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  • 251.
    Granholm, Anders
    et al.
    Copenhagen Univ Hosp, Denmark; Collaborat Res Intens Care CRIC, Denmark.
    Munch, Marie Warrer
    Copenhagen Univ Hosp, Denmark; Collaborat Res Intens Care CRIC, Denmark.
    Myatra, Sheila Nainan
    Tata Mem Hosp, India.
    Vijayaraghavan, Bharath Kumar Tirupakuzhi
    Apollo Hosp, India; Chennai Crit Care Consultants, India; George Inst Global Hlth, India.
    Cronhjort, Maria
    Karolinska Inst, Sweden.
    Wahlin, Rebecka Rubenson
    Karolinska Inst, Sweden.
    Jakob, Stephan M.
    Univ Bern, Switzerland.
    Cioccari, Luca
    Univ Bern, Switzerland.
    Kjaer, Maj-Brit Norregaard
    Copenhagen Univ Hosp, Denmark; Collaborat Res Intens Care CRIC, Denmark.
    Vesterlund, Gitte Kingo
    Copenhagen Univ Hosp, Denmark; Collaborat Res Intens Care CRIC, Denmark.
    Meyhoff, Tine Sylvest
    Copenhagen Univ Hosp, Denmark; Collaborat Res Intens Care CRIC, Denmark.
    Helleberg, Marie
    Univ Copenhagen, Denmark.
    Moller, Morten Hylander
    Copenhagen Univ Hosp, Denmark; Collaborat Res Intens Care CRIC, Denmark.
    Benfield, Thomas
    Univ Copenhagen, Denmark.
    Venkatesh, Balasubramanian
    Univ New Southern Wales, Australia.
    Hammond, Naomi E.
    Univ New Southern Wales, Australia; Royal North Shore Hosp, Australia.
    Micallef, Sharon
    Univ New Southern Wales, Australia.
    Bassi, Abhinav
    George Inst Global Hlth, India.
    John, Oommen
    George Inst Global Hlth, India; Manipal Acad Higher Educ, India.
    Jha, Vivekanand
    George Inst Global Hlth, India; Manipal Acad Higher Educ, India; Imperial Coll London, England.
    Kristiansen, Klaus Tjelle
    Univ Copenhagen, Denmark.
    Ulrik, Charlotte Suppli
    Univ Copenhagen, Denmark.
    Jorgensen, Vibeke Lind
    Univ Copenhagen, Denmark.
    Smitt, Margit
    Univ Copenhagen, Denmark.
    Bestle, Morten H.
    Copenhagen Univ Hosp North Zealand, Denmark; Univ Copenhagen, Denmark.
    Andreasen, Anne Sofie
    Univ Copenhagen, Denmark.
    Poulsen, Lone Musaeus
    Zealand Univ Hosp, Denmark.
    Rasmussen, Bodil Steen
    Collaborat Res Intens Care CRIC, Denmark; Aalborg Univ Hosp, Denmark.
    Brochner, Anne Craveiro
    Collaborat Res Intens Care CRIC, Denmark; Univ Hosp Southern Denmark, Denmark.
    Strom, Thomas
    Odense Univ Hosp, Denmark; Univ Hosp Southern, Denmark.
    Moller, Anders
    Ringsted Hosp, Denmark.
    Khan, Mohd Saif
    Rajendra Inst Med Sci, India.
    Padmanaban, Ajay
    Apollo Hosp, India.
    Divatia, Jigeeshu Vasishtha
    Tata Mem Hosp, India.
    Saseedharan, Sanjith
    SL Raheja Hosp, India.
    Borawake, Kapil
    Vishwaraj Hosp, India.
    Kapadia, Farhad
    Hinduja Hosp, India.
    Dixit, Subhal
    Sanjeevan Hosp, India.
    Chawla, Rajesh
    Indraprastha Apollo Hosp, India.
    Shukla, Urvi
    Symbiosis Univ Hosp, India.
    Amin, Pravin
    Bombay Hosp & Med Res Ctr, India.
    Chew, Michelle
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Wamberg, Christian Aage
    Bispebjerg Hosp, Denmark.
    Gluud, Christian
    Copenhagen Univ Hosp, Denmark; Univ Southern Denmark, Denmark.
    Lange, Theis
    Univ Copenhagen, Denmark.
    Perner, Anders
    Copenhagen Univ Hosp, Denmark; Collaborat Res Intens Care CRIC, Denmark.
    Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia: a pre-planned, secondary Bayesian analysis of the COVID STEROID 2 trial2022In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 48, no 1, p. 45-55Article in journal (Refereed)
    Abstract [en]

    Purpose We compared dexamethasone 12 versus 6 mg daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia in the international, randomised, blinded COVID STEROID 2 trial. In the primary, conventional analyses, the predefined statistical significance thresholds were not reached. We conducted a pre-planned Bayesian analysis to facilitate probabilistic interpretation. Methods We analysed outcome data within 90 days in the intention-to-treat population (data available in 967 to 982 patients) using Bayesian models with various sensitivity analyses. Results are presented as median posterior probabilities with 95% credible intervals (CrIs) and probabilities of different effect sizes with 12 mg dexamethasone. Results The adjusted mean difference on days alive without life support at day 28 (primary outcome) was 1.3 days (95% CrI -0.3 to 2.9; 94.2% probability of benefit). Adjusted relative risks and probabilities of benefit on serious adverse reactions was 0.85 (0.63 to 1.16; 84.1%) and on mortality 0.87 (0.73 to 1.03; 94.8%) at day 28 and 0.88 (0.75 to 1.02; 95.1%) at day 90. Probabilities of benefit on days alive without life support and days alive out of hospital at day 90 were 85 and 95.7%, respectively. Results were largely consistent across sensitivity analyses, with relatively low probabilities of clinically important harm with 12 mg on all outcomes in all analyses. Conclusion We found high probabilities of benefit and low probabilities of clinically important harm with dexamethasone 12 mg versus 6 mg daily in patients with COVID-19 and severe hypoxaemia on all outcomes up to 90 days.

  • 252.
    Grassi, Alberto
    et al.
    Ist Ortoped Rizzoli, Italy.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Marcheggiani Muccioli, Giulio Maria
    Ist Ortoped Rizzoli, Italy.
    Neri, Maria Pia
    Ist Ortoped Rizzoli, Italy.
    Marcacci, Maurilio
    Ist Ortoped Rizzoli, Italy.
    Zaffagnini, Stefano
    Ist Ortoped Rizzoli, Italy.
    Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 716-724Article, review/survey (Refereed)
    Abstract [en]

    Purpose To compare patient-reported and clinician-reported outcomes, and radiographic results between patients who had had revision ACL reconstruction and those who had had primary ACL reconstruction. Design Systematic review and meta-analysis Data sources The MEDLINE, CINAHL, EMBASE and SPORTDiscus electronic databases were searched on 6 August 2015, using 3 main concepts: (1) revision ACL reconstruction, (2) primary ACL reconstruction and (3) treatment outcomes. Eligibility criteria for selecting studies Articles that compared patient-reported or clinician-reported outcomes or radiographic results between patients who had had revision ACL reconstruction and those who had had primary surgery with a minimum of 2 years follow-up were included. The outcomes evaluated were the Lysholm Knee Scoring Scale, objective International Knee Documentation Committee (IKDC) classification, Tegner Activity Scale, side-to-side difference in anterior tibial translation measured with KT-1000/2000 arthrometer, pivot shift test, tibiofemoral osteoarthritis grading on plain radiographs and subsequent knee surgeries. Results 8 studies (300 revision ACL reconstructions and 413 primary ACL reconstructions) were included in the meta-analysis. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores (mean difference: 7.8 points), had inferior clinician-reported knee function as assessed with the objective IKDC classification (IKDC category A: 27% vs 57%; IKDC category C or D: 22% vs 8%) and pivot shift test (grade II or III: 7% vs 2%), and more radiographic evidence of tibiofemoral osteoarthritis (50% vs 25%) compared with patients who had had primary surgery. Conclusions Revision ACL reconstruction restored similar anterior-posterior knee laxity compared with primary ACL reconstruction. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores, had inferior clinician-reported knee function and more radiographic signs of tibiofemoral osteoarthritis compared with patients with primary ACL reconstruction.

  • 253.
    Griffith, May
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Maisonneuve Rosemont Hospital, Canada.
    Alarcon, E. I.
    University of Ottawa, Canada.
    Brunette, I.
    Maisonneuve Rosemont Hospital, Canada; University of Montreal, Canada.
    Regenerative approaches for the cornea2016In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 280, no 3, p. 276-286Article, review/survey (Refereed)
    Abstract [en]

    The cornea is the transparent front part of the eye that transmits light to the back of the eye to generate vision. Loss of corneal transparency, if irreversible, leads to severe vision loss or blindness. For decades, corneal transplantation using human donor corneas has been the only option for treating corneal blindness. Despite recent improvement in surgical techniques, donor cornea transplantation remains plagued by risks of suboptimal optical results and visual acuity, immune rejection and eventually graft failure. Furthermore, the demand for suitable donor corneas is increasing faster than the number of donors, leaving thousands of curable patients untreated worldwide. Here, we critically review the state of the art of biomaterials for corneal regeneration. However, the lessons learned from the use of the cornea as a disease model will allow for extension of the biomaterials and techniques for regeneration of more complex organs such as the heart.

  • 254.
    Grossmann, Benjamin
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Procedural sedation: Aspects on methods, safety and effectiveness2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Safety and effectiveness are fundamental principles within the healthcare sector to provide quality of care and health improvement for patients. By ensuring that care is provided based on evidence-based knowledge, risks and complications can be minimised and the use of scarce resources optimised. An increasing demand for diagnostic and therapeutic procedures challenges the traditional methods for sedation regarding safety and effectiveness. It is desirable that the fundamental principles are improved when refining existing or developing new sedation methods. In this doctoral thesis, safety and effectiveness were evaluated for adult patient-controlled sedation (PCS) using propofol during two endoscopic procedures: endoscopic retrograde cholangiopancreaticography (ERCP) and flexible bronchoscopy (FB); and different doses of rectal racemic ketamine for paediatric (< 4 years) burn wound care.

    Methods: Data on vital functions, sedation level, safety interventions, procedure feasibility, patient-reported outcome and experience measures, and recovery, from three clinical randomised controlled trials were collected. Costs of sedation for the endoscopic procedures were compiled in a cost-analysis study.

    Results: PCS with propofol and bedside anaesthetic personnel was shown to be a safe and effective alternative method of sedation during ERCP and FB compared with intravenous sedation with midazolam. The PCS method gives stable cardiorespiratory conditions with few adverse events and interventions, with a low risk of oversedation. PCS offers similar (FB) or better (ERCP) procedure feasibility and patient satisfaction during the procedures than midazolam. Recovery after PCS is quick, minimises the risk for prolonged hospitalisation and is thereby a potential cost-saving sedation method. The optimal dose of rectal racemic ketamine, 6 mg/kg with the addition of 0.5 mg/kg midazolam during severely painful procedures, gives minimal risk for outbreaks of pain, offers stable vital signs conditions and allows rapid recovery without affecting procedure feasibility.

    Conclusions: The sedation method can be adjusted to type of procedure and patient population. PCS with propofol offers an alternative and reliable method for adult sedation during endoscopic procedures, whereas rectal racemic ketamine combined with midazolam provides good conditions for burn care dressing procedures in young children.

    List of papers
    1. Sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled study of patient-controlled propofol sedation and that given by a nurse anaesthetist
    Open this publication in new window or tab >>Sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled study of patient-controlled propofol sedation and that given by a nurse anaesthetist
    Show others...
    2015 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, no 10, p. 1285-1292Article in journal (Refereed) Published
    Abstract [en]

    Objective: Different regimens are used for sedation during ERCP (endoscopic retrograde cholangiopancreatography). Our objectives were to compare safety, ease of treatment, time to recovery and patients’ experiences using PCS (patient-controlled sedation) with propofol as well as sedation given by a nurse anaesthetist (ACS) with propofol or midazolam during ERCP.

    Material and methods: The study included 281 adults in 301 procedures. The PCS group (n=101) delivered bolus doses of 5 mg of propofol according to their need for sedation. The ACS group (n=100) had 2-8 mg/kg/hour of propofol infused, with the target for sedation being Level 3 of the Observer’s Assessment of Alertness/Sedation scale (OAA/S). The control group was given 2-3 mg of midazolam for induction and additional 1 mg if required.

    Results: PCS and ACS increased the ease of the procedure and reduced the numbers of sedation failures compared to midazolam sedation (ACS n=0; PCS n=4; midazolam n=20). The ACS group had more deeply sedated patients (OAA/S Level 2), desaturations and obstructed airways than the PCS and midazolam groups. Over 90% of all patients had recovered (Aldrete score≥9) by the time they returned to the ward. PCS resulted in the least fatigue and pain after the procedure. Patients’ preference for PCS and ACS were the same.

    Conclusion: PCS with propofol is superior to midazolam and comparable to ACS. PCS resulted in a rapid recovery, tended to be the safest and was almost as effective as ACS in ensuring a successful examination.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2015
    Keywords
    Conscious sedation, propofol, Cholangiopancreatography, Endoscopic Retrograde
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:liu:diva-112371 (URN)10.3109/00365521.2015.1038848 (DOI)000361324600013 ()
    Available from: 2014-11-24 Created: 2014-11-24 Last updated: 2024-01-10Bibliographically approved
    2. Patient-controlled Sedation During Flexible Bronchoscopy: A Randomized Controlled Trial
    Open this publication in new window or tab >>Patient-controlled Sedation During Flexible Bronchoscopy: A Randomized Controlled Trial
    2020 (English)In: Journal of Bronchology & Interventional Pulmonology, ISSN 1944-6586, E-ISSN 1948-8270, Vol. 27, no 2, p. 77-85Article in journal (Refereed) Published
    Abstract [en]

    Background: Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB).

    Materials and Methods: This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol).

    Results: The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (P<0.0001). Between PCS groups, 96% of the PCS-G group patients were ready for discharge compared with 65% in the PCS-MS group (P=0.0002) at 2 hours. Bronchoscopists’ and patients’ satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups.

    Conclusion: PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2020
    Keywords
    analgesia, patient-controlled, conscious sedation, anesthesia, intravenous, bronchoscopy, propofol
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-161081 (URN)10.1097/LBR.0000000000000610 (DOI)000524951100010 ()31478938 (PubMedID)2-s2.0-85072015123 (Scopus ID)
    Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2021-05-04Bibliographically approved
    3. Patient-controlled sedation with propofol for endoscopic procedures: A cost analysis
    Open this publication in new window or tab >>Patient-controlled sedation with propofol for endoscopic procedures: A cost analysis
    Show others...
    2020 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 64, no 1, p. 53-62Article in journal (Refereed) Published
    Abstract [en]

    Background

    Patient‐controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation.

    Methods

    Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine‐scopolamine or glycopyrronium.

    Results

    Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine‐scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups.

    Conclusion

    Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2020
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-161080 (URN)10.1111/aas.13463 (DOI)000607414900008 ()31436310 (PubMedID)
    Note

    Funding agencies: Internal grants from Region of Ostergotland, Sweden Funding Source: Medline

    Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2021-04-25Bibliographically approved
    4. Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study
    Open this publication in new window or tab >>Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study
    2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 5, p. 1081-1088Article in journal (Refereed) Published
    Abstract [en]

    Background

    Worldwide, ketamine is used during paediatric procedures, but no recommendations are available regarding a suitable dose for rectal administration during procedures involving high levels of pain and/or anxiety such as burn wound dressing change.

    Methods

    We evaluated three different single doses of rectally administered racemic ketamine mixed with a fixed dose of 0.5 mg/kg of midazolam. In total, 90 children – aged 6 months to 4 years – were randomised 1:1:1 to receive 4 mg/kg (K-4 group), 6 mg/kg (K-6 group) or 8 mg/kg (K-8 group) of racemic ketamine for a maximum of three consecutive procedures. Primary outcome measure was procedural pain evaluated by Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. Secondary outcome included feasibility and recovery time. Patient safety was evaluated using surrogate outcomes.

    Results

    In total, 201 procedures in 90 children aged 19 ± 8 months were completed. The median maximum pain was FLACC 0 in all groups (p = 0.141). The feasibility was better for groups K-6 (p = 0.049) and K-8 (p = 0.027) compared with K-4, and the mean recovery time was the longest for group K-8 (36 ± 22 min) compared with groups K-4 (25 ± 15 min; p = 0.003) and K-6 (27 ± 20 min; p = 0.025). Median maximum sedation measured by the University of Michigan Sedation Scale (UMSS) was higher in group K-8 compared with group K-4 (p < 0.0001) and K-6 (p = 0.023). One child in group K-8 had a study drug-related serious adverse event — laryngospasm/airway obstruction. No rescue analgosedative medication was administered for group K-6.

    Conclusions

    A rectally administered mixture of racemic ketamine (6 mg/kg) and midazolam (0.5 mg/kg) during paediatric burn dressing procedures with a duration of approximately 30 min provides optimal conditions regarding pain relief, feasibility, recovery time and patient safety, with no need for rescue analgosedative medication.

    Place, publisher, year, edition, pages
    Pergamon Press, 2019
    National Category
    Anesthesiology and Intensive Care Public Health, Global Health, Social Medicine and Epidemiology Surgery
    Identifiers
    urn:nbn:se:liu:diva-156837 (URN)10.1016/j.burns.2018.12.012 (DOI)000470856100010 ()31060760 (PubMedID)2-s2.0-85065014700 (Scopus ID)
    Note

    Funding agencies: County Council of Ostergotland, Sweden

    Available from: 2019-05-14 Created: 2019-05-14 Last updated: 2024-01-10Bibliographically approved
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  • 255.
    Grossmann, Benjamin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Nilsson, Andreas
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 5, p. 1081-1088Article in journal (Refereed)
    Abstract [en]

    Background

    Worldwide, ketamine is used during paediatric procedures, but no recommendations are available regarding a suitable dose for rectal administration during procedures involving high levels of pain and/or anxiety such as burn wound dressing change.

    Methods

    We evaluated three different single doses of rectally administered racemic ketamine mixed with a fixed dose of 0.5 mg/kg of midazolam. In total, 90 children – aged 6 months to 4 years – were randomised 1:1:1 to receive 4 mg/kg (K-4 group), 6 mg/kg (K-6 group) or 8 mg/kg (K-8 group) of racemic ketamine for a maximum of three consecutive procedures. Primary outcome measure was procedural pain evaluated by Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. Secondary outcome included feasibility and recovery time. Patient safety was evaluated using surrogate outcomes.

    Results

    In total, 201 procedures in 90 children aged 19 ± 8 months were completed. The median maximum pain was FLACC 0 in all groups (p = 0.141). The feasibility was better for groups K-6 (p = 0.049) and K-8 (p = 0.027) compared with K-4, and the mean recovery time was the longest for group K-8 (36 ± 22 min) compared with groups K-4 (25 ± 15 min; p = 0.003) and K-6 (27 ± 20 min; p = 0.025). Median maximum sedation measured by the University of Michigan Sedation Scale (UMSS) was higher in group K-8 compared with group K-4 (p < 0.0001) and K-6 (p = 0.023). One child in group K-8 had a study drug-related serious adverse event — laryngospasm/airway obstruction. No rescue analgosedative medication was administered for group K-6.

    Conclusions

    A rectally administered mixture of racemic ketamine (6 mg/kg) and midazolam (0.5 mg/kg) during paediatric burn dressing procedures with a duration of approximately 30 min provides optimal conditions regarding pain relief, feasibility, recovery time and patient safety, with no need for rescue analgosedative medication.

  • 256.
    Guidet, Bertrand
    et al.
    Sorbonne Univ, France.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Boumendil, Ariane
    Hop St Antoine, France.
    Leaver, Susannah
    Res Lead Crit Care Directorate St Georges Hosp, England.
    Watson, Ximena
    St Georges Univ Hosp, England.
    Boulanger, Carol
    Royal Devon and Exeter NHS Fdn Trust, England.
    Szczeklik, Wojciech
    Jagiellonian Univ, Poland.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Morandi, Alessandro
    Hosp Ancelle Cremona Italy, Italy.
    Andersen, Finn
    Alesund Hosp, Norway.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa Tsakal Larissa, Greece.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Walther, Sten M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Oeyen, Sandra
    Univ Ghent, Belgium.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Cecconi, Maurizio
    Humanitas Clin and Res Ctr IRCCS, Italy; Humanitas Univ, Italy.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Nalapko, Yuriy
    European Wellness Int, Ukraine.
    Elhadi, Muhammed
    Alkhums Hosp, Libya.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Flaatten, Hans
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study2020In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 46, p. 57-69Article in journal (Refereed)
    Abstract [en]

    Purpose Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS amp;gt; 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE amp;gt;= 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL amp;lt;= 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaikes information criterion across imputations was used to evaluate the goodness of fit of our models. Results We included 3920 patients with a median age of 84 years (IQR: 81-87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83-8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3-6); IQCODE: 3.19 (3-3.69); ADL: 6 (4-6); Comorbidity and Polypharmacy score (CPS): 10 (7-14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.-1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14-1.17, p amp;lt; 0.0001) and CFS (per point): 1.1 (1.05-1.15, p amp;lt; 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model. Conclusion We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.

  • 257.
    Gumusoglu, Alpen Yahya
    et al.
    Univ Hlth Sci Turkey, Turkey.
    Kabuli, Hamit Ahmet
    Univ Hlth Sci Turkey, Turkey.
    Salik, Aysun Erbahceci
    Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Cakir, Caglayan
    Univ Hlth Sci Turkey, Turkey.
    Abdullayev, Seymur
    Doga Hosp, Turkey.
    Peker, Kivanc Derya
    Univ Hlth Sci Turkey, Turkey.
    Karabulut, Mehmet
    Univ Hlth Sci Turkey, Turkey.
    Adas, Gokhan Tolga
    Univ Hlth Sci Turkey, Turkey.
    Percutaneous Cholecystostomy as a Step or Final Treatment for Acute Cholecystitis2021In: Medical Journal of Bakirköy, ISSN 1305-9319, E-ISSN 1305-9327, Vol. 17, no 4, p. 354-358Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to investigate the effectiveness of percutaneous cholecystostomy (PC) as a step treatment in patients who underwent PC for acute cholecystitis. Methods: Data of 248 patients who underwent PC for acute cholecystitis between January 2015 and December 2019 were retrospectively analyzed. All patients who underwent PC were evaluated for a distal transition by cholangiography taken by the interventional radiology department in the third week after discharge. In addition, all patients were re-evaluated by the anesthesia department. Patients were retrospectively evaluated in terms of age, gender, American Society of Anesthesiologists physical status (ASA-PS) class, surgical procedure, complications after PC, and termination of PC. Results: A total of 231 patients were included in the study. The mean age of patients was 68.6 (minimum-maximum: 32-92 years) and the male/ female ratio was 1.04. The anesthesia evaluation of the patients categorized 44 patients (19.05%) as ASA-PS class I-II and 187 (80.95%) as ASAPS III-IV. A total of 17 (7.35%) patients died in the 30-day follow-up period. The examination of the remaining patient revealed that PC was used as a step treatment in the transition to elective cholecystostomy in 106 (45.8%) patients, whereas 108 (50.4%) had it as a final treatment method since an operation is impossible. The median follow-up period in these patients was 2.6 years. Recurrent cholecystitis developed in 14 (12.96%) patients in the group who underwent PC. Conclusion: PC should be noted as an alternative step treatment method for acute cholecystitis but maybe a final treatment option in patients with high comorbidity.

  • 258.
    Gunnarsson, Thordur
    et al.
    Lund Univ, Sweden; Helsingborg Hosp, Sweden.
    Bergman, Stefan
    Univ Gothenburg, Sweden; Spenshult Res & Dev Ctr, Sweden.
    Pärsson, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Gottsater, Anders
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Lindgren, Hans
    Lund Univ, Sweden; Helsingborg Hosp, Sweden.
    Long Term Results of a Randomised Trial of Stenting of the Superficial Femoral Artery for Intermittent Claudication2023In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 65, no 4, p. 513-519Article in journal (Refereed)
    Abstract [en]

    Objective: Primary stenting of the superficial femoral artery (SFA) in intermittent claudication (IC) has been shown to increase health related quality of life (HRQoL) after 12 and 24 months. An extended follow up of HRQoL 36 and 60 months after randomisation is presented.Methods: A multicentre randomised controlled trial was conducted at seven vascular clinics in Sweden between 2010 and 2020. One hundred patients randomised to either primary stenting and best medical treatment (BMT; n = 48) or BMT alone (n = 52) were followed for 60 months. HRQoL, assessed by the Short Form 36 Health Survey (SF-36) and EuroQoL 5 dimensions (EQ5D) 36 and 60 months after randomisation, was the primary outcome. Walking Impairment Questionnaire (WIQ) score, re-interventions, progression to chronic limb threatening ischaemia (CLTI), amputation, and death were secondary outcomes.Results: At the 36 month follow up, the stent group (n = 32) had statistically significantly better scores in the SF -36 domain "Role Physical" (p = .023) and the Physical Component Summary (p = .032) compared with the control group (n = 30); however, there was no statistically significant difference in EQ5D scores (p = .52). WIQ was statistically significantly better in the stent group compared with the control group (p = .029) at 36 months. At the 60 month follow up, no statistically significant difference in HRQoL was seen between patients in the stent (n = 31) and control groups (n = 32). Crossover from the control group to the stent group was 25% at 60 months. There were no differences in progression to CLTI, amputation (2.1% vs. 1.9%), or mortality (14.6% vs. 15.4%) between groups. Conclusion: In patients with IC caused by isolated SFA lesions, primary stenting conferred benefits to HRQoL until 36 months from treatment vs. BMT alone, but these benefits were no longer detectable at 60 months, where a high crossover rate affected the power of the final analysis.

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  • 259.
    Gunnarsson, Thordur
    et al.
    Lund Univ, Sweden; Helsingborg Hosp, Sweden.
    Lindgren, Hans
    Lund Univ, Sweden; Helsingborg Hosp, Sweden.
    Gottsater, Anders
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Pärsson, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Intraprocedural Transcutaneous Oxygen Pressure and Systolic Toe Pressure Measurements During and After Endovascular Intervention in Patients with Chronic Limb Threatening Ischaemia2021In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 62, no 4, p. 583-589Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to evaluate changes in transcutaneous oxygen pressure (tcpO(2)) and systolic toe pressure (TP) during endovascular intervention. Methods: This was a single centre prospective, non-randomised, observational feasibility study. Patients with chronic limb threatening ischaemia (CLTI) due to infrainguinal disease scheduled for endovascular treatment were included between March 2018 and December 2019. TcpO(2) was measured continuously bilaterally at foot level throughout the procedure and at follow up. Specific time points during the intervention were chosen for comparison to baseline (before arterial puncture): average tcpO(2) level five minutes prior to percutaneous transluminal angioplasty (PTA); 10 minutes after PTA; and at completion. Bilateral TP was recorded using laser Doppler flowmetry before arterial puncture, at completion, and at clinical follow up. Angiograms were analysed for successful revascularisation and vascular lesions classified according to the Global Limb Anatomical Scoring System (GLASS). Rutherford and WIfI (Wound, Ischaemia, and foot Infection) classifications were registered, as well as clinical outcome. Results: Twenty-one patients completed the study. Completion angiograms showed inline flow to the foot in all but two patients. Median time to follow up was 10 weeks (range 8 - 13 weeks) and all patients except one improved clinically. TcpO(2) decreased during the initial stage of the intervention, from before arterial puncture to five minute average before PTA (p &lt; .001) and did not recover to above baseline values at the end of intervention. TcpO(2) increased significantly at follow up (p &lt; .001). TP increased statistically significantly during intervention (p &lt; .001) and at follow up (p &lt; .001) compared with baseline. Conclusion: TcpO(2) and TP measurements are safe and feasible non-invasive techniques for haemodynamic monitoring during endovascular revascularisation. TP increased significantly immediately after completion of the successful intervention, whereas tcpO(2) did not. Both TP and tcpO(2) demonstrated a significant increase at the 10 week follow up.

  • 260.
    Gus, Eduardo
    et al.
    Victorian Adult Burns Service , Melbourne, Australia.
    Almeland, Stian Kreken
    Norwegian National Burn Center, Haukeland University Hospital, Bergen, Norway.
    Barnes, David
    St. Andrews Burns Service, Broomsfield Hospital, Chelmsford, United Kingdom.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Singer, Yvonne
    Victorian Adult Burns Service, Melbourne, Australia.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    van Zuijlen, Paul
    Red Cross Hospital, Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, The Netherlands.
    Cleland, Heather
    Victorian Adult Burns Service, Melbourne, Australia.
    Burn unit design - the missing link for quality and safety.2021In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 42, no 3, p. 369-375Article, review/survey (Refereed)
    Abstract [en]

    The relationship between infrastructure, technology, model of care and human resources influences patient outcomes and safety, staff productivity and satisfaction, retention of personnel, and treatment and social costs. This concept underpins the need for evidence-based design, and has been widely adopted to inform hospital infrastructure planning. The aim of this review is to establish evidence-based, universally-applicable key features of a burn unit that support function in a comprehensive patient-centred model of care. A literature search in medical, architectural and engineering databases was conducted. Burn associations' guidelines and relevant articles published in English, between 1990 and 2020, were included, and the available evidence is summarized in the review. Few studies have been published on burn unit design in the last thirty years. Most of them focus on the role of design in infection control and prevention, and consist primarily of descriptive or observational reports, opportunistic historical cohort studies, and reviews. The evidence available in the literature is not sufficient to create a definitive infrastructure guideline to inform burn unit design, and there are considerable difficulties in creating evidence that will be widely applicable. In the absence of a strong evidence base, consensus guidelines on burn unit infrastructure should be developed, to help healthcare providers, architects and engineers make informed decisions, when designing new or renovated facilities.

  • 261.
    Göransson, Nathanael
    et al.
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Johansson, Johannes
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Wårdell, Karin
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Zsigmond, Peter
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Postoperative Lead Movement after Deep Brain Stimulation Surgery and the Change of Stimulation Volume2021In: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 99, no 3, p. 221-229Article in journal (Refereed)
    Abstract [en]

    Introduction: Lead movement after deep brain stimulation may occur and influence the affected volume of stimulation. The aim of the study was to investigate differences in lead position between the day after surgery and approximately 1 month postoperatively and also simulate the electric field (EF) around the active contacts in order to investigate the impact of displacement on affected volume. Methods: Twenty-three patients with movement disorders underwent deep brain stimulation surgery (37 leads). Computed tomography at the 2 time points were co-fused respectively with the stereotactic images in Surgiplan. The coordinates (x, y, and z) of the lead tips were compared between the 2 dates. Eleven of these patients were selected for the EF simulation in Comsol Multiphysics. Postoperative changes of EF spread in the tissue due to conductivity changes in perielectrode space and due to displacement were evaluated by calculating the coverage coefficient and the Sorensen-Dice coefficient. Results: There was a significant displacement (mean +/- SD) on the left lead: x (0.44 +/- 0.72, p &lt; 0.01), y (0.64 +/- 0.54, p &lt; 0.001), and z (0.62 +/- 0.71, p &lt; 0.001). On the right lead, corresponding values were: x (-0.11 +/- 0.61, ns), y (0.71 +/- 0.54, p &lt; 0.001), and z (0.49 +/- 0.81, p &lt; 0.05). The anchoring technique was a statistically significant variable associated with displacement. No correlation was found between bilateral (n = 14) versus unilateral deep brain stimulation, gender (n = 17 male), age &lt;60 years (n = 8), and calculated air volume. The simulated stimulation volume was reduced after 1 month because of the perielectrode space. When considering perielectrode space and displacement, the volumes calculated the day after surgery and approximately 1 month later were partly overlapped. Conclusion: The left lead tip displayed a tendency to move lateral, anterior, and inferior and the right a tendency to move anterior and inferior. The anchoring technique was associated to displacement. New brain territory was affected due to the displacement despite considering the reduced stimulated volume after 1 month. Postoperative changes in perielectrode space and small lead movements are reasons for delaying programming to 4 weeks following surgery.

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  • 262.
    Hadimeri, Henrik
    et al.
    Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Hadimeri, Ursula
    Department of Radiology, Höglandssjukhuset, Eksjö, Sweden.
    Attman, Per-Ola
    Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Nyberg, Gudrun
    Transplant Unit, Sahlgrenska University Hospital, Göteborg, Sweden.
    Dimensions of Arteriovenous Fistulas in Patients with Autosomal Dominant Polycystic Kidney Disease2000In: Nephron. Clinical practice, ISSN 1660-8151, E-ISSN 2235-3186, Vol. 85, no 1, p. 50-53Article in journal (Refereed)
    Abstract [en]

    Background/Aim: Aneurysms are known manifestations of autosomal dominant polycystic kidney disease (ADPKD). We investigated whether the dimensions of arteriovenous fistulas created for performance of haemodialysis were affected by the original disease.

    Methods: The lumen diameter of the fistula was studied by ultrasound in 19 patients with ADPKD and in 19 control patients. The patients’ sex, age, the duration of their fistulas, haemoglobin values and blood pressure levels were similar in both groups. The monitoring was performed along the forearm part of the vein, and the maximal diameter was measured. The diameters at the two needle insertion sites were also measured.

    Results: The ADPKD patients had a significantly higher fistula diameter than the control patients: 12 (range 8–19) mm versus 8 (range 6–24) mm at the widest level (p = 0.003). There were no significant differences in the diameters at the needle insertion sites.

    Conclusion: The receiving veins of arteriovenous fistulas in patients with ADPKD have an abnormality that causes a greater than normal dilatation in response to the arterialization. We postulate that this phenomenon is linked with the increased prevalence of aneurysms in ADPKD.

  • 263.
    Hadimeri, Ursula
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Factors affecting the physical characteristics of arterio-venous fistula in patients with renal failure2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and Purpose

    A patent access is vital for a dialysis patient. The arterio-venous fistula (AVF), the most important access for haemodialysis (HD), is frequently affected by extensive complications such as stenosis and occlusions.

    Study I: To investigate whether the dimensions of AVFs used for performing haemodialysis were affected by the original disease.

    Study II: To investigate if the diameter of the distal radiocephalic fistula could influence left ventricular variables in stable haemodialysis patients.

    Study III: To investigate whether a single Far Infrared (FIR) light treatment could alter blood velocity, AVF diameter or inflammatory markers.

    Study IV: To evaluate in what extent the renal diagnosis and radiological interventions affected the dysfunction of AVF and results of percutaneous transluminal angioplasty (PTA).

    Materials and methods

    Study I: The lumen diameter of the AVF was studied by ultrasound in 19 patients with autosomal dominant polycystic kidney disease (ADPKD) and in 19 control patients. The monitoring was performed along the forearm part of the vein, the maximal diameter was measured. The diameters of the two needle insertion sites were also measured.

    Study II: Nineteen patients were investigated with echocardiography, using M-mode recordings and measurements in the 2D image. Ultrasound and doppler ultrasound were performed. Transsonic measurements were performed after the ultrasound investigation. Measurements of the diameter of the AVF were performed in four locations. Heart variables were analysed regarding left ventricular (LV) criteria.

    Study III: Thirty patients with native AVF in the forearm were included. Each patient was his/her own control. Ultrasound examinations of the AVF diameter and blood flow velocity were performed before and after a single Far Infrared light (FIR) treatment.

    Study IV: 522 radiological investigations and endovascular treatments between January 1, 2006 and December 31, 2014 were analysed in 174 patients, retrospectively. All investigations had been performed due to clinical suspicion of impaired AVF function. All stenoses were evaluated and the number, degree, length, location and relation to anastomosis were recorded. After PTA the remaining stenoses were evaluated again and complications were recorded.

    Results

    Study I: The diameter of the AVF at the maximal site in patients with ADPKD was significantly wider than that for the control patients.

    Study II: A larger AVF mean and maximal diameter worsened left ventricular characteristics.

    Study III: A single FIR treatment resulted in a significant increase in blood velocity over the AV fistula from a mean of 2.1±1.0 m/s to 2.3±1.0 m/s. The diameter of the arterialized vein became wider, i.e. 0.72±0.02 to 0.80±0.02 cm. The increase in fistula blood velocity correlated positively with baseline serum-urate and the increase in venous diameter correlated positively with the baseline plasma orosomucoid concentration.

    Study IV: The degree of AVF stenosis before PTA correlated significantly with the degree of remaining stenosis after intervention. Arterial stenosis was significantly more frequent among patients with diabetic nephropathy and interstitial nephritis. A shorter life span between PTAs was related to diabetic nephropathy.

    Conclusions

    Study I: The receiving veins of AVF in patients with ADPKD have an abnormality that causes a greater than normal dilatation in response to the arterialization.

    Study II: The maximal diameter of the distal AVF seems to be a sensitive marker of LV impairment in stable haemodialysis patients.

    Study III: A single FIR treatment increased AVF blood velocity and vein diameter. Thus, one FIR treatment can help maturation of AVF in the early postoperative course.

    Study IV: Repeated PTA was performed significantly more often in patients with diabetic nephropathy. Clinically significant stenosis should be dilated as soon as possible. Occlusion of the AVF should be thrombolyzed and/or dilated when diagnosed.

    List of papers
    1. Dimensions of Arteriovenous Fistulas in Patients with Autosomal Dominant Polycystic Kidney Disease
    Open this publication in new window or tab >>Dimensions of Arteriovenous Fistulas in Patients with Autosomal Dominant Polycystic Kidney Disease
    2000 (English)In: Nephron. Clinical practice, ISSN 1660-8151, E-ISSN 2235-3186, Vol. 85, no 1, p. 50-53Article in journal (Refereed) Published
    Abstract [en]

    Background/Aim: Aneurysms are known manifestations of autosomal dominant polycystic kidney disease (ADPKD). We investigated whether the dimensions of arteriovenous fistulas created for performance of haemodialysis were affected by the original disease.

    Methods: The lumen diameter of the fistula was studied by ultrasound in 19 patients with ADPKD and in 19 control patients. The patients’ sex, age, the duration of their fistulas, haemoglobin values and blood pressure levels were similar in both groups. The monitoring was performed along the forearm part of the vein, and the maximal diameter was measured. The diameters at the two needle insertion sites were also measured.

    Results: The ADPKD patients had a significantly higher fistula diameter than the control patients: 12 (range 8–19) mm versus 8 (range 6–24) mm at the widest level (p = 0.003). There were no significant differences in the diameters at the needle insertion sites.

    Conclusion: The receiving veins of arteriovenous fistulas in patients with ADPKD have an abnormality that causes a greater than normal dilatation in response to the arterialization. We postulate that this phenomenon is linked with the increased prevalence of aneurysms in ADPKD.

    Place, publisher, year, edition, pages
    Basel: S. Karger, 2000
    National Category
    Rheumatology and Autoimmunity Surgery Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-154621 (URN)10.1159/000045629 (DOI)
    Available from: 2019-02-22 Created: 2019-02-22 Last updated: 2019-02-22Bibliographically approved
    2. Fistula diameter correlates with echocardiographic characteristics in stable hemodialysis patients
    Open this publication in new window or tab >>Fistula diameter correlates with echocardiographic characteristics in stable hemodialysis patients
    Show others...
    2015 (English)In: Nephrology @ Point of Care, ISSN 2059-3007, Vol. 1, no 1, p. e44-e48Article in journal (Refereed) Published
    Abstract [en]

    Left ventricular hypertrophy (LVH) is a common finding in hemodialysis patients. The aim of the present study was to investigate if the diameter of the distal radiocephalic fistula could influence left ventricular variables in stable hemodialysis patients.

    Methods

    Nineteen patients were investigated. Measurements of the diameter of the arteriovenous (AV) fistula were performed in 4 different locations. The patients were investigated using M-mode recordings and measurements in the 2D image. Doppler ultrasound was also performed. Transonic measurements were performed after ultrasound investigation.

    Results

    Fistula mean and maximal diameter correlated with left ventricular characteristics. Fistula flow correlated neither with the left ventricular characteristics nor with fistula diameters.

    Conclusions

    The maximal diameter of the distal AV fistula seems to be a sensitive marker of LVH in stable hemodialysis patients.

    Place, publisher, year, edition, pages
    Wichtig Publishing, 2015
    National Category
    Cardiac and Cardiovascular Systems Radiology, Nuclear Medicine and Medical Imaging
    Identifiers
    urn:nbn:se:liu:diva-130611 (URN)
    Note

    DOI does not work: 10.5301/pocj.5000193

    Available from: 2016-08-18 Created: 2016-08-18 Last updated: 2019-02-22
    3. A single treatment, using Far Infrared light improves blood flow conditions in arteriovenous fistula
    Open this publication in new window or tab >>A single treatment, using Far Infrared light improves blood flow conditions in arteriovenous fistula
    2017 (English)In: Clinical hemorheology and microcirculation, ISSN 1386-0291, E-ISSN 1875-8622, Vol. 66, no 3, p. 211-217Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: A native arteriovenous fistula (AVF) is recommended for angio access in patients on chronic hemodialysis (HD). Fistula patency has been improved by exposure to Far Infrared light (FIR). OBJECTIVE: To investigate whether a single FIR treatment could alter blood velocity, AVF diameter or inflammatory markers. METHODS: Thirty patients with a native AVF in the forearm were included. Each patient was his/her own control. Ultrasound (US) examinations were performed before and after a single FIR treatment. RESULTS: A single FIR treatment resulted in a significant increase in blood velocity over the AV fistula from a mean of 2.1 +/- 1.0 m/s to 2.3 +/- 1.0 m/s (p = 0.02). The diameter of the arterialized vein became wider; 0,72 cm +/- 0.02 to 0,80 cm +/- 0.02, (p = 0.006). The increase in fistula blood velocity correlated positively with base line serum-urate p = 0.004) and the increase in venous diameter with the base line plasma orosomucoid concentration (p = 0.005). CONCLUSIONS: This study shows that a single FIR treatment significantly increased AVF blood velocity and vein diameter. Thus, one FIR treatment can help maturation of AVF in the early postoperative course.

    Place, publisher, year, edition, pages
    IOS PRESS, 2017
    Keywords
    Ultrasound; vascular access; Far Infrared therapy; hemodialysis
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-139673 (URN)10.3233/CH-170254 (DOI)000404475300004 ()28527196 (PubMedID)
    Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2019-02-22
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  • 264. Order onlineBuy this publication >>
    Hager, Jakob
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Abdominal Aortic Aneurysm (AAA) is a disease that mainly affects elderly men, and ruptured AAA (rAAA) is associated with a mortality of > 80%. AAA seldom gives any symptoms prior to rupture.

    The aims of this thesis were to investigate different aspects of how to affect mortality from rAAA.

    In Study I, we identified 849 patients treated for rAAA during 1987-2004, and studied the 30-day survival after surgery, depending on whether they came directly to the treating hospital (one-stop) or were transferred via another hospital (two-stop). A two-stop referral pattern resulted in a 27% lower population-based survival rate for patients 65-74 years of age. However, the consequences would be small even if a one-stop referral pattern could be generally accomplished, due to the huge over-all mortality related to rAAA, hence an argument to find and treat AAA before rupture, e.g. by screening.

    In Study II, we examined the AAA-prevalence and the risk factors for AAA among 70-year-old men. The screening-detected AAA-prevalence was 2.3%, thus less than half the predicted. The most important risk factor was smoking.

    In Study III, we compared the screening-detected AAA-prevalence, the attendance rate, and the rate of opportunistic detection of AAA, between almost 8000 65- and 6000 70-year-old men. There was no difference in the screening-detected prevalence; probably due to the fact that almost 40% of the AAAs among the 70-year-old were already known prior to screening, compared to roughly 25% in the 65-year-old. The attendance rate was higher among the 65-year-old men, 85.7% compared 84.0% in the 70-year-old. Thus, there is no benefit of screening for AAA among 70- instead of 65-year-old men.

    In Study IV, a cost-effectiveness analysis, we found that screening for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management.

    In conclusion, we found that mortality from rAAA is not affected in any substantial way by different referral patterns and hence centralisation of services for AAA/rAAA is not a solution. A better alternative is to prevent rupture through early detection by screening. Screening 65-year-old men for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management during the last decade. Screening 70- instead of 65-year-old men will not increase the efficacy of screening.

    List of papers
    1. Population-based survival rate with a one- or two-stop referral pattern for patients with ruptured abdominal aortic aneurysms
    Open this publication in new window or tab >>Population-based survival rate with a one- or two-stop referral pattern for patients with ruptured abdominal aortic aneurysms
    2013 (English)In: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 32, no 5, p. 492-500Article in journal (Refereed) Published
    Abstract [en]

    AIM:

    Is there a difference in the population-based survival rate for patients with ruptured abdominal aortic aneurysms (rAAA), handled by a "one-stop" or a "two-stop" referral pattern?

    METHODS:

    Ten regions in Sweden were identified where clear-cut "one-stop" or "two-stop" referral-patterns prevailed. From the Swedvasc Registry we identified 849 patients operated on for rAAA, 1987 to 2004, living in any of these ten regions, and related the number of survivors to the whole population served by each hospital.

    RESULTS:

    The population-based survival rate was 14% lower for patients following a "two-stop" compared to a "one-stop" referral pattern (P=0.084). For the group 65-74 years-of-age the difference was significant (P=0.021), but no corresponding effect was seen regarding operative mortality rate or sex.

    CONCLUSION:

    Compared to a "one-stop" referral pattern for rAAA, a "two-stop" referral pattern results in a lower population-based survival rate for patients 65-74 years old, but the consequences would be small even if a "one-stop" referral pattern could be generally accomplished.

    Place, publisher, year, edition, pages
    Turin, Italy: Edizioni Minerva Medica, 2013
    Keywords
    Abdominal aortic aneurysm ruptured one-stop two-stop
    National Category
    Surgery
    Identifiers
    urn:nbn:se:liu:diva-102480 (URN)23903308 (PubMedID)
    Available from: 2013-12-12 Created: 2013-12-12 Last updated: 2017-12-06
    2. Lower Prevalence than Expected when Screening 70-year-old Men for Abdominal Aortic Aneurysm
    Open this publication in new window or tab >>Lower Prevalence than Expected when Screening 70-year-old Men for Abdominal Aortic Aneurysm
    2013 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 46, no 4, p. 453-459Article in journal (Refereed) Published
    Abstract [en]

    Background

    Screening 65-year-old men for abdominal aortic aneurysms (AAA) is a cost-effective method to reduce the mortality from ruptured AAA. However, contemporary results show a lower than expected prevalence of AAA, thus questioning the benefit of screening. Since the prevalence increases with age, a possible way to enhance the benefit of screening might be to screen older men. Our aim was to determine the contemporary screening-detected prevalence among 70-year-old men.

    Methods

    A total of 5,623 unscreened 70-year-old men were invited to ultrasound screening. Uni- and multivariable analyses were used to assess the risk factors for AAA.

    Results

    The attendance rate was 84.0%. The prevalence of previously unknown AAAs was 2.3%. When adding the 64 men with an already known AAA to the screening-detected ones, the total prevalence in the population was at least 3.0%, and the previously discovered AAAs constituted 37.4% of the total prevalence. “Ex smoker” and “Current smoker” were the most important risk factors.

    Conclusions

    When screening 70-year-old men for AAA, the prevalence was less than half that expected, despite a high attendance rate. Smoking was the strongest risk factor. Almost 40% of the men with AAAs were already known from other means than screening.

    Keywords
    Abdominal aortic aneurysm, Screening, Prevalence, Attendance rate, Swedvasc
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102089 (URN)10.1016/j.ejvs.2013.07.014 (DOI)000326408400012 ()
    Note

    Funding Agencies|Swedish Heart-Lung Foundation||King Gustav V and Queen Victorias foundation||

    Available from: 2013-12-02 Created: 2013-11-29 Last updated: 2017-12-06
    3. No benefit of screening for abdominal aortic aneurysm among 70- instead of 65-year-old men
    Open this publication in new window or tab >>No benefit of screening for abdominal aortic aneurysm among 70- instead of 65-year-old men
    2014 (English)In: International Angiology, ISSN 0392-9590, Vol. 33, no 5, p. 474-479Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Screening 65-year-old men for abdominal aortic aneurysm (AAA) reduces mortality from ruptured AAA (rAAA). Lower than expected prevalence of AAA is now found, why screening at a higher age and rescreening has been discussed. Our aim was to determine if screening at 70 years of age, instead of 65, increases clinical effectiveness.

    Methods: 7951 and 5623 previously un-screened 65- and 70-year old men were invited to ultrasound screening.

    Results: The attendance rate was 85.7% and 84.0%, p<0.01, for the 65- and 70-year old men respectively. The screening-detected prevalence did not differ, being 1.9% and 2.3%, p=0.15, respectively, probably due to the fact that 23.5% and 37.4% of all known AAA among 65- and 70-year-old men, were detected by other means prior to screening, p<0.01. However, the total known prevalence differed between the age-groups, being at least 2.1% and 3.0% respectively, p<0.001.

    Conclusion: The screening-detected AAA-prevalence did not differ between 65- and 70-yearold men, due to the greater number of AAA known prior to screening among 70- compared to 65-year-old men. Screening men at 70 instead of 65 years of age would not result in detection of substantially more previously unknown AAA, thus not preventing rAAA and consequently not more saved life-years. Further, data also indicates that it is questionable if re-screening the 65-year-old male population after five years would generate any important clinical effect.

    Place, publisher, year, edition, pages
    EDIZIONI MINERVA MEDICA, 2014
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-102927 (URN)000345727000010 ()
    Available from: 2014-01-08 Created: 2014-01-08 Last updated: 2017-03-27Bibliographically approved
    4. Revisiting the cost-effectiveness of screening 65-year-old men for abdominal aortic aneurysm based on data from an implemented screening programme.
    Open this publication in new window or tab >>Revisiting the cost-effectiveness of screening 65-year-old men for abdominal aortic aneurysm based on data from an implemented screening programme.
    Show others...
    2017 (English)In: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 36, no 6, p. 517-525Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related, as well as all- cause mortality. However, follow-up from implemented screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men is cost-effective based on contemporary data on prevalence and attendance rates from an ongoing AAA screening programme.

    METHODS: A decision-analytic model, previously used to analyse the cost-effectiveness of an AAA screening programme prior to implementation in clinical practice, was updated using data collected from an implemented screening programme as well as data from contemporary published data and the Swedish register for vascular surgery (Swedvasc).

    RESULTS: The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were €4832 and €6325, respectively. Based on conventional threshold values of cost-effectiveness, the probability of screening being cost-effective was high.

    CONCLUSION: Despite the reduction of AAA-prevalence and changes in AAA-management over time, screening 65-year-old men for AAA still appears to yield health outcomes at a cost below conventional thresholds of cost-effectiveness.

    Place, publisher, year, edition, pages
    Edizioni Minerva Medica, 2017
    National Category
    Clinical Medicine Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-134656 (URN)10.23736/S0392-9590.16.03777-9 (DOI)000422949900003 ()27905693 (PubMedID)
    Available from: 2017-02-22 Created: 2017-02-22 Last updated: 2023-01-17
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    Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture
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  • 265.
    Hager, Jakob
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Lundgren, Fredrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Population-based survival rate with a one- or two-stop referral pattern for patients with ruptured abdominal aortic aneurysms2013In: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 32, no 5, p. 492-500Article in journal (Refereed)
    Abstract [en]

    AIM:

    Is there a difference in the population-based survival rate for patients with ruptured abdominal aortic aneurysms (rAAA), handled by a "one-stop" or a "two-stop" referral pattern?

    METHODS:

    Ten regions in Sweden were identified where clear-cut "one-stop" or "two-stop" referral-patterns prevailed. From the Swedvasc Registry we identified 849 patients operated on for rAAA, 1987 to 2004, living in any of these ten regions, and related the number of survivors to the whole population served by each hospital.

    RESULTS:

    The population-based survival rate was 14% lower for patients following a "two-stop" compared to a "one-stop" referral pattern (P=0.084). For the group 65-74 years-of-age the difference was significant (P=0.021), but no corresponding effect was seen regarding operative mortality rate or sex.

    CONCLUSION:

    Compared to a "one-stop" referral pattern for rAAA, a "two-stop" referral pattern results in a lower population-based survival rate for patients 65-74 years old, but the consequences would be small even if a "one-stop" referral pattern could be generally accomplished.

  • 266.
    Haj-Hosseini, Neda
    et al.
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Lindblad, Joakim
    Centre for Image Analysis, Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Hasséus, Bengt
    Department of Oral Medicine and Pathology, Institute of Odontology, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden; Clinic of Oral Medicine, Public Dental Service, Gothenburg, Region Västra Götaland, Sweden.
    Kumar, Vinay Vijaya
    Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore, India; Department of Surgical Sciences, Odontology and Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden.
    Subramaniam, Narayana
    Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore, India.
    Hirsch, Jan-Michaél
    Department of Research & Development, Public Dental Services Region Stockholm, Stockholm, Sweden; Department of Surgical Sciences, Odontology and Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden.
    Early Detection of Oral Potentially Malignant Disorders: A Review on Prospective Screening Methods with Regard to Global Challenges2022In: Journal of Maxillofacial and Oral Surgery, ISSN 0972-8279Article, review/survey (Refereed)
    Abstract [en]

    Oral cancer is a cancer type that is widely prevalent in low-and middle-income countries with a high mortality rate, and poor quality of life for patients after treatment. Early treatment of cancer increases patient survival, improves quality of life and results in less morbidity and a better prognosis. To reach this goal, early detection of malignancies using technologies that can be used in remote and low resource areas is desirable. Such technologies should be affordable, accurate, and easy to use and interpret. This review surveys different technologies that have the potentials of implementation in primary health and general dental practice, considering global perspectives and with a focus on the population in India, where oral cancer is highly prevalent. The technologies reviewed include both sample-based methods, such as saliva and blood analysis and brush biopsy, and more direct screening of the oral cavity including fluorescence, Raman techniques, and optical coherence tomography. Digitalisation, followed by automated artificial intelligence based analysis, are key elements in facilitating wide access to these technologies, to non-specialist personnel and in rural areas, increasing quality and objectivity of the analysis while simultaneously reducing the labour and need for highly trained specialists.

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  • 267.
    Hallböök, Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sjödahl, Rune
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Långvarigt Trendelenburgs läge kan orsaka ögonskador: Kortad operationstid i tippat läge och justering av tippningsvinkeln kan minska risken2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Article in journal (Refereed)
    Abstract [en]

    Risk of optic nerve injury after prolonged Trendelenburgs position Postoperative loss of vision due to acute ischaemic optic nerve injury is a rare complication following pelvic surgery. A steep Trendelenburgs position of the patient, high intraabdominal pressure and a long operative time in Trendelenburgs position are recognised risk factors associated with robot-assisted pelvic surgery. This manuscript presents the underlying pathophysiologic mechanism. Practical tips and tricks for prevention are discussed.

  • 268. Order onlineBuy this publication >>
    Halldestam, Ingvar
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Gallstone disease: Population based studies on risk factors, symptomatology and complications2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background & aims: Gallstone disease is common, costly and its complications are sometimes life threatening. The aim of this thesis is to determine the prevalence and incidence in relation to putative risk factors in the general population. Furthermore, to identify individuals with asymptomatic gallstones who are at risk of developing complications and, finally, to identify those who are at risk of an unsatisfactory outcome after cholecystectomy.

    Material & methods: A sample of the adult (35-85 y.) general population was screened with ultrasound examination, blood tests and a questionnaire regarding digestive symptoms, life-style and quality of life. After excluding 115 subjects, who previously had a cholecystectomy, 739 participated. The examination was repeated after a minimum of five years. The individuals who were shown to have gallstones were followed in order to identify risk factors for developing complications. 200 consecutive symptomatic patients were operated with cholecystectomy on defined indications. They completed a questionnaire regarding digestive symptoms, life-style and quality of life before and three and twelve months after surgery.

    Results: The crude prevalence of gallstone disease was 17.2 % for women and 12.4% for men. It increased with age and was higher among women. Symptoms did not differ between subjects with and without gallstones, but those previously operated with cholecystectomy did worse both regarding symptoms and quality of life. The estimated crude annual gallstone incidence was 1.5%. This increased with age, but did not differ between the sexes. Gallstone development was positively related to elevated blood lipids and negatively related to alcohol consumption. Fourteen of 120 subjects with gallstones at the primary screening developed a complication demanding treatment during a follow-up interval of 87 (3-146) months. In the patient series operated on strict indications, 91.3 % of those who had reported typical gallstone related pain preoperatively, experienced total or partial pain relief 3 months postoperatively. With atypical pain preoperatively, the corresponding figure was 77.1 %. The findings 12 months postoperatively were similar. In the logistic regression analysis, young age, frequency of pain episodes, atypical pain, specific food intolerance and disturbing abdominal gas were positively related to the frequency of abdominal pain 12 months after surgery.

    Conclusion: The prevalence of gallstones was positively related to age and female gender. Previous cholecystectomy was associated with more symptoms and worse quality of life. The annual gallstone incidence of 1.5 % was high in comparison with other studies, but our population was older. In general, neither prevalent nor incident gallstones in the general population were associated with specific symptoms. The cumulative risk of developing a complication to gallstone disease during a 5-year followup interval was 7.6 % with no tendency to level off.

    Patients with typical pain had a better outcome after cholecystectomy. Young age, atypical pain and frequent pain episodes before surgery were major risk factors for a worse outcome in terms of persistent pain.

    List of papers
    1. Prevalence of gallstone disease in a Swedish population sample: Relations to occuption, childbirth, health status, life style, medications and blood lipids
    Open this publication in new window or tab >>Prevalence of gallstone disease in a Swedish population sample: Relations to occuption, childbirth, health status, life style, medications and blood lipids
    Show others...
    1998 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 33, no 11, p. 1219-1225Article in journal (Refereed) Published
    Abstract [en]

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

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13291 (URN)10.1080/00365529850172601 (DOI)
    Available from: 2008-05-13 Created: 2008-05-13
    2. Development of symptoms and complications in individuals with asymptomatic gallstones
    Open this publication in new window or tab >>Development of symptoms and complications in individuals with asymptomatic gallstones
    2004 (English)In: British Journal of Surgery, ISSN 0007-1323, Vol. 91, no 6, p. 734-738Article in journal (Refereed) Published
    Abstract [en]

    Background: Gallbladder stones are common in the developed world. Complications of gallstones contribute substantially to healthcare costs and may be life threatening. The identification of individuals likely to develop complications would be of benefit in clinical practice as elective cholecystectomy could then be performed.

    Methods: Seven hundred and thirty-nine subjects aged 35-85 years from the general population were screened for gallbladder problems by ultrasonography and questionnaire assessment of putative risk factors and digestive symptoms. Gallstones, cholesterolosis or sludge in the gallbladder were diagnosed in 123 (16·3 per cent) of 739 subjects, 120 of whom were followed for a median of 87 (range 3-146) months to May 2003 or until treatment was required.

    Results: Fourteen patients were admitted to hospital and treated for gallstone-related complications or symptoms. The cumulative risk of being treated during the first 5 years after detection of asymptomatic gallstones was 7·6 per cent and there was no indication of this risk levelling off. There were no significant differences between treated and untreated subjects with regard to digestive symptoms or any of the risk factors monitored at the initial screening, although treated subjects were significantly younger than those who were not treated.

    Conclusion: Nearly one in ten individuals with asymptomatic gallbladder stones in the general population may be expected to develop symptoms or complications that require treatment within 5 years. Age may be inversely related to the incidence of complications.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13292 (URN)10.1002/bjs.4547 (DOI)
    Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2009-08-18
    3. Incidence of gallstone disease in a general population sample: relations to symptomatology and potential risk factors
    Open this publication in new window or tab >>Incidence of gallstone disease in a general population sample: relations to symptomatology and potential risk factors
    2008 (English)Article in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13293 (URN)
    Available from: 2008-05-13 Created: 2008-05-13
    4. Defined indications for elective cholcystectomy for gallstone disease
    Open this publication in new window or tab >>Defined indications for elective cholcystectomy for gallstone disease
    2008 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 5, p. 620-626Article in journal (Refereed) Published
    Abstract [en]

    Background: This study examined symptomatology and quality of life following elective cholecystectomy for symptomatic gallstone disease with defined indications for surgery.

    Methods: In this prospective study of 200 consecutive patients (161 women; median age 46·5 (range 24-79) years), strict indications for elective cholecystectomy were stipulated. Digestive symptoms and quality of life were recorded with a self-administered questionnaire before and at 3 and 12 months after surgery.

    Results: Of 149 patients who experienced abdominal pain with typical location before surgery, 136 (91·3 per cent) reported total remission or reduced frequency of that type of pain 12 months later. Of 35 patients who reported atypical or multiple pain location before operation, 27 (77 per cent) experienced reduced frequency or disappearance of that type of pain. Frequency of pain episodes, atypical or multiple pain location, specific food intolerance and frequency of disturbing abdominal gas at baseline correlated positively with the frequency of abdominal pain episodes at 12 months after surgery. There was a tendency towards an inverse relation to age.

    Conclusion: The frequency of persistent abdominal pain after elective cholecystectomy was low among patients with typical pain location before surgery. Atypical pain location, and frequent pain episodes before operation significantly reduced the chance of becoming pain-free.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13294 (URN)10.1002/bjs.6020 (DOI)
    Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2017-12-13Bibliographically approved
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  • 269.
    Halliday, T. A.
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Umeå University, Sweden.
    Sundqvist, J.
    Umeå University, Sweden.
    Hultin, M.
    Umeå University, Sweden.
    Wallden, J.
    Umeå University, Sweden.
    Post-operative nausea and vomiting in bariatric surgery patients: an observational study2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 5, p. 471-479Article in journal (Refereed)
    Abstract [en]

    Background: The risk of post-operative nausea and vomiting (PONV) in patients undergoing bariatric surgery is unclear. The aim of the study was to investigate the risk of PONV and the use and effectiveness of PONV prophylaxis. Methods: This prospective observational study included 74 patients undergoing bariatric surgery with total intravenous anaesthesia. Patients were given PONV prophylaxis based on published guidelines and a simplified PONV risk score. Perioperative data were collected and a questionnaire was used at 2, 4, 6, 24, 48 and 72 h after the operation to evaluate PONV. Data are presented as risk (%) with the 95% confidence interval. Results: Sixty five per cent (54-75) of the patients experienced PONV in the first 24 post-operative hours and the risk increased with the number of risk factors for PONV. PONV occurred in 78% (66-87) of women and 26% (12-49) of men during the first 24 h. In relation to the guidelines, one patient received suboptimal PONV prophylaxis, 23% received optimal prophylaxis and 76% supra-optimal prophylaxis. The risk of PONV was 82% (59-94) with optimal prophylaxis and 59% (46-71) with supra-optimal prophylaxis. Of all patients, 34% (24-45) experienced severe PONV in the first 24 h that limited their activity. Conclusions: The incidence of PONV in bariatric surgery patients was high despite a PONV prophylaxis regime following current guidelines. These results cast doubt as to the effectiveness of the usual PONV prophylaxis in this patient group and point to the need for further investigation of PONV prophylaxis and treatment in bariatric surgery patients.

  • 270.
    Hamid, Salik
    et al.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.
    Gadré, Ashok
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Linköping University, Faculty of Medicine and Health Sciences.
    Fornander, Liselott
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Sjöwall, Johanna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Muhrbeck, Måns
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.
    Clostridium septicum myonecrosis following gardening: A case report2023In: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 105, article id 108000Article in journal (Refereed)
    Abstract [en]

    Introduction and importance

    Clostridial myonecrosis (CM), or gas gangrene, is a rare necrotizing muscle infection caused most often by Clostridium perfringens or C. septicum. Inoculation can occur either traumatically or spontaneously. CM has a high mortality rate if not treated promptly.

    Case presentation

    A 64-year-old male presented to the emergency department (ED) with sudden onset left flank pain and fever. Repeated CT scans demonstrated progressive edema around the left iliopsoas muscle with gas formation and bleeding. The patient received intravenous fluids, meropenem, and clindamycin. Emergency laparotomy was performed on suspicion of necrotizing fasciitis and revealed a necrotic left iliopsoas muscle which was partially excised. Blood cultures were positive at 12 h with growth of C. septicum. Prolonged stay in the intensive care unit, and six additional surgical interventions to the abdomen, left thigh, and flank were needed. The patient was discharged after four months to a nursing home.

    Clinical discussion

    C. septicum CM more often occurs spontaneously and is associated with colorectal malignancy. However, for our patient, CT colonography and proctoscopy did not reveal any pathology. Therefore, we believe the CM resulted from an injury the patient sustained while working in his backyard, either a cut from barbed wire on his arm or from soil contaminating his psoriatic lesions. Successful outcomes for patients with CM require a high index of suspicion, timely treatment with antibiotics, and repeated surgical debridements.

    Conclusion

    This case report describes the presentation and management of a presumably injury-related CM caused by C. septicum.

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  • 271.
    Hammarström, Helena
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Krifors, Anders
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    Athlin, Simon
    Orebro Univ, Sweden.
    Friman, Vanda
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Golestani, Karan
    Skane Univ Hosp, Sweden.
    Hällgren, Anita
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Otto, Gisela
    Skane Univ Hosp, Sweden.
    Oweling, Sara
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Pauksens, Karlis
    Uppsala Univ, Sweden.
    Kinch, Amelie
    Uppsala Univ, Sweden.
    Blennow, Ola
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Treatment With Reduced-Dose Trimethoprim-Sulfamethoxazole Is Effective in Mild to Moderate Pneumocystis jirovecii Pneumonia in Patients With Hematologic Malignancies2023In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 76, no 3, p. e1252-e1260Article in journal (Refereed)
    Abstract [en]

    In a cohort of 113 patients with hematologic malignancies and Pneumocystis jirovecii pneumonia, treatment with reduced-dose trimethoprim-sulfamethoxazole was as effective as standard-dose treatment in patients with mild to moderate pneumonia. Background Recent studies have reported that reduced-dose trimethoprim-sulfamethoxazole (TMP-SMX) may be effective in the treatment of Pneumocystis jirovecii pneumonia (PJP), but data are lacking for patients with hematologic malignancies. Methods This retrospective study included all adult hematologic patients with PJP between 2013 and 2017 at 6 Swedish university hospitals. Treatment with 7.5-15 mg TMP/kg/day (reduced dose) was compared with &gt;15-20 mg TMP/kg/day (standard dose), after correction for renal function. The primary outcome was the change in respiratory function (Delta partial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO(2)]) between baseline and day 8. Secondary outcomes were clinical failure and/or death at day 8 and death at day 30. Results Of a total of 113 included patients, 80 patients received reduced dose and 33 patients received standard dose. The overall 30-day mortality in the whole cohort was 14%. There were no clinically relevant differences in Delta PaO2/FiO(2) at day 8 between the treatment groups, either before or after controlling for potential confounders in an adjusted regression model (-13.6 mm Hg [95% confidence interval {CI}, -56.7 to 29.5 mm Hg] and -9.4 mm Hg [95% CI, -50.5 to 31.7 mm Hg], respectively). Clinical failure and/or death at day 8 and 30-day mortality did not differ significantly between the groups (18% vs 21% and 14% vs 15%, respectively). Among patients with mild to moderate pneumonia, defined as PaO2/FiO(2) &gt;200 mm Hg, all 44 patients receiving the reduced dose were alive at day 30. Conclusions In this cohort of 113 patients with hematologic malignancies, reduced-dose TMP-SMX was effective and safe for treating mild to moderate PJP.

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  • 272.
    Hansen, Johan Liseth
    et al.
    Quantify Res, Sweden; Univ Oslo, Norway.
    Heilig, Markus
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Kalso, Eija
    Helsinki Univ Hosp, Finland; Univ Helsinki, Finland.
    Stubhaug, Audun
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Knutsson, Douglas
    Quantify Res, Sweden.
    Sandin, Patrik
    Quantify Res, Sweden.
    Dorling, Patricia
    Pfizer Inc, NY USA.
    Beck, Craig
    Pfizer Ltd, England.
    Grip, Emilie Toresson
    Quantify Res, Sweden; Karolinska Inst, Sweden.
    Blakeman, Karin Hygge
    Pfizer AB, Sweden.
    Arendt-Nielsen, Lars
    Aalborg Univ, Denmark.
    Problematic opioid use among osteoarthritis patients with chronic post-operative pain after joint replacement: analyses from the BISCUITS study2023In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 23, no 2, p. 353-363Article in journal (Refereed)
    Abstract [en]

    Objectives: Opioids are commonly used to manage pain, despite an increased risk of adverse events and complications when used against recommendations. This register study uses data of osteoarthritis (OA) patients with joint replacement surgery to identify and characterize problematic opioid use (POU) prescription patterns.Methods: The study population included adult patients diagnosed with OA in specialty care undergoing joint replacement surgery in Denmark, Finland, Norway, and Sweden during 1 January 2011 to 31 December 2014. Those with cancer or OA within three years before the first eligible OA diagnosis were excluded. Patients were allocated into six POU cohorts based on dose escalation, frequency, and dosing of prescription opioids post-surgery (definitions were based on guidelines, previous literature, and clinical experience), and matched on age and sex to patients with opioid use, but not in any of the six cohorts. Data on demographics, non-OA pain diagnoses, cardiovascular diseases, psychiatric disorders, and clinical characteristics were used to study patient characteristics and predictors of POU.Results: 13.7% of patients with OA and a hip/knee joint replacement were classified as problematic users and they had more comorbidities and higher pre-surgery doses of opioids than matches. Patients dispensing high doses of opioids pre-surgery dispensed increased doses post-surgery, a pattern not seen among patients prescribed lower doses pre-surgery. Being dispensed 1-4,500 oral morphine equivalents in the year pre-surgery or having a non-OA pain diagnosis was associated with post-surgery POU (OR: 1.44-1.50, and 1.11-1.20, respectively).Conclusions: Based on the discovered POU predictors, the study suggests that prescribers should carefully assess pain management strategies for patients with a history of comorbidities and pre-operative, long-term opioid use. Healthcare units should adopt risk assessment tools and ensure that these patients are followed up closely. The data also demonstrate potential areas for further exploration in improving patient outcomes and trajectories.

  • 273.
    Hansson, Emma
    et al.
    Gothenburg Univ, Sweden; Lund Univ, Sweden.
    Elander, Anna
    Gothenburg Univ, Sweden.
    Hallberg, Hakan
    Gothenburg Univ, Sweden.
    Sandman, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Vastra Gotaland Reg, Sweden; Boras Univ, Sweden.
    Should immediate breast reconstruction be performed in the setting of radiotherapy? An ethical analysis2020In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 54, no 2, p. 83-88Article in journal (Refereed)
    Abstract [en]

    Immediate breast reconstruction (IBR) combined with post-mastectomy radiotherapy (PMRT) is associated with an increased risk for complications. Here, we analyse whether IBR combined with PMRT is ethically acceptable. We employ normative analysis following reflective equilibrium and the principles of Beauchamp and Childress: non-maleficence, beneficence, autonomy, and justice. From the perspective of beneficence and non-maleficence, we can choose either IBR or PMRT according to documented risks and complications, delayed autologous breast reconstruction with corresponding benefits but less risk for complications, or even no reconstruction, which for some women, might be equally beneficial. In such a situation, given the level of severity associated with lacking a breast after mastectomy, IBR violates the principles of beneficence and non-maleficence. To deny an IBR in the context of PMRT does not violate the principle of autonomy as it is normally interpreted in the healthcare system, not even when patient-centred care is taken into consideration. Moreover, there is a risk that the decision of the patient will be affected by heuristics, optimism bias, and surgeon bias. IBR in the context of PMRT could be in conflict with the principle of justice, as it could lead to displacement of care for other patient groups. Furthermore, an acceptable level of cost effectiveness should be low, given that living without a breast is a condition of moderate severity. In conclusion, given the current knowledgebase and established ethical norms within the healthcare system, we find strong ethical reasons not to offer IBR when PMRT is expected.

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  • 274.
    Hansson, Emma
    et al.
    Sahlgrens Univ Hosp, Sweden; Gothenburg Univ, Sweden.
    Sandman, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Vastra Gotaland Reg, Sweden; Boras Univ, Sweden.
    Davidson, Thomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    A systematic review of direct preference measurements in health states treated with plastic surgery2022In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 56, no 3, p. 180-190Article, review/survey (Refereed)
    Abstract [en]

    One way to compare health care needs and outcomes on common scales is by estimating the strength of preferences or willingness-to-pay (WTP). The aim of this study was to review directly measured preference values and WTP estimates for health states treated by plastic surgery. The included articles had to meet the criteria defined in the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). Relevant databases were searched using predetermined strings. Data were extracted in a standardised manner. Included studies were appraised according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for rating the importance of outcomes. In total, 213 abstracts were retrieved. Of these, 179 did not meet the inclusion criteria and were excluded, leaving 34 studies in the review. The risk of bias was considered moderate in four studies and serious in the rest. The overall certainty of evidence for directly measured preference values and WTP estimates for health states treated by plastic surgery is low (Grade circle minus circle minus OO). The lowest preference scores were generally elicited for facial defects/anomalies and the highest for excess skin after massive weight loss. Scientific knowledge about preferences and the resulting health gains might play an essential role in deciding which procedures should be considered for public funding or rather rationed within the system. Better quality studies are required to allow for such applications.

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  • 275.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Halldestam, Ingvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Fraser, M. P.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Benjaminsson Nyberg, Pernilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Gasslander, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Does the Introduction of Laparoscopic Distal Pancreatectomy Jeopardize Patient Safety and Well-Being?2016In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 105, no 4, p. 223-227Article in journal (Refereed)
    Abstract [en]

    Background/Purpose: Despite retrospective data indicating short-term superiority for laparoscopic distal pancreatectomy compared to open distal pancreatectomy, the implementation of the procedure has been slow. The aim of this study was to investigate whether patients operated with laparoscopic distal pancreatectomy during the early phase of introduction are at higher risk for complications than patients operated with open distal pancreatectomy.

    Methods: A retrospective single-center analysis of patients operated with laparoscopic distal pancreatectomy (n=37) from the introduction of the procedure and comparison regarding demographic data, preoperative data, operative factors, and postoperative outcomes to patients operated with open distal pancreatectomy was done.

    Results: Operation duration shortened (195 vs 143min, p=0.04) and severe complications reduced (37% vs 6%, p=0.02) significantly in the laparoscopic distal pancreatectomy group between the first half of the study and the second half. Blood loss was significantly (pamp;lt;0.001) lower in the laparoscopic distal pancreatectomy group (75mL) than in the open distal pancreatectomy group (550mL), while complication rate and hospital stay as well as the percentage of radical resections were the same.

    Conclusion: Laparoscopic distal pancreatectomy can be introduced without jeopardizing patient safety and well-being during the early learning curve. The procedures should be compared in a prospective randomized manner.

  • 276.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Isaksson, Bengt
    Uppsala Univ, Sweden.
    Ardnor, Bjarne
    Umea Univ, Sweden.
    Lindell, Gert
    Lund Univ, Sweden.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Stromberg, Cecilia
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Loftås, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Liver resection is beneficial for patients with colorectal liver metastases and extrahepatic disease2020In: Annals of Translational Medicine, ISSN 2305-5839, E-ISSN 2305-5847, Vol. 8, no 4, article id 109Article in journal (Refereed)
    Abstract [en]

    Background: Liver metastases are the most common cause of death for patients with colorectal cancer and affect up to half of the patients. Liver resection is an established method that can potentially be curative. For patients with extrahepatic disease (EHD), the role of liver surgery is less established. Methods: This is a retrospective study based on data from the national quality registry SweLiv. Data were obtained between 2009 and 2015. SweLiv is a validated registry and has been in use since 2009, with coverage above 95%. Patients with liver metastases and EHD were analyzed and cross-checked against the national death cause registry for survival analysis. Results: During the study period, 2,174 patients underwent surgery for colorectal liver metastases (CRLM), and 277 patients with EHD were treated with resection or ablation. The estimated median survival time for the entire cohort from liver resection/ablation was 40 months (95% CI, 32-47). The survival time for patients treated with liver resection was 45 months compared to 26 months for patients treated with ablation (95% CI 38-53, 18-33, P=0.001). A subgroup analysis of resected patients revealed that the group with pulmonary metastases had a significantly longer estimated median survival (50 months; 95 % CI, 39-60) than the group with lymph node metastases (32 months; 95% CI, 7-58) or peritoneal carcinomatosis (28 months; 95% CI, 14-41) (P=0.022 and 0.012, respectively). Other negative prognostic factors were major liver resection and nonradical liver resection. Conclusions: For patients with liver metastases and limited EHD, liver resection results in prolonged survival compared to what can be expected from chemotherapy alone.

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  • 277.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Malago, Massimo
    UCL, England.
    Vyas, Soumil
    UCL, England.
    Robles Campos, Ricardo
    Vizgen De La Arrixaca University Hospital, Spain.
    Brusadin, Roberto
    Vizgen De La Arrixaca University Hospital, Spain.
    Linecker, Michael
    University of Zurich Hospital, Switzerland.
    Petrowsky, Henrik
    University of Zurich Hospital, Switzerland.
    Clavien, Pierre Alain
    University of Zurich Hospital, Switzerland.
    Machado, Marcel Autran
    University of Sao Paulo, Brazil.
    Hernandez-Alejandro, Roberto
    University of Rochester, NY USA.
    Wanis, Kerollos
    Western University, Canada.
    Walter, Lars
    Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Neoadjuvant chemotherapy does not affect future liver remnant growth and outcomes of associating liver partition and portal vein ligation for staged hepatectomy2017In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 161, no 5, p. 1255-1265Article in journal (Refereed)
    Abstract [en]

    Background. The only potentially curative treatment for patients with colorectal liver metastases is hepatectomy. Associating liver partition and portal vein ligation for staged hepatectomy has emerged as a method of treatment for patients with inadequate future liver remnant. One concern about associating liver partition and portal vein ligation for staged hepatectomy is that preoperative chemotherapy may negatively affect the volume increase of the future liver remnant and outcomes. Methods. This study from the International Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Registry (NCT01924741) includes 442 patients with colorectal liver metastases registered from 2012-2016. Future liver remnant hypertrophy (absolute increase, percent increase, and kinetic growth rate) and clinical outcome were analyzed retrospectively in relation to type and amount of chemotherapy. The analyzed groups included patients with no chemotherapy, 1 regimen of chemotherapy, amp;gt; 1 regimen, and a group that received monoclonal antibodies in addition to chemotherapy. Results. Ninety percent of the patients received neoadjuvant oncologic therapy including 42% with 1 regimen of chemotherapy, 44% with monoclonal antibodies, and 4% with amp;gt; 1 regimen. Future liver remnant increased between 74-92% with the largest increase in the group with 1 regimen of chemotherapy. The increase in milliliters was between 241 mL (amp;gt; 1 regimen) and 306 mL (1 regimen). Kinetic growth rate was between 14-18% per week and was greatest for the group with 1 regimen of chemotherapy. No statistical significance was found between the groups with any of the measurements of future liver remnant hypertrophy. Conclusion. Neoadjuvant chemotherapy, including monoclonal antibodies, does not negatively affect future liver remnant growth. Patients with colorectal liver metastases who might be potential candidates for associating liver partition and portal vein ligation for staged hepatectomy should be considered for neoadjuvant chemotherapy. (Surgery 2017;161:1255-65.)

  • 278.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Larsen, Peter N.
    Univ Copenhagen, Denmark.
    Sparrelid, Ernesto
    Karolinska Univ Hosp, Sweden.
    Lindell, Gert
    Skane Univ Hosp, Sweden.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn A.
    Oslo Univ Hosp, Norway.
    Isaksson, Bengt
    Akad Univ Hosp, Sweden.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM Survival Analysis From the Randomized Controlled Trial LIGRO2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 273, no 3, p. 442-448Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the oncological outcome for patients with colorectal liver metastases (CRLM) randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or 2-stage hepatectomy (TSH). Background: TSH with portal vein occlusion is an established method for patients with CRLM and a low volume of the future liver remnant (FLR). ALPPS is a less established method. The oncological outcome of these methods has not been previously compared in a randomized controlled trial. Methods: One hundred patients with CRLM and standardized FLR (sFLR) &lt;30% were included and randomized to resection by ALPPS or TSH, with the option of rescue ALPPS in the TSH group, if the criteria for volume increase was not met. The first radiological follow-up was performed approximately 4 weeks postoperatively and then after 4, 8, 12, 18, and 24 months. At all the follow-ups, the remaining/recurrent tumor was noted. After the first follow-up, chemotherapy was administered, if indicated. Results: The resection rate, according to the intention-to-treat principle, was 92% (44 patients) for patients randomized to ALPPS compared with 80% (39 patients) for patients randomized to TSH (P = 0.091), including rescue ALPPS. At the first postoperative follow-up, 37 patients randomized to ALPPS were assessed as tumor free in the liver, and also 28 patients randomized to TSH (P = 0.028). The estimated median survival for patients randomized to ALPPS was 46 months compared with 26 months for patients randomized to TSH (P = 0.028). Conclusions: ALPPS seems to improve survival in patients with CRLM and sFLR &lt;30% compared with TSH.

  • 279.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Røsok, Bård Ingvald
    Oslo University Hospital, Norway.
    Sparrelid, Ernesto
    Karolinska University Hospital, Sweden.
    Lindell, Gert
    Skane University Hospital, Sweden.
    Larsen, Peter Nørgaard
    University of Copenhagen, Denmark.
    Lindhoff Larsson, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Schultz, Nicolai A
    University of Copenhagen, Denmark.
    Björnbeth, Bjorn Atle
    Oslo University Hospital, Norway.
    Isaksson, Bengt
    Akademiska University Hospital, Sweden.
    Rizell, Magnus
    University of Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Future Liver Remnant (FLR) Increase in Patients with Colorectal Liver Metastases Is Highest the First Week After Portal Vein Occlusion: FLR Increase in Patients with CRLM Is Highest the First Week After PVO.2019In: Journal of Gastrointestinal Surgery, ISSN 1091-255X, E-ISSN 1873-4626, Vol. 23, no 3, p. 556-562Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Portal vein occlusion (PVO) is an established method to increase the volume of the future liver remnant (FLR). The main reasons for not proceeding to radical hepatectomy are lack of volume increase and tumor progression due to a wait-time interval of up to 8 weeks. The hypothesis was that the increase in FLR volume is not linear and is largest during the first weeks.

    METHODS: Patients with colorectal liver metastases (CRLM) and standardized future liver remnant (sFLR) < 30% treated with PVO were prospectively included. All patients had at least one CT evaluation before radical hepatectomy.

    RESULTS: Forty-eight patients were included. During the first week after PVO, the kinetic growth rate (KGR) was 5.4 (± 4), compared to 1.5 (± 2) between the first and second CT (p < 0.05). For patients reaching adequate FLR and therefore treated with radical hepatectomy, the KGR was 7 (± 4) the first week, compared to 4.3 (± 2) for patients who failed to reach a sufficient volume (p = 0.4). During the interval between the first and second CT, the KGR was 2.2 (± 2), respectively (± 0.1) (p = 0.017).

    DISCUSSION: The increase in liver volume after PVO is largest during the first week. As KGR decreases over time, it is important to shorten the interval between PVO and the first volume evaluation; this may aid in decision-making and reduce unnecessary waiting time.

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  • 280.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Gasslander, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Multivisceral Resection in Patients with Advanced Abdominal Tumors2016In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 105, no 3, p. 147-152Article in journal (Refereed)
    Abstract [en]

    Background/Aim: Multivisceral resection for advanced tumors can result in prolonged survival but may also increase the risk of postoperative morbidity and mortality. The primary aim of this study was to investigate whether extensive resections increase the severity of postoperative complications. Materials and Methods: A retrospective study was conducted between 2009 and 2014 at the Linkoping University Hospital surgical department. All patients with a confirmed or presumed malignant disease who underwent a non-standardized surgical procedure requiring a multivisceral resection were included. The primary endpoint was 90-day complications according to the Clavien-Dindo score. Results: Forty-eight patients were included, with an age range of 17-77years. A median of three organs was resected. The most common diagnoses were neuroendocrine tumor (n=8), gastric cancer (n=7), and gastrointestinal stromal tumor (n=6). One patient died during surgery. Complications grade 3b according to Clavien-Dindo score occurred in 10 patients. R0 resection was achieved in 32 patients. No correlation was observed between the number of anastomoses, perioperative blood loss, operative time, and complications. Only postoperative blood transfusion was correlated with severe complications (p=0.046); however, a tendency toward more complications with an increasing number of resected organs was observed (p=0.06). Conclusion: Multivisceral resection can result in R0, potentially curing patients with advanced tumors. Here, no correlation between extensive resections and complications was observed. Only postoperative blood transfusion was correlated with severe complications.

  • 281.
    Haverkamp, Frederike J C
    et al.
    Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands.
    van Gennip, Lisanne
    Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands.
    Muhrbeck, Måns
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.
    Veen, Harald
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands.
    Wladis, Andreas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Disaster Medicine and Traumatology.
    Tan, Edward C T H
    Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands.
    Global surgery for paediatric casualties in armed conflict2019In: World Journal of Emergency Surgery, E-ISSN 1749-7922, Vol. 14, article id 55Article in journal (Refereed)
    Abstract [en]

    Background: Understanding injury patterns specific for paediatric casualties of armed conflict is essential to facilitate preparations by organizations that provide medical care in conflict areas. The aim of this retrospective cohort study is to identify injury patterns and treatment requirements that are specific for paediatric patients in conflict zones.

    Methods: Characteristics of children (age < 15 years) treated in medical facilities supported by the International Committee of the Red Cross (ICRC) between 1988 and 2014 in Kabul, Kao-i-Dang, Lokichogio, Kandahar, Peshawar, Quetta and Goma were analysed; patient characteristics were compared between treatment facilities and with those of adult patients (age ≥ 15 years).

    Results: Of the patients listed in the database, 15% (5843/38,088) were aged < 15 years. The median age was 10 years (IQR 6-12); 75% (4406/5843) were male. Eighty-six percent (5012/5,843) of the admitted children underwent surgery, with a median of 2 surgeries per patient (IQR 1-3). When compared with adult patients, children were more frequently seen with fragment injuries, burns and mine injuries; they had injuries to multiple body regions more often and had higher in-hospital mortality rates.

    Conclusions: Children more often sustained injuries to multiple body regions and had higher in-hospital mortality than adults. These findings could have implications for how the ICRC and other organizations prepare personnel and structure logistics to meet the treatment needs of paediatric victims of armed conflicts.

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  • 282.
    Hayami, Masaru
    et al.
    Karolinska Univ Hosp, Sweden; Japanese Fdn Canc Res, Japan.
    Ndegwa, Nelson
    Karolinska Inst, Sweden.
    Lindblad, Mats
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Linder, Gustav
    Uppsala Univ, Sweden.
    Hedberg, Jakob
    Uppsala Univ, Sweden.
    Edholm, David
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Johansson, Jan
    Skåne Univ Hosp, Sweden.
    Lagergren, Jesper
    Karolinska Univ Hosp, Sweden; Kings Coll London, England.
    Lundell, Lars
    Karolinska Inst, Sweden; Odense Univ Hosp, Denmark.
    Nilsson, Magnus
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Rouvelas, Ioannis
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    ASO Author Reflections: Better Long-Term Survival in Esophageal Cancer After Minimally Invasive Versus Open Transthoracic Esophagectomy in Sweden: A Population-Based Cohort Study2022In: Annals of Surgical Oncology, ISSN 1068-9265, E-ISSN 1534-4681, Vol. 29, no 9, p. 5622-5623Article in journal (Other academic)
  • 283.
    Hayami, Masaru
    et al.
    Karolinska Univ Hosp, Sweden; Japanese Fdn Canc Res, Japan.
    Ndegwa, Nelson
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Lindblad, Mats
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Linder, Gustav
    Uppsala Univ, Sweden.
    Hedberg, Jakob
    Uppsala Univ, Sweden.
    Edholm, David
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Johansson, Jan
    Skane Univ Hosp, Sweden.
    Lagergren, Jesper
    Karolinska Univ Hosp, Sweden; Kings Coll London, England.
    Lundell, Lars
    Karolinska Inst, Sweden; Odense Univ Hosp, Denmark.
    Nilsson, Magnus
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Rouvelas, Ioannis
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Population-Based Cohort Study from a Prospective National Registry: Better Long-Term Survival in Esophageal Cancer After Minimally Invasive Compared with Open Transthoracic Esophagectomy2022In: Annals of Surgical Oncology, ISSN 1068-9265, E-ISSN 1534-4681, Vol. 29, no 9, p. 5609-5621Article in journal (Refereed)
    Abstract [en]

    Background Recent research indicates long-term survival benefits of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) for patients with esophageal and gastroesophageal junction (GEJ) cancers, but there is a need for more population-based studies. Methods We conducted a prospective population-based nationwide cohort study including all patients in Sweden diagnosed with esophageal or junctional cancer who underwent a transthoracic esophagectomy with intrathoracic anastomosis. Data were collected from the Swedish National Register for Esophageal and Gastric Cancer in 2006-2019. Patients were grouped into OE and MIE including hybrid MIE (HMIE) and totally MIE (TMIE). Overall survival and short-term postoperative outcomes were compared using Cox regression and logistic regression models, respectively. All models were adjusted for age, sex, American Society of Anesthesiologists (ASA) score, clinical T and N stage, neoadjuvant therapy, year of surgery, and hospital volume. Results Among 1404 patients, 998 (71.1%) underwent OE and 406 (28.9%) underwent MIE. Compared with OE, overall survival was better following MIE (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.55-0.94), TMIE (HR 0.67, 95% CI 0.47-0.94), and possibly also after HMIE (HR 0.76, 95% CI 0.56-1.02). MIE was associated with shorter operation time, less intraoperative bleeding, higher number of resected lymph nodes, and shorter hospital stay compared with OE. MIE was also associated with fewer overall complications (odds ratio [OR] 0.70, 95% CI 0.47-1.03) as well as non-surgical complications (OR 0.64, 95% CI 0.40-1.00). Conclusions MIE seems to offer better survival and similar or improved short-term postoperative outcomes in esophageal and GEJ cancers compared with OE in this unselected population-based cohort.

  • 284.
    Hedberg, Jakob
    et al.
    Uppsala Univ, Sweden.
    Sundbom, Magnus
    Uppsala Univ, Sweden.
    Edholm, David
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Aahlin, Eirik Kjus
    Univ Tromso, Norway; Univ Hosp Northern Norway, Norway.
    Szabo, Eva
    Orebro Univ, Sweden.
    Lindberg, Fredrik
    Umea Univ, Sweden.
    Johnsen, Gjermund
    Norwegian Univ Sci & Technol, Norway.
    Førland, Dag Tidemann
    Oslo Univ Hosp, Norway.
    Johansson, Jan
    Skane Univ Hosp, Sweden.
    Kauppila, Joonas H.
    Univ Oulu, Finland; Oulu Univ Hosp, Finland.
    Svendsen, Lars Bo
    Copenhagen Univ Hosp, Denmark.
    Nilsson, Magnus
    Karolinska Inst, Sweden; Univ Oxford, England.
    Lindblad, Mats
    Karolinska Inst, Sweden.
    Lagergren, Pernilla
    Karolinska Inst, Sweden; Imperial Coll London, England.
    Larsen, Michael Hareskov
    Odense Univ Hosp, Denmark.
    Åkesson, Oscar
    Skane Univ Hosp, Sweden.
    Löfdahl, Per
    Sahlgrens Univ Hosp, Sweden.
    Mala, Tom
    Oslo Univ Hosp, Norway.
    Achiam, Michael Patrick
    Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark.
    Randomized controlled trial of nasogastric tube use after esophagectomy: study protocol for the kinetic trial2024In: Diseases of the esophagus, ISSN 1120-8694, E-ISSN 1442-2050Article in journal (Refereed)
    Abstract [en]

    Esophagectomy is a complex and complication laden procedure. Despite centralization, variations in perioparative strategies reflect a paucity of evidence regarding optimal routines. The use of nasogastric (NG) tubes post esophagectomy is typically associated with significant discomfort for the patients. We hypothesize that immediate postoperative removal of the NG tube is non-inferior to current routines. All Nordic Upper Gastrointestinal Cancer centers were invited to participate in this open-label pragmatic randomized controlled trial (RCT). Inclusion criteria include resection for locally advanced esophageal cancer with gastric tube reconstruction. A pretrial survey was undertaken and was the foundation for a consensus process resulting in the Kinetic trial, an RCT allocating patients to either no use of a NG tube (intervention) or 5 days of postoperative NG tube use (control) with anastomotic leakage as primary endpoint. Secondary endpoints include pulmonary complications, overall complications, length of stay, health related quality of life. A sample size of 450 patients is planned (Kinetic trial: https://www.isrctn.com/ISRCTN39935085). Thirteen Nordic centers with a combined catchment area of 17 million inhabitants have entered the trial and ethical approval was granted in Sweden, Norway, Finland, and Denmark. All centers routinely use NG tube and all but one center use total or hybrid minimally invasive-surgical approach. Inclusion began in January 2022 and the first annual safety board assessment has deemed the trial safe and recommended continuation. We have launched the first adequately powered multi-center pragmatic controlled randomized clinical trial regarding NG tube use after esophagectomy with gastric conduit reconstruction.

  • 285.
    Hedberg, Suzanne
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Thorell, Anders
    Karolinska Inst, Sweden; Ersta Hosp, Sweden.
    Engstrom, My
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Stenberg, Erik
    Orebro Univ, Sweden.
    Olbers, Torsten
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Univ Gothenburg, Sweden.
    Surgical technique in constructing the jejunojejunostomy and the risk of small bowel obstruction after Roux-en-Y gastric bypass2022In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 18, no 9, p. 1151-1159Article in journal (Refereed)
    Abstract [en]

    Background: Mechanical problems at the level of the jejunojejunostomy (JJ) have been identified as a cause of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (RYGB). Objectives: The objective of the study was to investigate associations between specific surgical techniques used to construct the JJ and the subsequent risk of SBO. Setting: Nationwide Registry, Sweden. Methods: The risk of SBO after primary RYGB surgery during 2012-2019 was assessed using data from the Scandinavian Obesity Surgery Registry and the Swedish National Patient Register. The impact of unidirectional or bidirectional stapling and length of the mesenteric division (0, 1-4, or &gt;= 5 cm) at the JJ was analyzed with adjustments for known covariates. Results: We analyzed outcomes from 23,448 patients (mean follow-up = 4.3 +/- 2.2 yr). In multivar-iate analysis, bidirectional stapling of the JJ was associated with a reduced 30-day risk of SBO (hazard ratio [HR] = .52, 95% confidence interval [CI] = .29-.95, P &lt; .05), whereas limited mesenteric division (1-4 cm) increased the risk of SBO (HR = 1.66, 95% CI = 1.14-2.42, P &lt; .01). The long-term incidence of SBO was increased by bidirectional stapling but unaffected by mesenteric division. However, mesenteric division decreased the long-term risk of SBO in patients with a bidirectionally stapled JJ (1-4 cm, HR = .59, 95% CI = .38-.90, P &lt; .05; &gt;= 5 cm, HR = .30, 95% CI = .14-.65, P &lt; .005). Conclusions: The surgical technique for construction of the JJ may affect the incidence of SBO after RYGB surgery. (C) 2022 American Society for Bariatric Surgery. Published by Elsevier Inc.

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  • 286.
    Hedberg, Suzanne
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Xiao, Yao
    Univ Gothenburg, Sweden.
    Klasson, Adam
    Univ Gothenburg, Sweden.
    Maleckas, Almantas
    Univ Gothenburg, Sweden; Lithuanian Univ Hlth Sci, Lithuania.
    Wiren, Mikael
    Karolinska Inst, Sweden; Ersta Hosp, Sweden.
    Thorell, Anders
    Karolinska Inst, Sweden; Ersta Hosp, Sweden.
    Laurenius, Anna
    Univ Gothenburg, Sweden.
    Engstrom, My
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Olbers, Torsten
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Univ Gothenburg, Sweden.
    The Jejunojejunostomy: an Achilles Heel of the Roux-en-Y Gastric Bypass Construction2021In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 31, no 12, p. 5141-5147Article in journal (Refereed)
    Abstract [en]

    Background Laparoscopic Roux-en-Y gastric bypass (RYGB) has for long been the gold standard technique in bariatric surgery, especially in the Scandinavian countries. In a tertiary hospital setting, we observed an increasing number of patients with postprandial abdominal pain and nausea, often associated with complex hypoglycemia. Objectives The present study aimed to characterize the clinical patterns, patient characteristics, and clinical outcomes after surgical revision of dysfunctional RYGB at Sahlgrenska University Hospital in Gothenburg, Sweden. Methods This cohort study included patients with RYGB who underwent revision of the jejunojejunostomy (JJ) after 2013. Information was obtained by reviewing medical records and performing complementary interviews. Results Laparoscopic revisional surgery was performed in 115 cases with either adhesiolysis or total revision of the JJ (mean age 41 years, range 19-67 years; 90% women). The median time to assessment after the last revision was 33 months (range 12-75 months). Forty-four (38%) patients reported that they were symptom-free long-term after the intervention, and 32 (28%) patients experienced an improvement in the symptoms that were the indication for revision. However, 31 (27%) patients reported no long-term improvement, and half of them (n = 16) subsequently had a reversal of the anatomy. Eight (7%) patients were lost to follow-up. Conclusions Dysfunction of the JJ appears to be a relatively common cause of postprandial pain and nausea after ante-colic/ante-gastric RYGB. Most patients with symptoms of dysfunction experienced partial or total relief following revisional surgery, but a substantial minority had persistent problems, with one in five eventually undergoing reversal of the anatomy.

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  • 287.
    Hedbrant, Johan
    et al.
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, Faculty of Science & Engineering.
    Bjorne, Assar
    Specialisttandvården, Lasarettet Ystad.
    Ny mätmetod för käkmuskulaturen kan finna orsaken till tinnitus: Slutrapport Nutek 92-119041997Report (Other academic)
    Abstract [sv]

    Tinnitus är en åkomma som i lindrigare eller allvarligare former drabbar 17% av västvärldens befolkning. Ca 85 000 svenskar har tinnitus på invalidiserande nivå. Förutom mänskligt lidande orsakar tinnitus samhällskostnader på ca 1.5 miljard kr årligen. Orsaken är till största delen okänd.

    Vissa tecken tyder på ett samband mellan tinnitus och funktionsstörning i en käkmuskel. Några olika icke–invasiva metoder för mätning av muskelstörning i M Pterygoideus Lateralis har utvärderas. Två av dessa är intressanta för fortsatta studier.

    Termografi användes för att diagnosticera muskelstörningar på ytligt liggande muskler. Vi såg åtskilliga varma områden på ytliga käk– och nackmuskler på de patienter som hade käkledsstörningar, samt möjligen tecken på onormal värme från M Pterygoideus Lateralis. Mätförhållandena var dock ej ideala.

    En metod att mäta EMG med adaptiv noise cancelling provades. EMG från en ryggmuskel, stört av en “EKG–signal” från hjärtat användes. Metoden fungerade bra. Fortsatt metodutveckling på t.ex. ryggmuskler borde göras.

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  • 288.
    Heedman, Per-Anders
    et al.
    Region Östergötland, Local Health Care Services in Central Östergötland. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Åstradsson, E.
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Blomquist, K.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sjödahl, Rune
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Palliation of Malignant Biliary Obstruction: Adverse Events are Common after Percutaneous Transhepatic Biliary Drainage2018In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 107, no 1, p. 48-53Article in journal (Refereed)
    Abstract [en]

    Background and Aim: Endoscopic stents in the common bile duct is the first treatment choice to alleviate symptoms of biliary obstruction due to malignant disease. When endoscopic stenting fails in palliative patients, one option is to use a percutaneous transhepatic biliary drainage, but it is not clear whether and how it can reduce the symptom load. The aim of this study was to evaluate benefits and disadvantages of percutaneous transhepatic biliary drainage in palliative care. Material and Methods: Inclusion criteria were malignant disease and bilirubin 26 mu mol/L in plasma. A structured protocol for obtaining data from the medical records was used. Data were collected from the time of last computed tomography scan before the percutaneous transhepatic biliary drainage was placed and during 14days afterward. Results and Conclusion: Inclusion criteria were fulfilled in 140 patients. Median age was 70years (33-91years). Some 126 patients had a remaining external percutaneous transhepatic biliary drainage. Jaundice was the initial symptom in 62 patients (44%). Within the first week after percutaneous transhepatic biliary drainage, the bilirubin decreased from 237 mu mol/L (31-634) to 180 mu mol/L (17-545). Only 25% reached a level below the double upper reference value. Pruritus occurred in 27% before the percutaneous transhepatic biliary drainage, but the bilirubin value did not differ from patients without pruritus. However, the pruritus was relieved in 56% with percutaneous transhepatic biliary drainage. Antibiotic prophylaxis protected to some extent from infectious complications. Adverse events were common and early mortality was high (16% within 14days). Jaundice should not by itself be an indication for percutaneous transhepatic biliary drainage for palliation except when the aim is to prepare the patient for chemotherapy. It is mandatory that the patients are informed carefully about what can be expected regarding the positive effects and the risks of adverse events.

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  • 289.
    Heil, J.
    et al.
    Univ Zurich, Switzerland; Goethe Univ Frankfurt, Germany.
    Korenblik, R.
    Maastricht Univ, Netherlands; Maastricht Univ, Netherlands.
    Heid, F.
    Univ Zurich, Switzerland; Cantonal Hosp Winterthur, Switzerland.
    Bechstein, W. O.
    Goethe Univ Frankfurt, Germany.
    Bemelmans, M.
    Maastricht Univ, Netherlands.
    Binkert, C.
    Cantonal Hosp Winterthur, Switzerland.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Breitenstein, S.
    Cantonal Hosp Winterthur, Switzerland.
    Detry, O.
    Univ Liege, Belgium.
    Dili, A.
    Ctr Hosp Univ Dinant Godinne St Elisabeth UCL Nam, Belgium.
    Dondelinger, R. F.
    Univ Hosp Liege, Belgium.
    Gerard, L.
    Univ Hosp Liege, Belgium.
    Gimenez-Maurel, T.
    Miguel Univ Hosp, Spain; Univ Zaragoza, Spain.
    Guiu, B.
    St Eloi Univ Hosp, France.
    Heise, D.
    Univ Hosp Aachen, Germany.
    Hertl, M.
    Rush Univ, IL 60612 USA.
    Kalil, J. A.
    Rush Univ, IL 60612 USA.
    Klein, J. J.
    Rush Univ, IL 60612 USA.
    Lakoma, A.
    McGill Univ, Canada.
    Neumann, U. P.
    Univ Hosp Aachen, Germany.
    Olij, B.
    Maastricht Univ, Netherlands.
    Pappas, S. G.
    Rush Univ, IL 60612 USA.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Schnitzbauer, A.
    Goethe Univ Frankfurt, Germany.
    Serrablo, A.
    Miguel Univ Hosp, Spain; Univ Zaragoza, Spain.
    Tasse, J.
    Rush Univ, IL 60612 USA.
    Van der Leij, C.
    Maastricht Univ, Netherlands.
    Metrakos, P.
    McGill Univ, Canada.
    Van Dam, R.
    Maastricht Univ, Netherlands; Maastricht Univ, Netherlands; Univ Hosp Aachen, Germany.
    Schadde, E.
    Univ Zurich, Switzerland; Cantonal Hosp Winterthur, Switzerland; Rush Univ, IL 60612 USA.
    Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis2021In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 108, no 7, p. 834-842Article in journal (Refereed)
    Abstract [en]

    Y Background: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. Methods: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis. Results: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P=0.020) and resectability (90 versus 68 per cent; P=0.007). Major complications (26 versus 34 per cent; P=0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. Conclusion: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.

  • 290.
    Heil, Jan
    et al.
    Univ Zurich, Switzerland; Goethe Univ Frankfurt, Univ Hosp Frankfurt, Dept Gen Visceral & Transplant Surg, Frankfurt, Germany.
    Heid, Franziska
    Univ Zurich, Switzerland; Cantonal Hosp Winterthur, Switzerland.
    Bechstein, Wolf O.
    Goethe Univ Frankfurt, Univ Hosp Frankfurt, Dept Gen Visceral & Transplant Surg, Frankfurt, Germany.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Brismar, Torkel B.
    Karolinska Inst, Sweden.
    Carling, Ulrik
    Oslo Univ Hosp, Norway.
    Erdmann, Joris
    Univ Amsterdam, Netherlands.
    Fretland, Asmund A.
    Oslo Univ Hosp, Norway; Oslo Univ Hosp, Norway.
    Grunhagen, Dirk
    Erasmus Univ, Netherlands.
    Hana, Renato A.
    McGill Gen Hosp, Canada.
    Hohmann, Joachim
    Cantonal Hosp Winterthur, Switzerland; Univ Basel, Switzerland.
    Linke, Richard
    Goethe Univ Frankfurt, Univ Hosp Frankfurt, Dept Gen Visceral & Transplant Surg, Frankfurt, Germany.
    Meyer, Yannick
    Erasmus Univ, Netherlands.
    Nawawi, Abrar
    McGill Hlth Ctr Res Inst, Canada.
    Olthof, Pim B.
    Univ Amsterdam, Netherlands; Erasmus Univ, Netherlands.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Schnitzbauer, Andreas A.
    Goethe Univ Frankfurt, Univ Hosp Frankfurt, Dept Gen Visceral & Transplant Surg, Frankfurt, Germany.
    Sparrelid, Ernesto
    Karolinska Hosp, Sweden.
    Verhoef, Cornelis
    Erasmus Univ, Netherlands.
    Metrakos, Peter
    Department of Surgery, McGill Health Center Research Institute, Cancer Program, Montreal, Canada.
    Schadde, Erik
    Univ Zurich, Switzerland; Rush Univ, IL USA.
    Sarcopenia predicts reduced liver growth and reduced resectability in patients undergoing portal vein embolization before liver resection-A DRAGON collaborative analysis of 306 patients2022In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 24, no 3, p. 413-421Article in journal (Refereed)
    Abstract [en]

    Background: After portal vein embolization (PVE) 30% fail to achieve liver resection. Malnutrition is a modifiable risk factor and can be assessed by radiological indices. This study investigates, if sarcopenia affects resectability and kinetic growth rate (KGR) after PVE. Methods: A retrospective study was performed of the outcome of PVE at 8 centres of the DRAGON collaborative from 2010 to 2019. All malignant tumour types were included. Sarcopenia was defined using gender, body mass and skeletal muscle index. First imaging after PVE was used for liver volumetry. Primary and secondary endpoints were resectability and KGR. Risk factors impacting liver growth were assessed in a multivariable analysis. Results: Eight centres identified 368 patients undergoing PVE. 62 patients (17%) had to be excluded due to unavailability of data. Among the 306 included patients, 112 (37%) were non-sarcopenic and 194 (63%) were sarcopenic. Sarcopenic patients had a 21% lower resectability rate (87% vs. 66%, p &lt; 0.001) and a 23% reduced KGR (p = 0.02) after PVE. In a multivariable model dichotomized for KGR &gt;2.3% standardized FLR (sFLR)/week, only sarcopenia and sFLR before embolization correlated with KGR. Conclusion: In this largest study of risk factors, sarcopenia was associated with reduced resectability and KGR in patients undergoing PVE.

  • 291.
    Heimisdottir, Alexandra A.
    et al.
    Landspitali Univ Hosp, Iceland; Univ Iceland, Iceland.
    Enger, Eric
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Morelli, Simon
    Landspitali Univ Hosp, Iceland.
    Johannesdottir, Hera
    Landspitali Univ Hosp, Iceland.
    Helgadottir, Solveig
    Landspitali Univ Hosp, Iceland; Akad Univ Hosp, Sweden.
    Sigurdsson, Engilbert
    Landspitali Univ Hosp, Iceland; Univ Iceland, Iceland.
    Gudbjartsson, Tomas
    Landspitali Univ Hosp, Iceland; Univ Iceland, Iceland.
    Use of serotonin reuptake inhibitors is not associated with increased bleeding after CABG2020In: General Thoracic and Cardiovascular Surgery, ISSN 1863-6705 , E-ISSN 1863-6713, Vol. 68, p. 1312-1318Article in journal (Refereed)
    Abstract [en]

    Objectives Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) are the most commonly prescribed antidepressants worldwide. Studies suggest that SSRI/SNRIs can increase bleeding following different surgical procedures, including open heart surgery, but results are conflicting. The objective of this study was to analyse their effects on bleeding after coronary artery bypass grafting (CABG). Methods Of 1237 patients that underwent CABG in Iceland in 2007-2016, 97 (7.8%) used SSRIs/SNRIs preoperatively and were compared to a reference group (n = 1140). Bleeding was assessed using 24-h chest-tube output, number of RBC units transfused and reoperation for bleeding. Thirty-day mortality rates and incidence of complications were also compared. Results The two groups were comparable with respect to preoperative and operative variables, with the exception of BMI being significantly higher in the SSRI/SNRI group (30.2 vs. 28.3 kg/m(2), p &lt; 0.001). No significant differences were observed between groups in 24-h chest-tube output [815 (SSRI/SNRI) vs. 877 ml (reference), p = 0.26], number of RBC units transfused (2.2 vs. 2.2, p = 0.99) or the rate of reoperation for bleeding (4.1% vs. 6.0%, p = 0.61). The incidences of complications and 30-day mortality rate were also similar. Conclusions Using three different criteria, preoperative use of SSRIs/SNRIs was not shown to increase bleeding after CABG. Furthermore, short-term complications as well as 30-day mortality rates did not differ from those of controls. Thus, temporary cessation of SSRI/SNRI treatment prior to CABG to decrease the risk of bleeding is unwarranted.

  • 292.
    Heitz, F.
    et al.
    Evangelische Huyssens Stiftung, Germany; Charite Univ Med Berlin, Germany; Free Univ Berlin, Germany; Humboldt Unive Berlin, Germany; Berlin Inst Hlth, Germany; AGO Study Grp, Germany.
    Harter, P.
    Evangelische Huyssens Stiftung, Germany; AGO Study Grp, Germany.
    Åvall-Lundqvist, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology. Karolinska Inst, Linkoping, Sweden; NSGO Study Grp, Germany.
    Reuss, A.
    Coordinating Ctr Clin Trials, Germany; AGO Study Grp, Germany.
    Pautier, P.
    Inst Gustave Roussy, France; GINECO Study Grp, Germany.
    Cormio, G.
    Univ Bari, Italy; Natl Canc Inst Giovanni Paolo II, Italy; MITO Study Grp, Germany.
    Colombo, N.
    Univ Milano Bicocca, Italy; Inst Europeo Oncol, Italy; MaNGO Study Grp, Germany.
    Reinthaller, A.
    Med Univ Vienna, Austria; AGO Austria Study Grp, Austria.
    Vergote, I.
    Univ Leuven, Belgium; BGOG Study Grp, Austria.
    Poveda, A.
    Inst Valenciano Oncol, Spain; GEICO Study Grp, Spain.
    Ottevanger, P. B.
    Radboud Univ Nijmegen, Netherlands; DGOG Study Grp, Spain.
    Hanker, L. C.
    Univ Schleswig Holstein, Germany; AGO Study Grp, Germany.
    Leminen, A.
    Womens Hosp Med Ctr, Finland; NSGO Study Grp, Germany.
    Alexandre, J.
    Hop Univ Paris Ctr, France; GINECO Study Grp, Germany.
    Canzler, U.
    Tech Univ Dresden, Germany; AGO Study Grp, Germany.
    Sehouli, J.
    Charite Campus Virchow Klinikum, Germany; AGO Study Grp, Germany.
    Herrstedt, J.
    Odense Univ Hosp, Denmark; Zealand Univ, Denmark; NSGO Study Grp, Germany.
    Fiane, B.
    Stavanger Univ Hosp, Norway; NSGO Study Grp, Germany.
    Merger, M.
    Boehringer Ingelheim Pharma GmbH and Co KG, Germany.
    du Bois, A.
    AGO Study Grp, Germany.
    Early tumor regrowth is a contributor to impaired survival in patients with completely resected advanced ovarian cancer. An exploratory analysis of the Intergroup trial AGO-OVAR 122019In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 152, no 2, p. 235-242Article in journal (Refereed)
    Abstract [en]

    Objective. Surgical assessment of residual tumor provides the strongest prognostic information in advanced ovarian cancer (AOC), with the best outcome observed after complete resection. Postoperative radiological assessment before initiation of chemotherapy can supplement the information obtained by surgical assessment; however, it may also reveal conflicting findings. Methods. Patients with AOC enrolled in the AGO-OVAR 12 trial underwent baseline imaging before the first chemotherapy cycle. The findings from surgical and radiologic assessment for disease extend were compared. Additionally, an integrated approach was assessed. Results. Complete data from all 3 assessment methods were available for 1345 patients. Of 689 patients with complete resection, tumor was observed in 28% and 22% of patients undergoing radiologic and integrated assessment, respectively. Patients with surgical- radiological and surgical-integrated concordant findings showed a 5-year overall survival (5Y-OS) of 72% and 71%, whereas patients with surgical-radiological and surgical-integrated discordant results showed inferior 5Y-OS of 47% and 49%, respectively. Patients with surgically assessed residual disease had a 5-YOS of 37%. The interval between surgery and baseline assessment was independently associated with discordance between assessment methods, which might reflect early tumor regrowth. Conclusions. Baseline tumor assessment before chemotherapy provides information that stratifies patients with complete resection into different prognostic groups. Integrating the data from different assessment methods might lead to improved definitions of prognostic groups. Further investigation to determine if earlier initiation of chemotherapy after debulking surgery could increase survival of patients with early tumor regrowth is warranted. (C) 2018 Published by Elsevier Inc.

  • 293.
    Heliövaara, Arja
    et al.
    Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland.
    Küseler, Annelise
    Cleft Palate Center, Aarhus, Denmark.
    Skaare, Pål
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Shaw, William
    Dental School, University of Manchester, Manchester, UK.
    Mølsted, Kirsten
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark.
    Karsten, Agneta
    Division of Orthodontics, Department of Dental Medicine, Stockholm Craniofacial Team, Karolinska Institutet, Stockholm, Sweden.
    Brinck, Eli
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Rizell,, Sara
    Orthodontic clinic, University Clinics of Odontology Gothenburg, Sweden.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Sæle, Paul
    Oral Health Center of Excellence/Western Norway, Bergen, Norway.
    Hurmerinta, Kirsti
    Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland;.
    Rønning, Elisabeth
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Najar Chalien, Midia
    Orthodontic clinic, University Clinics of Odontology Gothenburg, Sweden.
    Bellardie,, Haydn
    Greater Manchester Cleft Unit, Royal Manchester Children’s Hospital, Manchester, UK.
    Mooney,, Jeanette
    Greater Manchester Cleft Unit, Royal Manchester Children’s Hospital, Manchester, UK.
    Eyres, Phil
    Dental School, University of Manchester, Manchester, UK.
    Semb, Gunvor
    Dental School, University of Manchester, Manchester, UK;Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet and Statped Sørøst, Oslo, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 6. Dental arch relationships in 5 year-olds.2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, p. 6p. 52-57Article in journal (Refereed)
    Abstract [en]

    Background and aim:Good dentofacial growth is a major goal in the treatment of unilateral cleft lip and palate (UCLP). The aim was to evaluate dental arch relationships at age 5 years after four different protocols of primary surgery for UCLP. Design:Three parallel randomised clinical trials were undertaken as an international multi-centre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods:Three different surgical procedures for primary palatal repair (Arms B, C, D) were tested against a common procedure (Arm A) in the total cohort of 448 children born with non-syndromic UCLP. Study models of 418 patients (273 boys) at the mean age of 5.1 years (range = 4.8–7.0) were available. Dental arch relationships were assessed using the 5-year index by a blinded panel of 16 orthodontists. Kappa statistics were calculated to assess reliability. The trials were tested statistically witht-and Chi-square tests. Results:Good-to-very good levels of intra- and interrater reliability were obtained (0.71–0.94 and 0.70–0.87). Comparisons within each trial showed no statistically significant differences in the mean 5-year index scores or their distributions between the common method and the local team protocol. The mean index scores varied from 2.52 (Trial 2, Arm C) to 2.94 (Trial 3, Arm D). Conclusion:The results of the three trials do not provide statistical evidence that one technique is better than the others. Further analysis of the possible influence of individual surgical skill and learning curve are being pursued in this dataset. Trial registration:ISRCTN29932826. [ABSTRACT FROM AUTHOR]

  • 294.
    Hellström Ängerud, Karin
    et al.
    Institutionen för omvårdnad, Umeå Universitet.
    Ericsson, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Isaksson, R-M
    Norrbotten County Council, Department of Research, Luleå.
    Sederholm Lawesson, Sofia
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Differences in symptoms in relation to myocardial infarction.2016Conference paper (Other academic)
    Abstract [en]

    Background: In myocardial infarction (MI) rapid diagnosis and treatment is crucial for the prognosis. Previous research has found that symptom presentation influence pre hospital delay times but studies about differences in MI symptoms between patients with ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) are sparse and inconclusive. To enhance the understanding of symptom presentation in regard to MI type, we aimed to describe symptoms in relation to MI type and to find predictors of STEMI versus NSTEMI in patients with MI.

    Methods: Patients with MI (n=694) from the SymTime study were included. SymTime was a multicentre cross-sectional study of symptoms and actions in the prehospital phase of MI and data were collected using a previously validated questionnaire administered to MI patients within 24 h of admission to hospital.

    Results: Patients with STEMI were younger, more often men and smokers. Patients with NSTEMI were more likely to have a history of hypertension, MI and stroke. Chest pain was the most common symptom in both groups. Pain, discomfort, or pressure located in the jaw or teeth, vertigo/pre-syncope, cold sweat and nausea/vomiting were significantly more frequent in patients with STEMI (Table 1). In a multivariate logistic regression model patients with STEMI were more likely to present with cold sweat (OR 4.13, 95% CI 2.71–6.29) jaw pain (OR 2.14, 95% CI 1.02–4.50), and nausea (OR 2.01, 95% CI 1.20–3.33), and less likely to have a history of stroke (OR 0.35, 95% CI 0.15–0.84), fluctuating symptoms (OR 0.54, 95% CI 0.36–0.83) and anxiety (OR 0.54, 95% CI 0.32–0.92) compared to patients with NSTEMI.

    Conclusion: Patients with STEMI differed significantly from those with NSTEMI regarding symptom presentation. This knowledge is important for health care personnel to recognize symptoms alarming for STEMI when evaluating patients with MI symptoms.

  • 295.
    Henricson, Joakim
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine in Linköping.
    Sandh, Jenny
    Absorbest AB, Sweden.
    Iredahl, Fredrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Åby.
    Moisture sensor for exudative wounds: A pilot study2021In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 27, no 5, p. 918-924Article in journal (Refereed)
    Abstract [en]

    Background Exudative wounds cause discomfort for patients. Introduction of a moisture sensor to dressings could facilitate change of dressings only when needed. The aim of this pilot study was to evaluate the ability of a newly developed moisture sensor to detect moisture in relation to the absorbing capacity of the dressing. Materials and Methods In five patients, with one leg ulcer each, three dressing changes per patient were observed. Interval of dressing change was according to clinical need and healthcare professionals decision. Sensor activation, dressing weight and complications were registered. To investigate the effect of dressing on sensor activation, half of the observations were made without an extra layer of non-woven between the dressing and sensor (Variant A), and half with (Variant B). Results The sensor indicated time for dressing change in six out of fifteen observations. Variants A and B did not differ regarding activation or the timing of the activation. Conclusions The addition of a moisture sensor for facilitating management of exudative wounds is promising. We recommend future larger studies evaluating the potential clinical benefits and risks of the addition of a moisture sensor. We also recommend evaluation of potential home monitoring of wounds by a moisture sensor.

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  • 296.
    Henriksson, M. Mörtzell
    et al.
    Umea Univ, Sweden.
    Weiner, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Nephrology.
    Sperker, W.
    Umea Univ, Sweden.
    Berlin, Gösta
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Segelmark, M.
    Lund Univ, Sweden.
    Martinez, A. Javier
    Uppsala Univ, Sweden.
    Audzijoniene, J.
    Vilnius Univ, Lithuania.
    Griskevicius, A.
    Vilnius Univ, Lithuania.
    Newman, E.
    Concord Hosp, Australia.
    Blaha, M.
    Kralove Univ, Czech Republic.
    Vrielink, H.
    Sanquin, Netherlands.
    Witt, V
    St Anna Childrens Hosp, Austria.
    Stegmayr, B.
    Umea Univ, Sweden.
    Analyses of registry data of patients with anti-GBM and antineutrophil cytoplasmatic antibody-associated (ANCA) vasculitis treated with or without therapeutic apheresis2021In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 60, no 6, article id 103227Article in journal (Refereed)
    Abstract [en]

    Therapeutic apheresis (TA) as a treatment for antibody-associated vasculitis (AAV) was questioned by the PEXIVAS although the MEPEX study favored TA. The aim of this study was to evaluate the efficacy of TA to improve renal function in patients consecutively included in the WAA-apheresis registry versus patients not treated with TA. Materials and methods: Included were 192 patients that suffered from anti-glomerular basement membrane disease (anti-GBM, n = 28) and antineutrophil cytoplasmic antibody-associated vasculitis of MPO or PR3 origin. Of these 119 had performed TA and the other 73 had not performed TA for theses diagnoses (CTRL). Results: Elderly had an increased risk to die within 12 months (p = 0.002). All 28 anti-GBM had renal involvement, 21 dialysis dependent. At 3 month nine (36 %) did not need dialysis. Baseline data regarding renal function of AAV patients, subtype MPO and PR3, were worse in the TA groups than in CTRL. Recovery out of dialysis was better for the PR3-TA group compared with 1) the controls of MEPEX (RR 0.59, CI 0.43-0.80) and 2) the MPO-TA patients (RR 0.28, CI 0.12-0.68). The MPO-TA recovered similarly as the MEPEX-CTRL. Renal function improved most for TA-patients from baseline during the first 3 months (MPO-TA and PR3-TA) and stabilized thereafter and less for MPO-CTRL and PR3-CTRL. Conclusion: PR3-TA patients seem to have best chances to get out of dialysis. PR3-TA and MPO-TA improved residual renal function better than CTRL. The present study recommends reconsiderations to use TA for AAV especially those with PR3-vasculitis with severe renal vasculitis.

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  • 297.
    Henriksson, Martin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Eilard, M. Sternby
    Univ Gothenburg, Sweden.
    Lindell, G.
    Lund Univ, Sweden.
    Strömberg, C.
    Karolinska Univ Hosp, Sweden.
    Hemmingsson, O.
    Umea Univ, Sweden.
    Isaksson, B.
    Uppsala Univ, Sweden.
    Rizell, M.
    Univ Gothenburg, Sweden.
    Sandström, Per A
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Treatment patterns and survival in patients with hepatocellular carcinoma in the Swedish national registry SweLiv2020In: BJS Open, E-ISSN 2474-9842, Vol. 4, no 1, p. 109-117Article in journal (Refereed)
    Abstract [en]

    Background Consistent data on clinical features, treatment modalities and long-term survival in patients with hepatocellular carcinoma (HCC) using nationwide quality registers are lacking. This study aimed to describe treatment patterns and survival outcomes in patients diagnosed with HCC using a national maintained database. Methods Characteristics and treatment patterns in patients diagnosed with HCC and registered in the national register of liver and bile duct tumours (SweLiv) between 2009 and 2016 were reviewed. Overall survival (OS) was estimated using Kaplan-Meier analysis and the log rank test to compare subgroups for clinical features, treatment modalities and outcomes according to the year of treatment. Results A total of 3376 patients with HCC were registered over 8 years, 246 (7 center dot 3 per cent) of whom underwent transplantation. Some 501 (14 center dot 8 per cent) and 390 patients (11 center dot 6 per cent) had resection and ablation as primary treatment. Transarterial chemoembolization and systemic sorafenib treatment were intended in 476 (14 center dot 1 per cent) and 426 patients (12 center dot 6 per cent) respectively; the remaining 1337 (39 center dot 6 per cent) were registered but referred for best supportive care (BSC). The 5-year survival rate was approximately 75 per cent in the transplantation group. Median OS was 4 center dot 6 (i.q.r. 2 center dot 0 to not reached) years after resection and 3 center dot 1 (2 center dot 3-6 center dot 7) years following ablation. In patients referred for palliative treatment, median survival was 1 center dot 4 (0 center dot 8-2 center dot 9), 0 center dot 5 (0 center dot 3-1 center dot 2) and 0 center dot 3 (0 center dot 1-1 center dot 0) years for the TACE, sorafenib and BSC groups respectively (P amp;lt; 0 center dot 001). Median survival was 0 center dot 9 years for the total HCC cohort in 2009-2012, before publication of the Swedish national treatment programme, increasing to 1 center dot 4 years in 2013-2016 (P amp;lt; 0 center dot 001). Conclusion The survival outcomes reported were in line with previous results from smaller cohorts. The introduction of national guidelines may have contributed to improved survival among patients with HCC in Sweden.

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  • 298.
    Hermsen, Meyke
    et al.
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Volk, Valery
    Hannover Med Sch, Germany.
    Bräsen, Jan Hinrich
    Hannover Med Sch, Germany.
    Geijs, Daan J.
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Gwinner, Wilfried
    Hannover Med Sch, Germany.
    Kers, Jesper
    Amsterdam Univ Med Ctr, Netherlands; Leiden Univ, Netherlands; Univ Amsterdam, Netherlands.
    Linmans, Jasper
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Schaadt, Nadine S.
    Hannover Med Sch, Germany.
    Schmitz, Jessica
    Hannover Med Sch, Germany.
    Steenbergen, Eric J.
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Swiderska-Chadaj, Zaneta
    Radboud Univ Nijmegen Med Ctr, Netherlands; Warsaw Univ Technol, Poland.
    Smeets, Bart
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Hilbrands, Luuk B.
    Radboud Univ Nijmegen Med Ctr, Netherlands.
    Feuerhake, Friedrich
    Hannover Med Sch, Germany; Univ Clin Freiburg, Germany.
    van der Laak, Jeroen
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical pathology. Radboud Univ Nijmegen Med Ctr, Netherlands.
    Quantitative assessment of inflammatory infiltrates in kidney transplant biopsies using multiplex tyramide signal amplification and deep learning2021In: Laboratory Investigation, ISSN 0023-6837, E-ISSN 1530-0307, Vol. 101, no 8, p. 970-982Article in journal (Refereed)
    Abstract [en]

    Delayed graft function (DGF) is a strong risk factor for development of interstitial fibrosis and tubular atrophy (IFTA) in kidney transplants. Quantitative assessment of inflammatory infiltrates in kidney biopsies of DGF patients can reveal predictive markers for IFTA development. In this study, we combined multiplex tyramide signal amplification (mTSA) and convolutional neural networks (CNNs) to assess the inflammatory microenvironment in kidney biopsies of DGF patients (n = 22) taken at 6 weeks post-transplantation. Patients were stratified for IFTA development (&lt;10% versus &gt;= 10%) from 6 weeks to 6 months post-transplantation, based on histopathological assessment by three kidney pathologists. One mTSA panel was developed for visualization of capillaries, T- and B-lymphocytes and macrophages and a second mTSA panel for T-helper cell and macrophage subsets. The slides were multi spectrally imaged and custom-made python scripts enabled conversion to artificial brightfield whole-slide images (WSI). We used an existing CNN for the detection of lymphocytes with cytoplasmatic staining patterns in immunohistochemistry and developed two new CNNs for the detection of macrophages and nuclear-stained lymphocytes. F1-scores were 0.77 (nuclear-stained lymphocytes), 0.81 (cytoplasmatic-stained lymphocytes), and 0.82 (macrophages) on a test set of artificial brightfield WSI. The CNNs were used to detect inflammatory cells, after which we assessed the peritubular capillary extent, cell density, cell ratios, and cell distance in the two patient groups. In this cohort, distance of macrophages to other immune cells and peritubular capillary extent did not vary significantly at 6 weeks post-transplantation between patient groups. CD163(+) cell density was higher in patients with &gt;= 10% IFTA development 6 months post-transplantation (p &lt; 0.05). CD3(+)CD8(-)/CD3(+)CD8(+) ratios were higher in patients with &lt;10% IFTA development (p &lt; 0.05). We observed a high correlation between CD163(+) and CD4(+)GATA3(+) cell density (R = 0.74, p &lt; 0.001). Our study demonstrates that CNNs can be used to leverage reliable, quantitative results from mTSA-stained, multi spectrally imaged slides of kidney transplant biopsies. This study describes a methodology to assess the microenvironment in sparse tissue samples. Deep learning, multiplex immunohistochemistry, and mathematical image processing techniques were incorporated to quantify lymphocytes, macrophages, and capillaries in kidney transplant biopsies of delayed graft function patients. The quantitative results were used to assess correlations with development of interstitial fibrosis and tubular atrophy.

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  • 299.
    Hernandez-Alejandro, Roberto
    et al.
    Univ Rochester, NY 14642 USA.
    Ruffolo, Luis I
    Univ Rochester, NY 14642 USA.
    Alikhanov, Ruslan
    Clin Res Ctr Moscow, Russia.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Torres, Orlando Jorge M.
    Univ Fed Maranhao, Brazil.
    Serrablo, Alejandro
    Miguel Servet Univ Hosp, Spain; Univ Zaragoza, Spain.
    Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure for colorectal liver metastasis2020In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 82, p. 103-108Article, review/survey (Refereed)
    Abstract [en]

    Since first described, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has garnered boisterous praise and fervent criticism. Its rapid adoption and employment for a variety of indications resulted in high perioperative morbidity and mortality. However recent risk stratification, refinement of technique to reduce the impact of stage I and progression along the learning curve have resulted in improved outcomes. The first randomized trial comparing ALPPS to two stage hepatectomy (TSH) for colorectal liver metastases (CRLM) was recently published demonstrating comparable perioperative morbidity and mortality with improved resectability and survival following ALPPS. In this review, as ALPPS enters the thirteenth year since conception, the current status of this contentious two stage technique is presented and best practices for deployment in the treatment of CRLM is codified.

  • 300.
    Himonakos, Christos
    et al.
    Karolinska Inst, Sweden; Karlstad Cent Hosp, Sweden.
    Burman, Pia
    Lund Univ, Sweden.
    Borg, Henrik
    Lund Univ, Sweden.
    Dahlqvist, Per
    Umea Univ, Sweden.
    Engstroem, Britt Eden
    Uppsala Univ, Sweden; Uppsala Univ Hosp, Sweden.
    Ekman, Bertil
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Endocrinology.
    Emilsson, Louise
    Univ Oslo, Norway; Cty Council Varmland, Sweden; Karolinska Inst, Sweden.
    Olsson, Daniel S.
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden; AstraZeneca, Sweden.
    Ragnarsson, Oskar
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Wahlberg, Jeanette
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden.
    Akerman, Anna-Karin
    Karolinska Inst, Sweden; Orebro Univ Hosp, Sweden.
    Hoybye, Charlotte
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Berinder, Katarina
    Karolinska Inst, Sweden.
    Long-term Follow-up of 84 Patients With Giant Prolactinomas-A Swedish Nationwide Study2023In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 108, no 12, p. e1506-e1514Article in journal (Refereed)
    Abstract [en]

    Purpose To describe the clinical presentation and treatment outcomes in a nationwide cohort of patients with giant prolactinomas. Methods Register-based study of patients with giant prolactinomas [serum prolactin (PRL) &gt; 1000 & mu;g/L, tumor diameter & GE;40 mm] identified in the Swedish Pituitary Register 1991-2018. Results Eighty-four patients [mean age 47 (SD & PLUSMN;16) years, 89% men] were included in the study. At diagnosis, the median PRL was 6305 & mu;g/L (range 1450-253 000), the median tumor diameter was 47 mm (range 40-85), 84% of the patients had hypogonadotropic hypogonadism, and 71% visual field defects. All patients were treated with a dopamine agonist (DA) at some point. Twenty-three (27%) received 1 or more additional therapies, including surgery (n = 19), radiotherapy (n = 6), other medical treatments (n = 4), and chemotherapy (n = 2). Ki-67 was & GE;10% in 4/14 tumors. At the last follow-up [median 9 years (interquartile range (IQR) 4-15)], the median PRL was 12 & mu;g/L (IQR 4-126), and the median tumor diameter was 22 mm (IQR 3-40). Normalized PRL was achieved in 55%, significant tumor reduction in 69%, and combined response (normalized PRL and significant tumor reduction) in 43%. In the primary DA-treated patients (n = 79), the reduction in PRL or tumor size after the first year predicted the combined response at the last follow-up (P &lt; .001 and P = .012, respectively). Conclusion DAs effectively reduced PRL and tumor size, but approximately 1 patient out of 4 needed multimodal treatment. Our results suggest that the response to DA after 1 year is useful for identifying patients who need more careful monitoring and, in some cases, additional treatment.

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