| 1. |
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| 2. |
- Anderberg, Magnus, et al.
(författare)
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Robot-assisted radical cystoprostatectomy in a small child with rhabdomyosarcoma: a case report
- 2008
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Ingår i: Journal of Robotic Surgery. - : Springer Science and Business Media LLC. - 1863-2483 .- 1863-2491. ; 2:2, s. 101-103
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Tidskriftsartikel (refereegranskat)abstract
- Abstract We report the first case of a robot-assisted radical cystoprostatectomy in a 22-month-old boy with embryonal rhabdomyosarcoma in his urinary bladder. Treatment according to international protocol CWS-2002 P (Cooperative Weichteilsarkom Studie) was given prior to surgery. The da Vinci S Surgical System from Intuitive Surgical (Sunnyvale, CA, USA) was used to laparoscopically remove the urinary bladder and prostate radically. The surgical procedure performed and the postoperative course were uneventful. This technique is safe and feasible also in small children. It seems to have advantages over open surgery and no disadvantages. We recommend this technique for further use.
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| 3. |
- Backman, Torbjörn, et al.
(författare)
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Pre- and postoperative vomiting in children undergoing video-assisted gastrostomy tube placement.
- 2014
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Ingår i: Surgery research and practice. - : Hindawi Limited. - 2356-7759 .- 2356-6124. ; 2014
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Tidskriftsartikel (refereegranskat)abstract
- Background. The aim of this study was to determine the incidence of pre- and postoperative vomiting in children undergoing a Video-Assisted Gastrostomy (VAG) operation. Patients and Methods. 180 children underwent a VAG operation and were subdivided into groups based on their underlying diagnosis. An anamnesis with respect to vomiting was taken from each of the children's parents before the operation. After the VAG operation, all patients were followed prospectively at one and six months after surgery. All complications including vomiting were documented according to a standardized protocol. Results. Vomiting occurred preoperatively in 51 children (28%). One month after surgery the incidence was 43 (24%) in the same group of children and six months after it was found in 40 (22%). There was a difference in vomiting frequency both pre- and postoperatively between the children in the groups with different diagnoses included in the study. No difference was noted in pre- and postoperative vomiting frequency within each specific diagnosis group. Conclusion. The preoperative vomiting symptoms persisted after the VAG operation. Neurologically impaired children had a higher incidence of vomiting than patients with other diagnoses, a well-known fact, probably due to their underlying diagnosis and not the VAG operation. This information is useful in preoperative counselling.
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| 4. |
- Eriksson, Mikael, et al.
(författare)
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STATUS OF THE MAX IV LIGHT SOURCE PROJECT
- 2006
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Ingår i: European Particle Accelerator Conference 2006, Edinburgh, UK.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 5. |
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| 6. |
- Anderberg, Magnus
(författare)
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Computer-assisted surgery in children
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Although positive in terms of patient trauma and recovery time, minimally invasive surgery has several technical drawbacks compared with open surgery. The new da Vinci® Surgical System from Intuitive Surgical® offers technical innovations aiming at overcoming these drawbacks and at improving the surgeon’s operating skills, such as the improved 3-D vision, tremor reduction and flexible instruments with a more natural and intuitive range of motion. In this thesis, the computer-assisted surgical instruments, and their application in paediatric surgery and paediatric urology, were investigated. In a prospective study of the first six fundoplications using the da Vinci® Surgical System, retrospective data from the open surgical procedure and the conventional laparoscopic technique were used as controls. Computer-assisted laparoscopic surgery (CALS) was safe and feasible. The operating time for the computer-assisted procedure was longer than the open one, but comparable to the laparoscopic procedure, and the need for postoperative morphine analgesics and the length of hospital stay were reduced with the two minimally invasive methods. The short-term clinical outcome did not differ, the symptoms of gastroesophageal reflux disease disappeared in all the children. The costs for CALS were compared with the costs for open and laparoscopic surgery in children. The total costs of CAL fundoplication amounted to EUR 9584. The costs for laparoscopic and open fundoplication amounted to EUR 8982 and EUR 10521, respectively. The cost of the CALS instruments per procedure (EUR 2081) accounted for the extra expense compared with laparoscopy. The increased costs for CALS due to longer operating time, were offset by the shorter hospital stay compared with open surgery, 3.8 and 7.9 days, respectively. An experimental study of students with no prior surgical experience and divided by gender was performed to test the hypothesis that maiden users master surgical tasks more quickly with computer-assisted than with standard laparoscopic instruments. Each surgical task was performed four times with one of the techniques before changing to the other. Speed and accuracy were measured. A cross-over technique was used to eliminate gender bias and the experience gained from carrying out the first part of the study. The more advanced task of tying a knot was performed faster with the computer-assisted than with the laparoscopic technique. Shorter time was observed when the change was made from laparoscopy to the computer-assisted technique. Gender did not influence the results. The lack of tactile feedback in computer-assisted laparoscopy seemed to matter. A case-control study of ten consecutive children undergoing computer-assisted retroperitoneoscopic nephrectomy due to a non- or malfunctioning kidney was performed. This prospectively gathered consecutive group of children was compared with a retrospectively collected group of all other children who had undergone open nephrectomy for benign renal disease at our centre between 2005 and 2009. All nephrectomies were performed with the retroperitoneal approach. Endpoints of this study were safety, the operating time, the number of postoperative doses of morphine, the length of hospital stay and the number of complications. Four out of ten patients in the CALS group had a total operating time within the range of the operating time for an open procedure but it was longer for the CALS procedure. The number of postoperative doses of morphine did not differ, but the hospital stay was shorter for the CALS group. The patient benefit from CALS, in the form of low morbidity, improved cosmetics and shorter hospitalisation was associated with the minimally invasive approach. Whether computer-assistance leads to better long-term results and fewer postoperative complications is too early to determine. However, considering all the potential benefits of the CALS instruments, the future will favour its use in paediatric surgery.
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| 7. |
- Anderberg, Magnus, et al.
(författare)
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Laparoskopi och robotassisterad kirurgi
- 2015
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Ingår i: Grottes Barnkirurgi och barnurologi. - 9789144071510 ; , s. 51-54
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Bokkapitel (populärvet., debatt m.m.)
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| 8. |
- Anderberg, Magnus, et al.
(författare)
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Morgagni Hernia Repair in a Small Child Using da Vinci Robotic Instruments - A Case Report.
- 2009
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 19, s. 110-112
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The recently introduced use of robotic surgery in minimally invasive surgery procedures facilitates several steps in the operative procedure. We report the first case of a robot-assisted laparoscopic repair of a Morgagni hernia using the da Vinci(R) Surgical System from Intuitive Surgical(R) (Sunnyvale, CA, USA) in a 7.8 kg 18-month-old child. METHODS: Four trocars were used to gain access to the abdomen. The robot-enhanced instruments were used to close the hernia defect with interrupted, absorbable sutures, using intracorporeal knot tying. RESULTS: The operation was completed laparoscopically without a patch. The total setup time for the robotic system was 35 minutes including draping. The operating time at the robotic console was 80 minutes. The child tolerated an oral intake the day after surgery and was discharged home on the third postoperative day. CONCLUSION: Robot-assisted laparoscopic Morgagni hernia repair is feasible in small children.
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| 9. |
- Anderberg, Magnus, et al.
(författare)
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Paediatric computer-assisted retroperitoneoscopic nephrectomy compared with open surgery.
- 2011
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Ingår i: Pediatric Surgery International. - : Springer Science and Business Media LLC. - 1437-9813 .- 0179-0358. ; 27:7, s. 761-767
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Computer-assisted laparoscopic surgery (CALS) in children is increasingly used and has proven to be feasible and safe. However, its full potential remains unclear and clinical comparative studies hardly exist. The aim of this study was to prospectively evaluate our experience with CALS for performing retroperitoneal nephrectomies in children when compared with controls undergoing open surgery in terms of safety, operative time, blood loss, opoid requirements, the duration of hospital stay and complications. CHILDREN AND METHODS: Computer-assisted retroperitoneoscopic nephrectomy was undertaken in ten consecutive children, mean age at the time of surgery 6.4 (SD ± 4.5) years, and compared with a retrospectively collected control group of all other children, mean age 3.9 (SD ± 4.6) years, who underwent the same procedure by conventional open surgery between the years 2005 and 2009. The endpoint of the study was 1 month postoperatively. RESULTS: Nephrectomies were performed in all the children and no child was excluded from the study. There was no per-operative complication in any of the groups. The median (range) operative time was 202 (128-325) and 72 (44-160) min for the CALS and open group, respectively. The blood loss was minimal (<20 ml) for all the patients. The postoperative opoid requirements did not differ. The median (range) postoperative hospital stay was 1 (1-4) and 2 (1-7) days for the CALS and the open group, respectively. One complication in the form of an urinoma appeared 5 days after surgery in the CALS group. CONCLUSION: Computer-assisted retroperitoneoscopic nephrectomy is a safe, feasible and effective procedure in children. Even though operative times are longer the patients benefit from the lower morbidity, improved cosmetics and shorter hospitalization associated with the minimally invasive approach.
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| 10. |
- Anderberg, Magnus, et al.
(författare)
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Paediatric robotic surgery in clinical practice: a cost analysis.
- 2009
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 19:5, s. 311-315
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Since 2006 we have used robotic assistance when performing minimally invasive laparoscopic fundoplications in children. We compared the costs of robotic surgery with the costs for open and laparoscopic surgery to test our hypothesis that the increased costs of the new technology are acceptable. METHOD: Costs were calculated using the regional hospital prices for our first 14 fundoplications in children, performed with the aid of the da Vinci Surgical System from Intuitive Surgical. We compared these costs with those of our ten latest fundoplications performed using open and laparoscopic surgery, respectively. There were no differences in the demographic data, work-up or indications for surgery between the three groups of children. RESULTS: The mean cost of robotic surgical fundoplications (EUR 9 584) was 7% higher than the mean cost of laparoscopic surgery (EUR 8 982) and 9% lower than the mean costs for open surgical procedures (EUR 10 521). These differences can be explained by the increased cost of robotic instruments (EUR 2 081 per operation). The duration of the operation and the duration of in-hospital stay are comparable to those of laparoscopic surgical interventions. The time required for the operative intervention was considerably longer than for the open surgical procedure; the duration of the in-hospital stay was only half of that of the open surgical procedure. The patients seemed to benefit from the use of robotic instruments with less morphine (as a marker of less postoperative pain) and a shorter hospital stay. CONCLUSION: The introduction of robotic assistance into surgical practice involves increased in-hospital costs, mainly because of the cost of the new instruments. This increase in cost can be offset by the shorter hospital stay compared to open surgery. After laparoscopic surgery the hospital stay is about the same as after operations performed with robotic assistance. Cheaper instruments and shorter operating time will make robotic surgery cost efficient in the future. The benefit for the patients is less trauma due to the use of minimally invasive surgery and a shorter hospital stay. Thus, the higher initial costs may be considered worthwhile.
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| 11. |
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| 12. |
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| 13. |
- Anderberg, Magnus, et al.
(författare)
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Robotic fundoplication in children
- 2007
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Ingår i: Pediatric Surgery International. - : Springer Science and Business Media LLC. - 1437-9813 .- 0179-0358. ; 23:2, s. 123-127
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Tidskriftsartikel (refereegranskat)abstract
- Since January 2006, robotic assistance has been used for performing minimal invasive laparoscopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci (R) Surgical System from Intuitive Surgical (R), were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive laparoscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term outcome. There was no significant difference between the three groups concerning age, body weight and preoperative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the laparoscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analgesics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastroesophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postoperative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include better visualisation for the surgeon and greater precision in the movements of the instruments used.
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| 14. |
- Anderberg, Magnus, et al.
(författare)
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Robotics versus laparoscopy - an experimental study of the transfer effect in maiden users.
- 2010
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Ingår i: Annals of Surgical Innovation and Research. - : Springer Science and Business Media LLC. - 1750-1164. ; 4, s. 3-3
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Robot-assisted laparoscopy (RL) is used in a wide range of operative interventions, but the advantage of this technique over conventional laparoscopy (CL) remains unclear. Studies comparing RL and CL are scarce. The present study was performed to test the hypothesis that maiden users master surgical tasks quicker with the robot-assisted laparoscopy technique than with the conventional laparoscopy technique. METHODS: 20 subjects, with no prior surgical experience, performed three different surgical tasks in a standardized experimental setting, repeated four times with each of the RL and CL techniques. Speed and accuracy were measured. A cross-over technique was used to eliminate gender bias and the experience gained by carrying out the first part of the study. RESULTS: The task "tie a knot" was performed faster with the RL technique than with CL. Furthermore, shorter operating times were observed when changing from CL to RL. There were no time differences for the tasks of grabbing the needle and continuous suturing between the two operating techniques. Gender did not influence the results. CONCLUSION: The more advanced task of tying a knot was performed faster using the RL technique than with CL. Simpler surgical interventions were performed equally fast with either technique. Technical skills acquired during the use of CL were transferred to the RL technique. The lack of tactile feedback in RL seemed to matter. There were no differences between males and females.
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| 15. |
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| 16. |
- Axelsson, Anton, 1981-, et al.
(författare)
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Can preschoolers profit from a teachable agent based play-and-learn game in mathematics?
- 2013
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Ingår i: Artificial Intelligence in Education. - Berlin, Heidelberg : Springer Berlin/Heidelberg. - 9783642391118 - 9783642391125 ; LNCS, vol 7926, s. 289-298
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Konferensbidrag (refereegranskat)abstract
- A large number of studies carried out on pupils aged 8-14 have shown that teachable agent (TA) based games are beneficial for learning. The present pioneering study aimed to initiate research looking at whether TA based games can be used as far down as preschool age. Around the age of four, theory of mind (ToM) is under development and it is not unlikely that a fully developed ToM is necessary to benefit from a TA’s socially engaging characteristics. 10 preschool children participated in an experiment of playing a mathematics game. The participants playing a TA-version of the game engaged socially with the TA and were not disturbed by his presence. Thus, this study unveils exciting possibilities for further research of the hypothesised educational benefits in store for preschoolers with regard to play-and-learn games employing TAs.
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| 17. |
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| 18. |
- Brands Viktorsdóttir, Margrét, et al.
(författare)
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Complications according to underlying disease in children undergoing video-assisted gastrostomy
- 2017
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Ingår i: Medical Research Archives. - 2375-1916. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to identify short-term complications after video-assisted gastrostomy in children and to examine the association between complications and underlying disease.Methods: This was a retrospective study at a single institution. Data for all children who underwent video-assisted gastrostomy during 12 years was collected. Complications occurring within three months postoperatively were analyzed.Results: Among 421 children undergoing video-assisted gastrostomy, 402 were included in the study. The median age at surgery was two years (range one month-14 years). The most common underlying disorder was neurological disease (49%). There were two major postoperative complications and 78% had minor complications. Minor complications included granulation tissue (43%), leakage (16%), wound infection (14%), vomiting, dislodgement and pain. There was no significant difference in frequency of the various complications when compared between the underlying diseases (p=0.10-0.82). Wound infection was registered in overall 14% and occurred least frequently in children with neurologic disease and syndromes (10% and 9% respectively).Conclusion: Serious complications after video-assisted gastrostomy are rare, while minor complications occur in 78% of the children. There is no association between the frequency of complications and underlying disease according to this study.
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| 19. |
- Ekelund, Magnus, et al.
(författare)
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Genetic prediction of postpartum diabetes in women with gestational diabetes mellitus
- 2012
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 1872-8227 .- 0168-8227. ; 97:3, s. 394-398
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To examine whether genetic variants that predispose individuals to type 2 diabetes (T2D) could predict the development of diabetes after gestational diabetes mellitus (GDM). Methods: 13 SNPs (FTO rs8050136, CDKAL1 rs7754840 and rs7756992, CDKN2A/2B rs10811661, HHEX rs1111875, IGF2BP2 rs1470579 and rs4402960, SLC30A8 rs13266634, TCF7L2 rs7903146, PPARG rs1801282, GCK rs1799884, HNF1A rs1169288, and KCNJ11 rs5219) were genotyped in 793 women with GDM after a median follow-up of 57 months. Results: After adjustment for age and ethnicity, the TCF7L2 rs7903146 and the FTO rs8050136 variants significantly predicted postpartum diabetes; hazard ratio (95% confidence interval 1.29 (1.01-1.66) and 1.36 (1.06-1.74), respectively (additive model) versus 1.45 (1.01-2.08) and 1.56 (1.06-2.29) (dominant model)). Adjusting for BMI attenuated the effect of the FTO variant, suggesting that the effect was mediated through its effect on BMI. Combining all risk alleles to a weighted risk score was significantly associated with the risk of postpartum diabetes (hazard ratio 1.11, 95% confidence interval 1.05-1.18, p = 0.00016 after adjustment for age and ethnicity). Conclusions: The TCF7L2 rs7903146 and FTO rs8050136 polymorphisms, and particularly a weighted risk score of T2D risk alleles, predict diabetes after GDM. Further studies in other populations are needed to confirm our results. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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| 20. |
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| 21. |
- Eriksson, Mikael, et al.
(författare)
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The MAX IV Synchrotron Light Source
- 2011
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Ingår i: [Host publication title missing]. - 9789290833666 ; , s. 3026-3028
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Konferensbidrag (refereegranskat)abstract
- The MAX IV synchrotron radiation facility is currently being constructed in Lund, Sweden. It consists of a 3 GeV linac injector and 2 storage rings operated at 1.5 and 3 GeV respectively. The linac injector will also be used for the generation of short X-ray pulses. The three machines mentioned above are described with some emphasis on the effort to create a very small emittance in the 3 GeV ring. Some unconventional technical solutions will also be presented.
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| 22. |
- Granéli, Christina, et al.
(författare)
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Outcome after Computer-Assisted (Robotic) Nissen Fundoplication in Children Measured as Pre- and Postoperative Acid Reducing and Asthma Medications Use.
- 2015
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 25:6, s. 532-536
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This study aims to report the clinical outcome of computer-assisted fundoplication (CAF) in children. Methods As our center changed policy to using computer-assisted surgery only, a prospectively studied cohort of 40 children underwent CAF, during the period from January 2006 through May 2013. The collected data include patient demographics and postoperative complications as well as medication, 24-hour pH measurements and DeMeester scores before and after surgery. Results In the studied group, the median percentage of the duration of the 24-hour pH < 4 decreased postoperatively from 11 (range, 5-39) to 1% (range, 0-12) (p < 0.001); the DeMeester score decreased from 40 (range, 17-137) to 5 (range, 1-42) (p < 0.001). All 40 patients required antireflux medication before the fundoplication. This number decreased significantly to 8 (20%) after the fundoplication (p < 0.001). Before the fundoplication, 22 children (55%) were using asthma medication and 12 (30%) after the fundoplication (p = 0.04). Conclusions The CAF significantly reduced the acid reflux from the stomach to the esophagus and the use of antireflux as well as asthma medication during the median observation period of 5 years. The evidence of advantages compared with conventional laparoscopic fundoplication remain to be confirmed.
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| 23. |
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| 24. |
- Gunnarsson, Marie, 1980-
(författare)
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Lärande i arbetslivets övergångar
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Over the course of the last few decades, work-life has changed and now includes a higher degree of instability and insecurity. This thesis takes this change as its starting point, aiming to understand the ways in which individuals manage involuntary work-life transitions at the workplace, in terms of learning.The study has a longitudinal focus, based on interviews of twelve people who used to work at the same plant. Seven of the interviewees were laid off during the financial crisis of 2008, five of them were not laid off, but continued their employment throughout the crisis. Theoretically, the approach is a combination of a pragmatic learning perspective, through which learning is seen as a kind of problem-solving activity, and a narrative perspective that provides tools with which to view stories as carriers of meaning.The results show that insecurity is accepted by many as a non-negotiable part of work-life. Work-life is in many aspects affected by market globalisation the discourse of employability, where the individual bears the responsibility for their personal work-life. By preparing as best they can to be financially, socially and employability-wise well equipped, the interviewees do what they can to minimize the negative effects of the bad times that are bound to come at some point. Across time, many of the interviewees are moving between different approaches to dealing with the insecurity of work-life. In the process of making meaningful strategic choices, they are involved in learning. Experience and future plans play a role in which choices are made, and thereby also form the route that is constructed by each individual as they navigate between different points in their work-life.The final discussion aims at pointing out the effects an insecure work-life impose on people. People tell stories of acceptance towards the instability of work-life, not because they find work-life satisfying or well-functioning, but because they need to. In order to match the qualifications of an employable individual, they cannot oppose it. In doing so they would automatically define themselves as not so flexible, not so employable. This is a result of learning in work-life transitions.
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| 25. |
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| 26. |
- Hagelsteen, Kristine, et al.
(författare)
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Faster acquisition of laparoscopic skills in virtual reality with haptic feedback and 3D vision
- 2017
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Ingår i: Minimally Invasive Therapy and Allied Technologies. - : Informa UK Limited. - 1364-5706 .- 1365-2931. ; 26:5, s. 269-277
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The study investigated whether 3D vision and haptic feedback in combination in a virtual reality environment leads to more efficient learning of laparoscopic skills in novices.MATERIAL AND METHODS: Twenty novices were allocated to two groups. All completed a training course in the LapSim(®) virtual reality trainer consisting of four tasks: 'instrument navigation', 'grasping', 'fine dissection' and 'suturing'. The study group performed with haptic feedback and 3D vision and the control group without. Before and after the LapSim(®) course, the participants' metrics were recorded when tying a laparoscopic knot in the 2D video box trainer Simball(®) Box.RESULTS: The study group completed the training course in 146 (100-291) minutes compared to 215 (175-489) minutes in the control group (p = .002). The number of attempts to reach proficiency was significantly lower. The study group had significantly faster learning of skills in three out of four individual tasks; instrument navigation, grasping and suturing. Using the Simball(®) Box, no difference in laparoscopic knot tying after the LapSim(®) course was noted when comparing the groups.CONCLUSIONS: Laparoscopic training in virtual reality with 3D vision and haptic feedback made training more time efficient and did not negatively affect later video box-performance in 2D. [Formula: see text].
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| 27. |
- Hagelsteen, Kristine, et al.
(författare)
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Performance and perception of haptic feedback in a laparoscopic 3D virtual reality simulator
- 2019
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Ingår i: Minimally Invasive Therapy and Allied Technologies. - : Informa UK Limited. - 1364-5706 .- 1365-2931. ; 28:5, s. 309-316
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Tidskriftsartikel (refereegranskat)abstract
- Background: The benefit of haptic feedback in laparoscopic virtual reality simulators (VRS) is ambiguous. A previous study found 32% faster acquisition of skills with the combination of 3 D and haptic feedback compared to 2 D only. This study aimed to validate perception and effect on performance of haptic feedback by experienced surgeons in the previously tested VRS. Material and methods: A randomized single blinded cross-over study with laparoscopists (>100 laparoscopic procedures) was conducted in a VRS with 3 D imaging. One group started with haptic feedback, and the other group without. After performing the suturing task with haptics either enabled or disabled, the groups crossed over to the opposite setting. Face validity was assessed through questionnaires. Metrics were obtained from the VRS. Results: The haptics for ‘handling the needle’, ‘needle through tissue’ and ‘tying the knot’ was scored as completely realistic by 3/22, 1/22 and 2/22 respectively. Comparing the metrics for maximum stretch damage between the groups revealed a significantly lower score when a group performed with haptics enabled p =.027 (haptic first group) and p <.001(haptic last group). Conclusion: Haptic feedback in VRS has limited fidelity according to the tested laparoscopic surgeons. In spite of this, significantly less stretch damage was caused with haptics enabled.
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| 28. |
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| 29. |
- Hofko Lindkvist, Emma, et al.
(författare)
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National survey of physicians in Swedish child health centres finds insecurity and unawareness regarding management of undescended testicles
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Ingår i: Acta Paediatrica, International Journal of Paediatrics. - 0803-5253.
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate underlying factors for previously reported shortcomings in child health centres' (CHC) referral process of boys with undescended testicles. Methods: A total of 386 physicians working at Swedish CHCs were surveyed regarding their knowledge about undescended testicles and their clinical management. Multivariate regression analyses were performed to identify risk factors of non-adherence to guidelines and self-reported lack of clinical skills. Results: The overall knowledge of the health benefits of undescended testicle surgery was high (89%), while two-thirds were unaware of surgery being recommended <1 year of age. One-fifth of respondents had never received guidance on examination techniques. Male gender (adjusted odds ratio [aOR] 0.51, 95% confidence interval [95% CI] 0.31–0.86), education in paediatrics (aOR 0.37, 95% CI 0.18–0.76) and more experience (aOR 0.02, 95% CI 0.01–0.09) significantly decreased the risk of unfamiliarity with examinations. More experience decreased the risk of stating the incorrect indications for undescended testicle surgery (aOR 0.17, 95% CI 0.03–0.95) and finding examinations difficult (aOR 0.22, 95% CI 0.07–0.72). Medical education outside Nordic countries was a risk factor for unawareness of guidelines (aOR 2.06, 95% CI 1.21–3.51). Conclusion: The knowledge and confidence level of the study population varied widely. The results indicate a need for further theoretical and practical education among Swedish CHC physicians.
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| 30. |
- Högberg, Linnea, et al.
(författare)
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Sex differences in children operated with pyeloplasty for pelvoureteric junction obstruction
- 2023
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Ingår i: Pediatric Surgery International. - 1437-9813. ; 39, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Pelvoureteric junction obstruction (UPJO) is a common cause of hydronephrosis in children but no previous studies have evaluated differences between boys and girls operated with pyeloplasty. This study aimed to evaluate potential differences between sexes in children operated with pyeloplasty for PUJO in terms of presentation, surgery, and long-term results.METHODS: Data was retrospectively collected from all children operated on with pyeloplasty between January 2002 and December 2020. Data contained several variables covering presentation, surgery, and long-term results.RESULTS: In total, 194 patients were included of which 126 (64.9%) were boys. There were no significant differences in prenatal findings, pelvic dilation on ultrasound, function of the affected kidney, surgical method, obstruction type, resolution of hydronephrosis, or improvement of function. Boys presented with pain more often than girls (47.4 vs 25.0%, p < 0.01) while girls were more prone to infections preoperatively (17.2 vs 7.0%, p = 0.04). All nine patients requiring reoperation were boys (p = 0.03).CONCLUSION: Girls with UPJO seem to experience infections as presenting symptoms more often than boys, while boys significantly more often present with pain. There is also a higher percentage of boys needing reoperation.
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| 31. |
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| 32. |
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| 33. |
- Ignell, Claes, et al.
(författare)
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Model for individual prediction of diabetes up to 5 years after gestational diabetes mellitus
- 2016
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Ingår i: SpringerPlus. - : Springer Science and Business Media LLC. - 2193-1801. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To identify predictors of diabetes development up to 5 years after gestational diabetes mellitus (GDM) and to develop a prediction model for individual use.METHODS: Five years after GDM, a 75-g oral glucose tolerance test (OGTT) was performed in 362 women, excluding women already diagnosed with diabetes at 1- to 2-year follow-up or later (n = 45). All but 21 women had results from follow-up at 1-2 years, while 84 women were lost from that point. Predictive variables were identified by logistic regression analysis.RESULTS: Five years after GDM, 28/362 women (8 %) were diagnosed with diabetes whereas 187/362 (52 %) had normal glucose tolerance (NGT). Of the latter, 139/187 (74 %) also had NGT at 1- to 2-year follow-up. In simple regression analysis, using NGT at 1-2 years and at 5 years as the reference, diabetes at 1- to 2-year follow-up or later was clearly associated with easily assessable clinical variables, such as BMI at 1- to 2-year follow-up, 2-h OGTT glucose concentration during pregnancy, and non-European origin (P < 0.0001). A prediction model based on these variables resulting in 86 % correct classifications, with an area under the receiver-operating characteristic curve of 0.91 (95 % CI 0.86-0.95), was applied in a function-sheet line diagram illustrating the individual effect of weight on diabetes risk.CONCLUSIONS: The results highlight the importance of BMI as a potentially modifiable risk factor for diabetes after GDM. Our proposed prediction model performed well, and should encourage validation in other populations in future studies.
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| 34. |
- Lopera, Carlos, et al.
(författare)
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Literature Review of the Frequency of Reoperations after One Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children
- 2012
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Ingår i: Surgical Science. - : Scientific Research Publishing, Inc.. - 2157-9415 .- 2157-9407. ; 3, s. 290-294
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Forskningsöversikt (refereegranskat)abstract
- Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) has gained worldwide acceptance. However surgical success is often reported separately, while the necessity for true reoperation is difficult to establish. Aim: To evaluate the incidence of reoperations following TERPT procedure. The findings will be important in counseling and planning childcare for HD patients as well as providing a benchmark for single centers clinical results. Methods: A literature review of reported TERPT operations on children with HD between 1998 through 2011 was performed. Only planned TERPT operation reports were included. Information was collected with particular emphasis on reoperations and their reasons. Results: Out of 26 published articles 23 were in-cluded, reporting on 836 children, female/male ratio: 1/3.3, undergoing the TERPT procedure as the only operative in-tervention with described postoperative courses. The children comprised neonates, <4 weeks (38%), babies <1 year (35%), toddlers, 1 - 3 years (15%) and children >3 years of age (12%). The average follow up was 18.5 (6 - 38) months. The resected bowel length mean was 20.5 cm. Forty-one reoperations were reported (4.9%), including 24 laparotomies, 8 laparoscopies, 6 colostomies and ileostomies in 3 children. Only 2 re-do TERPT were reported (0.2%). Seven patients were considered TERPT failures (0.8%) with 5 requiring diverting colostomies and additional transabdominal pull- through operations. Two myectomies were performed (0.2%). One child with aganglionosis underwent a Duhamel pull through. Two (0.2%) had serious damage to the urinary tract also one child with a vas deferens lesion was reoperated. Two bowel obstructions required adhesiolysis. Eight anastomotic dehiscences (0.9%) required surgery after reparation. One prolapse of the pulled through colon was reported. Six patients (0.7%) suffered anastomotic leaks. Anastomotic strictures rate was 2.8%, all repaired with anal dilatation. Conclusion: The review supports the low incidence of re-ported reoperations for the TERPT procedure.
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| 35. |
- Lundin, Johanna, et al.
(författare)
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Further support linking the 22q11.2 microduplication to an increased risk of bladder exstrophy and highlighting LZTR1 as a candidate gene
- 2019
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Ingår i: Molecular Genetics and Genomic Medicine. - : Wiley. - 2324-9269. ; 7:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: The bladder exstrophy-epispadias complex (BEEC) is a congenital malformation of the bladder and urethra. The underlying causes of this malformation are still largely unknown; however, aside from environment, genetics is thought to play an essential role. The recurrent 22q11.2 microduplication is the most persistently detected genetic aberration found in BEEC cases. Methods: We performed array comparative genomic hybridization (array-CGH) analysis of 76 Swedish BEEC patients. Statistical analysis was performed on current dataset pooled with previously published data on the 22q11.2 microduplication in BEEC patients. We performed massive parallel sequencing (MPS) of the 22q11.2 region in 20 BEEC patients without the 22q11.2 microduplication followed by functional studies. Results: We identified three additional cases with the 22q11.2 microduplication. Pooling data from this study with previously published reports showed a statistically significant enrichment of the 22q11.2 microduplication in BEEC patients (2.61% in cases vs. 0.08% in controls; OR = 32.6; p = 8.7 × 10−4). MPS of the 22q11.2 region in 20 BEEC patients without the 22q11.2 microduplication identified a novel variant in LZTR1 (p.Ser698Phe) in one patient. Functional evaluation of the LZTR1 p.Ser698Phe variant in live NIH 3T3 cells showed that the concentration and cytoplasmic mobility differ between the Lztr1wt and Lztr1mut, indicating a potential functional effect of the LZTR1mut. Conclusion: Our study further emphasizes the involvement of the 22q11.2 region in BEEC development and highlights LZTR1 as a candidate gene underlying the urogenital malformation.
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| 36. |
- Naredi, Maria, et al.
(författare)
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Single-Port Laparoscopy-Assisted Appendectomy in Children : A Method Described
- 2016
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Ingår i: Journal of Surgery: Open Access. - : Sci Forschen, Inc.. - 2470-0991. ; 2:3
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Tidskriftsartikel (refereegranskat)abstract
- Single-incision laparoscopic appendectomy (SILA) has gained popularity in children, and several different techniques have been described, including intracorporeal and extracorporeal techniques and single-channel and multi-channel single-port techniques. However, there has been a concern that exteriorizing an infected appendix through the umbilical channel would increase the risk of postoperative wound infections. This report aims to describe a technique for single-port laparoscopy-assisted appendectomy (SPLAA) using an operative laparoscope and conventional laparoscopic instruments, as well as a VersaStep™ sheath to protect the wound edge while removing the appendix from the abdomen.
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| 37. |
- Nordenskjöld, A., et al.
(författare)
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Copy number variants suggest different molecular pathways for the pathogenesis of bladder exstrophy
- 2023
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Ingår i: American Journal of Medical Genetics, Part A. - : Wiley. - 1552-4825 .- 1552-4833. ; 191:2, s. 378-390
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Tidskriftsartikel (refereegranskat)abstract
- Bladder exstrophy is a rare congenital malformation leaving the urinary bladder open in the midline of the abdomen at birth. There is a clear genetic background with chromosome aberrations, but so far, no consistent findings apart from 22q11-duplications detected in about 2%–3% of all patients. Some genes are implicated like the LZTR1, ISL1, CELSR3, and the WNT3 genes, but most are not explained molecularly. We have performed chromosomal microarray analysis on a cohort of 140 persons born with bladder exstrophy to look for submicroscopic chromosomal deletions and duplications. Pathogenic or possibly pathogenic microdeletions or duplications were found in 16 patients (11.4%) and further 9 with unknown significance. Two findings were in regions linked to known syndromes, two findings involved the same gene (MCC), and all other findings were unique. A closer analysis suggests a few gene networks that are involved in the pathogenesis of bladder exstrophy; the WNT-signaling pathway, the chromosome 22q11 region, the RIT2 and POU families, and involvement of the Golgi apparatus. Bladder exstrophy is a rare malformation and is reported to be associated with several chromosome aberrations. Our data suggest involvement of some specific molecular pathways.
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| 38. |
- Pedersen, Hanne, et al.
(författare)
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Visuospatial ability is associated to 2D laparoscopic simulator performance amongst surgical residents
- 2023
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Ingår i: Surgery Open Science. - : Elsevier BV. - 2589-8450. ; 11, s. 56-61
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Tidskriftsartikel (refereegranskat)abstract
- Background: The technical skills of a surgeon influence surgical outcome. Testing technical aptitude at point of recruitment of surgical residents is only conducted in a few countries. This study investigated the impact of visuospatial ability (VSA), background factors, and manual dexterity on performance in two different laparoscopic surgical simulators amongst applicants and 1st year surgical residents. Method: Applicants from general surgery, pediatric surgery, and urology were included from seven hospitals in Sweden between 2017 and 2021. Some 73 applicants were invited and 50 completed. Participants filled out a background form, and were tested for manual dexterity, and visuospatial ability. Two laparoscopic simulators were used, one 2D video box trainer and one 3D Virtual Reality Simulator. Results: A significant association was found between the visuospatial ability test and 2D video box laparoscopic performance (95 % CI: 1.028–1.2, p-value <0.01). For every point on the visuospatial test the odds of accomplishing the task increased by 11 %. No association was found between VSA and performance in a laparoscopic VR simulator using 3D vision. No other background factors were associated with performance in the two laparoscopic simulators. Conclusion: Visuospatial ability in applicants to surgical residency positions is associated to performance in a 2D video box trainer. Knowledge of a resident's visuospatial ability can be used to tailor individualized laparoscopic training programs, and in the future might function as a selection tool concerning laparoscopic ability. Key message: Visuospatial ability differs greatly amongst applicants for surgical residency and is associated to laparoscopic simulator performance. Testing applicants' visuospatial ability could possibly be used to tailor individualized laparoscopic training programs or in the future as a selection tool concerning laparoscopic ability.
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| 39. |
- Rieke, Johanna Magdalena, et al.
(författare)
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SLC20A1Is Involved in Urinary Tract and Urorectal Development
- 2020
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Ingår i: Frontiers in Cell and Developmental Biology. - : FRONTIERS MEDIA SA. - 2296-634X. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies in developingXenopusand zebrafish reported that the phosphate transporterslc20a1ais expressed in pronephric kidneys. The recent identification ofSLC20A1as a monoallelic candidate gene for cloacal exstrophy further suggests its involvement in the urinary tract and urorectal development. However, little is known of the functional role ofSLC20A1in urinary tract development. Here, we investigated this using morpholino oligonucleotide knockdown of the zebrafish orthologslc20a1a. This caused kidney cysts and malformations of the cloaca. Moreover, in morphants we demonstrated dysfunctional voiding and hindgut opening defects mimicking imperforate anus in human cloacal exstrophy. Furthermore, we performed immunohistochemistry of an unaffected 6-week-old human embryo and detectedSLC20A1in the urinary tract and the abdominal midline, structures implicated in the pathogenesis of cloacal exstrophy. Additionally, we resequencedSLC20A1in 690 individuals with bladder exstrophy-epispadias complex (BEEC) including 84 individuals with cloacal exstrophy. We identified two additional monoallelicde novovariants. One was identified in a case-parent trio with classic bladder exstrophy, and one additional novelde novovariant was detected in an affected mother who transmitted this variant to her affected son. To study the potential cellular impact ofSLC20A1variants, we expressed them in HEK293 cells. Here, phosphate transport was not compromised, suggesting that it is not a disease mechanism. However, there was a tendency for lower levels of cleaved caspase-3, perhaps implicating apoptosis pathways in the disease. Our results suggestSLC20A1is involved in urinary tract and urorectal development and implicateSLC20A1as a disease-gene for BEEC.
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| 40. |
- Salö, Martin, et al.
(författare)
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ABC om - Akut buk hos barn.
- 2014
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Ingår i: Läkartidningen. - 0023-7205. ; 111:46
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Tidskriftsartikel (refereegranskat)
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| 41. |
- Salö, Martin, et al.
(författare)
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Anastomotic Strictures after Esophageal Atresia Repair : Timing of Dilatation during the First Two Postoperative Years
- 2018
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Ingår i: The Surgery Journal. - : Georg Thieme Verlag KG. - 2378-5128 .- 2378-5136. ; 4:2, s. 62-65
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Tidskriftsartikel (refereegranskat)abstract
- Background We determined time frames for dilatation of anastomotic strictures (ASs) occurring during the first 2 years after esophageal atresia (EA) repair. Methods A retrospective study was conducted on children with EA (Gross type C) who underwent direct repair between January 2008 and March 2015 at a single tertiary center of pediatric surgery. Endoscopic signs of stricture were indications for dilatation because the endoscopy provides more reliable information than X-ray imagining methods. Results Among our cohort of 49 children with EA, 19 (39%) required at least one esophageal dilatation. All children required initial dilatation within the first year of life and none was older than 1 year during initial dilatation ( p < 0.01). A median of three dilatations (range: 1-13) took place per patient, with 87% performed during the first postoperative year. The timing of initial dilatation in the first year (< 6 months, 14/19 [74%] vs. 6-12 months, 5/19 [26%]) was predictive of the need for dilatation beyond the first year (9/14 [64%] vs. 0/5 [0%]; p = 0.03) but not of more numerous dilatations (median, 3 vs. 1; p = 0.07). Conclusion The need for dilatation within 6 months postoperatively predicts the need for dilatation after 1 year, but it does not indicate the number of dilatations that will be needed.
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| 42. |
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| 43. |
- Salö, Martin, et al.
(författare)
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Ten years of paediatric robotic surgery : Lessons learned
- 2022
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Ingår i: International Journal of Medical Robotics and Computer Assisted Surgery. - : Wiley. - 1478-596X .- 1478-5951. ; 18:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Costs and a low total number of cases may be obstacles to the successful implementation of a paediatric robotic surgery programme. The aim of this study was to evaluate a decade of paediatric robotic surgery and to reflect upon factors for success and to consider obstacles.MATERIALS AND METHODS: All children operated on with robotic-assisted laparoscopic surgery between 2006 and 2016 were included in a retrospective, single-institutional study in Lund, Sweden.RESULTS: A total of 152 children underwent robotic surgery during the study time with the most frequent procedures being fundoplication (n = 55) and pyeloplasty (n = 53). Procedure times decreased significantly during the study period. Overall, 18 (12%) of the operations were converted to open surgery, and seven (5%) patients required a reoperation.CONCLUSIONS: Despite a low volume of surgery, we have successfully introduced robotic paediatric surgery in our department. Our operative times and conversion rates are continuously decreasing.
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| 44. |
- Sandberg, Jacob, et al.
(författare)
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Comparing recalled versus experienced symptoms of breathlessness ratings : An ecological assessment study using mobile phone technology
- 2022
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Ingår i: Respirology (Carlton South. Print). - : John Wiley & Sons. - 1323-7799 .- 1440-1843. ; 27:10, s. 874-881
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: Recall of breathlessness is important for clinical care but might differ from the experienced (momentary) symptoms. This study aimed to characterize the relationship between momentary breathlessness ratings and the recall of the experience. It is hypothesized that recall is influenced by the peak (worst) and end (most recent) ratings of momentary breathlessness (peak-end rule). Methods: This study used mobile ecological momentary assessment (mEMA) for assessing breathlessness in daily life through an application installed on participants' mobile phones. Breathlessness ratings (0–10 numerical rating scale) were recorded throughout the day and recalled each night and at the end of the week. Analyses were performed using regular and mixed linear regression. Results: Eighty-four people participated. Their mean age was 64.4 years, 60% were female and 98% had modified Medical Research Council (mMRC) ≥ 1. The mean number of momentary ratings of breathlessness provided was 7.7 ratings/participant/day. Recalled breathlessness was associated with the mean, peak and end values of the day. The mean was most closely associated with the daily recall. Associations were strong for weekly values: peak breathlessness (beta = 0.95, r2 = 0.57); mean (beta = 0.91, r2 = 0.53); and end (beta = 0.67, r2 = 0.48); p < 0.001 for all. Multivariate analysis showed that peak breathlessness had the strongest influence on the breathlessness recalled at the end of the week. Conclusion: Over 1 week, recalled breathlessness is most strongly influenced by the peak breathlessness; over 1 day, it is mean breathlessness that participants most readily recalled. © 2022 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.
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| 45. |
- Sandberg, Jacob, et al.
(författare)
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Relating Experienced To Recalled breathlessness Observational (RETRO) study : A prospective study using a mobile phone application
- 2019
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Ingår i: BMJ Open Respiratory Research. - : BMJ Publishing Group. - 2052-4439. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Breathlessness, the subjective sensation of breathing discomfort, is common and appears in the daily life of people with cardiorespiratory diseases. Physicians often rely on patient's history based on symptom recall. The relation between recalled and experienced breathlessness is still poorly understood. This paper presents the protocol for a study primarily aimed at evaluating the relationship between experienced breathlessness and (1) recalled breathlessness and (2) predicted future breathlessness. Methods: A mobile phone application will be used to collect data during daily life. Medically stable participants, ≥18 years of age with mean daily breathlessness of Numerical Rating Scale (NRS) 3/10 and able to use a mobile phone with internet will rate their breathlessness intensity on a 0-10 NRS prompted the user several times daily for 1 week. Participants will recall their breathlessness each day and week. Multivariable random effects regression models will be used for statistical analyses. Results: Results of the study will be submitted for publication in peer-reviewed journals and presented at relevant conferences. Discussion: This protocol describes a study aimed at investigating previously unknown areas of the experience and recall of breathlessness using a new method of data collection. © 2019 Author(s).
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| 46. |
- Selin, Caroline, et al.
(författare)
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Orchidopexy for undescended testis—rate and predictors of re-ascent
- 2024
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Ingår i: Pediatric Surgery International. - 0179-0358. ; 40:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to investigate the rate of re-ascent requiring re-operation after primary orchidopexy and to investigate eventual differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent. Methods: A retrospective cohort study of children treated for undescended testis (UDT) with orchidopexy between 2018 and 2022 was conducted. The primary outcome was re-ascent requiring re-operation, and the secondary outcome was atrophy rate. Independent variables were age, underlying conditions, side, surgical approach, operation time, bilaterality, congenital/ascended UDT, presence of scrotal hypoplasia, presence of a patent processus vaginalis, division of external oblique, and suture of the testis. Univariate and logistic regression were used to evaluate differences between groups and risk for re-ascent. Results: A total of 662 testes in 554 patients were included. Re-operation occurred in 6% (7% with inguinal approach, 3% with scrotal approach, p = 0.04). Re-operation was associated with younger age, congenital UDT, and inguinal approach, but neither of these variables remained significant in multivariate analyses. Atrophy occurred in one testis. Conclusion: The rate of re-ascent was 6% and the atrophy rate was 0.15%. A larger study may find predictors for re-ascent but with very low absolute risk. The lower rate of re-ascent with the scrotal approach is probably due to selection bias.
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| 47. |
- Stattin, Karl, et al.
(författare)
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Inadequate prophylactic effect of low-molecular weight heparin in critically ill COVID-19 patients
- 2020
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Ingår i: Journal of critical care. - : Elsevier BV. - 0883-9441 .- 1557-8615. ; 60, s. 249-252
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to investigate potential markers of coagulopathy and the effects of thromboprophylaxis with low-molecular-weight heparin (LMWH) on thromboelastography (TEG) and anti-factor Xa in critically ill COVID-19 patients.MATERIAL AND METHODS: We conducted a prospective study in 31 consecutive adult intensive care unit (ICU) patients. TEG with and without heparinase and anti-factor Xa analysis were performed. Standard thromboprophylaxis was given with dalteparin (75-100 IU/kg subcutaneously).RESULTS: Five patients (16%) had symptomatic thromboembolic events. All patients had a maximum amplitude (MA) > 65 mm and 13 (42%) had MA > 72 mm at some point during ICU stay. Anti-factor Xa activity were below the target range in 23% of the patients and above target range in 46% of patients. There was no significant correlation between dalteparin dose and anti-factor Xa activity.CONCLUSIONS: Patients with COVID-19 have hypercoagulability with high MA on TEG. The effect of LMWH on thromboembolic disease, anti-factor Xa activity and TEG was variable and could not be reliably predicted. This indicates that standard prophylactic doses of LMWH may be insufficient. Monitoring coagulation and the LMWH effect is important in patients with COVID-19 but interpreting the results in relation to risk of thromboembolic disease poses difficulties.
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| 48. |
- Stenström, Pernilla, et al.
(författare)
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Congenital Heart Disease and Its Impact on the Development of Anastomotic Strictures after Reconstruction of Esophageal Atresia
- 2018
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Ingår i: Gastroenterology Research and Practice. - : Hindawi Limited. - 1687-6121 .- 1687-630X. ; 2018
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim was to explore if severe congenital heart disease (CHD) influenced the need for dilatation of anastomotic strictures (AS) after the repair of esophageal atresia (EA).Methods: A retrospective case-control study was conducted examining AS in children with EA and Gross type C. The spectra of CHD and cardiac interventions were reviewed. The frequency of dilatations of AS during the first year following EA reconstruction was compared between children with and without severe CHD requiring cardiac surgery during their first year of life. Endoscopic signs of stricture were an indication for dilatation.Results: Included in the follow-up for AS were 94 patients who had EA reconstructions, of whom 10 (11%) children had severe CHD requiring surgery during the first year including 19 different cardiac interventions. In total, 38 patients needed dilatation of esophageal AS, distributed as six (60%) with severe CHD and 32 (38%) without severe CHD (p = 0.31).Conclusion: Severe CHD was present in 11% of children with EA. Esophageal AS developed in 60% children with concomitant CHD, but although high, it did not reach statistical difference from children without CHD (38%).
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| 49. |
- Stenström, Pernilla, et al.
(författare)
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Dilations of anastomotic strictures over time after repair of esophageal atresia
- 2017
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Ingår i: Pediatric Surgery International. - : Springer Science and Business Media LLC. - 0179-0358 .- 1437-9813. ; 33:2, s. 191-195
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Tidskriftsartikel (refereegranskat)abstract
- Aim of the study: Anastomotic strictures commonly occur in patients undergoing surgery for esophageal atresia (EA). The primary aim of this study was to determine the age distribution of dilation procedures for anastomotic strictures over the patient’s childhood after reconstruction of EA. The secondary aim was to evaluate the effect of postoperative proton pump inhibitors (PPIs) on the frequency of dilations. Methods: This observational study was conducted at a single tertiary center of pediatric surgery. The times that dilations of strictures were performed were assessed during three study periods: 1983–1995, 2001–2009, and 2010–2014. PPIs were not used during the first period, and then, respectively, for 3 and 12 months postoperatively. The indications for dilation were signs of obstruction and/or radiological signs of stricture. Primary results: A total of 131 children underwent esophageal reconstruction, and of those, 60 (46%) required at least 1 dilation procedure for strictures. There were no differences in the frequencies of dilation procedures between the three study periods (28/66, 18/32 and 14/33, respectively; P = 0.42). The overall median number of dilations per patient was 3 (range 1–21) with no differences between the study periods. The differences between ages at which the first dilation was performed during each study period were significant, as follows: 7, 2, and 8 months, respectively (P = 0.03). Fiftyone percent of all dilation procedures were performed during the first year of life, 16% during the second year, and 33% during years 2–15. Four children (2%) underwent >12 dilations. Conclusion: The first year of life was the time of greatest need for dilation of AS after reconstruction of EA; however, dilations were also performed several years later. PPIs did not affect the frequency of dilations during the first year of life.
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| 50. |
- Stenström, Pernilla, et al.
(författare)
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Endoscopically placed rectourethral guidewire facilitates the reconstruction of anus in children with anorectal malformations : a case report
- 2013
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Ingår i: European journal of pediatric surgery reports. - : Georg Thieme Verlag KG. - 2194-7619 .- 2194-7627. ; 1:1, s. 7-46
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this report is to present a technical detail of use in the management of an anorectal malformation (ARM). A boy with ARM and a fistula to the urethra was operated on with a posterior sagittal anorectoplasty (PSARP). Before the PSARP operation, a videoendoscopy was performed through the distal stoma down to the distal end of the rectum. The rectourethral fistula was identified and a guidewire was passed through the endoscope, through the fistula, and out through the urethra. The endoscopically placed rectourethral guidewire was used as a landmark and facilitated the PSARP operation.
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