| 1. |
- Lundberg, Jonas, 1961, et al.
(författare)
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Avoidance of complications after the use of deep inferior epigastric perforator flaps for reconstruction of the breast.
- 2006
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Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - : Informa UK Limited. - 0284-4311. ; 40:2, s. 79-81
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Tidskriftsartikel (refereegranskat)abstract
- We assessed 50 consecutive unilateral deep inferior epigastric perforator (DIEP) flaps for breast reconstruction to find out our morbidity and how to avoid it. We routinely dissected the superficial epigastric vein bilaterally and perforators ipsilaterally. If there were insufficient perforators on the ipsilateral side, we then dissected the contralateral side. We made an additional anastomosis to the superficial epigastric vein in cases of venous congestion after reperfusion that could threaten flap survival. One perforator was used on 31 occasions, and the contralateral side was dissected in 16. A prophylactic anastomosis of superficial epigastric vein was done in 3. No flap was lost completely but 5 partially necrosed. A comparison of the first 25 and the second 25 flaps showed more dissections of the contralateral side and more prophylactic anastomoses of the superficial epigastric vein in the second 25. Partial necrosis was less common in the second 25. We suggest that more liberal dissection of the contralateral side and the prophylactic anastomosis of the superficial epigastric vein to lower morbidity and give better cosmetic results.
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| 2. |
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| 3. |
- Arver, Brita, et al.
(författare)
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Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey.
- 2011
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Ingår i: Annals of surgery. - : Lippincott Williams and Wilkins; 1999. - 1528-1140 .- 0003-4932. ; 253:6, s. 1147-1154
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/OBJECTIVE:: This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. METHODS:: Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. RESULTS:: A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low (3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1unanticipated secondary operation. CONCLUSIONS:: Bilateral prophylactic mastectomy is safe and efficacious in reducing future breast cancer in asymptomatic women at high risk. Unanticipated reoperations are common. Given the small number of patients centralization seems justified.
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| 4. |
- Hallberg, Håkan, et al.
(författare)
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Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up
- 2019
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 42:1, s. 33-42
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Tidskriftsartikel (refereegranskat)abstract
- © 2018, The Author(s). Background: Matrices are now commonly used in breast reconstruction, but the scientific evidence is still scares. The main aim was to compare complications and the need for corrections in immediate breast reconstruction with the porcine-derived Surgisis®with the traditional muscle-covered technique. The secondary aim was to compare long-term quality of life and satisfaction. Methods: All consecutive patients who had their breast reconstructed with a Surgisis®or muscle-covered tissue expander/implant were included. Patients were followed clinically and with BREAST-Q. Results: During the study period, 116 reconstructions (71 patients) were operated in the Surgisis®group and 132 reconstructions (90 patients) in the control group. The median follow-up time was 74 months (min 43–max 162). The total early complication rate was 37% in the Surgisis®group and 27% in the control group. There were no differences in implant loss (p = 0.68) or total number of complications (p = 0.24) between the two groups. Risk factors for complications were mainly patient characteristics and the use of a tissue expander. There was a slightly higher capsular contracture frequency in the Surgisis®patients (4.2% vs. 2.5%). The need for corrections and patient satisfaction and quality of life were similar in the two groups. Conclusions: The use of Surgisis®in implant-based reconstruction seems to result in an acceptable total early complication rate. The rate might be higher in tissue expander-based reconstruction. Risk factors are mainly patient characteristics. The capsular contracture rate and need for corrections, as well as patient satisfaction and quality of life, are similar in the Surgisis®patients and muscle-covered controls. Level of evidence: III.
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| 5. |
- Khort, Aliaksandr, Dr, 1987-, et al.
(författare)
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Influence of natural organic matter on the transformation of metal and metal oxide nanoparticles and their ecotoxic potency in vitro
- 2022
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Ingår i: Nanoimpact. - : Elsevier BV. - 2452-0748. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- Increased use and production of engineered nanoparticles (NPs) lead to an elevated risk of their diffuse dispersion into the aquatic environment and increased concern on unknown effects induced by their release into the aquatic ecosystem. An improved understanding of the environmental transformation processes of NPs of various surface characteristics is hence imperative for risk assessment and management. This study presents results on effects of natural organic matter (NOM) on the environmental transformation and dissolution of metal and metal oxide NPs of different surface and solubility properties in synthetic freshwater (FW) with and without NOM. Adsorption of NOM was evident on most of the studied NPs, except Sb and Sb2O3, which resulted in the formation of negatively charged colloids of higher stability and smaller size distribution compared with the same NPs in FW only. The dissolution rate of the NPs in the presence of NOM correlated with the strength of interactions between the carboxylate group of NOM and the particle surface, and resulted in either no (Mn, Sb, ZnO NPs), increased (Co, Sn NPs) and decreased (Ni, NiO, Sb2O3, Y2O3 NPs) levels of dissolution. One type of metal NP from each group (Mn, Ni, Sn) were investigated to assess whether observed differences in adsorption of NOM and dissolution would influence their ecotoxic potency. The results showed Mn, Ni, and Sn NPs to generate intracellular reactive oxygen species (ROS) in a time and dose-dependent manner. The extent of ROS generation in FW was similar for both Mn and Ni NPs but higher for Sn NPs. These findings are possibly related to interactions and infiltration of the NPs with the cells, which lead to redox imbalances which could induce oxidative stress and cell damage. At the same time, the presence of NOM generally reduced the intracellular ROS generation by 20-40% for the investigated NPs and also reduced cytotoxicity of Sn NPs, which can be attributed to the stronger interaction of carboxylate groups of NOM with the surface of the NPs.
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| 6. |
- Lewin, Richard, 1976, et al.
(författare)
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A Randomized Prospective Study of Prophylactic Cloxacillin in Breast Reduction Surgery.
- 2015
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Ingår i: Annals of plastic surgery. - 1536-3708. ; 74:1, s. 17-21
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Tidskriftsartikel (refereegranskat)abstract
- Postoperative infection after breast reduction surgery is a common complication, with the most commonly involved pathogen being Staphylococcus aureus. Previous studies of antibiotic prophylaxis in breast reduction surgery have been inconclusive. The aim of the present study was to clarify the role of prophylactic antibiotics in breast reduction surgery.
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| 7. |
- Lewin, Richard, 1976, et al.
(författare)
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Prospective Evaluation of Health After Breast Reduction Surgery Using the Breast-Q, Short-Form 36, Breast-Related Symptoms Questionnaire, and Modified Breast Evaluation Questionnaire.
- 2019
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Ingår i: Annals of plastic surgery. - 1536-3708. ; 83:2, s. 143-151
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Tidskriftsartikel (refereegranskat)abstract
- Breast hypertrophy is a condition associated with physical, psychological, and psychosocial problems. The primary aims of this study were to determine the impact of breast hypertrophy and the effects of breast reduction, performed on the basis of well-described inclusion criteria, on general and breast-related health, using both general and diagnosis-specific validated questionnaires. We used a prospective, longitudinal paired study design. A secondary aim was to analyze the relationship between preoperative breast volume, body mass index, sternal notch-to-nipple distance and the weight of resected tissue on the one hand and improvements in health on the other.Three hundred forty-eight consecutive patients undergoing breast reduction were included and the Short-Form 36 (SF-36), Breast-Related Symptoms Questionnaire (BRSQ), Modified Breast Evaluation Questionnaire (mBEQ) and BREAST-Q were distributed preoperatively and 1 year postoperatively.A total of 284 (83%) patients answered the questionnaires either preoperatively or postoperatively, or both, and 159 (46%) patients answered both. The breast hypertrophy patients had significantly lower scores preoperatively than the matched normal population when it came to all dimensions of the SF-36 and mBEQ. The preoperative scores for both the BRSQ and BREAST-Q were low.After breast reduction, there were significant improvements in all dimensions of the BRSQ, mBEQ, and Breast-Q and in several dimensions of the SF-36.Breast reduction reduces or removes disease-associated pain. It improves or normalizes perceived health and psychosocial self-esteem in slightly obese women or women of normal weight with preoperative breast volumes around 1000 mL. Women with higher preoperative breast volumes and longer sternal notch-to-nipple distances appear to be more satisfied with the cosmetic result postoperatively.
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| 8. |
- Lewin, Richard, 1976, et al.
(författare)
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Validation of the breast evaluation questionnaire for breast hypertrophy and breast reduction.
- 2018
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 52:5, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of published, validated questionnaires for evaluating psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery.To validate the breast evaluation questionnaire (BEQ), originally developed for the assessment of breast augmentation patients, for the assessment of psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery.Validation study Subjects: Women with macromastia Methods: The validation of the BEQ, adapted to breast reduction, was performed in several steps. Content validity, reliability, construct validity and responsiveness were assessed.The original version was adjusted according to the results for content validity and resulted in item reduction and a modified BEQ (mBEQ) that was then assessed for reliability, construct validity and responsiveness. Internal and external validation was performed for the modified BEQ. Convergent validity was tested against Breast-Q (reduction) and discriminate validity was tested against the SF-36. Known-groups validation revealed significant differences between the normal population and patients undergoing breast reduction surgery. The BEQ showed good reliability by test-re-test analysis and high responsiveness.The modified BEQ may be reliable, valid and responsive instrument for assessing women who undergo breast reduction.
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| 9. |
- Lindgård, Ann, 1977, et al.
(författare)
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Preservation of rat skeletal muscle energy metabolism by illumination.
- 2003
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Ingår i: Life sciences. - 0024-3205. ; 72:23, s. 2649-58
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Tidskriftsartikel (refereegranskat)abstract
- Skeletal muscle viability is crucially dependent on the tissue levels of its high energy phosphates. In this study we investigated the effect of the preservation medium Perfadex and illumination with Singlet Oxygen Energy (SOE). Singlet oxygen can be produced photochemically by energy transfer from an excited photosensitizer. The energy emitted from singlet oxygen upon relaxation to its triplet state is captured as photons at 634 nm and is here referred to as SOE. Rat hind limb rectus femoris muscles were preserved for five hours at 22 degrees C in Perfadex, saline, SOE illuminated Perfadex or SOE illuminated saline. Extracts of the muscles were analysed by 31P NMR. Data were analysed using two-way analysis of variance and are given as mean values micromol/g dry weight) +/- SEM. The ATP concentration was higher (p = 0.006) in saline groups (4.52) compared with Perfadex groups (2.82). There was no statistically significant difference in PCr between the saline groups (1.25) and Perfadex groups (0.82). However, there were higher (p = 0.003) ATP in the SOE illuminated groups (4.61) compared with the non-illuminated groups (2.73). The PCr was also higher (p < 0.0001) in the SOE illuminated groups (1.89) compared with the non-illuminated groups (0.18). In conclusion, Perfadex in this experimental model was incapable of preserving the high energy phosphates in skeletal muscle during 5 hours of ischemia. Illumination with SOE at 634 nm improved the preservation potential, in terms of a positive effect on the energy status of the muscle cell.
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| 10. |
- Lundberg, Jonas, 1961
(författare)
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Energy metabolism in skeletal muscle during ischemia and reperfusion. Experimental and clinical aspects.
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Microsurgical operations, using free vascularised transfer of tissues, induce an obligatory period of ischemia followed by reperfusion. The degree of ischemia and reperfusion injury is dependent on the ischemia time. To deminish the injury after skeletal muscle tissue transfers, a preservation method is needed all along with improved mechanistical knowledge. This is important especially in a situation where the aim of the transfer is a functioning unit and in circumstances where a long ischemia time is expeceted, such as complicated cases or during reoperations. The aim of this thesis was to evaluate the ischemia and reperfusion injury in the clinical and experimental situation with special reference to energy metabolism and to evaluate different treatments using energy metabolites as markers for the degree of injury.Muscle biopsies from patients having microsurgical muscle transfers were analysed for high energy phosphates, during ischemia and reperfusion, by high pressure liquid chromatography (HPLC) and by in vitro 31P- magnetic resonance spectroscopy (MRS). To evaluate different treatments, a model of pedicled rat rectus femoris muscle was developed where phosphorous metabolites and intracellular pH were analysed during ischemia and reperfusion by in vitro and in vivo 31P- MRS, continuously and noninvasively. Results from the clinical study showed a partial recovery of PCr to 79% of normal control after revascularisation and a mean ischemia time of 114 min (median 85 min). Furthermore, regression analysis showed a recovery of 60% after 3 h of ischemia and 1 h of reperfusion, in accordance with earlier experimental results, why it is of great importance to further elucidate the mechanisms behind ischemia and reperfusion injury, and to establish preservation methods for the muscle cell. Hypothermia of 9-12°C improved the energetic recovery after postischemic reperfusion with 22% regarding PCr and with 35% regarding ATP compared to room temperature (22-24°C). Intracellular pH was also improved after postischemic recovery (pH 6.88 in hypothermia , pH 6.55 at room temperature). Illumination with Singlet Oxygen Energy (SOE), (l= 634 nm) on skeletal muscle preserved in NaCl or Perfadex decreased the high energy phosphate degradation, thus improving the cellular energy status. Furthermore, SOE-illumination on the in vivo rat skeletal muscle model showed a decreased degradation of 21% regarding ATP during ischemia. SOE-illumination also improved postischemic energetic recovery as demonstrated with an improvement of 22% regarding PCr and with 20% regarding ATP, measured continuously by in vivo 31P MRS.This thesis has thus demonstrated in a novel approach mechanistic similarities between experimental and clinical energetic behavior of skeletal muscle during ischemia and reperfusion. It is also shown that muscle cell injury after ischemia and reperfusion can be deminished by hypothermia.Isolated skeletal muscle can be better preserved by illumination with SOE. Furthermore, skeletal muscle ischemia and reperfusion injury in the living animal can be significantly decreased by illumination with SOE.
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