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Träfflista för sökning "WFRF:(Graf Wilhelm) ;srt2:(2015-2019)"

Sökning: WFRF:(Graf Wilhelm) > (2015-2019)

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  • Föregående 1[2]3Nästa
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11.
  • Enblad, Malin (författare)
  • Colorectal and appendiceal peritoneal metastases From population studies to genetics
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Peritoneal dissemination of colorectal and appendiceal origin was previously considered the end-stage of malignant disease. Today, treatment with cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) has prolonged survival and cured some patients with peritoneal metastases (PM). Unfortunately, a majority of patients still have fatal outcomes. In this thesis, colorectal and appendiceal PM were studied from a wide population-based perspective down to the detailed perspectives of histopathology and genetics, with the aim of further contributing to prolonged survival.</p><p>In Paper I, the heterogeneous histopathology of PM was investigated and a substantial proportion of patients undergoing CRS and HIPEC were found to have surgical specimens lacking neoplastic epithelium. These patients had a favourable prognosis and the results illustrate the importance of thorough analysing and reporting of histopathology for understanding differences in survival outcomes and for improving patient selection. In Paper II, the role of inflammation in colorectal and appendiceal carcinogenesis was investigated at a population-based level. Patients with non-surgical treatment of appendicitis had an increased incidence of cancer (especially of appendiceal and right-sided colon cancer) compared to the general population. This should be taken into consideration in the discussion of optimal management of patients with appendicitis. In Paper III, risk factors for PM were studied with the aim of aiding in the detection of PM at earlier stages. Appendiceal and right-sided colon cancer, advanced tumour and node stages, mucinous histopathology and vascular invasion were identified as high risk features for developing PM, and should increase awareness of potential PM. In Paper IV, genome-wide chromosomal copy number alterations of PM were explored and associated with prognosis after CRS and HIPEC. Colorectal PM exhibited a wide range of alterations of which copy number gain on parts of chromosome 1p and 15q were significantly associated with poor prognosis and have the potential to be used as prognostic molecular markers in the future.</p><p>In conclusion, this thesis provides new insights into the field of colorectal and appendiceal cancer and PM to be used for improved patient selection, early detection and prevention, ultimately contributing to improved survival.</p>
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12.
  • Enblad, Malin, et al. (författare)
  • Importance of Absent Neoplastic Epithelium in Patients Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
  • 2016
  • Ingår i: Annals of Surgical Oncology. - 1068-9265 .- 1534-4681. ; 23:4, s. 1149-1156
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>The importance of absent neoplastic epithelium in specimens from cytoreductive surgery (CRS) is unknown. This study aimed to investigate the prevalence and prognostic value of histopathology without neoplastic epithelium in patients treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC). Data were extracted from medical records and histopathology reports for patients treated with initial CRS and HIPEC at Uppsala University Hospital, Sweden, between 2004 and 2012. Patients with inoperable disease and patients undergoing palliative non-CRS surgery were excluded from the study. Patients lacking neoplastic epithelium in surgical specimens from CRS, with or without mucin, were classified as "neoplastic epithelium absent" (NEA), and patients with neoplastic epithelium were classified as "neoplastic epithelium present" (NEP). The study observed NEA in 78 of 353 patients (22 %). Mucin was found in 28 of the patients with NEA. For low-grade appendiceal mucinous neoplasms and adenomas, the 5-year overall survival rate was 100 % for NEA and 84 % for NEP, and the 5-year recurrence-free survival rate was 100 % for NEA and 59 % for NEP. For appendiceal/colorectal adenocarcinomas (including tumors of the small intestine), the 5-year overall survival rate was 61 % for NEA and 38 % for NEP, and the 5-year recurrence-free survival rate was 60 % for NEA and 14 % for NEP. Carcinoembryonic antigen level, peritoneal cancer index, and completeness of the cytoreduction score were lower in patients with NEA. A substantial proportion of patients undergoing CRS and HIPEC have NEA. These patients have a favorable prognosis and a decreased risk of recurrence. Differences in patient selection can affect the proportion of NEA and hence explain differences in survival rates between reported series.</p>
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13.
  • Enblad, Malin, et al. (författare)
  • Increased incidence of bowel cancer after non-surgical treatment of appendicitis
  • 2017
  • Ingår i: European Journal of Surgical Oncology. - Elsevier. - 0748-7983 .- 1532-2157. ; 43:11, s. 2067-2075
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>BACKGROUND:</strong> There is an ongoing debate on the use of antibiotics instead of appendectomy for treating appendicitis but diagnostic difficulties and longstanding inflammation might lead to increased incidence of bowel cancer in these patients. The aim of this population-based study was to investigate the incidence of bowel cancer after non-surgical treatment of appendicitis.</p><p><strong>PATIENTS AND METHODS:</strong> Patients diagnosed with appendicitis but lacking the surgical procedure code for appendix removal were retrieved from the Swedish National Inpatient Register 1987-2013. The cohort was matched with the Swedish Cancer Registry and the standardised incidence ratios (SIR) with 95% confidence interval (95% CI) for appendiceal, colorectal and small bowel cancers were calculated.</p><p><strong>RESULTS:</strong> Of 13 595 patients with non-surgical treatment of appendicitis, 352 (2.6%) were diagnosed with appendiceal, colorectal or small bowel cancer (SIR 4.1, 95% CI 3.7-4.6). The largest incidence increase was found for appendiceal (SIR 35, 95% CI 26-46) and right-sided colon cancer (SIR 7.5, 95% CI 6.6-8.6). SIR was still elevated when excluding patients with less than 12 months since appendicitis and the incidence of right-sided colon cancer was elevated five years after appendicitis (SIR 3.5, 95% CI 2.1-5.4). An increased incidence of bowel cancer was found after appendicitis with abscess (SIR 4.6, 95% CI 4.0-5.2), and without abscess (SIR 3.5, 95% CI 2.9-4.1).</p><p><strong>CONCLUSION:</strong> Patients with non-surgical treatment of appendicitis have an increased short and long-term incidence of bowel cancer. This should be considered in the discussion about optimal management of patients with appendicitis.</p>
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14.
  • Graf, Wilhelm, et al. (författare)
  • Bukhinnan
  • 2017
  • Ingår i: Kirurgi. - 9. - Liber. - 9789147112982 ; s. 357-364
  • Bokkapitel (refereegranskat)
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15.
  • Graf, Wilhelm, et al. (författare)
  • Long-term outcome after surgery for Crohn's anal fistula.
  • 2016
  • Ingår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - 1463-1318. ; 18:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Treatment of Crohn's anal fistula remains challenging and little is known about factors associated with healing. The aim of this study was to assess the rate of healing after surgical treatment and analyse clinical variables related to healing.
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16.
  • Graf, Wilhelm, et al. (författare)
  • Long-term outcome after surgery for Crohn's anal fistula
  • 2016
  • Ingår i: Colorectal Disease. - 1462-8910 .- 1463-1318. ; 18, s. 80-85
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>AIM:</strong> Treatment of Crohn's anal fistula remains challenging and little is known about factors associated with healing. The aim of this study was to assess the rate of healing after surgical treatment and analyse clinical variables related to healing.</p><p><strong>METHOD:</strong> 119 patients (63 female, mean age 36 (±13.7) years with histopathologically verified Crohn's disease underwent a surgical procedure for anal fistula at four main referral centres in Sweden, January 1998 - December 2009. Baseline and treatment-related variables were recorded and analysed for correlation with fistula healing at a final follow-up at a mean 7.2 (median 7.1, 1.0-17.5) years.</p><p><strong>RESULTS:</strong> Of the 119 patients 62 (52%) were healed at final follow-up. Fourteen healed after one procedure and the remaining 48 healed after a further median of 4.0 (2-20) procedures. Ten (8%) patients were subjected to a proctectomy. Final healing was more common in patients operated with a procedure aiming at eradicating the fistula (P=0.0001), without proctitis (P=0.02), and a shorter duration of Crohn' disease (P=.0019).</p><p><strong>CONCLUSION:</strong> Long-term healing of a Crohn's anal fistula can be expected in about half of the patients, usually after repeated surgical treatment. The probability for cure was higher when a curative operation was performed in a patient without proctitis and a shorter duration of Crohn's disease. An attempt to close a Crohn's anal fistula is thus often worthwhile. This article is protected by copyright. All rights reserved.</p>
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17.
  • Graf, Wilhelm, et al. (författare)
  • Results after sacral nerve stimulation for chronic constipation
  • 2015
  • Ingår i: Neurogastroenterology and Motility. - 1350-1925 .- 1365-2982. ; 27:5, s. 734-739
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>BACKGROUND:</strong> Sacral nerve stimulation is an established treatment for fecal incontinence and initial reports describe successful results also in subjects with chronic constipation.</p><p><strong>METHODS:</strong> Consecutive patients with slow transit or outlet obstruction type constipation were offered external stimulation through a test electrode inserted in a sacral foramen during a 3-week period. The symptomatic evaluation was based on the number of bowel movements and a validated obstructed defecation score (ODS). A permanent implant was performed provided an overall 50% decrease in symptoms was observed.</p><p><strong>KEY RESULTS:</strong> In total, 44 patients with chronic constipation were treated with a 3-week test stimulation. Fifteen experienced a 50% reduction of symptoms and received a permanent implant. Four of the 15 with permanent implants were explanted during the course of the study. Five subjects (11% of original group) reported sustained symptom relief at final follow-up after a mean of 24 months (range 4-81). Mean ODS score did not change during the treatment. Patients with predominantly slow transit constipation or outlet obstruction did not differ concerning success rate.</p><p><strong>CONCLUSIONS &amp; INFERENCES:</strong> Sacral nerve stimulation has limited efficacy in unselected patients with chronic constipation and cannot be recommended for treatment on routine basis.</p>
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18.
  • Graf, Wilhelm, et al. (författare)
  • Tjocktarmen och ändtarmen
  • 2017
  • Ingår i: Kirurgi. - 9. - Liber. - 9789147112982 ; s. 288-348
  • Bokkapitel (refereegranskat)
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19.
  • Isacson, Daniel (författare)
  • Treatment of Acute Uncomplicated Colonic Diverticulitis
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The overall aim of this thesis was to evaluate the clinical management of AUD with regard to the no-antibiotic policy and its long-term effect, treatment on an outpatient basis and the potential health-care cost savings</p><p>Study I:  a retrospective study at Västmanlands Hospital that evaluated and confirmed the adherence to the no-antibiotic policy in patients with AUD and its safety regarding complications and recurrences. A total of 246 patients with acute diverticulitis were identified, of which 195 had computed tomography (CT) confirmed AUD. In total, 91.3% of these patients did not receive any antibiotics and only two developed complications.</p><p>Study II: a retrospective study with the aim to conduct a long-term follow-up of all Swedish patients who participated in the AVOD trial in terms of recurrences, complications, surgery and quality of life. The medical records of 96% of the patients were reviewed with a mean follow up of 11 years. Quality of life questionnaires were sent out to all patients. There were no differences regarding the rates of recurrence, complications or surgery for diverticulitis. There were no differences in the quality of life between groups according to the EQ-5D questionnaire.</p><p>Study III: a prospective study where 155 patients with CT-verified AUD as were treated as outpatients without antibiotics. On day 3, patients reported an average pain score of 1.8 of 10 on the VAS scale and only 30% of patients were using analgesia. Four patients returned to hospital because of treatment failure.</p><p>Study IV: a retrospective cohort study at Västmanland’s Hospital evaluated the impact on admissions, complication rates and health-care costs of the policy of outpatient treatment without using antibiotics. Medical records of all patients diagnosed with AUD in the year before (2011) and after (2014) the implementation of outpatient management without antibiotics were reviewed. Overall 494 episodes of AUD were identified: 254 in 2011 and 240 in 2014. Three patients developed complications in 2011 and four in 2014. The proportion of patients managed as outpatients was 20% in 2011 compared with 61% in 2014. The hospital admissions, total length of stay of and total health-care costs were almost halved.</p><p>In conclusion, these studies confirm the low complication and recurrence rates of AUD and strengthens findings that antibiotics have no benefit in the treatment of this disease. The no-antibiotic policy had no impact on short- or long-term outcomes regarding the rates of recurrence, complications, surgery or quality of life. Outpatient management was found to be feasible and safe, and significantly reduced admissions, which led to large health-care cost savings.</p>
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20.
  • Kakoulidis, Thanos P., et al. (författare)
  • Reduced Need for In-hospital Care After Sleeve Gastrectomy a Single Center Observational Study
  • 2019
  • Ingår i: Obesity Surgery. - 0960-8923 .- 1708-0428. ; 29:10, s. 3228-3231
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Setting</strong></p><p>Private clinic, Stockholm, and nation-wide in-hospital care, Sweden.</p><p><strong>Objectives</strong></p><p>The use of sleeve gastrectomy (SG) for treatment of morbid obesity has increased worldwide, but information about long-term outcome is still limited. Our objective was to evaluate the need for additional in-hospital care after SG for obesity (body mass index [BMI] &gt;30) in 862 patients, all operated at a single center.</p><p><strong>Methods</strong></p><p>Two national registries, the Inpatient Registry and the Death Registry, were used to collect long-term data on in-hospital care, grouped by the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and mortality, respectively.</p><p><strong>Results</strong></p><p>In-hospital care for SG-operated females was decreased for four groups of obesity-related ICD-10 diagnoses: endocrine and metabolic diseases and circulatory, digestive, and genitourinary diseases, as well as injuries and poisoning (p&lt;0.001 for all). However, female SG patients still required in-hospital care above the national level for women of corresponding ages.</p><p><strong>Conclusions</strong></p><p>Although a significant reduction in in-hospital care was observed, SG patients did not reach national levels.</p>
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