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  • 251.
    Angsten, Gertrud
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Danielson, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Kassa, Ann-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Lilja, Helene Engstrand
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Outcome of laparoscopic versus open gastrostomy in children2015Ingår i: Pediatric surgery international (Print), ISSN 0179-0358, E-ISSN 1437-9813, Vol. 31, nr 11, s. 1067-1072Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Laparoscopic gastrostomy (LAPG) has gained popularity in children. The aim of this study was to compare the outcome of LAPG versus open gastrostomy (OG) in children with focus on complications, operative times and postoperative length of stay. Retrospective study of children who had gastrostomies inserted at our tertiary Pediatric Surgery Center from 2000 until 2013. The indications for a gastrostomy were an anticipated need for enteral support for at least 6 months. Totally 243 children were included in the study, 83 with LAPG and 160 with OG. We found a significant difference in postoperative length of stay, 3 days in the LAPG group versus 4 days in the OG group but no difference in a sub-group analysis from 2010 to 2013 when both techniques were used. There was no difference in median operative time or complications rates. Granuloma was the dominating complication in both groups. These two feeding-access techniques are comparable regarding complications, operative times and postoperative length of stay. The choice of surgical method should be individualized based on the patient's characteristics and the experience of the surgeon. The favorable results with LAPG in adults are not necessarily transferable to children since there are physiological and anatomical differences.

  • 252.
    Anker, I.
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Zimmerman, M.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Nyman, Erika
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Dahlin, Lars
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Ulnar nerve dislocation in ulnar nerve entrapment at the elbow. Influence on surgical outcome: Luxation du nerf ulnaire lors du syndrome canalaire au coude. Influence sur le résultat chirurgical2022Ingår i: Hand Surgery and Rehabilitation, ISSN 2468-1229, Vol. 41, nr 1, s. 96-102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Our aim was to assess the incidence of symptomatic ulnar nerve dislocation and its influence on surgical outcome after primary and revision surgeries in ulnar nerve entrapment at the elbow (ulnar neuropathy at the elbow (UNE) or cubital tunnel syndrome). The influence of pre-or intra-operative ulnar nerve dislocation on postoperative outcome was assessed in 548 surgically treated cases (548 nerves) from two hand surgery departments reporting to the Swedish National Quality Registry for Hand Surgery, using QuickDASH, a patient-reported outcome measure (PROM), before surgery and at 3 and 12 months postoperatively, and a doctor-reported outcome measure (DROM), grading as "cured-improved "or "unchanged-worsened, at a median follow-up of 3.0 months [IQR, 1.5-6.0]. 109 of the 548 cases (20%) showed documented pre-or intra-operative ulnar nerve dislocation; more often found at revision (35/ 75, 47%) than at primary surgery (74/473, 16%) (p < 0.0001). Cases with dislocation presented higher QuickDASH scores at 12 months (p = 0.026). A linear regression model, adjusted for age and gender, predicted higher QuickDASH scores at 12 months postoperatively for cases with dislocation (unstandardized B 11.3 [95% CI 0.4-22.2], p = 0.043). DROM grading as unchanged-worsened at a median 3 months predicted worse QuickDASH scores (p < 0.0001) than in cured-improved cases at 3 (unstandardized B, 18.4 [95% CI 9.4-27.3]) and 12 months (unstandardized B, 18.1 [9.1-27.0]). Primary surgeries had better DROM grading than revision surgeries (p = 0.033; cured-improved, 75% and 63%, respectively), but QuickDASH scores did not differ. Presence of a clinically relevant ulnar nerve dislocation resulted in worse outcome, perhaps due to more extensive surgery with transposition. Nerve dislocation needs attention when treating UNE patients. (C) 2021 SFCM. Published by Elsevier Masson SAS.

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  • 253.
    Anker, Ilka
    et al.
    Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden; Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
    Nyman, Erika
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Zimmerman, Malin
    Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden; Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
    Svensson, Ann-Marie
    5 National Diabetes Register, Centre of Registers, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Andersson, Gert S.
    Department of Neurophysiology, Skåne University Hospital, Lund University, Lund, Sweden.
    Dahlin, Lars
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Department of Translational Medicine – Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden; Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
    Preoperative Electrophysiology in Patients With Ulnar Nerve Entrapment at the Elbow-Prediction of Surgical Outcome and Influence of Age, Sex and Diabetes.2022Ingår i: Frontiers in clinical diabetes and healthcare, ISSN 2673-6616, Vol. 3, artikel-id 756022Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The impact of preoperative electrophysiology on outcome of surgical treatment in ulnar nerve entrapment at the elbow (UNE) is not clarified. Our aim was to evaluate influence of preoperative electrophysiologic grading on outcome and analyse how age, sex, and in particular diabetes affect such grading. Electrophysiologic protocols for 406 UNE cases, surgically treated at two hand surgery units reporting to the Swedish National Quality Register for Hand Surgery (HAKIR; 2010-2016), were retrospectively assessed, and graded as normal, reduced conduction velocity, conduction block or axonal degeneration. Outcome of surgery after primary and revision surgery was evaluated using QuickDASH and a doctor reported outcome measure (DROM) grading. No differences in QuickDASH or DROM were found between the four groups with different electrophysiologic grading preoperatively, or at three and 12 months or at follow up, respectively. When dichotomizing the electrophysiologic grading into normal and pathologic electrophysiology, cases with normal electrophysiology had worse QuickDASH than cases with pathologic electrophysiology preoperatively (p=0.046). Presence of a conduction block or axonal degeneration indicated a worse outcome by DROM grading (p=0.011). Primary surgeries had electrophysiologic more pronounced nerve pathology compared to revision surgeries (p=0.017). Cases of older age, men, and those with diabetes had more severe electrophysiologic nerve affection (p<0.0001). In the linear regression analysis, increasing age (unstandardized B=0.03, 95% CI 0.02-0.04; p<0.0001) and presence of diabetes (unstandardized B=0.60, 95% CI 0.25-0.95; p=0.001) were associated with a higher risk of a worse electrophysiologic classification. Female sex was associated with a better electrophysiologic grading (unstandardized B=-0.51, 95% CI -0.75- -0.27; p<0.0001). We conclude that older age, male sex, and concomitant diabetes are associated with more severe preoperative electrophysiologic nerve affection. Preoperative electrophysiologic grade of ulnar nerve affection may influence surgical outcome.

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  • 254.
    Anna Karin, Hedström
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Stenberg, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of surgery.
    Tim, Spelman
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Lars, Forsberg
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Erik, Näslund
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Jan, Hillert
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The impact of bariatric surgery on disease activity and progression of multiple sclerosis: A nationwide matched cohort study2022Ingår i: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 28, nr 13, s. 2099-2105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Surgical outcomes in patients with multiple sclerosis (MS) following metabolic surgery appear to be similar compared to those of the general bariatric population.

    OBJECTIVE: To study the impact of metabolic surgery on the clinical course of MS.

    METHODS: Using data from the Scandinavian Obesity Surgery Registry and the Swedish Multiple Sclerosis register, we compared disease outcomes in 122 cases of MS who had undergone metabolic surgery with those of 122 cases of MS without surgery, matched by a two-staged Propensity score match, including age at disease onset, sex, MS phenotype, body mass index, and preoperative severity of MS as measured by the Expanded Disability Status Scale.

    RESULTS: The time to 6-month confirmed disability progression during the first five years postbaseline was shorter among the surgical patients (hazard ratio (HR) = 2.31, 95% confidence interval (CI) = 1.09-4.90; p = 0.03). No differences were observed regarding postoperative annual relapse rate (p = 0.24) or time to first postoperative relapse (p = 0.52).

    CONCLUSION: Although metabolic surgery appears to be a safe and efficient treatment of obesity in patients with MS, the clinical course of the disease might be negatively affected. Long-term nutritional follow-up after surgery and supplementation maintenance are crucial, particularly among those with preoperative deficits.

  • 255.
    Annebäck, Matilda
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Hypoparathyroidism after thyroid surgery- rates, risks, prevention and consequences2023Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Hypoparathyroidism is the most common complication after thyroid surgery and associated with short- and long-term consequences. The lack of a consensus on the definition of hypoparathyroidism has led to a broad range in the rates reported in the literature. The overall aim of this thesis was to study different aspects of hypoparathyroidism, in terms rates, risks and long-term impact. Paper I is a case control study, investigating prophylactic, preoperative treatment with active vitamin D and early hypocalcemia after total thyroidectomy. The study showed that patients with preoperative treatment had a lower risk of early hypocalcemia and a reduced length of stay in hospital, compared to patients without treatment. No adverse outcomes were found. Paper II is a population-based retrospective cohort study on the rate and risks for permanent hypoparathyroidism after total thyroidectomy for benign thyroid disease. Data was retrieved from The Swedish National Patient Register, The Swedish Quality Register for Thyroid, Parathyroid and Adrenal Surgery and The Swedish Prescribed Drug Registry. Permanent hypoparathyroidism was defined as dispensation of calcium and/or active vitamin D >12 months after surgery. Among 7852 patients, 12.5% developed permanent hypoparathyroidism. Surgery at low volume centers, parathyroid autotransplantation, female gender and high age were independent risk factors. In Paper III the aim was to validate the high rate of permanent hypoparathyroidism found in Paper II. A regional cohort was extrapolated from the national cohort. A retrospective chart review, of 1636 patients, was performed. Using a strict definition, 6.2 % were found to have definitive permanent hypoparathyroidism. Additionally, 2.5 % were found to have possible permanent hypoparathyroidism. Of these, at least 1.7 % might have been overtreated due to lacking attempts to unwind the treatment. The study also proposed that the rate of low early PTH in a cohort might be useful to predict the rate of permanent hypoparathyroidism. Paper IV investigated health related quality of life (HRQoL) in patients with and without permanent hypoparathyroidism using the same cohort as in Paper III and SF-36 v.2. No impact of definitive hypoparathyroidism on HRQoL could be found. In conclusion, the use of preoperative active vitamin D may be useful as a tool to lower the risk of early hypocalcemia. The risk of permanent hypoparathyroidism after total thyroidectomy is high and there is a need for improved follow up. Permanent hypoparathyroidism may not have a negative effect on HRQoL in most patients.

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  • 256.
    Annebäck, Matilda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Hedberg, Jakob
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
    Almquist, Martin
    Stålberg, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Norlén, Olov
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Risk of Permanent Hypoparathyroidism After Total Thyroidectomy for Benign Disease: A Nationwide Population-based Cohort Study From Sweden2021Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, nr 6, s. e1202-e1208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence and risk factors for permanent hypoparathyroidism after total thyroidectomy for benign disease in a population-based setting with data independent of input of complication data.

    SUMMARY OF BACKGROUND DATA: The reported rate of permanent hypoparathyroidism is highly variable and mostly rely on reported complication data from national or institutional registries.

    METHODS: All patients who underwent total thyroidectomy in Sweden from 2005 to 2015 were identified through Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery and the Swedish National Patient Register. Patients were matched to outcome data from the Swedish Prescribed Drug Register. Permanent hypoparathyroidism was defined as treatment with calcium and/or active vitamin D more than 1 year after surgery.

    RESULTS: Seven thousand eight hundred fifty-two patients were included and 938 (12.5%) developed permanent hypoparathyroidism. The risk was lower in patients registered in the quality register (11.0% vs 16%, P < 0.001). In a multivariable analysis there was a higher risk of permanent hypoparathyroidism in patients with parathyroid autotransplantation [Odds ratio (OR) 1.72; 95% confidence interval 1.47-2.01], center-volume <100 thyroidectomies per year (OR 1.22; 1.03-1.44), age above 60 year (OR 1.64; 1.36-1.98) and female sex (OR 1.27; 1.05-1.54). Reported data from the quality register only identified 178 of all 938 patients with permanent hypoparathyroidism.

    CONCLUSION: The risk of permanent hypoparathyroidism after total thyroidectomy was high and associated with parathyroid autotransplantation, higher age, female sex and surgery at a low volume center. Reported follow-up data might underestimate the rate of permanent hypoparathyroidism.

  • 257.
    Annebäck, Matilda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    McHale Sjödin, Edward
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Hellman, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Stålberg, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Norlén, Olov
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Preoperative prophylactic active vitamin D to streamline total thyroidectomy2022Ingår i: BJS Open, E-ISSN 2474-9842, Vol. 6, nr 3, artikel-id zrac060Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Hypocalcaemia is a common complication after total thyroidectomy (TT). Treatment consists of calcium and active vitamin D supplementation. Low levels of vitamin D before surgery have been shown to be a risk factor for postoperative hypocalcaemia, yet studies examining routine preoperative vitamin D supplementation have shown conflicting results. This retrospective cohort study aims to investigate the potential benefit of preoperative active vitamin D supplementation on hypocalcaemia and its symptoms after TT.

    Methods

    This study included patients undergoing TT at Uppsala University Hospital from January 2013 to December 2020, resulting in a total of 401 patients after exclusion. Routine preoperative alfacalcidol treatment was initiated for all TT patients in January 2017 resulting in two groups for comparison: one group (pre-January 2017) that was prescribed preoperative alfacalcidol and one that was not. Propensity score matching was used to reduce bias. The primary outcome was early postoperative hypocalcaemia (serum calcium, S-Ca less than 2.10 mmol/l); secondary outcomes were symptoms of hypocalcaemia and length of stay.

    Results

    After propensity score matching, there were 108 patients in each group. There were 2 cases with postoperative day one S-Ca less than 2.10 in the treated group and 10 cases in the non-treated group (P < 0.001). No patients in the treated group had a S-Ca below 2.00 mmol/l. Preoperative alfacalcidol was associated with higher mean serum calcium level day one (2.33 versus 2.27, P = 0.022), and reduced duration of hospital stay (P < 0.001). There was also a trend toward fewer symptoms of hypocalcaemia (18.9 per cent versus 30.5 per cent, P = 0.099).

    Conclusions

    Prophylactic preoperative alfacalcidol was associated with reduced biochemical hypocalcaemia and duration of hospital stay following TT. Also, with this protocol, it is suggested that routine day 1 postoperative S-Ca measurement is not required.

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  • 258.
    Annebäck, Matilda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Osterman, Carolina
    Arlebrink, Jesper
    Mellerstedt, Simon
    Papathanasakis, Nicolas
    Wallin, Göran
    Hessman, Ola
    Annerbo, Maria
    Norlén, Olov
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Validating the risk of hypoparathyroidism after total thyroidectomy in a population-based cohort: plea for improved follow-up2024Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 111, nr 1, artikel-id znad366Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    A previous nationwide study from Sweden showed that the rate of permanent hypoparathyroidism is high and under-rated in the Swedish Quality Register. This retrospective population-based study aimed to validate the rate and diagnosis of permanent hypoparathyroidism found in the previous study. A secondary aim was to assess the relationship between the rate of low parathyroid hormone (PTH) levels within 24 h after surgery and the rate of permanent hypoparathyroidism.

    Methods

    All patients who underwent total thyroidectomy from 2005 to 2015 in a region of Sweden were included. Data were retrieved from local health records, the National Patient Registry, the Swedish Prescribed Drug Registry, and the Swedish Quality Register. A strict definition of permanent hypoparathyroidism was used, including biochemical data and attempts to stop the treatment.

    Results

    A total of 1636 patients were included. Altogether, 143 patients (8.7 per cent) developed permanent hypoparathyroidism. Of these, 102 (6.2 per cent) had definitive permanent hypoparathyroidism, whereas 41 (2.5 per cent) had possible permanent hypoparathyroidism, because attempts to stop the treatment were lacking (28) or patients were lost to follow-up (13). The agreement between the Swedish Quality Register and the chart review was 29.3 per cent. A proportion of 23.2 per cent with a PTH level below the reference value corresponded to a 6.7 per cent rate of permanent hypoparathyroidism.

    Conclusion

    The risk of permanent hypoparathyroidism after total thyroidectomy is high. Some patients are overtreated because attempts to stop the treatment are lacking. Quality registers might underestimate the risk of permanent hypoparathyroidism. Approximately one-quarter of all patients with low PTH levels immediately after surgery developed permanent hypoparathyroidism.

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  • 259.
    Annebäck, Matilda
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Wachtmeister, Sofia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Stålberg, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Norlén, Olov
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Quality of life in patients with permanent hypoparathyroidism after thyroidectomy: a population-based study with long-term follow upManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background

    In recent years, several studies have shown that permanent hypoparathyroidism has a negative impact on health-related quality of life (HRQoL). However, these results could have been affected by short-term follow up, selection bias and confounding factors. The aim of this study was to investigate HRQoL in patients with and without permanent hypoparathyroidism after total thyroidectomy for benign thyroid disease, using a strict definition of permanent hypoparathyroidism and long-term follow up data. A secondary aim was to evaluate if permanent hypoparathyroidism affects the risk of death.

    Material and Methods

    All patients who underwent total thyroidectomy in a region of Sweden between 2005 and 2015 were assessed for eligibility. All eligible patients were invited to participate in the study through by letter on August, 2021. SF-36v.2 was used to compare HRQoL in patients with and without permanent hypoparathyroidism. 

    Results

    Out of 1636 patients, 1483 patients were invited to participate in the study. In total, 716 (48.3%) patients answered the SF-36v.2 questionnaire and were included in the study cohort. Mean follow-up was 10.9 (SD ±3.2) years. Patients with and without permanent hypoparathyroidism did not differ in baseline characteristics, with the exception that patients with permanent hypoparathyroidism were younger. No difference was found in HRQoL between the groups regarding all health domains and the summary component scores (p>0.05). Survival analysis revealed no increased risk of death in patients with permanent hypoparathyroidism.

    Conclusions

    No difference in HRQoL was found when comparing patients with and without permanent hypoparathyroidism after total thyroidectomy for benign thyroid disease on long-term follow up. Permanent hypoparathyroidism did not affect mortality in the present study; however, this needs to be further investigated in larger studies

  • 260.
    Annerbo, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Hultin, Hella
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Stålberg, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Hellman, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Left-shifted relation between calcium and parathyroid hormone in Graves' Disease2014Ingår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 99, nr 2, s. 545-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Patients with Graves' disease (GD) have disturbances in calcium regulation with manifestations such as postoperative hypocalcemia. We have investigated the thyroid as well as the parathyroid function in detail.

    Material and Method:

    A series of patients undergoing total thyroidectomy for GD (n=56) or Multi Nodular Goitre (MNG, n=50) were scrutinized for postoperative hypocalcemia, need for calcium and/or vitamin D substitution. CiCa-clamp was used in 14 patients and 21 controls to quantify the secretion of PTH in relation to the ionized plasma calcium level. The setpoint, equal to the plasma ionized calcium concentration at which 50% of the maximal secretion of PTH is inhibited, as well as other CiCa-related parameters were calculated.

    Results:

    Hypocalcemia was present in 48% of GD and 41.2% of patients with MNG postoperatively. Patients with GD had lower calcium levels, 18% had S-Ca< 2.00 mmol/L compared to 4.0% in the MNG group, p=0.02. A higher degree of GD patients were given parenteral calcium-substitution during the hospital stay (3.6% vs 0 %) and oral calcium substitution at discharge (48% vs 10%), although they had normal vitamin D3 levels. The GD group showed a significantly left-shifted setpoint compared to the normal group on CiCa clamp, 1.16 mmol/l vs. 1.20 mmol/L (p<0.001), as well as an increased PTH release to hypocalcemic stimulus. GD patients also show an association between degree of subclinical toxicosis at time of surgery and risk for developing postoperative hypocalcemia.

    Conclusion:

    Patients with GD demonstrate dysregulation of the calcium homeostasis by several parameters. GD patients have lower postoperative S-calcium compared to patients with MNG, lower calcium/PTH setpoint and a significantly increased release of PTH to hypocalcemic stimulus compared to controls. The CiCa clamp response in GD patients with normal 25-OH-vitamin D3 levels mimics that of obese patients in which vitamin D insufficiency has been proposed as an underlying cause.

  • 261.
    Annerbo, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Stålberg, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Hellman, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Management of Grave's Disease Is Improved by Total Thyroidectomy2012Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 36, nr 8, s. 1943-1946Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A retrospective analysis was performed on 267 consecutive patients with Graves' disease (GD). The principal aim of this study was to evaluate the risk for recurrence and complications when changing the surgical method from subtotal (ST) to total thyroidectomy (TT). Information from 267 consecutive patients operated on for GD between 2000 and 2006 was collected at Uppsala University Hospital (143) and Falun County Hospital (128). There were 229 women and 38 men. Four patients were operated on twice. A total of 40 STs and 229 TTs were performed. Results were compared to those of a previous cohort from the same hospital, with a majority of STs (157/176) performed from 1980 to 1992. The risk for relapse of GD was reduced from 20 to 3.3 % after the shift from ST to TT. In terms of surgical complications, 2.2 % demonstrated permanent vocal cord paralysis and 4.5 % had persistent hypocalcemia, not significant when compared to the previous cohort. In spite of TT, there were four recurrences, all due to remnant thyroid tissue high up at the hyoid bone. Changing the surgical method did not affect postoperative progression of dysthyroid ophthalmopathy (DO, 7.0 vs. 7.5 %). There were no differences in outcome with respect to which hospital the patients had their operation. Change from ST to TT dramatically reduced the risk for recurrence of GD without increasing the rate of complications. TT is not more effective than ST in hampering progression of DO as has been advocated by some. Careful surgical dissection up to the hyoid bone is necessary to avoid recurrence.

  • 262. Antona-Makoshi, Jacobo
    et al.
    Mikami, Koji
    Lindkvist, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Davidsson, Johan
    Schick, Sylvia
    Accident analysis to support the development of strategies for the prevention of brain injuries in car crashes2018Ingår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 117, s. 98-105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    2+ injuries. Belted occupants were at lower risks than unbelted occupants for most brain injury categories, including concussions. After controlling for the effects of age and crash severity, belted female occupants involved in frontal crashes were estimated to be 1.5 times more likely to sustain a concussion than male occupants in similar conditions. Belted elderly occupants were found to be at 10.5 and 8 times higher risks for sub-dural haemorrhages than non-elderly belted occupants in frontal and side crashes, respectively. Adopted occupant protection strategies appear to be insufficient to achieve significant decreases in risk of both life-threatening brain injuries and concussions for all car occupants. Further effort to develop occupant and injury specific strategies for the prevention of brain injuries are needed. This study suggests that these strategies may consider prioritization of life-threatening brain vasculature injuries, particularly in elderly occupants, and concussion injuries, particularly in female occupants.

  • 263.
    Antona-Makoshi, Jacobo
    et al.
    Japan Automobile Research Insitute, Ibaraki, 2530 Karima, Tsukuba, Japan.
    Mikami, Koji
    Japan Automobile Research Insitute, Ibaraki, 2530 Karima, Tsukuba, Japan.
    Lindquist, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Davidsson, Johan
    Chalmers University of Technology, Gothenburg, Sweden.
    Analysis of Traumatic Brain Injuries Sustained by Occupants in Japanese Brand Car Crashes in the US2018Ingår i: International Journal of Automotive Engineering, E-ISSN 2185-0992, Vol. 9, nr 3, s. 145-150Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study estimates, by means of an analysis of accident data from the US, the incidence and risk of car crash related traumatic brain injuries for occupants in Japanese brand cars. The study incorporated crash type, crash severity, car model year, belt use and the victim's age and sex. Concussion risk was the highest among all brain injury categories for all crash types and severities; females were at higher risks than males. When concussions were excluded, Subdural Haemorrhages, Intracranial Haemorrhages and Sub-Arachnoid Haemorrhages comprised the most frequent injury categories. Elderly occupants were at considerably higher risks than non-elderly for these bleeding injuries

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  • 264.
    Antoniou, George A.
    et al.
    Manchester Univ NHS Fdn Trust, Dept Vasc & Endovasc Surg, Manchester, Lancs, England.;Univ Manchester, Sch Med Sci, Div Cardiovasc Sci, Manchester, Lancs, England..
    Antoniou, Stavros A.
    Mediterranean Hosp Cyprus, Dept Surg, Limassol, Cyprus..
    Mani, Kevin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Enhancing the Reporting of Systematic Reviews and Meta-Analyses in Vascular Surgery: PRISMA 20202021Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 62, nr 4, s. 664-666Artikel i tidskrift (Övrigt vetenskapligt)
  • 265.
    Antoniou, George A.
    et al.
    Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK .
    Bastos Gonçalves, Frederico
    Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; NOVA Medical School, Universidade NOVA de Lisboa, Portuga.
    Björck, Martin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Chakfé, Nabil
    Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.
    Coscas, Raphaël
    Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
    Dias, Nuno V.
    Vascular Centre, Skåne University Hospital, Malmö, Sweden.
    Dick, Florian
    Department of Vascular Surgery, Kantonsspital St. Gallen, University of Bern, Bern, Switzerland.
    Kakkos, Stavros K.
    Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
    Mees, Barend M.E.
    Department of Vascular Surgery, Maastricht University Medical Centre and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.
    Resch, Timothy
    Department of Vascular Surgery, Copenhagen University Hospital- Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Trimarchi, Santi
    Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
    Tulamo, Riikka
    Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Twine, Chris P.
    Department of Vascular Surgery, North Bristol NHS Trust, UK, Bristol, United Kingdom; Centre for Surgical Research, University of Bristol, UK, Bristol, United Kingdom.
    Vermassen, Frank
    Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
    Wanhainen, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Kolh, Philippe
    Department of Biomedical and Preclinical Sciences, University of Liège, Belgium; GIGA Cardiovascular Sciences, University of Liège, Belgium; Department of Information System Management, University Hospital of Liège, Belgium.
    European society for vascular surgery clinical practice guideline development scheme: an overview of evidence quality assessment methods, evidence to decision frameworks, and reporting standards in guideline development2022Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 63, nr 6, s. 791-799Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objective: A structured and transparent approach is instrumental in translating research evidence to health recommendations and evidence informed clinical decisions. The aim was to conduct an overview and analysis of principles and methodologies for health guideline development.

    Methods: A literature review on methodologies, strategies, and fundamental steps in the process of guideline development was performed. The clinical practice guideline development process and methodology adopted by the European Society for Vascular Surgery are also presented.

    Results: Sophisticated methodologies for health guideline development are being applied increasingly by national and international organisations. Their overarching principle is a systematic, structured, transparent, and iterative process that is aimed at making well informed healthcare choices. Critical steps in guideline development include the assessment of the certainty of the body of evidence; evidence to decision frameworks; and guideline reporting. The goal of strength of evidence assessments is to provide well reasoned judgements about the guideline developers’ confidence in study findings, and several evidence hierarchy schemes and evidence rating systems have been described for this purpose. Evidence to decision frameworks help guideline developers and users conceptualise and interpret the construct of the quality of the body of evidence. The most widely used evidence to decision frameworks are those developed by the GRADE Working Group and the WHO-INTEGRATE, and are structured into three distinct components: background; assessment; and conclusions. Health guideline reporting tools are employed to ensure methodological rigour and transparency in guideline development. Such reporting instruments include the AGREE II and RIGHT, with the former being used for guideline development and appraisal, as well as reporting.

    Conclusion: This guide will help guideline developers/expert panels enhance their methodology, and patients/clinicians/policymakers interpret guideline recommendations and put them in context. This document may be a useful methodological summary for health guideline development by other societies and organisations.

  • 266.
    Antoniou, George A.
    et al.
    Manchester Univ NHS Fdn Trust, Dept Vasc & Endovasc Surg, Manchester, Lancs, England.;Univ Manchester, Manchester Acad Hlth Sci Ctr, Sch Med Sci, Div Cardiovasc Sci, Manchester, Lancs, England..
    Goncalves, Frederico Bastos
    Ctr Hosp Univ Lisboa Cent, Lisbon, Portugal.;Univ NOVA Lisboa, NOVA Med Sch, Lisbon, Portugal..
    Björck, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Chakfe, Nabil
    Grp Europeen Rech Protheses Appl Chirurg Vasc, Strasbourg, France.;Univ Hosp Strasbourg, Dept Vasc Surg & Kidney Transplantat, Strasbourg, France..
    Coscas, Raphael
    Ambroise Pare Univ Hosp, Assistance Publ Hop Paris AP HP, Dept Vasc Surg, Boulogne, France.;Univ Versailles St Quentin En Yvelines, UFR Sci Sante Simone Veil, Fac Med Paris Ile France Ouest, Montigny Le Bretonneux, France..
    Dias, Nuno, V
    Skane Univ Hosp, Vasc Ctr, Malmö, Sweden..
    Dick, Florian
    Univ Bern, Kantonsspital St Gallen, Dept Vasc Surg, Bern, Switzerland..
    Kakkos, Stavros K.
    Univ Patras Med Sch, Dept Vasc Surg, Patras, Greece..
    Mees, Barend M. E.
    Maastricht Univ, Dept Vasc Surg, Maastricht Univ Med Ctr, Maastricht, Netherlands.;Maastricht Univ, CARIM Sch Cardiovasc Dis, Maastricht, Netherlands..
    Resch, Timothy
    Univ Copenhagen, Fac Hlth & Med Sci, Rigshosp, Dept Vasc Surg,Copenhagen Univ Hosp, Copenhagen, Denmark..
    Trimarchi, Santi
    IRCCS Ca Granda Osped Maggiore Policlin, Vasc Surg, Milan, Italy.;Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy..
    Tulamo, Riikka
    Univ Helsinki, Helsinki Univ Hosp, Dept Vasc Surg, Helsinki, Finland..
    Twine, Chris P.
    North Bristol NHS Trust, Dept Vasc Surg, Bristol, Avon, England.;Univ Bristol, Ctr Surg Res, Bristol, Avon, England..
    Vermassen, Frank
    Ghent Univ Hosp, Dept Thorac & Vasc Surg, Ghent, Belgium..
    Wanhainen, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi. Umeå Univ, Dept Surg & Perioperat Sci, Umeå, Sweden..
    Kolh, Philippe
    Univ Liege, Dept Biomed & Preclin Sci, Liege, Belgium.;Univ Liege, GIGA Cardiovasc Sci, Liege, Belgium.;Univ Hosp Liege, Dept Informat Syst Management, Liege, Belgium..
    European Society for Vascular Surgery Clinical Practice Guideline Development Scheme: An Overview of Evidence Quality Assessment Methods, Evidence to Decision Frameworks, and Reporting Standards in Guideline Development2022Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 63, nr 6, s. 791-799Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: A structured and transparent approach is instrumental in translating research evidence to health recommendations and evidence informed clinical decisions. The aim was to conduct an overview and analysis of principles and methodologies for health guideline development.

    Methods: A literature review on methodologies, strategies, and fundamental steps in the process of guideline development was performed. The clinical practice guideline development process and methodology adopted by the European Society for Vascular Surgery are also presented.

    Results: Sophisticated methodologies for health guideline development are being applied increasingly by national and international organisations. Their overarching principle is a systematic, structured, transparent, and iterative process that is aimed at making well informed healthcare choices. Critical steps in guideline development include the assessment of the certainty of the body of evidence; evidence to decision frameworks; and guideline reporting. The goal of strength of evidence assessments is to provide well reasoned judgements about the guideline developers' confidence in study findings, and several evidence hierarchy schemes and evidence rating systems have been described for this purpose. Evidence to decision frameworks help guideline developers and users conceptualise and interpret the construct of the quality of the body of evidence. The most widely used evidence to decision frameworks are those developed by the GRADE Working Group and the WHO-INTEGRATE, and are structured into three distinct components: background; assessment; and conclusions. Health guideline reporting tools are employed to ensure methodological rigour and transparency in guideline development. Such reporting instruments include the AGREE II and RIGHT, with the former being used for guideline development and appraisal, as well as reporting.

    Conclusion: This guide will help guideline developers/expert panels enhance their methodology, and patients/clinicians/policymakers interpret guideline recommendations and put them in context. This document may be a useful methodological summary for health guideline development by other societies and organisations.

  • 267.
    Antoniou, Stavros A.
    et al.
    Surgical Department, Mediterranean Hospital of Cyprus, Limassol, Cyprus; Medical School, European University Cyprus, Nicosia, Cyprus.
    Mavridis, Dimitris
    Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece; Faculté de Médecine, Université Paris Descartes, Paris, France.
    Kontouli, Katerina Maria
    Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
    Drakopoulos, Vasileios
    1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
    Gorter-Stam, Marguerite
    Department of Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands.
    Eriksson, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Leone, Marc
    Department of Anesthesiology and Critical Care Medicine, Nord Hospital, Marseille, France.
    Pérez-Bocanegra, Maria Carmen
    Geriatrics Department, Hospital Universitari Vall D’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
    Smart, Neil J.
    Department of Surgery, Department of Surgery, Royal Devon & Exeter Hospital, Exeter, United Kingdom.
    Milone, Marco
    Department of Clinical Medicine and Surgery, University “Federico II” of Naples, Naples, Italy.
    Carrano, Francesco Maria
    PhD Program in Applied Medical-Surgical Sciences, University of Rome “Tor Vergata”, Rome, Italy; Department of Surgical Sciences, University of Rome “Tor Vergata”, Rome, Italy.
    Antoniou, George A.
    Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom.
    Vandvik, Per Olav
    Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
    EAES rapid guideline: appendicitis in the elderly2021Ingår i: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 35, nr 7, s. 3233-3243Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients.

    Methods: We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.

    Results: This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494.

    Conclusions: This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.

  • 268. Antonsson, J B
    et al.
    Engström, L
    Rasmussen, I
    Wollert, S
    Haglund, U H
    Changes in gut intramucosal pH and gut oxygen extraction ratio in a porcine model of peritonitis and hemorrhage.1995Ingår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 23, nr 11, s. 1872-81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To establish the relationship between gut intramucosal pH and blood flow to the gut, gut oxygen delivery, and gut oxygen extraction ratio in a porcine model of peritonitis and hemorrhage.

    DESIGN: Prospective, controlled study.

    SETTING: Experimental laboratory in a university teaching hospital.

    SUBJECTS: Thirty pigs of both sexes, weighing 15 to 22 kg.

    INTERVENTIONS: Animals were anesthetized, intubated, and mechanically ventilated. A flow probe was placed around the superior mesenteric artery for registration of blood flow. A tonometer was placed in the lumen of midileum for calculation of gut intramucosal pH. Hourly, for 5 hrs, blood samples were taken from mixed venous, mesenteric venous, and arterial blood. Five animals served as controls, ten animals had peritonitis induced by fecal instillation in the abdominal cavity, five were bled stepwise, five were bled rapidly (to a mean arterial pressure of 30 mm Hg), and five were bled rapidly and reinfused after 3 hrs.

    MEASUREMENTS AND MAIN RESULTS: Both peritonitis and hemorrhage caused decreases in gut blood flow and intramucosal pH. In mild peritonitis, the intramucosal pH decrease preceded that of blood flow. In all experimental groups, oxygen delivery decreased over time; in both mild and severe peritonitis, this decrease was preceded by a decrease of intramucosal pH. Intramucosal pH correlated well with gut oxygen extraction ratio in peritonitis (r2 = .86). In hemorrhage, there was a correlation of r2 = .66, but in intramucosal pH of < 7.12, a further decrease was accompanied only by minor changes in extraction ratio.

    CONCLUSIONS: Since a reduction in blood flow was preceded by a decrease in intramucosal pH, low intramucosal pH in peritonitis cannot be explained by low flow alone. Gut oxygen delivery proved to be a poor indicator of gut acidosis (i.e., low intramucosal pH). In peritonitis, a decreasing intramucosal pH was associated with an increasing oxygen extraction ratio. In hemorrhage, this association had a sharp deflection point below which a further decrease in intramucosal pH occurred concomitantly with an unchanged gut oxygen extraction ratio. Increased extraction ratio was not sufficient, not even initially, to maintain aerobic metabolism (i.e., unchanged intramucosal pH).

  • 269.
    Appelgren, Matilda
    et al.
    Karolinska Inst, Dept Mol Med & Surg, Anna Stecksens Gata 35, S-17176 Stockholm, Sweden..
    Sackey, Helena
    Karolinska Inst, Dept Mol Med & Surg, Anna Stecksens Gata 35, S-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Div Canc, Dept Breast Endocrine Tumors & Sarcoma, S-17164 Solna, Sweden..
    Wengstrom, Yvonne
    Karolinska Univ Hosp, Karolinska Comprehens Canc Ctr, S-17164 Solna, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, S-14152 Huddinge, Sweden..
    Johansson, Karin
    Lund Univ, Dept Hlth Sci, S-22100 Lund, Sweden..
    Ahlgren, Johan
    Univ Hosp, Dept Oncol, S-70185 Örebro, Sweden.;Midsweden Hlth Care Reg, Reg Oncol Ctr, S-75185 Uppsala, Sweden..
    Andersson, Yvette
    Vastmanland Cty Hosp, Dept Surg, S-72189 Västerås, Sweden.;Uppsala Univ, Vastmanland Cty Hosp, Ctr Clin Res, S-72189 Västerås, Sweden..
    Bergkvist, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Frisell, Jan
    Karolinska Univ Hosp, Div Canc, Dept Breast Endocrine Tumors & Sarcoma, S-17164 Solna, Sweden..
    Lundstedt, Dan
    Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Inst Clin Sci,Dept Oncol, S-41345 Gothenburg, Sweden..
    Ryden, Lisa
    Lund Univ, Dept Clin Sci Lund, Div Surg, S-22184 Lund, Sweden.;Skane Univ Hosp, Dept Surg & Gastroenterol, S-21428 Malmö, Sweden..
    Sund, Malin
    Umeå Univ, Dept Surg & Perioperat Sci Surg, S-70987 Umeå, Sweden.;Univ Helsinki, Dept Surg, POB 440, Helsinki, Finland.;Helsinki Univ Hosp, POB 440, Helsinki, Finland..
    Alkner, Sara
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Div Oncol, S-22184 Lund, Sweden..
    Offersen, Birgitte Vrou
    Aarhus Univ Hosp, Dept Expt Clin Oncol, DK-8200 Aarhus, Denmark.;Aarhus Univ Hosp, Dept Oncol, DK-8200 Aarhus, Denmark.;Aarhus Univ Hosp, Danish Breast Canc Grp Ctr, DK-8200 Aarhus, Denmark.;Aarhus Univ Hosp, Clin Late Effects, DK-8200 Aarhus, Denmark..
    Tvedskov, Tove Filtenborg
    Rigshosp, Dept Breast Surg, DK-2100 Copenhagen, Denmark..
    Christiansen, Peer
    Aarhus Univ Hosp, Danish Breast Canc Grp Ctr, DK-8200 Aarhus, Denmark.;Aarhus Univ Hosp, Clin Late Effects, DK-8200 Aarhus, Denmark.;Aarhus Univ Hosp, Dept Plast & Breast Surg, DK-8200 Aarhus, Denmark..
    de Boniface, Jana
    Karolinska Inst, Dept Mol Med & Surg, Anna Stecksens Gata 35, S-17176 Stockholm, Sweden.;Capio St Gorans Hosp, Dept Surg, S-11219 Stockholm, Sweden..
    Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial2022Ingår i: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 63, s. 16-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: This report evaluates whether health related quality of life (HRQoL) and patient-reported arm morbidity one year after axillary surgery are affected by the omission of axillary lymph node dissection (ALND). Methods: The ongoing international non-inferiority SENOMAC trial randomizes clinically node-negative breast cancer patients (T1-T3) with 1-2 sentinel lymph node (SLN) macrometastases to completion ALND or no further axillary surgery. For this analysis, the first 1181 patients enrolled in Sweden and Denmark between March 2015, and June 2019, were eligible. Data extraction from the trial database was on November 2020. This report covers the secondary outcomes of the SENOMAC trial: HRQoL and patient-reported arm morbidity. The EORTC QLQC30, EORTC QLQ-BR23 and Lymph-ICF questionnaires were completed in the early postoperative phase and at one-year follow-up. Adjusted one-year mean scores and mean differences between the groups are presented corrected for multiple testing.

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  • 270.
    Appelgren, Matilda
    et al.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Sackey, Helena
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Solna, Sweden.
    Wengström, Yvonne
    Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Solna, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Johansson, Karin
    Department of Health Sciences, Lund University, Lund, Sweden.
    Ahlgren, Johan
    Department of Oncology, University Hospital, Örebro, Sweden; Regional Oncology Centre, Mid-Sweden Health Care Region, Uppsala, Sweden.
    Andersson, Yvette
    Department of Surgery, Västmanland County Hospital, Västerås, Sweden; Västmanland County Hospital, Center for Clinical Research, Uppsala University, Västerås, Sweden.
    Bergkvist, Leif
    Västmanland County Hospital, Center for Clinical Research, Uppsala University, Västerås, Sweden.
    Frisell, Jan
    Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Solna, Sweden.
    Lundstedt, Dan
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rydén, Lisa
    Division of Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Alkner, Sara
    Division of Oncology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden.
    Vrou Offersen, Birgitte
    Department of Experimental Clinical Oncology Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus University Hospital, Aarhus, Denmark.
    Filtenborg Tvedskov, Tove
    Department of Breast Surgery, Rigshospitalet, Copenhagen, Denmark.
    Christiansen, Peer
    Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus University Hospital, Aarhus, Denmark; Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.
    de Boniface, Jana
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden.
    Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial2022Ingår i: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 63, s. 16-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: This report evaluates whether health related quality of life (HRQoL) and patient-reported arm morbidity one year after axillary surgery are affected by the omission of axillary lymph node dissection (ALND).

    Methods: The ongoing international non-inferiority SENOMAC trial randomizes clinically node-negative breast cancer patients (T1-T3) with 1–2 sentinel lymph node (SLN) macrometastases to completion ALND or no further axillary surgery. For this analysis, the first 1181 patients enrolled in Sweden and Denmark between March 2015, and June 2019, were eligible. Data extraction from the trial database was on November 2020. This report covers the secondary outcomes of the SENOMAC trial: HRQoL and patient-reported arm morbidity. The EORTC QLQ-C30, EORTC QLQ-BR23 and Lymph-ICF questionnaires were completed in the early postoperative phase and at one-year follow-up. Adjusted one-year mean scores and mean differences between the groups are presented corrected for multiple testing.

    Results: Overall, 976 questionnaires (501 in the SLN biopsy only group and 475 in the completion ALND group) were analysed, corresponding to a response rate of 82.6%. No significant group differences in overall HRQoL were identified. Participants receiving SLN biopsy only, reported significantly lower symptom scores on the EORTC subscales of pain, arm symptoms and breast symptoms. The Lymph-ICF domain scores of physical function, mental function and mobility activities were significantly in favour of the SLN biopsy only group.

    Conclusion: One year after surgery, arm morbidity is significantly worse affected by ALND than by SLN biopsy only. The results underline the importance of ongoing attempts to safely de-escalate axillary surgery.

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  • 271.
    Arakelian, Erebouni
    Uppsala universitet, Institutionen för kirurgiska vetenskaper.
    Operating Room Efficiency and Postoperative Recovery after Major Abdominal Surgery: The Surgical Team’s Efficiency and the Early Postoperative Recovery of Patients with Peritoneal Carcinomatosis2011Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    In selected patients, surgical treatments such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have enabled curative treatment options for previously incurable diseases, such as peritoneal carcinomatosis (PC). The introduction of resource demanding surgery could affect the work process, efficiency, and productivity within a surgical department and factors influencing patient postoperative recovery processes may have an impact on the efficiency of patient care after major surgery.

    The aim of this thesis was to investigate operating room efficiency from the perspective of both staff and leaders’ in two different settings (Papers I and II) and the early postoperative recovery of patients with peritoneal carcinomatosis (Papers III and IV).

    Interviews were held with 21 people in a county hospital and 11 members of the PC team in a university hospital, and a phenomenographic approach was used to analysis the data (Papers I and II). The patients’ postoperative recovery and pulmonary adverse events (AE) were determined from data retrieved from the electronic health records of 76 patients (Papers III and IV).

    The concept of efficiency was understood in different ways by staff members and their leaders (Paper I). However, when working in a team, the team members had both organisation-oriented and individual-oriented understanding of efficiency at work that focused on the patients and the quality of care (Paper II).

    The patients with PC regained gastrointestinal functions and could be mobilised during early postoperative recovery phase, although many patients suffered from psychological disturbances, sleep deprivation, and nausea (Paper III). Postoperative clinical and radiological pulmonary AE were common, but did not affect the early recovery process (Paper IV).

    In conclusion, leaders who are aware of the variation in understanding the concept of efficiency are better able to create the same platform for staff members by defining the concept of efficiency within the organisation. In a team organisation, the team members have a wider understanding of the concept of efficiency with more focus on the patients. The factors affecting postoperative recovery and pulmonary AE should be considered when designing individualised patient care plans in order to attain a more efficient recovery.

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  • 272.
    Arakelian, Erebouni
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Operating Room Efficiency and Postoperative Recovery after Major Abdominal Surgery: The Surgical Team’s Efficiency and the Early Postoperative Recovery of Patients with Peritoneal Carcinomatosis2011Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    In selected patients, surgical treatments such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have enabled curative treatment options for previously incurable diseases, such as peritoneal carcinomatosis (PC). The introduction of resource demanding surgery could affect the work process, efficiency, and productivity within a surgical department and factors influencing patient postoperative recovery processes may have an impact on the efficiency of patient care after major surgery.

    The aim of this thesis was to investigate operating room efficiency from the perspective of both staff and leaders’ in two different settings (Papers I and II) and the early postoperative recovery of patients with peritoneal carcinomatosis (Papers III and IV).

    Interviews were held with 21 people in a county hospital and 11 members of the PC team in a university hospital, and a phenomenographic approach was used to analysis the data (Papers I and II). The patients’ postoperative recovery and pulmonary adverse events (AE) were determined from data retrieved from the electronic health records of 76 patients (Papers III and IV).

    The concept of efficiency was understood in different ways by staff members and their leaders (Paper I). However, when working in a team, the team members had both organisation-oriented and individual-oriented understanding of efficiency at work that focused on the patients and the quality of care (Paper II).

    The patients with PC regained gastrointestinal functions and could be mobilised during early postoperative recovery phase, although many patients suffered from psychological disturbances, sleep deprivation, and nausea (Paper III). Postoperative clinical and radiological pulmonary AE were common, but did not affect the early recovery process (Paper IV).

    In conclusion, leaders who are aware of the variation in understanding the concept of efficiency are better able to create the same platform for staff members by defining the concept of efficiency within the organisation. In a team organisation, the team members have a wider understanding of the concept of efficiency with more focus on the patients. The factors affecting postoperative recovery and pulmonary AE should be considered when designing individualised patient care plans in order to attain a more efficient recovery.

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  • 273.
    Arakelian, Erebouni
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Larsson, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Norlén, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Mahteme, Haile
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy2011Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 37, nr 10, s. 897-903Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can prolong survival in selected patients with peritoneal carcinomatosis (PC). However, there is little data on patients' recovery process after this complex treatment. This study aimed to describe the in-hospital postoperative recovery and factors related to the recovery of patients who undergo CRS and HIPEC.

    METHOD:

    A retrospective audit of the electronic health record (EHR) was undertaken for 76 PC patients (42 women, 34 men) treated primarily with CRS and HIPEC between 2005 and 2006 in Sweden.

    RESULTS:

    Oral intake, regaining bowel functions and mobilisation usually occurred between 7 and 11 days postoperatively. Patients experienced nausea for up to 13 days postoperatively. Forty-two patients were satisfied with their pain management, which usually took the form of epidural anaesthesia and which continued for about one week post-surgery. Sleep disturbance was observed in 51 patients and psychological problems in 49 patients during the first three postoperative weeks. Tumour burden, stoma formation, use of CPAP, primary diagnosis, and the length of stay in the ICU were factors related to an early recovery process.

    CONCLUSION:

    Drinking, eating, regaining bowel functions and mobilisation were re-established within 11 days of CRS and HIPEC. Tumour burden, stoma formation, use of CPAP, primary diagnosis and the length of stay in the ICU all had an impact on postoperative recovery, and should be discussed with the patients preoperatively and taken into consideration in designing an individualised patient care plan, in order to attain a more efficient recovery.

  • 274.
    Arakelian, Erebouni
    et al.
    Uppsala universitet, Kolorektalkirurgi.
    Gunningberg, Lena
    Uppsala universitet, Vårdvetenskap.
    Larsson, Jan
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Norlén, Karin
    Uppsala universitet, Anestesiologi och intensivvård.
    Mahteme, Haile
    Uppsala universitet, Kolorektalkirurgi.
    Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy2011Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 37, nr 10, s. 897-903Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can prolong survival in selected patients with peritoneal carcinomatosis (PC). However, there is little data on patients' recovery process after this complex treatment. This study aimed to describe the in-hospital postoperative recovery and factors related to the recovery of patients who undergo CRS and HIPEC.

    METHOD:

    A retrospective audit of the electronic health record (EHR) was undertaken for 76 PC patients (42 women, 34 men) treated primarily with CRS and HIPEC between 2005 and 2006 in Sweden.

    RESULTS:

    Oral intake, regaining bowel functions and mobilisation usually occurred between 7 and 11 days postoperatively. Patients experienced nausea for up to 13 days postoperatively. Forty-two patients were satisfied with their pain management, which usually took the form of epidural anaesthesia and which continued for about one week post-surgery. Sleep disturbance was observed in 51 patients and psychological problems in 49 patients during the first three postoperative weeks. Tumour burden, stoma formation, use of CPAP, primary diagnosis, and the length of stay in the ICU were factors related to an early recovery process.

    CONCLUSION:

    Drinking, eating, regaining bowel functions and mobilisation were re-established within 11 days of CRS and HIPEC. Tumour burden, stoma formation, use of CPAP, primary diagnosis and the length of stay in the ICU all had an impact on postoperative recovery, and should be discussed with the patients preoperatively and taken into consideration in designing an individualised patient care plan, in order to attain a more efficient recovery.

  • 275.
    Arana Håkanson, Cecilia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Barnkirurgisk forskning.
    Fredriksson, Fanny
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Barnkirurgisk forskning. Section of Pediatric Surgery, Uppsala University Children's Hospital.
    Engstrand Lilja, Helene
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Barnkirurgisk forskning. Section of Pediatric Surgery, Uppsala University Children's Hospital.
    Adhesive small bowel obstruction after appendectomy in children: Laparoscopic versus open approach2020Ingår i: Journal of Pediatric Surgery, ISSN 0022-3468, E-ISSN 1531-5037, Vol. 55, nr 11, s. 2419-2424Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The aims of this study were to compare the incidence of small bowel obstruction (SBO) requiring laparotomy after laparoscopic appendectomy (LA) and open appendectomy (OA) in children and to identify risk factors for SBO.

    Methods

    Medical records of patients who underwent appendectomy from 2000 to 2014 at our department of Pediatric Surgery were reviewed. Risk factors were analyzed using Cox proportional hazard regression.

    Results

    Totally 619 out of 840 patients were included. OA was performed in 474 (76.6%), LA in 130 patients (21%), and 15 (2.4%) were converted from LA to OA. Age, sex and proportion of perforated appendicitis were comparable in the LA and OA groups. Median follow-up time was 11.4 years (2.6–18.4). The incidence of SBO after LA was 1.5%, after OA 1.9% and in the converted group 6.7% (p = 0.3650). There were no significant differences in the incidence of postoperative intraabdominal abscess, wound infection or length of stay between LA and OA. Perforation and postoperative intra-abdominal abscess were identified as risk factors with 9.03 (p < 0.001) and 6.98 (p = 0.004) times higher risk of SBO, respectively.

    Conclusions

    The risk for SBO after appendectomy in children was significantly related to perforated appendicitis and postoperative intra-abdominal abscess and not to the surgical approach.

    Level of Evidence

    Level III.

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  • 276.
    Arbeus, Mikael
    et al.
    Örebro Univ, Fac Med & Hlth, Dept Cardiothorac & Vasc Surg, Örebro, Sweden..
    Souza, Domingos
    Örebro Univ, Fac Med & Hlth, Dept Cardiothorac & Vasc Surg, Örebro, Sweden..
    Geijer, Hakan
    Örebro Univ, Fac Med & Hlth, Dept Radiol, Örebro, Sweden..
    Liden, Mats
    Örebro Univ, Fac Med & Hlth, Dept Radiol, Örebro, Sweden..
    Pinheiro, Bruno
    Hosp Coracao Anis Rassi, Dept Cardiovasc Surg, Goiania, Go, Brazil..
    Bodin, Lennart
    Karolinska Inst, Inst Environm Med, Intervent & Implementat Res, Stockholm, Sweden..
    Samano, Ninos
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala Univ, Uppsala Univ Hosp, Dept Cardiothorac Surg, Uppsala, Sweden..
    Five-year patency for the no-touch saphenous vein and the left internal thoracic artery in on- and off-pump coronary artery bypass grafting2021Ingår i: Journal of cardiac surgery, ISSN 0886-0440, E-ISSN 1540-8191, Vol. 36, nr 10, s. 3702-3708Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Randomized trials show high long-term patency for no-touch saphenous vein grafts in coronary artery bypass grafting. The patency rate in off-pump coronary bypass surgery for these grafts has not been investigated. Our center participated in the CORONARY randomized trial, NCT00463294. This is a study aimed to assess the patency of no-touch saphenous veins in on- versus off-pump coronary bypass surgery at five-year follow-up. Methods Fifty-six patients were included. Forty of 49 patients, alive at 5 years, participated in this follow-up. There were 21 and 19 patients in the on- and off-pump groups respectively. No-touch saphenous veins were used to bypass all targets and in some cases the left anterior descending artery. Graft patency according to distal anastomosis was evaluated with computed tomography angiography. Results The five-year patency rate was 123/139 (88.5%). The patency for the no-touch vein grafts was 57/64 (89.1%) in the on-pump versus 37/45 (82.2%) in the off-pump group. All left internal thoracic arteries except for one, 29/30 (96.6%), were patent. All vein grafts used to bypass the left anterior descending and the diagonal arteries were patent 32/32. The lowest patency rate for the saphenous veins was to the right coronary territory, particularly in off-pump surgery (80.0% vs. 62.5% for the on- respective off-pump groups). Conclusions Comparable 5-year patency for the no-touch saphenous veins and the left internal thoracic arteries to the left anterior descending territory in both on- and off-pump coronary artery bypass grafting. Graft patency in off-pump CABG is lower to the right coronary artery.

  • 277. Archibugi, Livia
    et al.
    Graglia, Benedetta
    Valente, Roberto
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Digestive and Liver Disease Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Milan, Italy; Department of Surgery, Anschutz Medical Campus, University of Colorado, Denver, USA.
    Stigliano, Serena
    Roberto, Michela
    Capalbo, Carlo
    Marchetti, Paolo
    Nigri, Giuseppe
    Capurso, Gabriele
    Gynecological and reproductive factors and the risk of pancreatic cancer: A case-control study2020Ingår i: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 20, nr 6, s. 1149-1154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: /Objectives: Pancreatic ductal adenocarcinoma (PDAC) has a higher incidence in men compared to women, although the difference in known risk factors cannot explain this disparity completely. Reproductive and hormonal factors have been demonstrated in pre-clinical studies to influence pancreatic carcinogenesis, but the few published data on the topic are inconsistent. The aim was to investigate the role of reproductive and hormonal factors on PDAC occurrence in women.

    METHODS: We conducted a unicenter case-control study; PDAC cases were matched to controls by age with a 1:2 ratio. Risk factors were screened through questionnaires about gynecologic and medical history. Comparisons were made using Chi-square and Fisher's exact tests where appropriate for categorical variables and Student's t-test for continuous variables. Logistic regression was used to calculate Odds Ratios (ORs) and their 95% confidence intervals (CI). Multivariable logistic regression models were adjusted for potential confounders.

    RESULTS: 253 PDAC and 506 matched controls were enrolled. At logistic regression multivariable analysis adjusted for confounding factors, older age at menopause (OR:0.95 per year; 95% CI:0.91-0.98; p = 0.007), use of Oral Contraceptives (OR:0.52; 95% CI:0.30-0.89; p = 0.018), use of Hormonal Replacement Therapy (OR:0.31; 95% CI:0.15-0.64; p = 0.001), and having had two children (OR:0.57; 95% CI:0.38-0.84; p = 0.005) were significant, independent protective factors for the onset of PDAC.

    CONCLUSIONS: These data confirm some previous findings on menopause age and number of births while, to our knowledge, this is the first study to show a protective effect of HRT and OC use. The results collectively support the hypothesis that exposure to estrogens plays a protective role towards PDAC.

  • 278.
    Ardern, Clare L.
    et al.
    Linkoping Univ, Div Physiotherapy, Linkoping, Sweden.;Aspetar Orthopaed & Sports Med Hosp, Doha, Qatar.;La Trobe Univ, Sch Allied Hlth, Melbourne, Vic, Australia..
    Österberg, Annika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Linkoping, Sweden..
    Sonesson, Sofi
    Linkoping Univ, Div Physiotherapy, Linkoping, Sweden..
    Gauffin, Håkan
    Linkoping Univ, Dept Orthopaed, Linkoping, Sweden..
    Webster, Kate E.
    La Trobe Univ, Sch Allied Hlth, Melbourne, Vic, Australia..
    Kvist, Joanna
    Linkoping Univ, Div Physiotherapy, Linkoping, Sweden..
    Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity2016Ingår i: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 32, nr 8, s. 1631-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To assess whether patient-reported outcomes (psychological factors, appraisals of knee function, and physical activity participation) were associated with satisfaction with knee function after anterior cruciate ligament (ACL) reconstruction. Methods: Participants who were aged 18 to 45 years and a minimum 12 months post primary ACL reconstruction completed a questionnaire battery evaluating knee self-efficacy, knee-related quality of life, self-reported function, and physical activity participation. Participants' responses to the question "If you were to spend the rest of your life with your knee just the way it has been in the last week, would you feel.... (7-point ordinal scale; 1 = happy, 7 = unhappy)" were categorized as satisfied, mostly satisfied, or dissatisfied and used as the primary outcome. Ordinal regression was used to examine associations between independent variables and the primary outcome. Results: A total of 177 participants were included at an average of 3 years after primary ACL reconstruction. At follow-up, 44% reported they would be satisfied, 28% mostly satisfied, and 28% dissatisfied with the outcome of ACL reconstruction. There were significant differences in psychological responses and appraisal of knee function between the 3 groups (P = .001), and significantly more people in the satisfied group had returned to their preinjury activity (58%) than in the mostly satisfied (28%) and dissatisfied (26%) groups (P = .001). Multivariable analysis demonstrated that the odds of being satisfied increased by a factor of 3 with higher self-efficacy, greater knee-related quality of life, and returning to the preinjury activity. Conclusions: People who had returned to their preinjury physical activity and who reported higher knee-related self-efficacy and quality of life were more likely to be satisfied with the outcome of ACL reconstruction.

  • 279.
    Aresdahl, Alexander
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Käkkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Lindell, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Käkkirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Dukic, Milena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Klinisk och experimentell patologi.
    Thor, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Käkkirurgi.
    Congenital granular cell epulis: a case report2015Ingår i: Oral and Maxillofacial Surgery Cases, ISSN 2214-5419, Vol. 1, nr 1, s. 8-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Congenital granular cell epulis (CGCE) is an uncommon benign lesion found in newborns. It has predominance for females with an 8:1 ratio in relation to males and is exclusively encountered in the oral cavity. The most affected oral site is located around the canine/incisor region of the maxillary alveolar ridge, where the lesion arises from the soft tissue as a solitary pedunculated mass. CGCE's histogenesis remains obscure and controversial. We present a rare case of 2 separate CGCE lesions adjacent to each other measuring 23 × 18 × 10 and 15 × 10 mm, positioned facially on the right maxillary alveolar process. The patient, a 2-day-old female newborn, did not experience any serious difficulty regarding breathing or deglutition. Complete surgical excision was the treatment of choice in this case, and the procedure was performed under both general and local anesthesia. Histologic and immunohistochemical analysis confirmed the diagnosis of CGCE. The patient showed satisfactory postoperative healing and excellent health at both the 10-day recall appointment and the 6-month follow-up.

  • 280.
    Arezzo, Alberto
    et al.
    Univ Torino, Italy.
    Francis, Nader
    Yeovil Dist Hosp NHS Fdn Trust, England; Northwick Pk & St Marks Hosp, England.
    Mintz, Yoav
    Hebrew Univ Jerusalem, Israel.
    Adamina, Michel
    Cantonal Hosp Winterthur, Switzerland; Univ Basel, Switzerland.
    Antoniou, Stavros A.
    European Univ Cyprus, Cyprus; Mediterranean Hosp Cyprus, Cyprus.
    Bouvy, Nicole
    Maastricht Univ, Netherlands.
    Copaescu, Catalin
    Ponderas Acad Hosp, Romania.
    de Manzini, Nicolo
    Univ Trieste, Italy.
    Di Lorenzo, Nicola
    Univ Roma Tor Vergata, Italy.
    Morales-Conde, Salvador
    Univ Seville, Spain.
    Mueller-Stich, Beat P.
    Univ Heidelberg Hosp, Germany.
    Nickel, Felix
    Univ Heidelberg Hosp, Germany.
    Popa, Dorin
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Tait, Diana
    Royal Marsden NHS Fdn Trust, England.
    Thomas, Cenydd
    Yeovil Dist Hosp NHS Fdn Trust, England.
    Nimmo, Susan
    Western Gen Hosp, Scotland.
    Paraskevis, Dimitrios
    Natl & Kapodistrian Univ Athens, Greece.
    Pietrabissa, Andrea
    Fdn IRCCS Policlin San Matteo, Italy.
    EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic2021Ingår i: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 35, s. 1-17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic. Methods Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement. Results A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus. Conclusion The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems.

  • 281.
    Aristokleous, Iliana
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala Univ Hosp, Dept Surg, Endocrine and Breast Unit, S-75237 Uppsala, Sweden..
    Öberg, Johanna
    Uppsala Univ Hosp, Dept Surg, Endocrine and Breast Unit, S-75237 Uppsala, Sweden.;Uppsala Univ, Fac Med, Dept Surg Sci, S-75236 Uppsala, Sweden..
    Pantiora, Eirini
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Uppsala Univ Hosp, Dept Surg, Endocrine and Breast Unit, S-75237 Uppsala, Sweden..
    Sjökvist, Olivia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, S-75237 Uppsala, Sweden..
    Navia, Jaime E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala Univ Hosp, Dept Surg, Endocrine and Breast Unit, S-75237 Uppsala, Sweden..
    Mani, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi. Uppsala Univ Hosp, Dept Plast & Maxillofacial Surg, S-75237 Uppsala, Sweden..
    Karakatsanis, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Uppsala Univ Hosp, Dept Surg, Endocrine and Breast Unit, S-75237 Uppsala, Sweden..
    Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy: A cross-sectional study2023Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, nr 1, s. 60-67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM).

    Methods: This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews.

    Results: There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs -1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy.

    Conclusions: These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity.

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  • 282.
    Arnadottir, Solrun Dogg
    et al.
    Univ Akureyri, Sch Hlth Sci, Akureyri, Iceland.;Landspitali Univ Hosp, Vasc Surg Unit, Reykjavik, Iceland..
    Palsdottir, Gudbjorg
    Landspitali Univ Hosp, Wound Care Unit, Reykjavik, Iceland..
    Logason, Karl
    Landspitali Univ Hosp, Vasc Surg Unit, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Arnardottir, Harpa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning. Univ Akureyri, Sch Hlth Sci, Akureyri, Iceland.;Akureyri Hosp, Rehabil Unit, Akureyri, Iceland..
    Aflimanir ofan ökkla 2010-2019 vegna útæðasjúkdóms og/eða sykursýki: Aðdragandi og áhættuþættir2024Ingår i: Laeknabladid: The icelandic medical journal, ISSN 0023-7213, E-ISSN 1670-4959, Vol. 110, nr 1, s. 20-27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: No recent studies exist on lower extremity amputations (LLAs) in Iceland. The aim of this study was to investigate LLA incidence in Iceland 2010-2019 and preceding procedures in amputations induced by peripheral arterial disease (PAD) and diabetes mellitus (DM).

    MATERIAL AND METHODS: Retrospective study on clinical records of all patients (>18 years) who underwent LLA in Iceland's two main hospitals during 2010-2019. Patients were excluded if LLA was performed for reasons other than DM and/or PAD. Symptoms, medication and circulation assessment were recorded from first hospital visit due to symptoms, and prior to the last LLA, respectively. Previous arterial surgeries and amputations were also recorded.

    RESULTS: A total of 167 patients underwent LLA. Thereof, 134 (77 ± 11 years, 93 men and 41 woman) due to DM and/or PAD. The LLA-rate due to those diseases increased from 4.1/100,000 inhabitants in 2010-2013 to 6.7/100,000 in 2016-2019 (p=0,04). Risk factors were mainly hypertension, 84%, and smoking, 69%. Chronic limb -threatening ischemia induced 71% of first hospital visits. Revascularisations were performed (66% endovascular) in 101 patients. Non -diabetic patients were 52% and had statins less frequently prescribed than DM patients (26:45, p<0.001).

    CONCLUSION: DM and/or PAD are the leading causes of LLA in Iceland. Amputation rate increased during the period but is low in an international context. Amputation is most often preceded by arterial surgery. DM is present in almost half of cases, similar or less than in most other countries. Opportunities for improved prevention should aim on earlier diagnosis and preventive treatment of non -diabetic individuals with PAD.

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  • 283.
    Arnardottir, Steinunn
    et al.
    Uppsala Univ, Sweden; Uppsala Univ Hosp, Sweden.
    Jaras, Jacob
    Reg Canc Ctr RCC Stockholm Gotland, Sweden.
    Burman, Pia
    Lund Univ, Sweden.
    Berinder, Katarina
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Dahlqvist, Per
    Umea Univ, Sweden.
    Erfurth, Eva Marie
    Lund Univ, Sweden.
    Hoybye, Charlotte
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Larsson, Karin
    Uppsala Univ, Sweden; Uppsala Univ Hosp, Sweden.
    Ragnarsson, Oskar
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Ekman, Bertil
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Endokrinmedicinska kliniken. Region Östergötland, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Engstrom, Britt Eden
    Uppsala Univ, Sweden; Uppsala Univ Hosp, Sweden.
    Long-term outcomes of patients with acromegaly: a report from the Swedish Pituitary Register2022Ingår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 186, nr 3, s. 329-339Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To describe the treatment and long-term outcomes of patients with acromegaly from all healthcare regions in Sweden. Design and methods: Analysis of prospectively reported data from the Swedish Pituitary Register of 698 patients (51% females) with acromegaly diagnosed from 1991 to 2011. The latest clinical follow-up date was December 2012, while mortality data were collected for 28.5 years until June 2019. Results: The annual incidence was 3.7/million; 71% of patients had a macroadenoma, 18% had visual field defects, and 25% had at least one pituitary hormone deficiency. Eighty-two percent had pituitary surgery, 10% radiotherapy, and 39% medical treatment. At the 5- and 10-year follow-ups, insulin-like growth factor 1 levels were within the reference range in 69 and 78% of patients, respectively. In linear regression, the proportion of patients with biochemical control including adjuvant therapy at 10 years follow-up increased over time by 1.23% per year. The standardized mortality ratio (SMR) (95% CI) for all patients was 1.29 (1.11-1.49). For patients with biochemical control at the latest follow-up, SMR was not increased, neither among patients diagnosed between 1991 and 2000, SMR: 1.06 (0.85-1.33) nor between 2001 and2011, SMR: 0.87 (0.61-1.24). In contrast, non-controlled patients at the latest follow-up from both decades had elevated SMR, 1.90 (1.33-2.72) and 1.98 (1.24-3.14), respectively. Conclusions: The proportion of patients with biochemical control increased over time. Patients with biochemically controlled acromegaly have normal life expectancy, while non-controlled patients still have increased mortality. The high rate of macroadenomas and unchanged age at diagnosis illustrates the need for improvements in the management of patients with acromegaly.

  • 284.
    Arndt, Helene
    et al.
    Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Res Grp GermanVasc, Hamburg, Germany..
    Nordanstig, Joakim
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden..
    Bertges, Daniel J.
    Univ Vermont, Div Vasc Surg, Med Ctr, Burlington, VT USA..
    Budtz-Lilly, Jacob
    Aarhus Univ, Dept Cardiovasc Surg, Aarhus, Denmark..
    Venermo, Maarit
    Helsinki Univ Hosp, Abdominal Ctr, Vasc Surg, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland..
    Espada, Cristina Lopez
    Univ Hosp Virgen Nieves, Dept Vasc Surg, Granada, Spain..
    Sigvant, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Behrendt, Christian-Alexander
    Univ Med Ctr Hamburg Eppendorf, Dept Vasc Med, Res Grp GermanVasc, Hamburg, Germany.;Brandenburg Med Sch Theodor Fontane, Neuruppin, Germany..
    A Delphi Consensus on Patient Reported Outcomes for Registries and Trials Including Patients with Intermittent Claudication: Recommendations and Reporting Standard2022Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 64, nr 5, s. 526-533Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study aimed to develop a core set of patient reported outcome quality indicators (QIs) for the treatment of patients with intermittent claudication (IC), that allow a broad international implementation across different vascular registries and within trials.

    Methods: A rigorous modified two stage Delphi technique was used to promote consensus building on patient reported outcome QIs among an expert panel consisting of international vascular specialists, patient representatives, and registry members of the VASCUNET and the International Consortium of Vascular Registries. Potential QIs identified through an extensive literature search or additionally proposed by the panel were validated by the experts in a preliminary survey and included for evaluation. Consensus was reached if >= 80% of participants agreed that an item was both clinically relevant and practical.

    Results: Participation rates in two Delphi rounds were 66% (31 participants of 47 invited) and 90% (54 of 60), respectively. Initially, 145 patient reported outcome QIs were documented. Following the two Delphi rounds, 18 quality indicators remained, all of which reached consensus regarding clinical relevance. The VascuQoL questionnaire (VascuQoL-6), currently the most common patient reported outcome measurement (PROM) used within vascular registries, includes a total of six items. Five of these six items also matched with high rated indicators identified in the Delphi study. Consequently, the panel recommends the use of the VascuQoL-6 survey as a preferred core PROM QI set as well as an optional extension of 12 additional patient reported QIs that were also identified in this study.

    Conclusion: The current recommendation based on the Delphi consensus building approach, strengthens the international harmonisation of registry data collection in relation to patient reported outcome quality. Continuous and standardised quality assurance will ensure that registry data may be used for future quality benchmarking studies and, ultimately, positively impact the overall quality of care provided to patients with peripheral arterial occlusive disease.

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  • 285.
    Arnell, Kai
    et al.
    Department of Paediatric Surgery, University Hospital, Uppsala.
    Koskinen, Lars-Owe D
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Neurokirurgi.
    Malm, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Neurologi.
    Eklund, Anders
    Evaluation of Strata NSC and Codman Hakim adjustable cerebrospinal fluid shunts and their corresponding antisiphon devices: laboratory investigation2009Ingår i: Journal of Neurosurgery: Pediatrics, ISSN 1933-0707, E-ISSN 1933-0715, Vol. 3, nr 3, s. 166-172Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECT: The authors investigated and compared the in vitro characteristics of 2 CSF shunts, the Strata NSC and the Codman Hakim, and their corresponding antisiphon devices (ASDs).

    METHODS: Six new CSF shunts and the corresponding ASDs for each model were tested in an automated, computerized experimental setup based on pressure regulation. Opening pressure accuracy, resistance, sensitivity to abdominal pressure, antisiphon effect, and the influence of different ASD positions were determined.

    RESULTS: In general the shunts performed according to the manufacturers' specifications. However, at the lowest setting, the opening pressure of the Strata NSC was close to 0, and in the Codman Hakim shunt, it was higher than specified. The resistance in the Codman Hakim shunt (5.4 mm Hg/ml/min) was much higher than that in the Strata NSC (3.6 mm Hg/ml/min). Abdominal pressure affected opening pressure in both valves. Positioning the Strata ASD above or below the ventricular catheter tip resulted in higher and lower opening pressures, respectively, than when it was placed in line with the catheter. The positioning of the Codman Hakim ASD did not influence the opening pressure.

    CONCLUSIONS: Both CSF shunts work properly, but at the lowest setting the opening pressure of the Strata NSC was near 0 and in the Codman Hakim it was twice the manufacturer's specifications. The resistance in the Strata NSC was below the normal physiological range, and in the Codman Hakim device it was in the lower range of normal. The ASD did not change the shunt characteristics in the lying position and therefore might not do so in children. If this is the case, then a shunt system with an integrated ASD could be implanted at the first shunt insertion, thus avoiding a second operation and the possibility of infection.

  • 286. Arnelo, Urban
    et al.
    Siiki, Antti
    Swahn, Fredrik
    Segersvärd, Ralf
    Enochsson, Lars
    del Chiaro, Marco
    Lundell, Lars
    Verbeke, Caroline S
    Löhr, J-Matthias
    Single-operator pancreatoscopy is helpful in the evaluation of suspected intraductal papillary mucinous neoplasms (IPMN)2014Ingår i: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 14, nr 6, s. 510-514Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Even when advanced cross-sectional imaging modalities have been employed, endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMN) is often required in order to assess the final character and extent of lesions. The current study addresses the use of SpyGlass single-operator peroral pancreatoscopy in suspected IPMN.

    DESIGN: A prospective, non-randomized exploratory cohort study.

    SETTING: Single-center.

    PATIENTS AND INTERVENTION: A prospective study-cohort of 44 consecutive patients in a single tertiary referral center who underwent ERCP and peroral pancreatoscopy, was prospectively collected between July 2007 and March 2013 because of a radiological signs of IPMN. These IPMN-findings were discovered incidentally in 44% of the cases.

    MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy (specificity & sensitivity) and complications.

    RESULTS: The targeted region of the pancreatic duct was reached with the SpyGlass system in 41 patients (median age 65 years, 41% female). Three patients were excluded from analysis because of failed deep cannulation of the pancreatic duct. Brush cytology was taken in 88% and direct biopsies in 41%. IPMN with intermediate or high-grade dysplasia was the main final diagnosis (76%) in 22 patients who had surgery. Out of the 17 patients with a final diagnosis of MD-IPMN, 76% were correctly identified by pancreatoscopy. Of the 9 patients with a final diagnosis of BD-IPMN, the pancreatoscopy identified 78% of the cases correctly.The incidence of post-ERCP pancreatitis was 17%. Pancreatoscopy was found to have provided additional diagnostic information in the vast majority of the cases and to affect clinical decision-making in 76%.

    LIMITATIONS: Single-center study.

    CONCLUSIONS: Single-operator peroral pancreatoscopy contributed to the clinical evaluation of IPMN lesions and influenced decision-making concerning their clinical management. The problem of post-procedural pancreatitis needs further attention.

  • 287.
    Arnelo, Urban
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Valente, Roberto
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
    Scandavini, Chiara Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Halimi, Asif
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Mucelli, Raffaella M.Pozzi
    Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, Stockholm, Sweden; Division of Radiology, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Rangelova, Elena
    Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Section for Upper Abdominal Surgery at Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Svensson, Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Schulick, Richard D.
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Torphy, Robert J.
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Fagerström, Niklas
    Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Moro, Carlos Fernández
    Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Huddinge, Sweden; Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Huddinge, Sweden.
    Vujasinovic, Miroslav
    Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Matthias Löhr, Johannes
    Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Del Chiaro, Marco
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: a pilot study2023Ingår i: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 23, nr 6, s. 704-711Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Intraoperative pancreatoscopy is a promising procedure that might guide surgical resection for suspected main duct (MD) and mixed type (MT) intraductal papillary mucinous neoplasms (IPMNs). The aim of the present study was to assess the diagnostic yield and clinical impact of intraoperative pancreatoscopy in patients operated on for MD and MT-IPMNs.

    Methods: This is a retrospective cohort study. Patients undergoing surgery for suspected MD or MT-IPMN underwent intraoperative pancreatoscopy and frozen section analysis. In all patients who required extended resection due to pancreatoscopic findings, we compared the final histology with the results of the intraoperative frozen section analysis.

    Results: In total, 46 patients, 48% females, mean age (range) 67 years (45–82 years) underwent intraoperative pancreatoscopy. No mortality or procedure related complications were observed. Pancreatoscopy changed the operative course in 30 patients (65%), leading to extended resections in 20 patients (43%) and to parenchyma sparing procedures in 10 patients (22%). Analyzing the group of patients who underwent extended resections, 7 (35%) displayed lesions that needed further surgical treatment (six high grade dysplasia and one with G1 pancreatic neuroendocrine tumor) and among those 7, just 1 (14%) would have been detected exclusively with histological frozen section analysis of the transection margin. The combination of both pancreatoscopy and frozen section analysis lead to 86% sensitivity and 92% specificity for the detection of pathological tissue in the remnant pancreas.

    Conclusion: Intraoperative pancreatoscopy is a safe and feasible procedure and might allow the detection of skip lesions during surgery for suspect MD-involving IPMNs.

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  • 288.
    Arnerlöv, Conny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Söderström, Minette
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Öhberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Mobile kidney pain provocation ultrasonography before surgery for symptomatic mobile kidney: A prospective study of 43 consecutive patients2016Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 1, s. 61-64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of this study was to evaluate whether mobile kidney pain provocation ultrasonography together with intravenous pyelography in supine and standing positions and a full medical history can confirm the diagnosis of the clinical condition of symptomatic mobile kidney and aid the selection of patients for surgical treatment.

    MATERIALS AND METHODS: In a consecutive study, 43 patients with the clinical picture of symptomatic mobile kidney, a positive mobile kidney pain provocation ultrasonography and a renal descent of at least 2 lumbar vertebral heights on intravenous pyelography in the standing position, were operated on with nephropexy. Patients' pain relief after nephropexy was evaluated by clinical follow-up, a questionnaire and visual analogue scale (VAS) scoring.

    RESULTS: Reduction of pain after nephropexy was associated with a significant decrease in VAS scoring from a median of 8 (range 4-10) preoperatively to a median of 0 (range 0-7) postoperatively (p < 0.001). Thirty-four patients (79%) were cured of their pain and seven patients (16%) experienced substantial relief from their pain symptoms. In two patients (5%) the symptoms were unchanged.

    CONCLUSION: The results indicate that mobile kidney pain provocation ultrasonography and intravenous pyelography in supine and standing positions can verify the diagnosis of symptomatic mobile kidney and aid the selection of patients who will benefit from nephropexy.

  • 289.
    Arnerlöv, Conny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Öhberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Ghaffarpour, Ramin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Trippeldiagnostik säker vid symtomgivande rörlig njure: [Triple diagnostic can establish the diagnosis of symptomatic mobile kidney and nephropexy can give freedom of pain]2020Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, nr 37, artikel-id 20025Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Symtomatic mobile kidney is a rare condition and diagnosis is difficult. Typical symptoms are position dependent back-flank-abdominal pain with increase of pain when walking, jogging and lifting or other physical activities which increase the descent of the kidney. Triple diagnostic with typical pain history, an intravenous pyelography with a renal descent of ≥ 2 lumbar vertebral heights in the erect position, and an ultrasound with a positive pain provocation can establish the diagnosis of symptomatic mobile kidney. In our study nephropexy gives freedom of pain for 75% of patients and substantial relief for 15% of patients with severe pain.

  • 290.
    Arnlind, Anna
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurokirurgiska kliniken US.
    Danielsson, Marita
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Övr Regionledningskontoret. Swedish Natl Patient Insurance Co LOF, Sweden.
    Engerström, Lars
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Tobieson, Lovisa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för cell- och neurobiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurokirurgiska kliniken US.
    Orwelius, Lotti
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US.
    Patients with aneurysmal subarachnoid haemorrhage treated in Swedish intensive care: A registry study2024Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening disease with high mortality and morbidity. Patients with aSAH in Sweden are cared for at one of six neuro intensive care units (NICU) or at a general intensive care unit (ICU).This study aimed to describe the incidence, length of stay, time in ventilator and mortality for these patients. Methods: This is a retrospective, descriptive study of patients with aSAH, registered in the Swedish Intensive care Registry between 2017 and 2019. The cohort was divided in sub-cohorts (NICU and general ICU) and regions. Mortality was analysed with logistic regression. Results: A total of 1520 patients with aSAH from five regions were included in the study. Mean age of the patients were 60.6 years and 58% were female. Mortality within 180 days of admission was 30% (n = 456) of which 17% (n = 258) died during intensive care. A majority of the patients were treated at one hospital and in one ICU (70%, n = 1062). More than half of the patients (59%, n = 897) had their first intensive care admission at a hospital with a NICU. Patients in the North region had the lowest median GCS (10) and the highest SAPS3 score (60) when admitted to NICU. Treatment with invasive mechanical ventilation differed significantly between regions; 91% (n = 80) in the region with highest proportion versus 56% (n = 94) in the region with the lowest proportion, as did mortality; 16% (n = 44) versus 8% (n = 23). No differences between regions were found regarding age, sex and length of stay. Conclusions: Patients with aSAH treated in a NICU or in an ICU in Sweden differs in characteristics. The study further showed some differences between regions which might be reduced if there were national consensus and treatment guidelines implemented.

  • 291. Arver, Brita
    et al.
    Isaksson, Karin
    Atterhem, Hans
    Baan, Annika
    Bergkvist, Leif
    Brandberg, Yvonne
    Ehrencrona, Hans
    Emanuelsson, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Hellborg, Henrik
    Henriksson, Karin
    Karlsson, Per
    Loman, Niklas
    Lundberg, Jonas
    Ringberg, Anita
    Askmalm, Marie Stenmark
    Wickman, Marie
    Sandelin, Kerstin
    Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey2011Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 253, nr 6, s. 1147-1154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/Objective: This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. Methods: Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. Results: A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low(3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1 unanticipated secondary operation.

  • 292. Arvidsson, D
    et al.
    Rasmussen, I
    [Laparoscopic surgery. A shift in paradigm?].1993Ingår i: Nordisk Medicin, ISSN 0029-1420, Vol. 108, nr 10, s. 247-50Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Since it was first introduced at the beginning of the century, laparoscopy has been developed by pioneers in the field of gynaecological surgery from a diagnostic aid to a high tech tool for use in various branches of surgery. In the near future, this rapidly developing technique, with three-dimensional video and robot-assisted surgery, will require well planned theoretical and practical training.

  • 293. Arvidsson, D
    et al.
    Rasmussen, I
    Almqvist, P
    Niklasson, F
    Haglund, U
    Splanchnic oxygen consumption in septic and hemorrhagic shock.1991Ingår i: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 109, nr 2, s. 190-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Oxygen consumption (VO2) is dependent on oxygen delivery (DO2) in septic shock. Local hypoxia with later secondary organ failure may develop, however, despite an often hyperdynamic circulation. The splanchnic organs seem to be of vital importance in this context. In experiments performed in pigs we compared total body VO2 and DO2 with oxygen consumption and delivery in the gastrointestinal organs and the liver in two different shock states: (1) septic shock induced by peritonitis (n = 6) and (2) hemorrhagic shock (n = 6). Another group of six animals not in shock served as controls. Total, gastrointestinal, and liver DO2 decreased in a similar pattern in both septic and hemorrhagic shock. Gastrointestinal and liver VO2 increased in sepsis, whereas it was unchanged in hemorrhage. In the later phase of sepsis, liver VO2, but not gastrointestinal VO2, again decreased, because liver oxygen extraction was almost total and liver DO2 decreased further. The development of flow-dependent liver hypoxia was reflected in a decrease in liver lactate turnover (increased liver lactate release) during late sepsis. Early hypoxia in the splanchnic region is suggested as a plausible mechanism behind the development of secondary organ failure, especially in sepsis.

  • 294.
    Arzola, Luis H.
    et al.
    Natl Inst Med Sci & Nutr Salvador Zubiran, Dept Surg, Sect Vasc Surg & Endovasc Therapy, Mexico City, Mexico..
    Mani, Kevin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Zuccon, Gianmarco
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Ekberg, Tomas
    Uppsala Univ Hosp, Dept Otorhinolaryngol Head & Neck Surg, Uppsala, Sweden..
    Wanhainen, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi. Umeå Univ, Dept Surg & Perioperat Sci, Surg, Umeå, Sweden..
    Viabahn-assisted sutureless anastomosis (VASA) repair of a complex internal carotid artery aneurysm2023Ingår i: Journal of Vascular Surgery Cases and Innovative Techniques, E-ISSN 2468-4287, Vol. 9, nr 2, artikel-id 101161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Extracranial carotid artery aneurysms (CAAs) are extremely rare and often require surgical intervention to avoid complications such as local compression symptoms and thrombo-embolization. We present the case of a 63-year-old man with a history of hypertension, meningioma, and an incidental finding of a right saccular internal carotid artery aneurysm at the base of the skull. He underwent open surgical repair; nonetheless, end-to-end anastomosis was not feasible. As bailout, the internal carotid artery was successfully reconstructed with a novel Viabahn-assisted sutureless anastomosis technique (GORE, Viabahn). Postoperative clinical assessment revealed no complications, postoperative computed tomography angiography revealed a patent reconstruction, and the patient was discharged home uneventfully with 1-year clinical and computed tomography angiography follow-up without remarks. Hybrid procedure is a viable option for technically challenging carotid anastomoses near the skull base.

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  • 295.
    Arzola, Luis H.
    et al.
    Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
    Mani, Kevin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Zuccon, Gianmarco
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Ekberg, Tomas
    Department of Otorhinolaryngology-Head and Neck Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Wanhainen, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Viabahn-assisted sutureless anastomosis (VASA) repair of a complex internal carotid artery aneurysm2023Ingår i: Journal of Vascular Surgery Cases and Innovative Techniques, E-ISSN 2468-4287, Vol. 9, nr 2, artikel-id 101161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Extracranial carotid artery aneurysms (CAAs) are extremely rare and often require surgical intervention to avoid complications such as local compression symptoms and thrombo-embolization. We present the case of a 63-year-old man with a history of hypertension, meningioma, and an incidental finding of a right saccular internal carotid artery aneurysm at the base of the skull. He underwent open surgical repair; nonetheless, end-to-end anastomosis was not feasible. As bailout, the internal carotid artery was successfully reconstructed with a novel Viabahn-assisted sutureless anastomosis technique (GORE, Viabahn). Postoperative clinical assessment revealed no complications, postoperative computed tomography angiography revealed a patent reconstruction, and the patient was discharged home uneventfully with 1-year clinical and computed tomography angiography follow-up without remarks. Hybrid procedure is a viable option for technically challenging carotid anastomoses near the skull base.

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  • 296.
    Asbun, H.J.
    et al.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Moekotte, A.L.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Vissers, F.L.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Kunzler, F.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Cipriani, F.
    Department of Surgery, San Raffaele Hospital, Milan, Italy.
    Alseidi, A.
    Division of Hepatopancreatobiliary and Endocrine Surgery, Virginia Mason Medical Center, Seattle, VA, United States.
    DAngelica, M.I.
    Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, United States.
    Balduzzi, A.
    Division of Pancreatic Surgery, University Hospital of Verona, Verona, Italy.
    Bassi, C.
    Division of Pancreatic Surgery, University Hospital of Verona, Verona, Italy.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Boggi, U.
    Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
    Callery, M.P.
    Department of General and Gastrointestinal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
    Del, Chiaro M.
    Department of Surgery, Division of Surgical Oncology, University of Colorado, Denver, CO, United States.
    Coimbra, F.J.
    Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
    Conrad, C.
    Department of Surgery, St. Elizabeths Medical Center, Boston, MA, United States.
    Cook, A.
    Wessex Institute, University of Southampton, United Kingdom.
    Coppola, A.
    General Surgery and Liver Transplant, Unit Department of General Surgery, Fondazione Policlinico, Universitario Agostino Gemelli, IRCCS, Rome, Italy.
    Dervenis, C.
    Department of Surgery, Medical School, University of Cyprus, Cyprus.
    Dokmak, S.
    Department of Surgery, Beaujon Hospital, Paris, France.
    Edil, B.H.
    Department of Surgery, University of Oklahoma, Oklahoma City, OK, United States.
    Edwin, B.
    Intervention Centre, Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Giulianotti, P.C.
    Division of Minimally Invasive, General Surgery and Robotic Surgery, University of Illinois, Chicago, IL, United States.
    Han, H.-S.
    Department of Surgery, Seoul National University Hospital, Seoul, South Korea.
    Hansen, P.D.
    Department of Surgery, Portland Providence Medical Center, Portland, OR, United States.
    Van, Der Heijde N.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Van, Hilst J.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Hester, C.A.
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
    Hogg, M.E.
    Department of Surgery, NorthShore University Health System, Evanston, IL, United States.
    Jarufe, N.
    Department of Digestive Surgery, Pontifical Catholic University of Chile, Santiago, Chile.
    Jeyarajah, D.R.
    Department of HPB Surgery, Methodist Richardson Medical Center, Richardson, TX, United States.
    Keck, T.
    Clinic for Surgery, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany.
    Kim, S.C.
    Department of Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, South Korea.
    Khatkov, I.E.
    Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation.
    Kokudo, N.
    Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
    Kooby, D.A.
    Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States.
    Korrel, M.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    De, Leon F.J.
    HPB and Transplant Unit, Regional Hospital, Málaga, Spain.
    Lluis, N.
    Department of Surgery, Bellvitge University Hospital, Barcelona, Spain.
    Lof, S.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Machado, M.A.
    Department of Surgery, University of São Paulo, São Paulo, Brazil.
    Demartines, N.
    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
    Martinie, J.B.
    Division of HPB Surgery, Department of Surgery, Carolinas Health Care Hospital, Charlotte, NC, United States.
    Merchant, N.B.
    Division of Surgical Oncology, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, United States.
    Molenaar, I.Q.
    Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands.
    Moravek, C.
    Pancreatic Cancer Action Network, Manhattan Beach, CA, United States.
    Mou, Y.-P.
    Department of Gastroenterology and Pancreatic Surgery, Zhengjiang Provincial Peoples Hospital, Peoples Hospital of Hangzhou Medical College, Zhejiang, China.
    Nakamura, M.
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
    Nealon, W.H.
    Department of Surgery, Northwell Health, Manhasset, NY, United States.
    Palanivelu, C.
    Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
    Pessaux, P.
    Division of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France.
    Pitt, H.A.
    Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
    Polanco, P.M.
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
    Primrose, J.N.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Rawashdeh, A.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Sanford, D.E.
    Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University, School of Medicine, St. Louis, MO, United States.
    Senthilnathan, P.
    Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
    Shrikhande, S.V.
    Department of Surgery, Tata Memorial Center, Mumbai, India.
    Stauffer, J.A.
    Department of General Surgery, Mayo Clinic Florida, Jacksonville, FL, United States.
    Takaori, K.
    Department of Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
    Talamonti, M.S.
    Department of Surgery, NorthShore University Health System, Evanston, IL, United States.
    Tang, C.N.
    Department of Surgery, Pamela Youde Nethersle Eastern Hospital, Chai Wan, Hong Kong, Hong Kong.
    Vollmer, C.M.
    Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
    Wakabayashi, G.
    Center for Advanced Treatment of HPB Diseases, Ageo Central General Hospital, Saitama, Japan.
    Walsh, R.M.
    Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States.
    Wang, S.-E.
    Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
    Zinner, M.J.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Wolfgang, C.L.
    Division of Surgical Oncology, Department of Surgery, John Hopkins University, School of Medicine, Baltimore, MD, United States.
    Zureikat, A.H.
    Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
    Zwart, M.J.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Conlon, K.C.
    Department of Surgery, Trinity College Dublin, Tallaght University Hospital, Dublin, Ireland.
    Kendrick, M.L.
    Department of Surgery, Mayo Clinic, Rochester, MN, United States; Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy.
    Zeh, H.J.
    Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
    Hilal, M.A.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Besselink, M.G.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection2020Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this study was to develop and externally validate the first evidence-based guidelines on minimally invasive pancreas resection (MIPR) before and during the International Evidence-based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR) meeting in Miami (March 2019).Summary Background Data: MIPR has seen rapid development in the past decade. Promising outcomes have been reported by early adopters from high-volume centers. Subsequently, multicenter series as well as randomized controlled trials were reported; however, guidelines for clinical practice were lacking. Methods: The Scottisch Intercollegiate Guidelines Network (SIGN) methodology was used, incorporating these 4 items: systematic reviews using PubMed, Embase, and Cochrane databases to answer clinical questions, whenever possible in PICO style, the GRADE approach for assessment of the quality of evidence, the Delphi method for establishing consensus on the developed recommendations, and the AGREE-II instrument for the assessment of guideline quality and external validation. The current guidelines are cosponsored by the International Hepato-Pancreato-Biliary Association, the Americas Hepato-Pancreato-Biliary Association, the Asian-Pacific Hepato-Pancreato-Biliary Association, the European-African Hepato-Pancreato-Biliary Association, the European Association for Endoscopic Surgery, Pancreas Club, the Society of American Gastrointestinal and Endoscopic Surgery, the Society for Surgery of the Alimentary Tract, and the Society of Surgical Oncology. Results: After screening 16,069 titles, 694 studies were reviewed, and 291 were included. The final 28 recommendations covered 6 topics; laparoscopic and robotic distal pancreatectomy, central pancreatectomy, pancreatoduodenectomy, as well as patient selection, training, learning curve, and minimal annual center volume required to obtain optimal outcomes and patient safety.Conclusion: The IG-MIPR using SIGN methodology give guidance to surgeons, hospital administrators, patients, and medical societies on the use and outcome of MIPR as well as the approach to be taken regarding this challenging type of surgery. © 2019 Wolters Kluwer Health, Inc. All rights reserved.

  • 297.
    Asciutto, Giuseppe
    et al.
    Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Ibrahim, Abdulhakim
    Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany.
    Leone, Nicola
    Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy.
    Gennai, Stefano
    Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy.
    Piazza, Michele
    Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University, Padua, Italy.
    Antonello, Michele
    Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University, Padua, Italy.
    Wanhainen, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Mani, Kevin
    Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Lindström, David
    Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Struk, Lisa
    Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany.
    Oberhuber, Alexander
    Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany.
    Intravascular ultrasound in the detection of bridging stent graft instability during fenestrated and branched endovascular aneurysm repair procedures: a multicentre study on 274 target vessels2024Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 67, nr 1, s. 99-104Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The use of intravascular ultrasound (IVUS) reduces contrast medium use and radiation exposure during conventional endovascular aneurysm repair (EVAR). The aim of this study was to evaluate the safety and efficacy of IVUS in detecting bridging stent graft (bSG) instability during fenestrated and branched EVAR (F/B-EVAR).

    Methods: This was a prospective observational multicentre study. The following outcomes were evaluated: (1) technical success of the IVUS in each bSG, (2) IVUS findings compared with intra-operative angiography, (3) incidence of post-operative computed tomography angiography (CTA) findings not detected with IVUS, and (4) absence of IVUS related adverse events. Target visceral vessel (TVV) instability was defined as any branch or fenestration issues requiring an additional manoeuvre or re-intervention. Any IVUS assessment that detected stenosis, kinking, or any geometric TVV issue was considered to be branch instability. All procedures were performed in ad hoc hybrid rooms.

    Results: Eighty patients (69% males; median age 72 years; interquartile range 59, 77 years) from four aortic centres treated with F/B-EVAR between January 2019 and September 2021 were included: 70 BEVAR (21 off the shelf; 49 custom made), eight FEVAR (custom made), and two F/B-EVAR (custom made), for a total of 300 potential TVVs. Two TVVs (0.7%) were left unstented and excluded from the analysis. The TVVs could not be accessed with the IVUS catheter in seven cases (2.3%). Furthermore, 17 (5.7%) TVVs could not be examined due to a malfunction of the IVUS catheter. The technical success of the IVUS assessment was 91.9% (274/298), with no IVUS related adverse events. Seven TVVs (2.5%) showed signs of bSG instability by means of IVUS, leading to immediate revisions. The first post-operative CTA at least 30 days after the index procedure was available in 268 of the 274 TVVs originally assessed by IVUS. In seven of the 268 TVVs (2.6%) a re-intervention became necessary due to bSG instability.

    Conclusion: This study suggests that IVUS is a safe and potentially valuable adjunctive imaging technology for intra-operative detection of TVV instability. Further long term investigations on larger cohorts are required to validate these promising results and to compare IVUS with alternative technologies in terms of efficiency, radiation exposure, procedure time, and costs.

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  • 298.
    Asciutto, Giuseppe
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Munster Univ Hosp, Dept Vasc & Endovasc Surg, Albert Schweitzer Campus 1, D-48149 Munster, Germany..
    Usai, Marco, V
    St Franziskus Hosp Munster, Dept Vasc & Endovasc Surg, Munster, Germany..
    Ibrahim, Abdulhakim
    Munster Univ Hosp, Dept Vasc & Endovasc Surg, Albert Schweitzer Campus 1, D-48149 Munster, Germany..
    Oberhuber, Alexander
    Munster Univ Hosp, Dept Vasc & Endovasc Surg, Albert Schweitzer Campus 1, D-48149 Munster, Germany..
    Early experience with the Bolton Relay Pro/Plus for physician-modified fenestrated TEVAR2022Ingår i: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 41, nr 2, s. 105-109Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Thoracic endovascular aortic repair (TEVAR) can be challenging in cases involving the aortic arch and the visceral segment. We report our initial experience with fenestrated TEVAR (f-TEVAR) for thoracic aortic disease involving aortic branches using physician-modified stent grafts (PMSGs). Methods: Between February 2019 and November 2020 nine patients were treated with a PMSG. Indication to treatment were a symptomatic acute type B aortic dissection (TBAD) in three cases, a penetrating aortic ulcer in three cases (two in zone 3 and one in zone 6), one case of an endoleak type IA after TEVAR, a chronic TBAD after TEVAR in one case and one case of a contained rupture of a thoracoabdominal aneurysm in zone 3. Pre-, intra-and postoperative clinical data were recorded. Results: The median patient age was 65 (IQR 60.5-71) years, and eight (89%) patients were men. Nine stent grafts (six Bolton Relay Plus and three Bolton Relay Pro, Terumo Aortic, Vascutek Ltd., Inchinnan, UK) were deployed. Small fenestrations (8 mm) were created on table, median duration for on table stent graft modifications was 20 minutes (range 13-22). The technical success rate was 100%. Median operative time was 188 (range 116-252) minutes. No major adverse events of any sort occurred during the first 30-day postoperatively. There were no type I or type III endoleaks at the end of the procedure, and no cases of spinal cord ischemia. Two access related complications occurred (22%). After a median of 12 (range 5-12) months all patients survived and all target vessels remained patent with one case of fenestration-related type I endoleak, which required open conversion. Conclusions: The results of our initial experience with f-TEVAR using PMSGs with the Bolton Relay stentgraft for the treatment of aortic diseases are acceptable. These results should be confirmed on larger patient cohorts. (Cite this article as: Asciutto G, Usai MV, Ibrahim A, Oberhuber A. Early experience with the Bolton Relay Pro/Plus for physician-modified fenestrated TEVAR. Int Angiol 2022;41:105-9. DOI: 10.23736/S03929590.22.04745-9)

  • 299.
    Ashammakhi, Nureddin
    et al.
    Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME); Department of Microbiology and Molecular Genetics Michigan State University East Lansing MI.
    Nasiri, Rohollah
    KTH, Skolan för kemi, bioteknologi och hälsa (CBH), Proteinvetenskap, Nanobioteknologi. KTH, Centra, Science for Life Laboratory, SciLifeLab.
    Contag, Christopher H.
    Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME); Department of Microbiology and Molecular Genetics Michigan State University East Lansing MI.
    Herland, Anna
    KTH, Skolan för kemi, bioteknologi och hälsa (CBH), Proteinvetenskap, Nanobioteknologi. KTH, Centra, Science for Life Laboratory, SciLifeLab.
    Modelling Brain in a Chip2023Ingår i: The Journal of Craniofacial Surgery, ISSN 1049-2275, E-ISSN 1536-3732, Vol. 34, nr 3, s. 845-847Artikel i tidskrift (Övrigt vetenskapligt)
  • 300.
    Ashley, Thomas
    et al.
    Connaught Hosp, Sierra Leone.
    Ashley, Hannah F.
    Connaught Hosp, Sierra Leone; Upper Eden Med Practice, England.
    Wladis, Andreas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Katastrofmedicinskt centrum.
    Nordin, Par
    Umea Univ, Sweden.
    Ohene-Yeboah, Michael
    Univ Ghana, Ghana.
    Rukas, Rimantas
    Trondheim Reg & Univ Hosp, Norway.
    Lipnickas, Vytautas
    Vilnius Univ Hosp Santaros Klin, Lithuania.
    Smalle, Isaac O.
    Connaught Hosp, Sierra Leone.
    Holm, Kristina
    Malarsjukhuset, Sweden.
    Kalsi, Herta
    Capio St Gorans Hosp, Sweden.
    Palmu, Juuli
    Orebro Univ Hosp, Sweden.
    Sahr, Foday
    Coll Med & Allied Hlth Sci COMAHS, Sierra Leone; Republ Sierra Leone Armed Forces RSLAF, Sierra Leone.
    Beard, Jessica H.
    Temple Univ, PA USA.
    Loefgren, Jenny
    Karolinska Inst, Sweden.
    Bolkan, Hakon A.
    Trondheim Reg & Univ Hosp, Norway; Norwegian Univ Sci & Technol NTNU, Norway.
    van Duinen, Alex J.
    Trondheim Reg & Univ Hosp, Norway; Norwegian Univ Sci & Technol NTNU, Norway.
    Standardised Competency-Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone2023Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, nr 10, s. 2330-2337Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IntroductionIn low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training.MethodsAll trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeons Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training.ResultsDuring three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery.Discussion and conclusionMesh repair is the international standard for inguinal hernia repair worldwide. Nevertheless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe.Trial Registration: International Clinical Trial Registry ISRCTN63478884.

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