| 1. |
- Abul-Kasim, Kasim, et al.
(författare)
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Combined Clinical and Radiological Prognostic Model in Acute Ischemic Stroke
- 2010
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Ingår i: Acta Neurologica Belgica. - 2240-2993. ; 110:3, s. 239-245
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Tidskriftsartikel (refereegranskat)abstract
- We sought to propose and test the validity of a comprehensive prognostic model in middle cerebral artery-stroke treated with Intravenous thrombolysis. A total of 127 consecutive patients (aged 70 +/- 12 years; 54% males) were included in this retrospective study. Variables included in our prognostic model were: NIHSS on admission (1-3 points), occurrence of hyperdense middle cerebral artery sign and early ischemic signs on baseline CT (1 point each). NIHSS at 24 hours (0-3 points), posttreatment hemorrhage (1 point), and infarct volume (0-4 points). The score range teas 1-13, with higher values suggest unfavorable prognosis. Our prognostic score was correlated with the modified Rankin scale (mRS) at 3 months after stroke [correlation coefficient of 0.62, P < 0.001] and can thus help early prediction of the functional outcome. Logistic regression showed that NIHSS at 24 hours and EICs on baseline CT were independent predictor of our prognostic score (adjusted odds ratio of 4.1 and 5). Adopting a cut-off value of prognostic score <= 3 for favorable prognosis and >= 7 for unfavorable prognosis helped to predict the need for institutionalization and the functional outcome with higher accuracy and predictive values compared with using scores only based on NIHSS.
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| 2. |
- Abul-Kasim, Kasim, et al.
(författare)
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Transient ischemic attack with deceptive presentation
- 2009
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Ingår i: Acta Neurologica Belgica. - 2240-2993. ; 109:4, s. 333-335
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Tidskriftsartikel (refereegranskat)abstract
- A patient with an initial diagnosis of TIA presented with a deceptive course of events and unfavorable outcome. Only a non-enhanced brain CT was performed initially. Hemodynamic studies were clone later on and revealed internal carotid artery (ICA) dissection on CT-angiography and evidence of irreversible ischemic changes on perfusion studies indicating that the ischemic process presumably was ongoing since the initial ischemic episode. Efforts to define patients with TIA with risk of developing major stroke are ongoing. We hereby exhort for more effort to include hemodynamic studies as early as possible in the radiological work-up of TIA.
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| 3. |
- Agger, Erik, et al.
(författare)
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Circumferential resection margin and local recurrence after rectal cancer surgery: a population-based study cohort
- 2019
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 21:S3, s. 22-22
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Konferensbidrag (refereegranskat)abstract
- Aim: Studies have suggested that there is a difference in risk of local recurrence(LR) with circumferential resection margins (CRM) less than 1.0 mm. We aimed toexamine how exact resection margins affect LR risk.Method: Data from the Swedish Colorectal Cancer Registry (SCRCR) were usedfor retrospective analysis of resected rectal cancers between 2005 and 2013. Primaryendpoint was LR.Results: 12146 cases were identified of which 8666 cases were analysed after exclusion. 388 cases had CRM < 1.0 mm and 8278 cases CRM ≥ 1.0 mm. There were 42LR (11.4%) when CRM < 1.0 mm and 280 LR (3.5%) when CRM ≥ 1.0 mm. LRrate was 17% (n = 27/159), 7.1% (n = 15/210), 5.5% (n = 26/473) and 3.4%(n = 254/7550) when CRM was 0.0 mm, 0.1–0.9 mm, 1.0–1.9 mm andCRM ≥ 2 mm respectively. LR risk at CRM 0.0 mm was significantly increased compared to all other groups. No significant difference in LR between CRM 1.0–1.9 mm and ≥ 2 mm was observed. LR was diagnosed earlier when CRM < 1.0 mm.Conclusion: LR risk is related with accuracy to the surgical circumferential resec-tion margin distance. There was no difference in LR risk above CRM 1.0 mm.Most LRs occurred within two years after surgery when CRM was below 1.0 mm
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| 4. |
- Agger, Erik, et al.
(författare)
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Negative prognostic impact of tumor deposits in rectal cancer – a national study cohort
- 2023
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Ingår i: Annals of Surgery. - 1528-1140. ; 273:3, s. 526-533
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether tumor deposits (TDs) in rectal cancer are associated withincreased recurrence risk and decreased survival.Summary background data: Tumor deposits (TDs) are considered a risk factor forrecurrence after colon cancer resection and presence of TDs prompts adjuvant chemotherapy.The prognostic relevance of TDs in rectal cancer requires further exploration.Methods: All patients treated with abdominal resection surgery for rectal cancer in Swedenbetween 2011 and 2014 were eligible for inclusion in this retrospective cohort-study based onprospectively collected data from the Swedish ColoRectal Cancer Registry. Primary endpointwas local recurrence or distant metastasis. Secondary outcomes were overall and relativesurvival.Results: 5455 patients were identified. 3769 patients were analysed after exclusion. TDs werefound in 404 (10.7%) patients including where 140 (3.7%) patients with had N1c-status. InTD-positive patients, local recurrence and distant metastasis rates at 5 years were 6.3% [95%CI 3.8-8.8%] and 38.9% [95% CI, 33.6-43.5%] compared to 2.7% [95% CI, 2.1-3.3%] and14.3% [95% CI, 13.1-15.5%] in TD-negative patients. In multivariable regression analysis,risk of local recurrence and distant metastasis were increased; HR 1.86 [95% CI, 1.09-3.19;P=0.024] and 1.87 [95% CI, 1.52-2.31; P=was 68.8% [95% CI, 64.4-73.4%] in TD-positive patients and 80.7% [95% CI, 79.4-82.1%] inTD-negative patients. pN1c-patients had similar outcomes regarding local recurrence, distantCopyright © 2022 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited.ACCEPTEDmetastasis and survival as pN1a-b stage patients. TD-positive pN1a-b patients hadsignificantly worse outcomes while TDs did not affect outcomes in pN2a-b patients.Conclusion: This study suggests that TDs have a negative impact on prognosis in rectalcancer. Thus, efforts should be made to diagnose TD-positive rectal cancer patientspreoperatively.
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| 5. |
- Agger, Erik, et al.
(författare)
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Rektalcancer: : Risk för lokalt recidiv är beroende av RESEKTIONSMARGINAL
- 2020
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Ingår i: Onkologi i Sverige : den oberoende tidningen för svensk cancervård. - 1653-1582. ; 20:4, s. 27-32
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Rektalcancer är en sjukdom där behandlingsresultaten förbättrats kraftigt de senaste decennierna. Behandling för ändtarmscancer sker med antingen endast kirurgi eller kirurgi i kombination med onkologisk neoadjuvant behandling. Kirurgisk radikalitet, mikroskopisk marginal mellan tumörvävnad och frisk vävnad, är av stor betydelse för att minska risken för lokalrecidiv och öka överlevnaden
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| 6. |
- Azhar, Najia, et al.
(författare)
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Management of acute uncomplicated diverticulitis without antibiotics: compliance and outcomes -a retrospective cohort study
- 2022
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Ingår i: BMC Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- MethodsRecent randomized control trials (RCTs) have confirmed that antibiotics in acute uncomplicated diverticulitis (AUD) neither accelerate recovery nor prevent complications or recurrences.A retrospective cohort study was conducted, including all consecutive AUD patients hospitalized 2015- 2018 at Helsingborg Hospital (HH) and Skåne University Hospital (SUS), Sweden. HH had implemented a non-antibiotic treatment protocol in 2014 while SUS had not. Main outcomes were proportion of patients treated with antibiotics, complications, recurrences, and adherence to routinely colon evaluation.ResultsA total of 583 AUD patients were enrolled, 388 at SUS and 195 at HH. The diagnosis was CT-verified in 320 (83%) vs. 186 (95%) patients respectively (p < 0.001). Forty-three (11%) and 94 (48%) of patients respectively did not receive antibiotics during hospitalization (p < 0.001). CRP was higher in the antibiotic group compared to the non-antibiotic group, both at admission and peak (90 mg/L vs 65 mg/L; p = 0.016) and (138 mg/L and 97 mg/L; p < 0.001). There were no significant differences in recurrences (22.0% vs. 22.6%; p = 0.87) and complications (2.5% vs. 2.9%; p = 0.77) between the antibiotic/non-antibiotic groups.ConclusionThe structured treatment protocol led to reduced antibiotic use and a higher standard of care in terms of CT-verification. Clinicians’ compliance to the treatment protocol and best clinical practice was poor and warrants further studies.
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| 7. |
- Buchwald, Fredrik, et al.
(författare)
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Atrial Fibrillation in Transient Ischemic Attack Versus Ischemic Stroke : A Swedish Stroke Register (Riksstroke) Study
- 2016
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Ingår i: Stroke: a journal of cerebral circulation. - 0039-2499. ; 47:10, s. 2456-2461
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE—: Compared with ischemic stroke (IS), the association of atrial fibrillation (AF) with transient ischemic attack (TIA) is less well established. We aimed to assess the proportion of AF in patients with TIA, and these patients’ characteristics and secondary preventive treatment in comparison to patients with IS. METHODS—: Hospital-based data on TIA and IS events, registered from July 2011 to June 2013, were obtained from the Swedish Stroke Register (Riksstroke). A time-based TIA definition (duration of symptoms <24 hours) was applied. AF was registered as present when previously known or diagnosed at the time of assessment. RESULTS—: AF was present in 2779 of 14 980 (18.6%) patients with TIA and 13 258 of 44 173 (30.0%) patients with IS. The proportion of AF increased with age, reaching 32.9% in TIA and 46.6% in IS patients ≥85 years. Both in TIA and IS, age, hypertension, a history of stroke, and TIA, and being a nonsmoker were associated with the presence of AF. In contrast to IS, AF was less common in female than in male patients with TIA. At discharge, 64.2% of TIA and 50.0% of IS patients with AF were treated with oral anticoagulants. Proportions of AF patients treated with oral anticoagulants decreased substantially with increasing age. CONCLUSIONS—: AF is highly prevalent not only in IS but also in TIA patients, with proportions steeply increasing with age. In both TIA and IS, a substantial proportion of patients with AF were discharged without anticoagulant therapy.
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| 8. |
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| 9. |
- Buchwald, Fredrik
(författare)
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TIA in the Swedish Stroke Register (Riksstroke). Aspects on diagnostic validation, risk factors, investigations, and therapies
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Transient ischemic attacks (TIA) indicate an increased risk of stroke, one of the leading causes of death and disability worldwide. In order to prevent stroke, our knowledge of diagnosis, demographics, risk factors, investigations, and treatment of patients with TIA needs to be improved.Aims: The aims of this thesis were to validate data and diagnoses in the Riksstroke TIA module (Riksstroke-TIA), to clarify the role of atrial fibrillation (AF) in TIA and the extent of oral anticoagulant (OAC) treatment in patients with AF, to assess characteristics, risk factors, and secondary preventive treatment in TIA patients with a history of stroke in comparison to those without, and evaluate the degree of carotid imaging and determinants for its non-use in patients with TIA.Methods: Paper I was based on a study sample of 180 patients from 6 different hospitals, extracted from the cohort of patients registered in Riksstroke-TIA between 1/7/2011 to 30/6/2012 (n=7825). Medical files were retrieved from each hospital. Paper II – IV were based on data from patients registered in Riksstroke-TIA between 1/7/2011 to 30/6/2013 (n=15064). For comparison, data on patients with ischemic stroke (IS) registered in Riksstroke during the corresponding period of time were included in paper II – IV (n=44416).ResultsPaper I: Two independent assessors agreed on a likely or possible diagnosis of TIA in 77% (137/180), in 3% (5/180) on a diagnosis of IS, and in 2% (3/180) that a diagnosis of TIA was unlikely. The quality of documentation was fair.Paper II: AF was present in 19% (2779/14980) of patients with TIA compared to 30% (13258/44173) in those with IS. Proportions of AF increased markedly with age. At discharge, 64% (1778/2771) of patients with TIA and AF and 50% (5502/10899) of patients with IS and AF were treated with OACs.Paper III: Patients with TIA and a history of stroke were older, more likely to be male, and they had higher proportions of AF, hypertension, and diabetes mellitus than those without a history of stroke. In TIA patients with prior stroke aged ≥85 years, AF was present in 41% (300/724) compared to 30% (604/2028) in those without prior stroke. At discharge, levels of OAC treatment in TIA patients with AF and prior stroke were lower than in those without prior stroke.Paper IV: Carotid imaging was performed in 70% (10545/15023) of patients with TIA. Determinants for its non-use were age ≥85 years, age 74-84 years, female sex, AF, a history of stroke, and care at a non-university hospital. There were substantial regional variations regarding proportions of carotid imaging, especially in the very elderly.Conclusions: There was interobserver agreement on TIA diagnoses in a majority of cases. More systematic documentation aided by a guide or checklist might improve diagnostic certainty. Data registered in Riksstroke-TIA was valid and suited for scientific evaluation. AF was a common but insufficiently treated risk factor in TIA. Certain patient groups appeared neglected with regard to carotid imaging and secondary preventive treatment, namely the very elderly, women, those with AF, and a history of stroke. Opportunities of secondary prevention were likely missed in a substantial number of patients.
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| 10. |
- Buchwald, Fredrik, et al.
(författare)
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Validation of Diagnoses of Transient Ischemic Attack in the Swedish Stroke Register (Riksstroke) TIA-Module
- 2015
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Ingår i: Neuroepidemiology. - : S. Karger. - 0251-5350 .- 1423-0208. ; 45:1, s. 40-43
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2010, the Swedish Stroke Register (Riksstroke; RS) established a module for transient ischemic attacks (RS-TIA). We report a diagnostic validation study of patients included in RS-TIA.Methods: During the first year, 7,825 patients were registered at 59 out of 74 Swedish hospitals. A time-based TIA definition was applied. A sample of 180 patients (30 patients each from 6 hospitals), with a similar distribution of age and sex as in RS-TIA, was prepared. Two independent observers assessed medical records for quality of documentation and assigned a diagnosis of likely, possible, unlikely TIA or ischennic stroke, according to pre-specified criteria.Results:The 2 observers agreed in 77% of cases that the event was a likely or possible TIA, in 3% that the event was an ischemic stroke, and in 2% that the event was an unlikely TIA. The observers disagreed in 8% of patients on TIA vs. ischennic stroke, and in 11% on a vascular vs. non-vascular cause. Quality of documentation was fair.Conclusions: There was interobserver agreement on diagnosis of TIA in the majority of patients included in RS-TIA. Diagnostic accuracy may be further improved by more systematic documentation of symptoms and signs.
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