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| 2. |
- Arnbjörnsson, Einar
(författare)
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Acute Appendicitis and Dietary Fiber
- 1983
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Ingår i: Archives of Surgery. - : American Medical Association (AMA). - 0004-0010. ; 118:7, s. 868-870
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Tidskriftsartikel (refereegranskat)abstract
- The role of dietary fiber in the cause of acute appendicitis was evaluated. By means of food diaries the average daily fiber consumption was determined in 31 patients with acute appendicitis and in 30 control patients, matched for age and sex. The average daily dietary fiber intake was 17.4 g in the group with appendicitis and 21.0 g in the control group. The difference is statistically significant. Adjustment for the total energy intake in each instance did not change this conclusion. The results support the hypothesis that diet, in particular a lack of fiber, may be an important factor in the pathogenesis of acute appendicitis.
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| 3. |
- Bonjer, H. Jacob, et al.
(författare)
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Laparoscopically assisted vs open colectomy for colon cancer : a meta-analysis
- 2007
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Ingår i: Archives of surgery (Chicago. 1960). - 0004-0010 .- 1538-3644. ; 142:3, s. 298-303
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: To perform a meta-analysis of trials randomizing patients with colon cancer to laparoscopically assisted or open colectomy to enhance the power in determining whether laparoscopic colectomy for cancer is oncologically safe. DATA SOURCES: The databases of the Barcelona, Clinical Outcomes of Surgical Therapy (COST), Colon Cancer Laparoscopic or Open Resection (COLOR), and Conventional vs Laparoscopic-Assisted Surgery in Patients With Colorectal Cancer (CLASICC) trials were the data sources for the study. STUDY SELECTION: Patients who had at least 3 years of complete follow-up data were selected. DATA EXTRACTION: Patients who had undergone curative surgery before March 1, 2000, were studied. Three-year disease-free survival and overall survival were the primary outcomes of this analysis. DATA SYNTHESIS: Of 1765 patients, 229 were excluded, leaving 796 patients in the laparoscopically assisted arm and 740 patients in the open arm for analysis. Three-year disease-free survival rates in the laparoscopically assisted and open arms were 75.8% and 75.3%, respectively (95% confidence interval [CI] of the difference, -5% to 4%). The associated common hazard ratio (laparoscopically assisted vs open surgery with adjustment for sex, age, and stage) was 0.99 (95% CI, 0.80-1.22; P = .92). The 3-year overall survival rate after laparoscopic surgery was 82.2% and after open surgery was 83.5% (95% CI of the difference, -3% to 5%). The associated hazard ratio was 1.07 (95% CI, 0.83-1.37; P = .61). Disease-free and overall survival rates for stages I, II, and III evaluated separately did not differ between the 2 treatments. CONCLUSION: Laparoscopically assisted colectomy for cancer is oncologically safe.
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- Gustafsson, Ulf O., et al.
(författare)
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Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery
- 2011
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Ingår i: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 146:5, s. 571-577
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery. Design: Single-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression. All clinical data (114 variables) were prospectively recorded. Setting: Ersta Hospital, Stockholm, Sweden. Patients: Nine hundred fifty-three consecutive patients with colorectal cancer: 464 patients treated in 2002 to 2004 and 489 in 2005 to 2007. Main Outcome Measures: The association between improved adherence to the ERAS protocol and the incidence of postoperative symptoms, complications, and length of stay following major colorectal cancer surgery was analyzed. Results: Following an overall increase in preoperative and perioperative adherence to the ERAS protocol from 43.3% in 2002 to 2004 to 70.6% in 2005 to 2007, both postoperative complications (odds ratio, 0.73; 95% confidence interval, 0.55-0.98) and symptoms (odds ratio, 0.53; 95% confidence interval, 0.40-0.70) declined significantly. Restriction of intravenous fluid and use of a preoperative carbohydrate drink were major independent predictors. Across periods, the proportion of adverse postoperative outcomes (30-day morbidity, symptoms, and readmissions) was significantly reduced with increasing adherence to the ERAS protocol (>70%, >80%, and >90%) compared with low ERAS adherence (<50%). Conclusion: Improved adherence to the standardized multimodal ERAS protocol is significantly associated with improved clinical outcomes following major colorectal cancer surgery, indicating a dose-response relationship.
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| 7. |
- Hamberger, B
(författare)
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Surgery in Sweden
- 1998
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Ingår i: Archives of surgery (Chicago, Ill. : 1960). - : American Medical Association (AMA). - 0004-0010. ; 133:3, s. 323-326
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Tidskriftsartikel (refereegranskat)
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| 8. |
- Johansson, J, et al.
(författare)
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Adenocarcinoma in the distal esophagus with and without Barrett esophagus. Differences in symptoms and survival rates
- 1996
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Ingår i: Archives of Surgery. - : American Medical Association (AMA). - 0004-0010. ; 131:7, s. 13-708
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate differences in clinical appearance and survival rates in patients operated on for adenocarcinoma in the distal esophagus with and without Barrett epithelium.DESIGN: Prospective clinical study.SETTING: University hospital, Sweden.PATIENTS: Fifty-four patients with adenocarcinoma in the distal esophagus with (n = 17) or without (n = 37) Barrett epithelium.INTERVENTION: Esophagectomy or total gastrectomy.MAIN OUTCOME MEASURES: Preoperative symptoms, endoscopic results, and histological findings; postoperative morbidity, mortality, and survival rates.RESULTS: The main indication for the endoscopic examination that revealed tumor in the group with Barrett esophagus was reflex-related symptoms in 6 patients (routine Barrett examination, n = 4; symptoms of reflux, n = 2), symptoms related to upper gastrointestinal tract bleeding in 6, and malignant symptoms in 5 (dysphagia, n = 4; weight loss, n = 1). In contrast, most patients in the cardia cancer group were admitted because of malignant symptoms (dysphagia, n = 26; epigastric pain, n = 9; and anemia, n = 2). Ten of 17 patients in the Barrett esophagus cancer group had tumors limited to the mucosa and submucosa only. In 1 patient the tumor grew into the muscular layer but not through it. In the remaining 6 patients the tumor did grow through the muscular layer and lymph node metastases were found. Wall penetration was found in 30 patients and metastases to lymph nodes in 29 patients in the cardia cancer group. The hospital mortality rate was 0 of 17 patients in the Barrett cancer group and 2 of 37 patients in the cardia cancer group. In the patients operated on for adenocarcinoma in the distal esophagus, a better long-term survival rate was seen in those with Barrett epithelium (50%) than in those without this metaplasia (10%) (log rank P = .005; X2 = 7.80).CONCLUSIONS: Concomitant Barrett epithelium improved the prognosis for patients with adenocarcinoma in the distal esophagus. Probably the reason for this was a higher rate of early-stage disease, because symptoms of gastroesophageal reflux and other benign disorders, not dysphagia, were most common in patients with adenocarcinoma without Barrett epithelium in the distal esophagus.
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| 9. |
- Johansson, Jan, et al.
(författare)
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En bloc vs transhiatal esophagectorny for stage T3 N1 adenocarcinorna of the distal esophagus
- 2004
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Ingår i: Archives of Surgery. - 0004-0010. ; 139:6, s. 627-631
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: En bloc esophagectomy (EBE) provides improved survival over transhiatal esophagectomy (THE) in patients with similarly sized transmural tumors (T3) and lymph node metastases (N1). Design: A retrospective case-control study of 2 methods of esophageal resection for cancer. Setting: University hospital (tertiary referral center for esophageal disease). Patients: There were 49 patients (27 who underwent EBE and 22 who underwent THE) With similar T3 N1 disease and the following matched criteria: tumors of similar size and location, more than 20 lymph nodes in the surgical specimen, R0 resection, no previous chemotherapy or radiation therapy, and follow-up until death or for a minimum of 5 years. Main Outcome Measure: Survival adjusted for differences in demographic and patient characteristics. Results: The number of nodes harvested was greatest after EBE vs THE (median, 52 vs 29 [range, 21-85 vs 20-60]; P<.001). The median number of involved nodes was similar after EBE vs THE (median, 5 vs 7 [range, 1-19 vs 1-16]). The only 2 independent factors that affected survival. in a Cox analysis were the number of involved lymph nodes (P=.01) and the type of resection (P=.03). Patients who underwent EBE had a survival benefit over those who underwent THE (P=.01). The survival benefit of EBE was seen only in patients with fewer than 9 involved lymph nodes (P<.001). Conclusion: En bloc esophagectomy confers a better survival than THE in patients with T3 N1 disease and fewer than 9 lymph node metastases.
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| 10. |
- Jänes, Arthur, 1970-, et al.
(författare)
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Preventing parastomal hernia with a prosthetic mesh
- 2004
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Ingår i: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 139:12, s. 1356-1358
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Tidskriftsartikel (refereegranskat)abstract
- HYPOTHESIS: Parastomal hernia is a common complication following colostomy. The lowest recurrence rate has been produced when repair is with a prosthetic mesh. This study evaluated the effect on stoma complications of using a mesh during the primary operation. DESIGN: Randomized clinical study. METHODS: Patients undergoing permanent colostomy were randomized to have either a conventional stoma or the addition of a mesh placed in a sublay position. The mesh used was a large-pore lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material. RESULTS: Twenty-seven patients had a conventional stoma, and in 27 patients the mesh was used. No infection, fistula formation, or pain occurred (observation time, 12-38 months). At the 12-month follow-up, parastomal hernia was present in 13 of 26 patients without a mesh and in 1 of 21 patients in whom the mesh was used. CONCLUSIONS: A lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material placed in a sublay position at the stoma site is not associated with complications and significantly reduces the rate of parastomal hernia.
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