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Sökning: WFRF:(Andreasson Håkan) > Uppsala universitet

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1.
  • Andréasson, Håkan, et al. (författare)
  • Cytoreductive surgery in pseudomyxoma peritonei-aspects of the learning curve
  • 2013
  • Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 40:8, s. 930-936
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Cytoreductive surgery (CRS) plus perioperative intraperitoneal chemotherapy is a highly invasive treatment of peritoneal metastasis and requires many surgical procedures before mastering. The aim of this study was to estimate how many procedures are needed before stabilization can be seen in surgical outcome (R1 surgery, adverse events and bleeding) in patients with pseudomyxoma peritonei (PMP). Patients and methods: All 128 patients with PMP who were treated with CRS alone or CRS plus perioperative intraperitoneal chemotherapy between 2003 and 2008 at the Uppsala University Hospital, Uppsala, Sweden, were included. The learning curve was calculated using the partial least square (PLS) and cumulative sum control chart (CUSUM) graph. Two groups were formed based on the results of the learning curve. The learning curve plateau was considered the same as the stabilization in the CUSUM graph. Group I consisted of patients included during the learning period (n = 73) and Group 11 of patients treated after the learning period ended (n = 55). Comparisons between the groups were made on surgical outcome, survival and adverse events. Results: Stabilization was seen after 220 +/- 10 procedures. A higher occurrence of R1 surgery was seen in Group H (80%) compared to Group I (48%; P = 0.0002). Overall survival increased at four years after surgery in Group H compared to Group I (80% vs. 63%; P = 0.02). Conclusion: CRS plus perioperative intraperitoneal chemotherapy is a highly demanding procedure that requires more than 200 procedures before optimisation in surgical outcome is seen.
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2.
  • Andreasson, Håkan, et al. (författare)
  • Histopathological classification of pseudomyxoma peritonei and the prognostic importance of PINCH protein
  • 2012
  • Ingår i: Anticancer Research. - : International Institute of Anticancer Research (IIAR). - 0250-7005 .- 1791-7530. ; 32:4, s. 1443-1448
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: The aims of this study were i) to assess a new and more detailed histopathological classification and to analyze concordance between pathologists in the histopathological classification of pseudomyxoma peritonei (PMP); ii) to analyze the expression in the stroma of the particularly interesting new cysteine-histidine (PINCH) protein and its prognostic importance in PMP.MATERIALS AND METHODS: Surgical specimens from 81 patients, classified according to the Ronnett et al histopathological classification were compared to a new system with four groups ranging from indolent to aggressive growth patterns. PINCH protein expression was analyzed and was related to clinical variables.RESULTS: The new four-group classification provided better prognostic information than the classification according to Ronnett et al. (p=0.04). Expression of the PINCH protein in the stroma was found in 83% of the cases and was associated with high tumor burden (p=0.002) and a poor prognosis (p=0.04).CONCLUSION: The proposed new PMP classification system may provide additional prognostic information. PINCH protein is expressed in PMP and has prognostic information.
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3.
  • Andréasson, Håkan, et al. (författare)
  • Outcome differences between debulking surgery and cytoreductive surgery in patients with pseudomyxoma peritonei
  • 2012
  • Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 38:10, s. 962-968
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND:The aim of this study was to compare debulking surgery and cytoreductive surgery (CRS) in patients with Pseudomyxoma peritonei (PMP) regarding efficacy and safety.PATIENTS AND METHODS:Data were extracted from medical records and treatment outcomes were analyzed for all 152 patients with PMP who were scheduled for debulking surgery and intraperitoneal chemotherapy (IPC) or CRS and IPC at Uppsala University Hospital, Uppsala, Sweden, between September 1993 and December 2008.RESULTS:One hundred and ten patients (73%) were treated with CRS and IPC and 40 (27%) with debulking surgery and IPC. In two patients (1%), surgery was defined as open and close. Patients with CRS and IPC had a 74% 5-year overall survival (OS) rate compared with 40% for those treated with debulking surgery (P < 0.001). Patients with no residual macroscopic tumour (R1 resection) had a better 5-year OS rate of 94% compared with 28% for patients with macroscopic residual tumour (R2) (P < 0.001). Grades II-IV adverse events were seen in 29% of debulked patients and in 47% of CRS/IPC patients (P = 0.053).CONCLUSIONS:CRS and IPC seems more efficient than debulking surgery and IPC but with numerically higher morbidity. Therefore, if surgically possible, CRS should be the treatment of choice for PMP patients. However, debulking surgery may still be of benefit to selected patients for palliative purposes.
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4.
  • Andréasson, Håkan (författare)
  • Pseudomyxoma Peritonei : Aspects of Natural History, Learning Curve, Treatment Outcome and Prognostic Factors
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Pseudomyxoma peritonei (PMP) is a rare disease characterized by mucinous peritoneal metastasis (PM). Different loco-regional treatment strategies, i.e. debulking surgery and cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC), have changed the prognosis for these patients. CRS is an aggressive surgical procedure with a long learning curve. PMP exists in different types; how many depends on which classification is used.The aims of this thesis were to investigate the time-frame of PMP development from an isolated appendiceal neoplasm, examine the learning process for CRS, evaluate the differences in treatment outcome between debulking surgery and CRS in combination with HIPEC, to evaluate a more detailed PMP classification and to investigate particularly interesting new cysteine-histidine (PINCH) protein as a prognostic factor for PMP.Retrospectively 26 PMP patients were identified as having had an appendectomy with a neoplasm in the appendix but with no evidence of PM at the appendectomy. They were treated for PMP within a median of 13.1 months (3.8-95.3) after the appendectomy. No difference was seen between the types of PMP regarding the time to a clinically significant development of PMP and how much tumour was found at treatment. CRS is a highly invasive treatment and stabilization in the learning curve was seen after 220±10 procedures. Patients treated with CRS+HIPEC had a better 5-year overall survival (OS) than patients treated with debulking surgery, 74% vs. 40%. CRS increased the rate of complete cytoreduction from 25% in patients treated with debulking surgery to 72%. The new four-grade PMP classification showed very good inter-rater agreement between two independent pathologists and a difference in survival rates was observed between the different grades. A positive PINCH staining was recorded in 83% of the tumours and that was associated with poorer survival.
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6.
  • Bjersand, Kathrine, et al. (författare)
  • Drug Sensitivity Testing in Cytoreductive Surgery and Intraperitoneal Chemotherapy of Pseudomyxoma Peritonei
  • 2015
  • Ingår i: Annals of Surgical Oncology. - : Springer Science and Business Media LLC. - 1068-9265 .- 1534-4681. ; 22, s. S810-S816
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) is an established therapy for pseudomyxoma peritonei (PMP). However, the role of IPC is unclear. By ex vivo assessment of PMP tumor cell sensitivity to cytotoxic drugs, we investigated the basis for IPC drug selection and the role of IPC in the management of PMP.METHODS: Tumor cells were prepared by collagenase digestion of tumor tissue from 133 PMP patients planned for CRS and IPC. Tumor cell sensitivity to oxaliplatin, 5FU, mitomycin C, doxorubicin, irinotecan, and cisplatin was assessed in a 72-h cell-viability assay. Drug sensitivity was correlated to progression-free survival (PFS) and overall survival (OS).RESULTS: Samples from 92 patients were analyzed successfully. Drug sensitivity varied considerably between samples. Peritoneal mucinous carcinomatosis (PMCA), compared with PMCA intermediate or disseminated peritoneal adenomucinosis, was slightly more resistant to platinum and 5FU and tumor cells from patients previously treated with chemotherapy were generally less sensitive than those from untreated patients. Multivariate analysis showed patient performance status and completeness of CRS to be prognostic for OS. Among patients with complete CRS (n = 61), PFS tended to be associated with sensitivity to mitomycin C and cisplatin (p ≈ 0.06). At the highest drug concentration tested, the hazard ratio for disease relapse increased stepwise with drug resistance for all drugs.CONCLUSIONS: Ex vivo assessment of drug sensitivity in PMP provides prognostic information. The results suggest a role for IPC as therapeutic adjunct to CRS and for individualization of IPC by pretreatment assessment of drug sensitivity.
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7.
  • Cashin, Peter, et al. (författare)
  • Appendiceal Adenocarcinoids with Peritoneal Carcinomatosis Treated with Cytoreductive Surgery and Intraperitoneal Chemotherapy : a retrospective study of in vitro drug sensitivity and survival
  • 2011
  • Ingår i: Clinical Colorectal Cancer. - : Elsevier BV. - 1533-0028 .- 1938-0674. ; 10:2, s. 108-112
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The purpose of this study was to present results on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) of appendiceal adenocarcinoid (MC) with peritoneal carcinomatosis (PC), to assess drug sensitivity of AAC, as compared with colorectal cancer (CRC), and to report any discordant histopathology. Methods: Ten patients were treated with CRS and HIPEC. Treatment, drug sensitivity profiles, histopathology, and survival data were recorded and matched with potential prognostic indicators. Drug sensitivity was assessed with short-term fluorometric microculture cytotoxicity assay and compared with peritoneal metastases from CRC. Results: Patients with completeness of cytoreduction score (CC) 1 (16.4 months). In the CC 1 group. For standard drugs, tumor cells from MC and CRC were equally sensitive; except for docetaxel, to which MC was more sensitive than CRC. Conclusion: The CC-score correlated with overall survival. Candidates for this type of treatment should be referred early for evaluation in order to reach a better CC score. Drugs used for CRC also seem adequate for treatment of MC, although other drugs, eg, docetaxel, might be more active.
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8.
  • Ciray, Ipek, et al. (författare)
  • Evaluation of new sclerotic bone metastases in breast cancer patients during treatment
  • 2000
  • Ingår i: Acta Radiologica. - 0284-1851 .- 1600-0455. ; 41:2, s. 178-182
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: According to the World Health Organization (WHO) criteria for response of bone metastases to therapy, new lesions indicate progressive disease. We intended to prove that a new sclerotic lesion on conventional radiography may also be a sign of a positive therapeutic response in a previously undetectable lytic metastasis. MATERIAL AND METHODS: In a previous placebo-controlled clinical trial of clodronate (Ostac) therapy, 139 breast cancer patients with bone metastases underwent both conventional radiography and bone scan every 6 months for 2 years with 99mTc before and during clodronate treatment. WHO criteria were applied for therapy response evaluation. RESULTS: In 24 patients, 52 new sclerotic lesions observed during therapy were selected for re-evaluation of conventional radiographs and bone scans. In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. These lesions were possibly misinterpreted as new when applying WHO criteria. CONCLUSION: For better assessment of new sclerotic lesions during treatment, more sensitive techniques, e.g. bone scan, are needed as a complement to conventional radiography.
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9.
  • Holmberg, Lina, et al. (författare)
  • Penetrating Trauma on the Rise – Nine-year Trends of Severe Trauma in Sweden
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • PurposeSweden has an established trauma system involving national trauma criteria and a registry, SweTrau, since over a decade. Meanwhile, the injury panorama has evolved, with an increase in gang-related violence in the Swedish community. In this study, we aimed to investigate long-term trends in mortality, management and trauma type in two major Swedish trauma centers over a nine-year period. MethodsAll trauma patients with a New Injury Score (NISS)>15 or a Trauma Alert call during 2013-2021 were identified in the participating centers’ SweTrau registries. Data were analysed regarding mortality, proportion of emergency interventions, intensive care unit (ICU) admissions, mechanism of injury and type of trauma (penetrating or blunt). To assess trends, Chi-Squared test for trend and JoinPoint regression method were used. ResultsA total of 10585 patients were included in the study. Mortality remained unchanged over time in patients with NISS>15 (10.0% - 10.9%, p=0.963) but increased in NISS<15 (1.3% - 2.7%, p=0.005), partly comprising penetrating trauma, suicides and traumatic cardiac arrests. For NISS>15, the proportion undergoing emergency interventions was stable (53.9%-48.8%, p=0.297) while ICU admissions declined (62.1%-45.7%, p<0.001). Penetrating trauma increased (12.4%-19.6%, p<0.001), including knife (10.0%-15.7%, p<0.001) and gunshot wounds (2.3%-3.8%, p<0.001), whereas accidents involving motorcycles (8.8%-7.0%, p=0.004) and pedestrians (5.3%-2.2%, p<0.001) decreased. ConclusionsIn this trend analysis at two major Swedish trauma centers during 2013-2021, penetrating trauma increased with over 50% while traffic injuries decreased. The rise in mortality in patients with NISS<15 is concerning and requires further evaluation, as do the reduction in ICU admissions. 
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10.
  • Holmberg, Lina (författare)
  • Trauma Care - Implementation, Evaluation and Validation
  • 2024
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Trauma is a major cause of death and morbidity in all ages, which makes continuous improvement of trauma care a high priority. During the last decades, Sweden’s trauma system has evolved with initiation of a national trauma registry (SweTrau) in 2011 and the Swedish National Trauma Triage criteria (SNTTC) in 2017. However, the Swedish trauma panorama has evolved as well, something this thesis aimed to explore, alongside with evaluating the safety and accuracy of the SNTTC and performing the first validation of SweTrau. Paper I is a prospective stepped-wedge cohort study, showing unchanged 30-day mortality, over- and undertriage after the implementation of the SNTTC, as well as a reduction of the lowest level of trauma call by almost 50%, proving that the SNTTC are safe to use. In Paper II, a retrospective multicentre cohort study, the SNTTC are further investigated, displaying a sensitivity of almost 85% while also assessing specificity, positive predictive value (PPV) and positive likelihood ratio (LR+). With no additional enhancing criteria found, the SNTTC are concluded to efficiently identify severely injured patients. Paper III reports the first validation of SweTrau; an on-site re-registration compared with the original registration in SweTrau. It demonstrates that the data in SweTrau is reliable, with high accuracy (85.8%), correctness (89.7%), data completeness (88.5%) and correlation (87.5%), while being comparable to international trauma registries using the Utstein template of trauma. Case completeness and timeliness are identified as areas of improvement. In Paper IV, nine-year trauma trends in two major trauma centres are analysed in a retrospective cohort study. A sharp reduction in intensive care unit admissions is seen, as well as a worrying increase in penetrating trauma (>50%) and mortality for patients with a low injury severity score (1.3%-2.7%, p=0.005), all of which require further investigation. In conclusion; this thesis has confirmed that the SNTTC are safe and efficient, as well as pin-pointed important trauma areas to focus on in the future. Finally, it has established the validity of the data in SweTrau - a major source of Swedish trauma research.   
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