| 1. |
- El-Hajj, Victor Gabriel, et al.
(författare)
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The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas : a longitudinal cohort study
- 2024
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Ingår i: Neurosurgical Focus. - : American Association of Neurological Surgeons. - 1092-0684. ; 56:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment of sdAVFs.METHODS In this retrospective, population-based cohort study, the authors examined consecutive patients with diagnosed sdAVFs at a tertiary care center between 2005 and 2020. Patients were assessed using the Aminoff-Logue disability scale (ALS) at various time points including symptom onset, primary care visit, first specialist outpatient visit, as well as both short and long-term follow-ups. The postoperative long-term ALS gait and bladder grades constituted the primary outcomes of the study.RESULTS Among the 34 patients included in the study, the median age was 65 years, and there was a male predominance (71%). Most lesions were in the lumbar region (47%). Significant worsening in ALS gait and bladder grades was observed preoperatively, followed by postoperative improvements (p < 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03-1.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18-12.4, p < 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00-1.01, p = 0.040) were independently associated with worse long-term gait outcomes. Only the preoperative ALS bladder score was a predictor of worse long-term bladder function (OR 92.7, 95% CI 28.0-306.7, p < 0.001).CONCLUSIONS Both surgical and endovascular treatments for sdAVFs led to significant neurological improvements. However, treatment delays were associated with less favorable long-term outcomes. Prompt diagnosis and early intervention prior to symptom progression may enhance recovery and help to preserve neurological function.
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| 2. |
- Eriksson, Carl, 1981-, et al.
(författare)
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Long-term effectiveness of vedolizumab in inflammatory bowel disease : a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 52:6-7, s. 722-729
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Clinical trials have demonstrated the efficacy of vedolizumab in inflammatory bowel disease (IBD). However, these findings may not reflect the clinical practice. Therefore, we aimed to describe a vedolizumab-treated patient population and assess long-term effectiveness.Materials and methods: Patients initiating vedolizumab between 1 June 2014 and 30 May 2015 were identified through the Swedish National Quality Registry for IBD. Prospectively collected data on treatment and disease activity were extracted. Clinical remission was defined as Patient Harvey Bradshaw index<5 in Crohn's disease (CD) and Patient Simple Clinical Colitis Activity index<3 in ulcerative colitis (UC).Results: Two-hundred forty-six patients (147CD, 92 UC and 7 IBD-Unclassified) were included. On study entry, 86% had failed TNF-antagonist and 48% of the CD patients had undergone1 surgical resection. After a median follow-up of 17 (IQR: 14-20) months, 142 (58%) patients remained on vedolizumab. In total, 54% of the CD- and 64% of the UC patients were in clinical remission at the end of follow-up, with the clinical activity decreasing (p<.0001 in both groups). Faecal-calprotectin decreased in CD (p<.0001) and in UC (p=.001), whereas CRP decreased in CD (p=.002) but not in UC (p=.11). Previous anti-TNF exposure (adjusted HR: 4.03; 95% CI: 0.96-16.75) and elevated CRP at baseline (adjusted HR: 2.22; 95% CI: 1.10-4.35) seemed to be associated with discontinuation because of lack of response. Female sex was associated with termination because of intolerance (adjusted HR: 2.75; 95% CI: 1.16-6.48).Conclusion: Vedolizumab-treated patients represent a treatment-refractory group. A long-term effect can be achieved, even beyond 1 year of treatment.
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| 3. |
- Karlsson, Bengt, et al.
(författare)
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Risk for Brain Arteriovenous Malformation Rupture During Pregnancy and Puerperium
- 2023
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Ingår i: Neurosurgery. - : Ovid Technologies (Wolters Kluwer Health). - 0148-396X .- 1524-4040. ; 93:4, s. 918-923
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The hemorrhage risk of unruptured and untreated cerebral arteriovenous malformations (AVMs) has been shown to be higher for female patients than male patients in their child bearing ages. Although it has been neurosurgical practice to advise female patients in their childbearing ages to postpone pregnancy until proven AVM obliteration, there is no literature consensus regarding this potential hemorrhage risk increase. OBJECTIVE: To accurately quantify the risk increase for AVM hemorrhage during pregnancy. METHODS: This study is based on data from previous publications, consisting of known age at the first AVM hemorrhage in 3425 patients. The risk increase during pregnancy could be calculated from the difference in age distribution for the first AVM hemorrhage between male patients and female patients, taking the average pregnancy time per female into account. A comparison was also made with data for all hospital discharges (13 751) in Germany 2008 to 2018 with the diagnosis brain AVM. RESULTS: The average pregnancy and puerperium time was 1.54 years per female in the patient population, which was used to determine the annual AVM hemorrhage risk during pregnancy to be around 9%. The increased risk during pregnancy was further evidenced by analysis of a subgroup of 105 female patients, for which pregnancy status at the time of hemorrhage was known. CONCLUSION: The quantified annual risk for AVM hemorrhage during pregnancy is about 3 times higher than that of male patients at corresponding age. This provides an important basis for advising female patients with patent AVMs about the increased risk for hemorrhage that a pregnancy would entail.
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| 4. |
- Lasic, Samo, et al.
(författare)
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Investigations of vesicle gels by pulsed and modulated gradient NMR diffusion techniques
- 2011
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Ingår i: Soft Matter. - : Royal Society of Chemistry (RSC). - 1744-6848 .- 1744-683X. ; 7:8, s. 3947-3955
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Tidskriftsartikel (refereegranskat)abstract
- Vesicle gels are surfactant systems that form stiff gels with rather low amounts of surfactant. So far their structures have mostly been investigated using scattering techniques, which are generally appropriate for the study of structures on the nm-length-scale. Here we examine these gels using two complementary diffusion NMR techniques, which are both sensitive to structures on the mu m-scale. The presented results imply structural features on the mm-scale, indicating a more complex structure than just that of densely packed small vesicles, as previously found for these systems. It is demonstrated that a combination of the diffusion NMR methods, described here, can provide useful insights, when morphological features extend over a wide range of length scales.
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| 5. |
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| 6. |
- Rosengren, Lars, 1954, et al.
(författare)
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Värna utförarens kompetens vid intrakraniell trombektomi
- 2018
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Ingår i: Läkartidningen. - 0023-7205. ; 2018:115
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Den snabbkurs för kardiologer om 3–6 månader som föreslås av Sjögren och medförfattare utgör endast en bråkdel av den utbildningsinsats som det finns konsensus om, skriver 12 medlemmar i Nationella arbetsgruppen för stroke i en replik om trombektomi. De föreslår att ett modernt nationellt ambulanshelikoptersystem etableras.
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| 7. |
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| 8. |
- Söderman, Michael
(författare)
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Volume determination and predictive models in the management of cerebral arteriovenous malformations
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cerebral arteriovenous malformations (AVMs) entail a high cumulative risk of severe neurological symptoms and are usually treated with surgery, radiosurgery, embolisation or combinations thereof. There are well supported models to predict the outcome of radiosurgery, but similar models do not exist for surgery or embolisation. The aim of this work was to improve the models and implement them in the general management of AVM patients, notably those treated by embolisation. Aims of the present investigation: 1) To improve predictive models for radiosurgery and adapt them to use without dose planning. 2) To create a method for uncomplicated measurement of AVM volume from angiography. 3) To devise a method to correct for the geometric distortion in digital subtraction angiography. 4) To make a hypothetical comparison of two major management strategies, using the methods and models as reference standard. Materials and methods: 1) Roughly 1500 patients treated with Gamma Knife radiosurgery for AVM during the period 1970-1993 were retrospectively studied. 2) The "intersecting cone model" for AVM measurement was created and validated. 3) Qualitative and quantitative aspects of the geometric distortion were investigated and corrected for with a calibration-correction scheme. 4) A prospective study of 88 consecutive patients was done during 1997-1999. AVM volumes and clinical information were recorded before the first and after the last embolisation. Results and conclusions: 1) The obliteration rate depended only on the minimum dose to the periphery of the AM The complication rate depended also on AVM volume, location and patient history. The risk for haemorrhage in the latency period after radiosurgery depended on the minimum dose to the AM patient age and AVM Volume. 2) The "intersecting cone model" call be used instead of volume data from the dose planning system. 3) Geometric distortion may affect high precision stereotaxy but its impact on volume measurement is limited. It can be corrected. 4) For AVM> 1oml the outcome models are not very well substantiated. However, embolisation had comparative advantages. For AVM=1oml the hypothetical outcome of combined treatment with embolisation and radiosurgery was equal to that of radiosurgery alone. Outcome models from radiosurgery can be used in clinical practise as a reference standard in the management of AM However, further studies are necessary to identify specific patient and AVM subgroups amenable to each treatment.
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