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Hörer, T. M., Skoog, P., Pirouzram, A., Nilsson, K. F. & Larzon, T. (2016). A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review. European Journal of Trauma and Emergency Surgery, 42(5), 585-592
Öppna denna publikation i ny flik eller fönster >>A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review
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2016 (Engelska)Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 42, nr 5, s. 585-592Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm.

We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma.

A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented.

Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients.

EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.

Ort, förlag, år, upplaga, sidor
Springer, 2016
Nyckelord
Hemorrhagic shock, Trauma, Intra-aortic balloon occlusion, Angiography, Access, Endovascular treatment
Nationell ämneskategori
Kardiologi
Forskningsämne
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-53378 (URN)10.1007/s00068-015-0574-0 (DOI)000385176400008 ()26416402 (PubMedID)2-s2.0-84944620095 (Scopus ID)
Tillgänglig från: 2016-11-03 Skapad: 2016-11-03 Senast uppdaterad: 2019-03-26Bibliografiskt granskad
Hörer, T. M., Skoog, P., Quell, R., Nilsson, K. F., Larzon, T. & Souza, D. R. (2016). No-touch technique for radiocephalic arteriovenous fistula - surgical technique and preliminary results. Journal of Vascular Access, 17(1), 6-12
Öppna denna publikation i ny flik eller fönster >>No-touch technique for radiocephalic arteriovenous fistula - surgical technique and preliminary results
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2016 (Engelska)Ingår i: Journal of Vascular Access, ISSN 1129-7298, E-ISSN 1724-6032, Vol. 17, nr 1, s. 6-12Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: The radiocephalic arteriovenous fistula (RC-AVF) has significant failure rates due to occlusions and failure to mature. The size and quality of the veins are considerable limiting factors for the procedure. The aim of this pilot study was to describe the No-Touch technique (NTT) to create RC-AVF and present the results up to 1 year of follow-up.

Methods: Thirty-one consecutive patients who were referred for surgery for a RC-AVF were included (17 men, mean age 63 years, range 35-84) and operated by NTT where the vein and artery were dissected with a tissue cushion around it. Twenty-two patients had small veins or arteries (<= 2 mm), 12 patients had a small cephalic vein (<= 2 mm), and the mean distal cephalic vein diameter was 2.4 mm (range 1.0-4.1 mm).

Results: Technical surgical success and immediate patency were obtained in all patients. Clinical success was achieved in 23 of the 27 (85%) patients who required hemodialysis. The proportion of primary patency at 30 days and 6 months was 84% and 64%, respectively. Secondary patency at 30 days and 6 months was 97% and 83%, respectively. At 1-year follow-up, primary patency was 54% and secondary patency was 80%. There was no major difference in patency due to preoperative vein diameter.

Conclusions: The results of this study indicate that NTT can be used for primary radio-cephalic fistula surgery with very good results. This method offers the potential to create a RC-AVF in patients who are not usually considered appropriate for a distal arm fistula due to a small cephalic vein.

Ort, förlag, år, upplaga, sidor
Wichtig Publishing, 2016
Nyckelord
Access, Dialysis, No-touch technique, Patency, Radiocephalic fistula
Nationell ämneskategori
Kardiologi
Forskningsämne
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-49714 (URN)10.5301/jva.5000456 (DOI)000371981400010 ()26391584 (PubMedID)2-s2.0-84956908067 (Scopus ID)
Tillgänglig från: 2016-04-08 Skapad: 2016-04-08 Senast uppdaterad: 2019-03-26Bibliografiskt granskad
Skoog, T., Skoog, P. & Özdemir, M. (2015). Ungdomars identitetsutveckling och idrottande. Skolhälsan (1), 12-13
Öppna denna publikation i ny flik eller fönster >>Ungdomars identitetsutveckling och idrottande
2015 (Svenska)Ingår i: Skolhälsan, ISSN 0284-284X, nr 1, s. 12-13Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm)) Published
Ort, förlag, år, upplaga, sidor
Riksföreningen för Skolsköterskor / Swedish Association of School Nurses, 2015
Nationell ämneskategori
Psykologi
Forskningsämne
Psykologi
Identifikatorer
urn:nbn:se:oru:diva-42423 (URN)
Forskningsfinansiär
Forte, Forskningsrådet för hälsa, arbetsliv och välfärd
Tillgänglig från: 2015-02-05 Skapad: 2015-02-05 Senast uppdaterad: 2019-04-03Bibliografiskt granskad
Skoog, P., Hörer, T. M., Nilsson, K. F. F., Norgren, L., Larzon, T. & Jansson, K. (2014). Abdominal Hypertension and Decompression: The Effect on Peritoneal Metabolism in an Experimental Porcine Study. , 47(4)
Öppna denna publikation i ny flik eller fönster >>Abdominal Hypertension and Decompression: The Effect on Peritoneal Metabolism in an Experimental Porcine Study
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2014 (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Objective: This study aims to investigate the abdominal metabolic response and circulatory changes after decompression of intra-abdominal hypertension in a porcine model. Design: Prospective study with controls. Setting: University hospital research laboratory.

Subjects: Three-months old domestic pigs of both sexes. Interventions: The animals were anesthetised and ventilated. Nine animals had a pneumoperitoneum-induced intra-abdominal hypertension of 30 mmHg for six hours. Twelve animals had corresponding intra-abdominal hypertension for four hours followed by decompression and were monitored for another two hours.

Measurements and Main Results: Hemodynamics, urine output and arterial blood samples were analysed. Laserdoppler measured mucosal blood flow and urine output decreased with pressure induction and showed a statistically significant restitution after decompression. Glucose, glycerol, lactate and pyruvate concentrations and lactate-pyruvate (l/p) ratio were measured by microdialysis. Both groups developed distinct metabolic changes intraperitoneally at pressure induction including an increased l/p ratio as signs of organ hypoperfusion. In the decompression group the intraperitoneal l/p ratio normalised during the second decompression hour, indicating partially restored perfusion.

Conclusions: Decompression after four hours of intra-abdominal hypertension results in restoration of intestinal blood flow and normalised intraperitoneal metabolism.

Nyckelord
Glycerol, Intra-abdominal hypertension, Lactate, Laser Doppler flowmetry, Microdialysis, Pyruvate
Nationell ämneskategori
Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-34963 (URN)
Tillgänglig från: 2014-05-05 Skapad: 2014-05-05 Senast uppdaterad: 2018-08-27Bibliografiskt granskad
Hörer, T. M., Skoog, P., Nilsson, K. F., Oikonomakis, I., Larzon, T., Norgren, L. & Jansson, K. (2014). Intraperitoneal Metabolic Consequences of Supraceliac Aortic Balloon Occlusion in an Experimental Animal Study Using Microdialysis. Annals of Vascular Surgery, 28(5), 1286-1295
Öppna denna publikation i ny flik eller fönster >>Intraperitoneal Metabolic Consequences of Supraceliac Aortic Balloon Occlusion in an Experimental Animal Study Using Microdialysis
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2014 (Engelska)Ingår i: Annals of Vascular Surgery, ISSN 0890-5096, E-ISSN 1615-5947, Vol. 28, nr 5, s. 1286-1295Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: To investigate the effects of supraceliac aortic balloon occlusion (ABO) and superior mesenteric artery (SMA) occlusion on abdominal visceral metabolism in an animal model using intraperitoneal microdialysis (IPM) and laser Doppler flowmetry.

Methods: A total of 9 pigs were subjected to ABO and 7 animals were subjected to SMA occlusion for 1 hour followed by 3 hours of reperfusion. Seven animals served as controls. Hemodynamic data, arterial blood samples, urinary output, and intestinal mucosal blood flow (IBF) were followed hourly. Intraperitoneal (i.p) glucose, glycerol, lactate, and pyruvate concentrations and lactate-to-pyruvate (lip) ratio were measured using IPM.

Results: Compared with the baseline, ABO reduced IBF by 76% and decreased urinary output. SMA occlusion reduced IBF by 75% without affecting urinary output. ABO increased the i.p lip ratio from 18 at baseline, peaking at 46 in early reperfusion. SMA occlusion and reperfusion tended to increase the i.p lip ratio, peaking at 36 in early reperfusion. ABO increased the i.p glycerol concentration from 87 mu M at baseline to 579 p,M after 3 hours of reperfusion. SMA occlusion and reperfusion increased The i.p glycerol concentration but to a lesser degree.

Conclusions: Supraceliac ABO caused severe hemodynamic, renal, and systemic metabolic disturbances compared with SMA occlusion, most likely because of the more extensive ischemia-reperfusion injury. The intra-abdominal metabolism, measured by microdialysis, was affected by both ABO and SMA occlusion but the most severe disturbances were caused by ABO. The i.p lip ratios and the glycerol concentrations increased during ischemia and reperfusion and may serve as markers of these events and indicate anaerobic metabolism and cell damages respectively.

Ort, förlag, år, upplaga, sidor
Elsevier, 2014
Nationell ämneskategori
Kirurgi Kardiologi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-35805 (URN)10.1016/j.avsg.2014.01.005 (DOI)000338090700030 ()24509366 (PubMedID)2-s2.0-84902795983 (Scopus ID)
Tillgänglig från: 2014-08-28 Skapad: 2014-07-30 Senast uppdaterad: 2019-03-26Bibliografiskt granskad
Skoog, P., Hörer, T. M., Ågren, G., Jansson, K. & Norgren, L. (2013). Intra-Abdominal Metabolism and Blood Flow During Abdominal Hypertension: A Porcine Pilot Study Under Intravenous Anaesthesia. Archives Of Clinical Experimental Surgery, 2(3), 176-185
Öppna denna publikation i ny flik eller fönster >>Intra-Abdominal Metabolism and Blood Flow During Abdominal Hypertension: A Porcine Pilot Study Under Intravenous Anaesthesia
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2013 (Engelska)Ingår i: Archives Of Clinical Experimental Surgery, ISSN 2146-8133, Vol. 2, nr 3, s. 176-185Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To study the splanchnic metabolism and intestinal circulation in a porcine model with increased abdominal pressure.

Methods: In an experimental porcine study, performed under intravenous anaesthesia, five animals were subjected to gradually increasing intra-abdominal pressure (15 mmHg, 25 mmHg, and 35 mmHg) with pneumoperitoneum. Microdialysis and laser Doppler were the main outcome methods for monitoring the metabolic and circulatory changes.

Results: During stable anaesthesia and gradually increasing intra-abdominal pressure obtained by CO2-pneumoperitoneum, blood flow (microcirculation) was deprived and moderate signs of impaired splanchnic metabolism were recorded.

Conclusions: The model appears usable for studies of splanchnic metabolic consequences of intra-abdominal hypertension.

Ort, förlag, år, upplaga, sidor
Gulhane Military Medical Academy, 2013
Nyckelord
intra-abdominal hypertension, microdialysis, laser-doppler flowmetry, lactates, pyruvates, glycerol
Nationell ämneskategori
Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-34964 (URN)10.5455/aces.20130118045113 (DOI)
Tillgänglig från: 2014-05-05 Skapad: 2014-05-05 Senast uppdaterad: 2019-04-02Bibliografiskt granskad
Hörer, T., Skoog, P., Norgren, L., Magnuson, A., Berggren, L., Jansson, K. & Larzon, T. (2013). Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms. European Journal of Vascular and Endovascular Surgery, 45(6), 596-606
Öppna denna publikation i ny flik eller fönster >>Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms
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2013 (Engelska)Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 45, nr 6, s. 596-606Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives: This study aims to evaluate intra-peritoneal (ip) microdialysis after endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) in patients developing intra-abdominal hypertension (IAH), requiring abdominal decompression.

Design: Prospective study.

Material and methods: A total of 16 patients with rAAA treated with an emergency EVAR were followed up hourly for intra-abdominal pressure (IAP), urine production and ip lactate, pyruvate, glycerol and glucose by microdialysis, analysed only at the end of the study. Abdominal decompression was performed on clinical criteria, and decompressed (D) and non-decompressed (ND) patients were compared.

Results: The ip lactate/pyruvate (l/p) ratio was higher in the D group than in the ND group during the first five postoperative hours (mean 20 vs. 12), p = 0.005 and at 1 h prior to decompression compared to the fifth hour in the ND group (24 vs. 13), p = 0.016. Glycerol levels were higher in the D group during the first postoperative hours (mean 274.6 vs. 121.7 mu M), p = 0.022. The IAP was higher only at 1 h prior to decompression in the D group compared to the ND group at the fifth hour (mean 19 vs. 14 mmHg).

Conclusions: lp l/p ratio and glycerol levels are elevated immediately postoperatively in patients developing IAH leading to organ failure and subsequent abdominal decompression.

Nyckelord
Ruptured aortic aneurysm, Intra-abdominal hypertension, Metabolism, Microdialysis, Lactate, Pyruvate, Glycerol
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicin
Identifikatorer
urn:nbn:se:oru:diva-30189 (URN)10.1016/j.ejvs.2013.03.002 (DOI)000320745100012 ()
Tillgänglig från: 2013-08-13 Skapad: 2013-08-13 Senast uppdaterad: 2018-09-11Bibliografiskt granskad
Skoog, P. (2013). On the metabolic consequenses of abdominal compartment syndrome. (Doctoral dissertation). Örebro: Örebro universitet
Öppna denna publikation i ny flik eller fönster >>On the metabolic consequenses of abdominal compartment syndrome
2013 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Intra-abdominal hypertension (IAH) and the progression to abdominal compartment syndrome (ACS) are known complications of vascular and abdominal surgery, trauma, sepsis, and burns. ACS is associated with high mortality. In ACS, hypoperfusion, hypoxia, onset of inflammatory pathways and increased levels of oxygen reactive species are believed to cause tissue damage and initiate organ failure. Early detection of IAH is central in order to stop the pathological processes. Microdialysis is a method to determine extracellular metabolic changes through analysis of glucose, pyruvate, lactate and glycerol. Microdialysis is known to be feasible in the abdomen to detect early signs of postoperative complications. The ratio of lactate and pyruvate (l/p ratio) reflects the intracellular relationship between aerobic and anaerobic metabolism. Glycerol is elevated when cells have increased energy needs and in cell damage. Our hypothesis was that IAH and ACS cause early metabolic changes in the abdomen which could be determined by microdialysis, and possibly serve as clinical markers for organ failure due to IAH. In Paper I methodology was established using a porcine model with CO2 pneumoperitoneum. Using the model in Paper II and III, we showed that metabolic changes (elevated l/p ratio and glycerol) occurred early in the abdomen as IAH was induced and also restituted after decompression. Decrease in urine output, circulatory changes and impaired mucosal circulation indicated that the model mimicked ACS well. In a clinical study (Paper IV), patients that underwent endovascular surgery for rAAA and later needed decompression due to IAH with organ failure, had more pronounced early metabolic alterations than patients without severe IAH. In conclusion, early abdominal metabolic changes due to IAH are seen experimentally in a model and in patients after rAAA. These changes can be measured with microdialysis and they could, if the results are verified in further studies,be used as clinical markers for IAH and ACS.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro universitet, 2013. s. 59
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 97
Nyckelord
intra-abdominal hypertension; intra-abdominal metabolism microdialysis; laserdoppler flowmetry; lactate; pyruvate; glycerol; lactate/pyruvate ratio; ruptured abdominal aortic aneurysm
Nationell ämneskategori
Medicin och hälsovetenskap Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-32016 (URN)978-91-7668-976-9 (ISBN)
Disputation
2013-11-29, Wilandersalen, Örebro universitetssjukhus, S Grev Rosengatan, 703 62 Örebro, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2013-10-15 Skapad: 2013-10-15 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
Hörer, T. M., Skoog, P., Pirouzram, A. & Larzon, T. (2012). Tissue plasminogen activator-assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Journal of Endovascular Therapy, 19(2), 144-148
Öppna denna publikation i ny flik eller fönster >>Tissue plasminogen activator-assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm
2012 (Engelska)Ingår i: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 19, nr 2, s. 144-148Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: To describe our experience with a novel technique to decompress abdominal compartment syndrome after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA).

Method: From January 2003 to April 2010, 13 patients (12 men; mean age 75 years) treated for rAAA with EVAR underwent tissue plasminogen activator (tPA)-assisted decompression for intra-abdominal hypertension. All of the patients but one had intra-abdominal pressure >20 mmHg, with signs of multiple organ failure or abdominal perfusion pressure <60 mmHg. With computed tomography guidance, a drain was inserted into the retroperitoneal hematoma, and tPA solution was injected to facilitate evacuation of the coagulated hematoma and decrease the abdominal pressure.

Results: In the 13 patients, the mean intra-abdominal pressure decreased from 23.5 mmHg (range 12-35) to 16 mmHg (range 10-28.5). A mean 1520 mL (range 170-2900) of blood was evacuated. Urine production (mean 130 mL/h, range 50-270) increased in 7 patients at 24 hours after tPA-assisted decompression; among the 5 patients in which urine output did not increase, 3 underwent hemodialysis by the 30-day follow-up. One patient did not respond with clinical improvement and required laparotomy. The 30-day, 90-day, and 1-year mortality was 38% (5/13 patients); none of the deaths was related to the decompression technique.

Conclusion: tPA-assisted decompression of abdominal compartment syndrome after EVAR can decrease the intra-abdominal pressure and could be useful in preventing multiple organ failure. It is a minimally invasive technique that can be used in selected cases but does not replace laparotomy or retroperitoneal surgical procedures as the gold standard treatments. J Endovasc Thor. 2012;19:144-148

Ort, förlag, år, upplaga, sidor
Sage Publications, 2012
Nyckelord
abdominal compartment syndrome, decompression, endovascular aneurysm repair, ruptured abdominal aorta aneurysm, tissue plasminogen activator
Nationell ämneskategori
Kardiologi Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-58683 (URN)000303644300003 ()22545876 (PubMedID)2-s2.0-84860752930 (Scopus ID)
Tillgänglig från: 2017-07-12 Skapad: 2017-07-12 Senast uppdaterad: 2018-05-15Bibliografiskt granskad
Skoog, P., Hörer, T. M., Nilsson, K. F., Ågren, G., Norgren, L. & Janson, K.Intra-abdominal hypertension: exploration of early changes in intra-abdominal metabolism in a porcine model.
Öppna denna publikation i ny flik eller fönster >>Intra-abdominal hypertension: exploration of early changes in intra-abdominal metabolism in a porcine model
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(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Objective: To investigate the early effects of intra-abdominal hypertension on intraabdominal metabolism and intestinal mucosal blood flow.

Design: Prospective animal study.

Setting: University hospital research laboratory.

Subjects: Three-month old domestic pigs of both sexes.

Interventions: The animals were anesthetized and ventilated. Fifteen animals were subjected to intra-abdominal hypertension of 30 mmHg for four hours by carbon dioxide insufflation. Seven animals served as controls.

Measurements and Main Results: Hemodynamic data, arterial blood samples and urine output were analyzed. Intraluminal laserdoppler flowmetry measured intestinal mucosal blood flow. Glucose, glycerol, lactate and pyruvate concentrations and lactate-pyruvate (l/p) ratio were measured intraperitoneally and intramurally in the small intestine and rectum by microdialysis. Intra-abdominal hypertension lowered the abdominal perfusion pressure by 12- 18 mmHg, reduced the intestinal mucosal blood flow by 45-63% and decreased urine output by 50-80%. While controls remained stable, glycerol concentrations increased at all locations at elevated intra-abdominal pressure, .pyruvate concentrations decreased and the l/p ratio increased intraperitoneally and intramurally in the small intestine. Glucose and lactate concentrations at all locations were only slightly affected or unchanged in both groups.

Conclusions: Intra-abdominal hypertension negatively influences intestinal blood flow and diuresis and causes early metabolic changes, indicating a discrete shift towards anaerobic metabolism. Metabolic changes, measured by intra-abdominal microdialysis, preferably by an intraperitoneal catheter, might be used as early markers of impaired visceral organ function in intra-abdominal hypertension and abdominal compartment syndrome.

Nyckelord
intra-abdominal hypertension; microdialysis; laserdoppler flowmetry; lactate;pyruvate; glycerol
Nationell ämneskategori
Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-34965 (URN)
Tillgänglig från: 2014-05-05 Skapad: 2014-05-05 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
Organisationer
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0003-0934-0063

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