| 1. |
- Akerstedt, Anita, et al.
(författare)
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Evaluation of single event multilevel surgery and rehabilitation in children and youth with cerebral palsy - A 2-year follow-up study
- 2010
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Ingår i: DISABILITY AND REHABILITATION. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 32:7, s. 530-539
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Tidskriftsartikel (refereegranskat)abstract
- Method. A prospective single-subject study with AB design and 2-year follow-up, included 11 children between 8 and 18 years old with CP, Gross Motor Function Classification System I-III. Visual analyses were used to present physical function with Physical Cost Index (PCI). Descriptive statistics were used to present number of children with a clinically important change in Gross Motor Function Measure (GMFM), self-reported walking ability, and HRQOL with child health questionnaire (CHQ). Results. PCI showed a trend of lower energy cost during gait in six children and GMFM was unchanged for 10 children and improved for one child. Walking ability was improved in 10 children. Gait distance increased in all 11. Both physical and psychosocial dimensions of CHQ improved in six of nine (two missing data). Expectations of outcomes were fulfilled in seven and partly fulfilled in four. Satisfaction with care was fulfilled in 10 of 11. Conclusion. Self-reported walking ability improved after multilevel surgery and intensive rehabilitation. This result was partly supported by lower energy cost and improved HRQOL. Expectations and satisfaction were fulfilled for the majority of children.
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| 2. |
- Anderson, Mattias, et al.
(författare)
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Limited angular remodelling after in-situ fixation for slipped capital femoral epiphysis
- 2024
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Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn Sweden, most children with slipped capital femoral epiphysis (SCFE) are operated on with a single smooth pin or a short-threaded screw, allowing further growth of the femoral neck. Using the Swedish Pediatric Orthopaedic Quality registry, SPOQ, we investigated whether angular remodelling occurs adjacent to the proximal femoral epiphysis after fixation of SCFE using implants, allowing continued growth of the femoral neck.MethodsDuring 2008-2010 a total national population of 155 children were reported to the SPOQ registry. Following our strict inclusion criteria, radiographs of 51 hips were further assessed. The lateral Head Shaft Angle (HSA), the Notzli 3-point alpha-angle, the anatomic alpha-angle, and the Anterior Offset Ratio (AOR) on the first postoperative radiographs and at follow-up were measured to describe the occurrence of remodelling. Slip severity was categorised as mild, moderate or severe according to postoperative HSA.ResultsMean and SD values for the change in HSA were 3,7 degrees (5,0 degrees), for 3-point alpha-angle 6,8 degrees (8,9 degrees), and anatomic alpha-angle 13,0 degrees (16,3 degrees). The overall increase in AOR was 0,038 (0.069). There were no significant differences between the slip severity groups.ConclusionsWe found limited angular remodelling after in situ fixation with smooth pins or short threaded screws for SCFE. The angular remodelling and the reduction of the CAM deformity was less than previously described after fixation of SCFE with similar implants. Results about the same magnitude with non-growth sparing techniques suggest that factors other than longitudinal growth of the femoral neck are important for angular remodelling.
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| 3. |
- Johansson, Torsten, et al.
(författare)
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Heterotopic bone formation following internal fixation or arthroplasty for displaced femoral neck fractures: a prospective randomized study
- 2001
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Ingår i: International Orthopaedics. - : Springer Science and Business Media LLC. - 0341-2695 .- 1432-5195. ; 25:4, s. 223-225
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Tidskriftsartikel (refereegranskat)abstract
- One hundred hips in 99 patients of 75 years or older, with a displaced femoral neck fracture, were studied for heterotopic ossification (HO). The patients were randomized to either internal fixation or total hip arthroplasty (THA). In the THA group HO was found in 32 of 45 hips compared with 1 of 39 in the internal fixation group (P<0.0012). The frequency of HO after THA corresponds well with findings in other studies on patients receiving THA for osteoarthrosis. In cervical fractures the surgical procedure of total hip replacement seems to be a prerequisite for HO, indicating that the procedure itself is more important than the patient's age and the diagnosis. Severe symptoms due to HO were found in only one patient. HO following THA for a femoral neck fracture is of little clinical importance and prophylaxis is unnecessary.
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| 4. |
- Larnert, Per, et al.
(författare)
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Hip displacement in relation to age and gross motor function in children with cerebral palsy
- 2014
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Ingår i: Journal of Children's Orthopaedics. - : SAGE Publications. - 1863-2521 .- 1863-2548. ; 8:2, s. 129-134
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Hip dislocation in cerebral palsy (CP) is a serious complication. By radiographic screening and prophylactic surgery of children at risk most dislocations can be prevented. CPUP, the Swedish CP registry and follow-up program, includes annual radiographic examinations of children at Gross Motor Function Classification System (GMFCS) levels III-V. Data from CPUP were analysed to assess the risk of hip displacement in relation to GMFCS levels and age. Methods: All children at GMFCS levels III-V (N = 353) whose first radiographic screening occurred before 3 years of age were followed between the ages 2-7 years. Migration percentages (MPs) were recorded annually (1,664 pelvic radiographs) and analysed using discrete time survival analysis. Results: The risk of hip displacement between 2 years and 7 years of age was significantly (p < 0.05) higher for children at GMFCS level V during the entire study period. The risk was highest at 2-3 years of age and decreased significantly (p < 0.001) with each year of age (OR = 0.71, 95 % CI 0.60-0.83). The cumulative risk at age 7 years for those at GMFCS V for MP ≥ 40 % was 47 % (95 % CI 37-58). The corresponding risk at GMFCS IV was 24 % (16-34) and at GMFCS III 23 % (12-42). Conclusions: Children at GMFCS V have a significantly higher risk of hip displacement compared with children at GMFCS III-IV. The risk is highest at 2-3 years of age. The results support a surveillance program including radiographic hip examinations as soon as the diagnosis of severe CP is suspected.
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| 5. |
- Lindqvist, Kent, 1948-, et al.
(författare)
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Evaluation of a child safety program based on the WHO Safe Community model
- 2002
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Ingår i: Injury Prevention. - : BMJ. - 1353-8047 .- 1475-5785. ; 8:1, s. 23-26
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries.Study design: A population based quasiexperimental design was used. Cross sectional pre-implementation and post-implementation data were collected in intervention (Motala municipality) and control (Mjölby municipality) areas, both in Östergötland county, Sweden.Results: The total relative risk of child injury in the intervention community decreased more (odds ratio 0.74; 95% confidence interval (CI) 0.68 to 0.81) than in a control community exposed only to national level injury prevention programs (0.93; 95% CI 0.82 to 1.05). The relative risk of moderately (abbreviated injury scale (AIS) 2) severe injury in the study area was reduced to almost a half (odds ratio 0.49; 95% CI 0.41 to 0.57), whereas the risk of minor (AIS 1) injuries decreased only slightly (odds ratio 0.89; 95% CI 0.80 to 0.99). The risk of severe or fatal (AIS 3–6) injuries remained constant.Conclusions: After introduction of an injury prevention program based on the WHO Safe Community model, the relative risk for child injury in the intervention community decreased significantly more than in a control community exposed only to national injury prevention programs.
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| 6. |
- Liu, Yawei, 1967-, et al.
(författare)
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Fibroblast proliferation due to exposure to a platelet concentrate in vitro is pH dependent
- 2002
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Ingår i: Wound Repair and Regeneration. - 1067-1927 .- 1524-475X. ; 10:5, s. 336-340
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Tidskriftsartikel (refereegranskat)abstract
- The influence of platelet-rich plasma lysates on fibroblast proliferation was studied in culture. Cells were exposed to platelet lysates that had been preincubated at different pHs (5.0, 7.1, and 7.6). Proliferation was evaluated with the MTT assay and incorporation of [3H]thymidine into macromolecules, while type I collagen production was assayed by Western blotting. Enzyme-linked immunosorbent assays were used to determine platelet-derived growth factor and transforming growth factor-β concentrations. Platelets preincubated in an acidic environment (pH 5.0) induced the highest degree of fibroblast proliferation, and the concentration of platelet-derived growth factor in the different treated lysates was the highest at that particular pH. The concentration of transforming growth factor-β, however, was lower after incubation at pH 5.0 than at either pH 7.1 or 7.6. These findings may be relevant to normal wound healing in vivo and useful in the treatment of wounds and delayed healing processes.
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| 7. |
- Liu, Yawei, 1967-, et al.
(författare)
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Time- and pH-dependent release of PDGF and TGF-ß from platelets in vitro
- 2003
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Ingår i: Platelets. - : Informa UK Limited. - 0953-7104 .- 1369-1635. ; 14:4, s. 233-237
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Tidskriftsartikel (refereegranskat)abstract
- We studied the spontaneous and thrombin-induced activation of platelets and their release of platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) at different pH values. Platelet activation was assayed with anti-bodies against P-selectin and performed in serum-free media. The release of PDGF and TGF-β was determined by ELISA after 15 min and 12 h. There was no activation at pH 5.0, while a time-dependent release of growth factors occurred at neutral and alkaline pH. The results suggest that release of growth factors is not only dependent on platelet activation but also on incubation time and pH. Although the used serum-free experimental situation is different from normal conditions for platelets in vivo, the findings of a late release of growth factors may, nevertheless, be relevant to wound healing.
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| 8. |
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| 9. |
- Risto, Anton, et al.
(författare)
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Long-term Follow-up, Patient Satisfaction, and Quality of Life for Patients With Kocks Continent Ileostomy
- 2021
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Ingår i: Diseases of the Colon & Rectum. - : LIPPINCOTT WILLIAMS & WILKINS. - 0012-3706 .- 1530-0358. ; 64:4, s. 420-428
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Continent ileostomy is a solution for patients after proctocolectomy. OBJECTIVE: The aim of this study was to assess the long-term complications and failure rate alongside patient satisfaction, function, and quality of life for patients with a continent ileostomy. DESIGN: This was a retrospective, descriptive cross-sectional study. SETTINGS: All patients were operated in 1 center between 1980 and 2016. PATIENTS: A total of 85 patients received a de novo continent ileostomy in our institution. Sixty-nine patients (80%) had ulcerative colitis, 12 (14%) had Crohns disease, 2 had indeterminate colitis, and 1 each had familial adenomatous polyposis and anal atresia. MAIN OUTCOME MEASURES: Medical charts were reviewed for reoperations and pouchitis. The 36-Item Short Form, Short Health Scale, and a local continent ileostomy questionnaire were used to assess quality of life, function, and satisfaction. RESULTS: After a median follow-up of 24 years, 67 patients (79%) underwent a total of 237 reoperations, of which 15 were conversions to end ileostomies, that is, failures. Fifty patients (59%) underwent repeat laparotomies, excluding loop ileostomy closures. Nipple detachment was the most common cause for repeat laparotomy, and fistulation was the most common cause for pouch removal. IPAA before continent ileostomy was associated with an increased risk for failure. Crohns disease was not associated with an increased risk for reoperation or failure. Forty-three patients (84%) reported that they were satisfied. Seventy patients were available for questionnaires, and 50 patients (71%) answered. There was no difference in the 36-Item Short Form between the continent ileostomy population and an age-matched control population. LIMITATIONS: The retrospective, single-center design of the study alongside <100% response rate are to be considered limitations. CONCLUSIONS: Despite large numbers of complications, patients are generally satisfied with their continent ileostomies, and their quality of life is comparable to the general population. See Video Abstract at http://links.lww.com/DCR/B444.
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| 10. |
- Risto, Anton, 1984-
(författare)
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Reconstruction after Colectomy for Inflammatory Bowel Disease
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- After colectomy there are four options available. The least complicated and most common is to leave the end ileostomy and not go for any reconstructive surgery. Then there is the ileal pouch anal anastomosis (IPAA) in which the rectum is removed, but the anal canal and a small rectal “cuff” is preserved. The pouch is created from the distal ileum and anastomosed to the rectal cuff. In the ileorectal anastomosis (IRA) the rectum is spared, and the distal ileum is anastomosed to the top of the rectum. In the continent ileostomy (CI), also referred to as the Kock pouch, the fecal flow is let out through the abdominal wall, but a pouch and a nipple valve mechanism is created making the stoma continent which needs to be manually emptied. This thesis aims to investigate function, quality of life, satisfaction, complications, and aspects associated with the chance of having reconstructive surgery after colectomy for inflammatory bowel disease (IBD), i.e. ulcerative colitis (UC) or Crohn’s disease (CD).The first two papers focus on the continent ileostomy, the most uncommon of the options after colectomy. In Paper 1 all patients who have received a CI at our center were identified and medical charts were reviewed for complications and CI patency. Function and quality of life were evaluated with the 36-item short form survey (SF-36), short health scale (SHS) and a local CI specific questionnaire for function and satisfaction. In Paper II, the Swedish national patient register (NPR) was used to identify all patients with an IBD diagnosis who had received a CI and data on diagnosis, demographics, reoperations, and excisions were obtained from the register. Paper III describes an ongoing prospective non-randomized, multi-center, open-label, controlled trial between IRA and IPAA in UC patients subjected to colectomy. The primary endpoint is satisfaction but Quality of Life (QoL), sexual function, bowel function and complications are also evaluated. In Paper IV, we investigated if the chance of getting reconstructed after colectomy was dependent on the IPAA volumes at the colectomy hospital using data from the national patient register. The hospitals were arranged in to four categories based on the average annual number of IPAA procedures: (0, 1-3, 4-7, >7 procedures per year). In Paper I we found that 59 % of CI patients needed repeat laparotomy after a median follow up of 24 years and nipple detachment was the most common cause of repeat laparotomy. Fifteen patients (18 %) had their CIs converted to end ileostomies and the most common cause for this was fistulas. Eighty-four per cent of CI patients reported satisfaction with their reconstruction. The national study in Paper II identified 727 IBD patients with CI and the median follow-up time was 27 years. During follow-up, 1484 reoperations were performed on 536 patients (74 %). Twenty-six per cent of the patients did not have any reoperations, 24 % had one reoperation, 20 % had two reoperations and the remaining 30 % had between three and 15 reoperations each. The CIs were identified to have been removed in 77 (11 %) patients. In Paper III we have so far included 47 patients in the intervention arms out of which 35 (74 %) have chosen IRA and 12 patients (26 %) have chosen IPAA. Another 44 (40 % of the whole group) patients have so far received an IPAA but were deemed non-eligible for both IRA and IPAA and were hence not eligible for the intervention arms. So far 18 patients (17 % of the whole group) have chosen an ileostomy. In Paper IV we first identified 4112 UC patients subjected to colectomy between 1997 and 2020. Out of these 4112 patients, 1932 (47 %) went through some kind of reconstruction, 964 (50 %) IRA, 927 (48 %) IPAA and 41 (2 %) CI. The proportion having restorative surgery was larger for patients subjected to colectomy at a high IPAA volume center (62 % vs 38 %) and the chance of getting an IPAA increased with each IPAA volume category (Hazard ratios (HR) were: 1; 1.49 95 % CI (1.25-1.78) ; 1.79 95 % CI (1.49-2.15) and 2.11 95 % CI (1.70-2.62) respectively)The IPAA volumes did not affect the chance of receiving an IRA or the risk of failure of reconstruction.
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