| 1. |
- Gudbjartsson, T, et al.
(författare)
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Congenital diaphragmatic hernia: Improved surgical results should influence abortion decision making
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 97:1, s. 71-76
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To compare surgical results for congenital diaphragmatic hernia (CDH) in two Scandinavian university hospitals and to evaluate the effects of abortions on the clinical profile of CDH in Iceland. Methods: A retrospective study including all CDH-cases in Iceland 1983-2002 and children referred to Lund University Hospital 1993-2002. Aborted fetuses with CDH from a nation-wide Icelandic abort-registry were also included. Results: In Iceland, 19 out of 23 children with CDH were diagnosed < 24 hours from delivery, one with associated anomalies. Eight fetuses were diagnosed prenatally and seven of them aborted, three having isolated CDH at autopsy. In Iceland, 15 of 18 children operated on survived surgery (83% operative survival). In Lund 28 children were treated with surgery, 23 of them diagnosed early after birth or prenatally. Four children did not survive surgery (86% operative survival) and 9 (31%) had associated anomalies. All the discharged children treated in Iceland and Lund are alive, 3-22 years postoperatively. Conclusion: CDH is a serious anomaly where morbidity and mortality is directly related to other associated anomalies and pulmonary hypoplasia. However, majority of CDH patients do not have other associated anomalies. In spite of improved surgical results (operative mortality < 20%), a large proportion of pregnancies complicated with CDH are terminated. We conclude that the improved survival rate after corrective surgery must be emphasized when giving information to parents regarding abortion of fetuses with a prenatally diagnosed CDH.
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| 2. |
- Gunnarsdottir, Anna, et al.
(författare)
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48-hour wireless oesophageal pH-monitoring in children: are two days better than one?
- 2007
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 17:6, s. 378-381
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Use of a catheter-free, radio telemetric, oesophageal pH-monitoring system in paediatric clinical practice allows patients to follow a more normal physiological pattern of activities and causes less discomfort. At our institution, placement of the capsule is done under general anaesthesia, which restricts the child's activity during the first day. The aim of this study was to determine whether oesophageal pH-measurements should be performed over 48 hours or whether 24-hour measurement provides sufficient and reliable results. CHILDREN AND METHODS: The study included 24 consecutive children with symptomatic gastro-oesophageal reflux problems who had undergone upper gastrointestinal endoscopies under general anaesthesia. The radio-transmitting Bravo capsule was introduced transorally and placed above the diaphragm at a width of two vertebral bodies. Oesophageal acid exposure was monitored via a portable receiver for 48 hours. The children's symptoms during measurements were registered. Wilcoxon signed rank test for paired samples was used after power analysis. RESULTS: The capsule was successfully attached to the oesophageal mucosa in all cases with minor technical problems in only one patient. The 48-hour pH-monitoring was completed in 23 patients. The median percentage time with an oesophageal pH of less than 4 was 5.4 +/- 6.8 for the first 24 hours and 5.8 +/- 7.4 for the 48-hour measurement. The DeMeester score was 20.5 +/- 23.7 and 22.2 +/- 25.7, respectively. CONCLUSIONS: Ambulatory pH-monitoring using the wireless system is feasible and safe. It was well-tolerated by the children. There was no statistical difference between the pH-measurements or DeMeester scores during the first 24 hours compared with the 48-hour measurements. Individual variations were noted but had no clinical significance except in two patients. Our results support the use of pH-measurement for a period of 24 hours only.
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| 3. |
- Gunnarsdottir, Anna, et al.
(författare)
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CART-peptide immunoreactivity in enteric nerves in patients with Hirschsprung's disease
- 2007
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 17:3, s. 184-189
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Cocaine- and amphetamine-regulated transcript (CART)-peptide is found in the brain and participates in the control of feeding behavior. It is also expressed in the peripheral nervous system and is suggested to have neuromodulatory and/or neurotrophic effects in rat intestine. The aims of this study were to investigate the presence of CART-peptide in the normal ganglionic as well as aganglionic intestine from patients with Hirschsprung's disease and the pepticle's possible coexistence with other neurotransmitters. Methods: Intestinal specimens from nine patients with Hirschsprung's disease were examined using immunohistochemistry. A double immunostaining technique was used in order to elucidate the presence of CART-peptide in NOS and VIP-containing enteric neurons. Results: in ganglionic intestine, CART-peptide was found in numerous nerve fibers, predominantly within the smooth muscle layers and in myenteric nerve cell bodies. A high degree of co-localization of CART with NOS and VIP was seen. Only very few CART immunoreactive nerve fibers and no nerve cell bodies were found in the aganglionic intestine. Conclusions: This is the first report on the presence of CART-peptide in the human intestine. In the ganglionic intestine CART was detected mainly in myenteric neurons, while only very few CART-IR nerve fibers were found in the aganglionic intestine. This, together with the coexistence of CART with NOS and VIP, indicates an intrinsic origin of the CART-containing neurons and suggests that CART may influence NO and VIP-induced effects.
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| 4. |
- Gunnarsdottir, Anna Gudlaug, et al.
(författare)
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Snemmkominn árangur opinna ósæðarlokuskipta við ósæðarlokuþrengslum hjá konum á Íslandi
- 2019
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Ingår i: Laeknabladid. - : Laeknabladid/The Icelandic Medical Journal. - 0023-7213 .- 1670-4959. ; 105:5, s. 215-221
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Aortic valve replacement (AVR) for aortic stenosis (AS) is the second most common open-heart procedure performed in Iceland. The aim of this study was to analyze the early outcome of AVR among females in Iceland.Materials and methods: This was a retrospective study including 428 patients who underwent surgical AVR due to AS in Iceland from 2002-2013. Information was gathered from medical records, including pre-and postoperative results of echocardiography and complications. Overall survival was estimated (Kaplan-Meier) and logistic regression used to identify predictors of operative mortality. The median follow-up time was 8.8 years (0-16.5 years).Results: Of the 428 patients, 151 were female (35.3%), that were on average 2 years older than men (72.6 ± 9.4 vs. 70.4 ± 9.8 yrs., p=0.020). Preoperative symptoms were similar, but women had significantly higher EurosSCORE II than men (5.2 ± 8.8 vs. 3.2 ± 4.6, p=0.002). Maximal pressure-gradient across the aortic valve was higher for women (74.4 ± 29.3 mmHg vs. 68.0 ± 23.4 mmHg, p=0,013) but postoperative complications, operative mortality (8.6% vs. 4.0%, p=0.068) and 5-year survival (78.6% vs. 83.1%, p=0.245) were comparable for women and men. Logistic regression analysis showed that female gender was not an independent predictor of 30-day mortality (OR 1.54, 95% CI 0.63-3.77).Conclusions: Females constitute one third of patients that undergo AVR for AS in Iceland. At the time of surgery females are two years older than men and appear to have a more significant aortic stenosis at the time of surgery. However, complication rates, operative mortality and long-term survival were comparable for both genders.
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| 5. |
- Gunnarsdottir, Anna
(författare)
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Hirschsprung´s Disease & Gastroesophageal Reflux. Aspects on Two Gastrointestinal Motility Disorders in Childhood
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gastrointestinal motility disorders are common in childhood and in this thesis we look at two of them, i.e. Hirschsprung´s Disease (HD) and gastroesophageal reflux disease (GERD) in five different studies. HD is a congenital disease characterized by an abscence of ganglion cells in myenteric and submucous ganglia, most commonly in the distal part of the large bowel. In Paper I, we have studied the CART peptide (cocaine-and amphetamine regulated transcript), in human bowel prepararions and were able to show for the first time that the CART peptide is localized in normal human bowel. It is primarily expressed in the myenteric ganglia with high colocalization with the neurotransmitters VIP (vasoactive intestinal peptide) and NO (nitric oxide) indicating a functional role in the intestinal wall. CART-IR (immunoreactive) neurons were not found in the aganglionic part of the bowel indicating an intrinsic origin of the peptide. In Paper II the quality of life (QoL) of adults operated on for HD in their childhood was studied. For that, two validated questionnaires were used, SF-36 health survey and GIQLI (gastrointestinal quality of life index). We found that the adults operated on for HD in childhood, had generally normal QoL. The women, however, had worse general and mental health when compared to the normal population. It was also noted that the longer the aganglionic segment was, the more affected the QoL of the patient. In Paper III we compared the outcome, after two year follow-up, of the Duhamel pull-through operation for rectosigmoid HD and the TERPT (transanal endorectal pull-through) method which we introduced in 2005 in Lund. The study showed that patients operated on with the TERPT-method recovered significantly faster and required fewer interventions during follow-up time, without compromising the functional results. Also the cosmetic results were far better for TERPT group. Our result support the use of the TERPT method in favor of the Duhamel pull-through for rectosigmoid HD. PH-monitoring is valuable in the diagnosis of GERD and the gold standard has been catheter-based monitoring. In Paper IV-V we have shown that a wireless esophageal pH-monitoring system is feasible for use and well-tolerated by children, and is to be recommended. Our result found no clear advantage of esophageal pH-monitoring for 48 hours compared to 24 hours in the diagnosis of GERD in children. It was also shown that it is the combination of symptoms, endoscopic findings, pH-monitoring results and pathological examination that gives the most reliable diagnosis of GERD in children.
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| 6. |
- Gunnarsdottir, Anna, et al.
(författare)
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Laparoscopic aided cholecystostomy as a treatment of inspissated bile syndrome.
- 2008
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Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 1531-5037 .- 0022-3468. ; 43:4, s. 33-35
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Tidskriftsartikel (refereegranskat)abstract
- We report a case of a newborn girl with inspissated bile syndrome (IBS) that did not respond to treatment with oral ursodeoxycholic acid (Ursofalk). A solution was found using laparoscopic aided cholecystostomy with an indwelling catheter for local Ursofalk flushing in the gallbladder and the choledochus. This is the first report of a laparoscopic aided management of IBS without cholecystectomy or exploration of the bile ducts. This minimal invasive approach showed a clear advantage for the patient. There were no complications. The method is recommended in the treatment of IBS.
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| 7. |
- Gunnarsdottir, Anna, et al.
(författare)
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Meðfædd vélindalokun á Íslandi 1963-2002
- 2004
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Ingår i: Laeknabladid. - 0023-7213. ; 90:9, s. 629-633
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Oesophageal atresia is an congenital anomali with incidence of 1/3000-1/4500 live births. The results of reconstructive surgery has improved greatly, to 80-92% survival reported in the last two decades. The aim of this study was to determine the incidence of oesophageal atresia in Iceland and to evaluate the results of operations at the Department of Pediatric surgery at The Children's Hospital, Landspítal inn - University Hospital in Iceland. Material and methods: This retrospective study included all children diagnosed with oesophageal atresia in Iceland between 1963 and 2002. Information was gathered from hospital records, including birth-weight, gestational age, the type of atresia and the presence of other congenital anomalies. The results of operation were determined including post operative complications. Information on life births in Iceland for the same period was gathered from the Icelandic National Register. Results: Thirtyseven children were diagnosed with oesophageal atresia in these 40 years. The average birth-weight was 2626g, including 14 children (38%) with low birth-weight (<2500g). Fifteen children (41%) were prematurely born (<38 weeks). Thirtyfour children (92%) had the most common type of oesophageal atresia with proximal blind loop and distal tracheooesophageal fistula. Thirtyfour children were operated on, including one in Denmark. Nine children died within 60 days after surgery. The most common cause of death was lung inflammation (n=7, 78%). The survival after surgery in Iceland was 73% in the study period. Other congenital defects were common in this patient group with congenital heart defects as the most common ones (n=12, 32%). The incidence decresead in the study period from 1/3737 in the first ten years to 1/10639 in the last decade, this did not reach statistical signifiquance. Conclusion: It is interesting to see this decrease in incidence in the study period and this is the lowest incidence known to us. The survival has improved from previous study but is however still lower compared to our neighbouring countries. Other congenital anomalies are common in this patient group.
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| 8. |
- Gunnarsdottir, Anna, et al.
(författare)
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Quality of Life in Adults Operated On for Hirschsprung Disease in Childhood.
- 2010
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - Jpgn. - 1536-4801. ; 51, s. 160-166
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:: The aim of this study is to explore the long-term quality of life (QoL) in adults after surgery for Hirschsprung disease in childhood. PATIENTS AND METHODS:: Altogether 51 patients were operated for HD at our center during the period 1969 to 1989. In 2007, the validated instruments for assessing QoL, the SF-36 health survey and the Gastrointestinal Quality of Life Index (GIQLI), were sent to the 47 patients still alive at the time of the study. A retrospective review of the patient records was also done. RESULTS:: Forty-two patients returned both questionnaires (89% response rate) at the median age of 28.5 (range 18-45) years. The median clinical follow-up time was 5.7 years (range 5 months-23 years). At the last clinical control, 4 (9%) patients had a terminal enterostomy, 12 (29%) had soiling, 5 (12%) had constipation, and 2 (5%) experienced recurrent enterocolitis. In contrast to males, the subscores for females were lower for general health and mental health than for an age- and sex-matched general population (P < 0.05). Patients having aganglionosis to the right colon had lower GIQLI scores than those with aganglionosis to the left colon (P < 0.05). In multivariate linear regression analysis, female sex was the only factor associated with lower GIQLI score (P < 0.05). CONCLUSIONS:: The long-term QoL of adults operated for Hirschsprung disease in their youth is satisfactory. Female scores were lower for general and mental health, compared with the matched control group. The study indicates that the longer the aganglionic segment, the greater its impact on QoL in later life.
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| 9. |
- Gunnarsdottir, Anna, et al.
(författare)
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Skurðaðgerðir við launeista á Barnaspítala Hringsins 1970-1993
- 2003
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Ingår i: Laeknabladid. - 0023-7213. ; 89:2, s. 119-123
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Cryptorchidism is a common congenital genito-urological anomali in males with increased risk of infertility and testicular cancer. In this retrospective study the results of operations for undescended testis at Landspitalinn University Hospital were reviewed with special emphasis on patients diagnosed with testicular cancer later in life. Material and methods: The study includes 593 males with undescended testis who were operated on between 1970 and 1993. Information was gathered from hospital records, including birth-weight, age at diagnosis and operation, localization of the testes and complications to surgery. Information on patients diagnosed with testicular cancer was aquired from the Icelandic Cancer Registry. Results: The average birth-weight was 3461 g, including 58 boys (10%) with low birth-weight (
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| 10. |
- Gunnarsdottir, Anna, et al.
(författare)
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Transanal Endorectal vs. Duhamel Pull-Through for Hirschsprung's Disease.
- 2010
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; Mar 4, s. 242-246
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The aim of this study was to test the hypothesis that the early functional outcome for patients with rectosigmoid Hirschsprung's disease (HD) is comparable for the Duhamel pull-through procedure and the transanal endorectal pull-through (TERPT) procedure, with less discomfort for the patient postoperatively after the TERPT technique. MATERIAL AND METHODS: Eleven patients operated on with the TERPT technique (T Group) were prospectively registered and compared retrospectively with 18 patients operated on with the Duhamel pull-through (D Group). Data recorded included patient demographics, operative treatment, complications, hospital stay and bowel functions. The follow-up time was limited to 24 months. RESULTS: The T Group started oral feeding sooner, their bowel movements started sooner and they had less need for analgesia postoperatively and a significantly shorter hospital stay. 71% of the patients in the D Group needed re-intervention compared to only 18% of the T Group. Enterocolitis was seen in two patients in both groups. At the last clinical control ten patients had constipation (59%) and three had soiling (18%) in the D Group. Three patients in the T Group had constipation (27%) and one had soiling (9%). CONCLUSION: Our results support the use of the TERPT method rather than the Duhamel pull-through for rectosigmoid HD.
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