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- Acosta, Stefan, et al.
(författare)
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Fatal colonic ischaemia : A population-based study
- 2006
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 41:11, s. 1312-1319
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To estimate the incidence of fatal colonic ischaemia (CI) and the cause-specific mortality of CI, and to describe the localization and extension of colonic infarction and quantify the risk factors associated with CI. Material and methods. Between 1970 and 1982 the autopsy rate in Malmo, Sweden, was 87%, creating the possibilities for a population-based study. Out of 23,446 clinical autopsies, 997 cases were coded for intestinal ischaemia in a database. In addition, 7569 forensic autopsy protocols were analysed. In a case-control study nested in the clinical autopsy cohort, four CI-free controls, matched for gender, age at death and year of death, were identified for each fatal CI case in order to evaluate the risk factors. Results. The cause-specific mortality ratio was 1.7/1000 autopsies. The overall incidence of autopsy-verified fatal CI was 1.7/100,000 person years, increasing with age up to 23/100,000 person years in octogenarians. Fatal cardiac failure (odds ratio (OR) 5.2), fatal valvular disease (OR 4.3), previous stroke (OR 2.5) and recent surgery (OR 3.4) were risk factors for fatal CI. Narrowing/occlusion of the inferior mesenteric artery (IMA) at the aortic origin was present in 68% of the patients. The most common segments affected by transmural infarctions were the sigmoid (83%) and the descending (77%) colon. Conclusions. Heart failure, atherosclerotic occlusion/stenoses of the IMA and recent surgery were the main risk factors causing colonic hypoperfusion and infarction. Segments of transmural infarctions were observed within the left colon in 94% of the patients. Awareness of the diagnosis and its associated cardiac comorbidities might help to improve survival.
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- Acosta, Stefan, et al.
(författare)
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Increasing incidence of ruptured abdominal aortic aneurysm : a population-based study
- 2006
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 44:2, s. 237-243
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the present population-based study was to assess the trends of age- and gender-specific incidence of ruptured abdominal aortic aneurysm (rAAA). Methods. Patients with rAAA from the city of Malmo, Sweden, were studied between 2000 and 2004. An analysis of trends of incidence and mortality of rAAA in Malmo was possible because of a previous population-based study on patients with rAAA between 1971 and 1986 (autopsy rate 85% compared with 25% for the time period 2000 to 2004). The in-hospital registry of Malmo University Hospital and the databases at the Department of Pathology, Malmo, and the Institution of Forensic Medicine, Lund, identified patients with rAAA, and the in-hospital registry identified all elective repairs for AAA. Results. Compared with the time period 1971 to 1986, the overall incidence of rAAA significantly increased from 5.6 (95 % confidence interval [CI], 4.9 to 6.3) to 10.6 (95% CI, 8.9 to 12.4) per 100,000 person-years (standardized mortality ratio, 1.6; 95% CI, 1.0 to 2.1). In men aged 60 to 69 and 70 to 79 years, the incidence increased significantly from 16 (95% CI, 11 to 21) and 56 (95% Cl, 43 to 69) to 46 (95% Cl, 28 to 63) and 117 (95% CI, 84 to 149) per 100,000 person-years, respectively, whereas no increase in the age-specific incidence in women could be demonstrated. The overall incidence of elective repair of AAA increased significantly from 3.4 (95% CI, 2.8 to 4.0) to 7.0 (95% CI, 5.6 to 8.4) per 100,000 person-years and increased most significantly from 12 (95% CI, 3.4 to 32) to 68 (95% CI, 34 to 102) per 100,000 person-years in men aged 80 to 89 years and from 5.1 (95% CI, 2.4 to 9.3) to 28 (95% CI, 15 to 41) per 100,000 person-years in women aged 70 to 79 years. The elective-acute repair ratio in women increased from 2.4 to 5.6 and decreased in men from 2.1 to 1.0. Conclusions: Between 1971 to 1986 and 2000 to 2004, the incidence of rAAA increased significantly, despite a 100% increase in elective repairs and notwithstanding a potential for bias towards underestimation due to lower autopsy rates in recent years. The reason behind this increase is unclear, and further studies are needed to identify risk groups for direction of effective prevention and screening.
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- Acosta, Stefan, 1967-
(författare)
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On Acute Thrombo-Embolic Occlusion of the Superior Mesenteric Artery
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods. Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease.Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor.A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions.Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated from clinical series. The patients were often nursed in non-surgical wards.
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- Acosta, Stefan, et al.
(författare)
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The clinical importance in differentiating portal from mesenteric venous thrombosis
- 2011
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 30:1, s. 71-78
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To relate the extent of portomesenteric thrombosis to the risk of intestinal infarction, concomitant venous thromboembolism and underlying diseases. Methods. Identification of patients with mesenteric (MVT) and portal vein thrombosis (PVT) at Malmo University Hospital from a clinical series from 2000 - 2006 as well as an autopsy cohort of 24000 consecutive autopsies from 1970 - 1982. Results. In the clinical comparative study, MVT (n=51) was associated with more thrombophilic disorders (P=0.040) and intestinal infarctions (P=0.046), whereas patients with PVT without extension to the superior mesenteric vein (n=20) more often had liver disease (P < 0.001). At autopsy, 270 patients with portomesenteric venous thrombosis were found; twenty-nine out of the 31 cases with MVT had intestinal infarction. None (0%) of the 239 patients with PVT without extension into the superior mesenteric vein had intestinal infarction. Portomesenteric venous thrombosis and intestinal infarction was associated with concomitant venous thromboembolism (O. R. 6.1 [95% CI 1.8-21]). Conclusions. MVT carries a high risk of developing intestinal infarction and is associated with concomitant venous thromboembolism, whereas PVT is associated with liver disease.
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- Agenäs, Sigrid, et al.
(författare)
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Gårdar anses för små – men gör stor nytta
- 2020
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Ingår i: Svenska Dagbladet Debatt. - 1101-2412.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- De små gårdarna är allvarligt hotade och därmed också mosaiklandskapet och den gastronomiska mångfalden. Det skriver flera debattörer.
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- Bengtsson, Anders K.H., et al.
(författare)
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Uniqueness of superstring actions
- 1984
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Ingår i: Nucl.Phys.B254 (1985) 625.
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Tidskriftsartikel (refereegranskat)abstract
- We consider local counterterms to 4-dimensional gravity and 4- and 10-dimensional super-gravity theories in the light-front gauge. With the technique developed, we show that there are no local counterterms other than the lagrangian possible in the superstring thoeries. This is a strong indication that these theories are finite or at least renormalizable to allorders in the perturbation expansions.
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- Bolling, Anne, et al.
(författare)
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SHAKE - an approach for realistic simulation of rough roads in a moving base driving simulator
- 2010
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Ingår i: Trends in driving simulation design and experiments. - Arcueil : Institut national de recherche sur les transports et leur securite, INRETS. - 9782857826859 ; , s. 135-143
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Konferensbidrag (refereegranskat)abstract
- With today’s advanced measurement equipment for measuring roads, it is possible to measure road geometry at high precision within a large span of wavelengths. Detailed information about the roads longitudinal and lateral profile, including macro texture, would in theory be sufficient for a realistic reproduction of road induced vibration and noise in a driving simulator. Especially, it would be possible to create a direct connection between the visual information of the road condition and the ride experience, which would increase the level of realism in the simulation. VTI has during three years performed an internal project called SHAKE with the aim to develop and implement models in VTI driving simulator III that use measured road data for generating realistic vibrations and audible road noise connected to the visual impression presented on the projection screen. This has indeed resulted in an more realistic driving experience, and a validation study with test persons driving both in the simulator and in the field has been undertaken. The OpenDRIVE standard is used as a framework for describing the road properties (e.g. visual, vibrations and noise). For this purpose some augumentations to the OpenDRIVE standard had to be made. This paper describes the technical implementations in the driving simulator, along with results from test drives on the implemented road sections
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