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Träfflista för sökning "WFRF:(Andreasson Håkan) srt2:(2010-2014);hsvcat:3"

Sökning: WFRF:(Andreasson Håkan) > (2010-2014) > Medicin och hälsovetenskap

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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)
  • 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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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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5.
  • Morén, Håkan, et al. (författare)
  • Angiography and mfERG show that blood supply to the pig retina may be both ipsilateral and contralateral.
  • 2013
  • Ingår i: Investigative Ophthalmology & Visual Science. - : Association for Research in Vision and Ophthalmology (ARVO). - 1552-5783. ; 54:9, s. 6112-6117
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: We recently presented a transfemoral endovascular coiling technique for inducing experimental retinal ischemia in pigs. Substantial variation was seen in the degree of ischemia. It was hypothesized that the blood supply to the retina may originate from both the ipsi- and contralateral ophthalmic arteries, and that there may be an interconnecting artery between the eyes. Methods: The external carotid system of ten pigs was catheterized using a fluoroscopy- monitored, transfemoral, endovascular approach. Vascular occlusion was achieved in the ophthalmic artery using coils. The effect of occlusion was examined using angiography and multifocal electroretinography (mfERG). Results: During angiography of the ophthalmic artery on one side, contrast filling was seen in the retinas on both sides, suggesting that the ophthalmic artery on one side may supply both retinas. A blood vessel connecting the eyes was visualized. mfERG recordings showed that the use of coiling to occlude the ophthalmic artery had greater ischemic effects in eyes that depended mainly on the ipsilateral ophthalmic artery for blood supply and smaller ischemic effect in retinas that received blood from both the ipsilateral and contralateral ophthalmic artery via the interconnecting vessel. Conclusions: The blood supply to the retina may originate from both the ipsi- and contralateral ophthalmic artery in the pig. There is an interindividual variability in the ischemic effect of occlusion depending on the architecture of the vasculature. These findings may be important in the development of new animal models of experimental retinal ischemia, since arterial occlusion in one eye may affect the blood supply to the contralateral eye.
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6.
  • Morén, Håkan, et al. (författare)
  • Endovascular Coiling of the Ophthalmic Artery in Pigs to Induce Retinal Ischemia
  • 2011
  • Ingår i: Investigative Ophthalmology & Visual Science. - : Association for Research in Vision and Ophthalmology (ARVO). - 1552-5783. ; 52:7, s. 4880-4885
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE. The authors recently showed that the retinal circulation can be accessed by transfemoral endovascular catheterization. The purpose of this study was to examine whether endovascular coiling can be used to induce different degrees of ischemic injury. The possibility of creating occlusions at different sites in the vasculature to cause retinal ischemia with different degrees of severity was investigated. METHODS. The ophthalmic artery was catheterized through the external carotid system using a fluoroscopy-monitored, transfemoral, endovascular approach in 12 pigs (mean weight, 70 kg). The effects were evaluated using angiography and multifocal electroretinography. RESULTS. Occlusion of arteries supplying the retina was established using endovascular coiling. Coiling in the proximal part of the ophthalmic artery caused no or little ischemia, presumably because of collateral blood supply. Coiling in the distal part of the ophthalmic artery, over the branching of the main ciliary artery, caused more severe retinal ischemia. Multifocal electroretinography recordings, which reflect retinal function in an area close to the visual streak, showed decreased amplitudes and increased implicit times after distal occlusion, but not after proximal occlusion of the ophthalmic artery. The responses were similar 1 hour and 72 hours after coiling, indicating that a permanent ischemic injury was established. CONCLUSIONS. The porcine ophthalmic artery can be occluded using an endovascular coiling technique. This provides an experimental animal model of retinal ischemia in which occlusion at different sites of the vasculature produces different degrees of severity of the ischemic damage. (Invest Ophthalmol Vis Sci. 2011;52:4880-4885) DOI:10.1167/iovs.11-7628
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7.
  • Morén, Håkan, et al. (författare)
  • Multifocal electroretinogram for functional evaluation of retinal injury following ischemia-reperfusion in pigs.
  • 2010
  • Ingår i: Graefe's Archive for Clinical and Experimental Ophthalmology. - : Springer Science and Business Media LLC. - 1435-702X .- 0721-832X. ; 248, s. 627-634
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Multifocal electroretinogram (mfERG) has the power to discriminate between localized functional losses and overall retinal changes when evaluating retinal injury. So far, full-field ERG has been the gold standard for examining retinal ischemia and the effects of different neuroprotectants in experimental conditions. The aim of the present study was to establish mfERG, with simultaneous fundus monitoring, for analyzing the localized functional response in the retina after ischemia-reperfusion in the porcine eye. METHODS: 70 kg pigs underwent pressure-induced retinal ischemia (1 hour) followed by reperfusion. mfERG recordings were obtained before and after ischemia, followed by 1 and 5 hours of reperfusion. Individual components of the summed mfERG responses were correlated to ischemia and the time of reperfusion. RESULTS: The visual streak area had significantly higher amplitudes than the optic nerve head and the area in between, suggesting that the mfERG monitors localized functional retinal responses. The mfERG recordings were altered following ischemia-reperfusion. In one group of animals, there was a complete flattening of the mfERG waveforms, indicating complete ischemic injury. In the other group of animals, ischemia-reperfusion altered the mfERG such that the implicit time was increased (20.82 +/- 0.18 before ischemia and 21.57 +/- 0.21 after ischemia and 1 hour of reperfusion, in the visual streak area, p < 0.05) and the amplitude was decreased (13.16 +/- 2.3 before ischemia and 11.47 +/- 0.88 after ischemia and 1 hour of reperfusion, in the visual streak area, p < 0.001), suggesting partial ischemic injury. CONCLUSIONS: In conclusion, the porcine model of pressure-induced retinal ischemia-reperfusion results in mfERG changes, typical for retinal ischemia. mfERG may be a useful tool for evaluating and monitoring localized cone dysfunction after an ischemic injury.
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