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  • 1. Adolfsson, Jan
    et al.
    Garmo, Hans
    Varenhorst, Eberhard
    Ahlgren, Göran
    Ahlstrand, Christer
    Andren, Ove
    Örebro University, School of Health and Medical Sciences.
    Bill-Axelson, Anna
    Bratt, Ola
    Damber, Jan-Erik
    Hellström, Karin
    Hellström, Magnus
    Holmberg, Erik
    Holmberg, Lars
    Hugosson, Jonas
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences.
    Petterson, Bill
    Törnblom, Magnus
    Widmark, Anders
    Stattin, Pär
    Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005: Data from the national prostate cancer register in Sweden2007In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 41, no 6, p. 456-477Article in journal (Refereed)
    Abstract [en]

    Objective. The incidence of prostate cancer is rising rapidly in Sweden and there is a need to better understand the pattern of diagnosis, tumor characteristics and treatment. Material and methods. Between 1996 and 2005, all new cases of adenocarcinoma of the prostate gland were intended to be registered in the National Prostate Cancer Register (NPCR). This register contains information on diagnosing unit, date of diagnosis, cause of diagnosis, tumor grade, tumor stage according to the TNM classification in force, serum prostate-specific antigen (PSA) levels at diagnosis and primary treatment given within the first 6 months after diagnosis. Results. In total, 72 028 patients were registered, comprising >97% of all pertinent incident cases of prostate cancer in the Swedish Cancer Register (SCR). During the study period there was a considerable decrease in median age at the time of diagnosis, a stage migration towards smaller tumors, a decrease in median serum PSA values at diagnosis, a decrease in the age-standardized incidence rate of men diagnosed with distant metastases or with a PSA level of >100 ng/ml at diagnosis and an increase in the proportion of tumors with Gleason score ≤6. Relatively large geographical differences in the median age at diagnosis and the age-standardized incidence of cases with category T1c tumors were observed. Treatment with curative intent increased dramatically and treatment patterns varied according to geographical region. In men with localized tumors and a PSA level of <20 ng/ml at diagnosis, expectant treatment was more commonly used in those aged ≥75 years than in those aged <75 years. Also, the pattern of endocrine treatment varied in different parts of Sweden. Conclusions. All changes in the register seen over time are consistent with increased diagnostic activity, especially PSA testing, resulting in an increased number of cases with early disease, predominantly tumors in category T1c. The patterns of diagnosis and treatment of prostate cancer vary considerably in different parts of Sweden. The NPCR continues to be an important source for research, epidemiological surveillance of the incidence, diagnosis and treatment of prostate cancer

  • 2.
    Agardh, Carl-David
    et al.
    Lund University, Lund, Sweden.
    Ahrén, Bo
    Lund University, Lund, Sweden.
    Hanås, Ragnar
    Jansson, Stefan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Uppsala University, Uppsala, Sweden.
    Smith, Ulf
    Gothenburg University, Gothenburg, Sweden.
    Toft, Eva
    Karolinska Institutet, Stockholm, Sweden.
    Östenson, Claes-Göran
    Karolinska Institutet, Stockholm, Sweden.
    Varning för okritisk användning av överviktskirurgi vid typ 2-diabetes2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 25, p. 1208-1209Article in journal (Refereed)
    Abstract [sv]

    Överviktskirurgi diskuteras nu som ett behandlingsalternativ även för patienter med typ 2-diabetes där BMI inte överstiger nuvarande indikationsgräns 35 kg/m2. Artikelförfattarna vill varna för en sådan utveckling i avvaktan på kritisk värdering av denna typ av kirurgi.

  • 3.
    Ahl, R.
    et al.
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Matthiessen, P.
    School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Fang, X.
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; .
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Department of Surgery.
    Lindgren, R.
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery2019In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 4, p. 477-483Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.

    METHODS: This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.

    RESULTS: A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.

    CONCLUSION: Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.

  • 4.
    Ahl, Rebecka
    Örebro University, School of Medical Sciences.
    The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress2019Doctoral thesis, comprehensive summary (Other academic)
  • 5.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Barmparas, Galinos
    Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Ley, Eric J
    Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
    Wallin, Göran
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Does beta-blockade reduce the risk of depression in patients with isolated severe extracranial injuries?2017In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, no 7, p. 1801-1806Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.

    METHODS: Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.

    RESULTS: Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).

    CONCLUSIONS: Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.

  • 6.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Lindgren, Rickard
    Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Solna, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Örebro, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Risk factors for depression following traumatic injury: An epidemiological study from a scandinavian trauma center2017In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 5, p. 1082-1087Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: A significant proportion of patients suffer depression following traumatic injuries. Once manifested, major depression is challenging to overcome and its presence risks impairing the potential for physical rehabilitation and functional recovery. Risk stratification for early detection and intervention in these instances is important. This study aims to investigate patient and injury characteristics associated with an increased risk for depression.

    METHODS: All patients with traumatic injuries were recruited from the trauma registry of an urban university hospital between 2007 and 2012. Patient and injury characteristics as well as outcomes were collected for analysis. Patients under the age of eighteen, prescribed antidepressants within one year of admission, in-hospital deaths and deaths within 30days of trauma were excluded. Pre- and post-admission antidepressant data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. To isolate independent risk factors for depression a multivariable forward stepwise logistic regression model was deployed.

    RESULTS: A total of 5981 patients met the inclusion criteria of whom 9.2% (n=551) developed post-traumatic depression. The mean age of the cohort was 42 [standard deviation (SD) 18] years and 27.1% (n=1620) were females. The mean injury severity score was 9 (SD 9) with 18.4% (n=1100) of the patients assigned a score of at least 16. Six variables were identified as independent predictors for post-traumatic depression. Factors relating to the patient were female gender and age. Injury-specific variables were penetrating trauma and GCS score of≤8 on admission. Furthermore, intensive care admission and increasing hospital length of stay were predictors of depression.

    CONCLUSION: Several risk factors associated with the development of post-traumatic depression were identified. A better targeted in-hospital screening and patient-centered follow up can be offered taking these risk factors into consideration.

  • 7.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Phelan, Herb A
    Univ of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas, USA.
    Dogan, Sinan
    Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cook, Allyson C.
    UT-Southwestern Medical Center. Parkland Memorial Hospital, Dallas, USA.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Predicting In-Hospital and 1-Year Mortality in Geriatric Trauma Patients Using Geriatric Trauma Outcome Score2017In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 224, no 3, p. 264-269Article in journal (Refereed)
    Abstract [en]

    Background: The Geriatric Trauma Outcome Score, GTOS (= [age] + [Injury Severity Score (ISS)x2.5] + 22 [if packed red blood cells (PRBC) transfused ≤24hrs of admission]), was developed and validated as a prognostic indicator for in-hospital mortality in elderly trauma patients. However, GTOS neither provides information regarding post-discharge outcomes, nor discriminates between patients dying with and without care restrictions. Isolating the latter, GTOS prediction performance was examined during admission and 1-year post-discharge in a mature European trauma registry.

    Study Design: All trauma admissions ≥65years in a university hospital during 2007-2011 were considered. Data regarding age, ISS, PRBC transfusion ≤24hrs, therapy restrictions, discharge disposition and mortality were collected. In-hospital deaths with therapy restrictions and patients discharged to hospice were excluded. GTOS was the sole predictor in a logistic regression model estimating mortality probabilities. Performance of the model was assessed by misclassification rate, Brier score and area under the curve (AUC).

    Results: The study population was 1080 subjects with a median age of 75 years, mean ISS of 10 and PRBC transfused in 8.2%). In-hospital mortality was 14.9% and 7.7% after exclusions. Misclassification rate fell from 14% to 6.5%, Brier score from 0.09 to 0.05. AUC increased from 0.87 to 0.88. Equivalent values for the original GTOS sample were 9.8%, 0.07, and 0.87. One-year mortality follow-up showed a misclassification rate of 17.6%, and Brier score of 0.13.

    Conclusion: Excluding patients with care restrictions and discharged to hospice improved GTOS performance for in-hospital mortality prediction. GTOS is not adept at predicting 1-year mortality.

  • 8.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Corrigendum to "Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?": [Injury 48 (2017) 101–105]2017In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 11, p. 2612-2612Article in journal (Refereed)
  • 9.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?2017In: Injury-International Journal of the Care of the Injured, ISSN 0020-1383, Vol. 48, no 1, p. 101-105Article in journal (Refereed)
    Abstract [en]

    Introduction: Depressive symptoms occur in approximately half of trauma patients, negatively impacting on functional outcome and quality of life following severe head injury. Pontine noradrenaline has been shown to increase upon trauma and associated beta-adrenergic receptor activation appears to consolidate memory formation of traumatic events. Blocking adrenergic activity reduces physiological stress responses during recall of traumatic memories and impairs memory, implying a potential therapeutic role of beta-blockers. This study examines the effect of pre-admission beta-blockade on post-traumatic depression.

    Methods: All adult trauma patients (>= 18 years) with severe, isolated traumatic brain injury (intracranial Abbreviated Injury Scale score (AIS) >= 3 and extracranial AIS <3) were recruited from the trauma registry of an urban university hospital between 2007 and 2011. Exclusion criteria were in-hospital deaths and prescription of antidepressants up to one year prior to admission. Pre- and post-admission beta-blocker and antidepressant therapy data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. Patients with and without pre-admission beta-blockers were matched 1: 1 by age, gender, Glasgow Coma Scale, Injury Severity Score and head AIS. Analysis was carried out using McNemar's and Student's t-test for categorical and continuous data, respectively.

    Results: A total of 545 patients met the study criteria. Of these, 15% (n = 80) were prescribed beta-blockers. After propensity matching, 80 matched pairs were analyzed. 33% (n = 26) of non beta-blocked patients developed post-traumatic depression, compared to only 18% (n = 14) in the beta-blocked group (p = 0.04). There were no significant differences in ICU (mean days: 5.8 (SD 10.5) vs. 5.6 (SD 7.2), p = 0.85) or hospital length of stay (mean days: 21 (SD 21) vs. 21 (SD 20), p = 0.94) between cohorts.

    Conclusion: beta-blockade appears to act prophylactically and significantly reduces the risk of posttraumatic depression in patients suffering from isolated severe traumatic brain injuries. Further prospective randomized studies are warranted to validate this finding.

  • 10.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden ; .
    Thelin, Eric Peter
    Department of Clinical Neuroscience, Karolinska Institutet Solna, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Bellander, Bo Michael
    Department of Clinical Neuroscience, Karolinska Institutet Solna, Stockholm, Sweden.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Talving, Peep
    Department of Surgery, Tartu University Hospital, Tartu, Estonia.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
    β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study2017In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 43, no 6, p. 783-789Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.

    METHODS: Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.

    RESULTS: 362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days, p < 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01-6.03, p = 0.03).

    CONCLUSION: Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.

  • 11.
    Ahlman, B.
    et al.
    Department of Surgery, Karolinska Hospital, Sweden.
    Andersson, K.
    Ljungqvist, Olle
    Persson, B.
    Wernerman, J.
    Elective abdominal surgery alters the free amino acid content of the human intestinal mucosa1995In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 161, no 8, p. 593-601Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the impact of a standard moderately severe surgical operation on the mucosal amino acid content of the duodenum and the colon.

    Design: Open study.

    Setting: University hospital, Sweden.

    Subjects: Nine patients who were to undergo elective open cholecystectomy.

    Interventions: Endoscopically obtained biopsy specimens from the intestinal mucosa. Main outcome measures: Changes in the content of free amino acids in the duodenum and colon at three days postoperatively.

    Results: The concentration of glutamine in the duodenum increased by 27% and that of glutamic acid by 34% after operation, whereas their content in colon remained unaltered. The concentration of branched chain amino acids increased by 26% in the duodenal mucosa after operation and by 24% in the colonic mucosa. The total concentration of amino acids (excluding taurine) increased by 9% in the duodenum, but remained unaltered in the colon.

    Conclusion: This study shows characteristic and consistent alterations in the free amino acid content of the intestinal tract after a moderately severe operation.

  • 12.
    Ahlsson, Anders
    Örebro University, School of Health and Medical Sciences.
    Atrial fibrillation in cardiac surgery2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. In cardiac surgery, one-third of the patients experience episodes of AF during the first postoperative days (postoperative AF), and patients with preoperative AF (concomitant AF) can be offered ablation procedures in conjunction with surgery, in order to restore ordinary sinus rhythm (SR). The aim of this work was to study the relation between postoperative AF and inflammation; the long-term consequences of postoperative AF on mortality and late arrhythmia; and atrial function after concomitant surgical ablation for AF.

    In 524 open-heart surgery patients, C-reactive protein (CRP) serum concentrations were measured before and on the third day after surgery. There was no correlation between levels of CRP and the development of postoperative AF.

    All 1,419 patients with no history of AF, undergoing primary aortocoronary bypass surgery (CABG) in the years 1997–2000 were followed up after 8.0 years. The mortality rate was 191 deaths/1,000 patients (19.1%) in patients with no AF and 140 deaths/419 patients (33.4%) in patients with postoperative AF. Postoperative AF was an age-independent risk factor for late mortality, with a hazard ratio (HR) of 1.56 (95% CI 1.23–1.98). Postoperative AF patients had a more than doubled risk of death due to cerebral ischaemia, myocardial infarction, sudden death, and heart failure compared with patients without AF.

    All 571 consecutive patients undergoing primary CABG during the years 1999–2000 were followed-up after 6 years. Questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.3% of all patients. In postoperative AF patients, 14.1% had AF at follow-up, compared with 2.8% of patients with no AF at surgery (p<.001). An episode of postoperative AF was found to be an independent risk factor for development of late AF, with an adjusted risk ratio (RR) of 3.11 (95% CI 1.41–6.87).

    Epicardial microwave ablation was performed in 20 open-heart surgery patients with concomitant AF. Transthoracic echocardiography was performed preoperatively and at 6 months postoperatively. At 12 months postoperatively 14/19 patients (74%) were in SR with no anti-arrhythmic drugs. All patients in SR had preserved left and right atrial filling waves (A-waves) and Tissue velocity echocardiography (TVE) showed preserved atrial wall velocities and atrial strain.

    In conclusion, postoperative AF is an independent risk factor for late mortality and later development of AF. There is no correlation between the inflammatory marker CRP and postoperative AF. Epicardial microwave ablation of concomitant AF results in SR in the majority of patients and seems to preserve atrial mechanical function.

    List of papers
    1. Postoperative atrial fibrillation is not correlated to C-reactive protein
    Open this publication in new window or tab >>Postoperative atrial fibrillation is not correlated to C-reactive protein
    2007 (English)In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 83, no 4, p. 1332-1337Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: The peak incidence of postoperative atrial fibrillation (AF) occurs around the second postoperative day, a time at which serum inflammatory markers are elevated. The aim of this study was to investigate differences between patients with and without postoperative AF with special regard to C-reactive protein (CRP) serum levels. METHODS: The study cohort included all heart surgery patients who had sinus rhythm preoperatively, survived postoperative day 3, and were operated on between July 1, 2004, and June 30, 2005 (n = 524). Any episode of AF during the first 7 postoperative days defined the patient as belonging to the postoperative AF group. Creatine kinase-myocardial band (CK-MB) was measured at postoperative day 1, and CRP was measured preoperatively and at postoperative day 3. Risk factors for postoperative AF were determined using bivariate and multivariate regression analysis. RESULTS: Of 524 patients, 182 had at least one episode of AF (34.7%). Preoperative and postoperative CRP concentrations did not differ between the groups (postoperative CRP 175.4 +/- 64.4 versus 175.3 +/- 60.1 mg/L respectively, p = 0.99). Atrial fibrillation patients were significantly older (p < 0.001) and had higher CK-MB levels (33.6 +/- 53.1 microg/L versus 22.5 +/- 26.7 microg/L, respectively, p = 0.009). The odds ratio for postoperative AF with postoperative CK-MB greater than 70 microg/L was 3.5 (confidence interval: 1.4 to 8.6). CONCLUSIONS: Postoperative AF has no correlation to the inflammatory marker CRP in heart surgery patients. Ischemic myocardial injury might predispose for postoperative AF.

    National Category
    Medical and Health Sciences Surgery Surgery
    Research subject
    Surgery esp. Thoracic and Cardivascular Surgery
    Identifiers
    urn:nbn:se:oru:diva-2986 (URN)10.1016/j.athoracsur.2006.11.047 (DOI)17383336 (PubMedID)
    Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-12-14Bibliographically approved
    2. Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality
    Open this publication in new window or tab >>Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality
    (English)Manuscript (Other academic)
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-2987 (URN)
    Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-10-18Bibliographically approved
    3. Postoperative atrial fibrillation as risk factor for late arrhythmia and cardiovascular death: a six-year follow-up after coronary artery bypass surgery
    Open this publication in new window or tab >>Postoperative atrial fibrillation as risk factor for late arrhythmia and cardiovascular death: a six-year follow-up after coronary artery bypass surgery
    (English)Manuscript (Other academic)
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-2988 (URN)
    Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-10-18Bibliographically approved
    4. Atrial function after epicardial microwave ablation in patients with atrial fibrillation
    Open this publication in new window or tab >>Atrial function after epicardial microwave ablation in patients with atrial fibrillation
    2008 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 192-201Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To study epicardial microwave ablation of concomitant atrial fibrillation and its effects on heart rhythm and atrial function during follow-up. DESIGN: The study included 20 open-heart surgery patients with concomitant atrial fibrillation. Transthoracic echocardiography with flow and tissue Doppler recordings was performed preoperatively and at 6 months postoperatively. Blood samples were obtained preoperatively and postoperatively for analysis of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and amino terminal precursor of brain natriuretic peptide (NT-proBNP). RESULTS: Fourteen of 19 patients (74%) were in sinus rhythm with no antiarrhythmic drugs at 12 months. All patients in sinus rhythm had preserved left and right atrial-filling waves through atrioventricular valves during atrial contraction. Tissue velocity echocardiography on patients in sinus rhythm showed preserved atrial wall velocities, atrial strain, and atrial strain rate. Levels of natriuretic peptides tended to decrease in patients with stable sinus rhythm at one year compared to patients in atrial fibrillation. CONCLUSIONS: Epicardial microwave ablation results in sinus rhythm in a majority of patients and seems to preserve atrial mechanical function

    Keywords
    Aged, Atrial Fibrillation/metabolism/physiopathology/*surgery/ultrasonography, Atrial Function, Atrial Natriuretic Factor/blood, Biological Markers/blood, Catheter Ablation/adverse effects/*methods, Echocardiography; Doppler, Female, Heart Conduction System/*physiopathology, Humans, Male, Microwaves/*therapeutic use, Middle Aged, Myocardial Contraction, Natriuretic Peptide; Brain/blood, Peptide Fragments/blood, Pericardium/*surgery, Prospective Studies, Time Factors, Treatment Outcome
    National Category
    Medical and Health Sciences Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-3585 (URN)10.1080/14017430701882418 (DOI)18569951 (PubMedID)
    Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved
  • 13.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bodin, Lennart
    Fengsrud, Espen
    Englund, Anders
    Patients with postoperative atrial fibrillation have a doubled cardiovascular mortalityManuscript (Other academic)
  • 14.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences.
    Fengsrud, Espen
    Bodin, Lennart
    Englund, Anders
    Postoperative atrial fibrillation as risk factor for late arrhythmia and cardiovascular death: a six-year follow-up after coronary artery bypass surgeryManuscript (Other academic)
  • 15.
    Ahlsson, Anders
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Källman, Jan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    An angry cat causing Pasteurella multocida endocarditis and aortic valve replacement: A case report2016In: International journal of surgery case reports, ISSN 2210-2612, E-ISSN 2210-2612, Vol. 24, p. 91-93Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Cat bite infections usually involve a mix of anaerobic and aerobic bacteria including species of Pasteurella, Streptococcus, Staphylococcus, Bacteroides, and Fusobacterium. We report a case of Pasteurella multocida infection from cat bites leading to endocarditis and subsequent aortic valve replacement.

    PRESENTATION OF CASE: A 70-year-old male was admitted because of fever, tachycardia, and malaise. He had a history of alcohol abuse and was living alone with a cat in a rural area. A sepsis of unknown origin was suspected, and intravenous treatment with gentamicin and cefotaxime was initiated. Blood cultures yielded Pasteurella multocida, and the patient history revealed repeated cat bites. After four days, the patient was discharged with oral penicillin V treatment. Two weeks later, the patient returned with fever and a new systolic murmur. An aortic valve endocarditis was diagnosed, and it became clear that the patient had not completed the prescribed penicillin V treatment. The patient underwent a biological aortic valve replacement with debridement of an annular abscess, and the postoperative course was uneventful.

    DISCUSSION: Endocarditis due to Pasteurella is extremely rare, and there are only a few reports in the literature. Predisposing factors in the present case were alcohol abuse and reduced compliance to treatment.

    CONCLUSION: Cat bites are often deep, and in rare circumstances can lead to life-threatening endocarditis. Proper surgical revision, antibiotic treatment, and patient compliance are necessary components in patient care to avoid this complication.

  • 16.
    Ahlsson, Anders J.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bodin, Lennart
    Lundblad, Olof H.
    Englund, Anders G.
    Örebro University, School of Health and Medical Sciences.
    Postoperative atrial fibrillation is not correlated to C-reactive protein2007In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 83, no 4, p. 1332-1337Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The peak incidence of postoperative atrial fibrillation (AF) occurs around the second postoperative day, a time at which serum inflammatory markers are elevated. The aim of this study was to investigate differences between patients with and without postoperative AF with special regard to C-reactive protein (CRP) serum levels. METHODS: The study cohort included all heart surgery patients who had sinus rhythm preoperatively, survived postoperative day 3, and were operated on between July 1, 2004, and June 30, 2005 (n = 524). Any episode of AF during the first 7 postoperative days defined the patient as belonging to the postoperative AF group. Creatine kinase-myocardial band (CK-MB) was measured at postoperative day 1, and CRP was measured preoperatively and at postoperative day 3. Risk factors for postoperative AF were determined using bivariate and multivariate regression analysis. RESULTS: Of 524 patients, 182 had at least one episode of AF (34.7%). Preoperative and postoperative CRP concentrations did not differ between the groups (postoperative CRP 175.4 +/- 64.4 versus 175.3 +/- 60.1 mg/L respectively, p = 0.99). Atrial fibrillation patients were significantly older (p < 0.001) and had higher CK-MB levels (33.6 +/- 53.1 microg/L versus 22.5 +/- 26.7 microg/L, respectively, p = 0.009). The odds ratio for postoperative AF with postoperative CK-MB greater than 70 microg/L was 3.5 (confidence interval: 1.4 to 8.6). CONCLUSIONS: Postoperative AF has no correlation to the inflammatory marker CRP in heart surgery patients. Ischemic myocardial injury might predispose for postoperative AF.

  • 17.
    Ahlsson, Anders
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Jidéus, Lena
    Uppsala University Hospital, Uppsala, Sweden.
    Albåge, Anders
    Karolinska University Hospital, Stockholm, Sweden.
    Källner, Göran
    Karolinska University Hospital, Stockholm, Sweden.
    Holmgren, Anders
    Umeå University Hospital, Umeå, Sweden.
    Boano, Gabriella
    Linköping University Hospital, Linköping, Sweden.
    Hermansson, Ulf
    Linköping University Hospital, Linköping, Sweden.
    Kimblad, Per-Ola
    Lund University Hospital, Lund, Sweden.
    Scherstén, Henrik
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Sjögren, Johan
    Lund University Hospital, Lund, Sweden.
    Ståhle, Elisabeth
    Uppsala University Hospital, Uppsala, Sweden.
    Åberg, Bengt
    Blekinge Hospital, Karlskrona, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Berglin, Eva
    Sahlgrenska University Hospital, Göteborg, Sweden.
    A Swedish consensus on the surgical treatment of concomitant atrial fibrillation2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 4, p. 212-218Article, review/survey (Refereed)
    Abstract [en]

    Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.

  • 18.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences.
    Linde, Peter
    Rask, Peter
    Englund, Anders
    Örebro University, School of Health and Medical Sciences.
    Atrial function after epicardial microwave ablation in patients with atrial fibrillation2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 192-201Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study epicardial microwave ablation of concomitant atrial fibrillation and its effects on heart rhythm and atrial function during follow-up. DESIGN: The study included 20 open-heart surgery patients with concomitant atrial fibrillation. Transthoracic echocardiography with flow and tissue Doppler recordings was performed preoperatively and at 6 months postoperatively. Blood samples were obtained preoperatively and postoperatively for analysis of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and amino terminal precursor of brain natriuretic peptide (NT-proBNP). RESULTS: Fourteen of 19 patients (74%) were in sinus rhythm with no antiarrhythmic drugs at 12 months. All patients in sinus rhythm had preserved left and right atrial-filling waves through atrioventricular valves during atrial contraction. Tissue velocity echocardiography on patients in sinus rhythm showed preserved atrial wall velocities, atrial strain, and atrial strain rate. Levels of natriuretic peptides tended to decrease in patients with stable sinus rhythm at one year compared to patients in atrial fibrillation. CONCLUSIONS: Epicardial microwave ablation results in sinus rhythm in a majority of patients and seems to preserve atrial mechanical function

  • 19.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Sandin, Mathias
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Cardiothorac & Vasc Surg, Örebro Univ Hosp, Örebro, Sweden.
    Souza, Domingos S. R.
    Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Annular abscess leading to free wall rupture2014In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 45, no 2, p. E39-E39Article in journal (Other academic)
  • 20.
    Ahlsson, Anders
    et al.
    Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Sobrosa, Claudio
    Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Kaijser, Lennart
    Division of Clinical Physiology and Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Jansson, Eva
    Division of Clinical Physiology and Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Bomfim, Vollmer
    Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Adenosine in cold blood cardioplegia: a placebo-controlled study2012In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 14, no 1, p. 48-55Article in journal (Refereed)
    Abstract [en]

    Objective: Adenosine as an additive in blood cardioplegia is cardioprotective in animal studies, but its clinical role in myocardial protection remains controversial. The aim of this study was to investigate whether the addition of adenosine in continuous cold blood cardioplegia would enhance myocardial protection.

    Methods: In a prospective double-blind study comparing adenosine 400 μmol l(-1) to placebo in continuous cold blood cardioplegia, 80 patients undergoing isolated aortic valve replacement were randomized into four groups: antegrade cardioplegia with adenosine (n = 19), antegrade cardioplegia with placebo (n = 21), retrograde cardioplegia with adenosine (n = 21) and retrograde cardioplegia with placebo (n = 19). Myocardial arteriovenous differences in oxygen and lactate were measured before, during and after aortic occlusion. Myocardial concentrations of adenine nucleotides and lactate were determined from left ventricular biopsies obtained before aortic occlusion, after bolus cardioplegia, at 60 min of aortic occlusion and at 20 min after aortic occlusion. Plasma creatine kinase (CK-MB) and troponin T were measured at 1, 3, 6, 9, 12 and 24 h after aortic occlusion. Haemodynamic profiles were obtained before surgery and 1, 8 and 24 h after cardiopulmonary bypass. Repeated-measures analysis of variance was used for significance testing.

    Results: Adenosine had no effects on myocardial metabolism of oxygen, lactate and adenine nucleotides, postoperative enzyme release or haemodynamic performance. When compared with the antegrade groups, the retrograde groups showed higher myocardial oxygen uptake (17.3 ± 11.4 versus 2.5 ± 3.6 ml l(-1) at 60 min of aortic occlusion, P < 0.001) and lactate accumulation (43.1 ± 20.7 versus 36.3 ± 23.0 µmol g(-1) at 60 min of aortic occlusion, P = 0.052) in the myocardium during aortic occlusion, and lower postoperative left ventricular stroke work index (27.2 ± 8.4 versus 30.1 ± 7.9 g m m(-2), P = 0.034).

    Conclusions: Adenosine 400 μmol l(-1) in cold blood cardioplegia showed no cardioprotective effects on the parameters studied. Myocardial ischaemia was more pronounced in patients receiving retrograde cardioplegia.

  • 21.
    Ahlstrand, Rebecca
    Örebro University, School of Health and Medical Sciences.
    Effects of anasthesia on esophageal sphincters2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The esophageal sphincters constitute the anatomical protection against pulmonary aspiration. The aim of this thesis was to study the esophageal sphincters and how they are affected by different components of emergency anesthesia using high-resolution solid-state manometry.

    The effect of propofol (0.3 mg/kg) was studied in young and elderly volunteers. Propofol can be given as an anxiolytic agent for manometric studies of the lower esophageal sphincter (LES) without affecting the results. However, propofol is not recommended for studies of the upper esophageal sphincter (UES).

    The effects of cricoid pressure (CP) and peripheral pain were studied in awake volunteers, with and without remifentanil infusion (5 ng/ml). Pain did not affect pressure in the LES, but CP or remifentanil induced a significant decrease in LES pressure. However, neither CP nor remifentanil affected the barrier pressure (LES-intra gastric pressure). When CP was applied during ongoing remifentanil infusion, no further decrease in LES pressure was measured. CP induced high pressures in the area of the UES independent of remifentanil infusion, indicating that CP is effective in preventing gastroesophageal regurgitation.

    Barrier pressure was also studied in anesthetized patients after rocuronium (0.6 mg/kg) administration and no decrease was measured. In addition, alfentanil (20 μ/kg) added during anesthesia induction with propofol did not decrease the barrier pressure.

    In conclusion, CP seems to be effective in preventing regurgitation and does not affect barrier pressure. Muscle relaxation with rocuronium does not risk gastro-esophageal integrity. In addition, opioids can be integrated, even during emergency anethesia, without increasing the risk for pulmonary aspiration.

    List of papers
    1. Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry
    Open this publication in new window or tab >>Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry
    2011 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 4, p. 273-278Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    The oesophageal sphincters play an important role in protecting the airway. During manometric studies, administration of an anxiolytic agent is often required to make insertion of the catheter acceptable for the patient. The anxiolytic should not affect the results of the measurements. This study evaluates the effects of two different doses of propofol on the pressures in the oesophageal sphincters. The effect of increased abdominal pressure was also studied.

    METHODS:

    Twenty healthy volunteers, 10 young (mean age 25 years) and 10 elderly (mean age 71 years), were recruited. The effects of a low dose of propofol [0.3 mg kg(-1) intravenously (i.v.)] and a high dose of propofol (young group 0.9 mg kg(-1) i.v. and elderly group 0.6 mg kg(-1) i.v.) were studied with and without external abdominal pressure.

    RESULTS:

    There were no statistically significant changes in lower oesophageal sphincter (LOS) pressure after the low dose of propofol. After the high dose, there was an increase in LOS pressure, which was statistically significant in the young group (P < 0.05). The upper oesophageal sphincter (UOS) pressure decreased after both doses of propofol (P < 0.01 for the higher dose and P < 0.05 for the lower dose).

    CONCLUSION:

    A low dose of propofol (0.3 mg kg(-1) i.v.) leaves the LOS unaffected in young and elderly volunteers and can be used safely as an anxiolytic agent during studies of the LOS without influencing the results. However, the UOS is more sensitive to the effects of propofol and we do not recommend the use of propofol as an anxiolytic agent during manometric studies of the UOS.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2011
    National Category
    Medical and Health Sciences Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15384 (URN)10.1097/EJA.0b013e3283413211 (DOI)000288196000009 ()21119519 (PubMedID)2-s2.0-79953874254 (Scopus ID)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-12-11Bibliographically approved
    2. Effects of cricoid pressure and remifentanil on the esophageal sphincters using high-resolution solid-state manometry
    Open this publication in new window or tab >>Effects of cricoid pressure and remifentanil on the esophageal sphincters using high-resolution solid-state manometry
    2011 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 2, p. 209-215Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Cricoid pressure has been shown to decrease the pressure in the lower esophageal sphincter (LES), increasing the risk of aspiration. Whether this reaction is due to pain associated with the application of cricoid pressure has not been studied. The aim of this study was to compare the effects of cricoid pressure with those of peripheral pain on pressures in the LES, and to study whether remifentanil influences these effects. Data from the upper esophageal sphincter (UES) are also described.

    METHODS: Continuous solid-state manometry was performed in 14 healthy volunteers. Initially, the effect of remifentanil (target-controlled infusion with a plasma target concentration of 5.0 ng/ml) was studied, and thereafter, the effects of cricoid pressure and peripheral pain stimulation (cold stimulation). Finally, these two interventions were repeated under ongoing remifentanil infusion.

    RESULTS: Remifentanil decreased the LES pressure significantly [ΔP-6.5 mmHg, 95% confidence interval (95% CI) -1.7 to -11.2]. Cricoid pressure application decreased the LES pressure significantly (ΔP-3.7 mmHg, 95% CI -1.4 to 6.1), whereas peripheral pain did not (ΔP 1.2 mmHg, 95% CI -3.5 to 1.1). Under ongoing remifentanil infusion, no cricoid pressure-induced LES relaxation was observed. Cricoid pressure induced high pressures in the area of the UES, 215.7 (±91.2) mmHg without remifentanil vs. 219.4 (±74.2) mmHg with remifentanil.

    CONCLUSIONS: Remifentanil as well as cricoid pressure per se induced decreases in LES pressure. However, cricoid pressure-induced changes of the barrier pressure were not significant whether induced with or without an infusion of remifentanil.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2011
    National Category
    Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15386 (URN)10.1111/j.1399-6576.2010.02367.x (DOI)000286208600010 ()21226863 (PubMedID)2-s2.0-78651516200 (Scopus ID)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2018-02-20Bibliographically approved
    3. High resolution solid-state manometry of the effect of rocuronium on esophagogastric junction integrity
    Open this publication in new window or tab >>High resolution solid-state manometry of the effect of rocuronium on esophagogastric junction integrity
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The pressure in the lower esophageal sphincter (LES) is partly dependent on striated muscles derived from the crural portion of the diaphragm. The effect of neuromuscular blockade on the integrity of the esophagogastric junction is not well studied. We conducted a prospective interventional study to determine the effect of rocuronium on the pressure in the LES and the barrier pressure (LES pressure – intra gastric pressure). We also studied the effect of positive pressure ventilation on the barrier pressure after neuromuscular blockade with rocuronium.

    Methods: Fourteen patients classified as ASA I or II (aged 18-75 years) who presented for elective surgery (11 cholecystectomy, 3 inguinal hernia) participated in the study. Esophageal manometry was performed after anesthetization with propofol, fentanyl and sevoflurane. After the insertion of a laryngeal mask airway, the patients breathed spontaneously for one minute. Rocuronium was administrated and the patients observed during the onset of apnea and during one minute of apnea and complete neuromuscular blockade. Volume controlled positive pressure ventilation followed.

    Results: Muscle relaxation with rocuronium showed no significant changes in barrier pressure comparing the pressure immediately before rocuronium administration with the pressure obtained at the time point of 0% TOF. Conversion to positive pressure ventilation did not change the barrier pressure with inspiration or expiration. The greatest decrease in barrier pressure was measured after inducing anesthesia when comparing pressures during inspiration (P< 0.01)

    National Category
    Medical and Health Sciences Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15387 (URN)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-10-17Bibliographically approved
    4. Integrity of the esophagogastric junction during propofol induction with and without remifentanil: a double-blind,randomized, crossover study in volunteers
    Open this publication in new window or tab >>Integrity of the esophagogastric junction during propofol induction with and without remifentanil: a double-blind,randomized, crossover study in volunteers
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Context: Practice varies regarding the use of opioids during rapid sequence induction. Controversy exists as to whether opioids may increase the risk of pulmonary aspiration by decreasing the barrier pressure (lower oesophageal sphincter pressure – intragastric pressure).

    Objectives: To evaluate the effects of adding alfentanil during anaesthesia induction with propofol with respect to the barrier pressure in the oesophagogastric junction.

    Participants and Setting: Seventeen healthy volunteers (11 males and 6 females) participated in a double-blind, randomised, crossover trial at the University Hospital in Örebro, Sweden.

    Interventions and outcome measures: The volunteers were anaesthetised on two different occasions, randomly assigned to receive either alfentanil 20 g kg ˉ1 or an equivalent amount of saline, administered intravenously, one minute before induction with propofol 2 mg kg ˉ1. One minute after propofol administration, a cricoid pressure of 30N was applied. The primary outcome was the difference in the change in barrier pressure between the alfentanil and the placebo occasion one minute after propofol administration. The secondary outcomes were differences in the changes in barrier pressure one minute after alfentanil or placebo administration and during ongoing cricoid pressure application.

    Results: There were no statistically significant differences in barrier pressure, at any time point, between anaesthesia induction with alfentanil and propofol compared with induction with placebo and propofol. The barrier pressure never decreased to less than 2.4 mmHg in any volunteer.

    Conclusion: Our study showed no increased risk regarding the integrity of the gastrooesophageal junction when alfentanil is added during an induction with propofol in volunteers. This supports the practice of adding opioids as adjuvants during rapid sequence induction.

    National Category
    Medical and Health Sciences Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-15388 (URN)
    Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-10-17Bibliographically approved
  • 22.
    Allvin, Renée
    Örebro University, School of Health and Medical Sciences.
    Postoperative recovery: development of a multi-dimensional questionnaire for assessment of Recovery2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis aims to present a multi-dimensional instrument for self-assessment of progress in postoperative recovery. The author employs different research paradigms and methodologies to achieve this aim.

    Walker and Avant’s approach to concept analysis was used to examine the basic elements of postoperative recovery (Study I). The analysis identified different recovery dimensions and developed a theoretical definition showing postoperative recovery to be an energy-requiring process of returning to normality and wholeness, defined by comparative standards.

    Fourteen patients and 28 staff members participated in individual and focus group interviews aimed at describing patient and staff experiences of patient recovery (Study II). The essence of the postoperative recovery process was described as a desire to decrease unpleasant physical symptoms, reach a level of emotional wellbeing, regain functions, and re-establish activities.

    In Study III, 5 dimensions and 19 items were identified as a part of the operationalization process of the concept postoperative recovery. Fifteen staff members and 16 patients participated in the evaluation of content validity. On average, 85% of the participants considered the items as essential to the recovery process. In a test run of the questionnaire, 14 of 15 patients considered the questionnaire to be easy to understand and easy to complete. Twenty-five patients participated in the evaluation of intra-patient reliability. Percentage agreement (PA), systematic disagreement (RP, RC), and individual variability (RV) between the two assessments were calculated. PA measures ranged from 72% to 100%. The observed disagreement could be explained mainly by systematic disagreement.

    In total, 158 patients participated in the evaluation of construct validity, the ability to discriminate between groups, and the investigation of important item variables (Study IV). A rank-based statistical method for evaluation of paired, ordered categorical data from rating scales was used to evaluate consistency between the assessments of the Postoperative Recovery Profile (PRP) questionnaire and a global recovery scale. The number of months needed by participants to be regarded as fully recovered was studied by means of recovery profiles displayed by the cumulative proportion of recovered participants over time. A ranking list based on the participant’s appraisal of the five most important item variables in the PRP questionnaire was compiled to illustrate the rank ordering of the items. In comparing the assessments from the PRP questionnaire and the global recovery scale, 7.6% of all possible pairs were disordered. Twelve months after discharge 73% in the orthopaedic group were regarded as fully recovered, compared to 51% of the participants in the abdominal group (95% CI: 6% to 40%). The pain variable appeared among the top five most important items on eight measurement occasions, of eight possible, in both study groups.

    In conclusion, the PRP questionnaire was developed and support was given for validity and reliability. The questionnaire enables one to evaluate progress in postoperative recovery.

    List of papers
    1. Postoperative recovery: a concept analysis
    Open this publication in new window or tab >>Postoperative recovery: a concept analysis
    2007 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 5, p. 552-558Article in journal (Refereed) Published
    Abstract [en]

    Aim. This papaer presents a concept analysis of the phenomeneon postoperative recovery.

    Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition.

    Method. Walker and Avant´s concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for english language papers published from 1982 to 2005 was used for the analysis.

    Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependence in activities of daily living and optimum level of psychological well-being.

    Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.

    Place, publisher, year, edition, pages
    Oxford: Blackwell, 2007
    Keywords
    concept analysis, definition, postoperative, recovery
    National Category
    Surgery Nursing
    Research subject
    Surgery; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-8079 (URN)10.1111/j.1365-2648.2006.04156.x (DOI)000244244000010 ()17284272 (PubMedID)2-s2.0-33846991897 (Scopus ID)
    Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13Bibliographically approved
    2. Experiences of the postoperative recovery process: an interview study
    Open this publication in new window or tab >>Experiences of the postoperative recovery process: an interview study
    2008 (English)In: The open nursing journal, ISSN 1874-4346, Vol. 2, p. 1-7Article in journal (Refereed) Published
    Abstract [en]

    Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.

    Place, publisher, year, edition, pages
    Bentham Science Publishers Ltd, 2008
    Keywords
    postoperative, recovery, experience, interview, content analysis
    National Category
    Surgery Medical and Health Sciences
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-8080 (URN)
    Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-10-18Bibliographically approved
    3. Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability
    Open this publication in new window or tab >>Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability
    Show others...
    2009 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 3, p. 411-419Article in journal (Refereed) Published
    Abstract [en]

    Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability.   The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.

    Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients´ postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.

    Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.

    Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

    Place, publisher, year, edition, pages
    Oxford: Blackwell Publishing Ltd, 2009
    National Category
    Surgery Medical and Health Sciences
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-8081 (URN)10.1111/j.1365-2753.2008.01027.x (DOI)000266425900002 ()
    Note
    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7731Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13Bibliographically approved
    4. The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles
    Open this publication in new window or tab >>The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles
    Show others...
    2011 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, p. 236-243Article in journal (Refereed) Published
    Abstract [en]

    Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.

    Methods. Postoperative recovery was assessed during the period from discharge to 12 months after lower abdominal- and orthopedic surgery. Construct validity was evaluated by comparing the assessments from the PRP-questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.

    Results. A total of 158 patients were included. The result showed that 7.6 % of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge 51 % participants in the abdominal group were fully recovered, as compared with the 73%, in the orthopedic group (95% CI: 6 % to 40 %). The item variable pain appeared as top five at eight measurement occasions of eight possible in both the abdominal and the orthopedic groups. The importance of the items was emphasized.

    Conclusions. The PRP questionnaire allows for evaluation of the progress of postoperative recovery, and can be useful to assess patient-reported recovery after surgical treatment. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2011
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-8083 (URN)10.1111/j.1365-2753.2010.01422.x (DOI)000288217700005 ()20846316 (PubMedID)2-s2.0-79952668667 (Scopus ID)
    Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-12-13
  • 23.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine. Department of Anaesthesiology and Intensive Care, Örebro University Hospital ,Örebro,Sweden.
    Berg, Katarina
    Department of Medicine and Care, Linköping University, Linköping, Sweden.
    Idvall, Ewa
    Research Section, Kalmar County Council, Kalmar,Sweden; Department of Medicine and Care, Linköping University, Linköping, Sweden.
    Nilsson, Ulrica
    Örebro University, Department of Nursing and Caring Sciences. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro,Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital , Örebro, Sweden.
    Postoperative recovery: a concept analysis2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 5, p. 552-558Article in journal (Refereed)
    Abstract [en]

    Aim. This papaer presents a concept analysis of the phenomeneon postoperative recovery.

    Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition.

    Method. Walker and Avant´s concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for english language papers published from 1982 to 2005 was used for the analysis.

    Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependence in activities of daily living and optimum level of psychological well-being.

    Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.

  • 24.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    Idvall, Ewa
    Experiences of the postoperative recovery process: an interview study2008In: The open nursing journal, ISSN 1874-4346, Vol. 2, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.

  • 25.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Idvall, Ewa
    Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability2009In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 3, p. 411-419Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability.   The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.

    Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients´ postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.

    Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.

    Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

  • 26.
    Allvin, Renée
    et al.
    Örebro University, School of Medical Sciences. Department of Anaesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Rawal, Narinder
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Johanzon, Eva
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Bäckström, Ragnar
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Open versus Laparoscopic Surgery: Does the Surgical Technique Influence Pain Outcome? Results from an International Registry2016In: Pain Research and Treatment, ISSN 2090-1542, E-ISSN 2090-1550, article id 4087325Article in journal (Refereed)
    Abstract [en]

    Postoperative pain management relevant for specific surgical procedures is debated. The importance of evaluating pain with consideration given to type of surgery and the patient's perspective has been emphasized. In this prospective cohort study, we analysed outcome data from 607 patients in the international PAIN OUT registry for assessment and comparison of postoperative pain outcome within the 24 first hours after laparoscopic and open colonic surgery. Patients from the laparoscopic group scored minimum pain at a higher level than the open group (P = 0.012). Apart from minimum pain, no other significant differences in patient reported outcomes were observed. Maximum pain scores >3 were reported from 77% (laparoscopic) and 68% (open) patients (mean >= 5 in both groups). Pain interference with mobilization was reported by 87-93% of patients. Both groups scored high levels of patient satisfaction. In the open group, a higher frequency of patients received a combination of general and regional anaesthesia, which had an impact of the minimum pain score. Our results from registry data indicate that surgical technique does not influence the quality of postoperative pain management during the first postoperative day if adequate analgesia is given.

  • 27.
    Allvin, Renée
    et al.
    Örebro University, Department of Clinical Medicine.
    Svensson, Elisabeth
    Örebro University, Swedish Business School at Örebro University.
    Rawal, Narinder
    Örebro University, Department of Clinical Medicine.
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Kling, Anna-Maria
    Statistical and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden.
    Idvall, Ewa
    The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles2011In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, p. 236-243Article in journal (Refereed)
    Abstract [en]

    Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.

    Methods. Postoperative recovery was assessed during the period from discharge to 12 months after lower abdominal- and orthopedic surgery. Construct validity was evaluated by comparing the assessments from the PRP-questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.

    Results. A total of 158 patients were included. The result showed that 7.6 % of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge 51 % participants in the abdominal group were fully recovered, as compared with the 73%, in the orthopedic group (95% CI: 6 % to 40 %). The item variable pain appeared as top five at eight measurement occasions of eight possible in both the abdominal and the orthopedic groups. The importance of the items was emphasized.

    Conclusions. The PRP questionnaire allows for evaluation of the progress of postoperative recovery, and can be useful to assess patient-reported recovery after surgical treatment. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.

  • 28.
    Alm, Fredrik
    et al.
    Örebro University, School of Health Sciences.
    Stalfors, Joacim
    Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Sheikh Khalifa Medical City, Ajman, United Arab Emirates.
    Nerfeldt, Pia
    Karolinska University Hospital, Huddinge, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Patient reported outcome of pain after tonsil surgery: An analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-20162017Conference paper (Refereed)
    Abstract [en]

    Tonsil surgery is common surgical procedure in children and cause significant pain under postoperative recovery. The objective of this register study was to explore factors affecting pain after pediatric tonsil surgery, using patient-reported outcomes from questionnaires in the National Tonsil Surgery Registry in Sweden, 30 days after surgery. A total of 32,225 tonsil surgeries on children (aged 1-18 years) during January 2009- November 2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE±A) and 18,321 tonsillotomies with or without adenoidectomy (TT±A). In surgery cases of indication obstruction, the TT±A stopped taking painkillers and returned to normal eating habits sooner, and had less contact with health care services due to pain, compared to TE±A. After TE±A, the indication infection group had more days on analgesics and more contacts with health care services due to pain, compared to the indication obstruction group. TE±A with cold-dissection technique resulted in fewer days on painkillers compared to warm-technique, and reduced the number of contacts with health care services due to pain. Older children were affected by more days of morbidity than the younger ones, but there was no gender difference after adjustment for age, dissection technique and hemostasis technique. Implementation of national guidelines for pain treatment (2013) and patient information on the website tonsilloperation.se seems to have increased the days on analgesics after surgery. Pain after tonsil surgery depends on the surgical procedure and technique, as well as factors such as the patient’s age and surgical indication. More studies including pain interventions are needed to improve the care of tonsillectomy patients.

  • 29.
    Alshamari, Muhammed
    Örebro University, School of Medical Sciences.
    Low-dose computed tomography of the abdomen and lumbar spine2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Radiography is a common radiologic investigation despite abundant evidence of its limited diagnostic value. On the other hand, computed tomography (CT) has a high diagnostic value and is widely considered to be among the most important advances in medicine. However, CT exposes patients to a higher radiation dose and it might therefore not be acceptable simply to replace radiography with CT, despite the powerful diagnostic value of this technique. At the expense of reduced CT image quality, which could be adjusted to the diagnostic needs, low-dose CT of abdomen and lumbar spine can be performed at similar dose to radiography. The aim of the current thesis project was to evaluate low-dose CT of the abdomen and lumbar spine and to compare it with radiography. The hypothesis was that CT would give better image quality and diagnostic information compared to radiography at similar dose levels. Firstly, the diagnostic accuracy of low-dose CT of the abdomen was evaluated. Results showed that low-dose CT of abdomen has a high sensitivity and specificity compared to radiography, i.e., it has higher diagnostic accuracy. Similar results were obtained from our systematic review. Secondly, in a phantom study, an ovine phantom was scanned at various CT settings. The image quality was evaluated to obtain a protocol for the optimal settings for low-dose CT of lumbar spine at 1 mSv. This new protocol was then used in a clinical study to assess the image quality of low-dose CT of the lumbar spine and compare it to radiography. Results showed that low-dose CT has significantly better image quality than radiography. Finally, the impact of Iterative reconstruction (IR) on image quality of lumbar spine CT was tested. Iterative reconstruction is a recent CT technique aimed to reduce radiation dose and/or improve image quality. The results showed that the use of medium strength IR levels in the reconstruction of CT image improves image quality compared to filtered back projection. In conclusion, low-dose CT of the abdomen and lumbar spine, at about 1 mSv, has better image quality and gives diagnostic information compared to radiography at similar dose levels and it could therefore replace radiography.

    List of papers
    1. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review
    Open this publication in new window or tab >>Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review
    Show others...
    2016 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 26, no 6, p. 1766-1774Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels.

    Methods: Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present.

    Results: Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %.

    Conclusions: Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain.

    Key points: • Low-dose CT has a higher diagnostic accuracy than radiography. • A systematic review shows that CT has better diagnostic accuracy than radiography. • Radiography has no place in the workup of acute non-traumatic abdominal pain.

    Place, publisher, year, edition, pages
    New York: Springer, 2016
    Keywords
    X-ray computed tomography, abdominal radiography, sensitivity and specificity, abdominal pain, abdomen, acute
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Research subject
    Radiology
    Identifiers
    urn:nbn:se:oru:diva-47089 (URN)10.1007/s00330-015-3984-9 (DOI)000376100100030 ()26385800 (PubMedID)2-s2.0-84942013953 (Scopus ID)
    Note

    Funding Agency:

    Region Örebro County

    Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2018-07-09Bibliographically approved
    2. Low-dose computed tomography of the lumbar spine: a phantom study on imaging parameters and image quality
    Open this publication in new window or tab >>Low-dose computed tomography of the lumbar spine: a phantom study on imaging parameters and image quality
    2014 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 55, no 7, p. 824-832Article in journal (Refereed) Published
    Abstract [en]

    Background: Lumbar spine radiography has limited diagnostic value but low radiation dose compared with computed tomography (CT). The average effective radiation dose from lumbar spine radiography is about 1.1 mSv. Low-dose lumbar spine CT may be an alternative to increase the diagnostic value at low radiation dose, around 1 mSv.

    Purpose: To determine the optimal settings for low-dose lumbar spine CT simultaneously aiming for the highest diagnostic image quality possible.

    Material and Methods: An ovine lower thoracic and lumbar spine phantom, with all soft tissues around the vertebrae preserved except the skin, was placed in a 20 L plastic container filled with water. The phantom was scanned repeatedly with various technical settings; different tube potential, reference mAs, and with different convolution filters. Five radiologists evaluated the image quality according to a modification of the European guidelines for multislice computed tomography (MSCT) quality criteria for lumbar spine CT 2004. In a visual comparison the different scans were also ranked subjectively according to perceived image quality. Image noise and contrast were measured.

    Results: A tube potential of 120 kV with reference mAs 30 and medium or medium smooth convolution filter gave the best image quality at a sub-millisievert dose level, i.e. with an effective dose comparable to that from lumbar spine radiography.

    Conclusion: Low-dose lumbar spine CT thus opens a possibility to substitute lumbar spine radiography with CT without obvious increase in radiation dose.

    Keywords
    conventional radiography; CT; spine; structures; techniques
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Research subject
    Radiology
    Identifiers
    urn:nbn:se:oru:diva-38243 (URN)10.1177/0284185113509615 (DOI)000342575300008 ()2-s2.0-84907878366 (Scopus ID)
    Available from: 2014-11-03 Created: 2014-10-30 Last updated: 2018-06-11Bibliographically approved
    3. Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice
    Open this publication in new window or tab >>Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice
    Show others...
    2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 5, p. 602-611Article in journal (Refereed) Published
    Abstract [en]

    Background: Lumbar spine radiography is often performed instead of CT for radiation dose concerns.

    Purpose: To compare image quality and diagnostic information from low dose lumbar spine CT at an effective dose of about 1 mSv with lumbar spine radiography.

    Material and Methods: Fifty-one patients were examined by both methods. Five reviewers scored all examinations on eight image quality criteria using a five-graded scale and also assessed three common pathologic changes.

    Results: Low dose CT scored better than radiography on the following: sharp reproduction of disc profile and vertebral end-plates (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.5), intervertebral foramina and pedicles (OR, 4.3; 95% CI, 3.1-5.9), intervertebral joints (OR, 139; 95% CI, 59-326), spinous and transverse processes (OR, 7.0; 95% CI, 4.3-11.2), sacro-iliac joints (OR, 4.2; 95% CI, 3.2-5.7), reproduction of the adjacent soft tissues (OR, 2.9; 95% CI, 2.1-4.0), and absence of any obscuring superimposed gastrointestinal gas and contents (OR, 188; 95% CI, 66-539). Radiography scored better on sharp reproduction of cortical and trabecular bone (OR, 0.3; 95% CI, 0.2-0.4). The reviewers visualized disk degeneration, spondylosis/diffuse idiopathic skeletal hyperostosis (DISH) and intervertebral joint osteoarthritis more clearly and were more certain with low dose CT. Mean time to review low dose CT was 204 s (95% CI, 194-214 s.), radiography 152 s (95% CI, 146-158 s.). The effective dose for low dose CT was 1.0-1.1 mSv, for radiography 0.7 mSv.

    Conclusion: Low dose lumbar spine CT at about 1 mSv has superior image quality to lumbar spine radiography with more anatomical and diagnostic information.

    Place, publisher, year, edition, pages
    London, United Kingdom: Sage Publications, 2016
    Keywords
    Radiation dose, radiography, tomography, X-ray computed, axial skeleton
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Research subject
    Radiology
    Identifiers
    urn:nbn:se:oru:diva-47090 (URN)10.1177/0284185115595667 (DOI)000374327600014 ()26221055 (PubMedID)
    Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2018-09-04Bibliographically approved
    4. Impact of iterative reconstruction on image quality of low-dose CT of the lumbar spine
    Open this publication in new window or tab >>Impact of iterative reconstruction on image quality of low-dose CT of the lumbar spine
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-49423 (URN)
    Available from: 2016-03-17 Created: 2016-03-17 Last updated: 2018-02-05Bibliographically approved
  • 30.
    Alshamari, Muhammed
    et al.
    Örebro University, School of Medical Sciences. Department of Radiology.
    Geijer, Mats
    Department of Radiology, School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Imaging and Physiology, Skåne University Hospital, Lund; Lund University, Lund, Sweden.
    Norrman, Eva
    Department of Medical Physics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Lidén, Mats
    Örebro University, School of Health Sciences.
    Krauss, Wolfgang
    Örebro University, School of Health Sciences.
    Jendeberg, Johan
    Örebro University, School of Health Sciences.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Geijer, Håkan
    Örebro University, School of Health Sciences.
    Impact of iterative reconstruction on image quality of low-dose CT of the lumbar spineManuscript (preprint) (Other academic)
  • 31.
    Alston-Smith, J.
    et al.
    Department of Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala, Sweden.
    Ljungqvist, Olle
    Boija, P.-O.
    Ware, J.
    Nilsson Ekdahl, K.
    Endotoxin, epinephrine, glucagon, insulin and calcium ionophore A23187 modulation of kinese activity in cultured rat hepatocytes1990In: Acta Chirurgica Scandinavica, ISSN 0001-5482, p. 677-681Article in journal (Refereed)
    Abstract [en]

    Altered glucose metabolism is one of the commonly observed sequelae of sepsis and septic shock. The present investigation was undertaken to determine the role of endotoxin (ET) upon hepatocyte glucoregulation, by measuring the activity of pyruvate kinase (PK), a key glycolytic enzyme. Hepatocytes were exposed to endotoxin concentrations known to occur in vivo during sepsis, i.e., from 1 X 10(-14) to 1 X 10(-8) g/ml. The alteration of the enzyme activities after addition of epinephrine, glucagon, insulin and calcium ionophore A23187 with and without ET preincubation were also examined. ET alone decreased the PK activity by 12% at all concentrations tested. The basal inhibition of the enzyme caused by epinephrine (-48%) was partially blocked by ET preincubation above 1 X 10(-10) g/ml. There were no ET-(glucagon, calcium ionophore, insulin) interaction. These in vitro results do not support pyruvate kinase as a site of hepatic enzyme regulation defect in endotoxaemia.

  • 32.
    Alström, Ulrica
    et al.
    Department of Cardiothoracic Surgery and Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
    Granath, Fredrik
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic Surgery.
    Ekbom, Anders
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Ståhle, Elisabeth
    Department of Cardiothoracic Surgery and Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
    Risk factors for re-exploration due to bleeding after coronary artery bypass grafting2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 1, p. 39-44Article in journal (Refereed)
    Abstract [en]

    Objective: The study aimed to investigate relevant clinical risk factors for re-exploration due to bleeding after primary coronary artery bypass graft (CABG) surgery, and to evaluate the influence of antiplatelet and antifibrinolytic drugs.

    Design: Three retrospective analyses were performed on patients who underwent CABG: (1) Logistic regression was used to identify clinical risk factors for re-exploration (n = 3000). (2) A case-control study (n = 228) was used to obtain information on exposure of antithrombotic and hemostatic therapy. (3) Based on exposure to antiplatelet and antifibrinolytic therapy, and odds ratios (ORs) in multivariate logistic models, the proportion of re-explorations attributed to these drugs was calculated.

    Results: A receiver operating characteristic curve was created for clinical risk factors. The C-index was 0.64, indicating limited ability to predict re-exploration for bleeding. Clopidogrel was the only drug influencing the risk of re-exploration (OR 3.2, 95% CI 1.7-5.9). The harmful effect of clopidogrel was confirmed in multivariate model (OR 4.7, 95% CI 2.2-9.9), and aprotinin had a protective effect of the same magnitude (OR 0.2, 95% CI 0.1-0.6).

    Conclusions: Clopidogrel is an essential risk factor for re-exploration due to bleeding, and attributable to at least one-quarter of surveyed cases. Aside from pharmaceuticals, there are no strong clinical risk factors.

  • 33.
    Ander, Fredrik
    Örebro University, School of Medical Sciences.
    Perioperative complications in obese patients: A thesis on risk reducing strategies2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients.

    The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention.

    In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated.

    The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain.

    The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.

    List of papers
    1. Time-to-intubation in obese patients: A randomized study comparing direct laryngoscopy and videolaryngoscopy in experienced anaesthetists
    Open this publication in new window or tab >>Time-to-intubation in obese patients: A randomized study comparing direct laryngoscopy and videolaryngoscopy in experienced anaesthetists
    Show others...
    2017 (English)In: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 83, no 9, p. 906-913Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Airway management may be difficult in obese patients. Moreover, during prolonged intubation, oxygen desaturation develops rapidly. Videolaryngoscopy improves the view of the larynx, and the Storz® C-MACTM has been shown to be superior to other videolaryngoscopes in terms of intubation time in obese patients. However, no effort has been made to compare the Storz® C-MACTM with direct laryngoscopy. The aim of the study was to evaluate if the use of Storz® C-MACTM may reduce intubation time when compared to direct laryngoscopy (classic Macintosh® blade).

    METHODS: eighty patients with body mass index > 35kg/m2 were randomized to orotracheal intubation using either Macintosh® laryngoscope, or the Storz® C-MACTM with the standard Macintosh blade. Patients had no previous history of a difficult airway. Time- to-intubation (TTI) was defined as the time from the moment anaesthetist took the laryngoscope until end-tidal carbon dioxide was detected.

    RESULTS: no significant difference in TTI could be demonstrated between the two devices tested (mean difference -1.7s (95% CI -6.9 to 3.5s). All patients in the videolaryngoscopy group were successfully intubated with the allocated device, whereas five patients in the direct laryngoscopy group required an alternative device for successful intubation. No significant difference regarding the subjective difficulty of intubation and postoperative sore throat between groups was demonstrated.

    CONCLUSION: in obese patients the airway may be secured equally fast using direct laryngoscopy (Macintosh®) and with videolaryngoscopy using the Stortz® C-MACTM. The risk for failed intubation, however, appears to be greater with direct laryngoscopy, especially in male obese patients.

    Place, publisher, year, edition, pages
    Edizioni Minerva Medica, 2017
    Keywords
    Laryngoscopy; Obesity; Intubation
    National Category
    Anesthesiology and Intensive Care
    Research subject
    Anaesthesiology
    Identifiers
    urn:nbn:se:oru:diva-57350 (URN)10.23736/S0375-9393.17.11740-2 (DOI)000413240600005 ()28358178 (PubMedID)2-s2.0-85029081376 (Scopus ID)
    Note

    Funding Agency:

    Research Fund of the Örebro County Council, Örebro, Sweden 

    Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2018-07-31Bibliographically approved
    2. Effects of Esmolol on the Esophagogastric Junction: A Double-Blind, Randomized, Crossover Study on 14 Healthy Volunteers
    Open this publication in new window or tab >>Effects of Esmolol on the Esophagogastric Junction: A Double-Blind, Randomized, Crossover Study on 14 Healthy Volunteers
    Show others...
    2017 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 125, no 4, p. 1184-1190Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Passive regurgitation may occur throughout the perioperative period, increasing the risk for pulmonary aspiration and postoperative pulmonary complications. Hypnotics and opioids, especially remifentanil, that are used during anesthesia have been shown to decrease the pressure in the esophagogastric junction (EGJ), that otherwise acts as a barrier against passive regurgitation of gastric contents. Esmolol, usually used to counteract tachycardia and hypertension, has been shown to possess properties useful during general anesthesia. Like remifentanil, the beta-1-adrenoreceptor antagonist may be used to attenuate the stress reaction to tracheal intubation and to modify perioperative anesthetic requirements. It may also reduce the need for opioids in the postoperative period. Its action on the EGJ is however unknown. The aim of this trial was to compare the effects of esmolol and remifentanil on EGJ pressures in healthy volunteers, when administrated as single drugs.

    METHODS: Measurements of EGJ pressures were made in 14 healthy volunteers using high resolution solid-state manometry. Interventions were administered in a randomized sequence and consisted of esmolol that was given IV as a bolus dose of 1 mg/kg followed by an infusion of 10 mu g.kg(-1).minute(-1) over 15 minutes, and remifentanil with target-controlled infusion of 4 ng/mL over 15 minutes. Interventions were separated by a 20-minute washout period. Analyses of EGJ pressures were performed at baseline, and during drug administration at 2 (T2) and 15 minutes (T15). The primary outcome was the inspiratory EGJ augmentation, while the inspiratory and expiratory EGJ pressures were secondary outcomes.

    RESULTS: There was no effect on inspiratory EGJ augmentation when comparing remifentanil and esmolol (mean difference -4.0 mm Hg [-9.7 to 1.7]; P = .15). In contrast, remifentanil significantly decreased both inspiratory and expiratory pressures compared to esmolol (-12.2 [-18.6 to 5.7]; P = .003 and 8.0 [-13.3 to 2.8]; P = .006).

    CONCLUSIONS: Esmolol, compared with remifentanil, does not affect EGJ function. This may be an advantage regarding passive regurgitation and esmolol may thus have a role to play in anesthesia where maintenance of EGJ barrier function is of outmost importance.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Lippincott Williams & Wilkins, 2017
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:oru:diva-61347 (URN)10.1213/ANE.0000000000002339 (DOI)000411423300017 ()28763358 (PubMedID)2-s2.0-85030770015 (Scopus ID)
    Note

    Funding Agency:

    Research Fund of the Örebro County Council

    Available from: 2017-10-09 Created: 2017-10-09 Last updated: 2018-08-06Bibliographically approved
    3. Does the β-receptor antagonist esmolol have analgesic effects?: A randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test
    Open this publication in new window or tab >>Does the β-receptor antagonist esmolol have analgesic effects?: A randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test
    2018 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 3, p. 165-172Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Esmolol may attenuate the sympathetic response to pain and reduce postoperative opioid consumption. It is not clear whether esmolol has an analgesic effect per se.

    OBJECTIVES: The aim of this study was to evaluate the analgesic effect of esmolol in the absence of anaesthetics and opioids. We tested the hypothesis that esmolol would reduce the maximum pain intensity perceived during the cold pressor test (CPT) by 2 points on a 0 to 10 numeric pain rating scale (NRS) compared to placebo.

    DESIGN: Randomised, placebo-controlled cross-over study.

    SETTING: Postoperative recovery area, Örebro University Hospital. Study period, November 2013 to February 2014.

    PARTICIPANTS: Fourteen healthy volunteers. Exclusion criteria included ongoing medication, pregnancy and breastfeeding and participation in other medical trials.

    INTERVENTIONS: At separate study sessions, participants received interventions: esmolol (0.7 mg kg bolus over 1 min followed by infusion at 10 μg kg min); 0.9% normal saline bolus then remifentanil infusion at 0.2 μg kg min and 0.9% normal saline bolus and infusion according to a random sequence. All infusions were administered over 30 min.

    MAIN OUTCOME MEASURES: Perceived maximum pain intensity score, pain tolerance and haemodynamic changes during CPT, and occurrence of side-effects to interventions compared to placebo, respectively.

    RESULTS: Esmolol did not reduce perceived pain intensity or pain tolerance during the CPT. The NRS-max score was similar for esmolol, 8.5 (±1.4) and placebo, 8.4 (±1.3). The mean difference was 0.1 [95% confidence interval (-1.2 to 1.4)], P value equal to 0.83. Remifentanil significantly reduced NRS-max scores, 5.4 (±2.1) compared to placebo, [mean difference -3.1 (95% confidence interval (-4.4 to -1.8)), P < 0.001]. Side-effects were seen with remifentanil but not with esmolol.

    CONCLUSION: No direct analgesic effect of esmolol could be demonstrated in the present study. The postoperative opioid-sparing effect demonstrated in previous studies, could therefore be secondary to other factors such as avoidance of opioid-induced hyperalgesia, synergy with coadministered opioids or altered pharmacokinetics of those drugs.

    TRIAL REGISTRATION: European clinical trials database, https://eudract.ema.europa.eu/, EudraCT no. 2011-005780-24.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2018
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:oru:diva-62086 (URN)10.1097/EJA.0000000000000711 (DOI)000430786800003 ()28922338 (PubMedID)2-s2.0-85042412590 (Scopus ID)
    Note

    Funding Agency:

    Medical Research Fund, Örebro County Council, Örebro, Sweden

    Available from: 2017-11-01 Created: 2017-11-01 Last updated: 2018-08-16Bibliographically approved
    4. The effect of intraoperative esmolol infusion compared to remifentanil on opiaterequirement after laparoscopic gastric bypass surgery: a randomised pilot study
    Open this publication in new window or tab >>The effect of intraoperative esmolol infusion compared to remifentanil on opiaterequirement after laparoscopic gastric bypass surgery: a randomised pilot study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-62089 (URN)
    Available from: 2017-11-02 Created: 2017-11-02 Last updated: 2018-09-18Bibliographically approved
  • 34.
    Ander, Fredrik
    et al.
    Örebro University, School of Medical Sciences. Dept. of Paediatric Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences.
    de leon, Alex
    Dept. of Anaesthesia and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden; Dept. of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    The effect of intraoperative esmolol infusion compared to remifentanil on opiaterequirement after laparoscopic gastric bypass surgery: a randomised pilot studyManuscript (preprint) (Other academic)
  • 35.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences.
    Urinary incontinence: prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

    List of papers
    1. Urinary incontinence prevalence, impact on daily living and desire for treatmentt: a population-based study
    Open this publication in new window or tab >>Urinary incontinence prevalence, impact on daily living and desire for treatmentt: a population-based study
    2004 (English)In: Scandinavian journal of urology and nephrology, ISSN 0036-5599, Vol. 38, no 2, p. 125-130Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE:

    To investigate the prevalence of urinary incontinence in a representative population in Sweden, and to assess to what extent the condition affects daily life and to what degree those afflicted desire treatment.

    MATERIAL AND METHODS:

    In a population-based study, a postal questionnaire comprising 12 questions on urinary incontinence was sent to a representative sample of 15 360 randomly selected residents (aged 18-79 years) of Orebro County, Sweden. This was a supplement to a comprehensive survey of public health and general living conditions.

    RESULTS:

    The response rate was 64.5%. The prevalence of urinary incontinence was 19% when defined as "any leakage" and 7% when defined as "at least once a week". Women were more afflicted than men, and the proportion of people with urinary incontinence increased markedly with increasing age. Most considered their problems to be minor, having little impact on daily life, which was reflected by the fact that only 18% of those with urinary incontinence desired treatment. About 17% of those with urinary incontinence reported severe problems that interfered with daily life. Of respondents with severe problems, 42% did not want treatment.

    CONCLUSION:

    According to this population-based study, urinary incontinence is not a major problem for most people in the community. Although a considerable proportion of the population report urinary incontinence, the majority experience minor problems and only 18% desire treatment. For a limited group of people, urinary incontinence is a severe problem. It is important that healthcare resources are optimized to identify and meet the needs of those who are most afflicted.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2004
    Keywords
    impact on daily life, population‐based study, prevalence, urinary incontinence Read More: http://informahealthcare.com/doi/abs/10.1080/00365590310022608
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3043 (URN)10.1080/00365590310022608 (DOI)000221058000005 ()15204395 (PubMedID)2-s2.0-1942422250 (Scopus ID)
    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2018-11-16Bibliographically approved
    2. Urinary incontinence - why refraining from treatment?: a population based study
    Open this publication in new window or tab >>Urinary incontinence - why refraining from treatment?: a population based study
    Show others...
    2005 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, no 4, p. 301-307Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate why persons with urinary incontinence (UI) refrain from seeking care and treatment.

    MATERIAL AND METHODS: A population-based study was undertaken in which a public health survey and a specific UI questionnaire were sent to 15 360 randomly selected residents (age 18-79 years) of Orebro County, Sweden. For all persons reporting UI, the expressed wish for treatment or no treatment was analyzed in relation to relevant variables from both inquiry forms using binary logistic regression analysis.

    RESULTS: The response rate was 64.5%. UI was reported by 2194 persons, 1724 of whom comprised the study population. A statistically significant association was found between the degree of UI and a desire for treatment. Persons who did not experience daily leakage and those who did not perceive the leakage as troublesome or having an affect on their daily life mostly stated that they did not desire treatment. Socioeconomic or other health-related factors were not associated with desiring or not desiring treatment for UI.

    CONCLUSIONS: Our results show that it is the perceived severity of UI that determines whether afflicted persons desire treatment or not. Other factors, relating to seeking healthcare in general, were not found to be of importance. Interventions to identify those in need of treatment for UI should primarily be directed towards those with severe symptoms.

    Place, publisher, year, edition, pages
    London: Taylor & Francis, 2005
    Keywords
    : Healthcare-seeking behavior, population-based study, urinary incontinence
    National Category
    Medical and Health Sciences Urology and Nephrology Nursing
    Research subject
    Medicine; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-4540 (URN)10.1080/00365590510031129 (DOI)000231453100007 ()16118105 (PubMedID)2-s2.0-27144476977 (Scopus ID)
    Note

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2713

    Available from: 2008-04-14 Created: 2008-04-14 Last updated: 2017-12-14Bibliographically approved
    3. Accepting and adjusting: Older women´s experiences of living with urinary incontinence
    Open this publication in new window or tab >>Accepting and adjusting: Older women´s experiences of living with urinary incontinence
    2008 (English)In: Urologic Nursing, ISSN 1053-816X, Vol. 28, no 2, p. 115-121Article in journal (Refereed) Published
    Abstract [en]

    In-depth interviews were performed with 11 Swedish women who contacted a district nurse to obtain sanitary protection. Three key constituents (themes) emerged: "learning to live with it despite difficulties," "other illnesses are more important," and "reluctance to seek care." The essence of the phenomenon of living with urinary incontinence (Ul) was expressed as "a situation to accept and adjust to."

    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3045 (URN)- ()18488587 (PubMedID)2-s2.0-45849087670 (Scopus ID)
    Note

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2713

    Funding agency:Orebro CountyCouncil's Research Fund

    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2017-10-18Bibliographically approved
    4. Perceptions of urinary incontinence among syrian Christian women living in Sweden
    Open this publication in new window or tab >>Perceptions of urinary incontinence among syrian Christian women living in Sweden
    2009 (English)In: Journal of Transcultural Nursing, ISSN 1043-6596, E-ISSN 1552-7832, Vol. 20, no 3, p. 296-303Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study was to describe the perception of urinary incontinence (UI) among Syrian women living in Sweden. DESIGN: A qualitative, descriptive design with focus group discussions (FGDs) was used and analyzed with content analysis. Fourteen Syrian women were interviewed in three FGDs. FINDINGS: Three categories emerged, "Thoughts on UI," "Managing UI," and "Communication With the Health Care System." Among the interviewees, UI was a common, and expected, problem, which could be managed. However, some expressed shame and embarrassment. Some talked about communication problems with health care. DISCUSSION: and Implications for Practice: The health care system should be adjusted to the women's needs, with awareness of the communication difficulties, which could result in misunderstanding and neglected treatments.

    Keywords
    urinary incontinence, ethnic group, interpreter, focus group discussion, psychosocial factors
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-7355 (URN)10.1177/1043659609334850 (DOI)000267504000005 ()19372538 (PubMedID)2-s2.0-67650503250 (Scopus ID)
    Available from: 2009-06-22 Created: 2009-06-22 Last updated: 2017-10-18Bibliographically approved
  • 36.
    Andersson, Karin
    Örebro University, School of Medical Sciences.
    Metal artifacts in computed tomography: impact of reduction methods on image quality and radiotherapy treatment planning2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

    List of papers
    1. Evaluation of a metal artifact reduction algorithm in CT studies used for proton radiotherapy treatment planning
    Open this publication in new window or tab >>Evaluation of a metal artifact reduction algorithm in CT studies used for proton radiotherapy treatment planning
    2014 (English)In: Journal of Applied Clinical Medical Physics, ISSN 1526-9914, E-ISSN 1526-9914, Vol. 15, no 5, p. 112-119Article in journal (Refereed) Published
    Abstract [en]

    Metal objects in the body such as hip prostheses cause artifacts in CT images. When CT images degraded by artifacts are used for treatment planning of radiotherapy, the artifacts can yield inaccurate dose calculations and, for particle beams, erroneous penetration depths. A metal artifact reduction software (O-MAR) installed on a Philips Brilliance Big Bore CT has been tested for applications in treatment planning of proton radiotherapy. Hip prostheses mounted in a water phantom were used as test objects. Images without metal objects were acquired and used as reference data for the analysis of artifact-affected regions outside of the metal objects in both the O-MAR corrected and the uncorrected images. Water equivalent thicknesses (WET) based on proton stopping power data were calculated to quantify differences in the calculated proton beam penetration for the different image sets. The WET to a selected point of interest between the hip prostheses was calculated for several beam directions of clinical relevance. The results show that the calculated differences in WET relative to the reference case were decreased when the O-MAR algorithm was applied. WET differences up to 2.0 cm were seen in the uncorrected case while, for the O-MAR corrected case, the maximum difference was decreased to 0.4 cm. The O-MAR algorithm can significantly improve the accuracy in proton range calculations. However, there are some residual effects, and the use of proton beam directions along artifact streaks should only be used with caution and appropriate margins.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2014
    Keywords
    metal artifact reduction, radiation therapy, water equivalent thickness, proton range
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Identifiers
    urn:nbn:se:oru:diva-65011 (URN)10.1120/jacmp.v15i5.4857 (DOI)000345121900010 ()28297224 (PubMedID)2-s2.0-84929502869 (Scopus ID)
    Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2018-02-15Bibliographically approved
    2. Metal artefact reduction in CT imaging of hip prostheses-an evaluation of commercial techniques provided by four vendors
    Open this publication in new window or tab >>Metal artefact reduction in CT imaging of hip prostheses-an evaluation of commercial techniques provided by four vendors
    Show others...
    2015 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 88, no 1052, article id 20140473Article in journal (Refereed) Published
    Abstract [en]

    Objective: The aim of this study was to evaluate commercial metal artefact reduction (MAR) techniques in X-ray CT imaging of hip prostheses.

    Methods: Monoenergetic reconstructions of dual-energy CT (DECT) data and several different MAR algorithms, combined with single-energy CT or DECT, were evaluated by imaging a bilateral hip prosthesis phantom. The MAR images were compared with uncorrected images based on CT number accuracy and noise in different regions of interest.

    Results: The three MAR algorithms studied implied a general noise reduction (up to 67%, 74% and 77%) and an improvement in CT number accuracy, both in regions close to the prostheses and between the two prostheses. The application of monoenergetic reconstruction, without any MAR algorithm, did not decrease the noise in the regions close to the prostheses to the same extent as did the MAR algorithms and even increased the noise in the region between the prostheses.

    Conclusion: The MAR algorithms evaluated generally improved CT number accuracy and substantially reduced the noise in the hip prostheses phantom images, both close to the prostheses and between the two prostheses. The study showed that the monoenergetic reconstructions evaluated did not sufficiently reduce the severe metal artefact caused by large orthopaedic implants.

    Advances in knowledge: This study evaluates several commercially available MAR techniques in CT imaging of large orthopaedic implants.

    Place, publisher, year, edition, pages
    British Institute of Radiology, 2015
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Research subject
    Radiology
    Identifiers
    urn:nbn:se:oru:diva-46510 (URN)10.1259/bjr.20140473 (DOI)000363313000002 ()26110201 (PubMedID)2-s2.0-84938837932 (Scopus ID)
    Available from: 2015-11-17 Created: 2015-11-16 Last updated: 2018-09-04Bibliographically approved
    3. Visual grading evaluation of commercially available metal artefact reduction techniques in hip prosthesis computed tomography
    Open this publication in new window or tab >>Visual grading evaluation of commercially available metal artefact reduction techniques in hip prosthesis computed tomography
    Show others...
    2016 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 89, no 1063, article id 20150993Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To evaluate metal artefact reduction (MAR) techniques from four computed tomography (CT) vendors in hip prosthesis imaging.

    Methods: Bilateral hip prosthesis phantom images, obtained by using MAR algorithms for single energy CT data or dual energy CT (DECT) data and by monoenergetic reconstructions of DECT data, were visually graded by five radiologists using ten image quality criteria. Comparisons between the MAR images and a reference image were performed for each scanner separately. Ordinal probit regression analysis was used.

    Results: The MAR algorithms in general improved the image quality based on the majority of the criteria (up to between 8/10 and 10/10) with a statistically improvement in overall image quality (P<0.001). However, degradation of image quality, such as new artefacts, was seen in some cases. A few monoenergetic reconstruction series improved the image quality (P<0.004) for one of the DECT scanners, but it was only improved for some of the criteria (up to 5/10). Monoenergetic reconstructions resulted in worse image quality for the majority of the criteria (up to 7/10) for the other DECT scanner.

    Conclusions: The MAR algorithms improved the image quality of the hip prosthesis CT images. However, since additional artefacts and degradation of image quality were seen in some cases, all algorithms should be carefully evaluated for every clinical situation. Monoenergetic reconstructions were in general concluded to be insufficient for reducing metal artifacts. Advances in knowledge: Qualitative evaluation of the usefulness of several MAR techniques from different vendors in CT imaging of hip prosthesis.

    Place, publisher, year, edition, pages
    London, United Kingdom: British Institute of Radiology, 2016
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Research subject
    Radiology
    Identifiers
    urn:nbn:se:oru:diva-50103 (URN)10.1259/bjr.20150993 (DOI)000378096400009 ()27123700 (PubMedID)
    Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2019-03-07Bibliographically approved
    4. CT image metal artifacts in proton radiotherapy treatment planning: evaluation of two commercial correction algorithms
    Open this publication in new window or tab >>CT image metal artifacts in proton radiotherapy treatment planning: evaluation of two commercial correction algorithms
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Identifiers
    urn:nbn:se:oru:diva-65012 (URN)
    Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2018-09-18Bibliographically approved
  • 37.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences.
    Aktuell forskare om barn med cancer, deras rädsla och sättet den hanteras på2008In: Barnbladet, ISSN 0349-1994, Vol. 33, no 2, p. 45-46Article in journal (Other (popular science, discussion, etc.))
  • 38.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences.
    Att hantera rädsla hos barn med cancer2008In: Onkologi i Sverige, ISSN 1653-1582, Vol. 4, no 6, p. 14-20Article in journal (Other (popular science, discussion, etc.))
  • 39.
    Anderzén-Carlsson, Agneta
    Örebro University, Department of Health Sciences.
    Existentiella rädslor hos barn med cancer: föräldrars och vårdpersonals berättelser2007In: Omsorg: Nordisk tidsskrift for Palliativ Medisin, ISSN 0800-7489, Vol. 24, no 4, p. 33-39Article in journal (Other academic)
  • 40.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, School of Health and Medical Sciences.
    Kihlgren, Annica
    Örebro University, School of Health and Medical Sciences.
    Sörlie, Venke
    Högskolan i Bodö.
    Embodied suffering: experiences of fear in adolescent girls with cancer2008In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 12, no 2, p. 129-143Article in journal (Refereed)
    Abstract [en]

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

  • 41.
    Andrén, Ove
    Örebro University, School of Health and Medical Sciences.
    Natural history and prognostic factors in localized prostate cancer2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

    List of papers
    1. Natural history of early, localized prostate cancer
    Open this publication in new window or tab >>Natural history of early, localized prostate cancer
    Show others...
    2004 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 291, no 22, p. 2713-2719Article in journal (Refereed) Published
    Abstract [en]

    Context Among men with early prostate cancer, the natural history without initial therapy determines the potential for survival benefit following radical local treatment. However, little is known about disease progression and mortality beyond 10 to 15 years of watchful waiting. Objective To examine the long-term natural history of untreated, early stage prostatic cancer. Design Population-based, cohort study with a mean observation period of 21 years. Setting Regionally well-defined catchment area in central Sweden (recruitment March 1977 through February 1984). Patients A consecutive sample of 223 patients (98% of all eligible) with early-stage (T0-T2 NX MO classification), initially untreated prostatic cancer. Patients with tumor progression were hormonally treated (either by orchiectomy or estrogens) if they had symptoms. Main Outcome Measures Progression-free, cause-specific, and overall survival. Results After complete follow-up, 39 (17%) of all patients experienced generalized disease. Most cancers had an indolent course during the first 10 to 15 years. However, further follow-up from 15 (when 49 patients were still alive) to 20 years, revealed a substantial decrease in cumulative progression-free survival (from 45.0% to 36.0%), survival without metastases (from 76.9% to 51.2%), and prostate cancer-specific survival (from 78.7% to 54.4%). The prostate cancer mortality rate increased from 15 per 1000 person-years (95% confidence interval, 10-21) during the first 15 years to 44 per 1000 person-years (95% confidence interval, 22-88) beyond 15 years of follow-up (P=.01). Conclusion Although most prostate cancers diagnosed at an early stage have an indolent course, local tumor progression and aggressive metastatic disease may develop in the long term. These findings would support early radical treatment, notably among patients with an estimated life expectancy exceeding 15 years.

    National Category
    Surgery
    Research subject
    Surgery esp. Urology Specific
    Identifiers
    urn:nbn:se:oru:diva-15599 (URN)10.1001/jama.291.22.2713 (DOI)000221862300025 ()
    Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2017-12-11Bibliographically approved
    2. How well does the Gleason score predict prostate cancer death?: A 20-year followup of a population based cohort in Sweden
    Open this publication in new window or tab >>How well does the Gleason score predict prostate cancer death?: A 20-year followup of a population based cohort in Sweden
    Show others...
    2006 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 175, no 4, p. 1337-1340Article in journal (Refereed) Published
    Abstract [en]

    Purpose

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

    Materials and Methods

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

    Results

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

    Conclusions

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

    Place, publisher, year, edition, pages
    Baltimore: Williams and Wilkins Co., 2006
    National Category
    Medical and Health Sciences Surgery Urology and Nephrology
    Research subject
    Surgery esp. Urology Specific
    Identifiers
    urn:nbn:se:oru:diva-5067 (URN)10.1016/S0022-5347(05)00734-2 (DOI)
    Available from: 2009-01-26 Created: 2009-01-26 Last updated: 2017-12-14Bibliographically approved
    3. Decreased alpha-methylacyl CoA racemase expression in localized prostate cancer is associated with an increased rate of biochemical recurrence and cancer-specific death
    Open this publication in new window or tab >>Decreased alpha-methylacyl CoA racemase expression in localized prostate cancer is associated with an increased rate of biochemical recurrence and cancer-specific death
    Show others...
    2005 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 14, no 6, p. 1424-1432Article in journal (Refereed) Published
    Abstract [en]

    alpha-Methylacyl CoA racemase (AMACR) is overexpressed in prostate cancer relative to benign prostatic tissue. AMACR expression is highest in localized prostate cancer and decreases in metastatic prostate cancer. Herein, we explored the use of AMACR as a biomarker for aggressive prostate cancer. AMACR protein expression was determined by immunohistochemistry using an image analysis system on two localized prostate cancer cohorts consisting of 204 men treated by radical prostatectomy and 188 men followed expectantly. The end points for the cohorts were time to prostate-specific antigen (PSA) failure (i.e., elevation > 0.2 ng/mL) and time to prostate cancer death in the watchful waiting cohort. Using a regression tree method, optimal AMACR protein expression cutpoints were determined to best differentiate prostate cancer outcome in each of the cohorts separately. Cox proportional hazard models were then employed to examine the effect of the AMACR cutpoint on prostate cancer outcome, and adjusted for clinical variables. Lower AMACR tissue expression was associated with worse prostate cancer outcome, independent of clinical variables (hazard ratio, 3.7 for PSA failure; P = 0.018; hazard ratio, 4.1 for prostate cancer death, P = 0.0006). Among those with both low AMACR expression and high Gleason score, the risk of prostate cancer death was 18-fold higher (P = 0.006). The AMACR cutpoint developed using prostate cancer-specific death as the end point predicted PSA failures independent of Gleason score, PSA, and margin status. This is the first study to show that AMACR expression is significantly associated with prostate cancer progression and suggests that not all surrogate end points may be optimal to define biomarkers of aggressive prostate cancer.

    National Category
    Surgery
    Research subject
    Surgery esp. Urology Specific
    Identifiers
    urn:nbn:se:oru:diva-15600 (URN)10.1158/1055-9965.EPI-04-0801 (DOI)000229766600017 ()
    Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2017-12-11Bibliographically approved
    4. MUC-1 gene is associated with prostate cancer death: a 20-year follow-up of a population-based study in Sweden
    Open this publication in new window or tab >>MUC-1 gene is associated with prostate cancer death: a 20-year follow-up of a population-based study in Sweden
    Show others...
    2007 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 97, no 6, p. 730-734Article in journal (Refereed) Published
    Abstract [en]

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

    Place, publisher, year, edition, pages
    London: Harcourt Publishers, 2007
    National Category
    Medical and Health Sciences Surgery Cancer and Oncology
    Research subject
    Oncology; Surgery esp. Urology Specific
    Identifiers
    urn:nbn:se:oru:diva-5063 (URN)10.1038/sj.bjc.6603944 (DOI)
    Available from: 2009-01-26 Created: 2009-01-26 Last updated: 2017-12-14Bibliographically approved
    5. Time trends and survival among men diagnosed with incidental prostate cancer in Sweden: a register-based study between 1970 and 2003
    Open this publication in new window or tab >>Time trends and survival among men diagnosed with incidental prostate cancer in Sweden: a register-based study between 1970 and 2003
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Research subject
    Surgery esp. Urology Specific
    Identifiers
    urn:nbn:se:oru:diva-15601 (URN)
    Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2017-10-17Bibliographically approved
  • 42.
    Andrén, Ove
    et al.
    Örebro University, School of Health and Medical Sciences.
    Fall, Katja
    Andersson, Swen-Olof
    Rubin, Mark A.
    Bismar, Tarek A.
    Karlsson, M.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences.
    Mucci, Lorelei A.
    MUC-1 gene is associated with prostate cancer death: a 20-year follow-up of a population-based study in Sweden2007In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 97, no 6, p. 730-734Article in journal (Refereed)
    Abstract [en]

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

  • 43.
    Andrén, Ove
    et al.
    Örebro University, Department of Clinical Medicine.
    Fall, Katja
    Franzén, Lennart
    Andersson, Swen-Olof
    Johansson, Jan-Erik
    Rubin, Mark A.
    How well does the Gleason score predict prostate cancer death?: A 20-year followup of a population based cohort in Sweden2006In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 175, no 4, p. 1337-1340Article in journal (Refereed)
    Abstract [en]

    Purpose

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

    Materials and Methods

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

    Results

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

    Conclusions

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

  • 44.
    Andrén, Ove
    et al.
    Örebro University, School of Health and Medical Sciences.
    Garmo, Hans
    Mucci, Lorelei
    Andersson, Swen-Olof
    Johansson, Jan-Erik
    Fall, Katja
    Time trends and survival among men diagnosed with incidental prostate cancer in Sweden: a register-based study between 1970 and 2003Manuscript (preprint) (Other academic)
  • 45.
    Angenete, Eva
    et al.
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Thornell, Anders
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp östra, Univ Gothenburg, Gothenburg, Sweden.
    Burcharth, Jakob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Pommergaard, Hans-Christian
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Skullman, Stefan
    Dept Surg, Skaraborgs Hosp, Skövde, Sweden.
    Bisgaard, Thue
    Div Surg, GastroUnit, Hvidovre Hosp, Univ Copenhagen, Hvidovre, Denmark.
    Jess, Per
    Dept Surg, Roskilde Hosp, Roskilde, Denmark.
    Lackberg, Zoltan
    NAL Hosp Grp, Trollhättan, Sweden.
    Matthiessen, Peter
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Heath, Jane
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Rosenberg, Jacob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Haglind, Eva
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis The First Results From the Randomized Controlled Trial DILALA2016In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 263, no 1, p. 117-122Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 46.
    Axer, Stephan
    et al.
    Örebro University, School of Medical Sciences.
    Szabo, Eva
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Näslund, Ingmar
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Weight loss and alterations in co-morbidities after revisional gastric bypass: A case-matched study from the Scandinavian Obesity Surgery Registry2017In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 13, no 5, p. 796-800Article in journal (Refereed)
    Abstract [en]

    Background: In Sweden, Roux-en-Y gastric bypass is the most common procedure when revising a previous bariatric procedure. This study is an analysis of all revisional gastric bypass operations (rGBP) compared with a matched group of primary gastric bypass (pGBP) operated between 2007 and 2012.

    Objective: The aim was to determine whether improvement of obesity-related co-morbidity and changes in weight after revisional gastric bypass surgery were comparable with those seen after primary surgery.

    Setting: 44 hospitals in Sweden

    Methods: Retrospective data were retrieved from the Scandinavian Obesity Surgery Registry. The study group (rGBP) comprised 1224 patients, and the control group (pGBP) comprised 3612 patients matched for age and gender.

    Results: The indication for revision was weight failure in 512 patients (42%), a late complication of the initial procedure in 330 patients (27%), and a combination of weight failure and complication in 303 patients (25%). A total of 66% of patients in the rGBP group and 67% in the pGBP group completed the 2-year follow-up in the Scandinavian Obesity Surgery Registry.

    The rGBP-group had significantly less excess BMI loss (%EBMIL, 59.4 +/- 147.0 versus 79.5 +/- 24.7, P < .001) and a lower dyslipidemia remission rate (42.9% versus 62.0%, P = .005) at the time of the 2-year follow-up. Remission rates of sleep apnea, hypertension, type 2 diabetes, and depression were similar. The effects on obesity-related co-morbidity were not related to the indication for revisional surgery or the initial bariatric procedure.

    Conclusion: Even if weight results might be inferior compared with primary bypass procedures, the improvement of co-morbidity is similar. (C) 2017 American Society for Metabolic and Bariatric Surgery. All right reserved

  • 47.
    Bark, Tor
    et al.
    Department of Surgery and Medicine, Karolinska Hospital, Stockholm, sweden.
    Engervall, Per A.
    Department of Surgery and Medicine, Karolinska Hospital, Stockholm, Sweden.
    Katouli, Mohammad
    Center for Microbiology and Tumorbiology, Karolinska Institute, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Oral Diagnostic Sciences, Karolinska Institute, Huddinge, Sweden.
    Loftenius, Annika
    Department of Oral Diagnostic Sciences, Karolinska Institute, Huddinge, Sweden.
    Möllby, Roland
    Center for Microbiology and Tumorbiology, Karolinska Institute, Stockholm, Sweden.
    Svenberg, Torgny E.
    Center for Microbiology and Tumorbiology, Karolinska Institute, Stockholm, Sweden.
    Oral arginine supplementation does not prevent bacterial translocation afterhemorrhagic stress in the rat1998In: Surgical Research Communications, ISSN 0882-9233, Vol. 19, p. 269-277Article in journal (Refereed)
  • 48.
    Bark, Tor
    et al.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Katouli, Mohammad
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Möllby, R.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Svenberg, Torgny E.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Bacterial translocation after non-lethal hemorrhage in the rat1993In: Circulatory Shock, ISSN 0092-6213, Vol. 41, no 1, p. 60-65Article in journal (Refereed)
    Abstract [en]

    Translocation of enteric bacteria has been suggested to compromise patients in severe catabolic stress. Mechanisms for this route of infection are not known. In this study, ratswere subjected to hemorrhage without reinfusion during 60 min, total blood loss was 3.28 +/- 0.14 ml/100 g BW. Control groups consisted of sham-operated animals without bleeding, and rats not operated at all. The mean number of viable bacteria found in mesenteric lymph nodes (MLN) of bled animals was 168 +/- 45 colony forming units (c.f.u./MLN), significantly higher compared to sham operated (5 +/- 3 c.f.u./MLN) and not operated (0 +/- 0 c.f.u./MLN) controls (P < 0.01). Cultures from MLN were positive in 7/9 rats after bleeding, in 3/9 of sham operated, and in 0/6 of non-instrumented control animals. No positive blood cultures were isolated. Escherichia coli was the dominant species found in MLN. A biochemical fingerprinting method (the PhP system) was used to identify translocating strains of E. coli among strains found in cecum. The method was also used to compare translocating strains between different animals. Our findings reveal that bacteria translocate to MLN after hemorrhage. Some phenotypes of E. coli strains translocate more frequently than others, suggesting that they have properties facilitating translocation.

  • 49.
    Bark, Tor
    et al.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Katouli, Mohammad
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Möllby, R.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Svenberg, Torgny E.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Glutamine supplementation does not prevent bacterial translocation after non-lethal haemorrhage in rats1995In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 161, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To find out whether supplementation of an enteral diet with glutamine would reduce translocation of bacteria to mesenteric lymph nodes or blood after major haemorrhage in rats.

    DESIGN:

    Open randomised study.

    SETTING:

    University departments of surgery and microbiology, Sweden.

    MATERIAL:

    49 Sprague-Dawley rats.

    INTERVENTIONS:

    Rats were fed enterally for 7 days on diets supplemented with either glutamine or an isonitrogenous amount of non-essential amino acids. After feeding, 8 experimental and 8 control rats underwent sham operation; 9 and 7, respectively, underwent moderate haemorrhage (to 65 mm Hg); and 9 and 8, respectively, underwent severe haemorrhage (50 mm Hg) without reinfusion.

    MAIN OUTCOME MEASURES:

    Microbiological analyses of samples of blood and mesenteric lymph nodes taken 24 hours after haemorrhage.

    RESULTS:

    The median (interquartile) number of colony forming units/mesenteric lymph nodes after moderate haemorrhage in animals who were given glutamine supplementation was 11 (0-34) and in control animals 20 (0-178). After severe haemorrhage the corresponding figures were 199 (10-310) and 22 (0-187). No pathogens were isolated from blood cultures.

    CONCLUSION:

    Glutamine supplementation before haemorrhage did not reduce bacterial translocation to mesenteric lymph nodes in this rat model.

  • 50.
    Barmparas, Galinos
    et al.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Harada, Megan Y.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Ko, Ara
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Dhillon, Navpreet K.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Smith, Eric J. T.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Li, Tong
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Division of Trauma and Emergency Surgery.
    Ley, Eric J.
    Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles California, USA.
    The Effect of Early Positive Cultures on Mortality in Ventilated Trauma Patients2018In: Surgical Infections, ISSN 1096-2964, E-ISSN 1557-8674, Vol. 19, no 4, p. 410-416Article in journal (Refereed)
    Abstract [en]

    Background: The purpose was to examine the incidence of positive cultures in a highly susceptible subset of trauma patients admitted to the surgical intensive care unit (SICU) for mechanical ventilation and to examine the impact of their timing on outcomes.

    Patients and Methods: A retrospective review was conducted of blunt trauma patients admitted to the SICU for mechanical ventilation at a level I trauma center over a five-year period. All urine, blood, and sputum cultures were abstracted. Patients with at least one positive culture were compared with those with negative or no cultures. The primary outcome was mortality. A Cox regression model with a time-dependent variable was utilized to calculate the adjusted hazard ratio (AHR).

    Results: The median age of 635 patients meeting inclusion criteria was 46 and 74.2% were male. A total of 298 patients (46.9%) had at least one positive culture, with 28.9% occurring within two days of admission. Patients with positive cultures were more likely to be severely injured with an injury severity score (ISS) 16 (68.5% vs. 45.1%, p<0.001). Overall mortality was 22%. Patients who had their first positive culture within two and three days from admission had a significantly higher AHR for mortality (AHR: 14.46, p<0.001 and AHR: 10.59, p=0.028, respectively) compared to patients with a positive culture at day six or later.

    Conclusions: Early positive cultures are common among trauma patients requiring mechanical ventilation and are associated with higher mortality. Early identification with damage control cultures obtained on admission to aid with early targeted treatment might be justified.

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