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Nilsson, Kristofer F.ORCID iD iconorcid.org/0000-0002-8461-5074
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Publications (10 of 64) Show all publications
McGreevy, D. T., Pirouzram, A., Gidlund, K. D., Nilsson, K. F. & Hörer, T. M. (2023). A 12-year experience of endovascular repair for ruptured abdominal aortic aneurysms in all patients. Journal of Vascular Surgery, 77(3), 741-749
Open this publication in new window or tab >>A 12-year experience of endovascular repair for ruptured abdominal aortic aneurysms in all patients
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2023 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 77, no 3, p. 741-749Article in journal (Refereed) Published
Abstract [en]

Objective: Endovascular aneurysm repair (EVAR) has been increasingly performed for ruptured abdominal aortic aneurysms (rAAAs). However, multiple randomized trials have failed to demonstrate a survival benefit compared with open aortic surgery. During a 12-year period, 100% of patients without a history of aneurysm surgery had undergone EVAR for a rAAA at orebro University Hospital, with no emergent open aortic surgery performed. In the present study, we evaluated the mortality and technical success during this "EVAR-only" period.

Methods: A single-center, retrospective observational study was conducted. We identified all patients who had presented to Orebro University Hospital with a rAAA between October 2009 and September 2021. Patients with isolated iliac artery, thoracic, and thoracoabdominal aortic ruptures were not included. Patients who had received previous aortic interventions (open or endovascular) and patients who had received palliative treatment instead of surgical intervention were also excluded. The patient characteristics, perioperative and postoperative data, and mortality rate were investigated.

Results: EVAR had been performed in 100 patients. Preoperative hemodynamic instability had been present in 54 patients (54%), and 18 (18%) had undergone aortic balloon occlusion. The aneurysm location was infrarenal in 89 patients (89%). Bifurcated stent grafts had been used in 97 patients (97%), and adjunct endovascular techniques had been used for 27 patients (27%). Of 98 patients, EVAR had been performed with the patient under local anesthesia for 62 patients (63%). Peri-and postoperative complications at 30 days had occurred in 20 of 100 patients (20%) and 22 of 79 patients (28%), respectively. The overall mortality at 30 days was 27% (27 of 100 patients), and the mortality for those with an isolated infrarenal rAAA was 24% (21 of 89 patients). The overall mortality at 1 year was 39% (39 of 100 patients) and for those with an isolated infrarenal rAAA was 37% (33 of 89 patients). The presence of preoperative hemodynamic instability and the use of ABO were statistically significantly and independently associated with increased 30-day mortality on multivariate logistic regression analysis.

Conclusions: All 100 patients who had undergone surgery for a rAAA had been treated using EVAR and endovascular adjuncts, with a relatively low mortality rate, thus continuing the "EVAR-only" approach. A low proportion of rAAA patients were considered surgically unsuitable. These findings support the applicability of EVAR for the treatment of all rAAAs at suitable centers.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Aortic aneurysm, Aortic rupture, Endovascular aortic repair, Endovascular procedures
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-105412 (URN)10.1016/j.jvs.2022.10.032 (DOI)000952530400001 ()37276170 (PubMedID)2-s2.0-85143604283 (Scopus ID)
Available from: 2023-04-12 Created: 2023-04-12 Last updated: 2023-06-19Bibliographically approved
Wikström, M. B., Åström, J., Hurtsén, A. S., Hörer, T. M. & Nilsson, K. F. (2023). A porcine study of ultrasound-guided versus fluoroscopy-guided placement of endovascular balloons in the inferior vena cava (REBOVC) and the aorta (REBOA). Trauma surgery & acute care open, 8(1), Article ID e001075.
Open this publication in new window or tab >>A porcine study of ultrasound-guided versus fluoroscopy-guided placement of endovascular balloons in the inferior vena cava (REBOVC) and the aorta (REBOA)
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2023 (English)In: Trauma surgery & acute care open, E-ISSN 2397-5776, Vol. 8, no 1, article id e001075Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: In fluoroscopy-free settings, alternative safe and quick methods for placing resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative endovascular balloon occlusion of the inferior vena cava (REBOVC) are needed. Ultrasound is being increasingly used to guide the placement of REBOA in the absence of fluoroscopy. Our hypothesis was that ultrasound could be used to adequately visualize the suprahepatic vena cava and guide REBOVC positioning, without significant time-delay, when compared with fluoroscopic guidance, and compared with the corresponding REBOA placement.

METHODS: Nine anesthetized pigs were used to compare ultrasound-guided placement of supraceliac REBOA and suprahepatic REBOVC with corresponding fluoroscopic guidance, in terms of correct placement and speed. Accuracy was controlled by fluoroscopy. Four intervention groups: (1) fluoroscopy REBOA, (2) fluoroscopy REBOVC, (3) ultrasound REBOA and (4) ultrasound REBOVC. The aim was to carry out the four interventions in all animals. Randomization was performed to either fluoroscopic or ultrasound guidance being used first. The time required to position the balloons in the supraceliac aorta or in the suprahepatic inferior vena cava was recorded and compared between the four intervention groups.

RESULTS: Ultrasound-guided REBOA and REBOVC placement was completed in eight animals, respectively. All eight had correctly positioned REBOA and REBOVC on fluoroscopic verification. Fluoroscopy-guided REBOA placement was slightly faster (median 14 s, IQR 13-17 s) than ultrasound-guided REBOA (median 22 s, IQR 21-25 s, p=0.024). The corresponding comparisons of the REBOVC groups were not statistically significant, with fluoroscopy-guided REBOVC taking 19 s, median (IQR 11-22 s) and ultrasound-guided REBOVC taking 28 s, median (IQR 20-34 s, p=0.19).

CONCLUSION: Ultrasound adequately and quickly guide the placement of supraceliac REBOA and suprahepatic REBOVC in a porcine laboratory model, however, safety issues must be considered before use in trauma patients.

LEVEL OF EVIDENCE: Prospective, experimental, animal study. Basic science study.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
multiple trauma, shock, hemorrhagic, ultrasonography, veins
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-105987 (URN)10.1136/tsaco-2022-001075 (DOI)000991834800005 ()37205275 (PubMedID)2-s2.0-85159958333 (Scopus ID)
Available from: 2023-05-22 Created: 2023-05-22 Last updated: 2023-06-07Bibliographically approved
Hurtsén, A. S., McGreevy, D. T., Karlsson, C., Frostell, C. G., Hörer, T. M. & Nilsson, K. F. (2023). A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury. Intensive Care Medicine Experimental, 11(1), Article ID 18.
Open this publication in new window or tab >>A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury
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2023 (English)In: Intensive Care Medicine Experimental, E-ISSN 2197-425X, Vol. 11, no 1, article id 18Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The definition of partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is not yet determined and clinical markers of the degree of occlusion, metabolic effects and end-organ injury that are clinically monitored in real time are lacking. The aim of the study was to test the hypothesis that end-tidal carbon dioxide (ETCO2) targeted pREBOA causes less metabolic disturbance compared to proximal systolic blood pressure (SBP) targeted pREBOA in a porcine model of hemorrhagic shock.

MATERIALS AND METHODS: Twenty anesthetized pigs (26-35 kg) were randomized to 45 min of either ETCO2 targeted pREBOA (pREBOAETCO2, ETCO2 90-110% of values before start of occlusion, n = 10) or proximal SBP targeted pREBOA (pREBOASBP, SBP 80-100 mmHg, n = 10), during controlled grade IV hemorrhagic shock. Autotransfusion and reperfusion over 3 h followed. Hemodynamic and respiratory parameters, blood samples and jejunal specimens were analyzed.

RESULTS: ETCO2 was significantly higher in the pREBOAETCO2 group during the occlusion compared to the pREBOASBP group, whereas SBP, femoral arterial mean pressure and abdominal aortic blood flow were similar. During reperfusion, arterial and mesenteric lactate, plasma creatinine and plasma troponin concentrations were higher in the pREBOASBP group.

CONCLUSIONS: In a porcine model of hemorrhagic shock, ETCO2 targeted pREBOA caused less metabolic disturbance and end-organ damage compared to proximal SBP targeted pREBOA, with no disadvantageous hemodynamic impact. End-tidal CO2 should be investigated in clinical studies as a complementary clinical tool for mitigating ischemic-reperfusion injury when using pREBOA.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Balloon occlusion, Carbon dioxide, Metabolism, Chock, hemorrhagic, Ischemia–reperfusion injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-105455 (URN)10.1186/s40635-023-00502-w (DOI)000982807300001 ()37032421 (PubMedID)2-s2.0-85153117195 (Scopus ID)
Available from: 2023-04-14 Created: 2023-04-14 Last updated: 2023-05-26Bibliographically approved
Seifu, D., Nilsson, K. F., Chawla, R., Genet, S., Holst, M., Debella, A. & Hellström, P. M. (2023). Detection and isolation of intestinal muscle relaxant substances from the root of Taverniera abyssinica A. Rich. Journal of Ethnopharmacology, 312, Article ID 116498.
Open this publication in new window or tab >>Detection and isolation of intestinal muscle relaxant substances from the root of Taverniera abyssinica A. Rich
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2023 (English)In: Journal of Ethnopharmacology, ISSN 0378-8741, E-ISSN 1872-7573, Vol. 312, article id 116498Article in journal (Refereed) Published
Abstract [en]

ETHNOPHARMACOLOGICAL RELEVANCE: In Ethiopian traditional medicine the root of Taverniera abyssinica A.Rich is known as a remedy for sudden gastrointestinal cramping and fever. In this study we have isolated and identified the bioactive principle of Taverniera abyssinica that exerts effects on isolated smooth muscle tissues of the rabbit duodenum and guinea-pig ileum.

AIM OF THE STUDY: To isolate and purify the bioactive principle from the root of Taverniera abyssinica A.Rich by bioassay-guided fractionation, HPLC purification and masspectrometry, with further investigation of its bioactivity on isolated smooth muscle strips.

MATERIALS AND METHODS: Roots of Taverniera abyssinica A.Rich extracted in 75% methanol/water were fractioned with a reverse phase column and then subjected to HPLC purification. Each fraction collected from the HPLC was tested for its bioactivity using electric field stimulation-evoked contractions of the rabbit duodenum and guinea-pig ileum. Finally, detailed structural analysis of the fraction displaying significant bioactivity was made by mass spectrometry.

RESULTS: Through bioassay-guided fractionation and HPLC purification the bioactive fractions were identified. These were tested for bioactivity on isolated smooth muscle strips which showed about 50% inhibition of contractions evoked by electric field stimulation. These compounds were identified as formononetin, afrormosin and tectorigenin by using masspectrometry applying relevant standards for detection.

CONCLUSION: The traditionally claimed smooth muscle-relaxing effect of the roots of Taverniera abyssinica A.Rich is essentially due the three isolated and purified the two isoflavones formononetin, afrormosin as well as the metoxyisoflavone tectorigenin, along with possibly other not yet purified bioactive substances, however with similar smooth muscle-relaxing properties.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Afrormosin, Bioassay, Formononetin, Muscle strip, Smooth muscle, Tectorigenin
National Category
Physiology
Identifiers
urn:nbn:se:oru:diva-105538 (URN)10.1016/j.jep.2023.116498 (DOI)000983637800001 ()37059252 (PubMedID)2-s2.0-85152664400 (Scopus ID)
Available from: 2023-04-17 Created: 2023-04-17 Last updated: 2023-06-02Bibliographically approved
Dogan, E. M., Axelsson, B., Jauring, O., Hörer, T. M., Nilsson, K. F. & Edström, M. (2023). Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation. Journal of Cardiovascular Translational Research, 16(4), 948-955
Open this publication in new window or tab >>Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation
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2023 (English)In: Journal of Cardiovascular Translational Research, ISSN 1937-5387, E-ISSN 1937-5395, Vol. 16, no 4, p. 948-955Article in journal (Refereed) Published
Abstract [en]

Intra-aortic balloon pump (IABP) use during CPR has been scarcely studied. Intra-caval balloon pump (ICBP) may decrease backward venous flow during CPR. Mechanical chest compressions (MCC) were initiated after 10 min of cardiac arrest in anesthetized pigs. After 5 min of MCC, IABP (n = 6) or ICBP (n = 6) was initiated. The MCC device and the IABP/ICBP had slightly different frequencies, inducing a progressive peak pressure phase shift. IABP inflation 0.15 s before MCC significantly increased mean arterial pressure (MAP) and carotid blood flow (CBF) compared to inflation 0.10 s after MCC and to MCC only. Coronary perfusion pressure significantly increased with IABP inflation 0.25 s before MCC compared to inflation at MCC. ICBP inflation before MCC significantly increased MAP and CBF compared to inflation after MCC but not compared to MCC only. This shows the potential of IABP in CPR when optimally synchronized with MCC. The effect of timing of intra-aortic balloon pump (IABP) inflation during mechanical chest compressions (MCC) on hemodynamics. Data from12 anesthetized pigs.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2023
Keywords
Cardiopulmonary resuscitation, Counterpulsation, Heart arrest, Hemodynamics
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-102657 (URN)10.1007/s12265-022-10343-9 (DOI)000895631500001 ()36481982 (PubMedID)2-s2.0-85143687279 (Scopus ID)
Available from: 2022-12-12 Created: 2022-12-12 Last updated: 2023-12-08Bibliographically approved
Skoog, P., Seilitz, J., Oikonomakis, I., Hörer, T. M. & Nilsson, K. F. (2023). NO-Donation Increases Visceral Circulation in a Porcine Model of Abdominal Hypertension. Journal of Cardiovascular Translational Research, 16(1), 42-50
Open this publication in new window or tab >>NO-Donation Increases Visceral Circulation in a Porcine Model of Abdominal Hypertension
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2023 (English)In: Journal of Cardiovascular Translational Research, ISSN 1937-5387, E-ISSN 1937-5395, Vol. 16, no 1, p. 42-50Article in journal (Refereed) Published
Abstract [en]

Intraabdominal hypertension (IAH) is negative for outcome after intensive care. Little research has focused on medical intervention to improve visceral circulation during IAH. A nitric oxide (NO)-donor was compared with placebo in 25 pigs; each pig was randomized into three groups: PDNO (NO-donor), Control (placebo), or Sham. IAH was induced by CO2 insufflation to 30 mmHg. Sham group had surgical preparation only. Blood gases, invasive venous and arterial blood pressure, intestinal microcirculation and superior mesenteric blood flow were measured. The PDNO group had significantly increased intestinal microcirculation compared with Controls during IAH (last hour, P = 0.009). The mean arterial pressure and abdominal perfusion pressures (APP) were decreased, and the cardiac index were increased in the PDNO group. Also, systemic and pulmonary vascular resistances were lower in the PDNO group compared with Controls. These experimental findings indicate that NO should be further explored with potential application to improve intestinal microcirculation in IAH patients.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2023
Keywords
Abdominal compartment syndrome, Intestinal microcirculation, Intraabdominal hypertension, Intraabdominal pressure, Nitric oxide-donor
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-100971 (URN)10.1007/s12265-022-10299-w (DOI)000847243300001 ()36036860 (PubMedID)2-s2.0-85142160606 (Scopus ID)
Funder
University of GothenburgSwedish Society for Medical Research (SSMF), P14-0170
Note

Funding agencies:

Research Committee of Region Örebro County OLL-929955

Nyckelfonden at Örebro University Hospital OLL-506681

Available from: 2022-08-30 Created: 2022-08-30 Last updated: 2023-03-15Bibliographically approved
Grenegård, M., Koufaki, M., Zervou, M., Fotopoulou, T., Lindström, E., Nilsson, K. F., . . . Fransén, K. (2023). The cardioprotective, anti-inflammatory and antithrombotic piperazinyl-purine analogue MK177 is a bifunctional drug with promising therapeutic potential. British Journal of Pharmacology, 180(Suppl. 1), 158-159, Article ID P0855.
Open this publication in new window or tab >>The cardioprotective, anti-inflammatory and antithrombotic piperazinyl-purine analogue MK177 is a bifunctional drug with promising therapeutic potential
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2023 (English)In: British Journal of Pharmacology, ISSN 0007-1188, E-ISSN 1476-5381, Vol. 180, no Suppl. 1, p. 158-159, article id P0855Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Nitrate ester bearing 6-piperazinyl-purine analogues (denoted MK drugs) are cardioprotective in infarction animal models and act as inhibitors of Janus kinase (JAK) and Rho-associated kinase (ROCK) [1-3]. Despite the presence of nitrate ester moiety, the MK drugs do not release nitric oxide (NO).

Methods: We utilized organic chemistry platforms to design a dinitrate ester derivative denoted MK177, cell-free and cellular assays to elucidate antithrom-botic and anti-ischemic mechanisms. Furthermore, we also used tissue models to analyze vasodilation, and animal models to evaluate drug activities in vivo.

Results: In anesthetized pigs, intravenous infusion of MK177 produced“nitroglycerin-like”effects on vital parameters. Analysis of exhaled air confirmed release of NO. MK177 caused concentration-dependent relaxation of iliac arteries (87±6.8 % relaxation of precontracted arteries, mean value ±SD, n=5) and this effect was mediated by activation of the NO/cyclic GMP signaling pathway. It is noteworthy that other mononitrate or non-nitrate MKs did not cause NO-induced vasodilation. In cellular model systems, MK177 evoked antithrombotic effects by targeting ROCK in a NO-independent manner. Specifically, MK177 inhibited platelet aggregation induced by collagen (72±12.6 % inhibition of aggregation, mean value±SD, n=7). Western blot analyses confirmed that MK177 reduced ROCK-dependent phosphorylation of myosin phosphatase sub-unit (MYPT-1) in platelets. Finally, kinase screening assay revealed that MK177 concentration-dependently inhibited ROCK and JAK (Kd values around 5μM).

Conclusion: We have developed a bifunctional drug molecule, MK177, that acts by NO-dependent and NO-independent mechanisms. MK 177 induced car-diovascular NO effects in vivo and relaxed vessels in vitro. MK177 also prevented blood platelet activation via NO-independent ROCK inhibition. The bifunctional nature of MK177 can be of significance in future management of thrombotic and ischemic disease. Collectively, the novel cardio-protective and bifunctional drug MK177 has promising therapeutic potential.

References:

1. Koufaki M, Fotopoulou T, Iliodromitis EK, Bibli SI, Zoga A, Kremastinos DT, Andreadou I. Discovery of 6-[4-(6-nitroxyhexanoyl)(piperazin-1-yl)]-9H-purine, as pharmacological post-conditioning agent. Bioorg Med Chem. 2012;20(19):5948-5956. https://doi.org/10.1016/j.bmc.2012.07.037

2. Kardeby C, Paramel GV, Pournara D, Fotopoulou T, Sirsjö A, Koufaki M, Fransén K, Grenegård M. A novel purine analogue bearing nitrate ester prevents platelet activation by ROCK activity inhibition. Eur J Pharmacol. 2019;15(857):172428-172434. https://doi.org/10.1016/j.ejphar.2019.172428

3. Paramel GV, Lindkvist M, Idosa BA, Sebina LS, Kardeby C, Fotopoulou T, Pournara D, Kritsi E, Ifanti E, Zervou M, Koufaki M, Grenegård M, Fransén K. Novel purine analogues regulate IL-1βrelease via inhibition of JAK activity in human aortic smooth muscle cells. Eur J Pharmacol. 2022;15(929):175128-175135. https://doi.org/10.1016/j.ejphar.2022.175128

Place, publisher, year, edition, pages
Macmillan Publishers Ltd., 2023
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:oru:diva-108921 (URN)001043027400113 ()
Available from: 2023-10-13 Created: 2023-10-13 Last updated: 2023-10-13Bibliographically approved
Oikonomakis, I., Brodin, D., Hörer, T. M., Skoog, P., Seilitz, J., Nilsson, K. F., . . . Jansson, K. (2022). Altered mRNA Expression Due to Rectal Perforation in a Porcine Model: A Pilot Study. Anticancer Research, 42(6), 2827-2833
Open this publication in new window or tab >>Altered mRNA Expression Due to Rectal Perforation in a Porcine Model: A Pilot Study
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2022 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 42, no 6, p. 2827-2833Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Anastomotic leakage is the most serious and unwelcome complication in rectal surgery. It has a great impact on postoperative morbidity and mortality. In this pilot study, changes of mRNA expression in blood were analyzed in an animal model designed to imitate anastomotic leakage.

MATERIALS AND METHODS: Twelve pigs were randomized into two groups: A sham-operated control group and an experimental group in which iatrogenic rectal perforation was performed. The changes in the mRNA expression at 4 hours after creating the perforation were studied. Microarray analysis was performed using Gene Chip whole porcine genome array. mRNA expression of 19,124 genes was investigated.

RESULTS: Significantly increased levels of genes with a fold change greater than 2 were found, including 276 coding for unknown proteins and 48 coding for known proteins. Eleven of those which coded for known proteins were up-regulated with a fold change >4.

CONCLUSION: Eleven known genes were highly up-regulated after rectal perforation. These genes were mainly involved in inflammatory response, intracellular signaling and cell membrane regulation. Their corresponding proteins might potentially be clinical biomarkers of anastomotic leakage and should be evaluated in further clinical studies.

Place, publisher, year, edition, pages
International Institute of Anticancer Research, 2022
Keywords
Colorectal surgery, anastomotic leakage, gene expression analysis, microarray
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-99511 (URN)10.21873/anticanres.15764 (DOI)000809335700004 ()35641253 (PubMedID)2-s2.0-85131151512 (Scopus ID)
Funder
Karolinska InstituteRegion Örebro County
Note

Funding agency:

Committee for Research at the Karolinska University Hospital, Stockholm, Sweden 

Available from: 2022-06-14 Created: 2022-06-14 Last updated: 2022-07-28Bibliographically approved
Oikonomakis, I., Jansson, D. T., Skoog, P., Nilsson, K. F., Meehan, A. D., Hörer, T. M. & Jansson, K. (2022). Fully covered self-expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent. Journal of Gastroenterology and Hepatology Open (JGH Open), 6(5), 338-343
Open this publication in new window or tab >>Fully covered self-expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent
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2022 (English)In: Journal of Gastroenterology and Hepatology Open (JGH Open), E-ISSN 2397-9070, Vol. 6, no 5, p. 338-343Article in journal (Refereed) Published
Abstract [en]

Background and Aim: Anastomotic leakage (AL) in colorectal resection and primary anastomosis is a common and feared complication. Fully covered self-expandable metal stents (FCSEMSs) have been used for the treatment of AL. It is still unknown whether FCSEMSs affect anastomosis healing negatively by causing ischemia. In an animal study, we investigated the metabolic effects over a FCSEMS covering a stapled colon anastomosis.

Methods: Seven pigs were investigated using microdialysis after laparotomy, colon resection, and anastomosis with stent placement. Measurements were done at the proximal and distal ends of the anastomosis and at a reference catheter placed at the small intestine. Measurements of glucose, pyruvate, lactate, glycerol, and the lactate/ pyruvate ratio (L/P) were carried out.

Results: Lactate and L/P were significantly higher at the oral part of the anastomosis, while glucose showed a small declining tendency. At the distal part of the anastomosis, glucose decreased significantly after the resection but did not reach zero. Lactate increased significantly whereas L/P increased only slightly. Glycerol levels were stable.

Conclusion: Colon resection caused initially hypermetabolism in the intestinal ends next to the resection site. This hypermetabolism neither deteriorated nor turned into ischemia during the initial postoperative course, but the start of hypoxemia could not be excluded during the study and after the placement of an FCSEMS.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
basic experimental study, clinical practice and treatment, colorectal cancer, endoscopy, gastroenterology
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-99031 (URN)10.1002/jgh3.12747 (DOI)000791602400001 ()35601129 (PubMedID)2-s2.0-85129423899 (Scopus ID)
Note

Funding agencies:

Research Committee of Region Örebro County

Nyckelfonden

Available from: 2022-05-17 Created: 2022-05-17 Last updated: 2023-12-08Bibliographically approved
McGreevy, D., Björklund, J., Nilsson, K. F. & Hörer, T. M. (2022). Hemodynamic Effect of Resuscitative Endovascular Balloon Occlusion Of The Aorta In Hemodynamic Instability Secondary To Acute Cardiac Tamponade In A Porcine Model. Shock, 57(2), 291-297
Open this publication in new window or tab >>Hemodynamic Effect of Resuscitative Endovascular Balloon Occlusion Of The Aorta In Hemodynamic Instability Secondary To Acute Cardiac Tamponade In A Porcine Model
2022 (English)In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 57, no 2, p. 291-297Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The pre-hospital use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasing, although remains controversial, in part because of suggested contraindications such as acute cardiac tamponade (ACT). As both the pre-hospital and in-hospital use of REBOA might potentially occur with concurrent ACT, knowledge of the hemodynamic effect of REBOA in this setting is crucial. This study, therefore, aimed at investigating the physiological effects of REBOA in hemodynamic instability secondary to ACT in a porcine model. We hypothesize that REBOA can temporarily increase systemic blood pressure and carotid blood flow, and prolong survival, in hemodynamic shock caused by ACT.

METHODS: Fourteen pigs (24-38 kg) underwent ACT, through true cardiac injury and hemorrhage into the pericardial space, and were allowed to hemodynamically deteriorate. At a systolic blood pressure (SBP) of 50 mmHg (SBP50) they were randomized to total occlusion REBOA in zone 1 or to a control group. Survival, hemodynamic parameters, carotid blood flow (CBF), femoral blood flow (FBF), cardiac output (CO), end-tidal CO2 and arterial blood gas parameters were analyzed.

RESULTS: REBOA intervention was associated with a significant increase in SBP (50 mmHg to 74 mmHg, p = 0.016) and CBF (110 mL/min to 195 mL/min, p = 0.031), with no change in CO, compared to the control group. At 20 minutes after SBP50, the survival rate in the intervention group was 86% and in the control group 14%, with time to death being significantly longer in the intervention group.

CONCLUSIONS: This randomized animal study demonstrates that REBOA can help provide hemodynamic stabilization and prolong survival in hemodynamic shock provoked by ACT. It is important to stress that our study does not change the fact that urgent pericardiocentesis or cardiac surgery is, and should remain, the standard optimal treatment for ACT.

Level of evidence: Prospective, randomized, experimental animal study. Basic science study, therapeutic.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2022
Keywords
Acute cardiac tamponade, endovascular resuscitation, REBOA, shock, trauma
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-95308 (URN)10.1097/SHK.0000000000001875 (DOI)000742170000018 ()34710883 (PubMedID)
Note

Funding agencies:

Örebro University Hospital

Örebro University

Available from: 2021-11-03 Created: 2021-11-03 Last updated: 2022-04-21Bibliographically approved
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