| 1. |
- Axelsson, Kristian F, 1973, et al.
(författare)
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Analysis of Comorbidities, Clinical Outcomes, and Parathyroidectomy in Adults With Primary Hyperparathyroidism
- 2022
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Ingår i: Jama Network Open. - : American Medical Association (AMA). - 2574-3805. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Patients with primary hyperparathyroidism (pHPT) appear to have an increased risk of fractures and other comorbidities, such as cardiovascular disease, although results from previous studies have been inconsistent. Evidence of the association of parathyroidectomy (PTX) with these outcomes is also limited because of the lack of large well-controlled trials. OBJECTIVE To investigate whether untreated pHPT was associated with an increased risk of incident fractures and cardiovascular events (CVEs) and whether PTX was associated with a reduced risk of these outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all patients who were diagnosed with pHPT at hospitals in Sweden between July 1, 2006, and December 31, 2017. Each patient was matched with 10 control individuals from the general population by sex, birth year, and county of residence. The patients were followed up until December 31, 2017. Data analyses were performed from October 2021 to April 2022. MAIN OUTCOMES AND MEASURES The primary outcomes were fractures, CVEs, and death. Cumulative incidence of events was estimated using the 1-minus Kaplan-Meier estimator of corresponding survival function. Cox proportional hazards regression models were used to calculate hazard ratios (HRs). RESULTS A total of 16 374 patients with pHPT were identified (mean [SD] age, 67.5 [12.9] years; 12 806 women [78.2%]), with 163 740 control individuals. The follow-up time was 42 310 person-years for the pH PT group and 803 522 person-years for the control group. Compared with the control group, the pH PT group had a higher risk of any fracture (unadjusted HR, 1.39; 95% CI, 1.31-1.48), hip fracture (unadjusted HR, 1.51; 95% CI, 1.35-1.70), CVEs (unadjusted HR, 1.45; 95% CI, 1.34-1.57), and death (unadjusted HR, 1.72; 95% CI, 1.65-1.80). In a time-dependent Poisson regression model, PTX was associated with a reduced risk of any fracture (HR, 0.83; 95% CI, 0.75-0.93), hip fracture (HR, 0.78; 95% CI, 0.61-0.98), CVEs (HR, 0.84; 95% CI, 0.73-0.97), and death (HR, 0.59; 95% CI, 0.53-0.65). CONCLUSIONS AND RELEVANCE Results of this study suggest that pHPT is associated with increased risk of fractures, CVEs, and death, highlighting the importance of identifying patients with this condition to prevent serious unfavorable outcomes. The reduced risk of these outcomes associated with PTX suggests a clinical benefit of surgery.
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| 2. |
- Duraj, Frans, et al.
(författare)
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Tarmtransplantation : Första svenska tunntarmstransplantationen till en vuxen patient med pseudoobstruktion
- 1998
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 95:28-29, s. 3172-3176
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Tidskriftsartikel (refereegranskat)abstract
- Recent advances, first and foremost the development of new immunosuppressive agents, have markedly improved the outcome of intestinal transplantation, which is a treatment option for patients with serious intestinal diseases who have become dependent on total parenteral nutrition. The first small bowel transplantation in Sweden was performed at Huddinge Hospital in 1997, in the adult patient with intestinal pseudo-obstruction. The article reports the course of this patient and an update of international progress in intestinal transplantation.
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| 3. |
- Esbjörnsson, Anna-Clara, et al.
(författare)
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Epidemiology of clubfoot in Sweden from 2016 to 2019 : A national register study
- 2021
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study aimed to estimate the birth prevalence of children born with isolated or non-isolated clubfoot in Sweden using a national clubfoot register. Secondarily we aimed to describe the clubfoot population with respect to sex, laterality, severity of deformity, comorbidity and geographic location.METHODS: A national register, the Swedish Pediatric Orthopedic Quality register, was used to extract data on newborn children with clubfoot. To calculate the birth prevalence of children with isolated or non-isolated clubfoot between 1st of January 2016 and 31st of December 2019, we used official reports of the total number of Swedish live births from the Swedish Board of Statistics. The Pirani score and predefined signs of atypical clubfoot were used to classify clubfoot severity at birth.RESULTS: In total 612 children with clubfoot were identified. Of these, 564 were children with isolated clubfoot, generating a birth prevalence of 1.24/1000 live births (95% confidence interval 1.15-1.35). About 8% were children with non-isolated clubfoot, increasing the birth prevalence to 1.35/1000 live births (95% confidence interval 1.25-1.46). Of the children with isolated clubfoot, 74% were boys and 47% had bilateral involvement. The children with non-isolated clubfoot had more severe foot deformities at birth and a greater proportion of clubfeet with atypical signs compared with children with isolated clubfoot.CONCLUSION: We have established the birth prevalence of children born with isolated or non-isolated clubfoot in Sweden based on data from a national register. Moreover, we have estimated the number of children born with atypical clubfeet in instances of both isolated and non-isolated clubfoot. These numbers may serve as a baseline for expected birth prevalence when planning clubfoot treatment and when evaluating time trends of children born with clubfoot.
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| 4. |
- Olsson, Lennart, et al.
(författare)
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Sverige kan leda en revolution i jordbruket
- 2019
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Ingår i: Svenska Dagbladet, SvD Opinion. - 1101-2412.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Sverige kan bli ledande i en radikal omställning av framtidens matproduktion. Genom forskning och utveckling av perenna livsmedelsgrödor kan vi aktivt främja en perenn revolution i jordbruket. Perenna grödor återkommer år efter år utan att behöva sås på nytt, skriver en rad forskare.
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| 5. |
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| 6. |
- Wallander, Henrik, et al.
(författare)
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Incidence of congenital clubfoot in Sweden
- 2006
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 77:6, s. 847-852
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Idiopathic clubfoot is one of the most common congenital orthopedic problems. Nationwide studies of the incidence are scarce. We performed a prospective multicenter study in order to assess the cumulative incidence in Sweden over 2 consecutive years. PATIENTS AND METHODS: 44 clinics identified as treating clubfoot reported new cases prospectively. The medical records of 280 children with clubfoot born during 1995- 1996 were collected and analyzed with special reference to gender, regional distribution and seasonal variation. RESULTS: The average cumulative incidence of clubfoot during the study period was 1.4/10(3) (95% CI 1.2- 1.6). Three-quarters of the cases were boys. In half of the cases both feet were affected. There was significant regional heterogeneity, but no seasonal variation in occurrence of clubfoot. INTERPRETATION: The cumulative incidence was higher than in earlier Scandinavian studies. Gender distribution and laterality were similar to those in previous reports. We found significant regional differences in incidence, but the cause of this observation must be investigated in greater depth.
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| 7. |
- Wallander, Henrik, et al.
(författare)
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Low prevalence of osteoarthritis in patients with congenital clubfoot at more than 60 years' follow-up
- 2012
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Ingår i: Journal of Bone and Joint Surgery. - 0301-620X .- 2044-5377. ; 94:11, s. 1522-1528
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Tidskriftsartikel (refereegranskat)abstract
- We investigated 60 patients (89 feet) with a mean age of 64 years (61 to 67) treated for congenital clubfoot deformity, using standardised weight-bearing radiographs of both feet and ankles together with a functional evaluation. Talocalcaneal and talonavicular relationships were measured and the degree of osteo-arthritic change in the ankle and talonavicular joints was assessed. The functional results were evaluated using a modified Laaveg-Ponseti score. The talocalcaneal (TC) angles in the clubfeet were significantly lower in both anteroposterior (AP) and lateral projections than in the unaffected feet (p < 0.001 for both views). There was significant medial subluxation of the navicular in the clubfeet compared with the unaffected feet (p < 0.001). Severe osteoarthritis in the ankle joint was seen in seven feet (8%) and in the talonavicular joint in 11 feet (12%). The functional result was excellent or good (≥ 80 points) in 29 patients (48%), and fair or poor (< 80 points) in 31 patients (52%). Patients who had undergone few (0 to 1) surgical procedures had better functional outcomes than those who had undergone two or more procedures (p < 0.001). There was a significant correlation between the functional result and the degree of medial subluxation of the navicular (p < 0.001, r2 = 0.164), the talocalcaneal angle on AP projection (p < 0.02, r2 = 0.025) and extent of osteoarthritis in the ankle joint (p < 0.001).We conclude that poor functional outcome in patients with congenital clubfoot occurs more frequently in those with medial displacement of the navicular, osteoarthritis of the talonavicular and ankle joints, and a low talocalcaneal angle on the AP projection, and in patients who have undergone two or more surgical procedures. However, the ankle joint in these patients appeared relatively resistant to the development of osteoarthritis.
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| 8. |
- Wallander, Henrik M, 1954-
(författare)
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Congenital clubfoot : Aspects on epidemiology, residual deformity and patient reported outcome
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis on congenital clubfoot was to estimate the incidence with a national perspective, analyse residual deformities and their management, and evaluate patient reported long-term quality of life and foot function. Paper I was a prospective, nationwide sampling of 280 children with congenital clubfoot during 1995-96. The average incidence was 1.4‰. There was regional heterogeneity but no seasonal variation. Paper II evaluated ultrasonography on 54 newborn, prospectively followed up to 12 months of age. Significant increase of medial malleolus to navicular distance (MM-N-distance) and of soft tissue thickness with increasing age was seen and with acceptable reliability. Paper III assessed 35 children (47 feet) after previous posterior release, mean age of 4.5 years, and the MM-N-distance was shorter in unilateral clubfeet (21 patients) than in contralateral normal feet. No association between navicular position and forefoot adduction (FFA) was determined. Smaller FFA yielded better subjective and functional outcome. Paper IV reviewed distraction treatment with Ilizarov External Fixator in seven patients (10 feet), 6-15 years of age, with relapsed deformities. All patients, except one, reported satisfaction with the overall result but less stiffness was experienced in only 4/10 feet. Paper V evaluated self-estimated outcome in 83 patients (63 males, 20 females), mean age of 64 years, through SF-36 and EQ-5D, and through AAOS foot and ankle score. Age and gender adjusted norm groups were used. Female patients scored worse than male patients did. Both males and females reported negative influence on foot and ankle function. Conclusion: The incidence of congenital clubfoot in Sweden is higher than in previous Scandinavian studies. Ultrasonography is reliable for describing pathoanatomy of the talo-navicular joint in clubfeet and can detect "spurious" (false) correction. Distraction treatment with the Ilizarov External Fixator yields subjective improvement but stiffness remains. Long-term influence on daily life activities is limited to foot and ankle function for both genders, but only female patients report negative influence on physical aspects of quality of life.
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| 9. |
- Wallander, Henrik, et al.
(författare)
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No association between residual forefoot adduction and the position of the navicular in clubfeet treated by posterior release
- 2007
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Ingår i: Journal of Pediatric Orthopaedics. - 0271-6798 .- 1539-2570. ; 27:1, s. 60-66
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Tidskriftsartikel (refereegranskat)abstract
- Medial displacement of the navicular has been considered a major explanation for residual forefoot adduction (FFA) in congenital clubfoot and also a frequent reason for dissatisfaction after limited surgery. In this study, it was hypothesized that there would be an association between the degree of medial displacement of the navicular and residual FFA in clubfeet. The position of the navicular was retrospectively measured by ultrasonography in 49 clubfeet in 35 children at ages 3 to 6 years and correlated to residual FFA measured on footprints and radiographs (talo-first metatarsal angle). In the 49 clubfeet, the navicular was significantly more medially displaced toward the medial malleolus than in the 21 contralateral normal feet (P < 0.001). However, there was no correlation between the degree of medial displacement of the navicular and the degree of FFA measured on footprints (P = 0.690) or on radiographs (P = 0.390). Thus, there were clubfeet with straight forefoot and a medially displaced navicular, that is, "spurious correction," and clubfeet with FFA and the navicular in correct position in relation to the head of the talus. Both patient satisfaction and foot score declined with larger FFA. The results support the view that ultrasonography is a helpful tool for assessing the position of the navicular. The critical issue for analysis is whether the FFA is due to malalignment in the talonavicular joint or more distally.
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| 10. |
- Wallander, Henrik, et al.
(författare)
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Patient Reported Outcome at 62-67 years of age in 83 patients treated for Congenital Clubfoot
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Patient reported outcome in 83 patients with congenital clubfoot was evaluated at a mean age of 64 years using three validated questionnaires assessing both quality of life (SF-36 and EQ-5D) and foot and ankle function (AAOS Foot and Ankle Questionnaire). In SF-36 male patients scored significantly better than male norms in 7/8 domains, while female patients scored significantly worse than female norms in 2/8 domains. The male patients scored better than male norms in both EQ-5D Index (p=0.027) and VAS (p=0.013) while female patients scored worse than female norms in VAS (p<0.001). Both male and female patients had a significantly worse outcome on the AAOS Core Scale when compared to norms. There was a significant correlation, for both genders, between the SF-36 Physical Component Summary Score and the AAOS Core Scale. In conclusion the influence on daily life activities was limited to foot and ankle problems, and in female patients’ also in physical aspects of quality of life.
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