| 61. |
- Pålsson, Simon, et al.
(författare)
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Risk factors for postoperative myocardial infarct following cholecystectomy : a population-based study
- 2020
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Ingår i: HPB. - : Elsevier. - 1365-182X .- 1477-2574. ; 22:1, s. 34-40
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim was to analyse the risk for myocardial infarction (MI) after cholecystectomy.Methods: The study is based on data from the Swedish Register for Gallstone Surgery (GallRiks) 2006–2014. The cohort was cross-linked with the Swedish Patient Register. Standardised incidence ratio (SIR) was calculated by dividing the observed incidence of MI within 30 days after surgery with the expected incidence of the background population.Results: Altogether 94,577 procedures were included. MI within 30 days postoperatively (30d-po) were registered in 87 cases (0.09%, SIR for MI 3.03; 95% CI 2.43–3.74). MI occurred more often in men (0.15% vs 0.06%), after open surgery (0.34% vs 0.04%), was age related (age >50 years OR 4.05 > 75 years OR 15.70) and occurred more frequently amongst those with gallstone complications and high ASA score (ASA 1; 0.02%, 2; 0.08%, ≥3; 0,64%). The risk for MI within 30d-po was 52.8% if the patient had suffered an infarct within 8 weeks preoperatively. Laparoscopy converted to open and primarily open surgery were independent risk factors (OR 3.05 vs 2.19). The mortality in the group with 30d-po MI was 11.5% vs 0.02%.Conclusion: Delaying elective cholecystectomy for at least 8 weeks after a recent MI reduces the risk for postoperative MI.
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| 62. |
- Sorensson, M., et al.
(författare)
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Self-reported sexual dysfunction in patients with rectal cancer
- 2020
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 22:5, s. 500-512
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Tidskriftsartikel (refereegranskat)abstract
- Aim Patients with rectal cancer often experience sexual dysfunction after treatment. The aim of this study was to evaluate sexual function in a prospective cohort of patients regardless of treatment and tumour stage and explore what factors might affect sexual activity 1 year after diagnosis. Method The QoLiRECT study (Quality of Life in RECTal cancer) is a prospective study on the health-related quality of life in patients with rectal cancer in Denmark and Sweden. Questionnaires were completed at diagnosis and 1 year. Clinical data were retrieved from national quality registries. Results Questionnaire data were available from 1085 patients at diagnosis and 920 patients at 1 year. Median age was 69 years (range 25-100). At diagnosis, 29% of the women and 41% of the men were sexually active, which was lower than an age-matched reference population. This was further reduced to 25% and 34% at 1 year. Risk factors for sexual inactivity were absence of sexual activity prior to the diagnosis and the presence of a stoma. Women experienced reduced lubrication and more dyspareunia at 1 year compared with the time of diagnosis. In men, erectile dysfunction increased from 46% to 55% at 1 year. Conclusion Sexual activity in patients with rectal cancer is lower at diagnosis compared with the population norm and is further reduced at 1 year. The presence of a stoma contributed to reduced sexual activity after operation. Sexual dysfunction was difficult to evaluate due to low sexual activity in the cohort. In men, erectile dysfunction is common.
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| 63. |
- Sturesson, Christian, et al.
(författare)
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Quality-of-life after bile duct injury repaired by hepaticojejunostomy: a national cohort study
- 2020
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 55:9, s. 1087-1092
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Reports on quality-of-life (QoL) after bile duct injury (BDI) show conflicting results. The aim of this cohort study was to evaluate QoL stratified according to type of treatment. Methods QoL assessment using the SF-36 (36-item short form health survey) questionnaire. Patients with post-cholecystectomy BDI needing hepaticojejunostomy (HJ) were compared to all other treatments (BDI repair) and to patients without BDI at cholecystectomy (controls). Results Patients needing a HJ after BDI reported reduced long-term QoL irrespective of time for diagnosis and repair in both the physical (PCS;p < .001) and mental (MCS;p < .001) domain compared to both controls and patients with less severe BDI. QoL was comparable for BDI repair (n = 86) and controls (n = 192) in both PCS (p = .171) and MCS (p = .654). As a group, patients with BDI (n = 155) reported worse QoL than controls, in both the PCS (p < .001) and MCS (p = .012). Patients with a BDI detected intraoperatively (n = 124) reported better QoL than patients with a postoperative diagnosis. Patients with an immediate intraoperative repair (n = 99), including HJ, reported a better long-term QoL compared to patients subjected to a later procedure (n = 54). Conclusions Patients with postoperative diagnosis and patients with BDIs needing biliary reconstruction with HJ both reported reduced long-term QoL.
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| 64. |
- Sundbom, Magnus, et al.
(författare)
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Low overall mortality during 10 years of bariatric surgery : nationwide study on 63,469 procedures from the Scandinavian Obesity Registry
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 16:1, s. 65-70
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bariatric surgery results in an improvement in quality of life, co-morbid diseases, and an increased life expectancy. However, to obtain these benefits perioperative mortality rates need to be low.Objectives: Evaluate 90-day and 1-year mortality after bariatric surgery in Sweden from 2008 to 2017.Setting: National quality register.Methods: Data on applicable patients from the Scandinavian Obesity Surgery Registry, including 63,469 patients (85.1% gastric bypass, 12.5% sleeve gastrectomy, .8% duodenal switch, .5% minor revisions, and 1.1% other procedures), were retrieved and matched to the Cause of Death registry.Results: During the 10-year period, 36 patients died within 90 days, resulting in a .06% overall mortality. The 1-year mortality rate was .19% (n = 111). Both mortality rates decreased over the study period. In a multivariate analysis, depression (odds ratio [OR] 2.38, [95% confidence interval 1.48-3.84]), leakage (OR 9.32 [4.85-17.94]), and thromboembolic events (OR 7.60 [1.63-35.37]) increased mortality risks at both 90 days and 1 year, whereas age (OR 1.03 [1.01-1.06] per increased year of age) and abdominal circumference (OR 1.03 [1.01-1.05] per cm) were also associated with increased mortality at 1 year. The predictive value of the Obesity Surgery Mortality Risk Score was confirmed.Conclusions: The low 90-day and 1-year mortality, .06% and .19%, respectively, demonstrates that bariatric surgery in Sweden is safe. The use of antidepressants and 2 serious postoperative complications were the most significant risk factors for early deaths, while increased age and preoperative abdominal circumference also contributed at 1 year.
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| 65. |
- Tapia, G., et al.
(författare)
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Maternal Microchimerism in Cord Blood and Risk of Celiac Disease in Childhood
- 2020
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Ingår i: Journal of pediatric gastroenterology and nutrition. - : Ovid Technologies (Wolters Kluwer Health). - 0277-2116 .- 1536-4801. ; 71:3, s. 321-327
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: During pregnancy, small quantities of maternal cells are naturally transmitted to the fetus. This transmission, termed maternal microchimerism (MMc), has been implicated in autoimmune diseases but its potential role is unclear. We aimed to investigate if MMc at birth predicted childhood celiac disease (CD) risk, a common immune-mediated enteropathy often presenting in childhood. Methods: We designed a case-control study, nested in the Norwegian Mother, Father and Child Cohort. Participants were HLA class II typed to determine noninherited, nonshared maternal alleles (NIMA). Droplet digital (dd) PCR assays specific for common HLA class II NIMAs (HLA-DQB1*03:01,*04:02 and*06:02/03)were used to estimate the quantity of maternal DNA, as a marker of maternal cells, in cord blood DNA from 124 children who later developed clinically diagnosed CD (median age at end of study 7.4 years, range 3.6-12.9) and 124 random controls. We tested whether presence of MMc was associated with CD using logistic regression, and compared ranks between cases and controls. Results: MMc, for example, maternal HLA antigens not inherited by the child, was found in 42% of cases and 43% of controls, and not associated with CD (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.58-1.60). The ranks of MMc quantities in cases and controls were also similar (Mann-WhitneyU-test,P = 0.71). The subgroup withHLA-DQB1:03*01as their NIMA had a potential association with MMc, where levels greater than median was associated with CD (OR 3.78, 95% CI 1.28-11.18). Conclusion: MMc measured in cord blood was not associated with later risk of CD.
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| 66. |
- van den Akker, Chris H. P., et al.
(författare)
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Probiotics and Preterm Infants : A Position Paper by the European Society for Paediatric Gastroenterology Hepatology and Nutrition Committee on Nutrition and the European Society for Paediatric Gastroenterology Hepatology and Nutrition Working Group for Probiotics and Prebiotics
- 2020
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : Lippincott Williams & Wilkins. - 0277-2116 .- 1536-4801. ; 70:5, s. 664-680
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Tidskriftsartikel (refereegranskat)abstract
- More than 10,000 preterm infants have participated in randomised controlled trials on probiotics worldwide, suggesting that probiotics in general could reduce rates of necrotising enterocolitis (NEC), sepsis, and mortality. Answers to relevant clinical questions as to which strain to use, at what dosage, and how long to supplement are, however, not available. On the other hand, an increasing number of commercial products containing probiotics are available from sometimes suboptimal quality. Also, a large number of units around the world are routinely offering probiotic supplementation as the standard of care despite lacking solid evidence. Our recent network meta-analysis identified probiotic strains with greatest efficacy regarding relevant clinical outcomes for preterm neonates. Efficacy in reducing mortality and morbidity was found for only a minority of the studied strains or combinations. In the present position paper, we aim to provide advice, which specific strains might potentially be used and which strains should not be used. In addition, we aim to address safety issues of probiotic supplementation to preterm infants, who have reduced immunological capacities and occasional indwelling catheters. For example, quality reassurance of the probiotic product is essential, probiotic strains should be devoid of transferable antibiotic resistance genes, and local microbiologists should be able to routinely detect probiotic sepsis. Provided all safety issues are met, there is currently a conditional recommendation (with low certainty of evidence) to provide either Lactobacillus rhamnosus GG ATCC53103 or the combination of Bifidobacterium infantis Bb-02, Bifidobacterium lactis Bb-12, and Streptococcus thermophilus TH-4 in order to reduce NEC rates.
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| 67. |
- Wallenius, Ville, 1970, et al.
(författare)
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Sleeve gastrectomy and Roux-en-Y gastric bypass in the treatment of type 2 diabetes. Two-year results from a Swedish multicenter randomized controlled trial
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 16:8, s. 1035-1044
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obesity is a world-wide epidemic and it is a risk factor for type 2 diabetes (T2D). Few randomized controlled studies have compared the 2 most common surgical procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in the treatment of obese patients with T2D. Objectives: To compare diabetes remission rates (glycosylated hemoglobin <= 6.0%, without diabetes medications) in obese T2D patients (body mass index, 35-50) undergoing RYGB or SG. Setting: Three University Hospital clinics and 1 Regional Hospital in Sweden. Methods: Forty-nine patients with T2D were included. Twenty-five were randomized to RYGB and 24 to SG. There was no difference between groups regarding patient characteristics, duration of T2D, overall usage of antidiabetic medications, or glycosylated hemoglobin levels. All patients (100%) completed 1-year follow-up and 47 (95.9%) 2-year follow-up. Results: Remission of T2D was not significantly different between the RYGB and SG, reaching 44% and 46% (n = 25 and n = 24, respectively, P = .897, power = .80) at 1 year, and 48% and 55% (n = 25 and n = 22, respectively, P = .654) at 2 years of follow-up. Similarly, mean glycosylated hemoglobin was improved in both groups at 1 and 2 years, with no significant differences between the groups (RYGB baseline versus 1 yr; mean +/- standard deviation: 7.9 +/- 1.5 versus 5.8 +/- .6%, P < .0001; versus 2 yr: 5.9 +/- .7%, P < .0001; SG baseline versus 1 yr: 8.2 +/- 1.9 versus 5.9 +/- .7%, P < .0001; versus 2 yr: 5.9 +/- 1.1%, P < .0001). Total weight loss was not different but percentage excess weight loss was higher after RYGB compared with SG both at 1 and 2 years; mean +/- standard deviation: 78 +/- 22 versus 60 +/- 22%, and 76 +/- 24 versus 54 +/- 21%, respectively (P < .01 for both). Waist circumference also decreased significantly more in the RYGB group. Conclusions: Despite superior excess weight loss after RYGB, T2D remission rates did not differ significantly between RYGB and SG after 2 years. Long-term follow-up data are needed to define the role of SG in the treatment of patients with obesity and T2D. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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| 68. |
- Walming, Sofie, et al.
(författare)
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Quality of life in patients with resectable rectal cancer during the first 24 months following diagnosis
- 2020
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 22:12, s. 2028-2037
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Tidskriftsartikel (refereegranskat)abstract
- Aim An increasing number of patients survive rectal cancer, resulting in more patients living with the side-effects of the treatment. Exploring quality of life before and after treatment enables follow-up and additional treatment to be adjusted to the patient's needs. The aim of the study was to describe the quality of life during the 24 months following diagnosis and to identify risk factors for poor quality of life. Method This is a prospective cohort study of patients with rectal cancer followed up by extensive questionnaires. Patients from 16 surgical departments in Denmark and Sweden from 2012 to 2015 were included. The self-assessed quality of life was measured with a seven-point Likert scale. Results A total of 1110 patients treated with curative intent were included, and the response rate at the 24-month follow-up was 71%. Patients with rectal cancer assessed their quality of life before start of treatment as poorer than that of a reference population. At the 12- and 24-month follow-up, the quality of life on group level had recovered to the same level as for the reference population. Risk factors for poor quality of life included bother with urinary, bowel and stoma function. A reference population was used for comparison. Conclusion The quality of life of patients with resectable rectal cancer recovered to levels comparable to a reference population 12 and 24 months after diagnosis. Our results indicate that the urinary, bowel and stoma function has an impact on quality of life.
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| 69. |
- Wennerlund, Jeff, et al.
(författare)
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Acid-related complications after laparoscopic Roux-en-Y gastric bypass : risk factors and impact of proton pump inhibitors
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 16:5, s. 620-625
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Tidskriftsartikel (refereegranskat)abstract
- Background: Laparoscopic Roux-en-Y (LRYGB) gastric bypass is an effective treatment for morbid obesity. Acid-related complications after LRYGB could be prevented by prophylactic proton pump inhibition (PPI).Objective: To identify the effect of PPI prophylaxis on short-term, acid-related complications in a large cohort.Setting: National Registry, Sweden.Methods: A total of 37,301 patients who underwent LRYGB in Sweden from 2009 to 2014 were identified in the Scandinavian Obesity Surgery Registry. Patient-specific factors were cross matched with socioeconomic variables and information on PPI dispensation. A logistic regression model was used to analyze acid-related complications (e.g., marginal ulcer, stricture, and perforation) within 30 days and at 1 year postoperatively.Results: PPI prophylaxis did not reduce the rate of acid-related complications. Instead, prolonged operation time (odds ratio [OR] 2.19 [1.53–3.13]) and immigrant background (OR 1.72 [1.17–2.53]) increased the risk of marginal ulcer within 30 days. At 1 year, medical treatment for diabetes (OR 1.75 [1.14–2.67]) and dyspepsia (OR 1.71 [1.06–2.75]), larger gastric pouch (OR 2.19 [1.528–3.248]), longer operation time (OR 1.67 [1.11–2.51]), smoking (OR 2.59 [1.77–3.78]), and immigrant background (OR 1.60 [1.08–2.36]) increased the risk for marginal ulcer, while older age (OR 2.20 [1.05–4.63]) predisposed for stricture. Inferior weight loss was associated with marginal ulcer at 1 year (OR 1.50 [1.04–2.15]).Conclusion: PPI prophylaxis did not reduce the risk for marginal ulcer and stricture. The risk for these complications was increased by several co-morbidities, smoking, immigrant background, and surgical factors. Routine use of PPI prophylaxis cannot be recommended, but smoking cessation and optimal surgery could be important.
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| 70. |
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