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  • 1.
    Alshamari, Muhammed
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Norrman, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Geijer, Mats
    Department of Medical Imaging and Physiology, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Jansson, Kjell
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Geijer, Håkan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review2016In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 26, no 6, p. 1766-1774Article in journal (Refereed)
    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.

  • 2.
    Hörer, Tal M.
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Surgery.
    Norgren, Lars
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Intraperitoneal glycerol levels and lactate/pyruvate ratio: early markers of postoperative complications2011In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 46, no 7-8, p. 913-919Article in journal (Refereed)
    Abstract [en]

    Objective: We have previously presented microdialysis findings of early intraperitoneal (ip) metabolic disturbances, mainly an increased lactate/pyruvate (l/p) ratio, in surgical patients developing postoperative complications. The aim of the present study was to investigate ip glycerol and l/p ratio after major surgery with and without complications.

    Material and methods :Sixty patients were followed with microdialysis for 48 h after major abdominal surgery, 44 patients without postoperative complications and 16 patients with major surgical complications. Intraperitoneal and subcutaneous (sc) measurements of glycerol, lactate, pyruvate and glucose were performed, and the l/p ratio was calculated.

    Results: Intraperitoneal glycerol was significantly lower in the complication group compared with the control group (64 vs. 94.6 μM; p = 0.0015), while the ip l/p ratio was significantly higher in the complication group compared with the control group (13.7 vs. 11.1; p = 0.0073).

    Conclusions: In this study, ip glycerol levels were lower and ip l/p ratio was higher in the immediate postoperative period in a group of patients with complications. These results might indicate early ip disturbances in fat and carbohydrate metabolism in patients who later developed symptoms of postoperative major complications.

  • 3.
    Hörer, Tal
    et al.
    Örebro University, School of Health and Medical Sciences.
    Vidlund, Mårten
    Lindell, Peter
    Jansson, Kjell
    A rare case of pacemaker electrode perforation of the heart with intra-abdominal migration2010In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 33, no 8, p. E20-E20Article in journal (Refereed)
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  • 4.
    Skoog, P.
    et al.
    Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University Hospital. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University Hospital. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Norgren, L.
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Örebro University Hospital. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Abdominal Hypertension and Decompression: The Effect on Peritoneal Metabolism in an Experimental Porcine Study2014In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 47, no 4, p. 402-410Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to investigate the abdominal metabolic response and circulatory changes after decompression of intra-abdominal hypertension in a porcine model.

    Methods: This was an experimental study with controls. Three-month-old domestic pigs of both sexes were anesthetized and ventilated. Nine animals had a pneumoperitoneum-induced IAH of 30 mmHg for 6 hours. Twelve animals had the same IAN for 4 hours followed by decompression, and were monitored for another 2 hours. Hemodynamics, including laser Doppler-measured mucosal blood flow, urine output, and arterial blood samples were analyzed every hour along with glucose, glycerol, lactate and pyruvate concentrations, and lactate-pyruvate (l/p) ratio, measured by microdialysis.

    Results: Laser Doppler-measured mucosal blood flow and urine output decreased with the induction of IAH and showed a statistically significant resolution after decompression. Both groups developed distinct metabolic changes intraperitoneally on induction of IAH, including an increased l/p ratio, as signs of organ hypoperfusion. In the decompression group the intraperitoneal l/p ratio normalized during the second decompression hour, indicating partially restored perfusion.

    Conclusion: Decompression after 4 hours of IAH results in an improved intestinal blood flow and a normalized intraperitoneal lip ratio.

  • 5.
    Skoog, Per
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Deparment of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Deparment of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Ågren, Göran
    Deparment of Surgery, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Örebro University Hospital. Deparment of Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Norgren, Lars
    Örebro University, School of Humanities, Education and Social Sciences. Deparment of Surgery, Örebro University Hospital, Örebro, Sweden.
    Intra-Abdominal Metabolism and Blood Flow During Abdominal Hypertension: A Porcine Pilot Study Under Intravenous Anaesthesia2013In: Archives Of Clinical Experimental Surgery, ISSN 2146-8133, Vol. 2, no 3, p. 176-185Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 6.
    Skoog, Per
    et al.
    Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal
    Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University Hospital. Dept Cardiothorac & Vasc Surg, Örebro University Hospital, Örebro, Sweden.
    Agren, Goran
    Dept Surg, Örebro University Hospital, Örebro, Sweden.
    Norgren, Lars
    Dept Surg, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Örebro University Hospital. Dept Surg, Örebro University Hospital, Örebro, Sweden.
    Intra-abdominal Hypertension: An Experimental Study of Early Effects on Intra-abdominal Metabolism2015In: Annals of Vascular Surgery, ISSN 0890-5096, E-ISSN 1615-5947, Vol. 29, no 1, p. 128-137Article in journal (Refereed)
    Abstract [en]

    Background: The main aim of this experimental study was to investigate the early effects of intra-abdominal hypertension (IAH) on intra-abdominal metabolism and intestinal mucosal blood flow to evaluate whether metabolites can serve as markers for organ dysfunction during IAH. Methods: A swine model was used, and the animals were anesthetized and ventilated. Fifteen animals were subjected to IAH of 30 mm Hg for 4 hr by carbon dioxide insufflation. Seven animals served as controls. Hemodynamic data, arterial blood samples, and urine output were analyzed. Intraluminal laser Doppler flowmetry measured intestinal mucosal blood flow. Glucose, glycerol, lactate, and pyruvate concentrations and lactate-to-pyruvate (l/p) ratio were measured intraperitoneally and intramurally in the small intestine and rectum using microdialysis. Results: IAH lowered the abdominal perfusion pressure by 12-18 mm Hg, reduced the intestinal mucosal blood flow by 45-63%, and decreased urine output by 50-80%. In the intervention group, glycerol concentrations increased at all locations, pyruvate concentrations decreased, and the l/p ratio increased intraperitoneally and intramurally in the small intestine. Control animals remained metabolically stable. Glucose and lactate concentrations were only slightly affected or unchanged in both the groups. Conclusions: IAH reduces intestinal blood flow and urinary output and causes early metabolic changes, indicating a discrete shift toward anaerobic metabolism. Intraperitoneal microdialysis may be useful in the early detection of impaired organ dysfunction with metabolic consequences in IAH and abdominal compartment syndrome.

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