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  • 1.
    Abbas, Monika
    Örebro University, School of Health and Medical Sciences.
    Bedömning av variabler vid postocklusiv reaktiv hyperemi (PORH)-test med Laser Doppler Flowmetry teknik2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2.
    Abdi-Ahmed, Shukri
    Örebro University, School of Health and Medical Sciences.
    Optimal undersökningsteknik vid utredning an hepatitcellulär cancer med datortomografi2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 3.
    Abdulkadir, Kauser
    Örebro University, School of Health and Medical Sciences.
    Värdet av datorstödd bildanalys vid CT-colografi2010Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 4.
    Abdulkadir, Nema
    Örebro University, School of Health and Medical Sciences.
    Analys av Ki67 i relation till den fraktala dimensionen hos coloncancer2010Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 5.
    Abdulla, Suzanne
    Örebro University, School of Health and Medical Sciences.
    Stråldos och bildkvalitet vid konventionell frontalbild av ländryggen med och utan kompression2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 6.
    Abraha, Genet
    Örebro University, School of Health and Medical Sciences.
    Patienters upplevda livskvalitet efter en överviktsoperation: En litteraturstudie2011Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 7. Abraham-Nordling, Mirna
    et al.
    Byström, Kristina
    Örebro University, School of Health and Medical Sciences.
    Torring, Ove
    Lantz, Mikael
    Berg, Gertrud
    Calissendorff, Jan
    Filipsson Nyström, Helena
    Jansson, Svante
    Jorneskog, Gun
    Karlsson, F. Anders
    Nyström, Ernst
    Ohrling, Hans
    Orn, Thomas
    Hallengren, Bengt
    Wallin, Göran
    Incidence of hyperthyroidism in Sweden2011In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 165, no 6, p. 899-905Article in journal (Refereed)
    Abstract [en]

    Introduction: The incidence of hyperthyroidism has been reported in various countries to be 23-93/100000 inhabitants per year. This extended study has evaluated the incidence for similar to 40% of the Swedish population of 9 million inhabitants. Sweden is considered to be iodine sufficient country. Methods:All patients including children, who were newly diagnosed with overt hyperthyroidism in the years 2003-2005, were prospectively registered in a multicenter study. The inclusion criteria are as follows:clinical symptoms and/or signs of hyperthyroidism with plasma TSH concentration below 0.2 mIE/l and increased plasma levels of free/total triiodothyronine and/or free/total thyroxine. Patients with relapse of hyperthyroidism or thyroiditis were not included. The diagnosis of Graves' disease (GD), toxic multinodular goiter (TMNG) and solitary toxic adenoma (STA), smoking, initial treatment, occurrence of thyroid-associated eye symptoms/signs, and demographic data were registered. Results:A total of 2916 patients were diagnosed with de novo hyperthyroidism showing the total incidence of 27.6/100 000 inhabitants per year. The incidence of GD was 21.0/100 000 and toxic nodular goiter (TNG=STA+TMNG) occurred in 692 patients, corresponding to an annual incidence of 6.5/100 000. The incidence was higher in women compared with men (4.2:1). Seventy-five percent of the patients were diagnosed with GD, in whom thyroid-associated eye symptoms/signs occurred during diagnosis in every fifth patient. Geographical differences were observed. Conclusion:The incidence of hyperthyroidism in Sweden is in a lower range compared with international reports. Seventy-five percent of patients with hyperthyroidism had GD and 20% of them had thyroid-associated eye symptoms/signs during diagnosis. The observed geographical differences require further studies.

  • 8.
    Abrahamsson, Max
    et al.
    Örebro University, School of Health and Medical Sciences.
    Olsson, Richard
    Örebro University, School of Health and Medical Sciences.
    Hot och våld inom den somatiska akutsjukvården2008Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 9. Acosta, Stefan
    et al.
    Nilsson, Torbjörn K
    Örebro University, School of Health and Medical Sciences.
    Malina, Janne
    Malina, Martin
    L-lactate after embolization of the superior mesenteric artery2007In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 143, no 2, p. 320-328Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Plasma markers for intestinal ischemia have not proven to be accurate. The value of L-lactate is unclear. Experimental models based on open surgery confound the effects of surgical trauma with that of ischemia. The aim was to create an endovascular model for acute superior mesenteric artery thromboembolism, and then to study L-lactate and lactate dehydrogenase (LD) activity in plasma and peritoneal fluid in pigs with extensive, high-grade intestinal ischemia. MATERIALS AND METHODS: Nine pigs underwent full superior mesenteric artery embolization with 4 h of intended intestinal ischemia, whereas six were control animals. Sampling of central venous and arterial blood was performed throughout the experiment, ending with laparotomy to collect peritoneal fluid and segmental intestinal biopsies. A pathologist, blinded to the performed interventions, graded the ischemic lesions. RESULTS: There were no differences in plasma L-lactate (P = 0.61) or LD activity levels (P = 0.69), measured at different time points from baseline to end of study, between animals with extensive, high-grade intestinal ischemia and sham. Intraperitoneal L-Lactate (P = 0.005) and LD activity (P = 0.018) levels were elevated compared with sham. There were differences in grades of ischemia in the duodenum (P = 0.003), small intestine (P < 0.001), proximal (P < 0.001), and sigmoid (P = 0.032) colon between experimental animals and sham. The grade of small bowel ischemia (n = 15) correlated to intraperitoneal fluid L-lactate (r = 0.80; P < 0.001) and LD activity levels (r = 0.72; P = 0.003). CONCLUSIONS: This endovascular study in a porcine model showed that L-lactate and LD activity levels in peritoneal fluid, not in plasma, reflect intestinal ischemia. The study suggests that plasma L-lactate not is a useful early marker in patients with suspicion of intestinal ischemia.

  • 10.
    Adam, Linnea
    et al.
    Örebro University, School of Health and Medical Sciences.
    Saied, Morsal
    Familjefokuserad omvårdnad: Barn med kroniska sjukdomar2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 11.
    Adenfelt, Gunilla
    et al.
    Örebro University, School of Health and Medical Sciences.
    Warnemark, Elisabeth
    Örebro University, School of Health and Medical Sciences.
    Arbetsskador hos sjukgymnaster: -en litteraturstudie2008Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 12.
    Adenäs, Josefine
    et al.
    Örebro University, School of Health and Medical Sciences.
    Trostek, Martina
    Örebro University, School of Health and Medical Sciences.
    Arbetsterapeutiska interventioner för behandling av stressrelaterad smärta: En litteraturstudie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 13.
    Adeteg, Sandra
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bergman, Eva-Lena
    Örebro University, School of Health and Medical Sciences.
    Att vara ung vuxen med reumatisk sjukdom och leva med kronisk smärta och trötthet: En kvalitativ intervjustudie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien var att fånga in hur trötthet och smärta påverkar vardagen för unga vuxna med reumatisk sjukdom.

    Metoden är kvalitativ och för datainsamlingen gjordes semistrukturerade intervjuer. Materialet transkriberades transkriberades i sin helt och när det var klart påbörjades analysering av det som framkommit. I analysen sökte vi efter meningsbärande enheter och försökte ordna dem i kategorier och underkategorier.

    Resultatet visar att sjukdomen har en stor påverkan på våra informanters liv, men att de också har bra strategier för att kunna leva med sjukdomen. Det visar också på att även om strategierna är bra och de vet hur de ska hantera sjukdomen så stöter de på hinder, till exempel har skolgången blivit negativt påverkad för de flesta av informanterna. Något som visat sig vara extra viktigt har varit vännerna och det sociala nätverket. Alla informanter har på ett eller annat sätt verkligen understrykt betydelsen av vänner som är förstående och som på det sättet hjälper till att hitta det positiva med livet.

    Slutsatsen som kan dras utifrån detta arbete är att vara ung och ha en reumatisk sjukdom är något som påverkar hela livet. Vi har sett på informanterna i studien att trots detta flyter livet på och de lyckas i de flesta fall att få balans mellan aktivitet och vila. Just denna balans är mycket viktig.

     

  • 14.
    Adolfsson Hultgren, Camilla
    et al.
    Örebro University, School of Health and Medical Sciences.
    Wedin, Madeleine
    Örebro University, School of Health and Medical Sciences.
    Evidens för användandet av hund vid arbete med klienter i olika situationer: En systematisk litteraturstudie2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie var att undersöka vilken evidens det fanns för att användandet av hund vid arbete med klienter i olika situationer har någon fysiologisk effekt. Frågor vi ställde oss var i vilka situationer hunden används som medel, vilka mätmetoder som har använts, vilka fysiologiska effekter som uppmätts, vilka ytterligare effekter som uppmätts samt hur hunden kan användas som medel i en arbetsterapeutisk kontext. En systematisk sökning efter vetenskapliga artiklar utfördes i databaserna Cinahl, PubMed och PsycInfo. Efter att studierna granskats utifrån kvalitet, samt inklusions- och exklusionskriterier, återstod 11 artiklar av kvantitativ karaktär som analyserades utifrån syfte och frågeställningar. Genom kritisk granskning och sammanställning av litteraturen skapades en syntes från tidigare genomförda empiriska studier. På detta sätta hittades vad som fungerar, vad som är effektivt och vilket vetenskapligt stöd för användningen av hund som finns. Resultatet visar viss evidens för några av de fysiologiska variablerna som sänkt hjärtfrekvens samt att rörelserelaterade aktiviteter i form av promenaders längd och hastighet samt personers gångmönster förbättrades. De övriga fysiologiska samt de ytterligare variabler författarna undersökte visade flera på statistisk signifikans. Dock nådde evidensstyrkan endast otillräckligt vetenskapligt underlag vilket gör att det inte går att dra några säkra slutsatser om evidens. Samtidigt såg författarna att orsaken till det otillräckliga vetenskapliga underlaget i flera fall berodde på att endast en studie undersökt en specifik variabel som i sig gav högt bevisvärde, och detta gör att författarna trots det begränsade vetenskapliga underlaget menar att det finns belägg för att uttrycka att hunden kan vara användbar i en arbetsterapeutisk kontext på flera plan. Detta då arbetsterapeutens arbetsområde ofta täcker in en stor del av en människas liv och att hunden där kan vara ett bra redskap i att nå flera av klientens behovsområden.

  • 15. 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

  • 16.
    Agneklev, Ulrica
    et al.
    Örebro University, School of Health and Medical Sciences.
    Byström Utterheim, Inga-Lisa
    Örebro University, School of Health and Medical Sciences.
    Fysisk aktivitet hos personer som fått diagnosen transitorisk ischemisk attack (TIA) - behov av sjukgymnastråd2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie var att beskriva hur fysiskt aktiva personer som fått diagnosen TIA var. Frågeställningarna rörde vilka aktiviteter studiedeltagarna ägnade sig åt, hur de upplevde sin hälsa, begränsande faktorer, eventuell förändring av aktivitetsvanor, samt om deltagarna fått råd om fysisk aktivitet. Som metod valdes enkätundersökning och 195 enkäter skickades till personer som sökt Universitetssjukhuset Örebro 2007 och fått diagnosen TIA. Resultat: Svarsfrekvensen, efter externt och internt bortfall, blev 74 %. Mer än hälften av de 144 studiedeltagarna var fysiskt aktiva mindre än 30 minuter/dag. Den vanligaste aktiviteten var promenader, vilket 72 % ägnade sig åt. Yngre personer ägnade sig oftare åt tre eller fler aktiviteter jämfört med äldre personer. De deltagare som var regelbundet fysiskt aktiva skattade sin hälsa som god till utmärkt, medan de med stillasittande fritid skattade sin hälsa som någorlunda eller dålig. De mest begränsande faktorerna var sjukdom och smärta. Av studiedeltagarna uppgav 98 personer att de inte fått råd om fysisk aktivitet och hälften av deltagarna hade inte förändrat sina aktivitetsvanor. Slutsats: Studien visar att många personer som fått diagnosen TIA är fysiskt inaktiva. Begränsande faktorer, som, sjukdom, smärta och hög ålder, medför att råd om fysisk aktivitet bör vara individanpassade. Att ge råd om fysisk aktivitet på lämplig nivå, utifrån den enskilde personens förutsättningar är ett centralt kunskapsområde för sjukgymnaster. Därför bör dessa patienter ges möjlighet att träffa sjukgymnast.

  • 17.
    Ahl, Carin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Larsson, Anna
    Örebro University, School of Health and Medical Sciences.
    Body Mass Index hos 16-åringar under fyra år: Epidemiologisk studie2009Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 18.
    Ahlander, Britt-Marie
    Örebro University. Örebro University, School of Health and Medical Sciences.
    Promising use of Contrast Enhanced Magnetic Resonance Imaging for the detection of ischemia and viability- a comparison with Myocardial Perfusion Scintigraphy2009Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 19.
    Ahlgren, Erica
    et al.
    Örebro University, School of Health and Medical Sciences.
    Mihaly, Tûnde
    Föräldrars upplevelse av föräldrastöd från barnhälsovården: En litteraturstudie2011Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 20.
    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
  • 21.
    Ahlsson, Anders
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Department of Statistics and Epidemiology, Örebro University Hospital, Örebro, Sweden.
    Fengsrud, Espen
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Englund, Anders
    Örebro University, School of Health and Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality2009In: Scandinavian cardiovascular journal : SCJ, ISSN 1651-2006, Vol. 43, no 5, p. 330-336Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the impact of postoperative AF on late mortality and cause of death in CABG patients.

    DESIGN: All CABG patients without preoperative AF surgically treated between January 1, 1997 and June 30, 2000 were included (N = 1419). Altogether, 419 patients (29.5%) developed postoperative AF. After a median follow-up of 8.0 years, survival data were obtained, causes of death were compared and Cox proportional hazard analysis was used to determine predictors of late mortality.

    RESULTS: The total mortality was 140 deaths/419 patients (33.4%) in postoperative AF patients and 191 deaths/1 000 patients (19.1%) in patients without AF. Death due to cerebral ischemia (2.6% vs. 0.5%), myocardial infarction (7.4% vs. 3.0%), sudden death (2.6% vs. 0.9%), and heart failure (6.7% vs. 2.7%) was more common among postoperative AF patients. Postoperative AF was an age-independent risk indicator for late mortality with a hazard ratio (HR) of 1.56 (95% confidence interval 1.23-1.98).

    CONCLUSIONS: Postoperative AF is an age-independent risk factor for late mortality in CABG patients, explained by an increased risk of cardiovascular death.

  • 22.
    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)
  • 23.
    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)
  • 24.
    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.

  • 25.
    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

  • 26. Ahlstrand, Erik
    et al.
    Svensson, K.
    Persson, Lennart
    Tidefelt, Ulf
    Örebro University, School of Health and Medical Sciences.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences.
    Glycopeptide resistance in coagulase-negative staphylococci isolated in blood cultures from patients with hematological malignancies during three decades2011In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 30, no 11, p. 1349-1354Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine if there was a long-term increase in glycopeptide minimum inhibitory concentration (MIC) values, MIC creep, among bloodstream isolates of Staphylococcus epidermidis and S. haemolyticus isolated from patients with hematological malignancies. We conducted a retrospective single-center study where all positive blood cultures of S. epidermidis (n = 387) and S. haemolyticus (n = 19) isolated from patients with hematological malignancies during three decades, 1980 to 2009, were re-evaluated for the presence of reduced susceptibility to vancomycin and teicoplanin. Three different methods for the detection of reduced susceptibility to glycopeptides were used; standard Etest, macromethod Etest, and glycopeptide resistance detection (GRD) Etest. The median MIC value for vancomycin was 2 mg/L. MIC values for vancomycin and teicoplanin did not show any statistically significant increase during the study period. The presence of heterogeneously glycopeptide-intermediate staphylococci (hGIS) was analyzed among 405 coagulase-negative staphylococci (CoNS) isolates. hGIS were found in 31-45% of the CoNS isolates by the macromethod Etest and in 53-67% by the GRD Etest during the three decades. In conclusion, we did not observe any long-term glycopeptide MIC creep determined by the standard Etest, although a high and increasing proportion of heterogeneous vancomycin resistance was observed.

  • 27.
    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
  • 28.
    Ahlstrand, Rebecca
    et al.
    Örebro University, School of Health and Medical Sciences.
    Magnuson, Anders
    Thörn, Sven-Egron
    Dahlkvist, Anette
    Wattvil, Magnus
    Integrity of the esophagogastric junction during propofol induction with and without remifentanil: a double-blind,randomized, crossover study in volunteersManuscript (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.

  • 29.
    Ahlstrand, Rebecca
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Anesthesiology and Intensive Care.
    Savilampi, Johanna
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Thörn, Sven-Egron
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Wattwil, Magnus
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Effects of cricoid pressure and remifentanil on the esophageal sphincters using high-resolution solid-state manometry2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 2, p. 209-215Article in journal (Refereed)
    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.

  • 30.
    Ahlstrand, Rebecca
    et al.
    Örebro University, School of Health and Medical Sciences.
    Thörn, Sven-Egron
    Wattvil, Magnus
    High resolution solid-state manometry of the effect of rocuronium on esophagogastric junction integrityManuscript (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)

  • 31.
    Ahlström, Daniel
    et al.
    Örebro University, School of Health and Medical Sciences.
    Karlsson, Christian
    Omvårdnad av personer med  demens som  har ätandeproblematik: En litteraturstudie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 32.
    Ahmed, K.
    et al.
    School of Health and Medical Science, Clinical Medicine, Örebro University, Örebro, Sweden.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health and Medical Sciences.
    Association between objectively measured physical activity and sub-clinical atherosclerosis in young adults2010In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, no Suppl 1, p. 388-388Article in journal (Other academic)
  • 33.
    Ahmed, Kamran
    Örebro University, School of Health and Medical Sciences.
    Serum apolipoproteins apoB/apoA-I ratio and objectively measured physical activity in elderly2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 34.
    Ahmed, Kamran
    Örebro University, School of Health and Medical Sciences.
    Sub-clinical carotid atherosclerosis and objectively measured physical activity among young adults2010Independent thesis Advanced level (degree of Master (Two Years)), 30 credits / 45 HE creditsStudent thesis
  • 35. Ahmed, Kamran
    et al.
    Rask, Peter
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health and Medical Sciences.
    Serum apolipoproteins, apoB/apoA-I ratio and objectively measured physical activity in elderly2011In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 45, no 2, p. 105-111Article in journal (Refereed)
    Abstract [en]

    Objectives: Several studies have suggested that subjectively reported physical activity is associated with favorable apolipoproteins and apoB/apoA-I ratio but this association has not been studied much in elderly, and seldom with objective methods. The specific aim of the current study was to increase our understanding of the association between objectively measured physical activity, and apolipoproteins and apoB/apoA-I ratio in elderly subjects.

    Design: In a long-term follow-up of coronary artery bypass graft surgery patients, a total of 89 subjects (55?88 years old) were recruited. Peak oxygen uptake was measured by ergospirometry and physical activity by accelerometry. Subjects were divided into two groups based on their activity levels (i.e. more or less than 30 minutes of moderate activity per day).

    Results: Only 26% (23/89) of participants achieved the recommended 30 min/day of moderate intensity activity. Objectively measured physical activity was associated with higher apolipoprotein A-I levels and smaller apoB/apoAI ratio and lower body mass index, whereas no significant association with apolipoprotein B was observed.

    Conclusion: The significant association of objectively measured physical activity with favorable apolipoprotein A-I levels and a apoB/apoA-I ratio stresses the importance of being physically active.

  • 36.
    Ahmed, Kani
    Örebro University, School of Health and Medical Sciences.
    Diagnostik av kolorektala polyper: En jämförelse mellan två metoder2010Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 37.
    Ahmedi, Shahin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ali, Sahra
    Örebro University, School of Health and Medical Sciences.
    Anhörigas upplevelser av att leva med  en partner som har Parkinsons sjukdom2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 38.
    Aho, Malin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Holmin Fridell, Petter
    Upplevelser när en make eller maka drabbats av Alzheimers sjukdom2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 39.
    Ahren, Maria
    et al.
    Linkoping Univ, Linkoping, Sweden.
    Selegard, Linnea
    Linkoping Univ, Linkoping, Sweden.
    Klasson, Anna
    Linkoping Univ, Linkoping, Sweden.
    Soderlind, Fredrik
    Linkoping Univ, Linkoping, Sweden.
    Abrikossova, Natalia
    Linkoping Univ, Linkoping, Sweden.
    Skoglund, Caroline
    Linkoping Univ, Linkoping, Sweden.
    Bengtsson, Torbjörn
    Örebro University, School of Health and Medical Sciences. Linkoping Univ, Linkoping, Sweden.
    Engstrom, Maria
    Linkoping Univ, Linkoping, Sweden.
    Kall, Per-Olov
    Linkoping Univ, Linkoping, Sweden.
    Uvdal, Kajsa
    Linkoping Univ, Linkoping, Sweden.
    Synthesis and Characterization of PEGylated Gd2O3 Nanoparticles for MRI Contrast Enhancement2010In: Langmuir, ISSN 0743-7463, E-ISSN 1520-5827, Vol. 26, no 8, p. 5753-5762Article in journal (Refereed)
    Abstract [en]

    Recently, much attention has been given to the development of biofunctionalized nanoparticles with magnetic properties for novel biomedical imaging. Guided, smart, targeting nanoparticulate magnetic resonance imaging (MRI) contrast agents inducing high MRI signal will be valuable tools for future tissue specific imaging and investigation of molecular and cellular events. In this study. We report a new design of functionalized ultrasmall rare earth based nanoparticles to be used as a positive contrast agent in NI RI. The relaxivity is compared to commercially available Gd based chelates. The synthesis, PEGylation, and dialysis of small (3-5 nm) gadolinium oxide (DEG-Gd2O3) nanoparticles are presented. The chemical and physical properties of the nanomaterial were investigated with Fourier transform infrared spectroscopy. X-ray photoelectron spectroscopy, transmission electron microscopy, and dynamic light scattering. Neutrophil activation after exposure to this nanomaterial was studied by means of fluorescence microscopy. The proton relaxation times as a function of dialysis time and functionalization were measured at 1.5 T. A capping procedure introducing stabilizing properties was designed and verified, and the dialysis effects were evaluated. A higher proton relaxivity was obtained for as-synthesized diethylene glycol (DEG)-Gd2O3 nanoparticles compared to commercial Gd-DTPA. A slight decrease of the relaxivity for as-synthesized DEG-Gd2O3 nanoparticles as a function of dialysis time was observed. The results for functionalized nanoparticles showed a considerable relaxivity increase for particles dialyzed extensively with r(1) and r(2) values approximately 4 times the corresponding values for Gd-DTPA. The microscopy study showed that PEGylated nanoparticles do not activate neutrophils in contrast to uncapped Gd2O3. Finally, the nanoparticles are equipped with Rhodamine to show that our PEGylated nanoparticles are available for further coupling chemistry, and thus prepared for targeting purposes. The long term goal is to design a powerful, directed contrast agent for MRI examinations with specific targeting possibilities and with properties inducing local contrast, that is. an extremely high MR signal at the cellular and molecular level.

  • 40. Aita, J. F.
    et al.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences.
    Smith, S.
    Hahn, F.
    White, V.
    Hereditary ataxia and multiple scleros1988Conference paper (Refereed)
  • 41. Aita, J.
    et al.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences.
    Smith, S.
    Cranial CT and olivopontocerebellar atrophy1987Conference paper (Refereed)
  • 42.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Analys och handläggning av äldres multisjuklighet måste samordnas [Analysis and management of comorbidity among the elderly must be coordinated]: med DBU-metod tillämpad vid äldrevårdscentral kan behandling utvärderas [Treatment can be evaluated with the DBU method implemented at community centers for the aged]2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 10, p. 758-765Article in journal (Refereed)
  • 43.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Analysis of multimorbidity in individual elderly nursing home residents: development of a multimorbidity matrix2009In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 49, no 3, p. 413-419Article in journal (Refereed)
    Abstract [en]

    The chronic multimorbidity in individual elderly people is rarely documented in its entirety in present medical records, neither as cross-sectional overview nor as longitudinal time-course of various health problems. This obviously hampers an integrated clinical analysis. This work was aimed at evaluating the chronic multimorbidity in individual elderly patients and developing a method to map, quantify and grade the prevalence of the multimorbidity. An explorative study in 70 nursing home residents (55 women), mean age 85 was performed. Information on health problems was obtained through history, clinical examination and medical records. A 19-item multimorbidity matrix that maps, quantifies and grades the chronic morbidity in individual patients is presented. The 70 residents exhibited 275 different health problems; the top 3 items being neuropsychiatric, cardiovascular and gastrointestinal ones. The residents had a mean of 17 different chronic health problems and were prescribed a mean of 6.6 continuous medications per day. There was a significant correlation between the number of continuous drug prescriptions and both quantitative and graded multimorbidity-scores. The presented multimorbidity matrix provides a useful taxonomic overview over the health situation in individual multimorbid elderly and constitutes the basis for ongoing work to develop and renew the electronic health record into an "interactive health analysis system".

  • 44.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Arbetsmetod2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, p. 45-50Chapter in book (Other academic)
  • 45.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Background2003In: Geriatric care and treatment: a systematic compilation of existing scientific literature / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, p. 23-42Chapter in book (Other academic)
  • 46.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Bakgrund2003In: Evidensbaserad äldrevård: en inventering av det vetenskapliga underlaget / [ed] Gunnar Akner, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2003, p. 25-44Chapter in book (Other academic)
  • 47.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Bedömning och behandling av nutritions- och undernutritionstillstånd inom äldrevården2006In: Nordisk geriatrik, ISSN 1403-2082, no 4, p. 24-34Article in journal (Other academic)
  • 48.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Bedömning och behandling av nutritions- och undernutritionstillstånd inom äldrevården2006Other (Other academic)
  • 49.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Bräckligt åldrande och multisjuklighet drabbar allt fler [Frail aging and multimorbidity affect more and more]: fokus måste flyttas från isolerade sjukdomar till komplexa hälsoproblem : klinisk översikt [Focus must be moved from isolated diseases to complex health problems]2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 44, p. 2707-2711Article in journal (Refereed)
  • 50.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Evidensbaserad behandling behövs inom äldrevården  [Evidence-based treatment is necessary in geriatric health care]: multibehandling av multisjuka äldre ställer stora krav på samordning [Multitreatment of elderly with multiple illness puts great demands on cooperation]2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, no 34, p. 2592-2596Article in journal (Other academic)
1234567 1 - 50 of 2681
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