Digitala Vetenskapliga Arkivet

Ändra sökning
Avgränsa sökresultatet
2345678 201 - 250 av 5345
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 201.
    Andersson, Gunnel
    Örebro universitet, Hälsoakademin.
    Urinary incontinence: prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this thesis is to describe urinary incontinence (UI) from a population perspective and to describe experiences and perceptions of UI from an individual perspective. This includes assessing the prevalence of urinary incontinence as well as describing treatment seeking and experiences of living with UI. A secondary aim was to describe the perception of UI among cultures other than the Swedish mainstream, exemplified in this case by Syrian women living in Sweden. Both quantitative and qualitative methods were used, including questionnaires and interviews.

    Studies I and II were quantitative studies based on a population-based study. Together with a postal survey on general health and living conditions “Life & Health”, a questionnaire on urinary incontinence was sent out to 15 360 randomly-selected residents aged 18-79 in Orebro County, Sweden. In Study I, UI was found to affect 19%. The majority of the respondents experienced minor problems, and only 18% of those reporting UI wanted treatment. However, there was also a group who reported severe problems, but despite this 42% of them did not want treatment. Study II investigated why people with UI refrain from seeking care and treatment. It was found that the desire for treatment was regulated by the frequency of UI, being restricted from participating in various activities, the degree of inconvenience, and the type of UI.

    Studies III and IV were both qualitative interview studies, describing older women’s experiences of living with UI (Study III) and Syrian women’s perceptions of UI (Study IV). There were similarities between the results of these two studies; the women described UI as a normal and expected problem, and they knew that the district nurse could prescribe incontinence protections and that treatments existed. In both studies, the women expressed difficulties in making contact with the health care service, while the women who did not speak Swedish (Study IV) also had difficulties due to different communication problems.

    In conclusion, it is important that health care resources are optimized to identify and meet the needs of those who experience major problems with UI, and that there is awareness of the communication difficulties that can be present in meeting with people who speak other languages. However it is also important not to medicalize those who experience minor problems and who have the desire to manage on their own.

    Ladda ner (pdf)
    COVER01
  • 202.
    Andersson, Henrik
    et al.
    University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Axelsson, Christer
    University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Larsson, Anna
    Ambulance Department, South Älvsborg's Hospital, Borås, Sweden.
    Bremer, Anders
    University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för informatik.
    Bång, Angela
    University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Infection Disease Department, Skövde, Sweden.
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care.2018Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 36, nr 12, s. 2211-2218, artikel-id S0735-6757(18)30279-1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28days after admission to hospital. Furthermore, the long-term outcome was assessed.

    METHODS: This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

    RESULTS: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p<0.0001).

    CONCLUSION: This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

  • 203.
    Andersson, Henrik
    et al.
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Axelsson, Christer
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Larsson, Anna
    Ambulance Department, South Älvsborg's Hospital, Borås, Sweden.
    Bremer, Anders
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economy and IT, Trollhättan, Sweden.
    Bång, Angela
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, PreHospen Centre for Prehospital Researc Borås, Sweden ; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Infection Disease Department, Skövde, Sweden.
    The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care2018Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 36, nr 12, s. 2211-2218Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28days after admission to hospital. Furthermore, the long-term outcome was assessed.

    METHODS: This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

    RESULTS: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p<0.0001).

    CONCLUSION: This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

  • 204.
    Andersson, Janina
    et al.
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013).
    Alm, Anna-Malin
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013).
    Nya operationsmetoder och ny medicinsk teknikOperationssjuksköterskors erfarenheter av kompetensutvecklande åtgärder: En intervjustudie2022Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Introduktion: Operationssjukvården är i ständig utveckling och det är viktigt att operationssjuksköterskor ges möjlighet att kontinuerligt inhämta information och kunskap om nya operationsmetoder och ny medicinsk teknik.

    Syfte: Syftet var att beskriva operationssjuksköterskors erfarenheter av kompetensutvecklande åtgärder i samband med införandet av nya operationsmetoder och ny medicinsk teknik. 

    Metod: Kvalitativ intervjustudie med 15 operationssjuksköterskor på två sjukhus i mellansverige där data analyserades via innehållsanalys.

    Resultat: Resultatet gav två huvudkategorier och fem subkategorier. Operationssjuksköterskorna erfor att inhämtad kompetensutveckling dels låg i deras eget yrkesansvar och intresse, men även var ett organisationss ansvar. Många gånger tillgodosågs kompetensutveckling men andra gånger inte.

    Konklusion: Ett ansvar hos operationssjuksköterskorna är att ta igen missad kompetensutveckling. Erfarenhetsbaserad kompetens gör att nya operationsmetoder och ny medicinsk teknik är lättare att ta till sig för operationssjuksköterskorna och de vet när det går att improvisera då kompetensutveckling uteblivit. Sättet på vilket operationssjuksköterskorna erhåller kompetensutveckling i samband med införandet av nya operationsmetoder och ny medicinsk teknik behöver synliggöras för att ytterligare förbättra rutiner. Rutiner behöver även förstärkas för att undvika att kompetensutvecklande åtgärder ibland uteblir.

    Ladda ner fulltext (pdf)
    Nya operationsmetoder och ny medicinsk teknikOperationssjuksköterskors erfarenheter av kompetensutvecklande åtgärder
    Ladda ner fulltext (pdf)
    Arkivfil
  • 205.
    Andersson, John
    et al.
    Göteborgs Universitet, Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy.
    Abis, G
    Alingsås Hospital, Department of Surgery.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it.
    Angenete, Eva
    Göteborgs Universitet, Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy.
    Angerås, Ulf
    Göteborgs Universitet, Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy.
    Cuesta, M A
    VU University Medical Centre, Department of Surgery, Amsterdam.
    Jess, P
    Roskilde Hospital, Department of Surgery, Roskilde, Denmark.
    Rosenberg, Jakob
    Copenhagen University, Department of Surgery, Herlev Hospital, Copenhagen, Denmark.
    Bonjer, H J
    VU University Medical Centre, Department of Surgery, Amsterdam.
    Haglind, Eva
    Göteborgs Universitet, Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy.
    Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II).2014Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 101, nr 10, s. 1272-1279Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This article reports on patient-reported sexual dysfunction and micturition symptoms following a randomized trial of laparoscopic and open surgery for rectal cancer.

    METHODS: Patients in the COLOR II randomized trial, comparing laparoscopic and open surgery for rectal cancer, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire before surgery, and after 4 weeks, 6, 12 and 24 months. Adjusted mean differences on a 100-point scale were calculated using changes from baseline value at the various time points in the domains of sexual functioning, sexual enjoyment, male and female sexual problems, and micturition symptoms.

    RESULTS: Of 617 randomized patients, 385 completed this phase of the trial. Their mean age was 67·1 years. Surgery caused an anticipated reduction in genitourinary function after 4 weeks, with no significant differences between laparoscopic and open approaches. An improvement in sexual dysfunction was seen in the first year, but some male sexual problems persisted. Before operation 64·5 per cent of men in the laparoscopic group and 55·6 per cent in the open group reported some degree of erectile dysfunction. This increased to 81·1 and 80·5 per cent respectively 4 weeks after surgery, and 76·3 versus 75·5 per cent at 12 months, with no significant differences between groups. Micturition symptoms were less affected than sexual function and gradually improved to preoperative levels by 6 months. Adjusting for confounders, including radiotherapy, did not change these results.

    CONCLUSION: Sexual dysfunction is common in patients with rectal cancer, and treatment (including surgery) increases the proportion of patients affected. A laparoscopic approach does not change this.

  • 206.
    Andersson, John
    et al.
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden ; Department of Surgery, Alingsås Hospital, Alingsås, Sweden.
    Abis, G
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Gellerstedt, Martin
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Angenete, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Angerås, Ulf
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Cuesta, M. A.
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Jess, P
    Roskilde Hospital, Roskilde, Denmark.
    Rosenberg, Jakob
    Herlev Hospital, Copenhagen University, Copenhagen, Denmark.
    Bonjer, H. J.
    Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
    Haglind, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II)2014Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 101, nr 10, s. 1272-1279Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This article reports on patient-reported sexual dysfunction and micturition symptoms following a randomized trial of laparoscopic and open surgery for rectal cancer.

    METHODS: Patients in the COLOR II randomized trial, comparing laparoscopic and open surgery for rectal cancer, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire before surgery, and after 4 weeks, 6, 12 and 24 months. Adjusted mean differences on a 100-point scale were calculated using changes from baseline value at the various time points in the domains of sexual functioning, sexual enjoyment, male and female sexual problems, and micturition symptoms.

    RESULTS: Of 617 randomized patients, 385 completed this phase of the trial. Their mean age was 67·1 years. Surgery caused an anticipated reduction in genitourinary function after 4 weeks, with no significant differences between laparoscopic and open approaches. An improvement in sexual dysfunction was seen in the first year, but some male sexual problems persisted. Before operation 64·5 per cent of men in the laparoscopic group and 55·6 per cent in the open group reported some degree of erectile dysfunction. This increased to 81·1 and 80·5 per cent respectively 4 weeks after surgery, and 76·3 versus 75·5 per cent at 12 months, with no significant differences between groups. Micturition symptoms were less affected than sexual function and gradually improved to preoperative levels by 6 months. Adjusting for confounders, including radiotherapy, did not change these results.

    CONCLUSION: Sexual dysfunction is common in patients with rectal cancer, and treatment (including surgery) increases the proportion of patients affected. A laparoscopic approach does not change this.

    Ladda ner fulltext (pdf)
    fulltext
  • 207.
    Andersson, John
    et al.
    Department of General and Orthopaedic Surgery, Alingsås Hospital, Sweden ; Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Angenete, Eva
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Gellerstedt, Martin
    Högskolan i Skövde, Institutionen för hälsovetenskaper. Högskolan i Skövde, Forskningsmiljön hälsa, hållbarhet och digitalisering.
    Haglind, Eva
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Developing a multivariable prediction model of global health-related quality of life in patients treated for rectal cancer: a prospective study in five countries2024Ingår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 39, artikel-id 35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose Rectal cancer and its treatment have a negative impact on health-related quality of life (HRQoL). If risk factors for sustained low HRQoL could be identified early, ideally before the start of treatment, individualised interventions could be identified and implemented to maintain or improve HRQoL. The study aimed to develop a multivariable prediction model for global HRQoL 12 months after rectal cancer treatment.

    Methods Within COLOR II, a randomised, multicentre, international trial of laparoscopic and open surgery for rectal cancer, a sub-study on HRQoL included 385 patients in 12 hospitals and five countries. The HRQoL study was optional for hospitals in the COLOR II trial. EORTC QLQ-C30 and EORTC QLQ-CR38 were analysed preoperatively and at 1 and 12 months postoperatively. In exploratory analyses, correlations between age, sex, fatigue, pain, ASA classification, complications, and symptoms after surgery to HRQoL were studied. Bivariate initial analyses were followed by multivariate regression models.

    Results Patient characteristics and clinical factors explained 4–10% of the variation in global HRQoL. The patient-reported outcomes from EORTC QLQ-C30 explained 55–65% of the variation in global HRQoL. The predominant predictors were fatigue and pain, which significantly impacted global HRQoL at all time points measured.

    Conclusion We found that fatigue and pain were two significant factors associated with posttreatment global HRQoL in patients treated for rectal cancer T1-T3 Nx. Interventions to reduce fatigue and pain could enhance global HRQoL after rectal cancer treatment.

    Ladda ner fulltext (pdf)
    fulltext
  • 208.
    Andersson, Karin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Metal artifacts in computed tomography: impact of reduction methods on image quality and radiotherapy treatment planning2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Degradation of image quality by metal artifacts is a common problem in computed tomography (CT) imaging, which can limit the diagnostic value of a CT examination and also introduce inaccuracies in radiotherapy (RT) treatment planning. In recent years, commercial metal artifact reduction (MAR) methods have been launched by several CT vendors. The overall aim of this thesis was to evaluate MAR methods in diagnostic imaging and RT treatment planning.

    Evaluations of hip prosthesis phantom CT images showed that MAR algorithms in general improved image quality, based on both visual grading analysis and quantitative measures, while the application of virtual monoenergetic reconstructions insufficiently reduced metal artifacts. In some cases additional artifacts were introduced by the MAR algorithms. MAR algorithms were also evaluated in hip prosthesis phantom CT imaging used for proton therapy treatment planning, where improvements in dose calculation accuracy were observed.

    Studies of Head & Neck (H&N) implant CT images in RT treatment planning were also performed. By visual grading of anatomy visualization with respect to target delineation in dental implant patient images, MAR algorithms were shown to significantly improve image quality. However, only minor effects of H&N implant artifacts on proton dose distributions were seen. The impact might be greater for more severe artifacts than those studied here, and thus further investigations of such cases are needed.

    In conclusion, MAR algorithms have been shown to enhance image quality for diagnostic applications and to improve anatomy visualization in RT treatment planning. The MAR algorithms led to increased proton dose calculation accuracy in some cases, while in other situations only minor changes were seen.

    Ladda ner (png)
    Bild
    Ladda ner (pdf)
    Cover
    Ladda ner (pdf)
    Spikblad
  • 209.
    Andersson, Magnus N.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Svensson, Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Björkgren, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Wiberg, Rebecca
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Prophylactic mastectomy – Correlation between skin flap thickness and residual glandular tissue evaluated postoperatively by imaging2022Ingår i: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 75, nr 6, s. 1813-1819Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Women with an increased hereditary risk of breast cancer can undergo risk-reducing prophylactic mastectomy. However, there is a balance between how much subcutaneous tissue should be resected to achieve maximal reduction of glandular tissue, while leaving viable skin flaps.

    Methods: Forty-five women previously operated with prophylactic mastectomy underwent magnetic resonance tomography (MRT) and ultrasound (US) to investigate the correlation between skin flap thickness and residual glandular tissue. Residual glandular tissue was documented as being present or not present, but not quantified, as the amount of residual glandular tissue in many cases was considered too small to make reliable volume quantifications with available tools. Since a mastectomy skin flap thickness of 5 mm is discussed as an oncologically safe thickness in the literature, this was used as a cut-off.

    Results: Following prophylactic mastectomy, residual glandular tissue was detected in 39.3% of all breasts and 27.9% of all the breast quadrants examined by MRT, and 44.1% of all breasts and 21.7% of all the breast quadrants examined by US. Residual glandular tissue was detected in 6.9% of the quadrants in skin flaps ≤ 5 mm and in 37.5% of the quadrants in skin flaps > 5 mm (OR 3.07; CI = 1.41–6.67; p = 0.005). Furthermore, residual glandular tissue increased significantly already when the skin flap thickness exceeded 7 mm.

    Conclusions: This study highlights that complete removal of glandular breast tissue during a mastectomy is difficult and suggests that this is an unattainable goal. We demonstrate that residual glandular tissue is significantly higher in skin flaps > 5 mm in comparison to skin flaps ≤ 5 mm, and that residual glandular tissue increases significantly already when the flap thickness exceeds 7 mm.

    Ladda ner fulltext (pdf)
    fulltext
  • 210.
    Andersson, Manne
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Structured management of patients with suspected acute appendicitis2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background. Acute appendicitis (“appendicitis”) is one of the most common abdominal surgical emergencies worldwide. In spite of this, the diagnostic pathways are highly variable across countries, between centres and physicians. This has implications for the use of resources, exposure of patients to ionising radiation and patient outcome. The aim of this thesis is to construct and validate a diagnostic appendicitis score, to evaluate new inflammatory markers for inclusion in the score, and explore the effect of implementing a structured management algorithm for patients with suspected appendicitis. Also, we compare the outcome of management with routine diagnostic imaging versus observation and selective imaging in equivocal cases.

    Methods. In study I, the Appendicitis Inflammatory Response (AIR) score was constructed from eight variables with independent diagnostic value (right lower quadrant pain, rebound tenderness or muscular defence, WBC count, proportion of polymorphonuclear granulocytes, CRP, body temperature and vomiting). Its diagnostic properties were evaluated and compared with the Alvarado score. In study II, we performed an external validation and evaluation of novel inflammatory markers for inclusion in the score on patients with suspected appendicitis at two Swedish hospitals. In study III we externally validated and evaluated the impact of an AIR-scorebased algorithm assigning patients to a low or high risk of having appendicitis in an interventional multicentre study involving 25 Swedish hospitals and 3791 patients. In study IV, we compared the efficiency of routine diagnostic imaging with repeated clinical assessment followed by selective imaging in a randomised trial of 1028 patients with equivocal signs of appendicitis, as indicated by an intermediate AIR score, from study III.

    Main results. In study I we found that the AIR score could assign 63% of the patients to either a high- or low-risk group of appendicitis with an accuracy of 97%, which compared favourably with the Alvarado score. In study II, the diagnostic properties of the AIR score proved to be  reproducible, but the inclusion of novel inflammatory markers did not improve the diagnostic accuracy. In study III, the AIR-score-based algorithm led to a reduction in negative explorations, operations for nonperforated appendicitis and hospital admissions in the low-risk group and reduced use of imaging in both low- and high-risk groups. In study IV, routine imaging led to more operations for nonperforated appendicitis but had no effect on negative explorations or perforated appendicitis.

    Conclusions. The AIR score was found to have promising diagnostic properties that were not improved further with the inclusion of novel inflammatory variables. Structured management of patients with suspected appendicitis according to an AIR-score-based algorithm may improve outcome while reducing hospital admissions and use of imaging. Patients with equivocal signs of appendicitis do not benefit from routine imaging which may lead to an increased detection of, and treatment for, uncomplicated cases of appendicitis that are otherwise allowed to resolve spontaneously.

    Ladda ner fulltext (pdf)
    fulltext
    Ladda ner (pdf)
    omslag
    Ladda ner (jpg)
    presentationsbild
  • 211.
    Andersson, Manne
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Cty Council Jonkoping, Dept Surg, Ryhov Cty Hosp, Jonkoping, Sweden.
    Kolodziej, B.
    County Council Jonköping, Sweden.
    Andersson, Roland
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. County Council Jonköping, Sweden.
    Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis2017Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, nr 11, s. 1451-1461Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThe role of imaging in the diagnosis of appendicitis is controversial. This prospective interventional study and nested randomized trial analysed the impact of implementing a risk stratification algorithm based on the Appendicitis Inflammatory Response (AIR) score, and compared routine imaging with selective imaging after clinical reassessment. MethodPatients presenting with suspicion of appendicitis between September 2009 and January 2012 from age 10years were included at 21 emergency surgical centres and from age 5years at three university paediatric centres. Registration of clinical characteristics, treatments and outcomes started during the baseline period. The AIR score-based algorithm was implemented during the intervention period. Intermediate-risk patients were randomized to routine imaging or selective imaging after clinical reassessment. ResultsThe baseline period included 1152 patients, and the intervention period 2639, of whom 1068 intermediate-risk patients were randomized. In low-risk patients, use of the AIR score-based algorithm resulted in less imaging (192 versus 345 per cent; Pamp;lt;0001), fewer admissions (295 versus 428 per cent; Pamp;lt;0001), and fewer negative explorations (16 versus 32 per cent; P=0030) and operations for non-perforated appendicitis (68 versus 97 per cent; P=0034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (64 versus 67 per cent respectively; P=0884), number of admissions, number of perforations and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for appendicitis (534 versus 463 per cent; P=0020). ConclusionAIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( ). Reduces imaging and admissions

  • 212.
    Andersson, Manne
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Cty Hosp Ryhov, Sweden.
    Kolodziej, Blanka
    Cty Hosp Ryhov, Sweden.
    Andersson, Roland
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Cty Hosp Ryhov, Sweden.
    Validation of the Appendicitis Inflammatory Response (AIR) Score2021Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 45, nr 7, s. 2081-2091Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Patients with suspicion of appendicitis present with a wide range of severity. Score-based risk stratification can optimise the management of these patients. This prospective study validates the Appendicitis Inflammatory Response (AIR) score in patients with suspicion of appendicitis. Method Consecutive patients over the age of five with suspicion of appendicitis presenting at 25 Swedish hospitals emergency departments were prospectively included. The diagnostic properties of the AIR score are estimated. Results Some 3878 patients were included, 821 with uncomplicated and 724 with complicated appendicitis, 1986 with non-specific abdominal pain and 347 with other diagnoses. The score performed better in detecting complicated appendicitis (ROC area 0.89 (95% confidence interval (CI) 0.88-0.90) versus 0.83 (CI 0.82-0.84) for any appendicitis, p &lt; 0.001), in patients below age 15 years and in patients with &gt;47 h duration of symptoms (ROC area 0.93, CI 0.90-0.95 for complicated and 0.87, CI 0.84-0.90 for any appendicitis in both categories). Complicated appendicitis is unlikely at AIR score &lt;4 points (Negative Predictive Value 99%, CI 98-100%). Appendicitis is likely at AIR score &gt;8 points, especially in young patients (positive predictive value (PPV) 96%, CI 90-100%) and men (PPV 89%, CI 84-93%). Conclusions The AIR score has high sensitivity for complicated appendicitis and identifies subgroups with low probability of complicated appendicitis or high probability of appendicitis. The discriminating capacity is high in children and patients with long duration of symptoms. It performs equally well in both sexes. This verifies the AIR score as a valid decision support.

    Ladda ner fulltext (pdf)
    fulltext
  • 213.
    Andersson, Mattias
    et al.
    Univ Gothenburg, Sweden; Sunderbyn Hosp, Sweden.
    Sandstrom, Charlotte
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Stackelberg, Otto
    Karolinska Inst Sodersjukhuset, Sweden; Karolinska Inst, Sweden; Soder Sjukhuset, Sweden.
    Lundqvist, Robert
    Umea Univ, Sweden.
    Nordanstig, Joakim
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Jonsson, Magnus
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Roy, Joy
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Andersson, Manne
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Ryhov Hosp, Sweden.
    Hultgren, Rebecka
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Roos, Hakan
    Univ Gothenburg, Sweden; Ryhov Hosp, Sweden.
    Editors Choice - Structured Computed Tomography Analysis can Identify the Majority of Patients at Risk of Post-Endovascular Aortic Repair Rupture2022Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 64, nr 2-3, s. 166-174Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The main objective was to report mechanisms and precursors for post-endovascular aneurysm repair (EVAR) rupture. The second was to apply a structured protocol to explore whether these factors were identifiable on follow up computed tomography (CT) prior to rupture. The third objective was to study the incidence, treatment, and outcome of post-EVAR rupture. Methods: This was a multicentre, retrospective study of patients treated with standard EVAR at five Swedish hospitals from 2008 to 2018. Patients were identified from the Swedvasc registry. Medical records were reviewed up to 2020. Index EVAR and follow up data were recorded. The primary endpoint was post-EVAR rupture. CT at follow up and at post-EVAR rupture were studied, using a structured protocol, to determine rupture mechanisms and identifiable precursors. Results: In 1 805 patients treated by EVAR, 45 post-EVAR ruptures occurred in 43 patients. The cumulative incidence was 2.5% over a mean follow up of 5.2 years. The incidence rate was 4.5/1 000 person years. Median time to post-EVAR rupture was 4.1 years. A further six cases of post-EVAR rupture in five patients found outside the main cohort were included in the analysis of rupture mechanisms only. The rupture mechanism was type IA in 20 of 51 cases (39%), IB in 20 of 51 (39%) and IIIA/B in 11 of 51 (22%). One of these had type IA + IB combined. One patient had an aortoduodenal fistula without another mechanism being identified. Precursors had been noted on CT follow up prior to post-EVAR rupture in 16 of 51 (31%). Retrospectively, using the structured protocol, precursors could be identified in 43 of 51 (84%). In 17 of 27 (63%) cases missed on follow up but retrospectively identifiable, the mechanisms were type IB/III. Overall, the 30 day mortality rate after post-EVAR rupture was 47% (n = 24/51) and the post-operative mortality rate was 21% (n = 7/33). Conclusions: Most precursors of post-EVAR rupture are underdiagnosed but identifiable before rupture using a structured follow up CT protocol. Precursors of type IB and III failures caused the majority of post-EVAR ruptures.

    Ladda ner fulltext (pdf)
    fulltext
  • 214.
    Andersson, Mattias
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sunderbyn Hospital, Sunderbyn, Sweden.
    Sandström, Charlotte
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University, of Gothenburg, Gothenburg, Sweden.
    Stackelberg, Otto
    Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska, Institutet at Södersjukhuset, Stockholm, Sweden; Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Lundqvist, Robert
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Nordanstig, Joakim
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jonsson, Magnus
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Roy, Joy
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Andersson, Manne
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Hultgren, Rebecka
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Roos, Håkan
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Structured computed tomography analysis can identify the majority of patients at risk of post-endovascular aortic repair rupture2022Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 64, nr 2-3, s. 166-174Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The main objective was to report mechanisms and precursors for post-endovascular aneurysm repair (EVAR) rupture. The second was to apply a structured protocol to explore whether these factors were identifiable on follow up computed tomography (CT) prior to rupture. The third objective was to study the incidence, treatment, and outcome of post-EVAR rupture.

    Methods: This was a multicentre, retrospective study of patients treated with standard EVAR at five Swedish hospitals from 2008 to 2018. Patients were identified from the Swedvasc registry. Medical records were reviewed up to 2020. Index EVAR and follow up data were recorded. The primary endpoint was post-EVAR rupture. CT at follow up and at post-EVAR rupture were studied, using a structured protocol, to determine rupture mechanisms and identifiable precursors.

    Results: In 1 805 patients treated by EVAR, 45 post-EVAR ruptures occurred in 43 patients. The cumulative incidence was 2.5% over a mean follow up of 5.2 years. The incidence rate was 4.5/1 000 person years. Median time to post-EVAR rupture was 4.1 years. A further six cases of post-EVAR rupture in five patients found outside the main cohort were included in the analysis of rupture mechanisms only. The rupture mechanism was type IA in 20 of 51 cases (39%), IB in 20 of 51 (39%) and IIIA/B in 11 of 51 (22%). One of these had type IA + IB combined. One patient had an aortoduodenal fistula without another mechanism being identified. Precursors had been noted on CT follow up prior to post-EVAR rupture in 16 of 51 (31%). Retrospectively, using the structured protocol, precursors could be identified in 43 of 51 (84%). In 17 of 27 (63%) cases missed on follow up but retrospectively identifiable, the mechanisms were type IB/III. Overall, the 30 day mortality rate after post-EVAR rupture was 47% (n = 24/51) and the post-operative mortality rate was 21% (n = 7/33).

    Conclusions: Most precursors of post-EVAR rupture are underdiagnosed but identifiable before rupture using a structured follow up CT protocol. Precursors of type IB and III failures caused the majority of post-EVAR ruptures.

    Ladda ner fulltext (pdf)
    fulltext
  • 215.
    Andersson, Peter
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Muhrbeck, Måns
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken ViN.
    Veen, Harald
    Int Comm Red Cross, Switzerland.
    Osman, Zaher
    Int Comm Red Cross, Switzerland.
    von Schreeb, Johan
    Karolinska Institute, Sweden.
    Hospital Workload for Weapon-Wounded Females Treated by the International Committee of the Red Cross: More Work Needed than for Males2018Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, nr 1, s. 93-98Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Civilians constitute 33-51% of victims in armed conflicts. Several reports on civilian injuries exist, but few have focused on injuries afflicting females. We analyzed routinely collected data on weapon-related injuries from the International Committee of the Red Cross (ICRC) hospital in northwestern Pakistan in order to define injury patterns and types of surgical treatment for females. A total of 3028 patient files (376 females) from consecutively admitted patients to the ICRC-hospital in Peshawar from February 2009 to May 2012 were included. Information regarding injury-mechanism, time since injury, vital parameters at admission, type of injury, treatment and basic outcome was extracted from the files and analyzed. Comparisons between gender and age-groups were done by cross-table analyses or nonparametric tests. Females were younger than males (20 vs. 25 years), arrived sooner after injury (24 vs. 48 h) (p amp;lt; 0.001 for both) and were victims of bombs and missiles more frequently (64.4 vs. 54.6%) (p amp;lt; 0.001). Vital parameters such as systolic blood pressure (110 vs. 113 mmHg) and pulse rate (100 vs. 86) were more affected at admission (p amp;lt; 0.001 for both). Females were subjected to surgery (83.0 vs. 77.4%) (p amp;lt; 0.05) and were given blood transfusions more often (18.8 vs. 13.6%) (p amp;lt; 0.01). No differences in amputations or in-hospital mortality were found. Females treated at the ICRC-hospital in northwestern Pakistan are markedly affected by indiscriminate weapons such as bombs and missiles. Their average consumption of surgery is greater than for males, and this might be relevant in planning for staffing and facility needs in similar contexts.

    Ladda ner fulltext (pdf)
    fulltext
  • 216.
    Andersson, Peter
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Continent Ileostomy2008Ingår i: Seminars in Colon and Rectal Surgery, ISSN 1043-1489, Vol. 19, nr 3, s. 124-131Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Continent ileostomy reservoir is today still an alternative to a standard (conventional) ileostomy in patients where ileal pouch-anal anastomosis is contraindicated or malfunctioning. It eliminates a protruding stoma, obviates the need for a stoma bag, and permits controlled evacuation of bowel contents. A well-functioning continent ileostomy also is entirely continent for gas and feces in the elderly. The reservoir is emptied three to five times a day. Obvious benefits are improved sexual life and facilitated leisure activities. The main drawbacks are frequent complications requiring reoperations in about 50% of the patients. Slippage of the nipple valve occurs in about one-third but in the majority of patients reoperations are successful in the long run. Other complications are pouchitis, enterocutaneous fistula, and stomal stricture. Modifications of the original Kock pouch have been developed as the Barnett pouch and the T-pouch to reduce complications associated with dysfunction of the nipple valve. Cancer of a continent ileostomy reservoir has been reported only in one patient and there seems to be no risk of high-grade dysplasia even after long-term follow-up. At present there are few indications for creating a continent ileostomy reservoir but it is still recommended in very select patients. © 2008 Elsevier Inc. All rights reserved.

  • 217.
    Andersson, Roland
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Cty Hosp Ryhov, Sweden.
    Less invasive pilonidal sinus surgical procedures2019Ingår i: Colo-Proctology, ISSN 0174-2442, E-ISSN 1615-6730, Vol. 41, nr 2, s. 117-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pilonidal disease can be treated by less invasive methods such as simple mechanical cleansing of the sinus and cavity of hairs and granulation tissue eventually supplemented by filling the space with an antiseptic or sclerosing agent like phenol (forbidden in Germany due to its toxicity) or space-holding fibrin glue. Minimal excision or debridement of the sinus and/or cavity through amidline or aseparate paramedial excision can also be performed, leaving the wounds open or closed. These methods are simple and cost-efficient, and associated with low pain, rapid healing, and arapid return to normal activity. Adisadvantage is the higher recurrence rate; however, these methods can be used repeatedly for recurrences. Whereas the evidence for treatment with phenol or fibrine glue is weak, there are numerous reports supporting the safety and efficiency of the minimally invasive surgical methods. Because of the associated low risk for complications and morbidity, these procedures are suitable for first-line treatment in the majority of pilonidal disease patients.

    Ladda ner fulltext (pdf)
    fulltext
  • 218.
    Andersson, Roland
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Cty Hosp Ryhov, Sweden.
    RIFT study and management of suspected appendicitis2020Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 107, nr 7, artikel-id e207Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 219.
    Andersson, Roland
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Cty Hosp Ryhov, Sweden; Acad Hlth & Care, Sweden.
    Agiorgiti, Maria
    Bra Liv Eksjo Primary Care Ctr, Sweden; Univ Ioannina, Greece.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid-19 Pandemic: a Systematic Review and Meta-analysis2023Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, s. 1901-1916Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    BackgroundReports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis.MethodWe did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND ("COVID" OR SARS-Cov2 OR "coronavirus"). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay.ResultsThe meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07).ConclusionThe increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.

    Ladda ner fulltext (pdf)
    fulltext
  • 220. Andersson, Roland
    et al.
    Hellman, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Experimentell kirurgi.
    Johansson, Jan
    Lagergren, Jesper
    Martling, Anna
    Naredi, Peter
    Nilsson, Magnus
    Sund, Malin
    Selektiv nivåstrukturering av svensk kirurgi behövs.2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, artikel-id E76EArtikel i tidskrift (Refereegranskat)
  • 221. Andersson, Roland
    et al.
    Hellman, Per
    Johansson, Jan
    Lagergren, Jesper
    Martling, Anna
    Naredi, Peter
    Nilsson, Magnus
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Selektiv nivåstrukturering av svensk kirurgi behövs2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, artikel-id E76EArtikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 222.
    Andersson, Thomas
    et al.
    Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bjerså, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Falk, Kristin
    Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Olsén, Monika Fagevik
    Department of Surgery and Department of Physical Therapy, Sahlgrenska University Hospital; Department of Gastrosurgical Research and Education, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Effects of chewing gum against postoperative ileus after pancreaticoduodenectomy: a randomized controlled trial2015Ingår i: BMC Research Notes, E-ISSN 1756-0500, Vol. 8, nr 37, artikel-id 25886536Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Postoperative ileus is common after surgery. One non-pharmacological intervention that has shown promising results in reducing the duration of postoperative ileus is chewing gum after surgery. However, this has not been investigated in upper gastrointestinal surgery such as pancreatic surgery. Hence the aim of this study was to investigate the effects of chewing gum treatment on patients undergoing pancreaticoduodenectomy ad modum whipple due to pancreatic or periampullary cancer.

    METHODS: This study was conducted as a phase III trial that was terminated early. Patients diagnosed with pancreatic tumours scheduled for pancreaticoduodenectomy ad modum whipple were included. The treatment group received chewing gum postoperatively and standard care. Controls received glucose solution and standard care. Chewing gum and glucose were used four times a day during the whole hospital stay. Time to first flatus and stool was defined as the primary outcome. The secondary outcome was start with clear liquids, start with liquid diet and length of hospital stay.

    RESULTS: No statistically significant differences could be observed between the chewing gum intervention group and the control group. However, a numerical difference in mean time was observed in first flatus, first stool, start of clear fluids, and start of liquid diet and length of hospital stay in favour of the intervention group.

    CONCLUSIONS: Although this study did not find statistically significant differences favouring the use of chewing gum for postoperative ileus, a positive trend was observed of a reduction of the impact of postoperative ileus among patients after pancreatic surgery. It also contributes valuable methodological experience that is important for future studies of chewing gum interventions during recovery after pancreatic surgery.

    TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02319512 , publication date 2014-12-17.

    Ladda ner fulltext (pdf)
    fulltext
  • 223.
    Andersson, Yvette
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Sentinel Node in Clinical Practice: Implications for Breast Cancer Treatment and Prognosis2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The introduction of sentinel lymph node biopsy (SLNB) has conveyed several new issues, such as the risk of false negativity, long-term consequences, the prognostic significance of micrometastases and whether ALND can be omitted in sentinel lymph node- (SLN) positive patients.

    Archived SLN specimens from 50 false negative patients and 107 true negative controls were serially sectioned and stained with immunohistochemistry. The detection rate of previously unknown metastases did not differ between the false and the true negative patients. The risk of false negativity was higher in patients with multifocal or hormone receptor-negative tumours, or if only one SLN was found.

    In a Swedish multicentre cohort, 2216 SLN-negative patients in whom ALND was omitted were followed up for a median of 65 months. The isolated axillary recurrence rate was only 1.0%, and the overall survival was high (93%).

    The survival of 3369 breast cancer patients (2383 node-negative (pN0), 107 isolated tumour cells (pN0(i+), 123 micrometastases (pN1mi) and 756 macrometastases (pN1)) was analysed. The 5-year cause-specific and event-free survival was worse for pN1mi and pN1 patients than for pN0 patients. There was no difference in survival between pN0(i+) and pN0 patients.

    Tumour and SLN characteristics in 869 SLN-positive patients were compared between those with and without non-SLN metastases, and the Tenon score was calculated. The risk of non-SLN metastases was higher in case of SLN macrometastases (compared with micrometastases), a high positive/total SLN ratio and Elston grade 3 tumours, and increased with increasing tumour size. The area under the curve (AUC) for the Tenon score was 0.65, and the test thus performed inadequately in this population.

    In conclusion, despite the risk of false negativity, SLNB with omission of ALND in SLN-negative patients appears to be safe even in the long term. The presence of micrometastases is of prognostic importance and should entail adjuvant treatment. The need for ALND in patients with SLN micro- and even macrometastases has been questioned, but the occurrence of non-SLN metastases is hard to predict, and strong evidence for the safe omission of ALND is lacking.

    Ladda ner fulltext (pdf)
    fulltext
  • 224.
    Andersson, Yvette
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Vastmanland Cty Hosp, Dept Surg, SE-72189 Vasteras, Sweden.
    Bergkvist, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Vastmanland Cty Hosp, Dept Surg, SE-72189 Vasteras, Sweden.
    Frisell, J.
    Karolinska Univ Hosp, Dept Breast & Endocrine Surg, Stockholm, Sweden;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    de Boniface, J.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden;Capio St Gorans Hosp, Dept Surg, Stockholm, Sweden.
    Do clinical trials truly mirror their target population?: An external validity analysis of national register versus trial data from the Swedish prospective SENOMIC trial on sentinel node micrometastases in breast cancer2019Ingår i: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 177, nr 2, s. 469-475Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Increasing evidence suggests that completion axillary lymph node dissection (ALND) may be omitted in breast cancer patients with limited axillary nodal metastases. However, the representativeness of trial participants for the original clinical practice population, and thus, the generalizability of published trials have been questioned. We propose the use of background data from national registers as a means to assess whether trial participants mirror their target population and to strengthen the generalizability and implementation of trial outcomes.

    Methods: The Swedish prospective SENOMIC trial, omitting a completion ALND in breast cancer patients with sentinel lymph node micrometastases, reached full target accrual in 2017. To assess the generalizability of trial results for the target population, a comparative analysis of trial participants versus cases reported to the Swedish National Breast Cancer Register (NKBC) was performed.

    Results: Comparing 548 trial participants and 1070 NKBC cases, there were no significant differences in age, tumor characteristics, breast surgery, or adjuvant treatment. Only the mean number of sentinel lymph nodes with micrometastasis per individual was lower in trial participants than in register cases (1.06 vs. 1.09, p=0.037).

    Conclusions: Patients included in the SENOMIC trial are acceptably representative of the Swedish breast cancer target population. There were some minor divergences between trial participants and the NKBC population, but taking these into consideration, upcoming trial outcomes should be generalizable to breast cancer patients with micrometastases in their sentinel lymph node biopsy.

    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 225.
    Andersson, Yvette
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Vastmanland Cty Hosp, Dept Surg, S-72189 Vasteras, Sweden.
    Bergkvist, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Vastmanland Cty Hosp, Dept Surg, S-72189 Vasteras, Sweden.
    Frisell, J.
    Karolinska Univ Hosp, Dept Breast & Endocrine Surg, Stockholm, Sweden;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    de Boniface, J.
    Capio St Gorans Hosp, Dept Surg, Stockholm, Sweden;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Long-term breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes2018Ingår i: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 171, nr 2, s. 359-369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The clinical significance of lymph node micrometastases and isolated tumor cells (ITCs) in breast cancer is still controversial. After a median follow-up of 52 months, a report from the Swedish Multicenter Cohort Study presented a worse cancer-specific and event-free survival for patients with micrometastases than node-negative individuals, but could not demonstrate a significant difference in overall survival (OS). Due to the tendency of breast cancer to relapse after more than 5-10 years, we now report the long-term survival of the cohort.

    Methods: Between September 2000 and January 2004, 3355 breast cancer patients were included in a prospective cohort. Sentinel lymph node biopsy was always performed. Patients were classified in four groups according to their overall nodal stage: node negative (N0, 2372), ITCs (113), micrometastases (123), and macrometastases (747). Kaplan-Meier survival estimates and Cox proportional hazard regression models were applied.

    Results: Median follow-up was 156 months. Ten-year cancer-specific survival and OS were significantly lower in case of micrometastases than in N0 (84.7 vs. 93.5%, p = 0.001, and 75.5 vs. 84.2%, p = 0.046, respectively). In case of macrometastases, corresponding survival rates were 82.8 and 74.3%. Only for those aged less than 50 years, cancer-specific survival and OS were significantly worse in case of ITCs than N0. Patients with micrometastases received less often chemotherapy than those with macrometastases (24.4 vs. 53.9%).

    Conclusions: Lymph node micrometastases in breast cancer have a prognostic significance. This study demonstrates a similar survival for patients with micrometastases and those with macrometastases, possibly due to systemic undertreatment.

  • 226.
    Andersson, Yvette
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Vastmanland Cty Hosp, Dept Surg, SE-72189 Västerås, Sweden..
    Bergkvist, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Vastmanland Cty Hosp, Dept Surg, SE-72189 Västerås, Sweden..
    Frisell, J.
    Karolinska Univ Hosp, Dept Breast & Endocrine Surg, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    de Boniface, J.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.;Capio St Gorans Hosp, Dept Surg, Stockholm, Sweden..
    Omitting completion axillary lymph node dissection after detection of sentinel node micrometastases in breast cancer: first results from the prospective SENOMIC trial2021Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 108, nr 9, s. 1105-1111Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Completion axillary lymph node dissection has been abandoned widely among patients with breast cancer and sentinel lymph node micrometastases, based on evidence from prospective RCTs. Inclusion in these trials has been subject to selection bias, with patients undergoing mastectomy being under-represented. The aim of the SENOMIC (omission of axillary lymph node dissection in SENtinel NOde MICrometases) trial was to confirm the safety of omission of axillary lymph node dissection in patients with breast cancer and sentinel lymph node micrometastases, and including patients undergoing mastectomy.

    Methods: The prospective SENOMIC multicentre cohort trial enrolled patients with breast cancer and sentinel lymph node micrometastases who had breast-conserving surgery or mastectomy at one of 23 Swedish hospitals between October 2013 and March 2017. No completion axillary lymph node dissection was performed. The primary endpoint was event-free survival, with a trial accrual target of 452 patients. Survival proportions were based on Kaplan-Meier survival estimates.

    Results: The trial included 566 patients. Median follow-up was 38 (range 7-67) months. The 3-year event-free survival rate was 96.2 per cent, based on 26 reported breast cancer recurrences, including five isolated axillary recurrences. The unadjusted 3-year event-free survival rate was higher than anticipated, but differed between patients who had mastectomy and those who underwent breast-conserving surgery (93.8 versus 97.8 per cent respectively; P=0.011). Patients who underwent mastectomy had significantly worse tumour characteristics. On univariable Cox proportional hazards regression analysis, patients who had mastectomy without adjuvant radiotherapy had a significantly higher risk of recurrence than those who underwent breast-conserving surgery (hazard ratio 2.91, 95 per cent c.i. 1.25 to 6.75).

    Conclusion: After 3 years, event-free survival was excellent in patients with breast cancer and sentinel node micrometastases despite omission of axillary lymph node dissection. Long-term follow-up and continued enrolment of patients having mastectomy, especially those not receiving adjuvant radiotherapy, are of utmost importance.

  • 227. Andersson, Yvette
    et al.
    de Boniface, J
    Jönsson, P-E
    Ingvar, C
    Liljegren, G
    Bergkvist, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Frisell, J
    Axillary recurrence rate 5 years after negative sentinel node biopsy for breast cancer2012Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 99, nr 2, s. 226-231Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) as the standard axillary staging procedure in breast cancer. Follow-up studies in SLN-negative women treated without ALND report low rates of axillary recurrence, but most studies have short follow-up, and few are multicentre studies.

    METHODS: Between September 2000 and January 2004, patients who were SLN-negative and did not have ALND were included in a prospective cohort. Kaplan-Meier estimates were used to analyse the rates of axillary recurrence and survival. The risk of axillary recurrence was also compared in centres with high and low experience with the SLN biopsy (SLNB) technique.

    RESULTS: A total of 2195 patients with 2216 breast tumours were followed for a median of 65 months. Isolated axillary recurrence was diagnosed in 1·0 per cent of patients. The event-free 5-year survival rate was 88·8 per cent and the overall 5-year survival rate 93·1 per cent. There was no difference in recurrence rates between centres contributing fewer than 150 SLNB procedures to the cohort and centres contributing 150 or more procedures.

    CONCLUSION: This study confirmed the low risk of axillary recurrence 5 years after SLNB for breast cancer without ALND.

  • 228. Andersson, Yvette
    et al.
    Frisell, J
    de Boniface, J
    Bergkvist, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Prediction of non-sentinel lymph node status in breast cancer patients with sentinel lymph node metastases: evaluation of the tenon score2012Ingår i: Breast Cancer: Basic and Clinical Research, E-ISSN 1178-2234, Vol. 6, s. 31-38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION:

    Current guidelines recommend completion axillary lymph node dissection (cALND) in case of a sentinel lymph node (SLN) metastasis larger than 0.2 mm. However, in 50%-65% of these patients, the non-SLNs contain no further metastases and cALND provides no benefit. Several nomograms and scoring systems have been suggested to predict the risk of metastases in non-SLNs. We have evaluated the Tenon score.

    PATIENTS AND METHODS:

    In a retrospective review of the Swedish Sentinel Node Multicentre Cohort Study, risk factors for additional metastases were analysed in 869 SLN-positive patients who underwent cALND, using uni- and multivariate logistic regression models. A receiver operating characteristic (ROC) curve was drawn on the basis of the sensitivity and specificity of the Tenon score, and the area under the curve (AUC) was calculated.

    RESULTS:

    Non-SLN metastases were identified in 270/869 (31.1%) patients. Tumour size and grade, SLN status and ratio between number of positive SLNs and total number of SLNs were significantly associated with non-SLN status in multivariate analyses. The area under the curve for the Tenon score was 0.65 (95% CI 0.61-0.69). In 102 patients with a primary tumour <2 cm, Elston grade 1-2 and SLN metastases ≤2 mm, the risk of non SLN metastasis was less than 10%.

    CONCLUSION:

    The Tenon score performed inadequately in our material and we could, based on tumour and SLN characteristics, only define a very small group of patients in which negative non-sentinel nodes could be predicted.

  • 229.
    Andersson, Yvette
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Frisell, Jan
    Insititution of Molecular Medicine and Surgery, Karolinska Institutet.
    Sylvan, Maria
    Department of Pathology, Karolinska University Hospital.
    de Boniface, Jana
    Insititution of Molecular Medicine and Surgery, Karolinska Institutet.
    Bergkvist, Leif
    Centre for Clinical Research Uppsala University.
    Serial sectioning of breast cancer sentinel nodes does not significantly improve false negativity rateManuskript (preprint) (Övrigt vetenskapligt)
  • 230.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Hälsoakademin.
    Aktuell forskare om barn med cancer, deras rädsla och sättet den hanteras på2008Ingår i: Barnbladet, ISSN 0349-1994, Vol. 33, nr 2, s. 45-46Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 231.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Hälsoakademin.
    Att hantera rädsla hos barn med cancer2008Ingår i: Onkologi i Sverige, ISSN 1653-1582, Vol. 4, nr 6, s. 14-20Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 232.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Existentiella rädslor hos barn med cancer: föräldrars och vårdpersonals berättelser2007Ingår i: Omsorg: Nordisk tidsskrift for Palliativ Medisin, ISSN 0800-7489, Vol. 24, nr 4, s. 33-39Artikel i tidskrift (Övrigt vetenskapligt)
  • 233.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro universitet, Hälsoakademin.
    Kihlgren, Annica
    Örebro universitet, Hälsoakademin.
    Sörlie, Venke
    Högskolan i Bodö.
    Embodied suffering: experiences of fear in adolescent girls with cancer2008Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 12, nr 2, s. 129-143Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Previously, fear in adolescents with cancer has been sparsely described from an emic perspective. The aim of this study was to illuminate fear in adolescents with personal experience of cancer. The participants were six adolescent girls between the age of 14 and 16 years who were no longer under active treatment for cancer but still went for regular check-ups. Open interviews were conducted. Data were analysed according to the phenomenological hermeneutic method. In the result one main theme was identified: `an embodied fear — a threat to the personal self'. This theme was built up by three separate but intertwined themes: `experiencing fear related to the physical body', `experiencing existential fear' and `experiencing fear related to the social self'. In the comprehensive understanding the fear was interpreted from youth cultural aspects as well as a holistic perspective. The importance of professionals taking the whole person and their situation into account when meeting the fear is underlined.

  • 234. Andreas, Svee
    The Long-Term Effects of DIEP Breast Reconstruction on Abdomen-Related Quality of Life: A Cohort Study with More Than Eight Years Follow-upManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: Although the long-term outcomes of breast reconstruction are important, current knowledge of patients’ perceptions of the abdominal donor site several years after breast reconstruction and its effect on health-related quality of life (HRQoL) is limited. This study aimed to evaluate long-term donor site-related HRQoL in women who had undergone a deep inferior epigastric perforator (DIEP) breast reconstruction.Methods: In this retrospective cohort study, 66 women who had undergone DIEP breast reconstruction between 2000-2007 were compared with a matched control cohort of 114 women who had undergone mastectomies without reconstruction. Between 2015-2016, the DIEP cohort patients were invited to complete the BREAST-Q Reconstruction Module questionnaire during outpatient visits to our institution. Each patient in the control cohort completed the same questionnaire 10 years after their mastectomy. Results: Follow-up time for the DIEP cohort was > 8 years post-reconstruction (mean ± SD; 11.4 ± 1.6 years) and for the control cohort 10 years (mean ± SD; post-mastectomy (11.0 ± 0.3 years). In the DIEP cohort, 93% of the patients reported experiencing no pain at all at the donor site. Furthermore, 89% (59/66) of this group had never experienced abdominal weakness, and 91% (60/66), had never experienced difficulties in performing everyday activities. The DIEP cohort was more likely to be very satisfied with their abdomen’s appearance than those in the control group (adjusted OR, 5.7; 95% CI 1.8–17.6). Conclusion: DIEP breast reconstruction does not cause long-term abdominal morbidity or negatively affect abdomen-related HRQoL.

  • 235.
    Andresen, Kristoffer
    et al.
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Kroon, Lovisa
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Holmberg, Henrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Öberg, Stina
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Rosenberg, Jacob
    Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital – Herlev Hospital, Denmark.
    Nordin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    de la Croix, Hanna
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital/Östra Hospital, Department of Surgery, Sweden.
    Collaboration between the Danish and Swedish hernia registers – a study protocol2022Ingår i: Danish Medical Journal, E-ISSN 2245-1919, Vol. 69, nr 12, artikel-id A06220408Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    NTRODUCTION: The most common laparo-endoscopic groin hernia repair techniques are TEP (total extraperitoneal) and TAPP (transabdominal preperitoneal) repair. Despite geographic proximity, Swedish surgeons distinctively favour TEP, whereas Danish surgeons prefer TAPP. The aim of this study is to analyse the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair using data from two nationwide registers. We also aim to discuss advantages of international collaboration between nationwide registers.

    METHODS: All groin hernia operations registered as TEP, TAPP or Lichtenstein repair in the Swedish Hernia Register and the Danish Hernia Database between January 2004 and December 2020 will be included. Cumulative hazard rate of reoperation for recurrence will be estimated using Cox-regression analyses adjusted for age and anatomy.

    CONCLUSION: Approximately 400,000 operations are estimated to have been registered prospectively in the inclusion period in the registers. The merging of two nationwide registers was made possible owing to close cooperation between the register steering committees and by obtaining the necessary approvals. This unique collaboration between nationwide registers will make it possible to compare the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair on an international level. In future, similar collaboration may be established to explore other outcomes such as complication rates and chronic pain.

  • 236.
    André, Camilla
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Capio St Gorans Hosp, Dept Surg, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Holsti, C.
    Cent Hosp Karlstad, Dept Surg, Karlstad, Sweden..
    Svenner, A.
    Karolinska Univ Hosp Huddinge, Dept Surg, Huddinge, Sweden..
    Sackey, H.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Surg, Solna, Sweden..
    Oikonomou, I
    Southern Gen Hosp, Dept Surg, Stockholm, Sweden..
    Appelgren, M.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Johansson, A. L. , V
    de Boniface, J.
    Capio St Gorans Hosp, Dept Surg, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Recurrence and survival after standard versus oncoplastic breast-conserving surgery for breast cancer2021Ingår i: BJS Open, E-ISSN 2474-9842, Vol. 5, nr 1, artikel-id zraa013Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Oncoplastic techniques in breast-conserving surgery (BCS) are used increasingly for larger tumours. This large cohort study aimed to assess oncological outcomes after oncoplastic BCS (OPS) versus standard BCS.

    Methods: Data for all women who had BCS in three centres in Stockholm during 2010-2016 were extracted from the Swedish National Breast Cancer Register. All patients with T2-3 tumours, all those receiving neoadjuvant treatment, and an additional random sample of women with T1 tumours were selected. Medical charts were reviewed for local recurrences and surgical technique according to the Hoffman-Wallwiener classification. Date and cause of death were retrieved from the Swedish Cause of Death Register.

    Results: The final cohort of 4178 breast cancers in 4135 patients was categorized into three groups according to surgical technique: 3720 for standard BCS, 243 simple OPS, and 215 complex OPS. Median duration of follow up was 64 (range 24-110) months. Node-positive and large tumours were more common in OPS than in standard BCS (P < 0.001). There were 61 local recurrences: 57 (1.5 per cent), 1 (0.4 per cent) and 3 (1.4 per cent) in the standard BCS, simple OPS and complex OPS groups respectively (P = 0.368). Overall, 297 patients died, with an unadjusted 5-year overall survival rate of 94.7, 93.1 and 92.6 per cent respectively (P = 0.350). Some 102 deaths were from breast cancer, with unadjusted 5-year cancer-specific survival rates of 97.9, 98.3 and 95.0 per cent respectively (P = 0.056).

    Discussion: Oncoplastic BCS is a safe surgical option, even for larger node-positive tumours, with low recurrence and excellent survival rates.

    Ladda ner fulltext (pdf)
    fulltext
  • 237.
    Andréasson, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Pseudomyxoma Peritonei: Aspects of Natural History, Learning Curve, Treatment Outcome and Prognostic Factors2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Pseudomyxoma peritonei (PMP) is a rare disease characterized by mucinous peritoneal metastasis (PM). Different loco-regional treatment strategies, i.e. debulking surgery and cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC), have changed the prognosis for these patients. CRS is an aggressive surgical procedure with a long learning curve. PMP exists in different types; how many depends on which classification is used.

    The aims of this thesis were to investigate the time-frame of PMP development from an isolated appendiceal neoplasm, examine the learning process for CRS, evaluate the differences in treatment outcome between debulking surgery and CRS in combination with HIPEC, to evaluate a more detailed PMP classification and to investigate particularly interesting new cysteine-histidine (PINCH) protein as a prognostic factor for PMP.

    Retrospectively 26 PMP patients were identified as having had an appendectomy with a neoplasm in the appendix but with no evidence of PM at the appendectomy. They were treated for PMP within a median of 13.1 months (3.8-95.3) after the appendectomy. No difference was seen between the types of PMP regarding the time to a clinically significant development of PMP and how much tumour was found at treatment. CRS is a highly invasive treatment and stabilization in the learning curve was seen after 220±10 procedures. Patients treated with CRS+HIPEC had a better 5-year overall survival (OS) than patients treated with debulking surgery, 74% vs. 40%. CRS increased the rate of complete cytoreduction from 25% in patients treated with debulking surgery to 72%. The new four-grade PMP classification showed very good inter-rater agreement between two independent pathologists and a difference in survival rates was observed between the different grades. A positive PINCH staining was recorded in 83% of the tumours and that was associated with poorer survival.

    Ladda ner fulltext (pdf)
    fulltext
  • 238.
    Andréasson, Håkan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Lorant, Tomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Transplantationskirurgi.
    Påhlman, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Graf, Wilhelm
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Mahteme, Haile
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Cytoreductive surgery in pseudomyxoma peritonei-aspects of the learning curve2013Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 40, nr 8, s. 930-936Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cytoreductive surgery (CRS) plus perioperative intraperitoneal chemotherapy is a highly invasive treatment of peritoneal metastasis and requires many surgical procedures before mastering. The aim of this study was to estimate how many procedures are needed before stabilization can be seen in surgical outcome (R1 surgery, adverse events and bleeding) in patients with pseudomyxoma peritonei (PMP). Patients and methods: All 128 patients with PMP who were treated with CRS alone or CRS plus perioperative intraperitoneal chemotherapy between 2003 and 2008 at the Uppsala University Hospital, Uppsala, Sweden, were included. The learning curve was calculated using the partial least square (PLS) and cumulative sum control chart (CUSUM) graph. Two groups were formed based on the results of the learning curve. The learning curve plateau was considered the same as the stabilization in the CUSUM graph. Group I consisted of patients included during the learning period (n = 73) and Group 11 of patients treated after the learning period ended (n = 55). Comparisons between the groups were made on surgical outcome, survival and adverse events. Results: Stabilization was seen after 220 +/- 10 procedures. A higher occurrence of R1 surgery was seen in Group H (80%) compared to Group I (48%; P = 0.0002). Overall survival increased at four years after surgery in Group H compared to Group I (80% vs. 63%; P = 0.02). Conclusion: CRS plus perioperative intraperitoneal chemotherapy is a highly demanding procedure that requires more than 200 procedures before optimisation in surgical outcome is seen.

  • 239.
    Andréasson, Håkan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Påhlman, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Mahteme, Haile
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    The natural history of pseudomyxoma peritonei- the early phaseManuskript (preprint) (Övrigt vetenskapligt)
  • 240.
    Andrén, Ove
    Örebro universitet, Hälsoakademin.
    Natural history and prognostic factors in localized prostate cancer2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The natural history of localized prostate cancer is not fully understood. In most patients the tumor will never progress to a lethal disease, while a subset of patients will ultimately die of the disease. Efficient tools to separate indolent from lethal disease is currently lacking which means that many patients will be offered treatment without any benefit, but still be at risk of experiencing treatment related side effects.

    The aims of these studies were to get more insight into the natural history of untreated localized prostate cancer, to assess the prognostic value of established clinical parameters such as Gleason score, nuclear grade and tumor volume and, moreover, some new prognostic markers Ki-67, AMACR and MUC-1. We also aimed to study time trends in the detection of incidental tumors in Sweden.

    Patients with localized disease (n=223) and no initial treatment were followed for 21 years. Most patients had a favorable outcome. However, a subset of patients developed lethal disease even beyond 15 years of follow-up and these patients define the group that may benefit most from treatment with curative intent. Patients with poorly differentiated tumors experienced a 9 time higher risk of dying in prostate cancer.

    The studies on prognostic markers are based on a cohort of patients (n=253) with incidental prostate cancer detected by transurethral resection for presumed benign hyperplasia. All patients were left without initial treatment. Gleason grade, nuclear grade and tumor volume turned all out to be independent prognostic factors. MUC-1, AMACR and Ki-67 also carried prognostic information. However, after adjustment for Gleason grade, nuclear grade and tumor volume only MUC-1 and AMACR remained as statistically significant prognostic factors. When tested for sensitivity and specificity they all failed and, consequently, they seem to be of less value in daily practice for cancelling an individual patient regarding the choice of treatment.

    Time trends in incidental prostate tumors in Sweden were analyzed in a cohort of patients with prostate tumors detected by transurethral resection (TUR-P). Through linkage of the national registration number (NRN) with several registers, e.g. the Swedish Cancer Registry, the National Inpatient registry and the Cause of Death Registry we identified, during the period 1970 through 2003, in total 23288 patients with incidental prostate cancer, who constituted the study group. As comparison group we choose all patients diagnosed with prostate cancer between 1970-2003 excluding those with incidental cancer, in total 112204 patients. Our result confirms earlier findings that there has been a dramatic change over time in incidence of incidental prostate cancers in Sweden, which parallels the introduction of prostate specific antigen. We also found that the cumulative incidence of prostate cancer death is high in the incidental group, opposing earlier findings that incidental tumours are a non-lethal disease.

    Ladda ner fulltext (pdf)
    FULLTEXT01
    Ladda ner fulltext (pdf)
    FULLTEXT02
    Ladda ner (pdf)
    COVER01
  • 241.
    Andrén, Ove
    et al.
    Örebro universitet, Hälsoakademin.
    Fall, Katja
    Andersson, Swen-Olof
    Rubin, Mark A.
    Bismar, Tarek A.
    Karlsson, M.
    Johansson, Jan-Erik
    Örebro universitet, Hälsoakademin.
    Mucci, Lorelei A.
    MUC-1 gene is associated with prostate cancer death: a 20-year follow-up of a population-based study in Sweden2007Ingår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 97, nr 6, s. 730-734Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Anti-adhesion mucins have proven to play an important part in the biology of several types of cancer. Therefore, we test the hypothesis that altered expression of MUC-1 is associated with prostate cancer progression. We retrieved archival tumour tissue from a population-based cohort of 195 men with localised prostate cancer (T1a-b, Nx, M0) that has been followed for up to 20 years with watchful waiting. Semi-automated, quantitative immunohistochemistry was undertaken to evaluate MUC-1 expression. We modelled prostate cancer-specific death as a function of MUC-1 levels accounting for age, Gleason grade and tumour extent, and calculated age-adjusted and multivariate adjusted hazard ratios (HR). Men that had tumours with an MUC-intensity lower or higher than normal tissue had a higher risk of dying in prostate cancer, independent of tumour extent and Gleason score (HR 5.1 and 4.5, respectively). Adjustment for Gleason grade and tumour stage did not alter the results. Men with a Gleason score >=7 and MUC-1 deviating from the normal had a 17 (RR=17.1 95% confidence interval=2.3–128) times higher risk to die in prostate cancer compared with men with Gleason score <7 and normal MUC-1 intensity. In summary, our data show that MUC-1 is an independent prognostic marker for prostate cancer death.

  • 242.
    Andrén, Ove
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Fall, Katja
    Franzén, Lennart
    Andersson, Swen-Olof
    Johansson, Jan-Erik
    Rubin, Mark A.
    How well does the Gleason score predict prostate cancer death?: A 20-year followup of a population based cohort in Sweden2006Ingår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 175, nr 4, s. 1337-1340Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    Adenocarcinoma of the prostate is the most common cancer among men in Western countries. Although the prognostic heterogeneity of prostate cancer is enormous, clinically insignificant aggressive prostate cancers cannot be reliably distinguished. Therefore, identifying prognostic factors is increasingly important, notably among men diagnosed with localized prostate cancer, because many of them may not require aggressive treatment.

    Materials and Methods

    We analyzed a population based cohort of 253 men with early stage (T1a-b, Nx, M0) initially untreated prostate cancer diagnosed between 1977 and 1991, before PSA screening was available. Tissue samples were available for 240 patients diagnosed with transurethral resection. During complete followup through September 2003, standardized criteria were used to classify histopathological characteristics, progression and causes of death.

    Results

    Higher Gleason grade, higher nuclear grade and larger tumor volume were independent predictors of death in prostate cancer with monotonous and statistically significant trends (p <0.05). In contrast, the level of Ki-67 – strongly correlated to Gleason score – was not an independent predictor of prostate cancer death. Given a Gleason score of 7 or greater, the probability of dying of prostate cancer was 29%. The corresponding predictive value for Gleason score 8 or greater was 48%.

    Conclusions

    Although a high Gleason score is a determinant of prostate cancer death, its PPV is relatively low. Thus, further efforts in finding other or complementary indicators of prostate cancer outcome are needed.

  • 243.
    Andrén, Ove
    et al.
    Örebro universitet, Hälsoakademin.
    Garmo, Hans
    Mucci, Lorelei
    Andersson, Swen-Olof
    Johansson, Jan-Erik
    Fall, Katja
    Time trends and survival among men diagnosed with incidental prostate cancer in Sweden: a register-based study between 1970 and 2003Manuskript (preprint) (Övrigt vetenskapligt)
  • 244. Angeles Martinez-Maestre, Maria
    et al.
    Gambadauro, Pietro
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Gonzalez-Cejudo, Carmen
    Torrejon, Rafael
    Total Laparoscopic Hysterectomy With and Without Robotic Assistance: A Prospective Controlled Study2014Ingår i: Surgical Innovation, ISSN 1553-3506, E-ISSN 1553-3514, Vol. 21, nr 3, s. 250-255Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Hysterectomies are very common, and most of them are still performed abdominally. The minimally invasive alternatives are perceived as difficult by gynecologists. Robotic assistance is thought to facilitate laparoscopic surgery. The aim of this study was to compare the surgical outcomes of robotic-assisted and conventional total laparoscopic hysterectomy. Methods. Patients, candidate to hysterectomy for benign indications, were allocated to either robotic or conventional laparoscopy in a quasi-randomized fashion. Patients were operated following a standardized surgical protocol. Main outcome measures were total surgical time, conversions to laparotomy, blood loss, hospital stay, and complications. Results. Fifty-one patients underwent robotic hysterectomy (mean age = 46.59 years) and 54 conventional laparoscopy (mean age = 50.02 years). The groups were homogeneous in body mass index and uterine weight. Robotic-assisted hysterectomies were significantly shorter (154.63 +/- 36.57 vs 185.65 +/- 42.98 minutes in the control group; P =.0001). Patients in the robotic group also had a significantly smaller reduction in hemoglobin (9.69% +/- 8.88% vs 15.29% +/- 8.39% in controls; P =.0012) and hematocrit (10.56% +/- 8.3% vs 14.89% +/- 8.11%; P =.008). No intraoperative conversions to laparotomy were required. Complication rate was low and similar in both groups. All patients were fully recovered at 1-month follow-up outpatient visit. Conclusions. Significantly lower operative times and blood loss indicate that robotic assistance can facilitate surgery already during the learning curve period. Nevertheless, proficiency can be reached in conventional laparoscopy through training, and the cost-effectiveness of robotic hysterectomy for benign conditions is yet to be confirmed.

  • 245.
    Angelsten, Jakob
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Predictive Factors for Recurrence Treatment in Papillary Thyroid Cancer - Pilot study at Östersund Hospital2020Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 246.
    Angenete, Eva
    et al.
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Jacobsson, Anders
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Gellerstedt, Martin
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Haglind, Eva
    Scandinavian Surgical Outcomes Research Group, Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
    Effect of Laparoscopy on the Risk of Small-Bowel Obstruction: A Population-Based Register Study2012Ingår i: Archives of surgery (Chicago. 1960), ISSN 0004-0010, E-ISSN 1538-3644, Vol. 147, nr 4, s. 359-365Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the incidence and risk factors for small-bowel obstruction (SBO) after certain surgical procedures.

    Design: A population-based retrospective register study.

    Setting: Small-bowel obstruction causes considerable patient suffering. Risk factors for SBO have been identified, but the effect of surgical technique (open vs laparoscopic) on the incidence of SBO has not been fully elucidated.

    Patients: The Inpatient Register held by the Swedish National Board of Health and Welfare was used. The hospital discharge diagnoses and registered performed surgical procedures identified data for cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery performed from January 1, 2002, through December 31, 2004. Data on demographic characteristics, comorbidity, previous abdominal surgery, and death were collected.

    Main Outcome Measures: Episodes of hospital stay and surgery for SBO within 5 years after the index surgery.

    Results: A total of 108 141 patients were included. The incidence of SBO ranged from 0.4% to 13.9%. Multivariate analysis revealed age, previous surgery, comorbidity, and surgical technique to be risk factors for SBO. Laparoscopy exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures.

    Conclusions: Open surgery seems to increase the risk of SBO at least 4 times compared with laparoscopy for most of the abdominal surgical procedures studied. Other factors such as age, previous abdominal surgery, and comorbidity are also of importance

  • 247.
    Angenete, Eva
    et al.
    University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Östra.
    Jacobsson, Anders
    Swedish National Board of Health and Welfare, Stockholm.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för datavetenskap och informatik.
    Haglind, Eva
    University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Östra.
    Laparoscopy on the Risk of Small-Bowel Obstruction: A Population-Based Register Study2012Ingår i: Archives of surgery (Chicago. 1960), ISSN 0004-0010, E-ISSN 1538-3644, ISSN 0004-0010, Vol. 147, nr 4, s. 359-365Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective  To investigate the incidence and risk factors for small-bowel obstruction (SBO) after certain surgical procedures. Design A population-based retrospective register study. Setting Small-bowel obstruction causes considerable patient suffering. Risk factors for SBO have been identified, but the effect of surgical technique (open vs laparoscopic) on the incidence of SBO has not been fully elucidated. Patients The Inpatient Register held by the Swedish National Board of Health and Welfare was used. The hospital discharge diagnoses and registered performed surgical procedures identified data for cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery performed from January 1, 2002, through December 31, 2004. Data on demographic characteristics, comorbidity, previous abdominal surgery, and death were collected. Main Outcome Measures Episodes of hospital stay and surgery for SBO within 5 years after the index surgery. Results A total of 108 141 patients were included. The incidence of SBO ranged from 0.4% to 13.9%. Multivariate analysis revealed age, previous surgery, comorbidity, and surgical technique to be risk factors for SBO. Laparoscopy exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures.

    Conclusions Open surgery seems to increase the risk of SBO at least 4 times compared with laparoscopy for most of the abdominal surgical procedures studied. Other factors such as age, previous abdominal surgery, and comorbidity are also of importance

  • 248.
    Angenete, Eva
    et al.
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Thornell, Anders
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp östra, Univ Gothenburg, Gothenburg, Sweden.
    Burcharth, Jakob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Pommergaard, Hans-Christian
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Skullman, Stefan
    Dept Surg, Skaraborgs Hosp, Skövde, Sweden.
    Bisgaard, Thue
    Div Surg, GastroUnit, Hvidovre Hosp, Univ Copenhagen, Hvidovre, Denmark.
    Jess, Per
    Dept Surg, Roskilde Hosp, Roskilde, Denmark.
    Lackberg, Zoltan
    NAL Hosp Grp, Trollhättan, Sweden.
    Matthiessen, Peter
    Region Örebro län. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Heath, Jane
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Rosenberg, Jacob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Haglind, Eva
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis The First Results From the Randomized Controlled Trial DILALA2016Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 263, nr 1, s. 117-122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective:To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.

    Background:Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment.

    Methods:Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively.

    Results: Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay.

    Conclusions:In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term.

  • 249.
    Angrisani, Luigi
    et al.
    Public Health Department - School of Medicine, “Federico II” University of Naples, Naples, Italy.
    Santonicola, Antonella
    Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
    Iovino, Paola
    Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
    Palma, Rossella
    Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy.
    Kow, Lilian
    Flinders University, Adelaide, South Australia.
    Prager, Gerhard
    Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
    Ramos, Almino
    Gastro-Obeso-Center Institute, Sao Paulo, Brazil.
    Shikora, Scott
    Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
    IFSO Worldwide Survey 2020-2021: Current Trends for Bariatric and Metabolic Procedures2024Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: This IFSO survey aims to describe the current trends of metabolic and bariatric surgery (MBS) reporting on the number and types of surgical and endoluminal procedures performed in 2020 and 2021, in the world and within each IFSO chapter.

    Methods: All national societies belonging to IFSO were asked to complete the survey form. The number and types of procedures performed (surgical and endoluminal interventions) from 2020 to 2021 were documented. A special section focused on the impact of COVID-19, the existence of national protocols for MBS, the use of telemedicine, and any mortality related to MBS. A trend analysis of the data, both worldwide and within each IFSO chapter, was also performed for the period between 2018 and 2021.

    Results: Fifty-seven of the 74 (77%) IFSO national societies submitted the survey. Twenty-four of the 57 (42.1%) reported data from their national registries. The total number of surgical and endoluminal procedures performed in 2020 was 507,806 and in 2021 was 598,834. Sleeve gastrectomy (SG) remained the most performed bariatric procedure. Thirty national societies (52%) had regional protocols for MBS during COVID-19, 61.4% supported the use of telemedicine, and only 47.3% collected data on mortality after MBS in 2020. These percentages did not significantly change in 2021 (p > 0.05).

    Conclusions: The number of MBS markedly decreased worldwide during 2020. Although there was a positive trend in 2021, it did not reach the values obtained before the COVID-19 pandemic. SG continued to be the most performed operation. Adjustable gastric banding (AGB) continues to decrease worldwide.

  • 250.
    Angsten, Gertrud
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Fat metabolism: A clinical and experimental study with special reference to newborns2002Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Lipid emulsion is an important constituent of total parenteral nutrition (TPN). In the investigations described in this thesis the effects of different lipid emulsions in neonates were studied.

    Twenty neonates in each of two studies, undergoing surgery for oesophago-gastrointestinal malformations, were assigned the day after the operation to receive TPN for 5 days, containing one of the two emulsions. In the first study 10 neonates received PFE 4501 containing gamma-linolenic acid (GLA) and carnitine and 10 were given Intralipid®and served as controls. In the second study 10 received Vasolipid® and 10, the control group, Intralipid®. In both studies linoleic acid and α-linolenic acid increased in plasma lipid esters and adipose tissue in each group. Arachidonic acid decreased in the PFE 4501 group in spite of GLA supplementation. Plasma carnitine increased two-fold in the PFE 4501 group, but decreased in the groups receiving Vasolipid® or Intralipid®. Reference ranges for muscle carnitine concentrations in children 1 days to 14 years of age were determined for comparisons. The results showed that the carnitine concentration in skeletal muscle tissue was greatly dependent on the gestational age in newborns. Accumulation of carnitine in skeletal muscle tissue continued during the first year of life, after which the concentration remained essentially constant.

    There are several methods for determining carnitine concentrations in plasma and muscle, but in the PET camera measurements are made in vivo. The transfer of long-chain fatty acids into the mitochondria, which relies on the carnitine-dependent transport system, was studied with PET, with labelling of the radioactive isotope carbon-11. Inhibition of carnitine palmitoyltransferase I by oxfenicine almost completely blocked the oxidative pathway of palmitic acid, while short carbon-chain fatty acids, which are independent of carnitine for their transport, were virtually unaffected. The fractional oxidative utilisation of long-chain fatty acids may thus be used as an index of the activity of the carnitine-dependent transport system.

2345678 201 - 250 av 5345
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf