| 1331. |
- Petrousis, Grigorios, et al.
(författare)
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Treatment-Refractory Eosinophilic Esophagitis Successfully Managed with benralizumab: A Case Presentation and literature review
- 2024
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Ingår i: ROMANIAN JOURNAL OF INTERNAL MEDICINE. - : SCIENDO. - 1582-3296.
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Tidskriftsartikel (refereegranskat)abstract
- Eosinophilic Esophagitis is a widely-recognized immune-mediated esophagus disease with distinct clinical and histopathological features, exhibiting an increased global incidence. Therapeutic options encompass either dietary measures or pharmacological approaches, including proton pump inhibitors and topical corticosteroids. The use of monoclonal antibodies is currently under comprehensive evaluation, with a plethora of ongoing clinical trials designed to determine their clinical efficacy. The present case report demonstrates an exceptional case of refractory Eosinophilic Esophagitis, unresponsive to conventional treatment, achieving both clinical and histopathological remission subsequent to initiation of benralizumab treatment. Concurrently, our case underscores the necessity for continued research in the field of monoclonal antibodies for their use as a future treatment approach against Eosinophilic Esophagitis.
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| 1332. |
- Petzina, Rainer, et al.
(författare)
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Major complications during negative pressure wound therapy in poststernotomy mediastinitis after cardiac surgery
- 2010
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 1097-685X .- 0022-5223. ; 140:5, s. 1133-1136
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Negative pressure wound therapy is the first-line treatment modality for poststernotomy mediastinitis in many heart centers. The aim of this study was to analyze major complications and possible preventive methods during negative pressure wound therapy in patients with deep sternal wound infections. Methods: We retrospectively analyzed 69 consecutive patients treated with negative pressure wound therapy for poststernotomy mediastinitis between June 2006 and September 2009. Results: Five (7.2%) patients sustained major complications during negative pressure wound therapy. Bleeding from coronary artery venous bypass grafts was observed in 4 patients and fulminant bleeding from an infected homograft of the ascending aorta was observed in 1 patient during routine dressing changes of the negative pressure wound therapy system. Conclusions: Bleeding is the major complication during negative pressure wound therapy for poststernotomy mediastinitis. Covering the heart with several layers of paraffin gauze is a necessary protective maneuver but cannot completely prevent major complications during negative pressure wound therapy. All operative procedures, including dressing changes, should be performed in the operating room under optimal hygienic and monitoring conditions to increase the salvage rate and to guarantee optimal surgical and anesthesiologic conditions in case of negative pressure wound therapy-related complications. (J Thorac Cardiovasc Surg 2010;140:1133-6)
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| 1333. |
- Petzina, Rainer, et al.
(författare)
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Negative pressure wound therapy for post-sternotomy mediastinitis reduces mortality rate and sternal re-infection rate compared to conventional treatment
- 2010
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 38:1, s. 110-113
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Konferensbidrag (refereegranskat)abstract
- Objective: Negative pressure wound therapy (NPWT) is a recently introduced treatment modality for post-sternotomy mediastinitis. The aim of this study was to compare the mortality rate, the sternal re-infection rate and the length of hospital stay in patients with post-sternotomy mediastinitis after NPWT and conventional treatment. Methods: We retrospectively analysed 118 patients with post-sternotomy mediastinitis after cardiac surgery. One group of 69 patients was treated with NPWT and the other group of 49 patients with conventional therapy. Results: There were no major differences between the two groups concerning preoperative data (EuroScore) or primary cardiac surgery (mainly coronary artery bypass grafting). NPWT therapy was found to reduce mortality rate (P = 0.005) and sternal re-infection rate (P = 0.008) compared with conventional treatment and tended to lead to a shorter length of hospital stay (P = 0.08). Conclusions: NPWT for post-sternotomy mediastinitis demonstrates encouraging clinical results with a reduction of the mortality rate and the sternal re-infection rate compared with conventional treatment. The results support NPWT as the first-line treatment for deep sternal wound infections. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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| 1334. |
- Petzina, Rainer
(författare)
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Negative pressure wound therapy in cardiac surgery
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Negative pressure wound therapy in cardiac surgery Rainer Petzina, M.D. Clinical Sciences, Lund, Lund University Poststernotomy mediastinitis is a devastating complication for patients undergoing cardiac surgery. Conventional treatment includes surgical revision, continuous irrigation with drainage and wound closure with the use of the greater omentum and muscle flaps. Widespread adoption of negative pressure wound therapy (NPWT) has been driven through favorable clinical experience and excellent healing effects. The aims of the research in this thesis were: I. To quantify cardiac output and left ventricular chamber volumes after NPWT, using magnetic resonance imaging (MRI). II. To examine the effects of NPWT on peristernal soft tissue blood flow after internal mammary artery harvesting, using laser Doppler velocimetry. III. To study the effect of NPWT on blood and fluid content of the sternal wound edge and bone marrow, using MRI (T2-STIR). IV. To identify the effects of NPWT on the position of the heart in relation to the thoracic wall, using MRI. An uninfected porcine sternotomy wound model was used for all studies. The hemodynamic effects of NPWT in cardiac surgery are debated. MRI measurements show that NPWT results in an immediate decrease in cardiac output, although to a lesser extent than shown in previous studies. MRI is known to be the most accurate method for quantifying cardiac output. Patients with poor blood perfusion of the sternotomy wound edge tissue have a higher risk of developing post-sternotomy mediastinitis. We show that the peristernal wound edge microvascular blood flow is decreased when the left internal mammary artery is harvested. NPWT therapy stimulates blood flow in the in the wound edge both before and after the mammary artery is removed. Stimulating blood flow to the wound edge in patients with impaired microcirculation may be crucial to ensure healing. MRI measurements show that NPWT increases sternotomy wound edge tissue fluid and/or blood content. Presumably, NPWT creates a pressure gradient that draws fluid from the surrounding tissue into the sternal wound edge and into the vacuum source. This “endogenous drainage” may be one possible mechanism by which osteitis is resolved. Heart rupture is a devastating complication to NPWT of sternotomy wounds. MR imaging shows that NPWT causes the heart to be sucked up towards the thoracic wall and, in some cases, the right ventricular free wall to bulge into the space between the sternal edges and the sharp edges of the sternum to poke into and deform the anterior surface of the heart. These can be effectively hindered by the placement of a rigid barrier over the anterior portion of the heart. Taken together, the studies of the present thesis demonstrate the effects of NPWT on the thorax and intrathoracic organs. NPWT alters wound edge microvascular blood flow and fluid content and affects heart pumping and heart position in relation to the thoracic wall. Rainer Petzina, MD Lund, January 15, 2009
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| 1335. |
- Pietrzak, Michal, et al.
(författare)
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A randomized controlled experimental medicine study of ghrelin in value-based decision making
- 2023
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Ingår i: Journal of Clinical Investigation. - : AMER SOC CLINICAL INVESTIGATION INC. - 0021-9738 .- 1558-8238. ; 133:12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND. The stomach-derived hormone ghrelin stimulates appetite, but the ghrelin receptor is also expressed in brain circuits involved in motivation and reward. We examined ghrelin effects on decision making beyond food or drug reward using monetary rewards. METHODS. Thirty participants (50% women and 50% men) underwent 2 fMRI scans while receiving i.v. ghrelin or saline in a randomized counterbalanced order. RESULTS. Striatal representations of reward anticipation were unaffected by ghrelin, while activity during anticipation of losses was attenuated. Temporal discounting rates of monetary reward were lower overall in the ghrelin condition, an effect driven by women. Discounting rates were inversely correlated with neural activity in a large cluster within the left parietal lobule that included the angular gyrus. Activity in an overlapping cluster was related to behavioral choices and was suppressed by ghrelin. CONCLUSION. This is, to our knowledge, the first human study to extend the understanding of ghrelins significance beyond the canonical feeding domain or in relation to addictive substances. Contrary to our hypothesis, we found that ghrelin did not affect sensitivity to monetary reward anticipation, but rather resulted in attenuated loss aversion and lower discounting rates for these rewards. Ghrelin may cause a motivational shift toward caloric reward rather than globally promoting the value of reward. TRIAL REGISTRATION. EudraCT 2018-004829-82.
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| 1336. |
- Pikilidou, Maria, et al.
(författare)
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Arterial Stiffness and Peripheral and Central Blood Pressure in Patients With Sickle Cell Disease.
- 2015
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1751-7176 .- 1524-6175. ; 17:9, s. 726-731
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Tidskriftsartikel (refereegranskat)abstract
- Blood pressure (BP) in patients with sickle cell disease (SCD) has been reported to be lower than in persons in the general population. Data on arterial stiffness, which is an important risk factor for the progression of BP, are inconclusive for this patient population. Forty-five adult patients with SCD and 40 controls matched for sex, age, and body mass index were studied. Brachial systolic BP (SBP) and diastolic BP (DBP) were significantly lower in the patient group (SBP 115.1±13.8 mm Hg vs 121.9±11.3 mm Hg and DBP 68.5±8.0 mm Hg vs 80.6±9.1 mm Hg, P<.05, respectively). Augmentation index (AIx), however, was significantly higher in SCD patients compared with healthy controls (24.9±9.6 for patients vs 12.4±10.8 for controls, P<.001), while carotid femoral pulse wave velocity was comparable between the two groups. The study shows that mechanisms other than arterial elasticity are involved in the low BP phenotype of patients with SCD.
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| 1337. |
- Pikilidou, Maria I., et al.
(författare)
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Oral Calcium Supplementation Ambulatory Blood Pressure and Relation to Changes in Intracellular Ions and Sodium-Hydrogen Exchange
- 2009
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Ingår i: American Journal of Hypertension. - : Oxford University Press (OUP). - 1941-7225 .- 0895-7061. ; 22:12, s. 1263-1269
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Calcium (Ca2+) supplementation has been shown paradoxically to reduce intracellular Ca2+ and induce vascular relaxation. The aim of the study was to assess 24-h blood pressure (BP) change after Ca2+ supplementation and to investigate its relation to changes in intracellular ions and the activity of the first isoform of sodium-hydrogen exchange (NHE-1) in subjects with hypertension and type 2 diabetes. METHODS This parallel, randomized controlled, single-blinded trial, consisted of 31 patients with type 2 diabetes, and hypertension who were allocated to receive 1,500 mg of Ca2+ per day (n = 15) or no treatment (n = 16) for 8 weeks. RESULTS In the Ca2+ group a decrease of 1.7 +/- 2.7 mm Hg (mean +/- SE) P = 0.52 for mean 24-h systolic BP (SBP) and 2.1 +/- 1.5 mm Hg, P = 0.19 for mean 24-h diastolic BP (DBP) was recorded. Whereas in the control group an increase of 1.4 +/- 2.7 mm Hg, P = 0.59 for mean 24-h SBP and 1.2 +/- 2.8 mm Hg, P = 0.83 for mean 24-h DBP was observed. Intraplatelet Ca2+ decreased whereas intraplatelet magnesium (Mg2+) and erythrocyte K+ increased in the intervention group. Change in mean 24-h SBP in the pooled group correlated with both change in intraplatelet Ca2+ (r = 0.49, P < 0.05) and NHE-1 activity (r = 0.6, P < 0.001). The contribution of intraplatelet Ca2+ was attenuated when both parameters were entered in a multivariate regression model. CONCLUSIONS The present study shows a weak, statistically nonsignificant trend towards association of Ca2+ supplementation on 24-h BP in hypertensive subjects with type 2 diabetes. However, our results indicated an interrelation of [Ca2+], levels and NHE-1 activity on BP in patients with hypertension and type 2 diabetes.
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| 1338. |
- Pikwer, Mitra
(författare)
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Hormonal factors in rheumatoid arthritis – Their impact on disease risk and severity
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rheumatoid arthritis (RA) is 4-6 times more common in women than men during the fertile years. For women, the incidence peaks shortly after menopause, and for men the risk is greater with higher age, when androgen levels drops. Sex hormones have been suggested to play a part in the pathogenesis, since low testosterone levels have been noted in men with RA and pregnancy has an ameliorating effect of the disease in women. Breastfeeding and use of exogenous hormones have been suggested to protect against the disease as well as being associated with a milder phenotype. Our aim was to further investigate associations between hormonal factors and RA. Two large community based cohorts were established in Malmö between 1974 and 1992 (Malmö preventive medicine programme, (MPMP)) and 1991-1996 (Malmö diet and cancer study (MDCS), respectively). Participants answered a questionnaire and blood samples were collected. We identified incident cases of RA by linking the cohorts to four different RA registers. In nested case-control studies, we studied hormonal predictors in women from the MDCS cohort, and analysed androgens in males from the MPMP. By a structured review of female incident cases in the MDCS, clinical outcomes were collected, with the purpose of classifying the severity of the disease. Three clusters were identified; severe RA, mild/moderate RF negative RA and mild/moderate RF positive RA. Longer duration of breastfeeding was associated with a reduced risk of RA (Odds ratio (OR)=0.46, 95% Confidence Interval (CI)=0.24-0.91), and menopause at 45 years of age or earlier was associated with an increased risk of RA (OR=2.42, 95% CI=1.32-4.45), in particular with a mild/moderate Rheumatoid factor (RF) negative phenotype. In multivariate analysis, there was a negative association between levels of testosterone and future development of RF negative RA in men (OR=0.31, CI=0.12-0.85). These results may improve our understanding about the impact hormones have in the complex pathogenesis of RA.
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| 1339. |
- Pompermaier, Laura, 1975-, et al.
(författare)
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Self-inflicted burns in a National Swedish Burn Centre [BRÛLURES VOLONTAIRES DANS UN CTB SUÉDOIS] : an overview [REVUE D’UNE SÉRIE]
- 2019
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Ingår i: Annals of burns and fire disasters. - : Mediterranean Council for Burns and Fire Disasters. - 1592-9558. ; 32:4, s. 272-277
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Tidskriftsartikel (refereegranskat)abstract
- In the Western world, self-inflicted burns are often associated with mental health disorders, and the management, particularly the pain treatment, can often be complicated by the psycho-social background of the patients. The aim was to describe a group of patients with self-inflicted burns by analysing their in-hospital mortality and the use of sedation during procedures. All patients with self-inflicted burns admitted to the Linköping Burn Centre during 2000-2017 were included. The control group consisted of adults (≥17 years) with accidental burns, admitted during the same period. Multivariable logistic and linear regression was used for analysis. Three percent of all patients (47/1601) had self-inflicted burns: most of them were men (60%, 28/47), none was younger than 17 years, and flame was the major cause of injury. Self-inflicted burn patients were younger and had larger burns: mean age (SD) was 42 (16) and 49 (20) years, respectively; mean TBSA (SD) was 29% (26) and 14% (17), respectively. The crude rate of procedures done under sedation was higher (mean (SD) 0.37 (0.23) compared with 0.24 (0.25)) as was crude in-hospital mortality (8/47, 17% compared with 72/1018, 7%). Multivariable analyses showed no difference in the use of sedation for procedures or in-hospital mortality after adjustment for TBSA%, full thickness burns, age and sex. Age and TBSA% were associated with in-hospital mortality, whereas the intentionality of the burn was not. TBSA% and female sex were associated with increased use of sedation for wound care procedures, whereas self-inflicted burns were not.
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| 1340. |
- Porter, MM, et al.
(författare)
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Biopsy sampling requirements for the estimation of muscle capillarization
- 2002
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Ingår i: Muscle and Nerve. - : Wiley. - 0148-639X .- 1097-4598. ; 26:4, s. 546-548
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to determine the number of tibialis anterior biopsy samples and muscle fibers required to estimate the capillary supply of individual muscle fibers (C:F-i). C:F-i was calculated for 25 type 1 fibers in each of 8 images from 3 biopsies of 5 young healthy individuals. Sequential estimation analysis indicated that 50 fibers from one biopsy are sufficient to characterize the C:F-i of the tibialis anterior for a group of subjects. Thus, when analyzing the capillarization of the tibialis anterior, the requirements of only one biopsy sample and 50 fibers means a great reduction in time for analysis and in the invasiveness of the procedure. (C) 2002 Wiley Periodicals, Inc.
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