| 1. |
- Stenberg, Erik, 1979-, et al.
(author)
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Early complications after laparoscopic gastric bypass surgery : results from the Scandinavian Obesity Surgery Registry
- 2014
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In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 260:6, s. 1040-1047
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients.BACKGROUND: Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications.METHODS: From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications.RESULTS: The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%.CONCLUSIONS: Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.
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| 2. |
- Bolling, Anette Kocbach, et al.
(author)
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Health effects of residential wood smoke particles : the importance of combustion conditions and physicochemical particle properties
- 2009
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In: Particle and Fibre Toxicology. - London : BioMed Central (BMC). - 1743-8977. ; 6
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Research review (peer-reviewed)abstract
- Background: Residential wood combustion is now recognized as a major particle source in many developed countries, and the number of studies investigating the negative health effects associated with wood smoke exposure is currently increasing. The combustion appliances in use today provide highly variable combustion conditions resulting in large variations in the physicochemical characteristics of the emitted particles. These differences in physicochemical properties are likely to influence the biological effects induced by the wood smoke particles.Outline: The focus of this review is to discuss the present knowledge on physicochemical properties of wood smoke particles from different combustion conditions in relation to wood smoke-induced health effects. In addition, the human wood smoke exposure in developed countries is explored in order to identify the particle characteristics that are relevant for experimental studies of wood smoke-induced health effects. Finally, recent experimental studies regarding wood smoke exposure are discussed with respect to the applied combustion conditions and particle properties.Conclusion: Overall, the reviewed literature regarding the physicochemical properties of wood smoke particles provides a relatively clear picture of how these properties vary with the combustion conditions, whereas particle emissions from specific classes of combustion appliances are less well characterised. The major gaps in knowledge concern; (i) characterisation of the atmospheric transformations of wood smoke particles, (ii) characterisation of the physicochemical properties of wood smoke particles in ambient and indoor environments, and (iii) identification of the physicochemical properties that influence the biological effects of wood smoke particles.
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| 3. |
- Molnár, Peter, 1967, et al.
(author)
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Domestic wood burning and PM2.5 trace elements: Personal exposures, indoor and outdoor levels
- 2005
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In: Atmospheric Environment. - : Elsevier BV. - 1352-2310. ; 39:14, s. 2643-2653
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Journal article (peer-reviewed)abstract
- Personal exposures as well as indoor and outdoor levels of PM2.5 were measured with cyclones and impactors simultaneously in the winter of 2003 in a residential area where wood burning for domestic space heating is common. Twenty-four-hour samples from both wood-burning households ("wood burners") and a reference group were analysed for mass and elemental concentration using energy dispersive X-ray fluorescence (EDXRF) and for black smoke (BS) concentration using an EEL 43 reflectometer. Wood-smoke particles made statistically significant contributions of K, Ca, and Zn for both personal exposure and indoor concentration, the median levels of these elements being 66-80% higher for the wood-burning group. In addition, Cl, Mn, Cu, Rb, and Pb were found to be possible markers of wood smoke, though levels of these were only significantly higher among the wood-burning group for either personal exposure or indoor concentrations. PM2.5 mass and S levels were not significantly elevated in wood burners, probably due to large variations in outdoor concentrations from long-distance transported air pollution. Personal exposure and indoor levels showed high correlations for all species, and the personal exposure levels were usually higher than or equal to the indoor levels. The associations between personal exposure and outdoor levels were generally weak except for outdoor S and PM2.5 levels that were both highly correlated with personal S exposure levels (r(s) > 0.8). (c) 2005 Elsevier Ltd. All rights reserved.
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| 4. |
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| 5. |
- Molnár, Peter, 1967, et al.
(author)
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Personal exposures and indoor, residential outdoor, and urban background levels of fine particle trace elements in the general population.
- 2006
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In: Journal of environmental monitoring. - : Royal Society of Chemistry (RSC). - 1464-0325. ; 8:5, s. 543-51
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Journal article (peer-reviewed)abstract
- Personal exposures and indoor, residential outdoor, and urban background levels of PM(2.5) and PM(1) were measured simultaneously in Göteborg, Sweden. A total of 270 24 hour samples from 30 subjects were analyzed for elemental concentrations using X-ray fluorescence (XRF) spectroscopy. Personal exposures to PM(2.5) were significantly higher for Cl, Ca, Ti, and Fe compared with the other locations. For most elements, residential outdoor levels were significantly higher than urban background levels. Correlations between personal exposure and stationary measurements were moderate to high for Zn, Br, and Pb (r(s)= 0.47-0.81), while Ca and Cu showed low correlations. The penetration indoors from outdoors was 0.7, as calculated from S and Pb ratios. For the pairs of parallel PM(1) and PM(2.5) measurements, only Ca and Fe levels were significantly lower for PM(1) at all sites. Significant correlations were found between urban background mass concentrations and personal exposure levels for elements attributed to combustion processes (S, V, and Pb) and resuspended dust (Ti, Fe, and Zn), indicating that both sources could be relevant to health effects related to urban background mass. Air mass origin strongly affected the measured urban background concentrations of some elements (S, Cl, V, Ni, Br, and Pb). These findings were also seen for personal exposure (S, Cl, V, and Pb) and indoor levels (S, Cl, V, Ni, and Pb). No differences were seen for crustal elements. Air mass origin should be taken into account in the description and interpretation of time series studies of air pollution and health.
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| 6. |
- Stenberg, Erik, 1979-, et al.
(author)
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Closure of mesenteric defects in laparoscopic gastric bypass : a multicentre, randomised, parallel, open-label trial
- 2016
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In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 387:10026, s. 1397-1404
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Journal article (peer-reviewed)abstract
- Background: Small bowel obstruction due to internal hernia is a common and potentially serious complication after laparoscopic gastric bypass surgery. Whether closure of surgically created mesenteric defects might reduce the incidence is unknown, so we did a large randomised trial to investigate.Method: This study was a multicentre, randomised trial with a two-arm, parallel design done at 12 centres for bariatric surgery in Sweden. Patients planned for laparoscopic gastric bypass surgery at any of the participating centres were off ered inclusion. During the operation, a concealed envelope was opened and the patient was randomly assigned to either closure of mesenteric defects beneath the jejunojejunostomy and at Petersen's space or non-closure. After surgery, assignment was open label. The main outcomes were reoperation for small bowel obstruction and severe postoperative complications. Outcome data and safety were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials. gov, number NCT01137201.Findings: Between May 1, 2010, and Nov 14, 2011, 2507 patients were recruited to the study and randomly assigned to closure of the mesenteric defects (n= 1259) or non-closure (n= 1248). 2503 (99.8%) patients had follow-up for severe postoperative complications at day 30 and 2482 (99.0%) patients had follow-up for reoperation due to small bowel obstruction at 25 months. At 3 years after surgery, the cumulative incidence of reoperation because of small bowel obstruction was signifi cantly reduced in the closure group (cumulative probability 0.055 for closure vs 0.102 for non-closure, hazard ratio 0.56, 95% CI 0.41-0.76, p= 0.0002). Closure of mesenteric defects increased the risk for severe postoperative complications (54 [4.3%] for closure vs 35 [2.8%] for non-closure, odds ratio 1.55, 95% CI 1.01-2.39, p= 0.044), mainly because of kinking of the jejunojejunostomy.Interpretation: The results of our study support the routine closure of the mesenteric defects in laparoscopic gastric bypass surgery. However, closure of the mesenteric defects might be associated with increased risk of early small bowel obstruction caused by kinking of the jejunojejunostomy.
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