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| 2. |
- Malterling, R R, et al.
(författare)
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Differentiated thyroid cancer in a Swedish county--long-term results and quality of life.
- 2010
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 49:4, s. 454-459
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is still no complete agreement about the proper treatment of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: All patients (n=130) with DTC in a defined population, treated with surgery between 1985 and 1999, were carefully followed up (median 13.1 years). Fifty three were operated with subtotal and 77 with total thyroidectomy. Twenty seven percent of the patients in the subtotal group and 56% of those in the total thyroidectomy group had postoperative radioiodine ablation. Thirty nine patients had papillary cancers incidentally detected during surgery for benign disorders (median size 7 (1-30) mm). Living patients answered the Swedish version of the SF-36 health survey. RESULTS: Eleven of 106 patients considered tumour-free after primary surgery developed recurrences during follow-up. Fifteen patients (12%) died from DTC but only one within stage I-II (1.2%). No patient below 50 years of age at diagnosis died from DTC. Only three of 29 patients with isolated loco-regional spreading of their disease at the time of diagnosis have died from thyroid cancer. There was no statistically significant difference in the 10 year cancer-specific survival rate between those operated with subtotal or total thyroidectomy--irrespective of stage. Survival rate was significantly better for papillary than for follicular cancer. Mental and physical quality of life among patients treated for DTC were similar to the healthy Swedish population. CONCLUSIONS: Patients with DTC stage I-II (according to TNM) or low-risk (according to AMES) have an excellent prognosis. Treatment as well as follow-up should not be exaggerated.
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| 3. |
- Rubér, Marie, et al.
(författare)
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Dysregulated Th1/Th17 response in advanced appendicitis
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The pathogenesis of appendicitis, the most common abdominal emergency for surgical intervention, is still unknown. Epidemiological differences between perforated and nonperforated appendicitis, polymorphism in the interleukin (IL)-6 gene associated with severity of appendicitis and a more pronounced Th1/Th17-like deviation in advanced compared to phlegmonous appendicitis has been reported. Altogether these findings may indicate that appendicitis harbours two different entities with different immuno-pathogenesis, one progressing to gangrene and perforation and one resolving. In this study we aimed to further investigate systemic cytokine profiles in a large sample of patients, with advanced and phlegmonous appendicitis from a Th1, Th2, Th17 and innate perspective, and also clarify if time as duration of symptoms could explain the differences.Methods: Blood samples were preoperatively collected from patients with advanced (n=61) and phlegmonous appendicitis (n=108). The Th1-associated (IFN-γ, IL-12p70), Th2-associated (IL-4, IL-5), Th17-associated (IL-17, IL-6, CCL20, CCL2) and innate-associated (IL-1β, IL-6, MPO, CXCL8, GM-CSF), markers were analyzed in plasma using multiplex bead assay.Results: Patients with advanced appendicitis had increased levels of IL-6 (P=0.0001), CCL2 (P=0.001), MPO (P=0.039), IL-12p70 (P=0.010) and CCL20 (P=0.002) as compared to phlegmonous appendicitis and age, sex or duration of symptoms at sampling could not explain the differences.Conclusion: The findings suggest a dysregulated Th1/Th17 type inflammation in advanced appendicitis, already early in the disease course, that eventuates in gangrene and perforation and gives further support to the notion of appendicitis as two entities.
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| 4. |
- Ahle, Margareta, 1966-, et al.
(författare)
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Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden. A national case-control study
- 2018
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Ingår i: Plos One. - San Francisco, United States : Public Library of Science (PLoS). - 1932-6203. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective To analyze associations of maternal, fetal, gestational, and perinatal factors with necrotizing enterocolitis in a matched case-control study based on routinely collected, nationwide register data. Study design All infants born in 1987 through 2009 with a diagnosis of necrotizing enterocolitis in any of the Swedish national health care registers were identified. For each case up to 6 controls, matched for birth year and gestational age, were selected. The resulting study population consisted of 720 cases and 3,567 controls. Information on socioeconomic data about the mother, maternal morbidity, pregnancy related diagnoses, perinatal diagnoses of the infant, and procedures in the perinatal period, was obtained for all cases and controls and analyzed with univariable and multivariable logistic regressions for the whole study population as well as for subgroups according to gestational age. Results In the study population as a whole, we found independent positive associations with necrotizing enterocolitis for isoimmunization, fetal distress, cesarean section, neonatal bacterial infection including sepsis, erythrocyte transfusion, persistent ductus arteriosus, cardiac malformation, gastrointestinal malformation, and chromosomal abnormality. Negative associations were found for maternal weight, preeclampsia, maternal urinary infection, premature rupture of the membranes, and birthweight. Different patterns of associations were seen in the subgroups of different gestational age. Conclusion With some interesting exceptions, especially in negative associations, the results of this large, population based study, are in keeping with earlier studies. Although restrained by the limitations of register data, the findings mirror conceivable pathophysiological processes and underline that NEC is a multifactorial disease. © 2018 Ahle et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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| 7. |
- Andersson, Roland E.
(författare)
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The Role of Antibiotic Therapy in the Management of Acute Appendicitis
- 2013
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Ingår i: Current Infectious Disease Reports. - : Current Medicine Group. - 1523-3847 .- 1534-3146. ; 15:1, s. 10-13
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Tidskriftsartikel (refereegranskat)abstract
- Nonsurgical treatment with antibiotics has recently been proposed as the first line of treatment for noncomplicated appendicitis. This has met with considerable interest, illustrated by the number of reviews and meta-analyses, which exceed the number of original reports of the issue. The results in these studies are seriously biased due to inclusion of patients with resolving appendicitis. At a time when we need to reduce inappropriate use of antibiotics in the struggle against the increasing rate of antibiotics resistance, there must be strong requirements of a proven effect and an improved cost-benefit ratio before antibiotics treatment is introduced for a new group of patients. These requirements have not yet been met for nonsurgical treatment with antibiotics for assumed uncomplicated appendicitis. Due to the high rate of spontaneous resolution, a randomized placebo-controlled trial is needed that can compare the efficiency of antibiotics treatment and expectant management in this group of patients. Antibiotics treatment, however, remains indicated for treatment of perforated appendicitis with localized abscess or phlegmone and in selected surgical high-risk patients.
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| 8. |
- Ansaloni, Luca, et al.
(författare)
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Guidelines in the management of obstructing cancer of the left colon : consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society
- 2010
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Ingår i: World Journal of Emergency Surgery. - London, UK : BioMed Central (BMC). - 1749-7922. ; 5, s. 29-
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Forskningsöversikt (refereegranskat)abstract
- Background: Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods: The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results: Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B). Conclusions: Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A.
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| 9. |
- Dimberg, Jan, et al.
(författare)
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Gene polymorphism in DNA repair genes XRCC1 and XRCC6 and association with colorectal cancer in Swedish patients
- 2016
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Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS). - : WILEY-BLACKWELL. - 0903-4641 .- 1600-0463. ; 124:9, s. 736-740
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Tidskriftsartikel (refereegranskat)abstract
- The DNA repair genes XRCC1 and XRCC6 have been proposed to participate in the pathological process of cancer by modulating the DNA repair capacity. This study evaluated the susceptibility of the single-nucleotide polymorphisms (SNPs) XRCC1 (rs25487, G amp;gt; A) and XRCC6 (rs2267437, C amp;gt; G) to colorectal cancer (CRC) and their association with clinical parameters in Swedish patients with CRC. Using the TaqMan system, these SNPs were screened in 452 patients and 464 controls. No significant difference in genotype distribution was found between the patients and controls, or any significant association with cancer-specific or disease-free survival in patients. However, we showed that the carriers of allele A in XRCC1 (rs25487, G amp;gt; A) were connected with a higher risk of disseminated CRC (Odds Ratio = 1.64; 95% Confidence Interval = 1.12-2.41, p = 0.012).
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| 10. |
- Magnusson, Amanda, 1986, et al.
(författare)
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Population-based study showed that necrotising enterocolitis occurred in space-time clusters with a decreasing secular trend in Sweden
- 2017
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Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 106:7, s. 1097-1102
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study investigated space-time clustering of neonatal necrotising enterocolitis over three decades. Methods: Space-time clustering analyses objects that are grouped by a specific place and time. The Knox test and Kulldorffs scan statistic were used to analyse space-time clusters in 808 children diagnosed with necrotising enterocolitis in a national cohort of 2 389 681 children born between 1987 and 2009 in Sweden. The municipality the mother lived in and the delivery hospital defined closeness in space and the time between when the cases were born - seven, 14 and 21 days - defined closeness in time. Results: The Knox test showed no indication of space-time clustering at the residential level, but clear indications at the hospital level in all the time windows: seven days (p = 0.026), 14 days (p = 0.010) and 21 days (p = 0.004). Significant clustering at the hospital level was found during 1987-1997, but not during 1998-2009. Kulldorffs scan statistic found seven significant clusters at the hospital level. Conclusion: Space-time clustering was found at the hospital but not residential level, suggesting a contagious environmental effect after delivery, but not in the prenatal period. The decrease in clustering over time may reflect improved routines to minimise the risk of contagion between patients receiving neonatal care.
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