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  • 151.
    Alm, Anders
    Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland. Linköpings universitet, Hälsouniversitetet.
    On the Anterior Cruciate Ligament: Lesions, Reconstruction, Morphology and Tensile Strength - A Clinical and Experimental Study1974Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
  • 152.
    Alm, Fredrik
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Stalfors, Joacim
    Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Sheikh Khalifa Medical City, Ajman, United Arab Emirates.
    Nerfeldt, Pia
    Karolinska University Hospital, Huddinge, Sweden.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Patient reported outcome of pain after tonsil surgery: An analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-20162017Konferensbidrag (Refereegranskat)
    Abstract [en]

    Tonsil surgery is common surgical procedure in children and cause significant pain under postoperative recovery. The objective of this register study was to explore factors affecting pain after pediatric tonsil surgery, using patient-reported outcomes from questionnaires in the National Tonsil Surgery Registry in Sweden, 30 days after surgery. A total of 32,225 tonsil surgeries on children (aged 1-18 years) during January 2009- November 2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE±A) and 18,321 tonsillotomies with or without adenoidectomy (TT±A). In surgery cases of indication obstruction, the TT±A stopped taking painkillers and returned to normal eating habits sooner, and had less contact with health care services due to pain, compared to TE±A. After TE±A, the indication infection group had more days on analgesics and more contacts with health care services due to pain, compared to the indication obstruction group. TE±A with cold-dissection technique resulted in fewer days on painkillers compared to warm-technique, and reduced the number of contacts with health care services due to pain. Older children were affected by more days of morbidity than the younger ones, but there was no gender difference after adjustment for age, dissection technique and hemostasis technique. Implementation of national guidelines for pain treatment (2013) and patient information on the website tonsilloperation.se seems to have increased the days on analgesics after surgery. Pain after tonsil surgery depends on the surgical procedure and technique, as well as factors such as the patient’s age and surgical indication. More studies including pain interventions are needed to improve the care of tonsillectomy patients.

  • 153.
    Almby, Kristina E.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk diabetologi och metabolism. Akademiska Sjukhuset.
    Edholm, David
    Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Anastomotic Strictures After Roux-en-Y Gastric Bypass: a Cohort Study from the Scandinavian Obesity Surgery Registry2019Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, nr 1, s. 172-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure worldwide. Anastomotic stricture is a known complication of RYGB. The aim was to explore the incidence and outcomes of strictures within the Scandinavian Obesity Surgery Registry (SOReg).

    Method

    SOReg included prospective data from 36,362 patients undergoing bariatric surgery in the years 2007–2013. Outcomes were recorded at 30-day and at 1-year follow-up according to the standard SOReg routine. The medical charts of patients suffering from stricture after RYGB were requested and assessed.

    Setting

    National bariatric surgery registry

    Results

    Anastomotic stricture within 1 year of surgery was confirmed in 101 patients representing an incidence of 0.3%. Risk factors for stricture were patient age above 60 years (odds ratio (OR), 6.2 95% confidence interval (CI) 2.7–14.3), circular stapled gastrojejunostomy (OR 2.7, 95% CI 1.4–5.5), postoperative anastomotic leak (OR 8.9 95%, CI 4.7–17.0), and marginal ulcer (OR 30.0, 95% CI 19.2–47.0). Seventy-five percent of the strictures were diagnosed within 70 days of surgery. Two dilatations or less was sufficient to successfully treat 50% of patients. Ten pecent of patients developed perforation during dilatation, and the risk of perforating at each dilatation was 3.8%. Perforation required surgery in six cases but there was no mortality. Strictures in SOReg may be underreported, which could explain the low incidence in the study.

    Conclusion

    Most strictures present within 2 months and are successfully treated with two dilatations or less. Dilating a strictured gastrojejunostomy entails a risk of perforation (3.8%).

  • 154.
    Almby, Kristina
    et al.
    Uppsala Univ, Sweden.
    Edholm, David
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Anastomotic Strictures After Roux-en-Y Gastric Bypass: a Cohort Study from the Scandinavian Obesity Surgery Registry2019Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, nr 1, s. 172-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundRoux-en-Y gastric bypass (RYGB) is the most common bariatric procedure worldwide. Anastomotic stricture is a known complication of RYGB. The aim was to explore the incidence and outcomes of strictures within the Scandinavian Obesity Surgery Registry (SOReg).MethodSOReg included prospective data from 36,362 patients undergoing bariatric surgery in the years 2007-2013. Outcomes were recorded at 30-day and at 1-year follow-up according to the standard SOReg routine. The medical charts of patients suffering from stricture after RYGB were requested and assessed.SettingNational bariatric surgery registryResultsAnastomotic stricture within 1year of surgery was confirmed in 101 patients representing an incidence of 0.3%. Risk factors for stricture were patient age above 60years (odds ratio (OR), 6.2 95% confidence interval (CI) 2.7-14.3), circular stapled gastrojejunostomy (OR 2.7, 95% CI 1.4-5.5), postoperative anastomotic leak (OR 8.9 95%, CI 4.7-17.0), and marginal ulcer (OR 30.0, 95% CI 19.2-47.0). Seventy-five percent of the strictures were diagnosed within 70days of surgery. Two dilatations or less was sufficient to successfully treat 50% of patients. Ten pecent of patients developed perforation during dilatation, and the risk of perforating at each dilatation was 3.8%. Perforation required surgery in six cases but there was no mortality. Strictures in SOReg may be underreported, which could explain the low incidence in the study.ConclusionMost strictures present within 2months and are successfully treated with two dilatations or less. Dilating a strictured gastrojejunostomy entails a risk of perforation (3.8%).

  • 155.
    Almirón Santa-Bárbara, Rafael
    et al.
    Department of Orthopaedic Surgery and Traumatology, Hospital de Antequera, Malaga, Spain ; School of Medicine, Universidad de Málaga, Spain.
    García Rivera, Francisco
    Högskolan i Skövde, Institutionen för ingenjörsvetenskap. Högskolan i Skövde, Forskningsmiljön Virtuell produkt- och produktionsutveckling.
    Lamb, Maurice
    Högskolan i Skövde, Institutionen för informationsteknologi. Högskolan i Skövde, Forskningsmiljön Informationsteknologi. Högskolan i Skövde, Institutionen för ingenjörsvetenskap. Högskolan i Skövde, Forskningsmiljön Virtuell produkt- och produktionsutveckling.
    Víquez Da-Silva, Rodrigo
    Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
    Gutiérrez Bedmar, Mario
    Preventive Medicine and Public Health Department, School of Medicine, University of Málaga, Spain ; Biomedical Research Institute of Malaga-IBIMA, Spain ; CIBERCV Cardiovascular Diseases, Carlos III Health Institute, Madrid, Spain.
    New technologies for the classification of proximal humeral fractures: Comparison between Virtual Reality and 3D printed models—a randomised controlled trial2023Ingår i: Virtual Reality, ISSN 1359-4338, E-ISSN 1434-9957, Vol. 27, nr 3, s. 1623-1634Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Correct classification of fractures according to their patterns is critical for developing a treatment plan in orthopaedic surgery. Unfortunately, for proximal humeral fractures (PHF), methods for proper classification have remained a jigsaw puzzle that has not yet been fully solved despite numerous proposed classifications and diagnostic methods. Recently, many studies have suggested that three-dimensional printed models (3DPM) can improve the interobserver agreement on PHF classifications. Moreover, Virtual Reality (VR) has not been properly studied for classification of shoulder injuries. The current study investigates the PHF classification accuracy relative to an expert committee when using either 3DPM or equivalent models displayed in VR among 36 orthopaedic surgery residents from different hospitals. We designed a multicentric randomised controlled trial in which we created two groups: a group exposed to a total of 34 3DPM and another exposed to VR equivalents. Association between classification accuracy and group assignment (VR/3DPM) was assessed using mixed effects logistic regression models. The results showed VR can be considered a non-inferior technology for classifying PHF when compared to 3DPM. Moreover, VR may be preferable when considering possible time and resource savings along with potential uses of VR for presurgical planning in orthopaedics. 

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  • 156.
    Almkvist, Louise
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Agreement between LARS and Wexner score Two fecal incontinence scoring systems2018Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 157.
    Almqvist Terán, Nicolas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Neurokirurgi.
    Loayza, Richard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Neurokirurgi.
    Wikström, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Ericson, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Neurokirurgi.
    Abu Hamdeh, Sami
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Neurokirurgi.
    Svedung-Wettervik, Teodor
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Neurokirurgi.
    In Reply to the Letter to the Editor Regarding "Posterior Fossa Volume and Dimensions: Relation to Pathophysiology and Surgical Outcomes in Classical Trigeminal Neuralgia"2023Ingår i: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 180, artikel-id 268Artikel i tidskrift (Övrigt vetenskapligt)
  • 158.
    Alnadhari, Ibrahim
    et al.
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Sampige, Venkata Ramana Pai
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdeljaleel, Osama
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    Högskolan i Skövde, Institutionen för hälsovetenskaper. Högskolan i Skövde, Forskningsmiljön hälsa, hållbarhet och digitalisering. Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Ali, Omar
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Salah, Morshed
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Shamsodini, Ahmad
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities2020Ingår i: Therapeutic advances in urology, ISSN 1756-2872, Vol. 12, s. 1-8, artikel-id 1756287220930627Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose:

    The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).

    The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities.

    Methods:

    We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence.

    Results:

    A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.

    The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample.

    Conclusion:

    Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

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  • 159.
    Alobaidy, Abdulqadir
    et al.
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Ibrahim, Tarek
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    Högskolan i Skövde, Institutionen för hälsovetenskaper. Högskolan i Skövde, Forskningsmiljön hälsa, hållbarhet och digitalisering. Department of Surgery, Hamad General Corporation, Doha ; College of Medicine, Qatar University, Doha, Qatar.
    Tawfik, Hosam
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Al-Naimi, Abdulla
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Hussain, Salam
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Al-Ansari, Abdulla
    Department of Surgery, Urology Section, Hamad Medical Corporation, Doha, Qatar.
    Grooved vs smooth ureteric stent before extracorporeal shockwave lithotripsy: Single-blind randomised clinical trial2022Ingår i: Arab Journal of Urology, ISSN 2090-598X, Vol. 20, nr 1, s. 41-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: No study compared the grooved stent to the widely used standard smooth (nongrooved) stent in humans. We compared stone clearance, complications, and patient tolerance of the grooved stent vs standard JJ stent. Patients and Methods: Single-blinded randomised trial among patients planned for pre-extracorporeal shockwave lithotripsy (ESWL) stenting. Adult patients with unilateral ureteric/ renal stones planned for ESWL were randomly assigned to receive (Percuflex) smooth ureteric stent or (Visiostar) grooved lithotripsy stent and blinded to the stent type. We collected and compared the baseline data and outcomes (stone-free rate, complications, and stent-related symptoms) of both patient groups. Results: A total of 96 adults were included (48 per arm). There were no significant differences between the groups at baseline in terms of demographics, body mass index, comorbidities, renal function, number of ESWL sessions, and stone characteristics, including pre-ESWL stone volume (mean [SD] smooth 310.2 [301.6] vs grooved 270.7 [278.6] mm3, P = 0.5). Stone clearance was statistically insignificant between the groups, although clinically relevant (smooth stent 70.8% vs grooved stent 81.2%, P = 0.2). Grooved-stent patients reported comparable urinary symptoms score (P = 0.05) and operative complications (P = 0.6), but significantly more urinary tract infections (UTIs) not requiring hospitalisation (P = 0.003). Conclusions: Although statistically insignificant, the grooved stent exhibited higher stone clearance compared to the smooth stent, with similar complication rates excpet that patients with grooved stents reported more UTIs. A re-visit to the size of the outer diameter of the grooved stent could enhance its stone clearance properties, and further development of its coating material could lead to better patient satisfaction.

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  • 160.
    Alping, P.
    et al.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
    Askling, J.
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
    Burman, J.
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Fink, K.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
    Fogdell-Hahn, A.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Gunnarsson, M.
    Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hillert, J.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
    Langer-Gould, A.
    Clinical and Translational Neuroscience, Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA, United States.
    Lycke, J.
    Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden.
    Nilsson, P.
    Department of Clinical Sciences/Neurology, Lund University, Lund, Sweden.
    Salzer, J.
    Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
    Svenningsson, A.
    Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Vrethem, Magnus
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för neurobiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurologiska kliniken i Linköping.
    Olsson, T.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
    Piehl, F.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
    Frisell, T.
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
    Cancer Risk for Fingolimod, Natalizumab, and Rituximab in Multiple Sclerosis Patients2020Ingår i: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 87, nr 5, s. 688-699Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Novel, highly effective disease-modifying therapies have revolutionized multiple sclerosis (MS) care. However, evidence from large comparative studies on important safety outcomes, such as cancer, is still lacking. Methods: In this nationwide register-based cohort study, we linked data from the Swedish MS register to the Swedish Cancer Register and other national health care and census registers. We included 4,187 first-ever initiations of rituximab, 1,620 of fingolimod, and 1,670 of natalizumab in 6,136 MS patients matched for age, sex, and location to 37,801 non-MS general population subjects. Primary outcome was time to first invasive cancer. Results: We identified 78 invasive cancers among treated patients: rituximab 33 (incidence rate [IR] per 10,000 person-years = 34.4, 95% confidence interval [CI] = 23.7–48.3), fingolimod 28 (IR = 44.0, 95% CI = 29.2–63.5), and natalizumab 17 (IR = 26.0, 95% CI = 15.1–41.6). The general population IR was 31.0 (95% CI = 27.8–34.4). Adjusting for baseline characteristics, we found no difference in risk of invasive cancer between rituximab, natalizumab, and the general population but a possibly higher risk with fingolimod compared to the general population (hazard ratio [HR] = 1.53, 95% CI = 0.98–2.38) and rituximab (HR = 1.68, 95% CI = 1.00–2.84). Interpretation: In this first large comparative study of 3 highly effective MS disease-modifying therapies, no increased risk of invasive cancer was seen with rituximab and natalizumab, compared to the general population. However, there was a borderline-significant increased risk with fingolimod, compared to both the general population and rituximab. It was not possible to attribute this increased risk to any specific type of cancer, and further studies are warranted to validate these findings. 

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  • 161.
    Alpstål, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gallium-Dotatoc-PET in GEP-NET and its correlation to hormonal biomarkers2019Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 162.
    Alshamari, Muhammed
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Low-dose computed tomography of the abdomen and lumbar spine2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Radiography is a common radiologic investigation despite abundant evidence of its limited diagnostic value. On the other hand, computed tomography (CT) has a high diagnostic value and is widely considered to be among the most important advances in medicine. However, CT exposes patients to a higher radiation dose and it might therefore not be acceptable simply to replace radiography with CT, despite the powerful diagnostic value of this technique. At the expense of reduced CT image quality, which could be adjusted to the diagnostic needs, low-dose CT of abdomen and lumbar spine can be performed at similar dose to radiography. The aim of the current thesis project was to evaluate low-dose CT of the abdomen and lumbar spine and to compare it with radiography. The hypothesis was that CT would give better image quality and diagnostic information compared to radiography at similar dose levels. Firstly, the diagnostic accuracy of low-dose CT of the abdomen was evaluated. Results showed that low-dose CT of abdomen has a high sensitivity and specificity compared to radiography, i.e., it has higher diagnostic accuracy. Similar results were obtained from our systematic review. Secondly, in a phantom study, an ovine phantom was scanned at various CT settings. The image quality was evaluated to obtain a protocol for the optimal settings for low-dose CT of lumbar spine at 1 mSv. This new protocol was then used in a clinical study to assess the image quality of low-dose CT of the lumbar spine and compare it to radiography. Results showed that low-dose CT has significantly better image quality than radiography. Finally, the impact of Iterative reconstruction (IR) on image quality of lumbar spine CT was tested. Iterative reconstruction is a recent CT technique aimed to reduce radiation dose and/or improve image quality. The results showed that the use of medium strength IR levels in the reconstruction of CT image improves image quality compared to filtered back projection. In conclusion, low-dose CT of the abdomen and lumbar spine, at about 1 mSv, has better image quality and gives diagnostic information compared to radiography at similar dose levels and it could therefore replace radiography.

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    Cover
  • 163.
    Alshamari, Muhammed
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology.
    Geijer, Mats
    Department of Radiology, School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Imaging and Physiology, Skåne University Hospital, Lund; Lund University, Lund, Sweden.
    Norrman, Eva
    Department of Medical Physics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Lidén, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Krauss, Wolfgang
    Örebro universitet, Institutionen för hälsovetenskaper.
    Jendeberg, Johan
    Örebro universitet, Institutionen för hälsovetenskaper.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskaper.
    Impact of iterative reconstruction on image quality of low-dose CT of the lumbar spineManuskript (preprint) (Övrigt vetenskapligt)
  • 164.
    Al-Shamkhi, Nasrin
    et al.
    Örebro Univ Hosp, Dept Internal Med, Örebro, Sweden.;Örebro Univ, Fac Med & Hlth, Sch Med Sci, Örebro, Sweden.;Uppsala Univ Hosp, Dept Endocrinol & Diabetol, Uppsala, Sweden.;Akadem Sjukhuset, Endokrin & Diabetesmottagningen, S-75185 Uppsala, Sweden..
    Berinder, Katarina
    Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Borg, Henrik
    Lund Univ, Skane Univ Hosp, Dept Endocrinol, Lund, Sweden..
    Burman, Pia
    Lund Univ, Skane Univ Hosp, Dept Endocrinol, Malmö, Sweden..
    Dahlqvist, Per
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå, Sweden..
    Hoybye, Charlotte
    Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Olsson, Daniel S.
    Sahlgrens Univ Hosp, Dept Endocrinol, Gothenburg, Sweden.;Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Gothenburg, Sweden.;AstraZeneca, BioPharmaceut R&D, Cardiovasc Renal & Metab CVRM, Gothenburg, Sweden..
    Ragnarsson, Oskar
    Sahlgrens Univ Hosp, Dept Endocrinol, Gothenburg, Sweden.;Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Gothenburg, Sweden.;Univ Gothenburg, Wallenberg Ctr Mol & Translat Med, Gothenburg, Sweden..
    Ekman, Bertil
    Linköping Univ, Dept Endocrinol Linköping & Norrköping, Linköping, Sweden.;Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden..
    Edén Engström, Britt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish Pituitary Register2023Ingår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 189, nr 2, s. 217-224Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Data on pre- and postoperative pituitary function in nonfunctioning pituitary adenomas (NFPA) are not consistent. We aimed to investigate pituitary function before and up to 5 years after transsphenoidal surgery with emphasis on the hypothalamic-pituitary-adrenal axis (HPA).

    Design and methods: Data from the Swedish Pituitary Register was used to analyze anterior pituitary function in 838 patients with NFPA diagnosed between 1991 and 2014. Patients who were reoperated or had received radiotherapy were excluded.

    Results: Preoperative ACTH, TSH, LH/FSH, and GH deficiencies were reported in 31% (236/755), 39% (300/769), 51% (378/742), and 28% (170/604) of the patients, respectively. Preoperative median tumor volume was 5.0 (2.4-9.0) cm(3). Among patients with preoperative, 1 year and 5 years postoperative data on the HPA axis (n = 428), 125 (29%) were ACTH-deficient preoperatively. One year postoperatively, 26% (32/125) of them had recovered ACTH function while 23% (70/303) patients had developed new ACTH deficiency. Thus, 1 year postoperatively, 163 (38%) patients were ACTH-deficient (P < .001 vs. preoperatively). No further increase was seen 5 years postoperatively (36%, P = .096). At 1 year postoperatively, recoveries in the TSH and LH/FSH axes were reported in 14% (33/241) and 15% (46/310), respectively, and new deficiencies in 22% (88/403) and 29% (83/288), respectively.

    Conclusions: Adrenocorticotrophic hormone deficiency increased significantly at 1 year postoperatively. Even though not significant, some patients recovered from or developed new deficiency between 1 and 5 years postoperatively. This pattern was seen in all axes. Our study emphasizes that continuous individual evaluations are needed during longer follow-up of patients operated for NFPA.

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  • 165.
    Al-Shamkhi, Nasrin
    et al.
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden; Uppsala Univ Hosp, Sweden; Akadem Sjukhuset, Sweden.
    Berinder, Katarina
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Borg, Henrik
    Lund Univ, Sweden.
    Burman, Pia
    Lund Univ, Sweden.
    Dahlqvist, Per
    Umea Univ, Sweden.
    Hoybye, Charlotte
    Karolinska Univ Hosp, 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.
    Ekman, Bertil
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Endokrinmedicinska kliniken.
    Engstrom, Britt Eden
    Uppsala Univ, Sweden.
    Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish Pituitary Register2023Ingår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 189, nr 2, s. 217-224Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Data on pre- and postoperative pituitary function in nonfunctioning pituitary adenomas (NFPA) are not consistent. We aimed to investigate pituitary function before and up to 5 years after transsphenoidal surgery with emphasis on the hypothalamic-pituitary-adrenal axis (HPA). Design and methods Data from the Swedish Pituitary Register was used to analyze anterior pituitary function in 838 patients with NFPA diagnosed between 1991 and 2014. Patients who were reoperated or had received radiotherapy were excluded. Results Preoperative ACTH, TSH, LH/FSH, and GH deficiencies were reported in 31% (236/755), 39% (300/769), 51% (378/742), and 28% (170/604) of the patients, respectively. Preoperative median tumor volume was 5.0 (2.4-9.0) cm(3). Among patients with preoperative, 1 year and 5 years postoperative data on the HPA axis (n = 428), 125 (29%) were ACTH-deficient preoperatively. One year postoperatively, 26% (32/125) of them had recovered ACTH function while 23% (70/303) patients had developed new ACTH deficiency. Thus, 1 year postoperatively, 163 (38%) patients were ACTH-deficient (P &lt; .001 vs. preoperatively). No further increase was seen 5 years postoperatively (36%, P = .096). At 1 year postoperatively, recoveries in the TSH and LH/FSH axes were reported in 14% (33/241) and 15% (46/310), respectively, and new deficiencies in 22% (88/403) and 29% (83/288), respectively. Conclusions Adrenocorticotrophic hormone deficiency increased significantly at 1 year postoperatively. Even though not significant, some patients recovered from or developed new deficiency between 1 and 5 years postoperatively. This pattern was seen in all axes. Our study emphasizes that continuous individual evaluations are needed during longer follow-up of patients operated for NFPA.

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  • 166.
    Al-Shamkhi, Nasrin
    et al.
    Department of Internal Medicine, Örebro University Hospital and School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Endocrinology and Diabetology, Uppsala University Hospital, Uppsala, Sweden.
    Berinder, Katarina
    Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Borg, Henrik
    Department of Endocrinology, Skåne University Hospital, Lund University, Lund, Sweden.
    Burman, Pia
    Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden.
    Dahlqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Höybye, Charlotte
    Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Olsson, Daniel S.
    Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Ragnarsson, Oskar
    Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Göteborg, Sweden.
    Ekman, Bertil
    Departments of Endocrinology in Linköping and Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Engström, Britt Eden
    Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
    Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish pituitary register2023Ingår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 189, nr 2, s. 217-224Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Data on pre- and postoperative pituitary function in nonfunctioning pituitary adenomas (NFPA) are not consistent. We aimed to investigate pituitary function before and up to 5 years after transsphenoidal surgery with emphasis on the hypothalamic-pituitary-adrenal axis (HPA).

    Design and methods: Data from the Swedish Pituitary Register was used to analyze anterior pituitary function in 838 patients with NFPA diagnosed between 1991 and 2014. Patients who were reoperated or had received radiotherapy were excluded.

    Results: Preoperative ACTH, TSH, LH/FSH, and GH deficiencies were reported in 31% (236/755), 39% (300/769), 51% (378/742), and 28% (170/604) of the patients, respectively. Preoperative median tumor volume was 5.0 (2.4-9.0) cm(3). Among patients with preoperative, 1 year and 5 years postoperative data on the HPA axis (n = 428), 125 (29%) were ACTH-deficient preoperatively. One year postoperatively, 26% (32/125) of them had recovered ACTH function while 23% (70/303) patients had developed new ACTH deficiency. Thus, 1 year postoperatively, 163 (38%) patients were ACTH-deficient (P < .001 vs. preoperatively). No further increase was seen 5 years postoperatively (36%, P = .096). At 1 year postoperatively, recoveries in the TSH and LH/FSH axes were reported in 14% (33/241) and 15% (46/310), respectively, and new deficiencies in 22% (88/403) and 29% (83/288), respectively.

    Conclusions: Adrenocorticotrophic hormone deficiency increased significantly at 1 year postoperatively. Even though not significant, some patients recovered from or developed new deficiency between 1 and 5 years postoperatively. This pattern was seen in all axes. Our study emphasizes that continuous individual evaluations are needed during longer follow-up of patients operated for NFPA.

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  • 167.
    Alstad, V.
    et al.
    Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Abtahi, Jahan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Käkkliniken US.
    Surgical removal of keratocystic odontogenic tumours via a Le Fort I osteotomy approach: a retrospective study of the recurrence rate2017Ingår i: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 46, nr 4, s. 6s. 434-439Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The keratocystic odontogenic tumour (KCOT) is one of the most aggressive odontogenic cysts and has a high recurrence rate. The treatment of these tumours is the subject of debate. A KCOT in the posterior maxilla with sinus involvement is rare. Few reports have been published in the literature. The purpose of this study was to evaluate the recurrence rate after surgical removal of maxillary KCOTs via a Le Fort I osteotomy. A search was performed to identify patients with a follow-up time of at least 5 years. Nine patients were included in the study. The following clinical variables were analyzed: age at surgery, sex, symptoms, site and size of the tumour, surgical approach, and recurrence rate. The surgical approaches were curettage (n=6) and enucleation (n=3). Recurrence was seen in three patients (33%); all had multilocular tumours. No recurrence was seen in patients with unilocular tumours. The Le Fort I osteotomy approach allows direct visualization and ensures wide excision, minimizing the risk of recurrence. In this series, cases with a multilocular KCOT showed a higher risk of recurrence due to the difficulty of removing the tumour in total. All recurrences took place within 2 years of the intervention; a 5-year follow-up is recommended.

  • 168.
    Alston-Smith, J.
    et al.
    Department of Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala, Sweden.
    Ljungqvist, Olle
    Boija, P.-O.
    Ware, J.
    Nilsson Ekdahl, K.
    Endotoxin, epinephrine, glucagon, insulin and calcium ionophore A23187 modulation of kinese activity in cultured rat hepatocytes1990Ingår i: Acta Chirurgica Scandinavica, ISSN 0001-5482, s. 677-681Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Altered glucose metabolism is one of the commonly observed sequelae of sepsis and septic shock. The present investigation was undertaken to determine the role of endotoxin (ET) upon hepatocyte glucoregulation, by measuring the activity of pyruvate kinase (PK), a key glycolytic enzyme. Hepatocytes were exposed to endotoxin concentrations known to occur in vivo during sepsis, i.e., from 1 X 10(-14) to 1 X 10(-8) g/ml. The alteration of the enzyme activities after addition of epinephrine, glucagon, insulin and calcium ionophore A23187 with and without ET preincubation were also examined. ET alone decreased the PK activity by 12% at all concentrations tested. The basal inhibition of the enzyme caused by epinephrine (-48%) was partially blocked by ET preincubation above 1 X 10(-10) g/ml. There were no ET-(glucagon, calcium ionophore, insulin) interaction. These in vitro results do not support pyruvate kinase as a site of hepatic enzyme regulation defect in endotoxaemia.

  • 169.
    Alström, Ulrica
    et al.
    Department of Cardiothoracic Surgery and Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
    Granath, Fredrik
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Friberg, Örjan
    Region Örebro län. Department of Cardiothoracic Surgery.
    Ekbom, Anders
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Ståhle, Elisabeth
    Department of Cardiothoracic Surgery and Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
    Risk factors for re-exploration due to bleeding after coronary artery bypass grafting2012Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, nr 1, s. 39-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The study aimed to investigate relevant clinical risk factors for re-exploration due to bleeding after primary coronary artery bypass graft (CABG) surgery, and to evaluate the influence of antiplatelet and antifibrinolytic drugs.

    Design: Three retrospective analyses were performed on patients who underwent CABG: (1) Logistic regression was used to identify clinical risk factors for re-exploration (n = 3000). (2) A case-control study (n = 228) was used to obtain information on exposure of antithrombotic and hemostatic therapy. (3) Based on exposure to antiplatelet and antifibrinolytic therapy, and odds ratios (ORs) in multivariate logistic models, the proportion of re-explorations attributed to these drugs was calculated.

    Results: A receiver operating characteristic curve was created for clinical risk factors. The C-index was 0.64, indicating limited ability to predict re-exploration for bleeding. Clopidogrel was the only drug influencing the risk of re-exploration (OR 3.2, 95% CI 1.7-5.9). The harmful effect of clopidogrel was confirmed in multivariate model (OR 4.7, 95% CI 2.2-9.9), and aprotinin had a protective effect of the same magnitude (OR 0.2, 95% CI 0.1-0.6).

    Conclusions: Clopidogrel is an essential risk factor for re-exploration due to bleeding, and attributable to at least one-quarter of surveyed cases. Aside from pharmaceuticals, there are no strong clinical risk factors.

  • 170.
    Alsuhaibani, Fatimah
    et al.
    Department of Restorative Dentistry, College of Dentistry, Qassim University, Buraydah, Saudi Arabia.
    Alsuhaibani, Abdulaziz
    Department of General Surgery, King Saud Medical City, Riyadh, Saudi Arabia.
    Ericson, Dan
    Malmö universitet, Odontologiska fakulteten (OD).
    Larsson, Kerstin
    Malmö universitet, Odontologiska fakulteten (OD).
    Risk Factors for Dental Erosion After Bariatric Surgery: A Patient Survey2021Ingår i: International Dental Journal, ISSN 0020-6539, E-ISSN 1875-595X, Vol. 72, nr 4, s. 491-498, artikel-id S0020-6539(21)00251-3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Treatment of obesity by bariatric surgery has increased in recent years. Reported side effects that may predispose to dental erosion include reflux, vomiting, and an increased frequency of intake of food and drink.

    OBJECTIVE: The aim was to investigate long-term dietary behaviour and experiences related to symptoms of dental erosion at least 5 years after bariatric surgery.

    METHODS: An online questionnaire study was conducted amongst 250 patients who had undergone bariatric surgery at King Saud Medical City in Saudi Arabia 5 years ago or more. It comprised 36 questions on demographic data, dietary habits, general health, dental health, and oral symptoms. The data were analysed using Chi-square and sign tests (significance level P < .05).

    RESULTS: A significant increase in acidic reflux and vomiting was found after bariatric surgery and appeared to increase with time after surgery. Also, a significant association between presence of acidic reflux and symptoms of dental erosion was found. However, 68.5% reported improved overall well-being after surgery. The response rate was 21.6% (most were female, aged 30-59 years). Respondents were generally not advised to visit a dentist in connection with bariatric surgery.

    CONCLUSIONS: This long-term cross-sectional study suggests a time-dependent, increasing occurrence of vomiting and acidic reflux after bariatric surgery. Vomiting and reflux became even more common after 5 to 10 years. A significant relationship emerged between a high frequency of acidic reflux and a high frequency of oral symptoms related to dental erosion. Daily occurrence of general symptoms related to dumping syndrome were reported by the majority. However, in a 5- to 10-year perspective, general symptoms related to dumping syndrome and symptoms from dental erosion did not seem to detract from the respondents' overall satisfaction with daily living. Oral health problems might be reduced if patients who had bariatric surgery were referred to a dentist for prevention and monitoring.

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  • 171.
    Al-Taai, Nameer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Persson, Maurits
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Ransjö, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Department of Orthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Levring Jäghagen, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Westerlund, Anna
    Department of Orthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dentoskeletal and soft tissue changes after treatment of crowding with premolar extractions: a 50-year follow-up2023Ingår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, nr 1, s. 79-87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The long-term effects on dentofacial morphology of interceptive treatment with premolar extractions, in the absence of subsequent orthodontic treatment, have not been fully explored.

    Objective: The aim was to investigate the effects of premolar extractions (without subsequent orthodontic treatment) on the dentoskeletal and soft tissue profile of patients aged between 12 and 62 years with Class I malocclusion with severe crowding, as compared to untreated controls.

    Materials and methods: The Extraction group (N = 30 with Class I crowding malocclusion) had their first premolars removed in early adolescence without subsequent orthodontic treatment. The Control group included 30 untreated subjects with Class I normal occlusion. Cephalograms were taken at 12 (T1), 15 (T2), 30 (T3), and 62 (T4) years of age. A superimposition-based cephalometric method was used to assess the dentoskeletal and soft tissue changes.

    Results: There were no significant differences between the Extraction and Control groups in terms of skeletal sagittal relation, incisor inclination, and protrusion, or most of the soft tissue parameters throughout the observation period. However, significant differences were observed between the groups with respect to the vertical relations in T2-T3, such that the Extraction group showed more-pronounced decreases in the ML/NSL, ML/NL, and Gonial angles and more-pronounced increases in facial heights.

    Conclusions and implications: Treatment for subjects with Class I malocclusion with severe crowding by the extraction of four premolars, without subsequent orthodontic treatment, does not affect the long-term dentoskeletal and soft tissue profile, as compared to an untreated Control group. The degree of crowding, rather than changes in dentofacial morphology, is crucial in deciding on extraction therapy.

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  • 172.
    Al-Tai, Saif
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Axer, Stephan
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Szabo, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Ottosson, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Stenberg, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    THE IMPACT OF THE BOUGIE SIZE AND THE EXTENT OF ANTRAL RESECTION ON WEIGHT-LOSS AND POSTOPERATIVE COMPLICATIONS FOLLOWING SLEEVE GASTRECTOMY: RESULTS FROM THE SCANDINAVIAN OBESITY SURGERY REGISTRY2023Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 33, nr Suppl. 2, s. 332-332, artikel-id O-316Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure has gained increasing popularity world-wide. However, controversies still exist regarding several operative aspects, such as the optimal diameter of thesleeve and the optimal distance from the pylorus to the edge of the resection line, and whether these aspects haveeffects on weight-loss results and the risk to develop postoperative complications.

    Objective: The aim of this study was to compare weight-loss results and the incidence of postoperative complications betweensleeve with different diameters measured in bougie size and with different distances from the pylorus to the edge ofthe resection line measured in centimeter.

    Setting: Nationwide registry-based study.

    Method: This study is an analysis of sleeve gastrectomy performed in Sweden between 2012 and 2019. Data were collectedfrom Scandinavian Obesity Surgery Registry (SOReg). Patients with bougie size 30-32 and 35-36 and patients withdistance from pylorus 1-4 cm, 5 cm, 6-8 cm were identified and compared regarding weight-loss results and the riskto develop postoperative complications.

    Results: 9,360 patients were included. Follow-up rate was 96% at day 30, 78.8% at one year and 50% at two years. Bothbougie size 30-32 compared to 35-36 and distance from the pylorus 1-4 cm compared to 5 cm were associated withsignificant higher weight-loss at one and two years. No difference in the risk for early or late complications was seenbetween bougie size groups 30-32 and 35-36. Resection starting 1-4 cm from the pylorus compared to 5 cm was as-sociated with higher risk for overall early postoperative complications (OR 1.46 (1.17-1.82, P=.001)), but there wasno significant difference in the risk to develop late complication at 1 and 2 years. No difference in the leak rate andin the risk to develop stricture was seen between different Bougie sizes, nor distances from the Pylorus.

    Conclusion: Using a smaller Bougie size and starting the resection closer to the pylorus was associated with better maximumweight-loss. Closer resection to the Pylorus, but not Bougie size was associated with increased risk for early postop-erative complications after sleeve gastrectomy.

  • 173.
    Al-Tai, Saif
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Torsby Hospital, Torsby, Sweden.
    Axer, Stephan
    Department of Surgery, Torsby Hospital, Torsby, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Szabo, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Ottosson, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Stenberg, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy: results from the Scandinavian Obesity Surgery Registry2024Ingår i: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 20, nr 2, s. 139-145Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial.

    OBJECTIVES: To evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG.

    SETTING: Nationwide registry-based study.

    METHODS: This study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35-36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30-32 Fr), shorter distances (1-4 cm), and extended distances (6-8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. RESULTS: The study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17-1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed.

    CONCLUSIONS: Using a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.

  • 174.
    Altgärde, Noomi
    Linköpings universitet, Institutionen för fysik, kemi och biologi.
    Local release of lithium from sol-gel coated orthopaedic screws: an in vitro and in vivo study2009Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Vid behandling av benbrott stabiliseras vanligtvis frakturen internt med metallskruvar och

    metallstavar. Detta görs för att hålla brottbitarna på plats under den relativt långsamma läkprocessen. Det är möjligt att minska tiden för frakturläkning genom att lokalt eller systemiskt behandla med olika läkemedel som främjar bentillväxt. På senare år har det presenterats bevis för att litium, som annars används som psykofarmaka, fungerar som ett sådant läkemedel.

     

    Syftet med detta examensarbete var att hitta en metod för att fästa litium på benimplantat. Litium skulle fästas på ett sådant sätt att frisläppning till omgivande vävnad blev möjlig.

     

    Litiumklorid inkorporerades i en titanat-solgel och lager av detta lades på kiselytor och rostfria skruvar genom s.k. ”dip-coating”. Kiselytorna användes för initiala in vitro-studier av hur litium ändrade beläggningens egenskaper. Litium sitter antagligen fast på ytan av det tredimensionella nätverk som utgör solgelen, istället för att sitta inbundet i nätverket. Lagerstrukturen ändras ju mer litium som inkorporeras och vid stora mängder skapas inte de nanopartiklar som vanligtvis finns i en solgel-baserad beläggning. En följd av detta är reducerad bioaktivitet för beläggningen, dvs. en minskad förmåga för kalciumfosfatkristaller att bildas på ytan. Litium frisläpps från beläggningen, dock sker denna frisläppning snabbt. Genom att belägga ytan med flera lager av solgel kan frisläppningskinetiken delvis ändras. Solgelen kunde också med god vidhäftning appliceras på skruvar och frisläppningskinetiken från en skruv är liknande den från en kiselyta.

    Slutligen användes en skruvmodell i råtta för att undersöka vilken effekt lokal respektive systemisk litiumbehandling har på frakturläkning. I modellen efterliknas ett benbrott genom att en skruv sätts in i skenbenet.  När benvävnaden runt skruven har läkt görs ett utdragstest på skruven vilket ger information om benets styrka. Ingen signifikant skillnad i skruvens utdragskraft kunde ses mellan de båda försöksgrupperna och kontrollgruppen. Däremot hade gruppen som fick systemisk litiumbehandling fått starkare ben totalt, vilket indikerar att litium har effekt på intakt ben. På grund av dessa resultat finns det fortfarande skäl att tro att litium har en positiv påverkan på ben, varför dess effekt på frakturläkning bör undersökas ytterligare. 

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  • 175.
    Altreuther, Martin
    et al.
    St Olavs Hosp, Dept Vasc Surg, Trondheim, Norway.;NTNU, Inst Circulat & Med Imaging, Trondheim, Norway..
    Grima, Matthew J.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi. Mater Dei Hosp, Dept Surg, Vasc Unit, Msida, Malta; Univ Malta, Fac Med & Surg, Msida, Malta.
    Lattmann, Thomas
    Kantonsspital Winterthur, Dept Vasc Surg, Winterthur, Switzerland.;Swiss Soc Vasc Surg, Lausanne, Switzerland..
    International Validation Of Vascular Registries: The VASCUNET Validation Template2023Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 66, nr 3, s. 438-439Artikel i tidskrift (Övrigt vetenskapligt)
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  • 176.
    Al-Yahri, Omer
    et al.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    Abdelaal, Abdelrahman
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    El Ansari, Walid
    Högskolan i Skövde, Institutionen för hälsovetenskaper. Högskolan i Skövde, Forskningsmiljön hälsa, hållbarhet och digitalisering. Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Farghaly, Hanan
    Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Murshed, Khaled
    Department of Lab Medicine & Pathology, Hamad General Hospital, Doha, Qatar.
    Zirie, Mahmoud A.
    Department of Endocrinology, Hamad General Hospital, Doha, Qatar.
    Al Hassan, Mohamed S.
    Department of General Surgery, Hamad General Hospital, Doha, Qatar.
    First ever case report of co-occurrence of hobnail variant of papillary thyroid carcinoma and intrathyroid parathyroid adenoma in the same thyroid lobe2020Ingår i: International Journal of Surgery Case Reports, E-ISSN 2210-2612, Vol. 70, s. 40-52Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The hobnail variant of papillary thyroid cancer (PTC) is rare. Intrathyroid parathyroid adenoma (ITPA) is also rare. Co-ocurrence of PTC and ITPA in the same thyroid lobe is extremely rare. Likewise, primary hyperparathyroidism with such non-medullary thyroid carcinoma is rare. The specific molecular profile of hobnail PTC (HPTC) is different from the classic, poorly differentiated and anaplastic variants and may contribute to its aggressive behavior. HPTC's genetic profile remains unclear. Presentation of case: A 61-year-old woman presented to our endocrine clinic with generalized aches, bone pain, polyuria, and right neck swelling of a few months’ duration. Laboratory findings revealed hypercalcemia and hyperparathyroidism. Ultrasound of the neck showed 4.6 cm complex nodule within the right thyroid lobe. Sestamibi scan suggested parathyroid adenoma in the right thyroid lobe. Fine-needle aspiration (FNA) revealed atypical follicular lesion of undetermined significance. She underwent right lobectomy, which normalized the intraoperative intact parathyroid hormone levels. Final pathology with immunohistochemical stains demonstrated HPTC and IPTA (2 cm each). Next-generation sequencing investigated the mutation spectrum of HPTC and detected BRAFV600E mutation. Conclusions: A parathyroid adenoma should not exclude the diagnosis of thyroid carcinoma. Thyroid evaluation is needed for patients with primary hyperparathyroidism to prevent missing concurrent thyroid cancers. Cytomorphologic features to distinguish thyroid from parathyroid cells on FNA cytology must be considered. Immunohistochemical stains are important. BRAFV600E is the most common mutation in HPTC. This is possibly the first reported case of HPTC and ITPA co-occurring within the same thyroid lobe. Studies that define other molecular abnormalities may be useful as therapeutic targets. © 2020 The Author(s)

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  • 177.
    Amanda, Demir
    et al.
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Elin, Påhlson
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Norrman, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Stenberg, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    The Influence of Mesenteric Defects Closure on the Use of Computed Tomography for Abdominal Pain 5 Years After Laparoscopic Gastric Bypass-a Post Hoc Analysis of a Randomized Clinical Trial2022Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 32, nr 2, s. 266-272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common and unwanted complication that typically leads to further exploration through radiology. Concerns have been raised regarding the consequences of this radiation exposure and its correlation with the lifetime risk of cancer. The aim of this study was to evaluate the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects and to assess the radiological findings and radiation doses.

    METHODS: This subgroup analysis included 300 patients randomized to either closure (n = 150) or nonclosure (n = 150) of mesenteric defects during LRYGB. The total number of CT scans performed due to abdominal pain in the first 5 postoperative years was recorded together with the radiological findings and radiation doses.

    RESULTS: A total of 132 patients (44%) underwent 281 abdominal CT scans, including 133 scans for 67 patients with open mesenteric defects (45%) and 148 scans for 65 patients with closed mesenteric defects (43%). Radiological findings consistent with small bowel obstruction or internal hernia were found in 31 (23%) of the scans for patients with open defects and in 18 (12%) of the scans for patients with closed defects (p = 0.014). The other pathological and radiological findings were infrequent and not significantly different between groups. At the 5-year follow-up, the total radiation dose was 82,400 mGy cm in the nonclosure group and 85,800 mGy cm in the closure group.

    CONCLUSION: Closure of mesenteric defects did not influence the use of CT to assess abdominal pain.

  • 178.
    Amba, Yvette Esah
    Örebro universitet, Institutionen för hälsovetenskaper.
    Effekten av sex olika kirurgiska tekniker på  postoperativ smärtintensitet efter visdomstand  operation i underkäke.  En systematisk litteraturöversikt.2020Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
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  • 179.
    Amin, Bawan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för diagnostik och intervention.
    Yttre vändningsförsök: Är det säkert?2023Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 180. Aminoff, Hedvig
    et al.
    Meijer, Sebastiaan
    Arnelo, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
    Frennert, Susanne
    Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes2021Ingår i: JMIR Formative Research, E-ISSN 2561-326X, Vol. 5, nr 1, artikel-id e20692Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption.

    OBJECTIVE: Our objective was to gain a deeper understanding of ERCP practitioners' attitudes toward teleguidance. These findings could inform the implementation process and future evaluations.

    METHODS: We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons' beliefs about teleguidance's contribution to performance and factors that might interact with implementation.

    RESULTS: Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard "Ease of Use" items for "Compatibility and Implementation Climate." In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05).

    CONCLUSIONS: Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes.

  • 181.
    Aminoff, Hedvig
    et al.
    Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
    Meijer, Sebastiaan
    Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
    Groth, Kristina
    The Center for Innovation, Karolinska University Hospital, Stockholm, Sweden.
    Arnelo, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. CLINTEC Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service2021Ingår i: JMIR Human Factors, E-ISSN 2292-9495, Vol. 8, nr 4, artikel-id e30867Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood.

    Objective:We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures.

    Methods:We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures.

    Results:In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%).

    Conclusions:Users’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes.

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  • 182.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Bergen, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Factors affecting in-hospital sleep-wake pattern in octogenarians during the early postoperative phase after transcutaneous aortic valve replacement2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S53-S53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Octogenarian patients are an increasing group admitted for advanced cardiac treatment. Little is known about factors disturbing their sleep-wake pattern in the early postoperative phase after transcutaneous aortic valve replacement (TAVI), as current knowledge is based upon studies on younger age groups treated for surgical aortic valve replacement.

    Aim: To determine factors affecting the in-hospital sleep wake pattern in octogenarian patients after TAVI.

    Methods: This is a prospective cohort study in a tertiary university hospital. Inclusion criteria were age > 80 years with severe aortic stenosis accepted for TAVI. Actigraphy was used to identify sleep-wake pattern (sleep time night and sleep time day), and the Minimal Insomnia Symptom Scale (MISS) to measure self-reported insomnia daily during the first five postoperative days. Charlson`s comorbidity index was used as a measure of comorbidities and the Visual Analog Scale (VAS) to rate pain severity. Information regarding duration of anesthesia, blood transfusion and parenteral administration of morphine equivalents were derived from the patients’ medical journals. Multiple regression analysis was used to test associations between variables.

    Results: In all, 65 patients (41 women) were included. Mean age was 85 years (SD 2.8). No significant associations were found between age, comorbidities, blood transfusion and morphine equivalents and sleep. Gender was significantly associated with sleep time night and sleep efficiency as men had shortest duration of sleep from the third to the fifth postoperative night (p < .001, and adjusted R2=.230 to .283). Duration of anesthesia had a significant association with sleep time night and sleep efficiency from the third to the fifth postoperative night (p=.013 to p < .001, and adjusted R2=.230 to .283), where longer duration gave less total sleep and lower sleep efficiency. VAS score correlated with wake time night the third night, where a higher VAS score gave more wake time (p=.006 and adjusted R2 .236).

    Conclusion: Male gender, longer duration of perioperative anesthesia and postoperative pain were associated with disturbances in the postoperative sleep-wake pattern in octogenarian patients in the early postoperative phase after TAVI. This knowledge is important and relevant and should have implications in improving patient care.

  • 183.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Faculty of Health and Social Science, Bergen, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway .
    Factors associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after surgical aortic valve replacement2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S63-S64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Disturbances of the sleep-wake pattern are known phenomenon in the postoperative phase after aortic valve replacement (SAVR) that have negative impact on the morbidity, quality of life and mortality. Octogenarian patients are an increasing group admitted for cardiac surgery, however knowledge is based on younger patients.

    Aims: To determine factors associated with disturbances in postoperative sleep-wake pattern in octogenarian patients after SAVR.

    Methods: A prospective cohort study of octogenarian patients in a single center university hospital. Inclusion criteria were age > 80 years, severe aortic stenosis, accepted for SAVR. Actigraphy was used to identify the sleep-wake pattern (sleep-time, sleep efficiency and wake time night and sleep- and wake-time day) for the five first postoperative days, and the sleep questionnaires Minimal Insomnia Symptom scale (MISS) to measure the selfreported insomnia at baseline and daily for the five first postoperative days. 

    Charlsons comorbidity index was used to score comorbidities and the Visual Analog Scale (VAS), was used to rate pain severity. The patients’ medical journals were used to record duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusions and parenteral administration of morphine equivalents. Multiple regression analysis was used to test associations between variables.

    Results: In all, 78 patients were included (40 women). Mean age was 82 years (SD 2.0). For the sleep-wake pattern first to fifth postoperative night, mean sleep-time night was 330-370 minutes (SD 32-124). Mean sleep efficiency was 68-77% (SD 21-26). Mean sleep-time day was 545-712 minutes (SD 146-169). Mean insomnia score was 1,8-5,3 (SD 2,6-3,8). On the first postoperative night the pain VAS score correlated with wake time night, where a higher VAS indicated more wake time (p=.014, adjusted R2=.213). No other variable; age, gender, duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusion or morphine equivalents showed significant association with the sleep-wake pattern or insomnia.

    Conclusion: Postoperative pain was associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after SAVR. This indicates that pain management may be inadequate for patients after SAVR. More research on this issue is needed to establish data needed to improve treatment and care.

  • 184.
    An, Feng-Wei
    et al.
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Yuan, Hu
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Guo, Weiwei
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Hou, Zhao-Hui
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Cai, Jian-Ming
    Chinese Peoples Liberat Army Gen Hosp, Dept Radiol, Beijing, Peoples R China.
    Luo, Chun-Cai
    Chinese Peoples Liberat Army Gen Hosp, Dept Radiol, Beijing, Peoples R China.
    Yu, Ning
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Jiang, Qing-Qing
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Cheng, Wei
    Chinese Peoples Liberat Army Gen Hosp, Dept Otolaryngol & Head Neck Surg, Beijing, Peoples R China;Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Liu, Wei
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Yang, Shi-Ming
    Chinese PLA Med Sch, Key Lab Hearing Impairment Sci, Minist Educ, Key Lab Hearing Impairment Prevent & Treatment Be, Beijing, Peoples R China.
    Establishment of a Large Animal Model for Eustachian Tube Functional Study in Miniature Pigs2019Ingår i: Anatomical Record Part A-discoveries in Molecular Cellular and Evolutionary Biology, ISSN 1552-4884, E-ISSN 1932-8494, Vol. 302, nr 6, s. 1024-1038Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study was performed to investigate whether miniature pigs are a suitable animal model for studies of the Eustachian tube (ET). Sixteen Chinese experimental miniature pigs were used in this investigation. Ten animals were used for anatomical and morphometric analyses to obtain qualitative and quantitative information regarding the ET. Three animals were used for histological analysis to determine the fine structure of ET cross-sections. Three animals were used to investigate the feasibility of balloon dilation of the Eustachian tube (BDET). The anatomical study indicated that the pharyngeal orifice and tympanic orifice of the miniature pig ET are located at the posterior end of the nasal lateral wall and anterior wall of the middle ear cavity, respectively. The cartilaginous tube was seen to pass through the whole length of the ET, the length of the cartilaginous part of the ET and the diameter of the isthmus were similar between humans and miniature pigs. The inclination of the ET in miniature pigs was larger than that in humans. The gross histology seemed to be slightly different between miniature pig and human, but the fine structures were essentially the same in both species. BDET experiments verified that the miniature pig model is suitable as a model for clinical operations. The miniature pig ET corresponds very well to that of humans. In addition, the miniature pig ET is suitable as a model for clinical operations. Therefore, the miniature pig is a valid animal model for ET study. 

  • 185.
    Analatos, Apostolos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogsvag 1, S-61139 Nyköping, Sweden.
    Hakanson, Bengt S.
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp, Dept Surg & Anaesthesiol, Stockholm, Sweden.
    Ansorge, Christoph
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogsvag 1, S-61139 Nyköping, Sweden.
    Lindblad, Mats
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Upper Abdominal Surg, Stockholm, Sweden.
    Lundell, Lars
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark.
    Thorell, Anders
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.
    Clinical Outcomes of a Laparoscopic Total vs a 270 degrees Posterior Partial Fundoplication in Chronic Gastroesophageal Reflux Disease: A Randomized Clinical Trial2022Ingår i: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 157, nr 6, s. 473-480Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance The efficacy of fundoplication operations in the management of gastroesophageal reflux disease (GERD) has been documented. However, few prospective, controlled series report long-term (>10 years) efficacy and postfundoplication concerns, particularly when comparing various types of fundoplication.

    Objective To compare long-term (>15 years) results regarding mechanical complications, reflux control, and quality of life between patients undergoing posterior partial fundoplication (PF) or total fundoplication (TF) (270 degrees vs 360 degrees) in surgical treatment for GERD.

    Design, setting and participants A double-blind randomized clinical trial was performed at a single center (Ersta Hospital, Stockholm, Sweden) from November 19, 2001, to January 24, 2006. A total of 456 patients were recruited and randomized. Data for this analysis were collected from August 1, 2019, to January 31, 2021.

    Interventions Laparoscopic 270 degrees posterior PF vs 360 degrees TF.

    Main Outcomes and Measures The main outcome was dysphagia scores for solid and liquid food items after more than 15 years. Generic (36-Item Short-Form Health Survey) and disease-specific (Gastrointestinal Symptom Rating Scale) quality of life and proton pump inhibitor consumption were also assessed.

    Results Among 407 available patients, relevant data were obtained from 310 (response rate, 76%; mean [SD] age, 66 [11.2] years; 184 [59%] men). A total of 159 were allocated to a PF and 151 to a TF. The mean (SD) follow-up time was 16 (1.3) years. At 15 years after surgery, mean (SD) dysphagia scores were low for both liquids (PF, 1.2 [0.5]; TF, 1.2 [0.5]; P = .58) and solids (PF, 1.3 [0.6]; TF, 1.3 [0.5]; P = .97), without statistically significant differences between the groups. Reflux symptoms were equally well controlled by the 2 types of fundoplications as were the improvements of quality-of-life scores.

    Conclusions and Relevance The long-term findings of this randomized clinical trial indicate that PF and TF are equally effective for controlling GERD and quality of life in the long term. Although PF was superior in the first years after surgery in terms of less dysphagia recorded, this difference did not prevail when assessed a decade later.

  • 186.
    Analatos, Apostolos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Nyköping, Sweden..
    Håkanson, B. S.
    Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden.;Karolinska Inst, Danderyds Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lundell, L.
    Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark..
    Lindblad, M.
    Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden..
    Thorell, A.
    Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden.;Karolinska Inst, Danderyds Hosp, Dept Clin Sci, Stockholm, Sweden..
    Author response to: Tension-free mesh versus suture-alone cruroplasty in antireflux surgery: a randomized, double-blind clinical trial2021Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 108, nr 11, s. E390-E390Artikel i tidskrift (Övrigt vetenskapligt)
  • 187.
    Analatos, Apostolos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden; Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Nyköping Hosp, Dept Surg, Nyköping, Sweden.
    Håkanson, B. S.
    Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden.;Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Danderyd, Sweden..
    Lundell, L.
    Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark..
    Lindblad, M.
    Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden..
    Thorell, A.
    Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden.;Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Danderyd, Sweden..
    Tension-free mesh versus suture-alone cruroplasty in antireflux surgery: a randomized, double-blind clinical trial2020Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 107, nr 13, s. 1731-1740Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Antireflux surgery is effective for the treatment of gastro-oesophageal reflux disease (GORD) but recurrence of hiatal hernia remains a challenge. In other types of hernia repair, use of mesh is associated with reduced recurrence rates. The aim of this study was to compare the use of mesh versus sutures alone for the repair of hiatal hernia in laparoscopic antireflux surgery.

    Methods

    Patients undergoing laparoscopic Nissen fundoplication for GORD between January 2006 and December 2010 were allocated randomly to closure of the diaphragmatic hiatus with crural sutures or non-absorbable polytetrafluoroethylene mesh (CruraSoft®). The primary outcome was recurrence of hiatal hernia, as determined by barium swallow study 12 months after surgery. Secondary outcomes were: intraoperative and postoperative complications, use of antireflux medication, postoperative oesophageal acid exposure, quality of life, dysphagia and duration of hospital stay.

    Results

    Some 77 patients were randomized to the suture technique and 82 patients underwent mesh repair. At 1 year, the hiatal hernia had recurred in six of 64 patients (9 per cent) in the mesh group and two of 64 (3 per cent) in the suture group (P = 0·144). Reflux symptoms, use of proton pump inhibitors and oesophageal acid exposure did not differ between the groups. At 3 years, recurrence rates were 13 and 10 per cent in the mesh and suture groups respectively (P = 0·692). Dysphagia scores decreased in both groups, but more patients had dysphagia for solid food after mesh closure (P = 0·013). Quality-of-life scores were comparable between the groups.

    Conclusion

    Tension-free crural repair with non-absorbable mesh does not reduce the incidence of recurrent hiatal hernia compared with use of sutures alone in patients undergoing laparoscopic fundoplication. NCT03730233 (http://www.clinicaltrials.gov).

  • 188.
    Analatos, Apostolos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogs Vag 1, S-61139 Nyköping, Sweden..
    Håkanson, Bengt S.
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp, Dept Surg & Anaesthesiol, Stockholm, Sweden..
    Ansorge, Christoph
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogs Vag 1, S-61139 Nyköping, Sweden..
    Lindblad, Mats
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Upper Abdominal Surg, Stockholm, Sweden..
    Lundell, Lars
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark..
    Thorell, Anders
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp, Dept Surg & Anaesthesiol, Stockholm, Sweden..
    Hiatal Hernia Repair With Tension-Free Mesh or Crural Sutures Alone in Antireflux Surgery A 13-Year Follow-Up of a Randomized Clinical Trial2024Ingår i: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 159, nr 1, s. 11-18Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance Antireflux surgery is an effective treatment of gastroesophageal reflux disease (GERD), but the durability of concomitant hiatal hernia repair remains challenging. Previous research reported that the use of a mesh-reinforced, tension-free technique was associated with more dysphagia for solid foods after 3 years without reducing hiatal hernia recurrence rates compared with crural sutures alone, but the long-term effects of this technique have not been assessed.

    Objective To assess the long-term anatomical and functional outcomes of using a mesh for hiatal hernia repair in patients with GERD.

    Design, Setting, and Participants A double-blind, randomized clinical trial was performed at a single center (Ersta Hospital, Stockholm, Sweden) from January 11, 2006, to December 1, 2010. A total of 159 patients were recruited and randomly assigned. Data for the current analysis were collected from September 1, 2021, to March 31, 2022. All analyses were conducted with the intention-to-treat population.

    Interventions Closure of the diaphragmatic hiatus with crural sutures alone vs a tension-free technique using a nonabsorbable polytetrafluoroethylene mesh (Bard CruraSoft).

    Main Outcomes and Measures The primary outcome was radiologically verified recurrent hiatal hernia after more than 10 years. Secondary outcomes were dysphagia scores (ranging from 1 to 4, with 1 indicating no episodes of dysphagia and 4 indicating more than 3 episodes of dysphagia per day) for solid and liquid foods, generic 36-Item Short Form Health Survey and disease-specific Gastrointestinal Symptom Rating Scale symptom assessment scores, proton pump inhibitor consumption, and reoperation rates. Intergroup comparisons of parametric data were performed using t tests; for nonparametric data, Mann-Whitney U, chi(2), or Fisher exact tests were used. For intragroup comparisons vs the baseline at follow-up times, the Friedman test was used, and post hoc analysis was performed using Wilcoxon matched pairs.

    Results Of 145 available patients, follow-up data were obtained from 103 (response rate 71%; mean [SD] age at follow-up, 65 [11.3] years; 55 [53%] female), with 53 initially randomly assigned to mesh reinforcement, and 50 to crural suture alone. The mean (SD) follow-up time was 13 (1.1) years. The verified radiologic hiatal hernia recurrence rates were 11 of 29 (38%) in the mesh group vs 11 of 35 (31%) in the suture group (P = .61). However, 13 years postoperatively, mean (SD) dysphagia scores for solids remained significantly higher in the mesh group (mean [SD], 1.9 [0.7] vs 1.6 [0.9]; P = .01).

    Conclusions and Relevance Findings from this long-term follow-up of a randomized clinical trial suggest that tension-free crural repair with nonabsorbable mesh does not reduce the incidence of hiatal hernia recurrence 13 years postoperatively. This finding combined with maintained higher dysphagia scores does not support the routine use of tension-free polytetrafluoroethylene mesh closure in laparoscopic hiatal hernia repair for treatment of GERD.

    Trial Registration ClinicalTrials.gov Identifier: NCT05069493

  • 189.
    Analatos, Apostolos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogs Vag 1, Nyköping, Sweden..
    Lindblad, Mats
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Upper Abdominal Surg, Stockholm, Sweden..
    Ansorge, Christoph
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogs Vag 1, Nyköping, Sweden..
    Lundell, Lars
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark..
    Thorell, Anders
    Ersta Hosp Stockholm, Danderyds Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp Stockholm, Dept Surg & Anaesthesiol, Stockholm, Sweden..
    Hakanson, Bengt S.
    Ersta Hosp Stockholm, Danderyds Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp Stockholm, Dept Surg & Anaesthesiol, Stockholm, Sweden..
    Total versus partial posterior fundoplication in the surgical repair of para-oesophageal hernias: randomized clinical trial2022Ingår i: BJS Open, E-ISSN 2474-9842, Vol. 6, nr 3, artikel-id zrac034Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Fundoplication is an essential step in para-oesophageal hernia (POH) repair, but which type minimizes postoperative mechanical complications is controversial.

    Methods: This was a randomized, double-blind clinical trial conducted between May 2009 and October 2018. Patients with symptomatic POH were allocated to either a total (Nissen) or a posterior partial (Toupet) fundoplication after hernia reduction and crural repair. The primary outcome was dysphagia (Ogilvie dysphagia scores) at 6 months postoperatively. Secondary outcomes were peri- and postoperative complications, swallowing difficulties assessed by the Dakkak dysphagia score, gastro-oesophageal reflux, quality of life (QoL), and radiologically confirmed hernia recurrence.

    Results: A total of 70 patients were randomized to a Nissen (n = 32) or a Toupet (n = 38) fundoplication. Compared with baseline, Ogilvie dysphagia scores were stable at the 3- and 6-month follow-up in the Nissen group (P = 0.075 and 0.084 respectively) but significantly improved in the Toupet group (from baseline mean (s.d.): 1.4 (1.1) to 0.5 (0.8) at 3 months, and 0.5 (0.6) at 6 months; P= 0.003 and P = 0.001 respectively). At 6 months, Dakkak dysphagia scores were significantly higher in the Nissen group than in the Toupet group (mean (s.d.): 10.4 (7.9) versus 5.1(7.2); P = 0.003). QoL scores improved throughout the follow-up. However, at 3 and 6 months postoperatively, the absolute median improvement (A) from preoperative values in the mental component scores of the Short Form-36 QoL questionnaire was significantly higher in the Toupet group (median (i.q.r.): 7.1 (-0.6 to 15.2) versus 1.0 (-5.4 to 3.3) at 3 months, and 11.2 (1.4 to 18.3) versus 0.4 (-9.4 to 7.5) at 6 months; (P =0.010 and 0.003 respectively)). At 6 months, radiologically confirmed POH recurrence occurred in 11 of 24 patients (46 per cent) of the Nissen group and in 15 of 32 patients (47 per cent) of the Toupet group (P = 1.001).

    Conclusions: A partial posterior wrap (Toupet fundoplication) showed reduced obstructive complications and improved QoL compared with a total (Nissen) fundoplication following POH repair.

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  • 190.
    Analatos, Apostolos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden; Nykoping Hosp, Dept Surg, Nykoping, Sweden.
    Lindblad, Mats
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Rouvelas, Ioannis
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Elbe, Peter
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Lundell, Lars
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Nilsson, Magnus
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Tsekrekos, Andrianos
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Tsai, Jon A.
    Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden; Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden.
    Evaluation of resection of the gastroesophageal junction and jejunal interposition (Merendino procedure) as a rescue procedure in patients with a failed redo antireflux procedure. A single-center experience2018Ingår i: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 18, artikel-id 70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Primary antireflux surgery has high success rates but 5 to 20% of patients undergoing antireflux operations can experience recurrent reflux and dysphagia, requiring reoperation. Different surgical approaches after failed fundoplication have been described in the literature. The aim of this study was to evaluate resection of the gastroesophageal junction with jejunal interposition (Merendino procedure) as a rescue procedure after failed fundoplication.

    Methods: All patients who underwent a Merendino procedure at the Karolinska University Hospital between 2004 and 2012 after a failed antireflux fundoplication were identified. Data regarding previous surgical history, preoperative workup, postoperative complications, subsequent investigations and re-interventions were collected retrospectively. The follow-up also included questionnaires regarding quality of life, gastrointestinal function and the dumping syndrome.

    Results: Twelve patients had a Merendino reconstruction. Ten patients had undergone at least two previous fundoplications, of which one patient had four such procedures. The main indication for surgery was epigastric and radiating back pain, with or without dysphagia. Postoperative complications occurred in 8/12 patients (67%). During a median follow-up of 35 months (range 20-61), four (25%) patients had an additional redo procedure with conversion to a Roux-en-Y esophagojejunostomy within 12 months, mainly due to obstructive symptoms that could not be managed conservatively or with endoscopic techniques. Questionnaires scores were generally poor in all dimensions.

    Conclusions: In our experience, the Merendino procedure seems to be an unsuitable surgical option for patients who require an alternative surgical reconstruction due to a failed fundoplication. However, the small number of patients included in this study as well as the small number of participants who completed the postoperative workout limits this study.

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  • 191.
    Anborg, Robyn
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Estetisk kirurgi: En kvantitativ studie om hur subjektiva upplevelser kring familj påverkar intresse av estetisk kirurgi2011Självständigt arbete på grundnivå (kandidatexamen), 15 poäng / 22,5 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Syfte och frågeställningar

    Syftet med denna studie är att förklara hur subjektiva upplevelser runt familj påverkar intresse av estetisk kirurgi. Specifika frågeställningar har formulerats för att undersöka detta:

    – Hur påverkas intresse av estetisk kirurgi av familjemedlemmar som pratat om att utföra eller som har utfört estetisk kirurgi?

    – Hur påverkas intresse av estetisk kirurgi av upplevd skilsmässa under uppväxt och uppväxt med en ensamstående förälder?

    – Hur påverkas intresse av estetisk kirurgi av fysisk eller psykisk frånvaro av mamma eller pappa under uppväxt?

    – Hur påverkas intresse av estetisk kirurgi av att minst en person gett stöd och varit älskande under uppväxt?

    – Hur påverkas intresse av estetisk kirurgi av ouppnådda familjefunktioner?

    – Hur påverkas intresse av estetisk kirurgi av en upplevd familjekris?

    Metod

    Denna uppsats har använts sig av en kvantitativ forskningsmetod med enkät. En egen enkät komponerades och delades ut i Stockholms län. 60 enkäter delades ut, varav 58 av dessa besvarades. Enkäterna hanterades anonymt och sammanställdes först i Excel-ark för att sedan analyseras i SPSS genom Mann-Whitney och Chi-2 test, samt logistisk regression.

    Resultat

    Prediktorer för intresse för estetisk kirurgi är föräldrar som pratat om att utföra estetisk kirurgi (P=0,049), lägre skattning av psykisk närvaro av mamma (P=0,029), lägre skattning av psykisk närvaro av pappa (P=0,042), lägre skattning av att pappa ingivit respekt kring den egna personens värde (P=0,001) och vid lägre skattning av att familj gett en god grund för en stabil och harmonisk uppväxt (P=0,003). Ingen av dessa kunde enskilt förklara den beroende variabelns variation, utan alla samvarierade. Genom att stegvis exkludera prediktorer i en logistisk regression kunde den viktigaste prediktorn till intresse av estetisk kirurgi identifieras, vilket var, den sistnämnda.

    Slutsats

    Slutsatsen är att vissa subjektiva upplevelser runt familj påverkar intresse av estetisk kirurgi medan påverkan av andra inte gett signifikanta skillnader.

     

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  • 192.
    Ander, Fredrik
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Perioperative complications in obese patients: A thesis on risk reducing strategies2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients.

    The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention.

    In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated.

    The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain.

    The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.

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    Perioperative complications in obese patients: A thesis on risk reducing strategies
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  • 193.
    Ander, Fredrik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Dept. of Paediatric Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro universitet, Institutionen för medicinska vetenskaper.
    de leon, Alex
    Dept. of Anaesthesia and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden; Dept. of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    The effect of intraoperative esmolol infusion compared to remifentanil on opiaterequirement after laparoscopic gastric bypass surgery: a randomised pilot studyManuskript (preprint) (Övrigt vetenskapligt)
  • 194.
    Anderberg, Leif
    et al.
    Lunds universitet.
    Aldskogius, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neuroanatomi.
    Holtz, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Spinal cord injury: scientific challenges for the unknown future2007Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 112, nr 3, s. 259-288Artikel, forskningsöversikt (Övrigt vetenskapligt)
    Abstract [en]

    The history of spinal cord injuries starts with the ancient Egyptian medical papyrus known as the Edwin Smith Surgical Papyrus. The papyrus, written about 2500 B. C. by the physician and architect of the Sakkara pyramids Imhotep, describes "crushed vertebra in his neck" as well as symptoms of neurological deterioration. An ailment not to be treated was the massage to the patients at that time. This fatalistic attitude remained until the end of World War II when the first rehabilitation centre focused on the rehabilitation of spinal cord injured patients was opened. Our knowledge of the pathophysiological processes, both the primary as well as the secondary, has increased tremendously. However, all this knowledge has only led to improved medical care but not to any therapeutic method to restore, even partially, the neurological function. Neuroprotection is defined as measures to counteract secondary injury mechanisms and/or limit the extent of damage caused by self-destructive cellular and tissue processes. The co-existence of several distinctly different injury mechanisms after trauma has provided opportunities to explore a large number of potentially neuroprotective agents in animal experiments such as methylprednisolone sodium succinate. The results of this research have been very discouraging and pharmacological neuroprotection for patients with spinal cord injury has fallen short of the expectations created by the extensive research and promising observations in animal experiments. The focus of research has now, instead, been transformed to the field of neural regeneration. This field includes the discovery of regenerating obstacles in the nerve cell and/or environmental factors but also various regeneration strategies such as bridging the gap at the site of injury as well as transplantation of foetal tissue and stem cells. The purpose of this review is to highlight selected experimental and clinical studies that form the basis for undertaking future challenges in the research field of spinal cord injury. We will focus our discussion on methods either preventing the consequences of secondary injury in the acute period ( neuroprotection) and/or various techniques of neural regeneration in the sub-acute and chronic phase and finally expose some thoughts about future avenues within this scientific field.

  • 195. Andersen, Lise Geisler
    et al.
    Ängquist, Lars
    Gamborg, Michael
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Bengtsson, Calle
    Canoy, Dexter
    Eriksson, Johan G.
    Eriksson, Marit
    Järvelin, Marjo-Riitta
    Lissner, Lauren
    Nilsen, Tom I.
    Osler, Merete
    Overvad, Kim
    Rasmussen, Finn
    Salonen, Minna K.
    Schack-Nielsen, Lene
    Tammelin, Tuija H.
    Tuomainen, Tomi-Pekka
    Sørensen, Thorkild I. A.
    Baker, Jennifer L.
    Birth weight in relation to leisure time physical activity in adolescence and adulthood: meta-analysis of results from 13 nordic cohorts2009Ingår i: PloS one, ISSN 1932-6203, Vol. 4, nr 12, s. e8192-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Prenatal life exposures, potentially manifested as altered birth size, may influence the later risk of major chronic diseases through direct biologic effects on disease processes, but also by modifying adult behaviors such as physical activity that may influence later disease risk. METHODS/PRINCIPAL FINDINGS: We investigated the association between birth weight and leisure time physical activity (LTPA) in 43,482 adolescents and adults from 13 Nordic cohorts. Random effects meta-analyses were performed on categorical estimates from cohort-, age-, sex- and birth weight specific analyses. Birth weight showed a reverse U-shaped association with later LTPA; within the range of normal weight the association was negligible but weights below and above this range were associated with a lower probability of undertaking LTPA. Compared with the reference category (3.26-3.75 kg), the birth weight categories of 1.26-1.75, 1.76-2.25, 2.26-2.75, and 4.76-5.25 kg, had odds ratios of 0.67 (95% confidence interval: 0.47, 0.94), 0.72 (0.59, 0.88), 0.89 (0.79, 0.99), and 0.65 (0.50, 0.86), respectively. The shape and strength of the birth weight-LTPA association was virtually independent of sex, age, gestational age, educational level, concurrent body mass index, and smoking. CONCLUSIONS/SIGNIFICANCE: The association between birth weight and undertaking LTPA is very weak within the normal birth weight range, but both low and high birth weights are associated with a lower probability of undertaking LTPA, which hence may be a mediator between prenatal influences and later disease risk.

  • 196.
    Andersen, Mikkel Österheden
    et al.
    Reg Southern Denmark, Ctr Spine Surg & Res, Middelfart, Denmark;Univ Southern Denmark, Odense, Denmark.
    Fritzell, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Capio St Goran Hosp, Stockholm, Sweden;Qulturum Ctr Learning & Innovat Healthcare, Jonkoping, Sweden.
    Eiskjaer, Sören Peter
    Aalborg Univ Hosp, Aalborg C, Denmark.
    Lagerbäck, Tobias
    Karolinska Univ Hosp, Huddinge, Sweden;Karolinska Inst, Huddinge, Sweden.
    Hägg, Olle
    Spine Ctr Goteborg, Gothenburg, Sweden.
    Nordvall, Dennis
    Qulturum Ctr Learning & Innovat Healthcare, Jonkoping, Sweden.
    Lönne, Greger
    Innlandet Hosp Trust, Lillehammer, Norway;Trondheim Reg & Univ Hosp, St Olavs Hosp, Trondheim, Norway.
    Solberg, Tore
    Univ Hosp Northern Norway, Tromso, Norway;Arctic Univ Norway, Tromso, Norway.
    Jacobs, Wilco
    van Hooff, Miranda
    Sint Maartenskliniek, Nijmegen, Netherlands;Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands.
    Gerdhem, Paul
    Karolinska Univ Hosp, Huddinge, Sweden;Karolinska Inst, Huddinge, Sweden.
    Gehrchen, Martin
    Univ Copenhagen, Rigshosp, Copenhagen, Denmark.
    Surgical Treatment of Degenerative Disk Disease in Three Scandinavian Countries: An International Register Study Based on Three Merged National Spine Registers2019Ingår i: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, Vol. 9, nr 8, s. 850-858Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design: Observational study of prospectively collected data.

    Objectives: Patients with chronic low back pain resistant to nonoperative treatment often face a poor prognosis for recovery. The aim of the current study was to compare the variation and outcome of surgical treatment of degenerative disc disease in the Scandinavian countries based on The International Consortium for Health Outcomes Measurement core spine data sets.

    Methods: Anonymized individual level data from 3 national registers were pooled into 1 database. At the time of surgery, the patient reports data on demographics, lifestyle topics, comorbidity, and data on health-related quality of life such as Oswestry Disability Index, Euro-Qol-5D, and back and leg pain scores. The surgeon records diagnosis, type of surgery performed, and complications. One-year follow-ups are obtained with questionnaires. Baseline and 1-year follow-up data were analyzed to expose any differences between the countries.

    Results: A total of 1893 patients were included. At 1-year follow-up, 1315 (72%) patients responded. There were statistically significant baseline differences in age, smoking, comorbidity, frequency of previous surgery and intensity of back and leg pain. Isolated fusion was the primary procedure in all the countries ranging from 84% in Denmark to 76% in Sweden. There was clinically relevant improvement in all outcome measures except leg pain.

    Conclusions: In homogenous populations with similar health care systems the treatment traditions can vary considerably. Despite variations in preoperative variables, patient reported outcomes improve significantly and clinically relevant with surgical treatment.

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  • 197.
    Andersen, Steven Arild Wuyts
    et al.
    Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Rigshospitalet, Copenhagen, Denmark.
    Hittle, Brad
    Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, U.S.A.
    Värendh, Maria
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden; Department of Otorhinolaryngology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Lee, Julian
    Department of Otorhinolaryngology, The Ohio State University, Columbus, Ohio, U.S.A; Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.
    Varadarajan, Varun
    Associates of Otolaryngology, Denver, Colorado, U.S.A.
    Powell, Kimerly A
    Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, U.S.A.
    Wiet, Gregory J.
    Department of Otorhinolaryngology, The Ohio State University, Columbus, Ohio, U.S.A; Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.
    Further Validity Evidence for Patient-Specific Virtual Reality Temporal Bone Surgical Simulation2024Ingår i: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 134, nr 3, s. 1403-1409Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Patient-specific virtual reality (VR) simulation of cochlear implant (CI) surgery potentially enables preoperative rehearsal and planning. We aim to gather supporting validity evidence for patient-specific simulation through the analysis of virtual performance and comparison with postoperative imaging.

    METHODS: Prospective, multi-institutional study. Pre- and postoperative cone-beam CT scans of CI surgical patients were obtained and processed for patient-specific VR simulation. The virtual performances of five trainees and four attendings were recorded and (1) compared with volumes removed during actual surgery as determined in postoperative imaging, and (2) assessed using the Copenhagen Cochlear Implant Surgery Assessment Tool (CISAT) by two blinded raters. The volumes compared were cortical mastoidectomy, facial recess, and round window (RW) cochleostomy as well as violation of the facial nerve and chorda.

    RESULTS: Trainees drilled more volume in the cortical mastoidectomy and facial recess, whereas attendings drilled more volume for the RW cochleostomy and made more violations. Except for the cochleostomy, attendings removed volumes closer to that determined in postoperative imaging. Trainees achieved a higher CISAT performance score compared with attendings (22.0 vs. 18.4 points) most likely due to lack of certain visual cues.

    CONCLUSION: We found that there were differences in performance of trainees and attendings in patient-specific VR simulation of CI surgery as assessed by raters and in comparison with actual drilled volumes. The presented approach of volume comparison is novel and might be used for further validation of patient-specific VR simulation before clinical implementation for preoperative rehearsal in temporal bone surgery.

    LEVEL OF EVIDENCE: n/a Laryngoscope, 2023.

  • 198.
    Andersson, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Betydelsen av sjukhustyp och region för tidpunkten av kolecystektomi i Sverige2021Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 199.
    Andersson, Caroline
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Omvårdnadsforskning.
    Ajanovic, Elma
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Patientens upplevelse av de första timmarna på en kirurgisk vårdavdelning efter ankomst från akutmottagningen: En intervjustudie2023Självständigt arbete på avancerad nivå (magisterexamen), 40 poäng / 60 hpStudentuppsats (Examensarbete)
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  • 200.
    Andersson, Gerhard
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Clinical Aspects of Tinnitus- Course, Cognition, PET, and the Internet2000Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The purpose of this thesis was to develop novel ways to study tinnitus, to investigate the course of tinnitus, and to study the effects of cognitive-behaviour therapy on tinnitus related distress. Data from 377 tinnitus patients were collected.

    A group of 216 patients completed audiological measures and were assessed in a structured interview. The Klockhoff and Lindblom's grading system was used and its inter-rater reliability assessed in a subsample showing a high degree of correspondence. A discriminant analysis showed that a substantial proportion of patients could be correctly classified into grade II or III, by measures of pitch, minimal masking level of tinnitus, avoidance of situations because of tinnitus, and tolerance in relation to onset.

    Using tests developed in cognitive psychology, it was found that tinnitus patients had impaired performance. There was no evidence for an attentional bias towards tinnitus related words using a computerized emotional Stroop task, but masking sounds of an "on-and-off" character were more disruptive than constant masking when patients performed the digit-symbol test. It is suggested that tinnitus distress may be increased by the 'changing-state' character of the tinnitus signal, or alternatively by intermittent masking sounds.

    In a case-study a patient received an i.v. injection of lidocaine while Positron Emission Tomograpy was conducted. The brain activity associated with tinnitus included the left primary, secondary and integrative auditory brain areas, as well as right paralimbic areas related to negative feelings. The precuneus (Brodmann area 7) might be a brain area involved in the aversiveness associated with tinnitus.

    Using a tinnitus questionnaire as the dependent measure it was found that tinnitus maskability at admission predicted distress at follow-up for an average of five years following admission. Some improvement in tinnitus occurred over time, but this was more evident in patients who had received a cognitive-behavioural treatment program.

    The effect of an Internet based cognitive-behavioural self-help treatment program for tinnitus was investigated showing a high dropout rate, but with positive results in that the treated patients improved.

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