| 1. |
- Åkerberg, Daniel, et al.
(författare)
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Early postoperative fluid retention is a strong predictor for complications after pancreatoduodenectomy
- 2019
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Ingår i: HPB. - : Elsevier BV. - 1365-182X. ; 21:12, s. 1784-1789
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Tidskriftsartikel (refereegranskat)abstract
- Background: Perioperative fluid overload has been reported to increase complications after a variety of operative procedures. This study was conducted to investigate the incidence of fluid retention after pancreatic resection and its association with postoperative complications. Methods: Data from 1174 patients undergoing pancreatoduodenectomy between 2010 and 2016 were collected from the Swedish National Pancreatic and Periampullary Cancer Registry. Early postoperative fluid retention was defined as a weight gain ≥2 kg on postoperative day 1. Outcome measures were overall complications, as well as procedure-specific complications. Results: The weight change on postoperative day 1 ranged from −1 kg to +9 kg. A total of 782 patients (66.6%) were considered to have early fluid retention. Patients with fluid retention had significantly higher rates of total complications (p = 0.002), surgical complications (p = 0.001), pancreatic anastomotic leakage (p = 0.018) and wound infection (p = 0.023). Multivariable logistic regression confirmed early fluid retention as an independent risk factor for total complications (OR 1.46; p = 0.003), surgical complications (OR 1.49; p = 0.002), pancreatic anastomotic leakage (OR 1.48; p = 0.027) and wound infection (OR 1.84; p = 0.023). Conclusions: Fluid retention is common after elective pancreatic resection, and its associated with an increased rate of postoperative complications.
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| 2. |
- Åkerberg, Daniel, et al.
(författare)
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Factors influencing receipt of adjuvant chemotherapy after surgery for pancreatic cancer : a two-center retrospective cohort study
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 52:1, s. 56-60
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The addition of adjuvant chemotherapy after surgical resection has improved survival rates for patients with pancreatic ductal adenocarcinoma (PDAC). However, outside clinical trials, many operated patients still do not receive adjuvant chemotherapy due to clinical and tumor-related factors. The aim of this study was to investigate factors that may influence the receipt of adjuvant chemotherapy and the effect on long-term survival. Materials and methods: Patients undergoing macroscopically curative resection for PDAC at the University Hospitals in Lund and Linköping, Sweden, between 1 January 2007 and 31 December 2015, were retrospectively reviewed. Clinical and pathological data were compared between adjuvant and non-adjuvant chemotherapy groups and factors affecting chemotherapy receipt were analyzed by multiple logistic regression. Multivariable Cox regression analysis was performed to select predictive variables for survival. Results: A total of 233 patients were analyzed. Adjuvant chemotherapy was administered to 167 patients (71.7%). The likelihood of receiving adjuvant chemotherapy decreased with age, OR 0.91, 95% CI 0.86–0.95, p < .001. Moreover, patients with severe postoperative complications (Clavien–Dindo grade ≥ III) were less likely to receive adjuvant chemotherapy, OR 0.31, 95% CI 0.14–0.71, p = .005. The presence of lymph node metastases on histopathological reporting was associated with increased likelihood of initiating adjuvant chemotherapy, OR 2.19, 95% CI 1.09–4.40, p = .028. Adjuvant chemotherapy was an independent factor for prolonged survival on multivariable Cox regression analysis, HR 0.45 (95% CI 0.31–0.65), p < .001. Conclusions: Age, postoperative complications and the presence of lymph node metastases affect the likelihood of receiving adjuvant chemotherapy after PDAC surgery.
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| 3. |
- Åkerberg, Daniel, et al.
(författare)
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Re-evaluation of classical prognostic factors in resectable ductal adenocarcinoma of the pancreas
- 2016
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Ingår i: World Journal of Gastroenterology. - : Baishideng Publishing Group Inc.. - 1007-9327. ; 22:28, s. 6424-6433
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic ductal adenocarcinoma carries a poor prognosis with annual deaths almost matching the reported incidence rates. Surgical resection offers the only potential cure. Yet, even among patients that undergo tumor resection, recurrence rates are high and long-term survival is scarce. Various tumorrelated factors have been identified as predictors of survival after potentially curative resection. These factors include tumor size, lymph node disease, tumor grade, vascular invasion, perineural invasion and surgical resection margin. This article will re-evaluate the importance of these factors based on recent publications on the topic, with potential implications for treatment and outcome in patients with pancreatic cancer.
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| 4. |
- Andersson, Roland, et al.
(författare)
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Treatment of acute pancreatitis: focus on medical care.
- 2009
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Ingår i: Drugs. - 0012-6667. ; 69:5, s. 505-514
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Tidskriftsartikel (refereegranskat)abstract
- Acute pancreatitis has an incidence of about 300 per 1 million individuals per year, of which 10-15% of patients develop the severe form of the disease. Novel management options, which have the potential to improve outcome, include initial proper fluid resuscitation, which maintains microcirculation and thereby potentially decreases ischaemia and reperfusion injury. The traditional treatment concept in acute pancreatitis, fasting and parenteral nutrition, has been challenged and early initiation of enteral feeding in severe pancreatitis and oral intake in mild acute pancreatitis is both feasible and provides some benefits. There are at present no data supporting immunonutritional supplements and probiotics should be avoided in patients with acute pancreatitis. There is also no evidence of any benefits provided by prophylactic antibacterials in patients with predicted severe acute pancreatitis. A variety of specific medical interventions have been investigated (e.g. intense blood glucose monitoring by insulin) but none has become clinically useful. Lessons can probably be learned from critical care in general, but studies are needed to verify these interventions in acute pancreatitis.
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| 5. |
- Bauden, Monika, et al.
(författare)
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Novel anti-adhesive barrier Biobarrier reduces growth of colon cancer cells.
- 2014
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Ingår i: Journal of Surgical Research. - : Elsevier BV. - 1095-8673 .- 0022-4804. ; 191:1, s. 196-202
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Tidskriftsartikel (refereegranskat)abstract
- Postoperative peritoneal carcinomatosis together with adhesion formation are considered as two major clinical complications after resection of malignant abdominal tumors, jeopardizing the beneficial effect of the curative surgery. Biobarrier is a novel anti-adhesive barrier fulfilling the criteria for a good adhesion preventive agent, possessing biochemical properties that may enable it to function as a dual efficient device, reducing both adhesion and tumor development. This study aims to evaluate the effect of novel anti-adhesive device Biobarrier on intra-abdominal tumor progression.
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| 6. |
- Isaksson, Karolin, et al.
(författare)
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Cationic polypeptides in a concept of oppositely charged polypeptides as prevention of postsurgical intraabdominal adhesions
- 2011
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Ingår i: Journal of Biomedical Science and Engineering. - : Scientific Research Publishing, Inc.. - 1937-6871 .- 1937-688X. ; 4:3, s. 200-206
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Two differently charged polypeptides, α-poly-L-lysine and poly-L-glutamate, have previ- ously been shown to effectively reduce postoperative intraabdominal adhesions. Though α-poly-L-lysine showed toxicity in doses too close to the lowest the-rapeutic dose, the aim in the present study was to investigate the possible antiadhesive effect of another four cationic polypeptides.
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| 7. |
- Isaksson, Karolin, et al.
(författare)
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In vivo toxicity and biodistribution of intraperitoneal and intravenous poly-L-lysine and poly-L-lysine/poly-L-glutamate in rats.
- 2014
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Ingår i: Journal of Materials Science: Materials in Medicine. - : Springer Science and Business Media LLC. - 1573-4838 .- 0957-4530. ; 25:5, s. 1293-1299
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Tidskriftsartikel (refereegranskat)abstract
- The combination of two differently charged polypeptides, poly-L-lysine (PL) and poly-L-glutamate (PG), has shown excellent postsurgical antiadhesive properties. However, the high molecular, positively charged PL is toxic in high doses, proposed as lysis of red blood cells. This study aims to elucidate the in vivo toxicity and biodistribution of PL and complex bound PLPG comparing intravenous and intraperitoneal administration. Fifty-six Sprague-Dawley rats were used in a model with repeated blood samples within 30 min examining blood gases and blood smears. Similarly, FITC labelled PL were used to track bio distribution and clearance of PL, given as single dose and complex bound to PG after intravenous and intraperitoneal administration. Tissue for histology and immunohistochemistry was collected. Blood gases and blood smears as well as histology points to a toxic effect of high dose PL given intravenously but not after intraperitoneal administration. The toxic effect is exerted through endothelial disruption and subsequent bleeding in the lungs, provoking sanguineous lung edema. FITC-labelled PL experiments reveal a rapid clearance with differences between routes and complex binding. This study advocates a new theory of the toxic effects in vivo of high molecular PL. PLPG complex is safe to use as antiadhesive prevention based on this toxicity study given that PL is always intraperitoneally administered in combination with PG and that the dose is adequate.
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| 8. |
- Isaksson, Karolin, et al.
(författare)
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Toxicity and Dose Response of Intra-Abdominally Administered Poly-L-alpha-Lysine and Poly-L-Glutamate for Postoperative Adhesion Protection.
- 2010
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Ingår i: European Surgical Research. - : S. Karger AG. - 0014-312X .- 1421-9921. ; 44:1, s. 17-22
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Two differently charged polypeptides, poly-L-lysine (PL) and poly-L-glutamate (PG), have previously been shown to reduce postoperative intra-abdominal adhesions. This study aims to investigate the possible toxic effects and to establish a lowest effective antiadhesive dose. Methods: 152 mice were investigated with a well-known adhesion model and given different concentrations of the two differently charged polypeptides as well as only the cationic PL. Results: For the first time, a probable toxic level of PL given intraperitoneally (40 mg/kg) and the lowest significant concentration of PL and PG for antiadhesive purposes (1.6 mg/kg) could be established. Conclusion: The gap between the possible toxicity level of PL and the lowest efficient antiadhesive dose is probably too narrow, and the shape and charge of PL warrant continuous research for another polycation in the concept of differently charged polypeptides used as antiadhesive agents.
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| 9. |
- Åkerberg, Daniel
(författare)
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Differently charged polypeptides and their impact on peritoneal and pleural postoperative adhesion formation
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Organization LUND UNIVERSITY Department of Surgery, Clinical Sciences Skånes University Hospital Lund SE-221 85 Lund Sweden Document name DOCTORAL DISSERTATION Date of issue: November 8, 2013 Author(s): Daniel Åkerberg Sponsoring organization Title and subtitle: Differently charged polypeptides and their impact on peritoneal and pleural postoperative adhesion formation Abstract: Abdominal adhesions are formed after previous peritoneal traumas where previous surgery poses the most frequent cause. An increasing number of clinical complications due to adhesions have been detected such as small bowel obstructions, female infertility, and pain. Postoperative adhesions also form in pleura and pericardium after thoracic surgery. Complications include risk of bleeding, organ perforation and prolonged surgery, both in the thorax and abdomen, during reoperations. Previous reports have shown increased healthcare expenditures due to complications of abdominal adhesions. Several prophylactic anti-adhesion devices exist on the market, but none of them are sufficient in every aspect, such as being able to be used during abdominal infections, bleeding and in case of an intestinal anastomosis. The use of two differently charged polypeptides covering the peritoneal wounds during surgery has, in previous studies, shown promising anti-adhesion effects. The aim of this study was to investigate whether the polypeptides in any way affected different important healing aspects of the peritoneum and if the polypeptides may be administered as a spray in an animal study (I). Furthermore, the aim was to elucidate if the administered polypeptides affected important aspects of the healing process during an extended time dynamic pattern (II). It was also investigated whether the polypeptides reduced adhesions after adhesiolysis in the abdomen (III) and pleura (IV), and if there was an impact on peritoneal/pleural healing. In order to investigate the impact of polypeptides, an in vitro cell model was set up (V). A significant decrease in adhesions was seen both in the abdomen and pleura using the polypeptides. A significant decrease in adhesion reformation was seen after adhesiolysis and polypeptide administration. Despite some variation, no significant impact on key parameters of peritoneal and pleural resolving processes were seen after administration of the polypeptides. It was feasible to administer the polypeptides with a spray atomizer. Cell proliferation was decreased when higher concentrations of the polypeptides were administered, indicating a dose response relationship relying on the configuration and amount of charges of the polypeptides. In conclusion, the use of the two differently charged polypeptides to prevent abdominal and pleural adhesions was feasible, reducing adhesions after primary surgery and relaparotomy, without affecting key parameters of the resolving process investigated. Key words: Abdominal adhesions, small bowel obstructions, pain, female infertility, pleural adhesions, peritoneal, pleural, resolving process and key substances. Classification system and/or index terms (if any) Supplementary bibliographical information Language English ISSN and key title 1652-8220 ISBN978-91-87651-18-2 Recipient’s notes Number of pages 150 Price Security classification
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| 10. |
- Åkerberg, Daniel, et al.
(författare)
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Effects of Polylysine and Polyglutamate on Inflammation and the Normal Process of Peritoneal Healing After Surgery
- 2012
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Ingår i: Journal of Tissue Science & Engineering. - : OMICS Publishing Group. - 2157-7552. ; 3:2, s. 1-7
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Introduction: Intraperitoneal adhesions are common after abdominal surgery and may lead to serious clinical complications. Previous studies have investigated the possible effects of the polypeptides poly-L-lysine (αPL) and poly-L-glutamate (PG) forming a polymer complex that prohibits local peritoneal adhesions after surgery. The aim of this study was to examine whether the normal process of peritoneal healing was affected by PL/PG polymer matrix. Material and methods: Male rats (Sprague Dawley) (n=84) underwent abdominal wall surgery and suturing. Rats were randomized in groups according to evaluation time (2, 4, 6, 8, 24 hours and 7 days) with corresponding control groups. Controls received saline (0.9%) and the experimental groups received PL/PG on the surgery site. tPA, PAI-1, IL-6 and active TGFb1 were analyzed at given time points postoperatively in peritoneal lavage. Adhesions were evaluated after seven days. Significant differences were considered to be p<0.05. Results: At a few individual time points small differences were seen between the groups (control and experiment) comparing levels of tPA, PAI-1, IL-6 and active TGFb1. When comparing levels of substances from all time points no statistical differences were seen between the groups as a total. Adhesions were significantly decreased on day 7, p=0.002. Conclusion: Despite significant reduction in adhesions PL/PG administered intraperitoneally as an anti-adhesion agent locally on surgically traumatized area does not seem to affect the normal process of peritoneal healing.
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| 11. |
- Åkerberg, Daniel, et al.
(författare)
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Prevention of Adhesions by PL/PG after Adhesiolysis
- 2012
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Ingår i: Journal of Tissue Science & Engineering. - : OMICS Publishing Group. - 2157-7552. ; 3:4
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Background: Previous studies of differently charged polypeptides, Poly-L-lysine (PL) and Poly-L-Glutamate (PG) have shown promising results, reducing postoperative adhesions. This study aimed to investigate the possible anti adhesion effect of those combined polypeptides, after adhesiolys. The concentration of tPA, PAI-1 and active TGFb1 in biopsies from adhesions, unharmed peritoneum before and after adhesiolysis, was also investigated. Materials and methods: A total of 24 male rats were divided in three groups A (N=8), B (N=8) and C (N=8). All rats underwent primary adhesion creating surgery at day 0, and adhesiolysis at day 7. Adhesions were evaluated at day 7 and 14, where group B received PL/PG after surgery at day 0 and after adhesiolysis at day 7, and group C received PL/PG after adhesiolysis at day 7. Tissue plasminogen activator (tPA), Plasminogen activator inhibitor 1(PAI-1) and active transforming growth factor beta 1(TGF-β1) were collected from biopsies of adhesions and normal peritoneum at day 0, 7 and 14. Results: Significant reduction of adhesions p<0.05 was seen in group B at day 7 after primary surgery, and at day 14 after adhesiolysis. Significantly p<0.05 reduction of adhesions was seen at day 14 after adhesiolysis in group C. Some variations were seen in tPA, PAI-1 and active TGFb1. Conclusions: PL/PG may be used to prevent adhesion formation after adhesiolysis. The process of fibrinolysis and fibrosis was not affected, after PL/PG prophylaxis and adhesiolysis.
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| 12. |
- Åkerberg, Daniel, et al.
(författare)
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Prevention of pleural adhesions by bioactive polypeptides - a pilot study.
- 2013
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Ingår i: International Journal of Medical Sciences. - : Ivyspring International Publisher. - 1449-1907. ; 10:12, s. 1720-1726
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Postoperative pleural adhesions lead to major problems in repeated thoracic surgery. To date, no antiadhesive product has been proven clinically effective. Previous studies of differently charged polypeptides, poly-L-lysine (PL) and poly-L-glutamate (PG) have shown promising results reducing postoperative abdominal adhesions in experimental settings. This pilot study examined the possible pleural adhesion prevention by using the PL+PG concept after pleural surgery and its possible effect on key parameters; plasmin activator inhibitor-1 (PAI-1) and tissue growth factor beta 1 (TGFb) in the fibrinolytic process. Methods: A total of 22 male rats were used in the study, one control group (n=10) and one experimental group (n=12). All animals underwent primary pleural surgery, the controls receiving saline in the pleural cavity and the experimental group the PL+PG solution administered by spray. The animals were evaluated on day 7. Macroscopic appearance of adhesions was evaluated by a scoring system. Histology slides of the adhesions and pleural biopsies for evaluation of PAI-1 and TGFb1 were taken on day 7. Results: A significant reduction of adhesions in the PL+PG group (p<0.05) was noted at day 7 both regarding the length and severity of adhesions. There were no significant differences in the concentration of PAI-1 and TGFb1 when comparing the two groups. Conclusions: PL+PG may be used to prevent pleural adhesions. The process of fibrinolysis, and fibrosis was though not affected after PLPG administration.
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| 13. |
- Åkerberg, Daniel, et al.
(författare)
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The influence on abdominal adhesions and inflammation in rabbits after exposure to differently charged polypeptides
- 2012
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Ingår i: Journal of Biomedical Science and Engineering. - : Scientific Research Publishing, Inc.. - 1937-6871 .- 1937-688X. ; 5, s. 432-438
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Background: Abdominal adhesions develop on da- maged peritoneal surfaces and constitute a significant health related problem. Previous animal studies have shown promising anti-adhesive effects when adminis- tering the polycation α-poly-L-lysine (αPL) and the polyanion poly-L-glutamate (PG) together. The ob- jective of the study was to examine the effect of these differently charged polypeptides when administered by spraying and to evaluate any possible effect on fibrinolysis, fibrosis and inflammation. Methods: Rab- bits were treated with PLPG after cecal abrasive surgery and analysis from peritoneal biopsies of ac- tive tPa/PAI-1 complex and from peritoneal fluid of IL-6 and active TGFb1 at day 0, 1, 4 and 10 were measured after surgery. Histological specimens were analyzed on day 10 regarding inflammation and fib- rosis. Peritoneal adhesions were evaluated by adhe- sion score. All values were compared to the control group (NaCl). Results: PLPG-treated rabbits had a significant diminished adhesion score on day 10 as compared to the control group (p < 0.005). Signifi- cantly reduced collagen depositions on the perito- neum were seen in the PLPG group when evaluating the histological specimens (p < 0.05). No significant differences between the experimental and control groups were seen in peritoneal fluid when analyzing for active protein levels. Conclusion: This is the first study to investigate the effect on key parameters in adhesion formation as well as the preventive effect of the PLPG complex on abdominal adhesions in rabbits and also the first study where administration by spraying the polypeptides was used. PLPG was non- toxic in this setting and without significant differences in adhesion formation parameters and a significant reduction in adhesions was observed. This was veri- fied both macroscopically and histologically.
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