| 51. |
- Fadl, Helena, 1965-, et al.
(författare)
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Gestational diabetes mellitus and later cardiovascular disease : a Swedish population based case-control study
- 2014
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell. - 1470-0328 .- 1471-0528. ; 121:12, s. 1530-1536
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify if gestational diabetes mellitus (GDM) is a clinically useful marker of future cardiovascular disease (CVD) risk and if GDM combined with other risks (smoking, hypertension or body mass) identifies high-risk groups.Design: Population-based matched case-control study.Setting: National Swedish register data from 1991 to 2008.Population: A total of 2639 women with a cardiovascular event and matched controls.Methods: Conditional logistic regression examined associations with CVD before and after adjustment for conventional risk factors and confounders. Effect modification for the association of GDM with CVD by body mass index (BMI), smoking and chronic hypertension was assessed by stratification and interaction testing. Adjustment for diabetes post-pregnancy evaluated its mediating role.Main outcome measures: Inpatient diagnoses or causes of death identifying ischemic heart disease, ischemic stroke, atherosclerosis or peripheral vascular disease.Results: The adjusted odds ratios (and 95% confidence intervals) for the association of CVD with GDM are 1.51 (1.07-2.14), 2.23 (2.01-2.48) for smoking, 1.98 (1.71-2.29) for obesity and 5.10 (3.18-8.18) for chronic hypertension. In stratified analysis the association of CVD with GDM was only seen among women with BMI 25, with an odds ratio of 2.39 (1.39-4.10), but only women with a BMI <30 accounted for this increased risk. Adjustment for post-pregnancy diabetes attenuated it somewhat to 1.99 (1.13-3.52).Conclusions: In the absence of other recognised cardiovascular risk factors, such as smoking, obesity or chronic hypertension, GDM is a useful marker of raised CVD risk among women with BMI between 25 and 29.
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| 52. |
- Fant, F., et al.
(författare)
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Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy
- 2013
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Ingår i: British Journal of Anaesthesia. - Oxford, USA : Oxford University Press. - 0007-0912 .- 1471-6771. ; 110:5, s. 747-757
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidural anaesthesia and analgesia has been shown to suppress the neurohormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropubic prostatectomy.Methods: Twenty-six patients were randomized to Group P (systemic opioid-based analgesia) or Group E (thoracic epidural-based analgesia) perioperatively. Induction and maintenance of anaesthesia followed a standardized protocol. The following measurements were made perioperatively: plasma cortisol, glucose, insulin, C-reactive proteins, leucocyte count, plasma cytokines [interleukin (IL)-6, tumour necrosis factor (TNF)-alpha], and pokeweed mitogen-stimulated cytokines [interferon (IFN)-gamma, IL-2, IL-12p70, IL-10, IL-4, and IL-17]. Other parameters recorded were pain, morphine consumption, and perioperative complications.Results: Plasma concentration of cortisol and glucose were significantly higher in Group P compared with Group E at the end of surgery, the mean difference was 232 nmol litre(-1) [95% confidence interval (CI) 84-381] (P=0.004) and 1.6 mmol litre(-1) (95% CI 0.6-2.5) (P=0.003), respectively. No significant differences were seen in IL-6 and TNF-alpha at 24 h (P=0.953 and 0.368, respectively) and at 72 h (P=0.931 and 0.691, respectively). IL-17 was higher in Group P compared with Group E, both at 24 h (P=0.001) and 72 h (P=0.018) after operation. Pain intensity was significantly greater in Group P compared with Group E (P<0.05) up to 24 h.Conclusions: In this small prospective randomized study, thoracic epidural analgesia reduced the early postoperative stress response but not the acute inflammatory response after radical retrobupic prostatectomy, suggesting that other pathways are involved during the acute phase reaction.
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| 53. |
- Fant, Federica, et al.
(författare)
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Thoracic epidural analgesia or patient-controlled local analgesia for radical retropubic prostatectomy: a randomized, double-blind study
- 2011
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Ingår i: British Journal of Anaesthesia. - : Oxford University Press (OUP). - 0007-0912 .- 1471-6771. ; 107:5, s. 782-789
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Tidskriftsartikel (refereegranskat)abstract
- Background. Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA). less thanbrgreater than less thanbrgreater thanMethods. Fifty patients, ASA I-II, participated in this prospective, double-blinded study. All patients had TEA. After operation, they were randomized into two groups of 25 patients: Group PCLA (patient-controlled local analgesia): self-administration of 10 ml of ropivacaine 2 mg ml(-1) via the intra-abdominal catheter for 48 h. Group TEA: infusion of 10 ml h(-1) of ropivacaine 1 mg ml(-1), fentanyl 2 mg ml(-1), and epinephrine 2 mg ml 21 epidurally for 48 h. The primary endpoint was pain on coughing at 4 h after operation. Rescue medication was morphine i.v. as required. less thanbrgreater than less thanbrgreater thanResults. Pain on coughing at 4, 24, and 48 h was significantly lower in Group TEA [0 (0-10)] compared with Group PCLA [4 (0-10)] (Pandlt;0.05). Significantly lower pain intensity was also found in Group TEA compared with Group PCLA at the incision site, deep pain, and pain on coughing at 4 and 24 h (Pandlt;0.05). Morphine consumption was significantly greater in Group PCLA [12 (0-46)] compared with Group TEA [0 (0-20)] at 0-48 h after operation [median (range)] (P=0.015). Maximum expiratory pressure was higher in Group TEA compared with Group PCLA at 24 h (Pandlt;0.01). less thanbrgreater than less thanbrgreater thanConclusions. TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.
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| 54. |
- Frisk, Margot L. A., et al.
(författare)
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Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators : a cross-sectional study in a Swedish population
- 2007
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 101:9, s. 2031-2035
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Tidskriftsartikel (refereegranskat)abstract
- A basic assumption was that exposure to the indoor environment would increase the manifestation of respiratory symptoms in predisposed individuals. The aim was to investigate the proportion of perceived respiratory symptoms attributed to specific environmental exposures, and associations related to indoor climate risk indicators, i.e. occurrence of damp or mould, insufficient ventilation and condensation on windows.MethodA questionnaire was mailed to a random sample of 8008 individuals, stratified for gender and age. The response rate was 84% (n=6732). Established criteria for current asthma were used to classify subjects into three subgroups: asthmatics, healthy and symptomatics (but without current asthma).ResultsThe proportion of symptoms attributed to specific environmental exposures increased in the total sample and in the three subgroups when indoor climate risk indicators, particularly damp or mould, were reported. Generally, the lowest proportions were found for healthy and the highest for asthmatics. Univariate analyses presented as relative risks (RR) (95% CI) showed significantly increased risks for perceived overall influence on airways for all groups, with RR ranging from 4.3 to 6.8. Although respiratory symptoms attributed to dust, environmental tobacco smoke (ETS) and strong scents increased when risk indicators were reported, RR were generally lower in all groups.ConclusionThe high frequency of respiratory symptoms among asthmatics increased when occurrences of risk indicators were reported. Similarly, increased symptoms were found for healthy indicating that indoor climate risk indicators may affect both healthy and unhealthy individuals.
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| 55. |
- Fryxelius, J., et al.
(författare)
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Synthesis and redox properties of a meso-tris(4-nitrophenyl) corrolato Mn(III) complex
- 2005
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Ingår i: Journal of Porphyrins and Phthalocyanines. - 1088-4246 .- 1099-1409. ; 9:6, s. 379-386
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Tidskriftsartikel (refereegranskat)abstract
- The Mn complexated corrole [T(4-NO2P)Corr]Mn(py) (3) has been prepared (py = pyridine) where [T(4-NO2P)Corr] is the trianion of the electron-poor 5,10,15-tris(4-nitrophenyl)-corrole (1). The preparation of 3 includes a new synthetic method to form the corrole ligand 1 in a two-step synthesis. The Mn(III) complex gives a parallel mode EPR signal centered around g = 8.2 with six distinct hyperfine lines (A(parallel to) = 139 x 10(-4) cm(-1)). Electrochemically 3 undergoes one reversible oxidation (E-1/2 = 0.12 V vs Fc) and two reversible reductions (E-1/2 = -1.45, -1.61 V). The oxidation is metal-centered and the product has been characterized by EPR spectroscopy as an S = 3/2 Mn(IV) species with no indication for oxidation of the macrocycle. The reductions of complex 3 are ligand based, and at the potential of the second reduction step a stable nitrogen centered radical with g = 2.0055 is generated. Chemical oxidation of 3 by iodosobenzene yields a Mn(IV) complex and epoxidation of cis-stilbene is not catalyzed by the Mn complex.
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| 56. |
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| 57. |
- Gustavsson, Anders, et al.
(författare)
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Clinical trial : colectomy after rescue therapy in ulcerative colitis-3-year follow-up of the Swedish-Danish controlled infliximab study
- 2010
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Ingår i: Alimentary Pharmacology and Therapeutics. - : Wiley. - 0269-2813 .- 1365-2036. ; 32:8, s. 984-989
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Tidskriftsartikel (refereegranskat)abstract
- Background The long-term efficacy of infliximab as rescue therapy in steroid-refractory ulcerative colitis is not well described. Aim To examine the long-term efficacy of infliximab as a rescue therapy through a 3-year follow-up of a previous placebo-controlled trial of infliximab in acute steroid-refractory ulcerative colitis. Method In the original study, 45 patients were randomized to a single infusion of infliximab 5 mg/kg or placebo, and at 3 months, 7/24 patients given infliximab were operated vs. 14/21 patients given placebo. Three years or later, patients were asked to participate in a clinical follow-up. Results Another seven patients underwent colectomy during follow-up: five in the infliximab group and two in the placebo group. After 3 years, a total of 12/24 (50%) patients given infliximab and 16/21 (76%) given placebo (P = 0.012) had a colectomy. None of eight patients in endoscopic remission at 3 months later had a colectomy compared with 7/14 (50%) patients who were not in remission (P = 0.02). There was no mortality. Conclusion The benefit of rescue therapy with infliximab in steroid-refractory acute ulcerative colitis remained after 3 years. The main advantage of infliximab treatment occurred during the first 3 months, whereas subsequent colectomy rates were similar in the two groups. Mucosal healing at 3 months influenced later risk of colectomy.
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| 58. |
- Gustavsson, Anders, 1964-, et al.
(författare)
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Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn's disease
- 2012
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Ingår i: Alimentary Pharmacology and Therapeutics. - Hoboken, USA : Wiley-Blackwell. - 0269-2813 .- 1365-2036. ; 36:2, s. 151-158
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bowel strictures are a major cause of morbidity, hospitalisation and surgery in Crohn's disease.Aim: We report short- and long-term efficacy and safety of endoscopic balloon dilation of strictures due to Crohn's disease.Methods: Retrospective study of patients who underwent endoscopic balloon dilation between 1987 and 2009.Results: We performed 776 dilations, of which 621 (80%) were on anastomotic strictures, in 178 patients (94 women) with Crohn's disease. At first dilation, median (IQR) age of patients was 45 (37-56) years and disease duration 16 (8-22) years. Technical success rate was 689/776 (89%). A subset of 75 patients from the primary catchment area, with >5-year follow-up, underwent a total of 246 dilations. At 1-year follow-up, 60/75 (80%) patients had undergone no further intervention or one additional dilation only. At 3 and 5 years, corresponding figures were 43/75 (57%) and 39/75 (52%). Cumulative proportions of patients undergoing surgery at 1, 3 and 5 years were 13%, 28% and 36%. Complication rate per procedure for all 178 patients was 41/776 (5.3%), bowel perforation (n = 11, 1.4%), major bleeding requiring blood transfusion (n = 8, 1.0%), minor bleeding (n = 10, 1.3%) and abdominal pain or fever (n = 12, 1.5%). Ten patients underwent surgery due to complications (perforation n = 8, bleeding n = 2). There was no procedure-related mortality.Conclusion: Endoscopic balloon dilation is an efficacious and safe alternative to surgical resection of intestinal strictures in Crohn's disease. At 5-year follow-up, 52% of patients required no further or one additional dilation only, whereas 36% had undergone surgical resection. Complication frequency was low.
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