| 151. |
- Olsson, Rolf, et al.
(författare)
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High prevalence of small duct primary sclerosing cholangitis among patients with overlapping autoimmune hepatitis and primary sclerosing cholangitis
- 2009
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Ingår i: EUROPEAN JOURNAL OF INTERNAL MEDICINE. - : Elsevier BV. - 0953-6205 .- 1879-0828. ; 20:2, s. 190-196
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Tidskriftsartikel (refereegranskat)abstract
- Background: Overlap syndrome is a term used for overlapping features of autoimmune hepatitis and primary sclerosing cholangitis or primary biliary cirrhosis and for autoimmune cholangitis. We describe a high prevalence of small duct primary sclerosing cholangitis among patients with overlapping autoimmune hepatitis and primary sclerosing cholangitis. Methods: We sought to retrieve all patients with overlap syndrome between primary sclerosing cholangitis and autoimmune hepatitis in six university hospitals in Sweden. The revised autoimmune hepatitis scoring system proposed by the International Autoimmune Hepatitis Group was used to establish the diagnosis autoimmune hepatitis. Endoscopic retrograde cholangiography and/or magnetic resonance cholangiography were used to separate the primary sclerosing cholangitis cases diagnosed through liver biopsy into small and large primary sclerosing cholangitis. A histologocial diagnosis compatible with both autoimmune hepatitis and primary sclerosing cholangitis was required for inclusion. Results: 26 patients fulfilled our criteria for histological overlap of autoimmune hepatitis and primary sclerosing cholangitis, 7 (27%) of which had small duct primary sclerosing cholangitis. The reliability of the diagnosis small duct primary sclerosing cholangitis was supported by a very close similarity between small and large duct primary sclerosing cholangitis patients in clinical and laboratory data, and by a poor response to immunosuppressive therapy in the small duct primary sclerosing cholangitis patients. Patients with large duct overlap syndrome had a good response to immunosuppressive therapy. In both groups, our limited experience from ursodeoxycholic acid was largely poor. Conclusions: Small duct primary sclerosing cholangitis is prevalent in the overlap syndrome between autoimmune hepatitis and primary sclerosing cholangitis.
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| 152. |
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| 153. |
- Olsson, Rolf, 1969-
(författare)
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MANAGING PROJECT UNCERTAINTY BY USING AN ENHANCED RISK MANAGEMENT PROCESS
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An increasing number of companies are focusing their efforts on project management. Project management is frequently used as an enabler for meeting an uncertain and turbulent environment. Consequently, the overall effectiveness of the project management process is essential for long-term profitability. The aim and final effects of project management are to predict the outcome, i.e. cost, time and quality. However, uncertainty is inherent in the objectives of the project itself, as we use assumptions and expectations in defining and realizing the outcome of the project. A project’s ability to identify and react to uncertainty will influence the outcome of the project. Presently, risk management processes exist in several forms and are often used to manage uncertainty. However, it is frequently argued in academia as well as for the practitioner that risk management does not live up to expected results. The overall objective of this research is to improve the process for managing risks and opportunities within a project organization. The research starts from the single project view, followed by the strategic link to business strategy by including the project portfolio management perspective. Finally, the research focuses on opportunities and the ability of a project to realize them. Thus, the research questions addressed concern how risk is conceived in a theoretical global context and how this would assist in developing a methodology for risk management in an international project organization. They also involve how risk management within a project portfolio could be conducted and its effectiveness measured. Finally, the research questions also address how the management of opportunities could be improved. This research includes the development of four methodologies, based on industrial need. A holistic approach with a systems perspective has been used in order to handle the complexity of the research task. Both empirical and theoretical material has been used for developing the proposed methodologies. The developed methodologies for project risk management and the measures of its effectiveness have been tested and improved over a five-year period within the complete case company. Subsequently, two of them were implemented. The developed methodologies show that the risk management process in a single project does not foster learning and is not directly applicable within a portfolio of projects. Furthermore, the risk management process is not able to address all types of uncertainty. The project manager is a major factor in an effective management of uncertainty. When identifying and managing opportunity, having the ability to create a holistic view, to oversee both customer expectations, and to communicate project related information are important factors. Furthermore, the implementation also showed that it is actually possible, through the consistent use of a risk management process, to develop a cultural behavior within an organization that is much more preventive and proactive than before.
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| 154. |
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| 155. |
- Olsson, Rolf, et al.
(författare)
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Simultaneous videoradiography and computerized pharyngeal manometry--videomanometry
- 1994
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Ingår i: Acta Radiologica. - 1600-0455. ; 35:1, s. 30-34
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Tidskriftsartikel (refereegranskat)abstract
- To obtain more information about muscle function in patients with dysphagia, simultaneous barium swallow and computerized pharyngeal manometry with solid-state pressure transducers was employed for the evaluation of the pharynx and the pharyngoesophageal segment (PES) in 30 consecutive patients. The manometry catheter was positioned under fluoroscopic control, providing localized measurements of the intraluminal pressures in the pharynx. Sixteen patients had a normal barium swallow. In 5 (31%) of these the manometry disclosed PES dysfunction, i.e. increased resting pressures between swallows in 3 patients (mean 120 +/- 13 mm Hg), and increased contraction pressures during peristalsis in 2 (mean 297 +/- 21 mm Hg). Barium swallow and manometry are complementary: the former reflecting transport through the pharynx and penetration to the airways, the latter the intraluminal pressures created by the pharyngeal wall. The combination of barium swallow and manometry gives information about pressure in relation to bolus transport, which may elucidate pharyngeal dysfunction.
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| 156. |
- Olsson, Rolf, et al.
(författare)
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Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers
- 1995
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Ingår i: Dysphagia. - 1432-0460. ; 10:1, s. 36-41
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Tidskriftsartikel (refereegranskat)abstract
- Recent technological advances in manometry, including solid state transducers and computerized analysis, allows for reliable interpretation of intraluminal pharyngeal pressures. Simultaneous videoradiography (barium swallow) provides fluoroscopic control of the manometric sensors (videomanometry), thereby eliminating the uncertainty of sensor dislocation during laryngeal elevation. This is the first study describing normal manometric parameters in videomanometry during barium swallow. Seven manometric parameters and six videoradiographic parameters were analyzed. We included 25 nondysphagic volunteers with normal videoradiographic parameters in the study. The examination was performed in an upright physiologic position during 10-ml barium and dry swallows. Mean resting pressure in the upper esophageal sphincter was 89.6 +/- 32.6 (+/- 2 SD) mmHg. Mean residual pressure during relaxation of the upper esophageal sphincter was 7.2 +/- 8.0 (+/- 2 SD) mmHg during barium swallow and 3.8 +/- 6.2 (+/- 2 SD) mmHg during dry swallow. The mean duration of upper esophageal sphincter relaxation was 601 +/- 248 (+/- 2 SD) msec. The mean peristaltic contraction of the upper esophageal sphincter was 253.8 +/- 142.8 (+/- 2 SD) mmHg. Fourteen (56%) of the 25 had a measurable intrabolus pressure (mean 33.2 +/- 17.3 mmHg) at the level of the inferior pharyngeal constrictor. A specific finding was discovered when the epiglottis tilts down hitting the manometric sensor. This epiglottic tilt was identified in 7 subjects (28%) and caused pressures of around 600 mmHg. A standardized manometric technique is important in videomanometry, and normal values as described in this study are essential in clinical use.
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| 157. |
- Olsson, Rolf, et al.
(författare)
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Solid-state computerized manometry improves diagnostic yield in pharyngeal dysphagia: simultaneous videoradiography and manometry in dysphagia patients with normal barium swallows
- 1995
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Ingår i: Abdominal Imaging. - 0942-8925. ; 20:3, s. 230-235
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Dynamic barium radiology with cine- or video recording has been the most frequently used technique for assessing patients with pharyngeal dysphagia. Although the diagnostic yield of the barium swallow has been high, many patients with pharyngeal dysphagia have normal dynamic barium radiology and remain a diagnostic dilemma. Could manometry add important diagnostic information in these patients? MATERIAL AND METHODS: We examined 19 patients (12 men and 7 women, mean age 47 years, range 19-69 years) with pharyngeal dysphagia but a normal barium swallow with simultaneous videoradiography and pharyngeal manometry and compared their manometry to that found in 24 normal volunteers (11 men and 13 women, mean age 37 years, range 23-59 years). RESULTS: Comparing mean values, the patient group showed statistically significant differences from the control group for eight of 10 manometric parameters. Fourteen of 19 patients showed at least one (five patients) and in most cases multiple (nine patients) manometric abnormalities (values exceeding normal mean by +/- 2SD) which might have contributed to their dysphagia: five patients with high upper esophageal sphincter (UES) resting pressures, five with high UES residual pressures, three with weak pharyngeal contractions, three with pharyngeal "spasms," seven with prolonged contraction/relaxation times, five with reduced compliance, and seven with UES/P incoordination. CONCLUSIONS: Solid-state computerized manometry is a useful adjunct to videoradiography and can provide potentially important additional information in the diagnosis of dysphagia patients.
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| 158. |
- Olsson, Rolf, et al.
(författare)
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Videomanometric aspects of pharyngeal constrictor activity
- 1996
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Ingår i: Dysphagia. - 1432-0460. ; 11:2, s. 83-86
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Tidskriftsartikel (refereegranskat)abstract
- Pressure changes were registered with videomanometry (simultaneous manometry and barium swallow) in the pharynx and in the pharyngoesophageal segment (PES) during swallowing. A considerable longitudinal asymmetry was found. Peak pressure was highest in the PES, lower in the inferior constrictor area, and lowest at the level of the tongue base. The rate of pressure rise was highest at the level of the PES. The speed of propagation of the contraction wave was 13 (+/- 2) cm/sec. There was no correlation between the measured variables (i.e., peak pressure, rate of pressure rise, and speed of contracting wave). Our findings can partly be explained by different mechanical constraints at different levels of the pharynx but may also reflect the organization of neural control of swallowing in the brainstem. Knowledge of transducer position and orientation is essential for the evaluation of pharyngeal pressure during swallowing. Such knowledge is best achieved by performing manometry simultaneously with fluoroscopy, i.e., videomanometry.
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| 159. |
- Olsson, Rolf, et al.
(författare)
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Videomanometry of the pharynx in dysphagic patients with a posterior cricopharyngeal indentation
- 1995
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Ingår i: Academic Radiology. - 1878-4046. ; 2:7, s. 597-601
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE AND OBJECTIVES: Patients with a posterior indentation in the pharyngoesophageal segment (PES) are generally considered to have an abnormality of the cricopharyngeal muscle (CPM). In this study we determined the actual width of the PES and the pressure circumstances during swallowing within the pharynx and PES in such patients. METHODS: Simultaneous videofluoroscopy and solid state manometry, radiologic examination of the pharynx, PES, and cervical esophagus were performed in 16 dysphagic patients with a cricopharyngeal (CP) bar. In eight patients the indentation was 25-50%, and in eight it was more than 50% of the adjacent gullet. Sixteen dysphagic patients without a CP bar were used as control subjects. In each patient swallows of 10-ml barium bolus were recorded. RESULTS: Patients with CP bars had a significantly wider PES above (p = .0005) and below (p = .02) the CPM, whereas the diameter at the level of the CPM was smaller only in the patients with more than 50% indentation compared with the patients without a CP bar. The contraction pressure above the CP bar (i.e., at the level of the inferior pharyngeal constrictor) was significantly (p = .002) weaker in patients with a CP bar (131 +/- 16 mm Hg) than in those without a CP bar (222 +/- 20 mm Hg). CONCLUSION: Our findings in patients with a posterior CP bar suggest that the major abnormality is weak constrictors with outpouching of the gullet above and below. Only in patients with more than 50% indentation was there a slight narrowing at the level of the CP bar. The CPM showed no manometric abnormalities in terms of resting pressure, relaxation, and contraction pressure. Therefore, the CPM is likely to relax and distend normally during swallowing in patients with a CP bar.
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| 160. |
- Olsson, Rolf, et al.
(författare)
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Videomanometry of the pharynx in dysphagic patients with laryngeal barium penetration during swallowing
- 1998
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Ingår i: Acta Radiologica. - 1600-0455. ; 39:4, s. 405-409
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study used simultaneous videomanometry to measure pressure characteristics in a group of patients with evidence of laryngeal and/or tracheal barium penetration, and to compare the results to those of one group of healthy volunteers and one group of patients with dysphagia but a normal barium swallow. MATERIAL AND METHODS: Videomanometry during barium swallowing was performed in 25 patients who showed penetration of barium into the laryngeal vestibule. Manometric abnormalities were determined by comparing these mean values with those of 25 healthy volunteers, and the frequency of manometric abnormalities was compared to that of 19 patients presenting with oropharyngeal dysphagia with a normal barium swallow. RESULTS: The frequency of abnormalities for four parameters (pharyngo-esophageal segment (PES) resting pressure, PES relaxation duration, pharyngeal peak pressure, pharyngeal contraction duration) differed significantly between the patients with penetration and those with normal barium studies. There was, however, no association between manometric abnormalities and the degree of barium penetration. CONCLUSION: The differences in manometric abnormalities between patients with laryngeal penetration and patients with normal barium swallows may be useful in identifying the mechanisms of laryngeal penetration.
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