a more individualized approach to surgery, (5) lower complication rates, and (6) foster innovation in technology and disease management. Two years of additional fellowship training in thyroid and endocrine surgery is now being advocated by increasing numbers of national endocrine surgical associations as the best way to prepare surgeons for society's needs for highly skilled, competent thyroid surgeons of the future.

  • 56. Hellberg, A
    et al.
    Rudberg, C
    Kullman, Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Enochsson, L
    Fenyö, G
    Graffner, H
    Prospective randomized multicentre study of laparoscopicversus open appendicectomy.1999In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 86, p. 48-53Article in journal (Refereed)
  • 57. Hellberg, Anders
    et al.
    Rudberg, Claes
    Enochsson, Lars
    Gudbjartson, Tomas
    Wenner, Jörgen
    Kullman, Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Fenyö, György
    Ringqvist, Ivar
    Sörensen, Stefan
    Conversion from laparoscopic to open appendicectomy: a possible drawback of the laparoscopic technique?2001In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 167, p. 209-213Article in journal (Refereed)
  • 58. Hua, Yang
    et al.
    Wirén, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Larsson, Jörgen
    Kir klin Huddinge.
    Permert, Johan
    Kir klin Huddinge.
    Whole-protein-based enteral formula stimulates intestinal ornithine decarboxylase activity more than single amino acids but does not affect mucosal adenosine triphosphate content in early postsurgical refeeding.1999In: JPEN - Journal of Parenteral and Enteral Nutrition, ISSN 0148-6071, E-ISSN 1941-2444, Vol. 23, p. 207-212Article in journal (Refereed)
  • 59. Ihse, Ingemar
    et al.
    Anderson, Roland
    Blind, Jonas
    Borgström, Anders
    Gasslander, Thomas
    Haglund, Ulf
    Henriksson, Bengt Åke
    Hyltander, Anders
    Larsson, Jörgen
    Lundstedt, Christer
    Permert, Johan
    Svanvik, Joar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Riktlinjer för handläggning av patienter med akut pankreatit.2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 2216-2223Article in journal (Other (popular science, discussion, etc.))
  • 60.
    Ihse, Ingemar
    et al.
    Depts. of Surgery and Pharmacology, University of Lund, Lund.
    Permert, Johan
    Institutionen för klinisk vetenskap, intervention och teknik (CLINTEC), Enheten för kirurgi, Karolinska Universitetssjukhuset, Stockholm.
    Andersson, Roland
    Lund University.
    Borgström, Anders
    Department of Surgery, Malmö University Hospital, University of Lund, Malmö.
    Dawiskiba, Sigmund
    Department of Pathology and Cytology, University Hospital, Lund.
    Enander, Lars Krister
    Glimelius, Bengt
    Department of Oncology, Radiology, and Clinical Immunology, Uppsala University, Uppsala.
    Hafström, Larsolof
    Department of Surgery, Umeå University Hospital, Umeå.
    Haglund, Ulf
    Department of Surgical Sciences, Section Surgery, Uppsala University, Uppsala.
    Larsson, Jörgen
    Linköping University, Faculty of Medicine and Health Sciences.
    Lindell, Gert
    Department of Surgery, Lund University Hospital, Lund.
    Olmarker, Anne
    Department of Radiology, Sahlgrenska University Hospital, Göteborg.
    von Rosen, Anette
    Department of Surgery, Karolinska University Hospital, Stockholm.
    Svanvik, Joar
    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.
    Svensson, Jan-Olof
    Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska University Hospital-Huddinge, Karolinska Institutet, Stockholm.
    Thune, Anders
    Department of Surgery, Sahlgrenska University Hospital, Gothenburg.
    Tranberg, Karl Göran
    Department of Surgery, Lund University Hospital.
    Riktlinjer för handläggning av patienter med pankreascancer [Guidelines for management of patients with pancreatic cancer]2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, no 15, p. 1676-1685Article in journal (Other academic)
    Abstract [sv]

    Transabdominellt ultraljud är förstahandsundersökning vid misstänkt pankreascancer, följt av spiral-DT eller MR för mer definitiv diagnos. Tumörmarkörer har ingen plats i rutindiagnostiken. Spiral-DT är basen i resektabilitetsbedömningen. Resektion av tumören är en förutsättning för bot. Ett samband har påvisats mellan antalet resektioner som görs vid ett sjukhus årligen och postoperativ mortalitet. Långtidsöverlevnaden efter resektion är oförändrat kort medan postoperativ mortalitet minskat dramatiskt vid enheter som rapporterat sina resultat. Adjuvant behandling efter resektion bör endast ges inom ramen för kliniska studier. Det palliativa omhändertagandet har förbättrats främst genom utveckling inom endoskopi, interventionell radiologi, smärt- och nutritionsbehandling. Palliativ cytostatikabehandling bör endast ges selektivt utanför kliniska studier. Radioterapi har ingen dokumenterad effekt på överlevnaden vid icke-resektabel pankreascancer. Internationellt rekommenderas speciella behandlingsteam för pankreascancer med tillräckliga upptagningsområden (2–4 miljoner invånare).

  • 61. Joelsson, M
    et al.
    Andersson, M
    Bark, T
    Gullberg, K
    Hallgren, T
    Jiborn, H
    Magnusson, I
    Raab, Y
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Öjerskog, B
    Öresland, T
    Allopurinol as prophylaxis against pouchitis following ileal pouch-anal anastomosis for ulcerative colitis.2001In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 36, no 11, p. 1179-1184Article in journal (Refereed)
  • 62.
    Kald, A
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Kullman, Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Anderberg, B
    Kir klin Huddinge.
    Wirén, M
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Carlsson, P
    Ringqvist, I
    Cost-minimisation analysis of laparoscopic and open appendicectomy.1999In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 579-582Article in journal (Refereed)
  • 63.
    Kald, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Domeij, Erica
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Landin, Susanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Wirén, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Anderberg, Bo
    Laparoscopic hernia repair in patients with bilateral groin hernias2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 3, p. 210-212Article in journal (Refereed)
    Abstract [en]

    Objective: To compare outcome of unilateral and bilateral laparoscopic hernia repair. Design: Prospective consecutive trial. Setting: University hospital, Sweden. Subjects: 380 patients who had unilateral hernias repaired laparoscopically and 64 patients who had bilateral hernias repaired. The median (range) age in the two groups was 56 (21-86) and 61 (30-85) years, respectively and the median (range) follow-up was 42 (24-58) months. Main outcome measures: Operating time, hospital stay, complications, and time to recovery. Results: The median (range) operating time was 70 (25-240) minutes in the unilateral and in the bilateral group 113 (55-330) minutes. The complication rate, recurrence rate, and time to full recovery did not differ between the groups. Conclusion: The laparoscopic approach seems to be a good option for patients with bilateral inguinal hernias.

  • 64.
    Kechagias, Stergios
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
    Jönsson, Kjell-Åke
    Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Borch, Kurt
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Jones, A. Wayne
    Linköping University, Department of Medical and Health Sciences, Forensic Science and Toxicology . Linköping University, Faculty of Health Sciences.
    Influence of Age, Sex, and Helicobacter pylori Infection Before and After Eradication on Gastric Alcohol Dehydrogenase Activity2001In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 25, no 4, p. 508-512Article in journal (Refereed)
    Abstract [en]

    Background: Gastric alcohol dehydrogenase may contribute to the metabolism of orally ingested ethanol and decrease the bioavailability of the drug. The aims of this study were to assess the impact of Helicobacter pylori infection and its eradication on gastric alcohol dehydrogenase activity and to relate the findings to gastric histology. Furthermore, the role of age- and sex-related differences in gastric alcohol dehydrogenase activity were studied.

    Methods: A total of 76 subjects (39 women and 37 men) underwent upper gastrointestinal endoscopy, and biopsies were obtained from the corpus and antrum. The specimens were used for determining gastric alcohol dehydrogenase activity, histological examination, and urease testing. Subjects with H. pylori infection (n= 36) received medication to eradicate the infection, and repeat biopsies were taken 2 and 12 months later.

    Results: No significant difference in gastric alcohol dehydrogenase activity was found between men and women (p > 0.05). Gastric alcohol dehydrogenase activity did not differ significantly between the subjects older than 50 years (n= 39) and those 50 years or younger (n= 37). In subjects with H. pylori infection, gastric alcohol dehydrogenase activity was significantly reduced in the antrum (p < 0.05). After eradication of H. pylori, alcohol dehydrogenase activity in the antrum increased significantly within 2 months (p < 0.01). Antral biopsies with the most pronounced inflammation and histological changes had significantly decreased alcohol dehydrogenase activity (p < 0.05). In contrast, no significant differences were found in corpus.

    Conclusions: H. pylori infection is associated with decreased antral alcohol dehydrogenase activity, which seems to be related to the severity of the inflammatory changes in the mucosa. Eradication of H. pylori normalizes antral alcohol dehydrogenase activity within 2 months.

  • 65.
    Kechagias, Stergios
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Kullman, Eric
    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.
    Ludvigsson, Johnny
    Sjödin, Ingemar
    Almér, Lars-Olof
    Replik: Samtalskonst och kommunikation efter AT2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 2466-2467Article in journal (Other academic)
  • 66. Khan, Tanweera
    et al.
    Sundin, Anders
    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.
    Långström, Bengt
    Bergström, Mats
    Eriksson, Barbro
    11C-metomidate PET imaging of adrenocortical cancer2003In: European Journal of Nuclear Medicine and Molecular Imaging, ISSN 1619-7070, E-ISSN 1619-7089, Vol. 30, p. 403-410Article in journal (Refereed)
  • 67.
    Koch Frisén, Angelica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Edwards, A.
    Surgical Directorate, Arrowe Park Hospital NHS Trust, Wirral, UK.
    Haapaniemi, Staffan
    Vrinnevi Hospital, Norrköping.
    Nordin, P.
    Östersund Hospital, Östersund, Sweden.
    Kald, Anders
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Prospective evaluation of 6895 groin hernia repairs in women2005In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 92, no 12, p. 1553-1558Article in journal (Refereed)
    Abstract [en]

    Background: Although 8 per cent of groin hernia repairs are performed in women, there is little published literature relating specifically to women. This study compared differences in outcome between women and men after groin hernia repair.

    Methods: Data collected prospectively in the Swedish Hernia Register between 1992 and 2003 were analysed, including 6895 groin hernia repairs in women and 83 753 in men.

    Results: A higher proportion of emergency operations was carried out in women (16.9 per cent) than men (5.0 per cent), leading to bowel resection in 16.6 and 5.6 per cent respectively. During reoperation femoral hernias were found in 41.6 per cent of the women who were diagnosed with a direct or indirect inguinal hernia at the primary operation. The corresponding proportion for men was 4.6 per cent. The hernia repair was not classified as a standard operation (e.g. Shouldice, Lichtenstein, Plug/Mesh, TAPP/TEP) in 38.2 per cent of women and 11.2 per cent of men. Women had a significantly higher risk of reoperation for recurrence than men, and techniques associated with the lowest risk for reoperation in men had the highest risk in women.

    Conclusion: A greater proportion of women than men require emergency groin hernia repair, with consequently higher rates of bowel resection, complications and death. Surgical techniques developed for use in men may put women at unnecessary risk. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

  • 68.
    Kullman, Eric
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Trends and current clinical aspects of complicated gallstone disease - with special reference to endoscopic treatment1993Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Time trends regarding incidence, management, and outcome of acute (AC) and elective cholecystectomy (EC), as well as symptomatic (cholangitis, pancreatitis, jaundice) and asymptomatic (detected accidentally during cholecystectomy) common bile duct (CBD) stones were studied during the time period 1970-1986 in a welldefined Swedish population. From period I (1970-1978) to period II (1979-1986) there was a four-fold increase in the ratio of AC (period I: mean 10/100,000/year, period II: mean 30/100,000/year) to EC (period 1: mean 190/100,000/year, period II: mean 120/100,000/year). For both AC and EC the fraction of patients older than 70 years increased significantly with time. For AC, the female to male ratio decreased significantly from 2.6 to 1.0. The duration of history and frequency of previous hospital stay for gallstone disease decreased significantly for both groups. The postoperative morbidity did not change, whereas the postoperative mortality after AC decreased significantly. Postoperative mortality was significantly higher after AC than EC in both periods. Complications occurred less frequently among patients with a short history of gallstone symptoms than among those with a long history.

    During the same time periods, there was a significant increase in the incidence of symptomatic CBD stones (8 - 20 cases/100,000 inhabitants/year), and a slight decrease in the incidence of asymptomatic CBD stones (12- 10 cases/lOO cholecystectomies/year). The fraction of patients older than 70 years increased from 31% to 60% for patients with symptomatic CBD stones and from 17% to 27% for patients with asymptomatic CBD stones. In period 11 endoscopic sphincterotomy (EST) accounted for 81 % of all primary procedures performed in patients with symptomatic CBD stones. Type of treatment disregarded, the frequency of clinically overt retained CBD stones increased from 7 % to 22 %. Overall, the frequency of general complications decreased significantly,mainly due to a decrease in the group with symptomatic CBD stones. The frequency of procedure related complications also decreased in the symptomatic group, whereas it increased in the asymptomatic group. Theoverall mortality rate decreased significantly. The total time of stay in hospital decreased by 48 % for patients with symptomatic CBD stones and 23 %for those with asymptomatic stones.

    EST for retained or recurrent CBD stones after cholecystectomy was performed in 128 patients with an overall success rate of 92 %. Late bile duct complications (recurrent stones and/or stenosis) occurred in seven patients at a median time of 20 months after EST and were best treated with repeat EST. To minimize short-term complications, efforts to extract all stones and confirmation of CBD clearance is mandatory at the initialprocedure. EST is safe and efficient as the first procedure of choice in patients with retained and recurrent CBD stones.

    EST was performed in 148 patients with CBD stones and the gallbladder left in situ with an overall success rate of 88 %. The median observation time in 118 patients discharged with the gallbladder in situ was 42 months. Complications necessitating acute surgery arose from the remaining gallbladder in seven patients (6 %) at a median of 14 months after EST. Another six patients (5 %) underwent elective cholecystectomy at a median of 21 months after EST. A stone bearing gallbladder left in situ after EST does not appear to be an additional risk factor for future complications compared to the natural history in patients with verified cholelithiasis. Leaving the gallbladder in situ after EST is justified in elderly and frail patients. Surgery should be restricted to patients in whom symptoms develop.

    The occurrence of bacteremia in association with diagnostic or therapeutic ERCP were studied in 180 patients undergoing 194 examinations, and it occurred in 15 % and 27 %, respectively. There was no correlation between the occurrence of bacteremia and the duration of the procedure. The frequency of complications in patients with bacteremia did not diffef from that in patients without bacteremia, whether the procedure was diagnostic or therapeutic. Routine antibiotic prophylaxis is not indicated in patients undergoing diagnostic or therapeutic ERCP.

    Extracorporeal shock wave lithotripsy (ESWL) was performed in 28 patients with problematic CBD stones and 9 patients with intrahepatic duct (IHD) stones. The overall fraction of successfully treated patients was 89 %, with no major complications or mortality. It is concluded that ESWL is a safe and efficient treatment modality for CBD and IHD stones after failed endoscopic treatment. It further extends the number of patients with bile duct stones who can be treated by non-surgical means.

  • 69.
    Kuremu, RT
    et al.
    Department of Surgery, Faculty of Health Sciences, Moi University, Eldoret, Kenya.
    Khwa-Otsyula, BO
    Duke University, Durham, UK.
    Svanvik, Joar
    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.
    Bwombengi, OSG
    Eldoret, Rift Valley, Kenya.
    Lelei, LK
    St Luke’s Orthopaedic & Trauma Hospital, Eldoret, Kenya.
    Mathews, D
    University of Maine, Orono, ME .
    Hydatid disease of the spine: Case report2002In: East African Medical Journal, ISSN 0012-835X, Vol. 79, no 3, p. 165-166Article in journal (Refereed)
    Abstract [en]

    A rare case of spinal hydatid disease presenting with paraparesis and sensory loss is reported. The patient was treated with albendazole resulting in significant improvement within eight weeks. Investigations and treatment modalities are discussed.

  • 70.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, GE: endokir.
    Effekten av varje åtgärd styr prioriteringen.1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, p. 3808-3810Article in journal (Other (popular science, discussion, etc.))
  • 71.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, GE: endokir.
    Which factors influence the time from submitting of a manuscript to publication?1999In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 404-406Article in journal (Refereed)
  • 72. Lester, B
    et al.
    Hallböök, Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Pouch pressures and motility in relation to functional results of the ileal pouch - anal anastomosis.1999In: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 3Article in journal (Refereed)
  • 73.
    Lilja, Ingela
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery.
    Gustafson-Svärd, Christina
    Franzén, L
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Tumor necrosis factor-alpha in ileal mast cells in patients with Crohn's disease2000In: Digestion, ISSN 0012-2823, E-ISSN 1421-9867, Vol. 61, no 1, p. 68-76Article in journal (Refereed)
    Abstract [en]

    Background: Reports that both intestinal and extraintestinal Crohn's disease (CD) had healed successfully after treatment with anti-tumor necrosis factor-alpha (TNF-a) antibody have strengthened the hypothesis that it has a role in the treatment of CD. The macrophage is one source of TNF-a. Intestinal mast cells are also thought to have a role in CD, but it is not known if human ileal mast cells express TNF-a. Aim: To find out whether TNF-a is expressed by mast cells in the ileal wall in CD patients and controls. Methods: TNF-a was sought immunohistochemically in full thickness specimens of ileal wall from patients with CD (histologically normal, n = 9, inflamed, n = 6) and controls (patients with colonic cancer, n = 8). Mast cells were identified by metachromasia and anti-mast cell tryptase immunoreactivity. Results: In all layers of the ileal wall, and in every specimen investigated, mast cells were the main cell type that expressed TNF-a immunoreactivity out of the TNF-a-labelled cells. The number of TNF-a-labelled mast cells was greater in the muscularis propria in patients compared with controls, both in uninflamed (1.7-fold, p < 0.05) and in inflamed bowel (4.6-fold, p < 0.002), greater in the submucosa in inflamed compared with uninflamed CD (1.6-fold, p < 0.01), and less in the lamina propria in inflamed compared with uninflamed CD (0.4-fold, p < 0.05). Conclusion: Mast cells are an important source of TNF-a in all layers of the ileal wall, and the increased density of TNF-a-positive mast cells in the submucosa and muscularis propria may contribute to the tissue changes and symptoms in CD.

  • 74. Lindell, Gert
    et al.
    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.
    Tingstedt, Bobby
    Enell, Eva-Lena
    Ihse, Ingemar
    Management of cancer of the ampulla of Vater: Does local resection play a role?2003In: Digestive Surgery, ISSN 0253-4886, E-ISSN 1421-9883, Vol. 20, no 6, p. 511-515Article in journal (Refereed)
    Abstract [en]

    Background: The clinical outcome of patients with ampullary carcinoma is significantly more favorable than for patients with pancreatic head carcinoma. The Whipple procedure is the operation of choice for both diagnoses. Still local resection is recommended in selected cases. The aim of this study was to assess the outcome of local resection of cancer of the ampulla of Vater by comparison with pancreaticoduodenectomy. Method: 92 patients with cancer of the ampulla of Vater treated between 1975 and 1999 with local resection (n = 10), pancreatic resection (n = 49) or laparotomy and no resection (n = 33) were studied retrospectively. The main outcome measures were postoperative morbidity and mortality, surgical radicality and long-term survival. Results: The postoperative complication rate was significantly lower after local resection (p = 0.036) whereas mortality did not differ between the 2 resection groups. UICC stages were less advanced in the local resection group (p < 0.04). Still, the frequency of positive resection margins and RO resections was the same in both groups, as was long-term survival. Local recurrence was diagnosed in 8/10 (80%) patients after local and in 11/49 (22%) patients after pancreatic resection (p = 0.001). Conclusion: Pancreaticoduodenectomy is the preferred operation for cancer of the ampulla of Vater in patients who are fit for the procedure. Local resection plays a limited role in carefully selected patients.

  • 75. Machado, Mikael
    et al.
    Hallböök, Olof
    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.
    Goldman, Sven
    Nyström, Per-Olof
    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.
    Järhult, Johannes
    Sjödahl, Rune
    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.
    Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer: A comparison between two hospitals with a different policy2002In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 45, no 7, p. 940-945Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to compare surgical outcome, after low anterior resection for rectal cancer with colonic J-pouch, at two departments with a different policy regarding the use of a routine diverting stoma. METHODS: A total of 161 consecutive patients with invasive rectal carcinomas operated on between 1990 and 1997 with a total mesorectal excision and a colonic J-pouch were included in the study. Eighty patients were operated on in a surgical unit using routine defunctioning stomas (96 percent), whereas 81 were operated on in a department in which diversion was rarely used (5 percent). Recorded data with respect to surgical outcome were analyzed and compared. RESULTS: There was no difference between the two centers in postoperative mortality in connection with the primary resection and subsequent stoma reversal (3.7 vs. 3.8 percent). No significant difference could be found in the number of patients with pelvic sepsis (anastomotic leaks, 9 vs. 12 percent). Surgical outcome in patients with pelvic sepsis was also similar. The frequency of reoperations associated with the anterior resection and subsequent stoma reversal was identical (14 percent). The total hospital stay (primary operation and stoma reversal) was significantly longer with than without a routine stoma (17 (range, 2-59) vs. 12 (range, 5-55) days, respectively, P < 0.001). CONCLUSION: This study suggests that the routine use of diversion does not protect the patient from anastomotic complications or pelvic sepsis and its use requires a second admission for closure.

  • 76.
    Matthiessen, Peter
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    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, M.
    University Hospital Örebro, Örebro, Sweden.
    Rutegård, J.
    University Hospital Örebro, Örebro, Sweden.
    Sjödahl, Rune
    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.
    Risk factors for anastomotic leakage after anterior resection of the rectum2004In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 6, no 6, p. 462-469Article in journal (Refereed)
    Abstract [en]

    Objective. Surgical technique and peri-operative management of rectal carcinoma have developed substantially in the last decades. Despite this, morbidity and mortality after anterior resection of the rectum are still important problems. The aim of this study was to identify risk factors for anastomotic leakage in anterior resection and to assess the role of a temporary stoma and the need for urgent re-operations in relation to anastomotic leakage.

    Patients and methods. In a nine-year period, from 1987 to 1995, a total of 6833 patients underwent elective anterior resection of the rectum in Sweden. A random sample of 432 of these patients was analysed (sample size 6.3%). The associations between death and 10 patient-and surgery-related variables were studied by univariate and multivariate analysis. Data were obtained by review of the hospital files from all patients.

    Results. The incidence of symptomatic clinically evident anastomotic leakage was 12% (53/432). The 30-day mortality was 2.1% (140/6833). The rate of mortality associated with leakage was 7.5%. A temporary stoma was initially fashioned in 17% (72/432) of the patients, and 15% (11/72) with a temporary stoma had a clinical leakage, compared with 12% (42/360) without a temporary stoma, not significant. Multivariate analysis showed that low anastomosis (≤ 6 cm), pre-operative radiation, presence of intra-opcrative adverse events and male gender were independent risk factors for leakage. The risk for permanent stoma after leakage was 25%. Females with stoma leaked in 3% compared to men with stoma who leaked in 29%. The median hospital stay for patients Arithout leakage was 10 days (range 5-61 days) and for patients with leakage 22 days (3-110 days).

    Conclusion. In this population based study, 12% of the patients had symptomatic anastomotic leakage after anterior resection of the rectum. Postoperative 30-day mortality was 2.1%. Low anastomosis, pre-operative radiation, presence of intra-operative adverse events and male gender were independent risk factors for symptomatic anastomotic leakage in the multivariate analysis. There was no difference in the use of temporary stoma in patients with or without anastomotic leakage.

  • 77.
    Matthiessen, Peter
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    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.
    Rutegård, J.
    University Hospital Örebro, Örebro, Sweden.
    Sjödahl, Rune
    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.
    Intraoperative adverse events and outcome after anterior resection of the rectum2004In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 91, no 12, p. 1608-1612Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this population-based study was to analyse the relationship between intraoperative adverse events and outcome after anterior resection.

    Methods: All 140 patients who underwent elective anterior resection in Sweden between 1987 and 1995, and who died within 30 days, were compared with a group of 423 randomly selected patients who underwent the same procedure during the same interval but survived the operation. Intraoperative adverse events and intraoperative measures taken were analysed in relation to outcome of surgery.

    Results: Of those who died, 45.7 per cent had intraoperative adverse events compared with 30.3 per cent in the cohort group. Major bleeding, gross spillage of faeces, and two or more intraoperative adverse events were more common among those who died. When the anastomosis was considered unsatisfactory, it was more frequently reconstructed (restapled or completely resutured), with or without a temporary stoma, in those who survived. The use of a temporary stoma was comparable in the two groups when adverse events were present.

    Conclusion: Intraoperative adverse events were important contributors to morbidity and mortality. Complete reconstruction of an unsatisfactory anastomosis, with or without addition of a temporary stoma, was more frequently performed in the survivors, and may have diminished the risk of postoperative death.

  • 78.
    Matthiessen, Peter
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    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.
    Rutegård, Jörgen
    Departments of Surgery, Örebro University Hospital, Örebro, Sweden.
    Simert, Göran
    Höglandssjukhuset, Eksjö, Sweden.
    Sjödahl, Rune
    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.
    Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: A randomized multicenter trial2007In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 246, no 2, p. 207-214Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were intraoperatively randomized to a defunctioning stoma or not.

    SUMMARY BACKGROUND DATA: The introduction of total mesorectal excision surgery as the surgical technique of choice for carcinoma in the lower and mid rectum has led to decreased local recurrence and improved oncological results. Despite these advances, perioperative morbidity remains a major issue, and the most feared complication is symptomatic anastomotic leakage. The role of the defunctioning stoma in regard to anastomotic leakage is controversial and has not been assessed in any randomized trial of sufficient size.

    METHODS: From December 1999 to June 2005, a total of 234 patients were randomized to a defunctioning loop stoma or no loop stoma. Loop ileostomy or loop transverse colostomy was at the choice of the surgeon. Inclusion criteria for randomization were expected survival >6 months, informed consent, anastomosis ≤7 cm above the anal verge, negative air leakage test, intact anastomotic rings, and absence of major intraoperative adverse events.

    RESULTS: The overall rate of symptomatic leakage was 19.2% (45 of 234). Patients randomized to a defunctioning stoma (n = 116) had leakage in 10.3% (12 of 116) and those without stoma (n = 118) in 28.0% (33 of 118) (odds ratio = 3.4, 95% confidence interval, 1.6-6.9, P < 0.001). The need for urgent abdominal reoperation was 8.6% (10 of 116) in those randomized to stoma and 25.4% (30 of 118) in those without (P < 0.001). After a follow-up of median 42 months (range, 6-72 months), 13.8% (16 of 116) of the initially defunctioned patients still had a stoma of any kind, compared with 16.9% (20 of 118) those not defunctioned (not significant). The 30-day mortality after anterior resection was 0.4% (1 of 234) and after elective reversal a defunctioning stoma 0.9% (1 of 111). Median age was 68 years (range, 32-86 years), 45.3% (106 of 234) were females, 79.1% (185 of 234) had preoperative radiotherapy, the level of anastomosis was median 5 cm, and intraoperative blood loss 550 mL, without differences between the groups.

    CONCLUSION: Defunctioning loop stoma decreased the rate of symptomatic anastomotic leakage and is therefore recommended in low anterior resection for rectal cancer.

  • 79.
    Matthiessen, Peter
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Strand, Ida
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Törnquist, Cathrine
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Andersson, Magnus
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Rutegård, Jörgen
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Norgren, Lars
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Is early detection of anastomotic leakage possible by intraperitoneal microdialysis and intraperitoneal cytokines after anterior resection of the rectum for cancer?2007In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 50, no 11, p. 1918-27Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This prospective study assessed methods of detecting intraperitoneal ischemia and inflammatory response in patients with and without postoperative complications after anterior resection of the rectum.

    METHODS: In 23 patients operated on with anterior resection of the rectum for rectal carcinoma, intraperitoneal lactate, pyruvate, and glucose levels were monitored postoperatively for six days by using microdialysis with catheters applied in two locations: intraperitoneally near the anastomosis, and in the central abdominal cavity. A reference catheter was placed subcutaneously in the pectoral region. Cytokines, interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-alpha, were measured in intraperitoneal fluid by means of a pelvic drain for two postoperative days.

    RESULTS: The intraperitoneal lactate/pyruvate ratio near the anastomosis was higher on postoperative Day 5 (P = 0.029) and Day 6 (P = 0.009) in patients with clinical anastomotic leakage (n = 7) compared with patients without leakage (n = 16). The intraperitoneal levels of IL-6 (P = 0.002; P = 0.012, respectively) and IL-10 (P = 0.002; P = 0.041, respectively) were higher on postoperative Days 1 and 2 in the leakage group, and TNF-alpha was higher in the leakage group on Day 1 (P = 0.011). In-hospital clinical anastomotic leakage was diagnosed on median Day 6, and leakage after hospital discharge on median Day 20.

    CONCLUSIONS: The intraperitoneal lactate/pyruvate ratio and cytokines, IL-6, IL-10, and TNF-alpha, were increased in patients who developed symptomatic anastomotic leakage before clinical symptoms were evident.

  • 80.
    Monstein, Hans-Jurg
    et al.
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Tiveljung, Annika
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Kraft, C. H.
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Borch, Kurt
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Jonasson, Jon
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Profiling of bacterial flora in gastric biopsies from patients with Helicobacter pylori-associated gastritis and histologically normal control individuals by temperature gradient gel electrophoresis and 16S rDNA sequence analysis2000In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 49, no 9, p. 817-822Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to establish bacterial profiles in gastric biopsy specimens from patients with Helicobacter pylori-associated gastritis by means of temporal temperature gradient gel electrophoresis (TTGE) of PCR-amplified 16S rDNA fragments. Specimens from eight patients with asymptomatic gastritis and five histologically normal controls revealed a Helicobacter-specific band in the TTGE profile with increased amounts of Helicobacter-specific DNA in the biopsies from most of the gastritis patients. DNA from other genera including Enterococcus, Pseudomonas, Streptococcus, Staphylococcus and Stomatococcus was also found in the stomach. In the absence of gastric inflammation, Helicobacter spp. appeared to be part of a complex, presumably indigenous microbial flora found in the biopsy specimens from the stomach.

  • 81. Monstein, H-J
    et al.
    Jonsson, Y
    Zdolsek, Johann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Svanvik, Joar
    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.
    Identification of Helicobacter pylori DNA in human cholesterol gallstones2002In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 37, no 1, p. 112-119Article in journal (Refereed)
    Abstract [en]

    Background: The gallbladder mucosa secretes hydrogen ions and is covered by mucus. The environmental conditions for bacterial colonization are similar to those in the stomach. Gallbladder stones often contain DNA from enteric bacteria, but no compelling evidence demonstrates that Helicobacter spp. have been present. The aim of this study was to establish bacterial DNA profiles in cholesterol gallstones with special reference to Helicobacter pylori. Methods: Cholesterol gallstones from 20 patients were subjected to polymerase chain reaction, bacterial profiling by temporal temperature gradient gel electrophoresis, automated DNA sequencing, and Southern blot analysis using a Helicobacter sp. specific primer. A nested ureI-PCR assay was used to discriminate between gastric and non-gastric H. pylori. Results: TTGE, partial 16S rDNA sequencing, and hybridization analysis revealed the presence of DNA presumably representing a mixed bacterial flora in cholesterol gallstones, including H. pylori in the gallstone centres in 11 out of 20 patients. In three cases, the ureI-PCR assay revealed non-gastric H. pylori. Conclusions: These data support the presence of DNA from a mixed bacterial population, including H. pylori in cholesterol gallstones, reflecting either that H. pylori is an indigenous part of a flora in the stone-containing gallbladder or, alternatively, that H. pylori colonization in the biliary tract predisposes to cholesterol gallstone formation.

  • 82.
    Morren, Geert
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Anatomical and physiological aspects of anorectal dysfunction2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objective: To analyse the results of anal-sphincter repair; to examine the feasibility of motor latency measurements of the anal sphincter after magnetic sacral stimulation in healthy subjects, patients with a spinal cord injury and patients with faecal incontinence, using a new recording technique; to study, in the same 3 groups, the effects ofphasic magnetic sacral root stimulation on the anal sphincter and rectum; to describe normal, undisturbed anatomy of the anal canal and perianal structures in both men and nulliparous women using high-resolution phased array magnetic resonance imaging; to study pelvic floor movements in healthy volunteers of both sexes using a new instrument.

    Methods: Latencies were recorded with an intraanal, bipolar sponge electrode and an intrarectal ground electrode. Rectal volume changes were measured with a barostat. Highresolution magnetic resonance images were obtained without an endoanal coil. Pelvic floor movements where measured with the subject seated, using a magnet attached to a rectal balloon.

    Results: After a median period of 40 months, 31/55 female patients rated the result of analsphincter repair as excellent or good. Age>50 years, and post-operative urgency and loose stools were associated with poor outcome. Eight patients became fully continent for stool. 17% of the latency measurements failed. There were no significant differences between leftand right-sided stimulation. Faecal incontinence patients had prolonged pudendal nerve terminal motor latencies and prolonged latencies after left-sided magnetic stimulation. Phasic magnetic stimulation increased anal pressure in 100% of the 14 healthy subjects, 86% of the 14 spinal cord injury patients and 73% of the 18 faecal incontinence patients. A decrease in rectal volume was provoked in respectively 72 %, 79 % and 50 %. In all 33 volunteers, anal and perianal structures could be well defined by magnetic resonance imaging. The mid-anal canal was significantly longer than its anterior and posterior part. The female anterior sphincter was shorter than the male and occupied 30 % of the anal canal length. The female perineal body was thicker and easier to define than the male. The median pelvic floor lift and descent measured in 28 healthy volunteers, were 2 cm and 1.8 cm respectively. Day-to-day and inter-observer reproducibility were good. 20/28 subjects were able to expel the rectal balloon.

    Conclusions: Anal-sphincter repair does not restore complete continence but leads to a satisfactory result in more than half of the patients. Additional bowel symptoms are common at follow-up. Latency measurements after magnetic stimulation are minimally invasive and have a low failure rate. They may be used to test the integrity of the distal motor pathway in patients who may benefit from continuous sacral root stimulation. Magnetic sacral root stimulation produces an increase in anal and rectal pressure and a decrease in rectal volume. Phased array magnetic resonance imaging is non-invasive and allows an accurate description of the normal anatomy of the anal canal and perianal structures. The new developed instrument measures cranial and caudal movement of the pelvic floor with minimal discomfort and good reproducibility.

    List of papers
    1. Audit of anal-sphincter repair
    Open this publication in new window or tab >>Audit of anal-sphincter repair
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    2001 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 3, no 1, p. 17-22Article in journal (Refereed) Published
    Abstract [en]

    Objective

    Structural damage of the anterior part of the anal sphincter is a major cause of faecal incontinence. Sphincter repair is the standard surgical treatment. This study was designed to analyse the results of anal sphincter repair, to identify possible predictors of outcome and to investigate the presence of bowel symptoms other than leakage at follow up.

    Patients and methods

    Fifty-five women (median age 39 years, range 24–73 years) who underwent anal sphincter repair between 1986 and 1997 at the University Hospital of Linköping answered a postal questionnaire. Current bowel function, degree of continence and the patients’ functional result as worse, unchanged, some improvement, good or excellent were assessed. Good or excellent function was regarded as a successful result, the rest as failure. Age, duration of symptoms, type of surgery, morbidity and length of follow up were analysed in relation to outcome. Results of pre- and post-operative anal manometry, endoanal ultrasound, anal sphincter electromyography and pudendal nerve function were also analysed.

    Results

    After a median (range) follow-up period of 40 months (5–137) months, 31 (56%) patients rated the result as either excellent (n=10) or good (n=21). Twenty-one (38%) patients rated the result as some improvement (n=14), unchanged (n=6) or worse (n=1). In three (5%) patients a colostomy was fashioned because of failure. Patients >50 years at surgery (n=18) had a worse outcome (P=0.001). Successful outcome was correlated to increased squeeze pressures post-operatively. The presence of post-operative urgency (P=0.01) and loose stools (P=0.02) was more common in patients with poor outcome. Eight patients became continent to formed and liquid stool.

    Keywords
    Anal sphincter repair, Audit, Faecal incontinence
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25046 (URN)10.1111/j.1463-1318.2001.00205.x (DOI)9474 (Local ID)9474 (Archive number)9474 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    2. Latency of compound muscle action potentials of the anal sphincter after magnetic sacral stimulation
    Open this publication in new window or tab >>Latency of compound muscle action potentials of the anal sphincter after magnetic sacral stimulation
    Show others...
    2001 (English)In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 24, no 9, p. 1232-1235Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to present the failure rate and normal values for motor latency of the anal sphincter after magnetic sacral stimulation (LMSS) using a modified recording technique. A bipolar sponge electrode was placed in the anal canal for recording. A ground electrode was placed in the rectum to reduce stimulus artifact. Magnetic stimulation was induced through a twin coil energized by a Maglite-r25 generator. Two groups were examined: 14 healthy volunteers and 14 patients with a spinal cord injury (SCI) above the conus. Nine of 56 studies (16%) failed. There were no significant differences in latency between right- and left-sided stimulation or between the healthy group and the SCI patients. As described, LMSS measurements are minimally invasive and have a low failure rate. They may be used to test the integrity of the distal motor pathway in patients with bladder or bowel dysfunction who may benefit from continuous electrical sacral root stimulation.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25053 (URN)10.1002/mus.1138 (DOI)9481 (Local ID)9481 (Archive number)9481 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    3. Evaluation of the sacroanal motor pathway by magnetic and electric stimulation in patients with fecal incontinence
    Open this publication in new window or tab >>Evaluation of the sacroanal motor pathway by magnetic and electric stimulation in patients with fecal incontinence
    Show others...
    2001 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 44, no 2, p. 167-172Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: The aim of this controlled study was to examine whether it was feasible to use magnetic stimulation as a new diagnostic tool to evaluate the motor function of the sacral roots and the pudendal nerves in patients with fecal incontinence.

    PATIENTS AND METHODS: Nineteen consecutive patients (17 females) with a median age of 67 (range, 36-78) years referred for fecal incontinence and 14 healthy volunteers (six females) with a median age of 42 (range, 23-69) years were examined. Latency times of the motor response of the external anal sphincter were measured after electric transrectal stimulation of the pudendal nerve and magnetic stimulation of the sacral roots.

    RESULTS: The success rates of pudendal nerve terminal motor latency and sacral root terminal motor latency measurements were 100 and 85 percent, respectively, in the control group and 94 and 81 percent, respectively, in the fecal incontinence group. Median left pudendal nerve terminal motor latency was 1.88 (range, 1.4-2.9) milliseconds in the control group and 2.3 (range, 1.8-4) milliseconds in the fecal incontinence group (P <0.006). Median right pudendal nerve terminal motor latency was 1.7 (range, 1.3-3.4) milliseconds in the control group and 2.5 (range, 1.7-6) milliseconds in the fecal incontinence group (P <0.003). Median left sacral root terminal motor latency was 3.3 (range, 2.1-6) milliseconds in the control group and 3.7 (range, 2.8-4.8) milliseconds in the fecal incontinence group (P <3 0.03). Median right sacral root terminal motor latency was 3 (range, 2.6-5.8) milliseconds in the control group and 3.9 (range, 2.5-7.2) milliseconds in the fecal incontinence group (P =0.15).

    CONCLUSIONS: Combined pudendal nerve terminal motor latency and sacral root terminal motor latency measurements may allow us to study both proximal and distal pudendal nerve motor function in patients with fecal incontinence. Values of sacral root terminal motor latency have to be interpreted cautiously because of the uncertainty about the exact site of magnetic stimulation and the limited magnetic field strength.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25050 (URN)10.1007/BF02234288 (DOI)9478 (Local ID)9478 (Archive number)9478 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    4. Effects of magnetic sacral root stimulation on anorectal pressure and volume
    Open this publication in new window or tab >>Effects of magnetic sacral root stimulation on anorectal pressure and volume
    2001 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 44, no 12, p. 1827-1833Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: Electrical sacral root stimulation induces defecation in spinal cord injury patients and is currently under examination as a new therapy for fecal incontinence. In contrast to electrical stimulation, magnetic stimulation is noninvasive. To gain more insight into the mechanism of action of sacral root stimulation, we studied the effects of magnetic sacral root stimulation on anorectal pressure and volume in both fecal incontinence and spinal cord injury patients.

    METHODS: Three groups were examined: 14 healthy volunteers, 18 fecal incontinence patients, and 14 spinal cord injury patients. Repetitive magnetic sacral root stimulation was performed bilaterally using bursts of five seconds at 5 Hz. Anal and rectal pressure changes and rectal volume changes were measured.

    RESULTS: An increase in anal pressure was seen in 100 percent of the control subjects, in 86 percent of the spinal cord injury patients, and in 73 percent of the fecal incontinence patients (P=0.03). The overall median pressure rise after right-sided and left-sided stimulation was 12 (interquartile range, 8-18.5) and 13 (interquartile range, 6-18) mmHg at the mid anal level. A decrease in rectal volume was provoked in 72 percent of the control subjects, in 79 percent of the spinal cord injury patients, and in 50 percent of the fecal incontinence patients. Overall median volume changes after right-sided and left-sided stimulation were 10 (range, 5-22) and 9 (range, 5-21) percent from baseline volume. An increase in rectal pressure could be measured in 56 percent of the control subjects, 77 percent of the fecal incontinence patients, and 43 percent of the spinal cord injury patients. Median pressure rises after right-sided and left-sided stimulation were 5 (range, 3-12) and 5 (range, 3-5) mmHg.

    CONCLUSIONS: Magnetic sacral root stimulation produces an increase in anal and rectal pressure and a decrease in rectal volume in healthy subjects and patients with fecal incontinence or a spinal cord injury.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26134 (URN)10.1007/BF02234462 (DOI)10593 (Local ID)10593 (Archive number)10593 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    5. Anatomy of the anal canal and perianal structures as defined by phased-array magnetic resonance imaging
    Open this publication in new window or tab >>Anatomy of the anal canal and perianal structures as defined by phased-array magnetic resonance imaging
    2001 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 88, no 11, p. 1506-1512Article in journal (Refereed) Published
    Abstract [en]

    Background:

    The anatomy of the anal canal and perianal structures has been imaged using endoluminal magnetic resonance imaging (MRI). Phased-array MRI avoids the use of an endoluminal coil that may distort anatomy. The aim of this study was to describe the anatomy of the anal canal and perianal structures using phased-array MRI.

    Methods:

    Imaging was performed in 14 men and 19 nulliparous women. The dimensions of the anal canal, puborectalis, external anal sphincter, perineal body, superficial transverse perineal muscle, bulbospongiosus, ischiocavernosus and anococcygeal body were measured in different planes, and sex differences were calculated.

    Results:

    The lateral canal was significantly longer than its anterior and posterior part (P < 0·001). The anterior external anal sphincter was shorter in women than in men (P = 0·01) and occupied, respectively, 30 and 38 per cent of the anal canal length (P = 0·001). The caudal ends of the external anal sphincter formed a double layer. The perineal body was thicker in women than in men (P < 0·001) and easier to define. The superficial transverse muscles had a lateral and caudal extension to the ischiopubic bones. The bulbospongiosus was thicker in men than in women (P < 0·001). The ischiocavernosus and anococcygeal body had the same dimensions in both sexes.

    Conclusion:

    Phased-array MRI is a non-invasive technique that allows an accurate description of the normal anatomy of the anal canal and perianal structures.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81477 (URN)10.1046/j.0007-1323.2001.01919.x (DOI)
    Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2017-12-07Bibliographically approved
    6. Clinical measurement of pelvic floor movement: Evaluation of a new device
    Open this publication in new window or tab >>Clinical measurement of pelvic floor movement: Evaluation of a new device
    Show others...
    2004 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 47, no 5, p. 787-792Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE:: A new device that measures pelvic floor movement clinically was evaluated.

    METHODS:: The device consists of a rectal balloon with a magnet at its exterior end. The magnet moves in an electromagnetic field synchronous with the pelvic floor movements. This movement is measured and displayed on a computer screen in front of the seated patient. Twenty-eight healthy volunteers (15 females) were examined. On a separate day, 17 of them were tested a second time by the same investigator and a third time by a different investigator.

    RESULTS:: One volunteer developed a vasovagal reaction. The median (range) pelvic floor lift and descent was 2 (range, 0.6-4.5) cm and 1.8 (range, 0.5-5.6) cm respectively. Day-to-day and interobserver reproducibility was good. Coughing and blowing a party balloon caused pelvic floor descent in the majority of participants. Twenty of 28 volunteers were able to expel the rectal balloon.

    CONCLUSIONS:: The device measures cranial and caudal movements of the pelvic floor with minimal discomfort and good reproducibility. The device may have a large potential as biofeedback device in pelvic floor training.

    Keywords
    Clinical method, Measurement, Movement, Pelvic floor
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-45747 (URN)10.1007/s10350-003-0109-3 (DOI)15073661 (PubMedID)
    Note

    On the day of the defence day the status of this article was submitted.

    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
  • 83.
    Morren, Geert
    et al.
    Department of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
    Hallböök, Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Nyström, Per-Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Baeten, C. G. M. I.
    Department of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
    Sjödahl, Rune
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Audit of anal-sphincter repair2001In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 3, no 1, p. 17-22Article in journal (Refereed)
    Abstract [en]

    Objective

    Structural damage of the anterior part of the anal sphincter is a major cause of faecal incontinence. Sphincter repair is the standard surgical treatment. This study was designed to analyse the results of anal sphincter repair, to identify possible predictors of outcome and to investigate the presence of bowel symptoms other than leakage at follow up.

    Patients and methods

    Fifty-five women (median age 39 years, range 24–73 years) who underwent anal sphincter repair between 1986 and 1997 at the University Hospital of Linköping answered a postal questionnaire. Current bowel function, degree of continence and the patients’ functional result as worse, unchanged, some improvement, good or excellent were assessed. Good or excellent function was regarded as a successful result, the rest as failure. Age, duration of symptoms, type of surgery, morbidity and length of follow up were analysed in relation to outcome. Results of pre- and post-operative anal manometry, endoanal ultrasound, anal sphincter electromyography and pudendal nerve function were also analysed.

    Results

    After a median (range) follow-up period of 40 months (5–137) months, 31 (56%) patients rated the result as either excellent (n=10) or good (n=21). Twenty-one (38%) patients rated the result as some improvement (n=14), unchanged (n=6) or worse (n=1). In three (5%) patients a colostomy was fashioned because of failure. Patients >50 years at surgery (n=18) had a worse outcome (P=0.001). Successful outcome was correlated to increased squeeze pressures post-operatively. The presence of post-operative urgency (P=0.01) and loose stools (P=0.02) was more common in patients with poor outcome. Eight patients became continent to formed and liquid stool.

  • 84.
    Morren, Geert
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Ryn, A.-K.
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Sjödahl, Rune
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Kaufman, H. S.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Clinical measurement of pelvic floor movement: Evaluation of a new device2004In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 47, no 5, p. 787-792Article in journal (Refereed)
    Abstract [en]

    PURPOSE:: A new device that measures pelvic floor movement clinically was evaluated.

    METHODS:: The device consists of a rectal balloon with a magnet at its exterior end. The magnet moves in an electromagnetic field synchronous with the pelvic floor movements. This movement is measured and displayed on a computer screen in front of the seated patient. Twenty-eight healthy volunteers (15 females) were examined. On a separate day, 17 of them were tested a second time by the same investigator and a third time by a different investigator.

    RESULTS:: One volunteer developed a vasovagal reaction. The median (range) pelvic floor lift and descent was 2 (range, 0.6-4.5) cm and 1.8 (range, 0.5-5.6) cm respectively. Day-to-day and interobserver reproducibility was good. Coughing and blowing a party balloon caused pelvic floor descent in the majority of participants. Twenty of 28 volunteers were able to expel the rectal balloon.

    CONCLUSIONS:: The device measures cranial and caudal movements of the pelvic floor with minimal discomfort and good reproducibility. The device may have a large potential as biofeedback device in pelvic floor training.

  • 85.
    Morren, Geert
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Walter, Susanna
    Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Sjödahl, Rune
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Effects of magnetic sacral root stimulation on anorectal pressure and volume2001In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 44, no 12, p. 1827-1833Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Electrical sacral root stimulation induces defecation in spinal cord injury patients and is currently under examination as a new therapy for fecal incontinence. In contrast to electrical stimulation, magnetic stimulation is noninvasive. To gain more insight into the mechanism of action of sacral root stimulation, we studied the effects of magnetic sacral root stimulation on anorectal pressure and volume in both fecal incontinence and spinal cord injury patients.

    METHODS: Three groups were examined: 14 healthy volunteers, 18 fecal incontinence patients, and 14 spinal cord injury patients. Repetitive magnetic sacral root stimulation was performed bilaterally using bursts of five seconds at 5 Hz. Anal and rectal pressure changes and rectal volume changes were measured.

    RESULTS: An increase in anal pressure was seen in 100 percent of the control subjects, in 86 percent of the spinal cord injury patients, and in 73 percent of the fecal incontinence patients (P=0.03). The overall median pressure rise after right-sided and left-sided stimulation was 12 (interquartile range, 8-18.5) and 13 (interquartile range, 6-18) mmHg at the mid anal level. A decrease in rectal volume was provoked in 72 percent of the control subjects, in 79 percent of the spinal cord injury patients, and in 50 percent of the fecal incontinence patients. Overall median volume changes after right-sided and left-sided stimulation were 10 (range, 5-22) and 9 (range, 5-21) percent from baseline volume. An increase in rectal pressure could be measured in 56 percent of the control subjects, 77 percent of the fecal incontinence patients, and 43 percent of the spinal cord injury patients. Median pressure rises after right-sided and left-sided stimulation were 5 (range, 3-12) and 5 (range, 3-5) mmHg.

    CONCLUSIONS: Magnetic sacral root stimulation produces an increase in anal and rectal pressure and a decrease in rectal volume in healthy subjects and patients with fecal incontinence or a spinal cord injury.

  • 86.
    Morren, Geert
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Walter, Susanna
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Lindehammar, Hans
    Linköping University, Department of Neuroscience and Locomotion, Neurophysiology. Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Sjödahl, Rune
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Evaluation of the sacroanal motor pathway by magnetic and electric stimulation in patients with fecal incontinence2001In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 44, no 2, p. 167-172Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this controlled study was to examine whether it was feasible to use magnetic stimulation as a new diagnostic tool to evaluate the motor function of the sacral roots and the pudendal nerves in patients with fecal incontinence.

    PATIENTS AND METHODS: Nineteen consecutive patients (17 females) with a median age of 67 (range, 36-78) years referred for fecal incontinence and 14 healthy volunteers (six females) with a median age of 42 (range, 23-69) years were examined. Latency times of the motor response of the external anal sphincter were measured after electric transrectal stimulation of the pudendal nerve and magnetic stimulation of the sacral roots.

    RESULTS: The success rates of pudendal nerve terminal motor latency and sacral root terminal motor latency measurements were 100 and 85 percent, respectively, in the control group and 94 and 81 percent, respectively, in the fecal incontinence group. Median left pudendal nerve terminal motor latency was 1.88 (range, 1.4-2.9) milliseconds in the control group and 2.3 (range, 1.8-4) milliseconds in the fecal incontinence group (P <0.006). Median right pudendal nerve terminal motor latency was 1.7 (range, 1.3-3.4) milliseconds in the control group and 2.5 (range, 1.7-6) milliseconds in the fecal incontinence group (P <0.003). Median left sacral root terminal motor latency was 3.3 (range, 2.1-6) milliseconds in the control group and 3.7 (range, 2.8-4.8) milliseconds in the fecal incontinence group (P <3 0.03). Median right sacral root terminal motor latency was 3 (range, 2.6-5.8) milliseconds in the control group and 3.9 (range, 2.5-7.2) milliseconds in the fecal incontinence group (P =0.15).

    CONCLUSIONS: Combined pudendal nerve terminal motor latency and sacral root terminal motor latency measurements may allow us to study both proximal and distal pudendal nerve motor function in patients with fecal incontinence. Values of sacral root terminal motor latency have to be interpreted cautiously because of the uncertainty about the exact site of magnetic stimulation and the limited magnetic field strength.

  • 87.
    Morren, Geert
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Walter, Susanna
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Lindehammar, Hans
    Linköping University, Department of Neuroscience and Locomotion, Neurophysiology. Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Sjödahl, Rune
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Latency of compound muscle action potentials of the anal sphincter after magnetic sacral stimulation2001In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 24, no 9, p. 1232-1235Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to present the failure rate and normal values for motor latency of the anal sphincter after magnetic sacral stimulation (LMSS) using a modified recording technique. A bipolar sponge electrode was placed in the anal canal for recording. A ground electrode was placed in the rectum to reduce stimulus artifact. Magnetic stimulation was induced through a twin coil energized by a Maglite-r25 generator. Two groups were examined: 14 healthy volunteers and 14 patients with a spinal cord injury (SCI) above the conus. Nine of 56 studies (16%) failed. There were no significant differences in latency between right- and left-sided stimulation or between the healthy group and the SCI patients. As described, LMSS measurements are minimally invasive and have a low failure rate. They may be used to test the integrity of the distal motor pathway in patients with bladder or bowel dysfunction who may benefit from continuous electrical sacral root stimulation.

  • 88.
    Mårdh, Erik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Cell biology.
    Mårdh, Sven
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Cell biology.
    Mårdh, Bibbi
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Cell biology.
    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.
    Diagnosis of gastritis by means of a combination of serological analyses2002In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 320, no 1-2, p. 17-27Article in journal (Refereed)
    Abstract [en]

    Background: Gastroscopy and examination of biopsy is normally required for diagnosis of gastritis. This is costly and inconvenient for the patient, and there is a need for a simple pregastroscopic screening method to reduce the endoscopy workload. Our aim was to develop a serological screening test for gastritis. Methods: Sera from subjects examined with gastroscopy and biopsy were analyzed for H,K-ATPase antibodies, Helicobacter pylori antibodies and pepsinogen I. The diagnoses were normal gastric mucosa (n=50), duodenal ulcer (n=53) and atrophic corpus gastritis, with (n=50) or without pernicious anemia (n=46). Results: An evaluation scheme was constructed to optimize the diagnostic agreement between serology and gastric mucosal morphology. The sensitivity to detect gastritis was 98% (146/149) (95% CI 94-100%) and the specificity 84% (42/50) (95% CI 71-93%). Additional sera from 483 subjects from the general population were analyzed. There was a good agreement between serology and gastric mucosal morphology. Conclusions: Assays of multiple serum analytes are useful for the initial screening of gastritis. They are complementary to upper gastroscopy by identification of subjects with a normal gastric mucosa, those who qualify for eradication of H. pylori, and those who have developed atrophy and are at risk of developing malignancy and, therefore, require gastroscopic examination.

  • 89.
    Nilsson, B
    et al.
    Department of Surgery, Sahlgrenska University Hospital, Göteborg.
    Valantinas, J
    Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
    Hedin, L
    Friman, S
    Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg,.
    Svanvik, Joar
    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.
    Acetazolamide inhibits stimulated feline liver and gallbladder bicarbonate secretion2002In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 174, no 2, p. 117-123Article in journal (Refereed)
    Abstract [en]

    Bile acidification is a key factor in preventing calcium carbonate precipitation and gallstone formation. Carbonic anhydrase II (CA II), that is inhibited by acetazolamide, plays a role in regulation of the acid-base balance in many tissues. This study examines the effect of acetazolamide on secretin- and vasoactive intestinal peptide (VIP)-stimulated gallbladder mucosal bicarbonate and acid secretion. Gallbladders in anaesthetized cats were perfused with a bicarbonate buffer bubbled with CO2 in air. In 20 experiments VIP (10 ╡g kg1 h1) and in 10 experiments secretin (4 ╡g kg1 h1) were infused continuously intravenous (i.v.). Hepatic bile and samples from the buffer before and after perfusion of the gallbladder were collected for calculation of ion and fluid transport. During basal conditions a continuous secretion of H+ by the gallbladder mucosa was seen. Intravenous infusion of vasoactive intestinal peptide (VIP) and secretin caused a secretion of bicarbonate from the gallbladder mucosa (P < 0.01). This secretion was reduced by intraluminal (i.l.) acetazolamide (P < 0.01). Bile flow was enhanced by infusion of VIP and secretin (P < 0.01) but this stimulated outflow was not affected by i.v. acetazolamide. The presence of CA II in the gallbladder was demonstrated by immunoblotting. Biliary CA activity has an important function in the regulation of VIP- and secretin-stimulated bicarbonate secretion across the gallbladder mucosa.

  • 90.
    Nilsson, Erik
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Haapaniemi, Staffan
    Vrinnevi Hospital, Norrköping, Sweden.
    Hernia Registers and Specialization1998In: Surgical Clinics of North America, ISSN 0039-6109, E-ISSN 1558-3171, Vol. 78, no 6, p. 1141-1155Article in journal (Refereed)
    Abstract [en]

    Registration of hernia surgery is useful in the demonstration of outcome quality provided reoperation is linked to the primary procedure. Prerequisites for a hernia register are discussed based on Swedish experience. Evidence indicates that register participation reduces reoperation rate and increases costeffectiveness. Monitoring of outcome quality is important for both specialized and nonspecialized hernia surgeons. Registers of the type discussed may assist general surgeons in their efforts to acheive levels defined by experts.

  • 91. Norberg, Karl-Axel
    et al.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, GE: endokir.
    Framtiden ställer nya krav på katastrofmedicinsk kunskap.1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, p. 4638-4639Article in journal (Other (popular science, discussion, etc.))
  • 92. Nordin, P
    et al.
    Haapaniemi, S
    Kald, Anders
    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, E
    Influence of suture material and surgical technique on risk of reoperation after non-mesh open hernia repair2003In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 90, no 8, p. 1004-1008Article in journal (Refereed)
    Abstract [en]

    Background: Although mesh techniques are used with increasing frequency, sutured repair still has a place in groin hernia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh technique on the risk of reoperation in open groin hernia repair using data from the Swedish Hernia Register. Methods: The relative risk of reoperation after sutured repair using non-absorbable, late absorbable and early absorbable sutures was compared in multivariate analyses, taking into account known confounding factors. Results: Between 1992 and 2000, 46 745 hernia repairs were recorded in the Swedish Hernia Register. Of these, 18 057 repairs were performed with open non-mesh methods and were included in the analysis. Using non-absorbable suture as reference, the relative risk of reoperation after repair with early absorbable suture and late absorbable suture was 1.50 (95 per cent confidence interval (c.i.) 1.22 to 1.83) and 1.03 (95 per cent c.i. 0.83 to 1.28) respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk of reoperation (1.22, 95 per cent c.i. 1.03 to 1.44). Conclusion: A non-absorbable or a late absorbable suture is recommended for open non-mesh groin hernia repair. The Shouldice technique was found to be superior to other open methods.

  • 93.
    Nordin, Pär
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Groin hernia surgery: studies on anaesthesia and surgical technique2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The modem era of groin hernia surgery began with Eduardo Bassini who in the late 19th century, developed the first modem anatomically based hernia repair. Surgical technique, anaesthesia, suture and biomaterials have been matters of discussion ever since.

    In recent decades new techniques using a mesh prosthesis as adjunct have, to a large extent, replaced sutured repairs in groin hernia surgery. The advantages and disadvantages of new methods and devices are not easy to establish. Excellent results from specialised hernia centres have frequently been presented in the form of retrospective series. However, hernia surgery is usually considered an area within general surgery and, therefore, often performed by non-specialised surgeons and trainees.

    The Swedish Hernia Register (SHR), initiated in 1992 has today become nationwide and covers some 90 % of all Swedish units where hernia surgery is performed. Register data may be used for local audit, follow-up studies, and as background for RCTs. Register data reflect the results obtained by general surgeons with varying background and experience of hernia surgery. The present thesis comprises flve studies (I-V), three RCTs and two analyses of SHR data.

    Paper I: The aim of this RCT trial was to compare the Shouldice procedure with the Lichtenstein repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice are able to reproduce the excellent results reported from specialised hernia centres. The Lichtenstein repair resulted in fewer recurrences took less time to perform and was easier to learn. It seemed possible to achieve excellent results with this technique even in non-specialised general surgical units.

    Paper II: Although mesh techniques are used with increasing frequency sutured repairs will continue to have a place in groin hernia surgery. Between 1992 and 2000 detailed information on 18,057 repairs with open sutured non-mesh methods was recorded in the SHR. The purpose of this study was to analyse the relative risk for reoperation with early absorbable, late absorbable, and nonabsorbable sutures, and to compare the relative risk of reoperation using the Shouldice technique with that of other sutured repairs. The relative risk for reoperation with early absorbable sutures was significantly higher than with other sutures. Among sutured repairs the Shouldice technique carried a lower risk for reoperation than other sutured repairs.

    Paper III: Data from 59,823 hernia operations recorded in SHR from 1992 through 2001 were used to estimate the relative risk of reoperation for recurrence (or chronic pain) when using general anaesthesia (GA), regional anaesthesia (RA), and local anaesthesia (LA). Time trends for anaesthetic and operative methods and other variables affecting risk for reoperation were also analysed. LA was associated with an enhanced risk for reoperation in primary but not recurrent repair. The Lichtenstein technique carried a significantly lower risk of reoperation compared to other methods.

    Paper IV: Within a three-armed multicentre RCT (n=616), perform by ten units all aligned to the SHR, surgical outcomes using the three anaesthetic alternatives were compared. LA was found to have considerable advantages over RA and GA. General surgeons in routine surgical practice could to a great extent, reproduce the favourable results obtained using LA in specialised hernia centres.

    Paper V: As part of Study IV patient satisfaction and quality of life following hernia surgery under GA,RA, and LA was compared in an RCT (n= 138) using a specially designed questionnaire. With the exception of slight intraoperative pain, LA was found to be well tolerated and associated with significant advantages when compared with GA and RA.

    Quality assessment of hernia surgery is essential. RCTs enable us to compare new surgical and anaesthetic alternatives. Register studies reflecting outcome in routine clinical practice can give this assessment a new dimension.

    List of papers
    1. Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice
    Open this publication in new window or tab >>Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice
    Show others...
    2002 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 89, no 1, p. 45-49Article in journal (Refereed) Published
    Abstract [en]

    Background:

    The aim of the present randomized trial was to compare the Shouldice procedure and the Lichtenstein hernia repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice were able to reproduce the excellent results reported from specialist hernia centres.

    Methods:

    Three hundred patients with primary inguinal hernia were randomized to either a Shouldice repair or to a tension-free Lichtenstein repair. In a pretrial training programme the five participating general surgeons were taught to perform the two techniques in a standard manner. Follow-up was performed after 8 weeks, 1 year and 3 years. The last examination was performed by an independent blinded assessor.

    Results:

    There was a significant difference in operating time in favour of the Lichtenstein technique. After a follow-up of 36–77 months seven recurrences were found in the Shouldice group (95 per cent confidence interval (c.i.) 1·3 to 8·1) and one in the mesh group (95 per cent c.i. 0·0 to 2·0). Chronic groin pain was reported by 4·2 and 5·6 per cent in the Shouldice and Lichtenstein groups respectively. It was characterized as mild or moderate in all except two patients who had the Shouldice operation.

    Conclusion: 

    Lichtenstein hernia repair was easier to learn, took less time and resulted in fewer recurrences. It was possible to achieve excellent results with this technique in a general surgical unit. © 2002 British Journal of Surgery Society Ltd

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84501 (URN)10.1046/j.0007-1323.2001.01960.x (DOI)
    Available from: 2012-10-10 Created: 2012-10-10 Last updated: 2017-12-07Bibliographically approved
    2. Sutures and surgical techniques in herniorrhaphy: an analysis of 18 057 sutured non-mesh repairs
    Open this publication in new window or tab >>Sutures and surgical techniques in herniorrhaphy: an analysis of 18 057 sutured non-mesh repairs
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Although mesh techniques are used with increasing frequency sutured repairs will continue to have a place in groin hemia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh techniques on risk for reoperation in open groin hernia repair using data from the Swedish Hernia Register (SHR).

    Methods: The relative risk for reoperation after sutured repairs using nonabsorbable, late absorbable and early absorbable sutures were compared in multivariate analyses taking into account known confounding factors.

    Results: During 1992 -2000, 46,745 hernia repairs were recorded in the SHR. Of these 18,057 repairs were performed with open non-mesh methods and included in the analysis. With nonabsorbable suture as reference the relative risk for reoperation of early absorbable suture and of late absorbable suture was 1.50 (95% CI 1.22-1.83) and 1.03 (95% CI 0.83-1.28), respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk for reoperation 1.22 (95% CI 1.03-1.44).

    Conclusion: For open non-mesh groin hernia repairs a nonabsorbable or a late absorbable suture is recommended. The Shouldice technique was found superior to other open methods.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84502 (URN)
    Available from: 2012-10-10 Created: 2012-10-10 Last updated: 2012-10-10Bibliographically approved
    3. Choice of anesthesia and risk of reooperation for recurrence in groin hernia repair
    Open this publication in new window or tab >>Choice of anesthesia and risk of reooperation for recurrence in groin hernia repair
    2004 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 240, no 1, p. 187-192Article in journal (Refereed) Published
    Abstract [en]

    Objective: To analyze the relative risk of reoperation for recurrence using 3 anesthetic alternatives, general anesthesia (GA), regional (spinal-, epidural-) anesthesia (RA), and local anesthesia (LA), and to study time trends for various anesthetic and operative methods, as well as other risk factors regarding reoperation for recurrence.

    Background: The method of anesthesia used for hernia repair is generally assumed not to affect the long-term outcome. The few studies on the topic have rendered conflicting results.

    Methods: Data from the Swedish Hernia Register was used. Relative risk was first estimated using univariate analysis for assumed risk variables and then selecting variables with the highest or lowest univariate risk for multivariate analysis.

    Results: From 1992 through 2001, 59,823 hernia repairs were recorded. Despite the fact that univariate analysis showed a somewhat lower risk for reoperation in the LA group, the multivariate analysis showed that LA was associated with a significantly increased risk for reoperation in primary but not in recurrent hernia repair. The Lichtenstein technique carried a significantly lower reoperation risk than any other method of operation.

    Conclusions: LA was associated with a higher risk of reoperation for recurrence after primary hernia repair. The use of mesh techniques has increased considerably, and among these the Lichtenstein repair was associated with a significantly lower risk for reoperation than any other repair.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84503 (URN)10.1097/01.sla.0000130726.03886.93 (DOI)
    Available from: 2012-10-10 Created: 2012-10-10 Last updated: 2017-12-07Bibliographically approved
    4. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial
    Open this publication in new window or tab >>Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial
    2003 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 362, no 9387, p. 853-858Article in journal (Refereed) Published
    Abstract [en]

    Background

    In specialised centres, local anaesthesia is almost always used in groin hernia surgery; whereas in routine surgical practice, regional or general anaesthesia are the methods of choice. In this three-arm multicentre randomised trial, we aimed to compare the three methods of anaesthesia and to determine the extent to which general surgeons can reproduce the excellent results obtained with local anaesthesia in specialised hernia centres.

    Methods

    Between January, 1999, and December, 2001, 616 patients at ten hospitals, were randomly assigned to have either local, regional, or general anaesthesia. Primary endpoints were early and late postoperative complications. Secondary endpoints were duration of surgery and anaesthesia, length of postoperative hospital stay, and time to normal activity. Analysis was by intention to treat.

    Findings

    Intraoperative tolerance for local anaesthesia was high. In the early postoperative period, local anaesthesia was superior to the other two types with respect to almost all endpoints. At 8 days' and 30 days' follow-up, there were no significant differences between the three groups. Although the mean duration of surgery was longer, the total anaesthesia time—ie, time from the start of anaesthesia until the patient left the operating room—was significantly shorter than it was for regional or general anaesthesia.

    Interpretation

    Local anaesthesia has substantial advantages compared with regional or general anaesthesia, such as shorter duration of admission, less postoperative pain, and fewer micturition difficulties. The favourable results obtained with local anaesthesia in specialised hernia centres can, to a great extent, be reproduced by general surgeons in routine surgical practice.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84504 (URN)10.1016/S0140-6736(03)14339-5 (DOI)
    Available from: 2012-10-10 Created: 2012-10-10 Last updated: 2017-12-07Bibliographically approved
    5. Type of anaesthesia and patient acceptance in groin hernia repair: a multicentre randomised trial
    Open this publication in new window or tab >>Type of anaesthesia and patient acceptance in groin hernia repair: a multicentre randomised trial
    Show others...
    2004 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 8, no 3, p. 220-225Article in journal (Refereed) Published
    Abstract [en]

    Background  Groin hernia repair can be performed under general (GA), regional (RA), or local (LA) anaesthesia. This multicentre randomised trial evaluates patient acceptance, satisfaction, and quality of life with these three anaesthetic alternatives in hernia surgery.

    Methods  One hundred and thirty-eight patients at three hospitals were randomised to one of three groups, GA, RA, or LA. Upon discharge, they were asked to complete a specially designed questionnaire with items focusing on pain, discomfort, recovery, and overall satisfaction with the anaesthetic method used. The global quality-of-life instrument EuroQol was used for estimation of health perceived.

    Results  Significantly more patients in the LA group than in the RA group felt pain during surgery (P<0.001). This pain was characterised as light or moderate and for the majority of LA patients was felt during infiltration of the anaesthetic agent. Postoperatively, patients in the LA group first felt pain significantly later than patients in the other two groups (P=0.012) and significantly fewer LA patients consumed analgesics more than three times during the first postoperative day (P=0.002). The results concerning nausea, vomiting, and time to first meal all favour LA. No difference was found among the three groups concerning overall satisfaction and quality of life.

    Conclusion   In a general surgical setting, we found LA to be well tolerated and associated with significant advantages compared to GA and RA.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-24775 (URN)10.1007/s10029-004-0234-5 (DOI)7036 (Local ID)7036 (Archive number)7036 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
  • 94.
    Nordin, Pär
    et al.
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Haapaniemi, Staffan
    Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden.
    Kald, Anders
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Nilsson, Erik
    Department of Surgery, Motala Hospital, Motala, Sweden.
    Sutures and surgical techniques in herniorrhaphy: an analysis of 18 057 sutured non-mesh repairsManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Although mesh techniques are used with increasing frequency sutured repairs will continue to have a place in groin hemia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh techniques on risk for reoperation in open groin hernia repair using data from the Swedish Hernia Register (SHR).

    Methods: The relative risk for reoperation after sutured repairs using nonabsorbable, late absorbable and early absorbable sutures were compared in multivariate analyses taking into account known confounding factors.

    Results: During 1992 -2000, 46,745 hernia repairs were recorded in the SHR. Of these 18,057 repairs were performed with open non-mesh methods and included in the analysis. With nonabsorbable suture as reference the relative risk for reoperation of early absorbable suture and of late absorbable suture was 1.50 (95% CI 1.22-1.83) and 1.03 (95% CI 0.83-1.28), respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk for reoperation 1.22 (95% CI 1.03-1.44).

    Conclusion: For open non-mesh groin hernia repairs a nonabsorbable or a late absorbable suture is recommended. The Shouldice technique was found superior to other open methods.

  • 95.
    Nyström, Per-Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Laparoskopische Sigmaresektion bei Divertikulitis.1999In: Zentralblatt für Chirurgie, ISSN 0044-409X, E-ISSN 1438-9592, Vol. 124, p. 1147-1151Article in journal (Refereed)
  • 96.
    Nyström, Per-Olof
    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.
    Wittman, D
    Patient to surgeon infections - Fact or fiction2003In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 90, no 11, p. 1315-1316Article in journal (Refereed)
  • 97.
    Nägga, Katarina
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Rajani, Rupesh
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Mårdh, Erik
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Borch, Kurt
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Mårdh, Sven
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Cobalamin, folate, methylmalonic acid, homocysteine, and gastritis markers in dementia2003In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 16, no 4, p. 269-275Article in journal (Refereed)
    Abstract [en]

    The prevalence of dementia disorders, cobalamin and/or folate deficiency as well as gastritis increases with age. To investigate whether there is an association between these conditions, plasma homocysteine (Hcy), serum methylmalonic acid, serum cobalamin and blood folate concentrations were measured. Gastritis was indirectly diagnosed by measuring serum antibodies against H,K-ATPase, Helicobacter pylori and intrinsic factor, using enzyme-linked immunosorbent assays. The studied groups consisted of 47 patients with Alzheimer’s disease (AD), 9 with AD pathology in combination with additive vascular lesions, 59 with vascular dementia, 8 who were cognitively impaired, and 101 control cases. Plasma Hcy concentrations were significantly elevated in the dementia groups, with the highest levels in patients with vascular pathology. We conclude that hyperhomocysteinemia is a common finding in patients with dementia disorders of different etiologies. The markers for gastritis did not contribute to an elucidation of a possible connection between this condition, dementia disorders, or cobalamin/folate deficiency.

  • 98. Ohlin, B
    et al.
    Cederberg, Å
    Kjellin, T
    Kullman, Eric
    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.
    Melén, K
    Staël von Holstein, C
    Thoring, M
    Dual versus triple therapy in eradication of Helicobacter pylori2002In: Hepato-Gastroenterology, ISSN 0172-6390, Vol. 49, p. 172-175Article in journal (Refereed)
  • 99.
    Olaison, Gunnar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Andersson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Myrelid, Pär
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Smedh, Kenneth
    Söderholm, Johan D
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    On-table endoscopy to define strictures and resection margins: Experience from 178 operations for Crohn's disease using intraoperative endoscopy2001In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 3, no SUPPL. 2, p. 58-62Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 100.
    Permert, Johan
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Glucose metabolism in patients with exocrine pancreatic adenocarcinoma1993Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Carc.inoma of the exocrine pancreas is the fifth leading cause of cancer death in the Western world and the survival rate is one of the lowest for cancers of any site. Pancreatic cancer is characterized by pronounced, early cachexia and frequent metabolic complications. An increased incidence of diabetes or impaired glucose tolerance have been reported in pancreatic cancer patients. Two different hypotheses for this association have been presented, one suggesting that diabetes is a predisposing factor for pancreatic cancer and the other suggesting that the diabetic state is a consequence of the malignant disease.

    In the present study, 50 patients with exocrine pancreatic adenocarcinoma were studied, 11 of whom were found suitable for radical surgery. These eleven patients were studied both preoperatively and 3 months after subtotal pancreatectomy. Healthy subjects, patients with cancer of other sites and diabetic patients without any malignancy were investigated as controls. The incidence of diabetes and impaired glucose tolerance was investigated. Insulin secretion from pancreatic cancer patients was evaluated in the basal state, during hyperglycemia and after glucagon stimulation. Whole-body and peripheral insulin sensitivity were determined. The abundance and distribution pattern of endocrine cells, and the concentration of pancreatic islet hormones were investigated in control tissues ·and human exocrine pancreatic adenocarcinomas. The metabolic effect of extracts of these tumors on muscle glycogen synthesis was studied in vitro. Concentrations of islet hormones were determined in plasma in the basal state, during hyperglycemia and after stimulation by glucagon. Production of islet amyloid polypeptide (IAPP) was evaluated by studies of mRNA expression and peptide immunoreactivity in pancreatic adenocarcinomas, in tissue adjacent to the tumor and in normal pancreas.

    Diabetes or impaired glucose tolerance was found in 74% of the patients with pancreatic cancer, and this high frequency resulted mainly from newly-diagnosed diabetes. The diabetic state was more a consequence of profound insulin resistance rather than an impaired insulin secretion. After subtotal pancreatectomy, the diabetic state, glucose tolerance and insulin sensitivity were improved despite a marked decrease in insulinsecretion. Endocrine cells were found in 80% of the adenocarcinomas, predominantly in well-differentiated adenocarcinomas. Extracts from the tumors contained islet hormones, but in varying concentrations and without any correlation to diabetic state. Tumor extracts from diabetic but not from non-diabetic pancreatic cancer patients inhibited glycogen synthesis in skeletal muscle. This metabolic effect could not be explained by the concentrations of the diabetogenic peptides in the extracts. Plasma IAPP, glucagon and somatostatin were normalized after subtotal pancreatectomy. The pattern of hormonal changes seen was suggestive of a paracrine action of pancreatic adenocarcinomas on the adjacent pancreatic islets. This was supported by the normal IAPP mRNA-staining in the absence of IAPP-immunoreactivity in endocrine pancreatic tissues adjacent to the tumor. In conclusion, diabetes occurs with an increased frequency in patients with exocrine pancreatic adenocarcinoma. The diabetic state is closely related to the tumor itself and is a consequence rather then the cause of the malignant disease. Overall the results indicate that the diabetic state results from the tumor acting either directly or indirectly.

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