| 1. |
- Arnelo, Urban, et al.
(författare)
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Single-operator pancreatoscopy is helpful in the evaluation of suspected intraductal papillary mucinous neoplasms (IPMN)
- 2014
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Ingår i: Pancreatology (Print). - : Elsevier. - 1424-3903 .- 1424-3911. ; 14:6, s. 510-514
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVE: Even when advanced cross-sectional imaging modalities have been employed, endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMN) is often required in order to assess the final character and extent of lesions. The current study addresses the use of SpyGlass single-operator peroral pancreatoscopy in suspected IPMN.DESIGN: A prospective, non-randomized exploratory cohort study.SETTING: Single-center.PATIENTS AND INTERVENTION: A prospective study-cohort of 44 consecutive patients in a single tertiary referral center who underwent ERCP and peroral pancreatoscopy, was prospectively collected between July 2007 and March 2013 because of a radiological signs of IPMN. These IPMN-findings were discovered incidentally in 44% of the cases.MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy (specificity & sensitivity) and complications.RESULTS: The targeted region of the pancreatic duct was reached with the SpyGlass system in 41 patients (median age 65 years, 41% female). Three patients were excluded from analysis because of failed deep cannulation of the pancreatic duct. Brush cytology was taken in 88% and direct biopsies in 41%. IPMN with intermediate or high-grade dysplasia was the main final diagnosis (76%) in 22 patients who had surgery. Out of the 17 patients with a final diagnosis of MD-IPMN, 76% were correctly identified by pancreatoscopy. Of the 9 patients with a final diagnosis of BD-IPMN, the pancreatoscopy identified 78% of the cases correctly.The incidence of post-ERCP pancreatitis was 17%. Pancreatoscopy was found to have provided additional diagnostic information in the vast majority of the cases and to affect clinical decision-making in 76%.LIMITATIONS: Single-center study.CONCLUSIONS: Single-operator peroral pancreatoscopy contributed to the clinical evaluation of IPMN lesions and influenced decision-making concerning their clinical management. The problem of post-procedural pancreatitis needs further attention.
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| 2. |
- Caballero-Corbalán, José, 1981-
(författare)
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Islet Transplantation a Technical Challenge : Studies on Human Pancreas Preservation and Enzymatic Digestion
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Islet transplantation has found its niche in diabetes treatment. It has contributed to a better quality of life and better glycemic control of patients with diabetes suffering from severe hypoglycemia that are not eligible for vascularized pancreas transplantation. Islet isolation is a technically challenging procedure. The different studies within this doctoral thesis aim to improve and standardize different steps in the isolation procedure. They are in particular looking to improve human pancreas preservation during cold storage, to optimize islet release from the exocrine tissue and to assess whether the isolated islet yield can be predicted from a biopsy. We found that pancreas preservation with pre-oxygenated perfluorodecalin (two-layer method) did not improve the ischemic tolerance of the human pancreas as compared to cold storage with the University of Wisconsin (UW) solution. Furthermore, in pancreas with long cold ischemia time (CIT) (>10 hours), Histidine-Tryptophan-Ketoglutarate (HTK) had a limited preservation capacity as compared with the UW solution with respect to isolation outcome. We also found that during enzymatic pancreas digestion, Vitacyte HA was able to provide a similar islet yield and quality as Serva NB1 with less collagenase activity and shorter digestion time. We further describe the first experience with a new GMP manufactured enzyme called Liberase MTF-S for successful human islet isolation. Finally, we found that the isolated islet yield could not be predicted from a biopsy taken from the head of the pancreas concerning solely morphological parameters of the islets tissue. The improvement of pancreas preservation will allow for marginal organs with prolonged cold ischemia time to expand the donor pool. Better knowledge of how the pancreatic extracellular matrix is digested by collagenase will lead to a fast and predictable islet release from the exocrine tissue. By standardizing the isolation procedure and improving organ selection we will increase the success rate in human islet isolation, thereby making islet transplantation available for more patients.
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| 3. |
- Christoffersson, Gustaf, et al.
(författare)
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Clinical and Experimental Pancreatic Islet Transplantation to Striated Muscle : Establishment of a Vascular System Similar to that in Native Islets
- 2010
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Ingår i: Diabetes. - : American Diabetes Association. - 0012-1797 .- 1939-327X. ; 59:10, s. 2569-2578
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Curing type 1 diabetes by transplanting pancreatic islets into the liver is associated with poor long-term outcome and graft failure at least partly due to inadequate graft revascularization. The aim of the current study was to evaluate striated muscle as a potential angiogenic site for islet transplantation. Research Design and Methods: The current study presents a new experimental model which is found applicable to clinical islet transplantation. Islets were implanted into striated muscle where after intra-islet vascular density and blood flow were visualized with intravital and confocal microscopy in mice, and by magnetic resonance imaging in three auto-transplanted pancreatectomized patients. Mice were rendered neutropenic by repeated injections of Gr-1 antibody and diabetes was induced by alloxan treatment. Results: Contrary to liver-engrafted islets, islets transplanted to mouse muscle were revascularized with vessel densities and blood flow entirely comparable to islets within intact pancreas. Initiation of islet revascularization at the muscular site was dependent on neutrophils, and the function of islets transplanted to muscle was proven by curing diabetic mice. The experimental data were confirmed in auto-transplanted patients where higher plasma volumes were measured in islets engrafted in forearm muscle compared to adjacent muscle tissue through high-resolution magnetic resonance imaging. Conclusions: This study presents a novel paradigm in islet transplantation whereby recruited neutrophils are crucial for the functionally restored intra-islet blood perfusion following transplantation to striated muscle under experimental and clinical situations.
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| 4. |
- Frykholm, Oscar, 1975-
(författare)
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Case-based presentation in medical multidisciplinary team meetings : Applied research in CSCW and IxD
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Advanced medical technology is widely used in modern healthcare, as more and more specialised examinations and treatments are performed on patients. In the case of particularly complex diseases, a number of medical specialists, each an expert in their own field, must collaboratively make diagnoses and plan for treatment. In multidisciplinary team meetings (MDTM), the medical specialists present their pieces of the puzzle, stitch them together and in consensus make a decision. A large amount of information from several sources must be taken into account, but the digital tools to support this decision-making are lacking.This thesis describes research in which engineers and medical specialists have cooperatively developed such a tool. The main research question concerns improving patient information visualisation to support the collaborative work in MDTMs; a secondary question concerns the role of interaction design in medical work. Several design activities have been conducted together with the medical specialists by utilising research methods derived from computer- supported cooperative work (CSCW) and interaction design (IxD). The new tool has been evaluated in two simulated MDTMs and even though it was developed with the users, the results cut both ways.Case-based presentation of patients in MDTMs has a positive effect, as more information can be displayed during discussions. It helps the participants keep a shared focus on the patient, her medical history, results from examinations, and decisions made in the meeting. It is a new and aggregated view of the patient and an example of how patient information visualisation can be improved. On the other hand introducing new technology and new ways of interacting with information, in the meetings was not considered entirely positive. The participants have different roles and tasks in the meeting, and the tools should support these without distracting the shared focus.This practical way of working (conducting field studies, design activities and evaluations) together with ingenious medical specialists can make a difference. By exploring and concretising stakeholders’ needs and making long-term commitments, the interaction designer can take a central position in the deve- lopment of digital, collaborative tools for medical work.
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| 5. |
- Gustavell, Tina, et al.
(författare)
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Symptoms and self-care following pancreaticoduodenectomy : Perspectives from patients and healthcare professionals - Foundation for an interactive ICT application
- 2017
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Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 26, s. 36-41
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Tidskriftsartikel (refereegranskat)abstract
- PurposePoor prognosis and a problematic recovery period after pancreaticoduodenectomy means that patients may benefit from early detection of symptoms and support for self-management. Interactive Information and Communication Technology tools can be used for this purpose, but the content needs to be relevant to patients as well as healthcare professionals. To facilitate development of the content of an application for this purpose, the aim of this study was to explore common symptoms and self-care in the first six months after pancreaticoduodenectomy, as identified by patients and healthcare professionals.MethodData were collected through individual interviews with patients (n = 14), along with two focus group interviews and one individual interview with healthcare professionals (n = 10). Data were analysed using qualitative content analysis.ResultsCommon symptoms after surgery were those related to eating, bowel function and emotional wellbeing, along with fatigue and pain. Some self-care activities and advice were mentioned in the interviews. The patients often experienced a lack of advice on self-care at discharge.ConclusionsThe results render knowledge of the symptoms it is important to be aware of and to assess regularly after pancreaticoduodenectomy. The results also contribute to knowledge about specific self-care related to these symptoms, even though it was not extensively described, and further research is needed to define evidence-based self-care advice.
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| 6. |
- Huang, Jiaqi, et al.
(författare)
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Variant Profiling of Candidate Genes in Pancreatic Ductal Adenocarcinoma.
- 2015
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Ingår i: Clinical Chemistry. - : Oxford University Press (OUP). - 0009-9147 .- 1530-8561. ; 61:11, s. 1408-16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis. Variant profiling is crucial for developing personalized treatment and elucidating the etiology of this disease.METHODS: Patients with PDAC undergoing surgery from 2007 to 2012 (n = 73) were followed from diagnosis until death or the end of the study. We applied an anchored multiplex PCR (AMP)-based next-generation sequencing (NGS) method to a panel of 65 selected genes and assessed analytical performance by sequencing a quantitative multiplex DNA reference standard. In clinical PDAC samples, detection of low-level KRAS (Kirsten rat sarcoma viral oncogene homolog) mutations was validated by allele-specific PCR and digital PCR. We compared overall survival of patients according to KRAS mutation status by log-rank test and applied logistic regression to evaluate the association between smoking and tumor variant types.RESULTS: The AMP-based NGS method could detect variants with allele frequencies as low as 1% given sufficient sequencing depth (>1500×). Low-frequency KRAS G12 mutations (allele frequency 1%-5%) were all confirmed by allele-specific PCR and digital PCR. The most prevalent genetic alterations were in KRAS (78% of patients), TP53 (tumor protein p53) (25%), and SMAD4 (SMAD family member 4) (8%). Overall survival in T3-stage PDAC patients differed among KRAS mutation subtypes (P = 0.019). Transversion variants were more common in ever-smokers than in never-smokers (odds ratio 5.7; 95% CI 1.2-27.8).CONCLUSIONS: The AMP-based NGS method is applicable for profiling tumor variants. Using this approach, we demonstrated that in PDAC patients, KRAS mutant subtype G12V is associated with poorer survival, and that transversion variants are more common among smokers.
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| 7. |
- Löhr, Johannes-Matthias, et al.
(författare)
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Outcome of probe-based confocal laser endomicroscopy (pCLE) during endoscopic retrograde cholangiopancreatography : a single-center prospective study in 45 patients.
- 2015
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Ingår i: United European Gastroenterology journal. - : Wiley. - 2050-6406 .- 2050-6414. ; 3:6, s. 551-560
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Diagnosis of pre-malignant and malignant lesions in the bile duct and the pancreas is sometimes cumbersome. This applies in particular to intraductal papillary mucinous neoplasia (IPMN) and bile duct strictures in primary sclerosing cholangitis (PSC).AIMS: To evaluate in a prospective cohort study the sensitivity and specificity of probe-based confocal laser microscopy (pCLE) during endoscopic retrograde cholangiopancreatography (ERCP).METHODS: We performed pCLE together with mother-baby endoscopy (SpyGlass) during 50 ERCP sessions in 45 patients. The Miami and Paris criteria were applied. Clinical diagnosis via imaging was compared to pCLE and the final pathological diagnosis from surgically-resected, biopsy, or cytology specimens. Patients were followed up for at least 1 year.RESULTS: We were able to perform pCLE in all patients. Prior to endoscopy, the diagnosis was benign in 23 patients and undetermined (suspicious) in 16 patients, while six patients had an unequivocal diagnosis of malignancy. Sensitivity was 91% and specificity 52%. The positive (PPV) and negative predictive value (NPV) was 82% and 100%, respectively. Apart from mild post-ERCP pancreatitis in two patients, no complications occurred.CONCLUSIONS: Our study showed that pCLE is a safe, expert endoscopic method with high technical feasibility, high sensitivity and high NPV. It provided diagnostic information that can be helpful for decisions on patient management, especially in the case of IPMN and unclear pancreatic lesions, in individuals whom are at increased risk for pancreatic cancer.
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| 8. |
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| 9. |
- Rosenblad, Andreas, Fil. dr, docent, 1973-, et al.
(författare)
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Differences in health-related quality of life between native and foreign-born gynaecological cancer patients in Sweden : a five-year cross-sectional study
- 2024
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Ingår i: Quality of Life Research. - : Springer Nature. - 0962-9343 .- 1573-2649. ; 33, s. 667-678
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To examine differences in health-related quality of life (HRQoL) between native and foreign-born gynaecological cancer patients in Sweden, taking into account clinical, demographic, and socioeconomic factors.Methods: The 30-item European Organisation for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) and a study-specific questionnaire covering demographic and socioeconomic factors were answered by 684 women aged ≥ 18 years old, diagnosed in 2014, 2016, or 2018 with gynaecological cancer in the Stockholm-Gotland health care region, Sweden. Clinical data were obtained from the Swedish Cancer Register. Data were analysed using the Kruskal–Wallis test and linear regression.Results: The women had a mean age of 65.4 years, with 555 (81.1%) born in Sweden, 54 (7.9%) in other Nordic countries (ONC), 43 (6.3%) in other European countries (OEC), and 32 (4.7%) in non-European countries (NEC). HRQoL differed significantly between the four groups for 14 of the 15 QLQ-C30 scales/items. On average, Swedish-born women scored 2.0, 15.2, and 16.7 points higher for QoL/functioning scales/items and 2.2, 14.1, and 18.7 points lower for symptom scales/items, compared with ONC-, OEC-, and NEC-born women, respectively. In adjusted analyses, none of the differences between Swedish-born and ONC-born women were significant, while for OEC- and NEC-born women the differences were significant for most QLQ-C30 scales/items.Conclusion: HRQoL differs between native and foreign-born gynaecological cancer patients in Sweden, with lower HRQoL the further from Sweden the women are born. A more individualised cancer care, with tailored support to optimize HRQoL is needed for this vulnerable group of patients.
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| 10. |
- Sanjeevi, Srinivas, et al.
(författare)
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Comparison of end-to-end invagination and duct-to-mucosa pancreaticojejunostomies following Whipple's resection : A randomized controlled trial in patients at high risk of postoperative pancreatic fistula
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Postoperative pancreatic fistula (POPF) is a major cause of morbidity and mortality after pancreatic resection. Various pancreatoenteric reconstruction techniques exist, yet there is no consensus on the optimal strategy to decrease POPF. The aim of this trial was to compare a novel end-to-end invaginated pancreaticojejunostomy (INV) with the duct-to-mucosa anastomosis (DM) in patients at high risk for POPF. Methods: Consecutive patients between September 2011 and 2015 that were evaluated at a multidisciplinary tumor board and planned for a pancreaticoduodenectomy were randomized prospectively to INV or DM, in an unblinded dual-institution superiority trial. All patients had an assessment of their pancreatic gland both pre- and intra-operatively to select for patients at high risk for POPF. The primary end point was clinically relevant POPF as classified by established definitions. Secondary outcomes were postoperative mortality and morbidity.Results: Hundred and twenty-three patients were included in the final analysis (61 DM, 62 INV). All patients had a soft pancreas with a main pancreatic duct <3mm. There was no difference in clinically significant pancreatic leaks (POPF B-C) between the groups (p=0.72). Significantly fewer cases of POPF C were observed in the INV group compared to the DM group (DM n=13, INV n=2, p=0.002). Six life-threatening complications (Clavien-Dindo IV) occurred in the DM group, compared to one in the INV group (p=0.06). Grade C post-pancreatectomy hemorrhage was significantly higher in the DM group (DM n=7, INV n=0, p=0.006). There were no differences between the groups in median operating times, in-hospital mortality, or blood loss. Conclusion: The end-to-end invagination pancreaticojejunostomy is not significantly superior with regards to clinically significant POPF. It does however appear to be a safe reconstruction technique, possibly associated with a lower incidence of severe POPF and post-pancreatectomy hemorrhage.
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