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  • 5251.
    Zetterling, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Regarding "Somatotropic and thyroid hormones in the acute phase of subarachnoid hemorrhage"2014Ingår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 156, nr 5, s. 977-977Artikel i tidskrift (Övrigt vetenskapligt)
  • 5252.
    Zetterling, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Edén Engström, Britt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Medicin.
    Hallberg, Lena
    Department of Radiology, Karolinska University Hospital, Huddinge.
    Hillered, Lars
    Uppsala universitet. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Enblad, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Karlsson, Torbjörn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Ronne Engström, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Cortisol and ACTH dynamics in the acute phase of subarachnoid haemorrhageIngår i: British Journal of Neurosurgery, ISSN 0268-8697, E-ISSN 1360-046XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: An adequate response of hypothalamic-pituitary-adrenal (HPA) axis is important for survival and recovery after a severe disease. The hypothalamus and the pituitary glands are at risk of damage after subarachnoid haemorrhage (SAH). A better understanding of the hormonal changes would be valuable for optimizing care in the acute phase of SAH.

    Patients: 55 patients with spontaneous SAH were evaluated regarding morning levels of S-Cortisol and P-ACTH seven days after the bleeding. In a subgroup of 20 patients the diurnal changes of S-Cortisol and P-ACTH levels were studied and U-Cortisol measured. The relations of hormone levels to clinical and radiological parameters and to outcome were assessed.

    Results: S-Cortisol and P-ACTH were elevated the day of SAH. S-Cortisol levels below reference range were uncommon. Early global cerebral oedema was associated with higher S-Cortisol concentrations at admission and a worse WFNS and RLS85 grade. Patients in better WFNS grade had higher U-Cortisol levels. All patients showed diurnal variations of S-Cortisol and P-ACTH. A reversed diurnal variation of S-Cortisol was more frequently seen in mechanically ventilated patients. Periods of suppressed P-ACTH associated with S-Cortisol peaks occurred especially in periods of secondary brain ischemia.

    Conclusion: There is a HPA response acutely after SAH with an increase of P-ACTH and S-Cortisol levels. Higher U-Cortisol levels in patients in a better clinical grade may indicate a more robust response of the HPA system. Global cerebral oedema was associated with higher S-Cortisol levels at admission and may be the result of the stress response initiated by the brain injury. Periods of suppressed P-ACTH occurred particularly in periods of brain ischemia, indicating a possibly connection between brain ischemia and ACTH suppression. These two novel findings should be evaluated in further studies.

  • 5253.
    Zetterling, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Enblad: Neurokirurgi.
    Elf, Kristin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi.
    Semnic, Robert
    Uppsala Univ, Dept Surg Sci, Radiol, S-75185 Uppsala, Sweden..
    Latini, Francesco
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Enblad: Neurokirurgi.
    Ronne-Engström, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Enblad: Neurokirurgi.
    Time course of neurological deficits after surgery for primary brain tumours2020Ingår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 162, nr 12, s. 3005-3018Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The postoperative course after surgery for primary brain tumours can be difficult to predict. We examined the time course of postoperative neurological deficits and analysed possible predisposing factors. Method Hundred adults with a radiological suspicion of low- or high-grade glioma were prospectively included and the postoperative course analysed. Possible predictors of postoperative neurological deterioration were evaluated. Results New postoperative neurologic deficits occurred in 37% of the patients, and in 4%, there were worsening of a preoperative deficit. In 78%, the deficits occurred directly after surgery. The probable cause of deterioration was EEG-verified seizures in 7, ischemic lesion in 5 and both in 1, resection of eloquent tissue in 6, resection close to eloquent tissue including SMA in 11 and postoperative haematoma in 1 patient. Seizures were the main cause of delayed neurological deterioration. Two-thirds of patients with postoperative deterioration showed complete regression of the deficits, and in 6% of all patients, there was a slight disturbance of the function after 3 months. Remaining deficits were found in 6% and only in patients with preoperative neurological deficits and high-grade tumours with mainly eloquent locations. Eloquent tumour location was a predictor of postoperative neurological deterioration and preoperative neurological deficits of remaining deficits. Conclusions Postoperative neurological deficits occurred in 41% and remained in 6% of patients. Remaining deficits were found in patients with preoperative neurological deficits and high-grade tumours with mainly eloquent locations. Eloquent tumour location was a predictor of neurological deterioration and preoperative neurological deficits of remaining deficits.

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  • 5254.
    Zetterling, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Hallberg, Lena
    Department of Radiology Karolinska University Hospital, Huddinge.
    Ronne-Engström, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Early global brain oedema in relation to clinical admission parameters and outcome in patients with aneurysmal subarachnoid haemorrhage2010Ingår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 152, nr 9, s. 1527-1533Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous studies on spontaneous aneurysmal subarachnoid haemorrhage (SAH) treatment have found the presence of global cerebral oedema on the first CT scan to be a predictor of poor outcome. We have reviewed our own experience with SAH in order to evaluate the relation of global cerebral oedema to clinical parameters at admission and to functional outcome. METHODS: One hundred ninety patients with spontaneous aneurysmal SAH were included in the study. The first CT scan for each patient was evaluated for signs of global cerebral oedema. Clinical status on admission was assessed according to the Hunt & Hess score and the World Federation of Neurosurgical Societies (WFNS) grade and functional outcome using the Glasgow Outcome Scale (GOS). Clinical condition at admission was dichotomised as 'better' (Hunt & Hess 1-2, WFNS 1-2) or 'worse' (Hunt & Hess 3-5, WFNS 3-5) and outcome as 'favourable' (GOS 4-5) or 'poor' (GOS 1-3). The amount of blood on the CT scan was assessed using the Fisher scale. Comparisons were made between patients with and without global cerebral oedema on the first CT regarding clinical condition, age, gender, mode of aneurysm treatment, outcome, 6-month mortality, amount of blood on the CT scan and time lag to the first CT scan. RESULTS: Global cerebral oedema was observed in 57% of patients admitted with aneurysmal SAH, which is a much higher frequency than has been reported previously. Patients with oedema were admitted in a worse clinical status, but there was no difference between patients with and without oedema regarding other clinical parameters or outcome. The median time between the haemorrhage and the first CT scan was short compared to earlier studies, 2.5 h for those with oedema and 3.4 for those without. This difference was significant, suggesting that global cerebral oedema can be a very early phenomenon after SAH, and may be missed in later CT scans. Early global brain oedema, occurring within a few hours of bleeding, may be more common than previously thought. In aneurysmal SAH patients, the presence of global cerebral oedema was associated with a worse clinical condition at admission which in turn could indicate a more severe initial injury. The clinical significance of early oedema may differ from that of late oedema, which may explain the lack of an association between global oedema and poor outcome in this study. However, the nature of the oedema as well as its relation to the clinical course has to be further studied in separate studies.

  • 5255.
    Zetterling, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Hillered, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Enblad, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Karlsson, Torbjörn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Ronne Engström, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Relation between brain interstitial and systemic glucose levels after subarachnoid hemorrhageIngår i: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objects: The optimal blood glucose level after acute brain injury is not known. The aim of the present investigation was to study the relation between brain interstitial and systemic blood glucose levels during the acute phase after SAH. We also studied the effects of insulin administration on local brain energy metabolism.

    Methods: 19 patients with spontaneous SAH were monitored with intracerebral microdialysis (MD). The relation between plasma (P)-glucose and interstitial MD-glucose levels and the temporal pattern of MD-metabolites was studied seven days after SAH. With a target P-glucose of 5-10 mmol/L, the effect of insulin injection on brain energy metabolites (MD-glucose, lactate, pyruvate) and glutamate was evaluated.

    Results: The mean correlation coefficient between P-glucose and MD-glucose was 0.27 ± 0.27, (p=0.0005) with a high degree of individual variation. MD-glucose, MD/P-glucose ratio and MD-glutamate levels decreased in parallel with a gradual increase in MD-pyruvate and MD-lactate levels. There were no significant changes of MD-L/P ratio or MD-glycerol. Insulin administration induced a statistically significant decrease in MD-glucose and MD-pyruvate.

    Conclusion: After SAH, there was a positive correlation between P-glucose and MD-glucose levels with a high degree of individual variation. A gradual decline of MD-glucose and MD/P-glucose ratio and an increase of MD-pyruvate and MD-lactate levels during the first week after SAH could suggest a transition to a hyperglycolytic state with increased cerebral glucose consumption. Administration of insulin was related to lowering of MD-glucose and MD-pyruvate, often to critically low levels even though plasma glucose values remained above 6 mmol/L. Thus, P-glucose should not be low in the acute phase after SAH and administration of insulin should be done with caution, even more crucial when the cerebral glucose metabolism has recovered and an increased energy demand is developing in the injured, repairing brain.

  • 5256.
    Zetterlund, Christina
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Visual, musculoskeletal, and balance symptoms in people with visual impairments2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Worldwide, about 300 million people have some kind of visual impairment (VI). Most people with VI are in the older age range, as visual deficits increase with age. It is not unusual that people with VI suffer both from neck pain or scapular area symptoms and reduced balance, which they consider to be symptoms of old age. However, their symptoms may not be attributable to age, but rather to poor vision.

    Aims: First, to identify associations between visual, musculoskeletal and balance symptoms in people engaging in near work every day and in people with VI. Second, to design and validate a suitable instrument for gathering information about visual, musculoskeletal and balance symptoms in people with VI. Third, to explore differences in perceived symptoms between VI patients and people with normal vision in cross-sectional studies and by following a group of age-related macular degeneration (AMD) patients in a longitudinal study. Fourth, to identify the most specific predictors of higher levels of visual, musculoskeletal and balance symptoms.

    Methods: A specific instrument was developed: the Visual, Musculoskeletal and Balance symptoms (VMB) questionnaire. Patients with VI were compared to an age-matched reference group with normal vision in three different studies in order to detect differences in self-reported symptoms between the groups. In addition, a follow-up was conducted in a group of AMD patients.

    Results: Patients with VI reported higher levels of VMB symptoms than controls, and this increased over time. Visual deficits and the need for visual enhancement increased the risk of VMB symptoms.

    Conclusion: People with VI run a potentially higher risk of VMB symptoms than age-matched controls.

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  • 5257.
    Zetterström, Henrik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Artursson, Gösta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Plasma oncotic pressure and plasma protein concentration in patients following thermal injury1980Ingår i: Acta Anaesthesiologica Scandinavica, ISSN ISSN 0001-5172, Vol. 24, s. 288-294Artikel i tidskrift (Refereegranskat)
  • 5258. Zhang, Cheng-Gang
    et al.
    Welin, Dag
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Novikov, Lev
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Kellerth, Jan-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Wiberg, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Hart, Andrew McKay
    Motorneuron protection by N-acetyl-cysteine after ventral root avulsion and ventral rhizotomy2005Ingår i: British Journal of Plastic Surgery, ISSN 0007-1226, E-ISSN 1465-3087, Vol. 58, nr 6, s. 765-773Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Motor recovery after proximal nerve injury remains extremely poor, despite advances in surgical care. Several neurobiological hurdles are implicated, the most fundamental being extensive cell death within the motorneuron pool. N-acetyl-cysteine almost completely protects sensory neurons after peripheral axotomy, hence its efficacy in protecting motorneurons after ventral root avulsion/rhizotomy was investigated. In adult rats, the motorneurons supplying medial gastrocnemius were unilaterally pre-labelled with retrograde tracer (true-blue/fluoro-gold), prior to L5 and 6 ventral root avulsion, or rhizotomy. Groups received either intraperitoneal N-acetyl-cysteine (ip, 150 or 750 mg/kg/day), immediate or delayed intrathecal N-acetyl-cysteine treatment (it, 2.4 mg/day), or saline; untreated animals served as controls. Either 4 (avulsion model) or 8 (rhizotomy model) weeks later, the pre-labelled motorneurons' mean soma area and survival were quantified. Untreated controls possessed markedly fewer motorneurons than normal due to cell death (avulsion 53% death; rhizotomy 26% death, P<0.01 vs. normal). Motorneurons were significantly protected by N-acetyl-cysteine after avulsion (ip 150 mg/kg/day 40% death; it 30% death, P<0.01 vs. no treatment), but particularly after rhizotomy (ip 150 mg/kg/day 17% death; ip 750 mg/kg/day 7% death; it 5% death, P<0.05 vs. no treatment). Delaying intrathecal treatment for 1 week after avulsion did not impair neuroprotection, but a 2-week delay was deleterious (42% death, P<0.05 vs. 1-week delay, 32% death). Treatment prevented the decrease in soma area usually found after both types of injury. N-acetyl-cysteine has considerable clinical potential for adjuvant treatment of major proximal nerve injuries, including brachial plexus injury, in order that motorneurons may survive until surgical repair facilitates regeneration.

  • 5259.
    Zhang, Rong
    et al.
    Univ Bonn, Inst Human Genet, Bonn, Germany.;Univ Bonn, Dept Genom, Life & Brain Ctr, Bonn, Germany..
    Knapp, Michael
    Univ Bonn, Inst Med Biometry Informat & Epidemiol, Bonn, Germany..
    Suzuki, Kentaro
    Wakayama Med Univ, Inst Adv Med, Dev Genet, Wakayama, Japan..
    Kajioka, Daiki
    Wakayama Med Univ, Inst Adv Med, Dev Genet, Wakayama, Japan..
    Schmidt, Johanna M.
    Univ Bonn, Inst Human Genet, Bonn, Germany.;Univ Bonn, Inst Anat, Bonn, Germany..
    Winkler, Jonas
    Univ Bonn, Inst Anat, Bonn, Germany..
    Yilmaz, Oeznur
    Univ Bonn, Inst Anat, Bonn, Germany..
    Pleschka, Michael
    Univ Bonn, Inst Anat, Bonn, Germany..
    Cao, Jia
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Kockum, Christina Clementson
    Univ Lund Hosp, Dept Pediat Surg, Lund, Sweden..
    Barker, Gillian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Holmdahl, Gundela
    Queen Silvias Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden..
    Beaman, Glenda
    Univ Manchester, Ctr Genom Med, Manchester M13 9PL, Lancs, England..
    Keene, David
    Woolf, Adrian S.
    Univ Manchester, Manchester Acad Hlth Sci, Inst Human Dev, Manchester M13 9PL, Lancs, England.;Royal Manchester Childrens Hosp, Manchester, Lancs, England..
    Cervellione, Raimondo M.
    Cent Manchester Univ Hosp NHS Fdn Trust, Royal Manchester Childrens Hosp, Paediat Urol, Manchester, Lancs, England..
    Cheng, Wei
    Capital Inst Pediat, Dept Pediat Surg, Beijing, Peoples R China.;Monash Univ, Fac Med Nursing & Hlth Sci, Southern Med Sch, Dept Paediat, Clayton, Vic, Australia.;Monash Univ, Fac Med Nursing & Hlth Sci, Southern Med Sch, Dept Surg, Clayton, Vic, Australia.;Beijing United Family Hosp, Dept Surg, Beijing, Peoples R China..
    Wilkins, Simon
    Cabrini Monash Univ, Cabrini Hosp, Dept Surg, Melbourne, Vic, Australia.;Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Clayton, Vic 3800, Australia..
    Gearhart, John P.
    Johns Hopkins Sch Med, Div Pediat Urol, Baltimore, MD USA..
    Sirchia, Fabio
    Univ Torino, Citta Salute & Sci Univ Hosp, Dept Med Sci, Turin, Italy.;Univ Torino, Citta Salute & Sci Univ Hosp, Med Genet Unit, Turin, Italy..
    Di Grazia, Massimo
    IRCCS Burlo Garofalo, Inst Maternal & Child Hlth, Trieste, Italy..
    Ebert, Anne-Karolin
    Univ Hosp Ulm, Dept Urol & Pediat Urol, Ulm, Germany..
    Roesch, Wolfgang
    St Hedwig Hosp Barmherzige Bruder, Dept Pediat Urol, Regensburg, Germany..
    Ellinger, Joerg
    Univ Hosp Bonn, Dept Urol, Bonn, Germany..
    Jenetzky, Ekkehart
    German Canc Res Ctr, Div Clin Epidemiol & Aging Res, Heidelberg, Germany.;Johannes Gutenberg Univ Mainz, Dept Child & Adolescent Psychiat & Psychotherapy, Mainz, Germany..
    Zwink, Nadine
    German Canc Res Ctr, Div Clin Epidemiol & Aging Res, Heidelberg, Germany..
    Feitz, Wout F.
    Radboud Univ Nijmegen, Med Ctr, Pediat Urol Ctr, Dept Urol, Nijmegen, Netherlands..
    Marcelis, Carlo
    Radboud Univ Nijmegen, Med Ctr, Dept Genet, Nijmegen, Netherlands..
    Schumacher, Johannes
    Univ Bonn, Inst Human Genet, Bonn, Germany..
    Martinon-Torres, Federico
    Hosp Clin Univ Santiago, Translat Pediat & Infect Dis, Santiago De Compostela, Spain.;Inst Invest Sanitaria Santiago Santiago, GENVIP Res Grp Www Genvip Org, Galicia, Spain..
    Hibberd, Martin Lloyd
    Genome Inst Singapore, Singapore, Singapore..
    Khor, Chiea Chuen
    Univ Calif Davis, Med Ctr, Dept Pediat, Div Genom Med, Sacramento, CA 95817 USA..
    Heilmann-Heimbach, Stefanie
    Univ Bonn, Inst Human Genet, Bonn, Germany.;Univ Bonn, Dept Genom, Life & Brain Ctr, Bonn, Germany..
    Barth, Sandra
    Univ Bonn, Inst Human Genet, Bonn, Germany.;Univ Bonn, Dept Genom, Life & Brain Ctr, Bonn, Germany..
    Boyadjiev, Simeon A.
    Univ Calif Davis, Med Ctr, Dept Pediat, Div Genom Med, Sacramento, CA 95817 USA..
    Brusco, Alfredo
    Univ Torino, Citta Salute & Sci Univ Hosp, Dept Med Sci, Turin, Italy.;Univ Torino, Citta Salute & Sci Univ Hosp, Med Genet Unit, Turin, Italy..
    Ludwig, Michael
    Univ Bonn, Dept Clin Chem & Clin Pharmacol, Bonn, Germany..
    Newman, William
    Univ Manchester, Ctr Genom Med, Manchester M13 9PL, Lancs, England..
    Nordenskjold, Agneta
    Karolinska Univ Hosp, Astrid Lindgren Children Hosp, Pediat Surg, Stockholm, Sweden..
    Yamada, Gen
    Wakayama Med Univ, Inst Adv Med, Dev Genet, Wakayama, Japan..
    Odermatt, Benjamin
    Univ Bonn, Inst Anat, Bonn, Germany..
    Reutter, Heiko
    Univ Bonn, Inst Human Genet, Bonn, Germany.;Childrens Hosp, Dept Neonatol & Pediat Intens Care, Bonn, Germany.;Univ Bonn, Bonn, Germany..
    ISL1 is a major susceptibility gene for classic bladder exstrophy and a regulator of urinary tract development2017Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 7, artikel-id 42170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Previously genome-wide association methods in patients with classic bladder exstrophy (CBE) found association with ISL1, a master control gene expressed in pericloacal mesenchyme. This study sought to further explore the genetics in a larger set of patients following-up on the most promising genomic regions previously reported. Genotypes of 12 markers obtained from 268 CBE patients of Australian, British, German Italian, Spanish and Swedish origin and 1,354 ethnically matched controls and from 92 CBE case-parent trios from North America were analysed. Only marker rs6874700 at the ISL1 locus showed association (p = 2.22 x 10(-08)). A meta-analysis of rs6874700 of our previous and present study showed a p value of 9.2 x 10(-19). Developmental biology models were used to clarify the location of ISL1 activity in the forming urinary tract. Genetic lineage analysis of Isl1-expressing cells by the lineage tracer mouse model showed Isl1-expressing cells in the urinary tract of mouse embryos at E10.5 and distributed in the bladder at E15.5. Expression of isl1 in zebrafish larvae staged 48 hpf was detected in a small region of the developing pronephros. Our study supports ISL1 as a major susceptibility gene for CBE and as a regulator of urinary tract development.

  • 5260.
    Zhang, Wei
    et al.
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Chen, Junxi
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Hua, Gang
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Zhu, Dan
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Tan, Qinghua
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Zhang, Liming
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Wang, Genbo
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Ding, Meichao
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Hu, Xiangshu
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Li, Hua
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Sharma, Hari Shanker
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Guo, Qiang
    Guangdong Sanjiu Brain Hosp, Epilepsy Ctr, Guangzhou, Peoples R China..
    Surgical treatment of low-grade brain tumors associated with epilepsy2020Ingår i: NOVEL THERAPEUTIC ADVANCES IN GLIOBLASTOMA / [ed] Bryukhovetskiy, I Sharma, A Zhang, Z Sharma, HS, LONDON ENGLAND: Elsevier, 2020, s. 171-183Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    Objective: To explore the strategy of surgical treatment of low-grade brain tumors associated with epilepsy. Methods: Clinical data of 158 patients with low-grade brain tumors were collected from January 2011 to December 2017 in Guangdong Sanjiu brain hospital. All patients received Preoperative evaluation. Lesion site: 18 cases were located in multiple cerebral lobes, 10 cases were in the functional zones, 130 cases were in the non-functional zones (including 74 cases were in the medial of temporal lobe). The surgical strategy included subtotal resection, gross-total resection and enlarged resection. Postoperative effects were evaluated by Engel classification. Results: A total of 158 patients underwent surgical treatment, among these patients, only 1 patient underwent intracranial electrode implantation. Surgical methods: 34 cases of subtotal resection, 3 cases of gross-total resection, 119 cases of enlarged resection (including Anterior temporal lobectomy in 74 cases) and 2 case of Selective hippocampal amygdalectomy. The final pathology suggested that there are 74 cases of ganglionglioma, 25 cases of dysembryoplastic neuroepithelial tumors, 9 cases of pilocytic astrocytoma, 16 cases of oligodendroglioma, 10 cases of pleomorphic xanthoastrocytoma, 4 case of diffuse astrocytoma, 9 cases of unclassified astrocytoma, 11 case of oligoastrocytoma. The follow-up time was between 1 and 7 years, with an average of 3.44 +/- 1.77 years. Postoperative recovery: 147 patients had an Engel Class I outcome, 10 patients were in Engel Class II, 1 patient was in Class IV. Conclusion: The strategy of surgical treatment of low-grade brain tumors associated with epilepsy should pay more attention to the preoperative assessment of the epileptogenic zone. The tumor is not exactly the same as the epileptogenic zone, and the strategy of surgical treatment depends on the tumor feature as well as whether it was located in temporal lobe or involved in functional areas.

  • 5261.
    Zhu, Wenyao
    et al.
    KTH, Skolan för elektroteknik och datavetenskap (EECS), Elektroteknik, Elektronik och inbyggda system, Elektronik och inbyggda system.
    Chen, Yizhi
    KTH, Skolan för elektroteknik och datavetenskap (EECS), Elektroteknik, Elektronik och inbyggda system, Elektronik och inbyggda system.
    Ko, Siu-Teing
    Res & Innovat, IS-110 Reykjavik, Iceland..
    Lu, Zhonghai
    KTH, Skolan för elektroteknik och datavetenskap (EECS), Elektroteknik, Elektronik och inbyggda system, Elektronik och inbyggda system.
    Redundancy Reduction for Sensor Deployment in Prosthetic Socket: A Case Study2022Ingår i: Sensors, E-ISSN 1424-8220, Vol. 22, nr 9, s. 3103-, artikel-id 3103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The irregular pressure exerted by a prosthetic socket over the residual limb is one of the major factors that cause the discomfort of amputees using artificial limbs. By deploying the wearable sensors inside the socket, the interfacial pressure distribution can be studied to find the active regions and rectify the socket design. In this case study, a clustering-based analysis method is presented to evaluate the density and layout of these sensors, which aims to reduce the local redundancy of the sensor deployment. In particular, a Self-Organizing Map (SOM) and K-means algorithm are employed to find the clustering results of the sensor data, taking the pressure measurement of a predefined sensor placement as the input. Then, one suitable clustering result is selected to detect the layout redundancy from the input area. After that, the Pearson correlation coefficient (PCC) is used as a similarity metric to guide the removal of redundant sensors and generate a new sparser layout. The Jenson-Shannon Divergence (JSD) and the mean pressure are applied as posterior validation metrics that compare the pressure features before and after sensor removal. A case study of a clinical trial with two sensor strips is used to prove the utility of the clustering-based analysis method. The sensors on the posterior and medial regions are suggested to be reduced, and the main pressure features are kept. The proposed method can help sensor designers optimize sensor configurations for intra-socket measurements and thus assist the prosthetists in improving the socket fitting.

  • 5262.
    Zimmerman, Malin
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Anker, Ilka
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Karlsson, Anna
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Arner, Marianne
    South Gen Hosp, Sweden; Soder Sjukhuset, Sweden.
    Svensson, Ann-Marie
    Ctr Registers, Sweden; Univ Gothenburg, Sweden.
    Eeg-Olofsson, Katarina
    Univ Gothenburg, 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 B.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Ulnar Nerve Entrapment in Diabetes: Patient-reported Outcome after Surgery in National Quality Registries2020Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 8, nr 4, artikel-id e2740Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Ulnar nerve entrapment at the elbow (UNE) is overrepresented in patients with diabetes, but the outcome of surgery is unknown. We aimed to evaluate patient-reported outcome in patients with and without diabetes, and to assess potential sex differences and compare surgical treatment methods. Methods: Data on patients operated for UNE (2010-2016, n = 1354) from the Swedish National Registry for Hand Surgery were linked to the Swedish National Diabetes Register. Symptoms were assessed preoperatively (n = 389), and 3 (n = 283), and at 12 months postoperatively (n = 267) by QuickDASH and HQ-8 (specific hand surgery questionnaire-8 questions). Only simple decompressions were included when comparing groups. Results: Men with diabetes reported higher postoperative QuickDASH scores than men without diabetes. Women scored their disability higher than men on all time-points in QuickDASH, but showed larger improvement between preoperative and 12 months postoperative values. Patients operated with transposition scored 10.8 points higher on QuickDASH than patients who had simple decompression at 12 months (95% confidence interval 1.98-19.6). Conclusions: Women with diabetes benefit from simple decompression for UNE to the same extent as women without diabetes. Men with diabetes risk not to benefit from simple decompression as much as women do. Ulnar nerve transposition had a higher risk of residual symptoms compared to simple decompression.

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  • 5263.
    Zimmerman, Malin
    et al.
    Department of Translational Medicine—Hand Surgery, Lund University Sweden; Department of Orthopedic Surgery, Helsingborg Hospital, Sweden.
    Anker, Ilka
    Department of Translational Medicine—Hand Surgery, Lund University 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.
    Socioeconomic Differences between Sexes in Surgically Treated Carpal Tunnel Syndrome and Ulnar Nerve Entrapment2022Ingår i: Epidemiologia, E-ISSN 2673-3986, Vol. 3, nr 3, s. 353-362Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We aimed to investigate socioeconomic differences between sexes and the influence on outcome following surgery for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE) at the elbow. Patients with CTS (n = 9000) or UNE (n = 1266) registered in the Swedish National Register for Hand Surgery (HAKIR) 2010–2016 were included and evaluated using QuickDASH 12 months postoperatively. Statistics Sweden (SCB) provided socioeconomic data. In women with CTS, being born outside Sweden, having received social assistance, and more sick leave days predicted worse outcomes. Higher earnings and the highest level of education predicted better outcomes. In men with CTS, more sick leave days and having received social assistance predicted worse outcomes. Higher earnings predicted better outcomes. For women with UNE, higher earnings predicted better outcomes. In men with UNE, only sick leave days predicted worse outcomes. In long-term follow up, socioeconomic status affects outcomes differently in women and men with CTS or UNE

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  • 5264.
    Zimmerman, Malin
    et al.
    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.
    Steen Carlsson, Katarina
    Lund Univ, Sweden.
    Dahlin, Lars B.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Socioeconomic Factors in Patients with Ulnar Nerve Compression at the Elbow: A National Registry-Based Study2020Ingår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, Vol. 2020, artikel-id 5928649Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims. To investigate demographics and socioeconomic status in patients with ulnar nerve compression and the influence of socioeconomic factors on patient-reported outcome measurements (PROM) as evaluated by QuickDASH (short version of Disabilities of Arm, Shoulder and Hand) after surgery for ulnar nerve compression at the elbow. Methods. Patients operated for primary ulnar nerve compression from 2010 to 2016 were identified in the National Quality Registry for Hand Surgery Procedures (HAKIR). Patients filled out questionnaires before and at three and 12 months after surgery. A total of 1346 surgically treated cases were included. Data from HAKIR were linked to data from Statistics Sweden (SCB) on socioeconomic status (i.e., education level, earnings, social assistance, immigrant status, sick leave, unemployment, and marital status). Results. Patients surgically treated for ulnar nerve compression at the elbow differed from the general population with lower levels of education, higher social assistance dependence, a high proportion of unemployment, and lower earnings. However, the results were not clear concerning the influence of socioeconomic factors on the outcome of surgery, except for long-term sick leave. Conclusion. Patients surgically treated for ulnar nerve compression at the elbow are socioeconomically deprived, but only a history of long-term sick leave influences the outcome of surgery. This information is crucial in the diagnosis and treatment of these patients.

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  • 5265.
    Zimmerman, Malin
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    (Svensson) 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 B.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Occurrence of cold sensitivity in carpal tunnel syndrome and its effects on surgical outcome following open carpal tunnel release2020Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 10, nr 1, artikel-id 13472Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cold sensitivity is common following nerve injuries in the upper extremity, but is less well studied in carpal tunnel syndrome (CTS). We investigated cold sensitivity in CTS and its effects on surgical outcome. A search of the Swedish National Registry for Hand Surgery (HAKIR) for open carpal tunnel releases (OCTR) from 2010-2016 identified 10,746 cases. Symptom severity questionnaires (HQ-8; HAKIR questionnaire 8, eight Likert-scale items scored 0-100, one item on cold sensitivity) and QuickDASH scores before and after surgery were collected. Patient mean age was 56 +/- SD 16 years, and 7,150/10,746 (67%) were women. Patients with severe cold sensitivity (defined as cold intolerance symptom severity score&gt;70; n=951), scored significantly higher on QuickDASH at all time points compared to those with mild cold sensitivity (cold intolerance symptom severity scores &lt;= 30, n=1,532); preoperatively 64 [50-75] vs. 40 [25-55], at three months 32 [14-52] vs. 18 [9-32] and at 12 months 25 [7-50] vs. 9 [2-23]; all p&lt;0.0001. Severe cold sensitivity predicted higher postoperative QuickDASH scores at three [12.9 points (95% CI 10.2-15.6; p&lt;0.0001)] and at 12 months [14.8 points (11.3-18.4; p&lt;0.0001)] compared to mild cold sensitivity, and adjustment for a concomitant condition in the hand/arm, including ulnar nerve compression, did not influence the results. Cold sensitivity improves after OCTR. A higher preoperative degree of cold sensitivity is associated with more preoperative and postoperative disability and symptoms than a lower degree of cold sensitivity, but with the same improvement in QuickDASH score.

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  • 5266.
    Zindovic, Igor
    et al.
    Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Gudbjartsson, Tomas
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Ahlsson, Anders
    Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital and School of Health and Medicine, Örebro University, Örebro, Sweden.
    Fuglsang, Simon
    Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Gunn, Jarmo
    Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
    Hansson, Emma C.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hjortdal, Vibeke
    Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark.
    Järvelä, Kati
    Heart Center, Tampere University Hospital, Tampere, Finland.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mennander, Ari
    Heart Center, Tampere University Hospital, Tampere, Finland.
    Olsson, Christian
    Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Pan, Emily
    Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
    Sjögren, Johan
    Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Wickbom, Anders
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic and Vascular Surgery.
    Geirsson, Arnar
    Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Nozohoor, Shahab
    Department of Clinical Sciences and Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
    Malperfusion in acute type A aortic dissection: An update from the Nordic Consortium for Acute Type A Aortic Dissection2019Ingår i: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 157, nr 4, s. 1324-1333Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry.

    Methods: We studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality.

    Results: Preoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% +/-0.9% vs 88.7% +/-1.9%, 90.1% +/-1.3% vs 84.0% +/-2.4%, and 85.4% +/-1.7% vs 80.8% +/-2.7%; log rank P = .009).

    Conclusions: Malperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.

  • 5267.
    Zineldin, Mosad
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för medicin och optometri (MEO).
    Hassan, Tamer
    Alexandria University, Egypt.
    Brain Arteriovenous Malformations (BAVMs) and Endovascular Catheter Embolization Treatment’s Safety and Complications2020Ingår i: Acta Scientific Neurology, E-ISSN 2582-1121, Vol. 3, nr 2, s. 44-49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although endovascular catheter embolization (ECE) has been accepted as a therapeutic option for arteriovenous malformations (AVMs) in children and adolescents, considerable and substantial data are still lacking regarding the outcomes of CE for AVMs. This study aimed to clarify the outcomes and the complications of ECE for the treatment of AVM in patients aged less than 18 years.

      This study reports a case of an <18 years old patient who presented a year ago with headaches, weakness, back pain and sift nick. A year later the patient was subject to bleeding and a ECE was performed. Endovascular embolization was performed according to the procedures, guide and techniques for AVM embolization.

      Endovascular catheter embolization (ECE) of brain AVMS is relatively safe with low rate of complications if the patient had good or excellent outcomes at discharge after AVM embolization using right liquid embolic agents. Long term following up is needed to decrease the probability of the future complication and assure the patient safety.

  • 5268. Zoerner, Frank
    et al.
    Semenas, Egidijus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Resuscitation with amiodarone increases survival after hemorrhage and ventricular fibrillation in pigs2014Ingår i: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 76, nr 6, s. 1402-1408Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim of this experimental study was to compare survival and hemodynamic effects of a low-dose amiodarone and vasopressin compared with vasopressin in hypovolemic cardiac arrest model in piglets. METHODS: Eighteen anesthetized male piglets (with a weight of 25.3 [1.8] kg) were bled approximately 30% of the total blood volume via the femoral artery to a mean arterial blood pressure of 35 mm Hg in a 15-minute period. Afterward, the piglets were subjected to 4 minutes of untreated ventricular fibrillation followed by 11 minutes of open-chest cardiopulmonary resuscitation. At 5 minutes, circulatory arrest amiodarone 1 mg/kg was intravenously administered in the amiodarone group (n = 9), while the control group received the same amount of saline (n = 9). At the same time, all piglets received vasopressin 0.4 U/kg intravenously administered and hypertonic-hyperoncotic solution 3-mL/kg infusion for 20 minutes. Internal defibrillation was attempted from 7 minutes of cardiac arrest to achieve restoration of spontaneous circulation. The experiment was terminated 3 hours after resuscitation. RESULTS: Three-hour survival was greater in the amiodarone group (p = 0.02). After the successful resuscitation, the amiodarone group piglets had significantly lower heart rate as well as greater systolic, diastolic, and mean arterial pressure. Troponin I plasma concentrations were lower and urine output was greater in the amiodarone group. CONCLUSION: Combined resuscitation with amiodarone and vasopressin after hemorrhagic circulatory arrest resulted in greater 3-hour survival, better preserved hemodynamic parameters, and smaller myocardial injury compared with resuscitation with vasopressin only.

  • 5269.
    Zrinzo, Ludvic
    et al.
    UCL, UCL Inst Neurol, Unit Funct Neurosurg, Sobell Dept Motor Neurosci & Movement Disorders, London, England.
    Foltynie, Thomas
    UCL, UCL Inst Neurol, Unit Funct Neurosurg, Sobell Dept Motor Neurosci & Movement Disorders, London, England.
    Limousin, Patricia
    UCL, UCL Inst Neurol, Unit Funct Neurosurg, Sobell Dept Motor Neurosci & Movement Disorders, London, England.
    Hariz, Marwan
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Image-verified deep brain stimulation reduces risk and cost with no apparent impact on efficacy2012Ingår i: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 27, nr 12, s. 1585-1586Artikel i tidskrift (Refereegranskat)
  • 5270. Zrinzo, Ludvic
    et al.
    Foltynie, Thomas
    Limousin, Patricia
    Hariz, Marwan I.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review Clinical article2012Ingår i: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 116, nr 1, s. 84-94Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Object. Hemorrhagic complications carry by far the highest risk of devastating neurological outcome in functional neurosurgery. Literature published over the past 10 years suggests that hemorrhage, although relatively rare, remains a significant problem. Estimating the true incidence of and risk factors for hemorrhage in functional neurosurgery is a challenging issue. Methods. The authors analyzed the hemorrhage rate in a consecutive series of 214 patients undergoing image-guided deep brain stimulation (DBS) lead placement without microelectrode recording (MER) and with routine postoperative MR imaging lead verification. They also conducted a systematic review of the literature on stereotactic ablative surgery and DBS over a 10-year period to determine the incidence and risk factors for hemorrhage as a complication of functional neurosurgery. Results. The total incidence of hemorrhage in our series of image-guided DBS was 0.9%: asymptomatic in 0.5%, symptomatic in 0.5%, and causing permanent deficit in 0.0% of patients. Weighted means calculated from the literature review suggest that the overall incidence of hemorrhage in functional neurosurgery is 5.0%, with asymptomatic hemorrhage occurring in 1.9% of patients, symptomatic hemorrhage in 2.1% and hemorrhage resulting in permanent deficit or death in 1.1%. Hypertension and age were the most important patient-related factors associated with an increased risk of hemorrhage. Risk factors related to surgical technique included use of MER, number of MER penetrations, as well as sulcal or ventricular involvement by the trajectory. The incidence of hemorrhage in studies adopting an image-guided and image-verified approach without MER was significantly lower than that reported with other operative techniques (p < 0.001 for total number of hemorrhages, p < 0.001 for asymptomatic hemorrhage, p < 0.004 for symptomatic hemorrhage, and p = 0.001 for hemorrhage leading to permanent deficit; Fisher exact test). Conclusions. Age and a history of hypertension are associated with an increased risk of hemorrhage in functional neurosurgery. Surgical factors that increase the risk of hemorrhage include the use of MER and sulcal or ventricular incursion. The meticulous use of neuroimaging-both in planning the trajectory and for target verification-can avoid all of these surgery-related risk factors and appears to carry a significantly lower risk of hemorrhage and associated permanent deficit. (DOI: 10.3171/2011.8.JNS101407)

  • 5271. Zrinzo, Ludvic
    et al.
    Hariz, Marwan
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Errors of Image Coregistration may Necessitate Intraoperative Refinement in Functional Neurosurgery2013Ingår i: J NEUROL SURG PART A, ISSN 2193-6315, Vol. 74, nr 5, s. 335-336Artikel i tidskrift (Refereegranskat)
  • 5272. Zrinzo, Ludvic
    et al.
    Hariz, Marwan
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap. UCL Institute of Neurology, University College London, London, United Kingdom.
    Hyam, Jonathan A.
    Foltynie, Thomas
    Limousin, Patricia
    A paradigm shift toward MRI-guided and MRI-verified DBS surgery2016Ingår i: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 124, nr 4, s. 1135-1137Artikel i tidskrift (Refereegranskat)
  • 5273.
    Zrinzo, Ludvic
    et al.
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London, UK.
    Yoshida, Fumiaki
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London, UK.
    Hariz, Marwan I.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Neurokirurgi.
    Thornton, John
    UCL Institute of Neurology and Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
    Foltynie, Thomas
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London, UK.
    Yousry, Tarek A.
    UCL Institute of Neurology and Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK .
    Limousin, Patricia
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London, UK.
    Clinical safety of brain magnetic resonance imaging with implanted deep brain stimulation hardware: large case series and review of the literature2011Ingår i: World Neurosurgery, ISSN 1878-8750, Vol. 76, nr 1-2, s. 164-172Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Over 75,000 patients have undergone deep brain stimulation (DBS) procedures worldwide. Magnetic resonance imaging (MRI) is an important clinical and research tool in analyzing electrode location, documenting postoperative complications, and investigating novel symptoms in DBS patients. Functional MRI may shed light on the mechanism of action of DBS. MRI safety in DBS patients is therefore an important consideration.

    Methods: We report our experience with MRI in patients with implanted DBS hardware and examine the literature for clinical reports on MRI safety with implanted DBS hardware.

    Results: A total of 262 MRI examinations were performed in 223 patients with intracranial DBS hardware, including 45 in patients with an implanted pulse generator. Only 1 temporary adverse event occurred related to patient agitation and movement during immediate postoperative MR imaging. Agitation resolved after a few hours, and an MRI obtained before implanted pulse generator implantation revealed edema around both electrodes. Over 4000 MRI examinations in patients with implanted DBS hardware have been reported in the literature. Only 4 led to adverse events, including 2 hardware failures, 1 temporary and 1 permanent neurological deficit. Adverse neurological events occurred in a unique set of circumstances where appropriate safety protocols were not followed. MRI guidelines provided by DBS hardware manufacturers are inconsistent and vary among devices.

    Conclusions: The importance of MRI in modern medicine places pressure on industry to develop fully MRI-compatible DBS devices. Until then, the literature suggests that, when observing certain precautions, cranial MR images can be obtained with an extremely low risk in patients with implanted DBS hardware.

  • 5274.
    Zuccon, Gianmarco
    et al.
    Vascular Division, Cardiovascular Department, HPG23 Hospital, Bergamo, Italy.
    D'Oria, Mario
    Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy.
    Gonçalves, Frederico Bastos
    NOVA Medical School – Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal.
    Fernandez-Prendes, Carlota
    Department of Vascular Surgery, Ludwig-Maximilians University Hospital, Munich, Germany.
    Mani, Kevin
    Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Caldeira, Daniel
    Serviço de Cardiologia, Hospital Universitário de Santa Maria – CHULN, Portugal, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), CAML, CEMBE, Faculdade de Medicina, Universidade de Lisboa, Portugal, Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
    Koelemay, Mark
    Department of Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.
    Bissacco, Daniele
    Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
    Trimarchi, Santi
    Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
    Van Herzeele, Isabelle
    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, Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Incidence, Risk Factors, and Prognostic Impact of Type Ib Endoleak Following Endovascular Repair for Abdominal Aortic Aneurysm: Scoping Review2023Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 66, nr 3, s. 352-361Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objective: The primary objectives of this scoping review were to assess the rate of and risk factors for type Ib endoleak and to evaluate the extent of the evidence base that links type Ib endoleak to short and long term outcomes in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).

    Methods: Potentially eligible studies were searched in the Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science Core Collection, SciELO Citation Index, Russian Science Citation Index, and KCI-Korean Journal Database. A scoping review was performed according to PRISMA extension for Scoping Reviews.

    Results: A total of 27 articles (four prospective registries and 23 retrospective cohort studies) dealing with type Ib endoleak were included in the final analysis. The number of patients reported on was 7 197, with follow up ranging between 12 months and 93 months. The reported frequency of type Ib endoleak in patients treated with EVAR ranged from 0% to 8%, Patient and or procedure related factors associated with risk of type Ib endoleak were (1) common iliac artery (CIA) diameter ˃ 18 mm requiring use of flared stent graft limbs (FLs) ˃ 20 mm, (2) length of CIA landing zone ˂ 20 mm, (3) marked iliac tortuosity, and (4) large initial AAA diameter. Depending on the study, 50 – 100% of type Ib endoleaks were corrected by endovascular means, with a reported immediate technical success of 100% in the studies providing this information.

    Conclusion: Type Ib endoleak after EVAR has been reported to occur in 0 – 8% of cases. Several anatomical features, including CIA diameter ˃ 18 mm or requiring the use of FLs ˃ 20 mm, length of CIA landing zone ˂ 20 mm, marked iliac tortuosity, and large initial AAA diameter, could increase the risk of type Ib endoleak and may require alternative therapeutic options and or more stringent follow up. Therefore, this updated scoping review provides a comprehensive summary of the frequency, risk factors, prognosis, and treatment of type Ib endoleaks, and has identified knowledge gaps in the literature to guide further studies.

  • 5275.
    Zuccon, Gianmarco
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Mani, Kevin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Intramural Haematoma Type B: Many Questions and Some Answers.2022Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 63, nr 1, s. 59-59Artikel i tidskrift (Refereegranskat)
  • 5276.
    Zuccon, Gianmarco
    et al.
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Faculty of Medicine and Surgery, University of Milan, Milan, Italy.
    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.
    Lindström, David
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Tegler, Gustaf
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Grima, Matthew Joe
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Faculty of Medicine Surgery, University of Malta, Msida, Malta; Department of Surgery, Vascular Unit, Mater Dei Hospital, Msida, Malta.
    Mani, Kevin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    A SiMplified bARe-Wire Target Vessel (SMART) Technique for Fenestrated Endovascular Aortic Repair2024Ingår i: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 31, nr 3, s. 381-389Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of this study was to present a new technique for fenestrated endovascular aortic aneurysm repair (FEVAR) and to review its preliminary results. The SiMplified bARe-wire Target vessel (SMART) technique for FEVAR aims to simplify the procedure by avoiding guiding sheaths into visceral arteries during the main graft deployment.

    Materials and Methods: The SMART technique requires a 12 to 16Fr contralateral introducer, depending on number of fenestrations—compared with standard 18 to 22Fr for 3 to 4 FEVAR—to achieve target vessel catheterization and stenting during FEVAR by avoiding the use of parallel 6 to 7Fr guiding sheaths into each visceral vessel. Fenestrations are sequentially catheterized, assisted by a steerable sheath. A Rosen wire is maintained in each fenestration, with a single sheath parked in the final target vessel while releasing the fenestrated graft. Data on patients treated for pararenal or thoracoabdominal aortic aneurysms with FEVAR, adopting the SMART technique, were retrospectively reviewed. End points were technical success, intraprocedural variables, 90-day mortality, major adverse events (MAEs), and target vessel patency.

    Results: From May 2018 to December 2020, 57 consecutive patients were treated for pararenal or thoracoabdominal aortic aneurysms. Median total procedure time and total fluoroscopy time were 223 (196–271) minutes and 81 (71–94) minutes, respectively. Primary technical success was 96.4% (55/57). No misalignment occurred from graft deployment. The total number of fenestrations was 169, including 54 left and 53 right renal arteries, 43 superior mesenteric arteries and 18 celiac trunks (3.0±0.9 vessels/patient), with target vessel technical success of 98.2%. During the first 90 days, there were no deaths (0%). The MAEs included acute kidney injury (AKI) in 3 patients (5%) with no new dialysis onset, respiratory failure requiring prolonged ventilation in 2 patients (4%), myocardial ischemia in 1 patient (2%), but no lower limb ischemia, stroke, or spinal cord ischemia (SCI) occurred. After a mean follow-up of 14±10 months, there was 1 aortic-related death. Primary and assisted primary target vessel patency was 94.6%±1.8 and 97.0%±1.3% respectively.

    Conclusions: The SMART technique proved to be a safe alternative to standard FEVARs, with excellent technical result and acceptable target vessel patency at mid-term, while reducing the risk for introducer-induced lower limb ischemia, related complications, and morbidity.

    Clinical Impact: This study evalautes the outcome of fenestrated endovascular aortic repair (FEVAR) procedures at Uppsala university hospital using a simplified bare-wire Target vessel (SMART) technique. The SMART technique requires a smaller contralateral introducer compared to standard 18-22Fr for 3-4 FEVAR to achieve target vessel catetherization and stenting. Fifty-seven consecutive patients were treated for pararenal or thoracoabdominal aortic aneurysms. The SMART technique proved to be a safe alternative to standard FEVARs with excellent technical result and acceptable target vessel patency at mid-term, while reducing the risk for introducer-induced lower limb ischemia, related complications, and morbidity.

  • 5277. Zwart, E S
    et al.
    Yilmaz, B S
    Halimi, Asif
    Division of Surgery, CLINTEC, Karolinska Institute, Sweden; Department of Surgical and Perioperative Sciences, Umeå University Hospital, Sweden.
    Ahola, R
    Kurlinkus, B
    Laukkarinen, J
    Ceyhan, G O
    Venous resection for pancreatic cancer, a safe and feasible option?: A systematic review and meta-analysis2022Ingår i: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 22, nr 6, s. 803-809Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    BACKGROUND: In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-).

    METHODS: A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test.

    RESULTS: Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5% vs. 5.6%), R1 resections (36.7% vs. 28.6%), N1 resections (70.3% vs. 66.8%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar.

    CONCLUSION: VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.

  • 5278.
    Zötterman, Johan
    et al.
    Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper.
    Bergkvist, Max
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Iredahl, Fredrik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Tesselaar, Erik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Farnebo, Simon
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Monitoring of partial and full venous outflow obstruction in a porcine flap model using laser speckle contrast imaging2016Ingår i: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 69, nr 7, s. 936-943Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In microsurgery, there is a demand for more reliable methods of postoperative monitoring of free flaps, especially with regard to tissue-threatening obstructions of the feeding arteries and draining veins. In this study, we evaluated laser speckle contrast imaging (LSCI) and laser Doppler flowmetry (LDF) to assess their possibilities to detect partial and full venous outflow obstruction, as well as full arterial occlusion, in a porcine flap model. Methods: Cranial gluteal artery perforator flaps (CGAPs) were raised, and arterial and venous blood flow to and from the flaps was monitored using ultrasonic flow probes. The venous flow was altered with an inflatable cuff to simulate partial and full (50% and 100%) venous obstruction, and arterial flow was completely obstructed using clamps. The flap microcirculation was monitored using LSCI and LDF. Results: Both LDF and the LSCI detected significant changes in flap perfusion. After partial (50%) venous occlusion, perfusion decreased from baseline, LSCI: 63.5 +/- 12.9 PU (p = 0.01), LDF 31.3 +/- 15.7 (p = 0.64). After 100% venous occlusion, a further decrease in perfusion was observed: LSCI 54.6 +/- 14.2 PU (p amp;lt; 0.001) and LDF 16.7 +/- 12.8 PU (p amp;lt; 0.001). After release of the venous cuff, LSCI detected a return of the perfusion to a level slightly, but not significantly, below the baseline level 70.1 +/- 11.5 PU (p=0.39), while the LDF signal returned to a level not significant from the baseline 36.1 +/- 17.9 PU (p amp;gt; 0.99). Perfusion during 100% arterial occlusion decreased significantly as measured with both methods, LSCI: 48.3 +/- 7.7 (PU, pamp;lt;0.001) and LDF: 8.5 +/- 4.0 PU (pamp;lt;0.001). During 50% and 100% venous occlusion, LSCI showed a 20% and 26% inter-subject variability (CV%), respectively, compared to 50% and 77% for LDF. Conclusions: LSCI offers sensitive and reproducible measurements of flap microcirculation and seems more reliable in detecting decreases in blood perfusion caused by venous obstruction. It also allows for perfusion measurements in a relatively large area of flap tissue. This may be useful in identifying areas of the flap with compromised microcirculation during and after surgery. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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  • 5279.
    Zötterman, Johan
    et al.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi.
    Opsomer, Dries
    Department of Plastic and Reconstructive Surgery, University of Ghent, Ghent, Belgium.
    Farnebo, Simon
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi.
    Blondeel, Phillip
    Department of Plastic and Reconstructive Surgery, University of Ghent, Ghent, Belgium.
    Monstrey, Stan
    Department of Plastic and Reconstructive Surgery, University of Ghent, Ghent, Belgium.
    Tesselaar, Erik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Medicinsk strålningsfysik. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi.
    Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction: A Prospective Case Series Study2020Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 8, nr 1, s. e2529-e2529Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Laser speckle contrast imaging (LSCI) is a laser-based perfusion imaging technique that recently has been shown to predict ischemic necrosis in an experimental flap model and predicting healing time of scald burns. The aims were to investigate perfusion in relation to the selected perforator during deep inferior epigastric artery perforator (DIEP) flap surgery, and to evaluate LSCI in assisting of prediction of postoperative complications. METHODS: Twenty-three patients who underwent DIEP-procedures for breast reconstruction at 2 centers were included. Perfusion was measured in 4 zones at baseline, after raising, after anastomosis, and after shaping the flap. The perfusion in relation to the selected perforator and the accuracy of LSCI in predicting complications were analyzed. RESULTS: After raising the flap, zone I showed the highest perfusion (65 ± 10 perfusion units, PU), followed by zone II (58 ± 12 PU), zone III (53 ± 10 PU), and zone IV (45 ± 10 PU). The perfusion in zone I was higher than zone III (P = 0.002) and zone IV (P < 0.001). After anastomosis, zone IV had lower perfusion than zone I (P < 0.001), zone II (P = 0.01), and zone III (P = 0.02). Flaps with areas <30 PU after surgery had partial necrosis postoperatively (n = 4). CONCLUSIONS: Perfusion is highest in zone I. No perfusion difference was found between zones II and III. Perfusion <30 PU after surgery was correlated with partial necrosis. LSCI is a promising tool for measurement of flap perfusion and assessment of risk of postoperative ischemic complications.

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  • 5280.
    Zötterman, Johan
    et al.
    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.
    Tesselaar, Erik
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Medicinsk strålningsfysik.
    Elawa, Sherif
    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.
    Farnebo, Simon
    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.
    Correlation between Indocyanine Green Fluorescence Angiography and Laser Speckle Contrast Imaging in a Flap Model2023Ingår i: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 11, nr 9, artikel-id e5187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Indocyanine green fluorescence angiography (ICG-FA) is used to assess tissue intraoperatively in reconstructive surgery. This requires an intra-venous dye injection for each assessment. This is not necessary in laser speckle contrast imaging (LSCI); therefore, this method may be better suited for tissue evaluation. To determine this, we compared the two methods in a porcine flap model.Methods:One random and one pedicled flap were raised on each buttock of six animals. They were assessed with LSCI at baseline, when raised (T0), at 30 minutes (T30) and with ICG-FA at T0 and T30. Regions of interest (ROI) were chosen along the flap axis. Perfusion, measured as perfusion units (PU) in the LSCI assessment and pixel-intensity for the ICG-FA video uptake, was calculated in the ROI. Correlation was calculated between PU and pixel-intensity measured as time to peak (TTP) and area under curve for 60 seconds (AUC60).Results:Correlation between LSCI and AUC60 for the ICG-FA in corresponding ROI could be seen in all flaps at all time points. The correlation was higher for T0 (r=0.7 for random flap and r=0.6 for pedicled flap) than for T30 (r=0.57 for random flap and r=0.59 for pedicled flap). Even higher correlation could be seen PU and TTP (T0: random flap r=-0.8 and pedicled flap r=0.76. T30: random flap r=-0.8 and pedicled flap r=0.71)Conclusion:There is a correlation between PU from LSCI and TTP and AUC60 for ICG-FA, indicating that LSCI could be considered for intraoperative tissue assessment.

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  • 5281.
    Zötterman, Johan
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Tesselaar, Erik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Medicinsk strålningsfysik.
    Farnebo, Simon
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model2019Ingår i: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 72, nr 5, s. 771-777Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We evaluated the use of laser speckle contrast imaging (LSCI) in the perioperative planning in reconstructive flap surgery. The aim of the study was to investigate whether LSCI can predict regions with a high risk of developing postoperative necrosis. Our hypothesis was that, perioperatively, such regions have perfusion values below a threshold value and show a negative perfusion trend. Methods: A porcine flap model based on the cranial gluteal artery perforator was used. Images were acquired before surgery, immediately after surgery (t = 0), after 30 min (t =30 min), and after 72h (t = 72 h). Regions of interest (ROIs) were chosen along the central axis of the flap. Clinical evaluation of the flap was made during each time point. Results: At t = 72 h, a demarcation line could be seen at a distance of 15.8 +/- 0.4 cm away from the proximal border of the flaps. At t =0, perfusion decreased gradually from the proximal to the distal ROI. At t =30 min, perfusion was significantly lower in the ROI distal to the final demarcation line than that at t = 0, and in all flaps, these ROIs had a perfusion amp;lt;25 PU. At t= 72 h, perfusion in the ROI proximal to this line returned to baseline levels, whereas perfusion in the distal ROI remained low. Conclusions: In our model, a decrease in perfusion during the first 30 min after surgery and a perfusion amp;lt;25 PU at t = 30 min was a predictor for tissue morbidity 72 h after surgery, which indicates that LSCI is a promising technique for perioperative monitoring in reconstructive flap surgery. (C) 2018 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

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  • 5282.
    Ängquist, Karl-Axel
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Human skeletal muscle fibre structure: effects of physical training and arterial insufficiency1978Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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    Human skeletal muscle fibre structure
  • 5283.
    Åberg, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Prediktorer för icke-kurativ kirurgi vid primär hyperparatyreoidism – en pilotstudie vid Östersunds sjukhus.2021Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 5284.
    Åberg, Jonas
    et al.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Tillämpad materialvetenskap.
    Pankotai, Eszter
    Weszl, Miklós
    Forster-Horváth, Casba
    Hulsart Billström, Gry
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Lacza, Zombor
    Engqvist, Håkan
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Tillämpad materialvetenskap.
    In vivo evaluation of an injectable premixed radiopaque calcium phosphate cement2011Ingår i: EFORT, 2011Konferensbidrag (Refereegranskat)
  • 5285.
    Åberg, Jonas
    et al.
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Tillämpad materialvetenskap.
    Persson, Cecilia
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Tillämpad materialvetenskap.
    Hulsart Billström, Gry
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Brisby, Helena
    Thomsen, Peter
    Engqvist, Håkan
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Tillämpad materialvetenskap.
    Evaluation of a radio-opaque premixed calcium phosphate cement2010Ingår i: Scandinavian Society or Biomaterials Annual Meeting, 2010Konferensbidrag (Refereegranskat)
  • 5286.
    Åberg, Torkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Defence, counterattack, retreat?2004Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 26, nr Suppl 1, s. S32-S35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cardio-thoracic surgery is facing changes which are imposed upon us from two sources, medical development within cardiology and the general demographic and economic development of the western world. These two developments have to be faced. This treaty describes one way of thinking in our response to the changes. Using old strategic principles our options are attack, defence and retreat. The three options are described in some detail. In order to be well prepared, knowledge and preparation for all three options is necessary in meeting the challenges of the future.

  • 5287.
    Åberg, Torkel
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Symposium for the future of cardiac surgery. Working group report. If retreat, how?2004Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 26, nr Suppl 1, s. S72-S73Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 5288.
    Åkerberg, Daniel
    et al.
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Ansari, Daniel
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Factors influencing receipt of adjuvant chemotherapy after surgery for pancreatic cancer: a two-center retrospective cohort study2017Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 1, s. 56-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The addition of adjuvant chemotherapy after surgical resection has improved survival rates for patients with pancreatic ductal adenocarcinoma (PDAC). However, outside clinical trials, many operated patients still do not receive adjuvant chemotherapy due to clinical and tumor-related factors. The aim of this study was to investigate factors that may influence the receipt of adjuvant chemotherapy and the effect on long-term survival. Materials and methods: Patients undergoing macroscopically curative resection for PDAC at the University Hospitals in Lund and Linkoping, Sweden, between 1 January 2007 and 31 December 2015, were retrospectively reviewed. Clinical and pathological data were compared between adjuvant and non-adjuvant chemotherapy groups and factors affecting chemotherapy receipt were analyzed by multiple logistic regression. Multivariable Cox regression analysis was performed to select predictive variables for survival. Results: A total of 233 patients were analyzed. Adjuvant chemotherapy was administered to 167 patients (71.7%). The likelihood of receiving adjuvant chemotherapy decreased with age, OR 0.91, 95% CI 0.86-0.95, pamp;lt;.001. Moreover, patients with severe postoperative complications (Clavien-Dindo grade amp;gt;= III) were less likely to receive adjuvant chemotherapy, OR 0.31, 95% CI 0.14-0.71, p=.005. The presence of lymph node metastases on histopathological reporting was associated with increased likelihood of initiating adjuvant chemotherapy, OR 2.19, 95% CI 1.09-4.40, p=.028. Adjuvant chemotherapy was an independent factor for prolonged survival on multivariable Cox regression analysis, HR 0.45 (95% CI 0.31-0.65), pamp;lt;.001. Conclusions: Age, postoperative complications and the presence of lymph node metastases affect the likelihood of receiving adjuvant chemotherapy after PDAC surgery.

  • 5289.
    Åkerblom, Hanna
    et al.
    Department of Ophthalmology, Region Västmanland, Västerås, Sweden.
    Franzén, Stefan
    National Diabetes Register, Center of Registers, Gothenburg, Sweden; Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zhou, Caddie
    National Diabetes Register, Center of Registers, Gothenburg, Sweden.
    Morén, Åsa
    Department of Ophthalmology, Region Västmanland, Västerås, Sweden.
    Ottosson, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Sundbom, Magnus
    Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden.
    Eliasson, Björn
    Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Svensson, Ann-Marie
    National Diabetes Register, Center of Registers, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Granstam, Elisabet
    Department of Ophthalmology, Region Västmanland, Västerås, Sweden; Center for Clinical Research, Region Västmanland/Uppsala University, Västerås, Sweden.
    Association of Gastric Bypass Surgery With Risk of Developing Diabetic Retinopathy Among Patients With Obesity and Type 2 Diabetes in Sweden: An Observational Study2021Ingår i: JAMA ophthalmology, ISSN 2168-6165, E-ISSN 2168-6173, Vol. 39, nr 2, s. 200-205Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance: Knowledge of the incidence and progression of diabetic retinopathy (DR) after gastric bypass surgery (GBP) in patients with obesity and diabetes could guide the management of these patients.

    Objective: To investigate the incidence of diabetic ocular complications in patients with type 2 diabetes after GBP compared with the incidence of diabetic ocular complications in a matched cohort of patients with obesity and diabetes who have not undergone GBP.

    Design, Setting, and Participants: Data from 2 nationwide registers in Sweden, the Scandinavian Obesity Surgery Registry and the National Diabetes Register, were used for this cohort study. A total of 5321 patients with diabetes from the Scandinavian Obesity Surgery Registry who had undergone GBP from January 1, 2007, to December 31, 2013, were matched with 5321 patients with diabetes from the National Diabetes Register who had not undergone GBP, based on sex, age, body mass index (BMI), and calendar time (2007-2013). Follow-up data were obtained until December 31, 2015. Statistical analysis was performed from October 5, 2018, to September 30, 2019.

    Exposure: Gastric bypass surgery.

    Main Outcomes and Measures: Incidence of new DR and other diabetic ocular complications.

    Results: The study population consisted of 5321 patients who had undergone GBP (3223 women [60.6%]; mean [SD] age, 49.0 [9.5] years) and 5321 matched controls (3395 women [63.8%]; mean [SD] age, 47.1 [11.5] years). Mean (SD) follow-up was 4.5 (1.6) years. The mean (SD) BMI and hemoglobin A1c concentration at baseline were 42.0 (5.7) and 7.6% (1.5%), respectively, in the GBP group and 40.9 (7.3) and 7.5% (1.5%), respectively, in the control group. The mean (SD) duration of diabetes was 6.8 (6.3) years in the GBP group and 6.4 (6.4) years in the control group. The risk for new DR was reduced in the patients who underwent GBP (hazard ratio, 0.62 [95% CI, 0.49-0.78]; P < .001). The dominant risk factors for development of DR at baseline were diabetes duration, hemoglobin A1c concentration, use of insulin, glomerular filtration rate, and BMI.

    Conclusions and Relevance: This nationwide matched cohort study suggests that there is a reduced risk of developing new DR associated with GBP, and no evidence of an increased risk of developing DR that threatened sight or required treatment.

  • 5290.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk endokrinologi.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Leo Swenne, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Ronquist, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Elective orthopedic and cardiopulmonary bypass surgery causes a reduction in serum endostatin levels2014Ingår i: European Journal of Medical Research, ISSN 0949-2321, E-ISSN 2047-783X, Vol. 19, s. 61-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Endostatin is an endogenous inhibitor of angiogenesis that inhibits neovascularisation. The aim of the study was to evaluate the effect of elective surgery on endostatin levels.

    Methods: Blood samples were collected prior to elective surgery and 4 and 30 days postoperatively in 2 patient groups: orthopedic surgery (n =27) and coronary bypass patients (n =21). Serum endostatin levels were measured by ELISA.

    Results: Serum endostatin was significantly reduced 30 days after surgery in comparison with presurgical values in both the orthopedic (P =0.03) and cardiopulmonary surgery (P =0.04) group.

    Conclusion: Serum endostatin is reduced 30 days after surgery. This reduction would favor angiogenesis and wound-healing.

    Ladda ner fulltext (pdf)
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  • 5291.
    Åkerfeldt, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk endokrinologi.
    Helmersson-Karlqvist, Johanna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Circulating Human Fractalkine is Decreased Post-operatively After Orthopedic and Coronary Bypass Surgery2014Ingår i: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 28, nr 2, s. 185-188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fractalkine is an important chemokine involved in resolving normal inflammatory processes such as wound healing. Soluble fractalkine acts as a chemoattractant bringing cytotoxic and cytokine-producing cells to areas of inflammation. The aim of the present study was to investigate circulating fractalkine during inflammatory response induced by surgery.

    MATERIALS AND METHODS: Fractalkine was analyzed in serum samples from orthopedic surgery patients (n=29) and coronary bypass patients (n=21). The samples were collected prior to surgery and 4 and 30 days after surgery, respectively.

    RESULTS: Fractalkine concentrations decreased from pre-operative levels of 1,764 (1,330-2,434) pg/mL to 1,520 (1,330-2,434) pg/mL at 4 days after surgery, and to 1,285 (1,099-1,462) pg/mL 30 days after surgery in patients undergoing orthopedic procedures (p<0.01, 30 days post-operatively versus pre-operatively). Furthermore, fractalkine concentrations decreased significantly from pre-operative levels of 1,856 (1,520-2,434) pg/mL to 1,338 (964-1,650) pg/mL 4 days post-operatively and to 1,266 (1,080-1,338) pg/mL 30 days post-operatively in patients undergoing coronary bypass surgery (p<0.01, 30 days post-operative versus pre-operative values).

    CONCLUSION: A significant and persistent decrease in circulating fractalkine was observed after orthopedic and coronary bypass surgery despite a marked inflammatory response.

  • 5292.
    Åkerlund, John
    et al.
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sundqvist, Pernilla
    Department of Urology, Faculty of Medicine and Health, Örebro University, Sweden.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lundstam, Sven
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Peeker, Ralph
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Månsson, Marianne
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Grenabo Bergdahl, Anna
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Predictors for complication in renal cancer surgery: a national register study2023Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 58, s. 38-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Nationwide register data provide unique opportunities for real-world assessment of complications from different surgical methods. This study aimed to assess incidence of, and predictors for, post-operative complications and to evaluate 90-day mortality  following different surgical procedures and thermal ablation for renal cell carcinoma (RCC).

    MATERIAL AND METHODS: All patients undergoing surgical treatment and thermal ablation for RCC in Sweden during 2015-2019 were identified from the National Swedish Kidney Cancer Register. Frequencies and types of post-operative complications were analysed. Logistic regression models were used to identify predictors for 90-day major (Clavien-Dindo grades III-V) complications, including death.

    RESULTS: The overall complication rate was 24% (1295/5505), of which 495 (8.7%) were major complications. Most complications occurred following open surgery, of which bleeding and infection were the most common. Twice as many complications were observed in patients undergoing open surgery compared to minimally invasive surgery (20% vs. 10%, P < 0.001). Statistically significant predictors for major complications irrespective of surgical category and technique were American society of anesthiologists (ASA) score, tumour diameter and serum creatinine. Separating radical and partial nephrectomy, surgical technique remained a significant risk factor for major complications. Most complications occurred within the first 20 days. The overall 90-day readmission rate was 6.2%, and 30- and 90-day mortality rates were 0.47% and 1.5%, respectively.

    CONCLUSIONS: In conclusion, bleeding and infection were the most common major complications after RCC surgery. Twice as many patients undergoing open surgery suffer a major post-operative complication as compared to patients subjected to minimally invasive surgery. General predictors for major complications were ASA score, tumour size, kidney function and surgical technique.

    Ladda ner fulltext (pdf)
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  • 5293.
    Åkerlund, John
    et al.
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sundqvist, Pernilla
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Urology.
    Ljungberg, Börje
    Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
    Lundstam, Sven
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Peeker, Ralph
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Månsson, Marianne
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Grenabo Bergdahl, Anna
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Predictors for complication in renal cancer surgery: a national register study2023Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 58, nr 1, s. 38-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Nationwide register data provide unique opportunities for real-world assessment of complications from different surgical methods. This study aimed to assess incidence of, and predictors for, post-operative complications and to evaluate 90-day mortality  following different surgical procedures and thermal ablation for renal cell carcinoma (RCC).

    MATERIAL AND METHODS: All patients undergoing surgical treatment and thermal ablation for RCC in Sweden during 2015-2019 were identified from the National Swedish Kidney Cancer Register. Frequencies and types of post-operative complications were analysed. Logistic regression models were used to identify predictors for 90-day major (Clavien-Dindo grades III-V) complications, including death.

    RESULTS: The overall complication rate was 24% (1295/5505), of which 495 (8.7%) were major complications. Most complications occurred following open surgery, of which bleeding and infection were the most common. Twice as many complications were observed in patients undergoing open surgery compared to minimally invasive surgery (20% vs. 10%, P < 0.001). Statistically significant predictors for major complications irrespective of surgical category and technique were American society of anesthiologists (ASA) score, tumour diameter and serum creatinine. Separating radical and partial nephrectomy, surgical technique remained a significant risk factor for major complications. Most complications occurred within the first 20 days. The overall 90-day readmission rate was 6.2%, and 30- and 90-day mortality rates were 0.47% and 1.5%, respectively.

    CONCLUSIONS: In conclusion, bleeding and infection were the most common major complications after RCC surgery. Twice as many patients undergoing open surgery suffer a major post-operative complication as compared to patients subjected to minimally invasive surgery. General predictors for major complications were ASA score, tumour size, kidney function and surgical technique.

  • 5294.
    Åkerström, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Introduction to symposium: "New genetics with impact on treatment of endocrine tumour disease"2016Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 286, nr 6, s. 536-539Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Read more articles from the symposium: Endocrine tumors - new generation sequencing with impact on therapy.

  • 5295.
    Åkerström, Göran
    et al.
    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.
    Edfeldt, Katarina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Crona, Joakim
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Björklund, Peyman
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Experimentell kirurgi.
    Westin, Gunnar
    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. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Experimentell kirurgi.
    Stålberg, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    A review on management discussions of small intestinal neuroendocrine tumors 'midgut carcinoids'2015Ingår i: INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY, ISSN 2045-0869, Vol. 2, nr 2, s. 119-128Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    European Neuroendocrine Tumor Society staging, together with the Ki67 grading system, has appeared as superior for classification of neuroendocrine tumors (NET). The management of small intestinal NET (SI-NET) has been overall controversial. Mesenteric metastases occur also with the smallest SI-NET, and the majority of patients risk to ultimately progress with liver metastases. 68Gallium (somatostatin receptor)/PET/CT has appeared as most sensitive for imaging, and fluorodeoxyglucose-PET is recommended to identify lesions with high proliferation. Our treatment policy for SINET is to initiate somatostatin analog treatment, and in order to prevent abdominal complications we recommend early intestinal resection for removal of primary tumors and clearance of lymph node metastases. Liver metastases are liberally treated by resection (or ablation), as this can efficiently palliate carcinoid syndrome-associated symptoms.

  • 5296.
    Åkerström, Göran
    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.
    Natural History of untreated primary hyperparathyroidism2016Ingår i: Textbook of Endocrine Surgery: / [ed] Dr. Orlo H Clark MD, Dr. Quan-Yang Duh MD, Dr. Electron Kebebew MD, Dr. Jessica E Gosnell MD and Dr. Wen T Shen MA MD, Jaypee Brothers Medical Publishers , 2016, 3Kapitel i bok, del av antologi (Refereegranskat)
  • 5297.
    Åkerström, Göran
    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.
    Resection of Small intestinal neuroendocrine tumors2016Ingår i: Atlas of endocrine surgical techniques / [ed] Sally E Carty, Jaypee Brothers Medical Publishers , 2016Kapitel i bok, del av antologi (Refereegranskat)
  • 5298.
    Åkerström, Göran
    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.
    Hessman, Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Remedial Parathyroid Surgery2012Ingår i: Surgery of the Thyroid and Parathyroid Glands / [ed] D. Oertli, R. Udelsman, Springer Berlin/Heidelberg, 2012, 2, s. 555-577Kapitel i bok, del av antologi (Refereegranskat)
  • 5299.
    Åkerström, Göran
    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.
    Skogseid, Britt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Multiple Endocrine Neoplasia type 22018Ingår i: Textbook of Complex General Surgical Oncology / [ed] Shane Y Morita, Charles M Balch, V. Suzanne Klimberg, Timothy M. Pawlik, Mitchell C. Posner, Kenneth K. Tanabe, McGraw-Hill, 2018Kapitel i bok, del av antologi (Refereegranskat)
  • 5300.
    Åkesson, Marlene
    et al.
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Gävleborg.
    Rahm, Vivi-Anne
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Gävleborg.
    Näringsdryck sju dagar före planerad operation: effekter på det pre- och postoperativa förloppet för tarmkirurgipatienter2005Rapport (Övrig (populärvetenskap, debatt, mm))
    Abstract [en]

    Introduction: During the last decades, the contribution of good nutrition to better results in health care has been emphasised.

    Aim: To investigate if a nutritional drink, given seven days before a planned operation to patients undergoing intestinal surgery, can influence the degree of malnutrition and insulin resistance and thereby consequences in the pre and postoperative phases, as compared to when patients did not receive the nutritional drink.

    Method: En randomised controlled trial. The data collected using two instruments, a diary together with protocols and a blood test. All together there were 24 patients in the intervention group and 22 patients in the control group.

    Results: Pre and postoperative nausea were significantly lower in the intervention group. Nutrition status, assessed as transtyretin values, declined from the point of inclusion to the day of operation in both groups but twice as much in the control group, despite that the latter were more postoperatively more insulin resistance. In the intervention group, clinically postoperative effects could be seen in terms of mobilisation, feelings of well-being, complications and earlier gas releases. There were no clinically or statistically significant differences in length of care or nutrition.

    Conclusions: A nutritional drink seven days prior to planned surgery had a positive effect on the pre and postoperative condition of the patients. The study can help the health care personal to realise the importance of patients being well nourished prior to intestinal surgery

    which will in turn be of benefit to the patients.

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