| 11131. |
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| 11132. |
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| 11133. |
- Jörgren, F., et al.
(författare)
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Impact of rectal perforation on recurrence during rectal cancer surgery in a national population registry
- 2020
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 107:13, s. 1818-1825
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Tidskriftsartikel (refereegranskat)abstract
- Background: Incidental perforation in rectal cancer surgery is considered a risk factor for poorer oncological outcome. Most studies emanate from the era before total mesorectal excision when staging, neoadjuvant treatment and surgical technique were suboptimal. This study assessed the impact of incidental perforation on oncological outcome in a cohort of patients with optimized management. Methods: Data from the Swedish Colorectal Cancer Registry for patients undergoing R0 abdominal surgery for TNM stage I–III rectal cancer between 2007 and 2012, with 5-year follow-up, were analysed. Multivariable analysis was performed. Results: In total, 6176 patients were analysed (208 with and 5968 without perforation). The local recurrence rate was increased after perforation (7·2 per cent (15 of 208) versus 3·2 per cent (188 of 5968); P = 0·001), but there were no differences in rates of distant metastasis (16·3 per cent (34 of 208) versus 19·8 per cent (1183 of 5968); P = 0·215) and overall recurrence (20·7 per cent (43 of 208) versus 21·0 per cent (1256 of 5968); P = 0·897). The 5-year overall survival rate was lower after perforation (66·4 versus 75·5 per cent; P = 0·002), but the 5-year relative survival rate was no different (79·9 versus 88·2 per cent; P = 0·083). In multivariable analysis, perforation was a risk factor for local recurrence (hazard ratio 2·10, 95 per cent c.i. 1·19 to 3·72; P = 0·011), but not for the other outcomes. Conclusion: Incidental perforation remains a significant risk factor for LR, even with optimized management of rectal cancer. This must be considered when discussing adjuvant treatment and follow-up.
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| 11134. |
- Jörgren, Fredrik
(författare)
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Risk Factors of Tumour Recurrence and Reduced Survival in Rectal Cancer
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden, 2000 patients are diagnosed with rectal cancer annually. In 1995, the Swedish Rectal Cancer Registry (SRCR) was launched to supervise and assure the quality of the management of rectal cancer. Advances in the management of rectal cancer have reduced the local recurrence (LR) rate and improved survival. To improve the outcome further, identification of prognostic and predictive factors is important for optimal, personalised neoadjuvant/adjuvant treatment and follow-up strategies. This thesis identifies potential risk factors of tumour recurrence and reduced survival – i.e., surgery-related and tumour biology-related prognostic factors – in a cohort of patients registered in the SRCR between 1995 and 1997 with 5-year follow-up. SRCR data were used and for subgroups additional data from the original medical records were retrieved. In addition, SRCR data were validated. In Paper I, preoperative radiotherapy (RT) significantly reduced the LR rate irrespective of the tumour height. Moreover, preoperative RT and rectal washout reduced the LR rate after incidental perforation. Preoperative RT prolonged time to LR. LR was an isolated tumour manifestation in 39% of the patients with LR. Paper II showed that anastomotic leakage had no impact on the oncological outcome. In Paper III, incidental perforation was a significant risk factor of increased LR and overall recurrence rates as well as reduced overall and cancer-specific 5-year survival. In Paper I-III, the validity of SRCR data was acceptable. In Paper IV, high immunohistochemical expression of the tumour marker ezrin in primary tumours from patients with LR correlated to earlier occurrence of LR. A linkage of high ezrin expression and aggressive biological behaviour is suggested.
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| 11135. |
- Jörgsholm, Peter
(författare)
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Distal radial fractures - Prognostic radiological factors/classification
- 2007
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Ingår i: Proceedings of the 10th Congress of the International Federation of Societies for Surgery of the Hand & 7th Congress of the International Federation of Societies for Hand Therapy. - 9788875873301 - 9788875873295 ; , s. 53-58
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Konferensbidrag (refereegranskat)abstract
- Different kind of classifications system for distal radius fractures has been published for almost a century. Very few of these has been validated. AOs classification in its three main group has a good observer agreement and is quiet simple as so. A evidence based Swedish treatment algorithm is proposed and good uniform outcome score (DASH) is demonstrated.
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| 11136. |
- Jörgsholm, Peter, et al.
(författare)
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Extension block pinning of mallet fractures.
- 2010
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 1651-2073. ; 44:1, s. 54-58
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Tidskriftsartikel (refereegranskat)abstract
- The operative treatment of mallet fractures of more than one third of the articular surface is controversial. The purpose of this study was to evaluate the complications and functional outcome of extension block pinning technique. Thirty-six consecutive patients with mallet fractures that involved more than one third of the joint surface were treated by extension block pinning a median of 3 days after injury (range 0-35, mean 7). Clinical outcome was graded according to Crawford's criteria. At a median follow-up of 16.5 months (range 2.5-52, mean 20) 23 patients had an excellent or good result, 11 patients had a fair, and 2 patients a poor, clinical outcome according to Crawford's criteria. None of the patients complained of pain. The median extension loss was 0 degrees (range 0-20, mean 4) and the median flexion was 70 degrees (range 30-95, mean 68). Eight patients had operative or direct postoperative complications including superficial infection (n = 6), loss of Kirschner wire (K-wire) fixation (n = 1), and K-wire mal position (n = 1). The extension block pinning technique is a minimally invasive method of treating mallet fractures with low morbidity and a good functional outcome.
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| 11137. |
- Jørgsholm, Peter, et al.
(författare)
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Scaphoid Fracture Instability
- 2017
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Ingår i: Scaphoid Fractures : Evidence-Based Management - Evidence-Based Management. - 9780323485647 - 9780323496056 ; , s. 91-98
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Bokkapitel (refereegranskat)
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| 11138. |
- Jörgsholm, Peter
(författare)
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Scaphoid Fractures - epidemiology, diagnosis and treatment.
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract The scaphoid is the most commonly fractured carpal bone. The diagnosis is difficult and untreated the long-term results are poor. Approximately 10% do not unite even if they are treated properly. The aim of this thesis was to study scaphoid fracture epidemiology, diagnosis and treatment. During a four-year period (2004-03-01 to 2008-02-28) all patients attending the Emergency Department at Skåne University Hospital in Malmö, due to posttraumatic radial sided wrist pain, were invited to participate in a scaphoid fracture study. The basis for this thesis consists of the 526 patients (531 wrists) who accepted to participate. First we assessed the diagnostic performance of radiographs and CT with MRI as the reference standard. In paediatric patients (<18 years) fracture patterns were studied in relation to skeletal maturity. Using arthroscopy we aimed at identifying factors, which could contribute to prolonged union or non-union of scaphoid fractures. Finally, we evaluated time-to-union of scaphoid waist fractures treated conservatively or by arthroscopy-assisted surgery. In the two diagnostic studies on adults and paediatric patients (paper I-II) 390 wrists were enrolled for MRI investigation. We were able to show that radiographs and CT scans are less sensitive in diagnosing carpal fractures compared to MRI. In particular radiographs in paediatric patients had a poor sensitivity when diagnosing carpal fractures; however, CT had a good sensitivity in finding scaphoid fractures regardless of patient age. We found more concomitant fractures than previously described, and the most common carpal fracture combination was that of the scaphoid and the capitate. Skeletal immature patients had a higher proportion of distal scaphoid fractures compared to the skeletal mature. In the descriptive study using arthroscopy (paper III) 41 scaphoid waist fractures were included. We found, that scapholunate ligament injuries were common with a complete rupture in 24% of the patients. Paper IV is a joint venture with Harvard Medical School, Boston, USA. In 58 scaphoid fractures we were able to show, that radiographic fracture comminution was strongly correlated to displacement and instability as judged by arthroscopy. Scapholunate ligament injuries and fracture comminution may be of importance when deciding on treatment of scaphoid fractures. Time-to-union based on CT was assessed in 65 scaphoid waist fractures in paper V. Of the nonor minimally-displaced fractures 90% united after six weeks of conservative treatment. In a randomized subgroup of non-displaced fractures we were not able to show any difference in time-to-union between conservatively and surgically treated patients. The present thesis shows, that MRI is superior in diagnosing carpal fractures in adults and children. Furthermore we found, that concomitant carpal fractures and ligament injuries are common in patients with scaphoid fractures. Radial fracture comminution is strongly correlated to fracture instability. Finally we recognized, that non- or minimally-displaced scaphoid waist fractures are best treated in a cast.
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| 11139. |
- Jørgsholm, Peter, et al.
(författare)
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The benefit of magnetic resonance imaging for patients with posttraumatic radial wrist tenderness.
- 2013
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 38:1, s. 29-33
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Tidskriftsartikel (refereegranskat)abstract
- To describe fractures revealed by magnetic resonance imaging (MRI) in a series of skeletally mature patients with radial wrist pain after an acute injury and clinically suspected to have a scaphoid fracture. Additionally, we attempted to assess the diagnostic value of radiographs and computed tomography (CT) in patients with scaphoid and other carpal fractures verified by MRI.
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| 11140. |
- Jørgsholm, Peter, et al.
(författare)
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The incidence of intrinsic and extrinsic ligament injuries in scaphoid waist fractures.
- 2010
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 35:3, s. 368-374
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To determine the incidence of associated intrinsic and extrinsic ligament injuries in patients with a nondisplaced or displaced scaphoid waist fracture. METHODS: During a 3-year period, a study of all scaphoid fractures was performed at our institution. Diagnosis was confirmed by plain radiographs, computed tomography, and magnetic resonance imaging. A 3-part anatomic classification was used to categorize the scaphoid fractures. The study population comprised 40 patients with 41 scaphoid waist fractures who had wrist arthroscopy for treatment and evaluation of the scaphoid fracture and associated carpal injuries. RESULTS: We observed fresh intrinsic ligament injuries in 34 of 41 wrists. In 29 cases, the scapholunate ligament was injured, with complete rupture occurring in 10 wrists. The lunotriquetral ligament was injured in 8 wrists, and the triangular fibrocartilage complex was injured in 11 wrists. Statistically, the number of intrinsic ligament injuries did not differ between nondisplaced and displaced scaphoid fractures (p> .30). CONCLUSIONS: In this study of acute scaphoid waist fractures, the overall incidence of associated ligament injuries was surprisingly high, at 34 of 41 wrists. Complete scapholunate ligament rupture was found in 10 of 41 wrists. This incidence is higher than previously reported and emphasizes the need for careful assessment of the intrinsic and extrinsic ligaments, particularly the scapholunate ligament, before deciding on treatment.
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