| 1. |
- Olsson, Anders, et al.
(författare)
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Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair
- 2017
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Ingår i: Surgery. - : Elsevier. - 0039-6060 .- 1532-7361. ; 161:2, s. 509-516
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic pain is common after inguinal hernia repair and has become one of the most important outcome measures for this procedure. The purpose of this study was to determine whether or not there is a relationship between specific postoperative complications and risk for chronic pain after open inguinal hernia repair.METHODS: A prospective cohort study was designed in which participants responded to the Inguinal Pain Questionnaire regarding postoperative groin pain 8 years after inguinal hernia repair. Responses to the questionnaire were matched with data from a previous study regarding reported postoperative complications after open inguinal hernia repair. Participants were recruited originally from the Swedish Hernia Register. Response rate was 82.4% (952/1,155). The primary outcome was chronic pain in the operated groin at follow-up. Grading of pain was performed using the Inguinal Pain Questionnaire.RESULTS: A total of 170 patients (17.9%) reported groin pain and 29 patients (3.0%) reported severe groin pain. The risk for developing chronic groin pain was greater in patients with severe pain in the preoperative or immediate postoperative period (odds ratio 2.09; 95% confidence interval 1.28-3.41). Risk for chronic pain decreased for every 1-year increase in age at the time of operation (odds ratio 0.99, 95% confidence interval 0.98-1.00).CONCLUSION: Both preoperative pain and pain in the immediate postoperative period are strong risk factors for chronic groin pain. Risk factor patterns should be considered before operative repair of presumed symptomatic inguinal hernias. The problem of postoperative pain must be addressed regarding both pre-emptive and postoperative analgesia.
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| 2. |
- Olsson, Anders, et al.
(författare)
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The Short-Form Inguinal Pain Questionnaire (sf-IPQ) : An Instrument for Rating Groin Pain After Inguinal Hernia Surgery in Daily Clinical Practice
- 2019
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Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 43:3, s. 806-811
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Inguinal Pain Questionnaire (IPQ) is a standardised and validated instrument for assessing persisting pain after groin hernia surgery. The IPQ is often perceived as being too extensive for routine use. The aim of this study was to develop and evaluate a condensed version of the IPQ in order to facilitate its use in daily clinical practice.Methods: The condensed form, i.e. Short-Form Inguinal Pain Questionnaire (sf-IPQ), comprises two main items taken from the IPQ. Four hundred patients were recruited from the Swedish Hernia Register and were sent the IPQ, sf-IPQ and the Short-Form McGill Pain Questionnaire (SF-MPQ) three years after hernia repair. Ratings from the IPQ and the sf-IPQ were converted to a 12-point scale. The reported scores for the two shared items in the IPQ and sf-IPQ were compared using the Intraclass Correlation Coefficient (ICC), Cohen’s kappa and McNemar’s test.Results: After two reminders, the response rate was 69.8% (n = 279/400). The ICC for the IPQ and sf-IPQ scores was 0.78 (95% confidence interval 0.73–0.82, p < 0.001). Cohen’s kappa was 0.66 (95% confidence interval 0.55–0.77, p < 0.001). The sf-IPQ systematically indicated a higher pain score than the IPQ (p = 0.013).Conclusions: Despite the systematic difference in level of pain scored, correlation, consistency and agreement were seen between the IPQ and sf-IPQ. The forms appear to be interchangeable, though the sf-IPQ may be a more sensitive instrument. The condensed structure of the sf-IPQ is more user-friendly and shows promise as a useful tool in daily clinical practice.
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| 3. |
- Alizadehgharib, Sara, et al.
(författare)
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Immunological response of human leucocytes after exposure to lipopolysaccharides from Porphyromonas gingivalis.
- 2021
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Ingår i: Clinical and experimental dental research. - : Wiley. - 2057-4347. ; 7:4, s. 531-538
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Tidskriftsartikel (refereegranskat)abstract
- Porphyromonas gingivalis (P. gingivalis) is a gram-negative bacterium and an important etiologic agent of periodontitis. P. gingivalis releases outer membrane vesicles containing lipopolysaccharides (LPS), which can penetrate periodontal tissues. Once in the periodontal tissues and in contact with immune cells, it may participate in the destructive innate host response associated with the disease. The exact mechanism of P. gingivalis LPS in the disease process is not clear, but it is known to affect a variety of immune responses.To investigate how LPS from P. gingivalis affect neutrophil extracellular trap (NET) formation, cell death and production of cytokines from human neutrophils and peripheral mononuclear blood mononuclear cells (PBMCs).Isolated neutrophils and PBMCs were cultured with LPS from P. gingivalis or Escherichia coli (E. coli) (control). The NET formation was measured using Sytox green stain. Cell death of neutrophils and PBMCs was analyzed using flow cytometry or Sytox green stain. Cytokine production was measured using enzyme-linked immunosorbent assay (ELISA) kit or Bio-Plex assay.Exposure to LPS from P. gingivalis and E. coli caused significantly lower cell death in neutrophils. NETs were formed after exposure to the two different LPS. In PBMCs, exposure to P. gingivalis and E. coli LPS caused increased levels of IL-1β and IL-6 compared to unstimulated controls. Increased cell death in PBMCs after exposure to LPS from E. coli in comparison to LPS from P. gingivalis and unstimulated controls was also observed.LPS from P. gingivalis has the ability to affect both human neutrophils and PBMCs with regard to cytokine production, cell death and production of NETs. LPS from P. gingivalis could be involved in the pathogenesis of periodontitis, and our results may contribute information regarding possible markers for diagnosis and targets for treatment of periodontal disease.
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| 4. |
- Alizadehgharib, Sara, et al.
(författare)
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The effects of the dental methacrylates TEGDMA, Bis-GMA, and UDMA on neutrophils in vitro.
- 2020
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Ingår i: Clinical and experimental dental research. - : Wiley. - 2057-4347. ; 6:4, s. 439-447
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Tidskriftsartikel (refereegranskat)abstract
- The prevalent usage of methacrylates in modern dentistry demands good knowledge of their biological impacts. While there have been several studies demonstrating the effects of different methacrylic monomers on mononuclear white blood cells, very little is known about the effects caused by these monomers on neutrophilic granulocytes. The objective of this study was to add novel knowledge about how neutrophils are affected by exposure to triethylene glycol dimethacrylate (TEGDMA), urethane dimethacrylate (UDMA), and bisphenol A glycol dimethacrylate (Bis-GMA) alone or in combinations.Isolated neutrophils were cultured in the presence or absence of methacrylates. The IL-8 release was measured using a DuoSet ELISA development kit. Apoptosis and necrosis were analyzed using flow cytometry. The formation of neutrophil extracellular traps (NETs) was investigated using Sytox green DNA staining combined with microscopically examination of released DNA and myeloperoxidase (MPO).The release of IL-8 was significantly increased after exposure to TEGDMA, Bis-GMA, UDMA, or TEGDMA in combination with Bis-GMA or UDMA compared to the unstimulated controls. Exposure to TEGDMA, UDMA, and Bis-GMA for 24hr separately or in combination did not affect apoptosis or necrosis of the exposed neutrophils. NET structures were formed by neutrophils after exposure to the different combinations of the methacrylates.The combination of TEGDMA and Bis-GMA had a synergistic proinflammatory effect on neutrophils by increasing the release of IL-8 and the formation of NET structures. The changes in the normal functions of neutrophils caused by methacrylate exposure may lead to altered inflammatory response and relate to previously reported adverse immune reactions caused by these substances.
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| 5. |
- Ansson, Cu, et al.
(författare)
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Blood perfusion in Hewes tarsoconjunctival flaps in pigs measured by laser speckle contrast imaging
- 2018
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Ingår i: JPRAS Open. - : Elsevier BV. - 2352-5878. ; 18, s. 98-103
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundHewes flap is a tarsoconjunctival eyelid flap, based at the lateral canthal tendon, and rotated and stretched to repair lateral defects in the lower eyelid commonly following tumor surgery. The aim of the present study was to monitor perfusion in a Hewes flap during reconstruction, which to the best of our knowledge, has not previously been done.MethodsA Hewes tarsoconjunctival eyelid flap was raised and the effects on blood perfusion of rotating the flaps by 90° and 180°, stretching the flaps with a force of 5 or 10 N, and repeated diathermic coagulation was monitored with laser speckle contrast imaging.ResultsRotating the flaps by 90° did not significantly affect perfusion, while further rotation to 180° reduced blood perfusion to 75% of the baseline value. When the tarsoconjunctival flaps were both rotated 90° and stretched with 5 N, the perfusion was reduced even further, to 63%. A further reduction in perfusion, to 36%, was seen when the higher force of 10 N was applied. Diathermy decreased blood perfusion to 56% after being applied once. Successive applications led to further decreases: 43%, 31%, and 15%, after the second, third and fourth applications.ConclusionsPerfusion in Hewes tarsoconjunctival flaps is affected by both rotation and stretching, but some perfusion is maintained despite these manipulations. Diathermy, however, has detrimental effects and should be avoided.
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| 6. |
- Ansson, Cu Dybelius, et al.
(författare)
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Perfusion in Upper Eyelid Flaps : Effects of Rotation and Stretching Measured With Laser Speckle Contrast Imaging in Patients
- 2020
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Ingår i: Ophthalmic Plastic and Reconstructive Surgery. - 1537-2677. ; 36:5, s. 481-484
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to investigate how the blood perfusion in human upper eyelid skin flaps is affected by the length of the flap and the degree of stretching and rotation of the flap.METHODS: Twenty-nine upper eyelids were dissected as part of a blepharoplastic procedure in patients. The 1-cm wide proximal end of the flap remains attached, to mimic a random pattern skin flap (hereafter called a "skin flap"). Blood perfusion was measured with laser speckle contrast imaging before and after the flap was stretched with forces of 0.5, 1, and 2 N. The flap was then rotated 90°, and the same tensions were applied.RESULTS: Blood perfusion decreased gradually from the base to the tip of the flap. The flap was only well perfused in the proximal 1 cm (60% at 0.5 cm and 37% at 1.0 cm) and was minimally perfused beyond 2 cm (22% at 2.0 cm). Stretching the nonrotated flaps affected perfusion slightly (decreased to 43% at 0.5 cm). Simply rotating the flaps by 90° had no significant effect on the perfusion. The combination of rotation (90°) and stretching reduced the perfusion to 22% at 2 N, when measured 0.5 cm from the base.CONCLUSIONS: Blood perfusion in upper eyelid skin flaps decreases rapidly with distance from the base of the flap. Rotating and stretching the skin flap reduces blood perfusion even further, leading to minimal perfusion in this kind of flap at distances greater than 1.5 cm from the base.
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| 7. |
- Berggren, Johanna, et al.
(författare)
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Reperfusion of Free Full-Thickness Skin Grafts in Periocular Reconstructive Surgery Monitored Using Laser Speckle Contrast Imaging
- 2021
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Ingår i: Ophthalmic Plastic and Reconstructive Surgery. - 1537-2677. ; 37:4, s. 324-328
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Free skin grafts are frequently used in reconstructive surgery. However, little is known about the course of reperfusion due to the previous lack of reliable perfusion monitoring techniques. The aim of this study was to use state-of-the-art laser speckle contrast imaging to monitor free skin grafts in the periocular area.METHODS: Seven patients needing surgery due to tumor removal or cicatricial ectropion in the periocular region underwent reconstructive surgery using free skin grafts from either the contralateral upper eyelid or the upper inner arm. The free skin grafts measured 10-30 mm horizontally and 9-30 mm vertically. Blood perfusion was monitored using laser speckle contrast imaging immediately postoperatively (0 weeks) and at follow-up after 1, 3, and 7 weeks.RESULTS: All grafts were reperfused gradually during healing, the median value being 46% in the central part of the graft after 1 week and 79% after 3 weeks. The grafts were completely reperfused after 7 weeks. No difference was observed in the rate of reperfusion between the center and periphery of the grafts (p = not significant). The cosmetic and functional outcome was excellent in all but 1 patient, who developed ectropion that had to be surgically corrected.CONCLUSIONS: Skin grafts in the periorbital area are fully reperfused after 7 weeks. The periocular area is known to be well-vascularized and thus forgiving to reconstructive surgery. Future investigations of the reperfusion of free skin grafts in other parts of the body or in higher-risk populations should be carried out.
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| 8. |
- Berggren, Johanna, et al.
(författare)
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Revascularization After H-plasty Reconstructive Surgery in the Periorbital Region Monitored With Laser Speckle Contrast Imaging
- 2021
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Ingår i: Ophthalmic Plastic and Reconstructive Surgery. - 1537-2677. ; 37:3, s. 269-273
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: H-plasty reconstructive surgery is commonly used to close defects after tumor excision in the periorbital region. Revascularization of the bipedicle skin flaps is essential for healing. However, it has not previously been possible to study this revascularization in humans due to the lack of noninvasive perfusion monitoring techniques. The aim was to monitor perfusion in H-plasty flaps during surgery and during postoperative follow-up, using laser speckle contrast imaging.METHOD: H-plasty, i.e., bipedicle random advancement skin flaps, was used for reconstruction of the eyelids after tumor removal in 7 patients. The median length and width of the skin flaps were 13 mm (range, 8-20 mm) and 10 mm (range, 5-11 mm), respectively. Blood perfusion was measured using laser speckle contrast imaging during surgery and at follow up 1, 3, and 6 weeks postoperatively, to monitor revascularization.RESULTS: Immediately postoperatively, the perfusion in the distal end of the flaps had fallen to 54% (95% CI, 38%-67%). The perfusion then quickly increased during the healing process, being 104% (86%-124%) after 1 week, 115% (94%-129%) after 3 weeks, and 112% (96%-137%) after 6 weeks. There was no clinically observable ischemia or tissue necrosis.CONCLUSIONS: Revascularization of the H-plasty procedure flaps occurs quickly, within a week postoperatively, presumably due to the existing vascular network of the flap pedicle, and was not dependent on significant angiogenesis. This perfusion study confirms the general opinion that H-plasty is a good reconstructive technique, especially in the periorbital region with its rich vascular supply.
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| 9. |
- Berggren, Johanna, et al.
(författare)
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Revascularization of Free Skin Grafts Overlying Modified Hughes Tarsoconjunctival Flaps Monitored Using Laser-Based Techniques
- 2019
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Ingår i: Ophthalmic Plastic and Reconstructive Surgery. - 1537-2677. ; 35:4, s. 378-382
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: It has recently been shown that the flap pedicle does not supply blood to a tarsoconjunctival graft in the modified Hughes procedure in patients. This raises questions concerning the rate of revascularization of the free skin graft commonly used to reconstruct the anterior lamella. The aim of this study was, thus, to monitor the course of revascularization in free skin grafts overlying modified Hughes tarsoconjunctival flaps, using laser-based techniques.Methods: Free skin grafts from the upper eyelid or upper arm in 9 patients were used to cover a tarsoconjunctival flap according to the modified Hughes procedure. Blood perfusion was monitored using laser speckle contrast imaging, and vascular reactivity was studied with laser Doppler velocimetry after heating the tissue to 44°C. Measurements were made at the time of surgery (baseline) and at 1, 3, 8, and 16 weeks postoperatively.Results: The gradual increase in perfusion of the free skin grafts during the healing process indicates revascularization. A slight increase in perfusion was seen already after 1 week. Perfusion reached 50% of the baseline after 3 weeks, and complete restoration of perfusion was seen after 8 weeks. The vascular function monitored with heat-induced hyperemia increased in a similar fashion.Conclusions: Full-thickness skin grafts revascularize within 3 to 8 weeks, despite overlying a tarsoconjunctival flap, which has recently been reported to be avascular. This provides further evidence that it should be possible to repair large eyelid defects using free full-thickness eyelid grafts.
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| 10. |
- Biel, Anders, 1948, et al.
(författare)
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Habitual and value-guided consumer behaviour.
- 2005
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Ingår i: Paper presented at the 14th General Meeting of EAESP, Würtzburg, Germany, 19-23 July 2005.
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Konferensbidrag (refereegranskat)abstract
- Consumer behaviour may be more or less guided by deliberate processes. In a deliberate phase, people are more attentive to, and, given the right circumstances, more influenced by values in their choice of products. When in a less deliberate phase consumers may fall back on habits and choose in a routine manner. This prediction was tested in a computer-based experiment, where participants purchased products in a simulated shop. They were randomly assigned to one of eight groups defined by whether they purchased under time pressure or not, whether an environmental value was primed or not, and whether ”organic food”-labels were salient or not. A discreetly placed “organic food”-poster at the entrance of the store was used to prime, or unobtrusively remind the consumer of an environmental value. Participants were unaware of this manipulation. As predicted, time pressure increased the likelihood of a habitual choice (as measured in a questionnaire) and inhibited directly value-guided choices. In addition, the poster, in combination with salient “organic food”-labels on the products, increased the likelihood of a choice directly guided by environmental values, but only under no time pressure.
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| 11. |
- Biel, Anders, 1948, et al.
(författare)
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Habitual and value-guided purchase behaviour.
- 2004
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Ingår i: Invited paper presented at the Food 21 Symposium Towards Sustainable Production and Consumption, Uppsala, Sweden..
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Konferensbidrag (refereegranskat)
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| 12. |
- Biel, Anders, 1948, et al.
(författare)
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Habitual and value-guided purchase behaviour
- 2005
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Ingår i: Ambio: a journal of the human environment. ; 34:4/5, s. 360-365
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Tidskriftsartikel (refereegranskat)abstract
- Society increasingly requests that individuals adopt environmentally benign be-haviour. Information campaigns purported to change peoples attitudes are often regarded as a pre-requisite to install such changes. While such information may be a necessary step, it is not a sufficient condition. We argue that much everyday behaviour with environmental consequences is habitual in kind, and that little attention is given to information directed toward changing these habitual behav-iours. In other instances, behaviour is guided by values in a more reflective proc-ess. However, other information besides environmental consequences may draw a persons attention and affect behavioural choice. Using surveys and experimental studies targeting consumer behaviour, we have studied under what conditions different kinds of information is likely to influence people with varying levels of environmental concern. Based on results from these studies, implications for be-havioural change are discussed.
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| 13. |
- Biel, Anders, 1948, et al.
(författare)
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Values and habits: A dual-process model. In S
- 2005
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Ingår i: Environment, information and consumer behaviour. - : Cheltenham: Edward Elgar. ; , s. 33-49
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Earlier research has shown that there is a relationship between life values and importance attached to information, as well as a relationship between impor-tance attached to information and preference change. This is true also for the en-vironmental domain. Given that a person holds environmental values to be cen-tral, he or she is more likely to attach importance to environmental product in-formation than a person whos environmental values are more peripheral and, as a consequence, also more likely to choose eco-labelled products. Our own research points in the same direction. We also extend earlier findings showing that nega-tive information (this is bad for the environment) carries greater weight than positive information (this is better for the environment) for consumers who hold environmental values to be of moderate importance. However, product choice is not always guided by a deliberate process. Our data show that consumers may also fall back on habits and choose in a routine manner. When this is the case past behaviour, or habits, mediates the effect of value centrality on choice of eco-labelled products. A dual-process model is introduced to account for these find-ings.
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| 14. |
- Bohman, Elin, et al.
(författare)
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Novel Evidence Concerning Lacrimal Sac Movement Using Ultra-High-Frequency Ultrasound Examinations of Lacrimal Drainage Systems
- 2021
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Ingår i: Ophthalmic Plastic and Reconstructive Surgery. - 1537-2677. ; 37:4, s. 334-340
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Current hypothesis regarding the mechanism of active tear drainage is based on studies performed ex vivo or under nonphysiological conditions. Novel ultra-high-frequency ultrasound has the advantage of generating images with superior resolution, enabling measurements of low flow in small vessels, and the tracking of tissue motion in real time. The purpose of this study was to investigate the lacrimal drainage system and active drainage using this modality.METHODS: The upper lacrimal drainage system was investigated with 40-70 MHz ultrasound in 22 eyes in 13 patients. Irrigation confirmed a lacrimal obstruction in 10 eyes. Motion tracking was used to map movement of the lateral lacrimal sac wall and to measure flow when possible.RESULTS: The anatomy of the upper lacrimal drainage system was mapped in vivo, including the proximal canaliculi, which have not previously been imaged. The lacrimal sac lumen is slit shaped in its resting state but is distended when irrigated or if a nasolacrimal duct obstruction is present. Thus, the healthy lacrimal sac is not a cavity, and the medial retinaculum does not act against a stretched structure. Motion tracking visualized the "lacrimal pump," showing that the direction of motion of the lateral lacrimal sac wall is mainly in the sagittal plane during blinking.CONCLUSIONS: Ultra-high-frequency ultrasound allows detailed physiological monitoring of the upper lacrimal drainage system in vivo. Our findings suggest that current theories of active tear drainage need to be reappraised.
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| 15. |
- Bunke, Josefine, et al.
(författare)
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Hyperspectral and Laser Speckle Contrast Imaging for Monitoring the Effect of Epinephrine in Local Anesthetics in Oculoplastic Surgery
- 2022
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Ingår i: Ophthalmic Plastic and Reconstructive Surgery. - 1537-2677. ; 38:5, s. 462-468
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Epinephrine is used in local anesthetics to induce vasoconstriction and thus reduce bleeding and prolong the anesthetic effect. Finding the optimal delay between the administration of the anesthetic and skin incision to ensure vasoconstriction and minimize bleeding is important and has recently become the subject of debate. This is the first study to assess blood perfusion and oxygen saturation (sO2) simultaneously in response to a local anesthetic containing epinephrine in human oculoplastic surgery.METHODS: A local anesthetic consisting of lidocaine and epinephrine (20 mg/ml + 12.5 μg/ml) was injected in the eyelids of 9 subjects undergoing blepharoplasty. The perfusion and sO2 of the eyelids were monitored using laser speckle contrast imaging and hyperspectral imaging, respectively.RESULTS: Laser speckle contrast imaging monitoring showed a decrease in perfusion over time centrally at the site of injection. Half-maximum effect was reached after 34 seconds, and full effect after 115 seconds, determined by exponential fitting. The drop in perfusion decreased gradually further away from the injection site and hypoperfusion was less prominent 4 mm from the injection site, with a spatially dependent half-maximum effect of 231 seconds. Hyperspectral imaging showed only a slight decrease in sO2 of 11 % at the injection site.CONCLUSIONS: The optimal time delay for skin incision in oculoplastic surgery is approximately 2 minutes after the injection of lidocaine with epinephrine. Longer delay does not lead to a further decrease in perfusion. As sO2 was only slightly reduced after injection, the results indicate that the use of epinephrine is safe in the periocular region.
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| 16. |
- Dahlstrand, Ursula, 1976-, et al.
(författare)
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Chronic pain after femoral hernia repair : a cross-sectional study
- 2011
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Ingår i: Annals of Surgery. - Philadelphia : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 254:6, s. 1017-1021
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the prevalence of and to identify possible risk factors for chronic pain after surgery for femoral hernia.Background: Chronic pain has become a very important outcome in quality assessment of inguinal hernia surgery. There are no studies on the risk for chronic pain after femoral hernia surgery. Methods: The Inguinal Pain Questionnaire was sent to 1967 patients who had had a repair for primary unilateral femoral hernia between January 1, 1997 and December 31, 2006. A follow-up period of at least 18 months was chosen. Answers from 1461 patients were matched with data recorded in the Swedish Hernia Register and analyzed.Results: Some degree of pain during the previous week was reported by 24.2% (354) of patients. Pain interfered with daily activities in 5.5% (81) of patients. Emergency surgery (OR = 0.54; 95% CI = 0.40-0.74) and longer time since surgery (OR = 0.93; 95% CI = 0.89-0.98 for each year added) were associated with lower risk for chronic postoperative pain, whereas a high level of preoperative pain was associated with a higher risk for chronic pain (OR = 1.17; 95% CI = 1.10-1.25). Surgical technique was not found to influence the risk for chronic pain in multivariate logistic regression analysis.Conclusions: Chronic postoperative pain is as important a complication after femoral hernia surgery as it is after inguinal hernia surgery. In contrast to inguinal hernia surgery, no risk factor related to surgical technique was found. Further investigations into the role of preoperative pain are necessary.
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| 17. |
- Dahlstrand, Ursula, et al.
(författare)
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Costs Related to Diverting Ileostomy After Rectal Cancer Surgery: A Population-Based Healthcare Cost Analysis Based on Nationwide Registers
- 2023
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Ingår i: Inquiry. - Thousand Oaks, CA : Sage Publications. - 0046-9580 .- 1945-7243. ; 60
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Tidskriftsartikel (refereegranskat)abstract
- Low anterior resection for rectal cancer often includes a diverting loop-ileostomy to avoid the severe consequences of anastomotic leakage. Reversal of the stoma is often delayed, which can incur health-care costs on different levels. The aim is to, on population basis, determine stoma-related costs, and to investigate habitual and socioeconomic factors associated to the level of cost. Multi-register design with data from the Swedish Rectal Cancer Registry, the National Prescribed Drug Register, Statistics Sweden and cost-administrative data from the National Board of Health and Welfare. Data was gathered for 3564 patients with rectal cancer surgery 2007 to 2013, for 3 years following the surgery. Factors influencing the cost of inpatient care and stoma-related consumables were assessed with linear regression analyses. All monthly costs were higher for females (consumables P
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| 18. |
- Dahlstrand, Ursula, et al.
(författare)
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Emergency femoral hernia repair : a study based on a national register.
- 2009
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Ingår i: Annals of Surgery. - : Lippincott, Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 249:4, s. 672-676
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations. BACKGROUND: Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias. METHODS: The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register. RESULTS: Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs. CONCLUSIONS: Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.
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| 19. |
- Dahlstrand, Ulf, et al.
(författare)
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Extended-wavelength diffuse reflectance spectroscopy with a machine-learning method for in vivo tissue classification
- 2019
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:10
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: An extended-wavelength diffuse reflectance spectroscopy (EWDRS) technique was evaluated for its ability to differentiate between and classify different skin and tissue types in an in vivo pig model.MATERIALS AND METHODS: EWDRS recordings (450-1550 nm) were made on skin with different degrees of pigmentation as well as on the pig snout and tongue. The recordings were used to train a support vector machine to identify and classify the different skin and tissue types.RESULTS: The resulting EWDRS curves for each skin and tissue type had a unique profile. The support vector machine was able to classify each skin and tissue type with an overall accuracy of 98.2%. The sensitivity and specificity were between 96.4 and 100.0% for all skin and tissue types.CONCLUSION: EWDRS can be used in vivo to differentiate between different skin and tissue types with good accuracy. Further development of the technique may potentially lead to a novel diagnostic tool for e.g. non-invasive tumor margin delineation.
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| 20. |
- Dahlstrand, Ursula, 1976-
(författare)
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Femoral and Inguinal Hernia : How to Minimize Adverse Outcomes Following Repair
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Groin hernia is common, and each year 200 repairs per 100 000 adult inhabitants are performed in Sweden. Groin hernias are either inguinal or femoral (2-4%). Elective repair is not associated with an excess mortality, but adverse outcomes include recurrence and long-term pain. Emergency procedures have a 4% mortality rate with an increased risk for bowel resection and postoperative complications. The aim of this thesis was to identify risk factors for adverse outcomes and to propose measures to improve groin hernia treatment. Twenty-three per cent of female hernias were femoral. Thirty-six per cent of femoral hernias, and 5% of inguinal hernias, have emergency procedures. Females (OR 1.47) and patients above 65 years-of-age (OR 2.24) were at higher risk for emergency repair. Bowel resection was performed in 23% of emergency femoral repairs, and the 30-day mortality was 10 times that of an age- and gender-matched population. The majority of emergency patients were unaware of their hernia, and one third had previously had no groin symptoms. Femoral repairs were at larger risk for recurrence than inguinal repairs. The surgical techniques with least risk for recurrence were preperitoneal mesh repairs (open HR 0.28, and laparoscopic HR 0.31). Long-term pain was present in 24% of femoral hernia patients, of whom 5.5% described pain interfering with daily activities. The only factor predicting the risk for long-term pain was pain preoperatively. Pain decreased with time. In a randomized study on inguinal hernia, TEP resulted in less pain six weeks after surgery than Lichtenstein repair performed under local anesthesia (LLA). TEP patients were to a larger extent able to perform sporting activities. No difference was seen in intra-operative complications. Femoral hernias should be given high priority for repair and preperitoneal techniques should be used. Earlier diagnosis, in the elective setting, is probably difficult to attain. Heightened awareness in the emergency department is required. TEP is safe, and results in less pain than LLA six weeks after surgery. A widening of indications for TEP in primary inguinal hernia repair is justifiable.
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| 21. |
- Dahlstrand, Ursula, et al.
(författare)
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Limited potential for prevention of emergency surgery for femoral hernia
- 2014
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Ingår i: World Journal of Surgery. - : Springer-Verlag New York. - 0364-2313 .- 1432-2323. ; 38:8, s. 1931-1936
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Femoral hernias are frequently operated on as an emergency. Emergency procedures for femoral hernia are associated with an almost tenfold increase in postoperative mortality, while no increase is seen for elective procedures, compared with a background population.OBJECTIVE: The aim of this study was to compare whether symptoms from femoral hernias and healthcare contacts prior to surgery differ between patients who have elective and patients who have emergency surgery.METHODS: A total of 1,967 individuals operated on for a femoral hernia over 1997-2006 were sent a questionnaire on symptoms experienced and contact with the healthcare system prior to surgery for their hernia. Answers were matched with data from the Swedish Hernia Register.RESULTS: A total of 1,441 (73.3%) patients responded. Awareness of their hernia prior to surgery was denied by 53.3% (231/433) of those who underwent an emergency procedure. Of the emergency operated patients, 31.3% (135/432) negated symptoms in the affected groin prior to surgery and 22.2% (96/432) had neither groin nor other symptoms. Elective patients had a considerably higher contact frequency with their general practitioner, as well as the surgical outpatient department, prior to surgery compared with patients undergoing emergency surgery (p < 0.001).CONCLUSIONS: Patients who have elective and patients who have emergency femoral hernia surgery differ in previous symptoms and healthcare contacts. Patients who need emergency surgery are often unaware of their hernia and frequently completely asymptomatic prior to incarceration. Early diagnosis and expedient surgery is warranted, but the lack of symptoms hinders earlier detection and intervention in most cases.
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| 22. |
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| 23. |
- Dahlstrand, Ulf
(författare)
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Novel Diagnostic Tools for Skin and Periorbital Cancer - Exploring Photoacoustic Imaging and Diffuse Reflectance Spectroscopy
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The eyelids are susceptible to a number of skin cancers which are challenging to excise radically without sacrificing excessive healthy tissue. The way in which a tumor is delineated preoperatively has not changed significantly over the past century. The aims of the work presented in this thesis were to investigate two novel non-invasive techniques for diagnosing and delineating skin tumors.Extended-wavelength diffuse reflectance spectroscopy (EWDRS) was evaluated to determine its ability to differentiate between and classify different skin and tissue types in an in vivo pig model, with the aid of machine learning methods.The recordings were used to train a support vector machine, and it was possible to perform classifications with an overall accuracy of over 98%. The ability of EWDRS to identify the borders of pigmented skin lesions in an in vivo pig model was also evaluated. Using a thin probe, it was possible to detect the border with a median discrepancy of 70 μm, compared to the border found on histological examination.Photoacoustic imaging (PAI), a biomedical imaging modality that combines laser irradiation and ultrasound, was used to examine basal cell carcinomas (BCCs) and human eyelids ex vivo. Typical photoacoustic spectra were observed for BCCs as well as for the different layers of the healthy eyelid, and these structures could be visualized in three-dimensional images. A case was described in which PAI showed that the pentagonal excision of an eyelid BCC was non-radical, as was later confirmed by histological examination.In conclusion, both EWDRS and PAI are capable of differentiating between different kinds of tissue and, following further development and studies, could potentially be used to diagnose and delineate skin and eyelid tumors prior to surgical excision.
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| 24. |
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| 25. |
- Dahlstrand, Ulf, et al.
(författare)
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Photoacoustic imaging for three-dimensional visualization and delineation of basal cell carcinoma in patients
- 2020
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Ingår i: Photoacoustics. - : Elsevier BV. - 2213-5979. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Photoacoustic (PA) imaging is an emerging non-invasive biomedical imaging modality that could potentially be used to determine the borders of basal cell carcinomas (BCC) preoperatively in order to reduce the need for repeated surgery.Methods: Two- and three-dimensional PA images were obtained by scanning BCCs using 59 wavelengths in the range 680-970 nm. Spectral unmixing was performed to visualize the tumor tissue distribution. Spectral signatures from 38 BCCs and healthy tissue were compared ex vivo.Results and discussion: The PA spectra could be used to differentiate between BCC and healthy tissue ex vivo (p < 0.05). Spectral unmixing provided visualization of the overall architecture of the lesion and its border.Conclusion: PA imaging can be used to differentiate between BCC and healthy tissue and can potentially be used to delineate tumors prior to surgical excision.
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| 26. |
- Dahlstrand, Ulf, et al.
(författare)
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Photoacoustic Imaging of Enucleated Eyes from Patients with Uveal Melanoma can Reveal Extrascleral Growth
- 2021
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Ingår i: Open Ophthalmology Journal. - : Bentham Science Publishers Ltd.. - 1874-3641. ; 15:1, s. 270-276
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Tidskriftsartikel (refereegranskat)abstract
- Background:Uveal melanoma is treated by either enucleation (removal of the eye) or local eye-sparing therapies, depending on tumor size and whether there are signs of extrascleral growth. Photoacoustic (PA) imaging is a novel imaging modality that provides high-resolution images of the molecular composition of tissues.Objective:In this study, the feasibility of PA imaging for uveal melanomas and detection of extrascleral growth was explored.Methods:Seven enucleated human eyes with uveal melanomas were examined using PA imaging. The spectral signatures of the melanomas and the layers of the normal eyewall were characterized using 59 excitation wavelengths from 680 to 970 nm.Results:Significant differences were seen between the spectra obtained from melanoma and the healthy eyewall. Using spectral unmixing, melanin, hemoglobin and collagen could be mapped out, showing the architecture of the tumor in relation to the eyewall. This allowed visualization of regions where the tumor extended into the extrascleral space.Conclusion:PA imaging appears to have the potential to aid in assessing uveal melanomas and as a diagnostic tool for the detection of extrascleral growth.
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| 27. |
- Dahlstrand, Ulf, et al.
(författare)
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Spectral Signatures in the Different Layers of the Human Eyelid by Photoacoustic Imaging
- 2019
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Ingår i: Lasers in Surgery and Medicine. - : Wiley. - 0196-8092 .- 1096-9101.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: The eyelids are susceptible to a number of skin cancers, which are challenging to excise radically without sacrificing excessive healthy tissue. Photoacoustic (PA) imaging is an emerging non-invasive biomedical imaging modality that could potentially be used for intraoperative micrographic control of the surgical margins of eyelid tumors. In this study, non-cancerous human eyelid tissue was characterized using PA as a first step in the development of this technique.STUDY DESIGN/MATERIALS AND METHODS: Twelve full-thickness samples from nine patients were analyzed ex vivo using PA imaging. Two-dimensional PA images were acquired using 59 wavelengths in the range of 680-970 nm to obtain the spectral signatures of the skin, orbicularis oculi muscle, and the tarsal plate. Three-dimensional images were obtained by scanning the tissues using a linear stepping motor. Spectral unmixing was performed to visualize the chromophore distribution.RESULTS: The resulting PA spectra could be used to differentiate between the orbicularis oculi muscle and the other two structures (P < 0.05). The signals from the skin and the tarsal plate were more similar in appearance, probably due to similarities in their molecular composition. Spectral unmixing provided a clear visualization of the overall architecture of the eyelids.CONCLUSIONS: PA imaging can be used to differentiate between the orbicularis oculi muscle and the eyelid skin and tarsal plate. The main structures of human eyelids could be visualized in three dimensions using PA imaging. This technique could potentially be used to examine eyelid tumors intraoperatively in the future. However, further studies on tumors in vivo are needed before considering such clinical use. Lasers Surg Med. © 2019 Wiley Periodicals, Inc.
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| 28. |
- Dahlstrand, Ursula, et al.
(författare)
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TEP under general anesthesia is superior to Lichtenstein under local anesthesia in terms of pain 6 weeks after surgery : results from a randomized clinical trial
- 2013
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 27:10, s. 3632-3638
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Tidskriftsartikel (refereegranskat)abstract
- Persistent pain is common after inguinal hernia repair. The methods of surgery and anesthesia influence the risk. Local anesthesia and laparoscopic procedures reduce the risk for postoperative pain in different time perspectives. The aim of this study was to compare open Lichtenstein repair under local anesthesia (LLA) with laparoscopic total extraperitoneal repair (TEP) with respect to postoperative pain. Between 2006 and 2010, a total of 389 men with a unilateral primary groin hernia were randomized, in an open-label study, to either TEP (n = 194) or LLA (n = 195). One patient in the TEP group and four in the LLA group were excluded due to protocol violation. Details about the procedure and patient and hernia characteristics were registered. Patients completed the Inguinal Pain Questionnaire (IPQ) 6 weeks after surgery. [The study is registered in ClinicalTrials.gov (No. NCT01020058)]. A total of 378 (98.4 %) patients completed the IPQ. One hundred forty-eight patients (39.1 %) reported some degree of pain, 22 of whom had pain that affected concentration during daily activities. Men in the TEP group had less risk for pain affecting daily activities (6/191 vs. 16/187; odds ratio [OR] 0.35; 95 % CI 0.13-0.91; p = 0.025). Pain prevented participation in sporting activities less frequently after TEP (4.2 vs. 15.5 %; OR 0.24; 95 % CI 0.09-0.56; p < 0.001). Twenty-nine patients (7.7 %) reported sick leave exceeding 1 week due to groin pain, with no difference between the treatment groups. Patients who underwent the laparoscopic TEP procedure suffered less pain 6 weeks after inguinal hernia repair than those who underwent LLA. Groin pain affected the LLA patients' ability to perform strenuous activities such as sports more than TEP patients.
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| 29. |
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| 30. |
- Emanuelsson, Peter, et al.
(författare)
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Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis : comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively
- 2014
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Ingår i: Hernia. - Paris : Springer. - 1265-4906 .- 1248-9204. ; 18:4, s. 465-471
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate and compare the consistency of agreement of two methods for measuring abdominal rectus diastasis (ARD), preoperative computed tomography (CT) scanning and preoperative clinical assessment were compared with direct measurement intraoperatively.METHODS: Fifty-five consecutive patients were retrieved from an ongoing prospective randomised trial comparing two operative techniques for the repair of ARD. All patients underwent a preoperative clinical assessment and CT scan, and the results were compared with intraoperative measurement of the ARD width. Agreement between methods was described with Bland-Altman plots (BA plots) and calculated using Lin's Concordance Correlation Coefficient (CCC).RESULTS: The median width of the diastasis was 4.0 cm in the upper midline and 3.0 cm in the lower midline for the intraoperative measurement. BA plots showed that measurements on CT and intraoperatively are not in agreement in the lower midline, whereas the agreement was stronger between the clinical and the intraoperative method. The CCC was higher for clinical vs. intraoperative measurement (0.479) than for CT vs. intraoperative measurement (-0.002) in the lower midline, although the agreement was over all low. CT scanning underestimated the width of the ARD when compared to 87 % of preoperative clinical assessments, and 83 % of intraoperative measurements. Preoperative clinical assessment overestimated ARD in 35 % when compared with intraoperative measurements.CONCLUSION: Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.
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| 31. |
- Emanuelsson, Peter, et al.
(författare)
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Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength : a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures
- 2016
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Ingår i: Surgery. - : Elsevier. - 0039-6060 .- 1532-7361. ; 160:5, s. 1367-1375
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only.METHODS: Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4.RESULTS: One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up.CONCLUSION: There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain.
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| 32. |
- Engqvist, Linn, et al.
(författare)
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Detailed measurements of the four extraocular rectus muscles’ contribution to the perfusion of the anterior segment of the eye
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Ingår i: British Journal of Ophthalmology. - 1468-2079.
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Tidskriftsartikel (refereegranskat)abstract
- Background/aims Anterior segment ischaemia (ASI) is a rare but serious complication of strabismus surgery, which may be caused by damage to the anterior ciliary arteries that run along the rectus muscles. To avoid ASI, clinical praxis is to operate on a maximum of two rectus muscles at a time. The aim of this study was to perform a detailed study of the contribution of the four ocular rectus muscles to the perfusion of the anterior segment using laser speckle contrast imaging (LSCI).Methods The four rectus muscles were successively detached during enucleation in nine patients with suspected uveal melanoma. Perfusion of the anterior segment was monitored with LSCI during the detachment of each of the rectus muscles, and after the ophthalmic artery had been severed.Results Perfusion of the anterior segment, measured in the paralimbal tissue, decreased gradually as the four rectus muscles were detached, showing a decrease to 98% when the first (lateral rectus) muscle was detached, to 88% when the second (medial rectus), and 69% when the third (inferior rectus) muscles were detached. The decrease was more pronounced and statistically significant when the fourth (superior rectus) muscle was detached (to 28%, p=0.0102).Conclusion LSCI is a valuable perfusion monitoring tool, as it has the capability to visualise the gradual decrease in anterior segment perfusion as the rectus muscles are successively detached. Further studies are needed to determine how many rectus muscles can be safely detached during strabismus surgery without risking ASI.Data are available on reasonable request.
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| 33. |
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| 34. |
- Engqvist, Linn, et al.
(författare)
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Laser speckle contrast imaging enables perfusion monitoring of the anterior segment during strabismus surgery: a study on the horizontal rectus muscles
- 2023
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Ingår i: British Journal of Ophthalmology. - : BMJ. - 1468-2079 .- 0007-1161. ; 107, s. 1704-1708
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Tidskriftsartikel (refereegranskat)abstract
- Background A dreaded complication of strabismus surgery is anterior segment ischaemia (ASI), caused by damage to the anterior ciliary arteries. To avoid ASI, a maximum of two rectus muscles are operated on at a time. However, these surgical protocols are based on empirical observations of clinical outcome, rather than objective perfusion measurements. There is no method available for perioperative, real-time perfusion measurements during ocular muscle surgery. The aims of this study were to investigate whether laser speckle contrast imaging (LSCI) could be used for such measurements, and to monitor perfusion during strabismus surgery on one or two horizontal rectus muscles.Methods Forty-four eyes in 44 patients with horizontal strabismus underwent corrective surgery involving medial and/or lateral rectus muscle detachment. Perfusion in the adjacent paralimbal and iris tissue was monitored with LSCI.Results When the first horizontal rectus muscle was detached perfusion in the adjacent paralimbal tissue decreased by 23% (p<0.0001), and by 12% (p<0.0001) when the second muscle was detached. The iris perfusion decreased by 5% (p<0.05) when the first muscle was detached but showed no significant decrease as the second muscle was cut.Conclusion This is the first study showing that perfusion of the anterior segment can be monitored non-invasively with LSCI during strabismus surgery. In this cohort, two horizontal rectus muscles were detached with only a small decrease in the anterior segment circulation. Future studies are required for complete mapping of the effect of surgery on multiple ocular muscles on the anterior segment circulation.Data are available upon request.
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| 35. |
- Erlöv, Tobias, et al.
(författare)
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Regional motion correction for in vivo photoacoustic imaging in humans using interleaved ultrasound images
- 2021
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Ingår i: Biomedical Optics Express. - 2156-7085. ; 12:6, s. 3312-3322
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Tidskriftsartikel (refereegranskat)abstract
- In translation from preclinical to clinical studies using photoacoustic imaging, motion artifacts represent a major issue. In this study the feasibility of an in-house algorithm, referred to as intensity phase tracking (IPT), for regional motion correction of in vivo human photoacoustic (PA) images was demonstrated. The algorithm converts intensity to phase-information and performs 2D phase-tracking on interleaved ultrasound images. The radial artery in eight healthy volunteers was imaged using an ultra-high frequency photoacoustic system. PA images were motion corrected and evaluated based on PA image similarities. Both controlled measurements using a computerized stepping motor and free-hand measurements were evaluated. The results of the controlled measurements show that the tracking corresponded to 97 ± 6% of the actual movement. Overall, the mean square error between PA images decreased by 52 ± 15% and by 43 ± 19% when correcting for controlled- and free-hand induced motions, respectively. The results show that the proposed algorithm could be used for motion correction in photoacoustic imaging in humans.
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| 36. |
- Grankvist, G., et al.
(författare)
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The Impact of Environmental Labelling on Consumer Preference: Negative vs. Positive Labels.
- 2004
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Ingår i: Journal of Consumer Policy. ; 27, s. 213-230
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Tidskriftsartikel (refereegranskat)abstract
- Eco-labels in use today signify environmentally benign outcomes: "Choose this product, it is better for the environment than the average product." Another strategy would be to indicate negative outcomes with the purpose of trying to persuade consumers to avoid a product: "Do not choose this product, it is worse for the environment than the average product." In a computer-based experiment, it was investigated how these two types of labels affected preference for some everyday products. Individuals who had a weak or no interest in environmental issues were unaffected by either kind of label. Individuals with an intermediate interest in environmental issues were more affected by a negative label than by a positive label. Individuals with a strong interest in environmental protection were equally affected by the two kinds of labels.
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| 37. |
- Gunnarsson, Ulf, 1967-, et al.
(författare)
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Correlation between Abdominal Rectus Diastasis Width and Abdominal Muscle Strength
- 2015
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Ingår i: Digestive Surgery. - : Karger. - 0253-4886 .- 1421-9883. ; 32:2, s. 112-116
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Tidskriftsartikel (refereegranskat)abstract
- Background: Surgery for Abdominal Rectus Diastasis (ARD) is a controversial topic and some argue that it is solely an aesthetic problem. Many symptoms in these patients are indefinite, and no objective criteria have been established, indicating which patients are likely to benefit from surgery. This study investigated the correlation between preoperative assessment and intraoperative measurement of ARD width, and objective measurements of muscle strength. Methods: 57 patients undergoing surgery for ARD underwent preoperative assessment of ARD width by clinical measurement and CT scan, and thereafter intraoperative measurement. Abdominal muscle strength was investigated using the Biodex System 4 including flexion, extension and isometric measurements. Correlations were calculated by the Spearman test. Results: Intraoperative ARD width between the umbilicus and the symphysis correlated strongly with Biodex measurements during flexion (p = 0.007, R = -0.35) and isometric work load (p = 0.01, R = -0.34). The following measurements showed no correlation: between muscle strength and BMI; muscle strength and waistline; or between muscle strength and ARD width above the umbilicus, assessed preoperatively at the outpatient clinic, by CT scan, or measured intraoperatively. Conclusion: There is a strong correlation between intraoperatively measured ARD width below the umbilicus and flexion and isometric abdominal muscle strength measured with the Biodex System 4.
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| 38. |
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| 39. |
- Gustafsson, Carl Pontus, et al.
(författare)
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Loop-ileostomy reversal : patient-related characteristics influencing time to closure
- 2018
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 33:5, s. 593-600
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To identify factors associated with timing of stoma reversal after rectal cancer surgery in a large Swedish register-based cohort.METHODS: Three thousand five hundred sixty-four patients with rectal cancer who received a protective stoma during surgery in 2007-2013 were identified in the Swedish colorectal cancer register. Time to stoma reversal was evaluated over a follow-up period of one and a half years. Factors associated with timing of stoma reversal were analysed using Cox regression analysis. Reversal within 9 months (12 months if adjuvant chemotherapy) was considered latest expected time to closure.RESULTS: Stoma reversal was performed in 2954 (82.9%) patients during follow-up. Patients with post-secondary education had an increased chance for early stoma reversal (HR 1.13; 95% CI 1.02-1.25). Postoperative complications (0.67; 0.62-0.73), adjuvant chemotherapy (0.63; 0.57-0.69), more advanced cancer stage (stage III 0.74; 0.66-0.83 and stage IV 0.38; 0.32-0.46) and higher ASA score (0.80; 0.71-0.90 for ASA 3-4) were associated with longer time to reversal. Two thousand four hundred thirty-seven (68.4%) patients had stoma reversal within latest expected time to closure. Factors associated to decreased chance of timely reversal were more advanced cancer stage (stage III 0.64; 0.50-0.81 and stage IV 0.19; 0.13-0.27), postoperative complications (0.50; 0.42-0.59) and higher ASA score (0.77; 0.61-0.96 for ASA 3-4).CONCLUSIONS: Patients with a high level of education had a higher chance of timely reversal but medical factors had a stronger association to time to reversal. Patients with advanced rectal cancer are at high risk for non-reversal and should be considered for permanent stoma.
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| 40. |
- Hellspong, Gustaf, et al.
(författare)
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Diabetes as a risk factor in patients undergoing groin hernia surgery
- 2017
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Ingår i: Langenbeck's archives of surgery (Print). - : Springer Science and Business Media LLC. - 1435-2443 .- 1435-2451. ; 402:2, s. 219-225
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Diabetes is a known risk factor for early postoperative complications. Even so, the incidence of acute postoperative complications following routine hernia surgery is seldom described, and the risk for reoperation for recurrence has hardly been studied. Our aim was to explore if diabetes is a significant risk factor for complications after inguinal hernia surgery.METHODS: All inguinal hernia repairs registered in the Swedish Hernia Register between 2002 and 2011 were identified. Information on comorbidity and postoperative complications was obtained through cross-referencing with the National Patient Register at the National Board of Health and Welfare. Complicated diabetes was defined as diabetes with secondary manifestations (corresponding to aDCSI >0). The hazards for postoperative complications and reoperation for recurrence after the index hernia operation were calculated.RESULTS: Altogether 162,713 inguinal hernia repairs on 143,041 patients were registered. Of these, the number of patients with diabetes was 4816 (3.4 %), including 1123 (0.8 %) patients with complicated diabetes (aDCSI > 0). A significantly increased risk for postoperative complications was observed up to 30 days after hernia surgery when adjusted for gender, age, BMI, history of liver disease, kidney disease or HIV/AIDS, type of hernia and surgical method (odds ratio 1.35, 95 % confidence interval 1.14-1.60). No significantly increased risk for reoperation up until December 31, 2011, was observed in either patient group.CONCLUSION: Diabetes seems to increase the risk for postoperative complications within 30 days of inguinal hernia surgery, especially for complicated diabetes. Diabetes does not seem to increase the long-term risk for reoperation for recurrence.
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| 41. |
- Hult, Jenny, et al.
(författare)
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A waiting time of 7 min is sufficient to reduce bleeding in oculoplastic surgery following the administration of epinephrine together with local anaesthesia
- 2018
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Ingår i: Acta Ophthalmologica. - : Wiley. - 1755-375X. ; 96:5, s. 499-502
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The time taken to reach maximal haemostatic effect following local anaesthesia with epinephrine is generally believed to be <10 min. This is based on clinical experience and indirect measurements of perfusion using methods such as laser Doppler flowmetry and oxygen spectroscopy. However, the only study in which bleeding has been measured quantitatively in an intra-operative setting in humans showed that the full haemostatic effect was not achieved until 30 min after anaesthesia. The aim of this study was to determine the time taken to reach maximum haemostatic effect when using epinephrine for local anaesthesia in oculoplastic surgery.METHODS: Intra-operative bleeding following infiltration anaesthesia with either lidocaine 20 mg/ml (2%) or lidocaine + epinephrine 12.5 μg/ml (1:80 000) was measured after 7, 15 and 30 min in the eyelids of 16 patients undergoing upper eyelid blepharoplasty.RESULTS: Bleeding was decreased by 74.6% (with 95% CI, 6.16-87.6%) 7 min after the injection of lidocaine + epinephrine (p = 0.0048) compared with lidocaine without epinephrine. There was no further decrease in bleeding after 15 or 30 min (p = n.s.).CONCLUSION: The optimal time for skin incision in eyelid surgery is within 7 min of injection of lidocaine with epinephrine. Waiting longer does not lead to a further decrease in bleeding.
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| 42. |
- Hult, Jenny, et al.
(författare)
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Comparison of photoacoustic imaging and histopathological examination in determining the dimensions of 52 human melanomas and nevi ex vivo : Biomedical Optics Express
- 2021
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Ingår i: Biomedical Optics Express. - 2156-7085. ; 12:7, s. 4097-4114
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Tidskriftsartikel (refereegranskat)abstract
- Surgical excision followed by histopathological examination is the gold standard for the diagnosis and staging of melanoma. Reoperations and unnecessary removal of healthy tissue could be reduced if non-invasive imaging techniques were available for presurgical tumor delineation. However, no technique has gained widespread clinical use to date due to shallow imaging depth or the absence of functional imaging capability. Photoacoustic (PA) imaging is a novel technology that combines the strengths of optical and ultrasound imaging to reveal the molecular composition of tissue at high resolution. Encouraging results have been obtained from previous animal and human studies on melanoma, but there is still a lack of clinical data. This is the largest study of its kind to date, including 52 melanomas and nevi. 3D multiwavelength PA scanning was performed ex vivo, using 59 excitation wavelengths from 680 nm to 970 nm. Spectral unmixing over this broad wavelength range, accounting for the absorption of several tissue chromophores, provided excellent contrast between healthy tissue and tumor. Combining the results of spectral analysis with spatially resolved information provided a map of the tumor borders in greater detail than previously reported. The tumor dimensions determined with PA imaging were strongly correlated with those determined by histopathological examination for both melanomas and nevi.
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| 43. |
- Hult, Jenny, et al.
(författare)
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Unique spectral signature of human cutaneous squamous cell carcinoma by photoacoustic imaging
- 2020
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Ingår i: Journal of Biophotonics. - : Wiley. - 1864-063X .- 1864-0648. ; 13:5
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Tidskriftsartikel (refereegranskat)abstract
- Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer with metastatic potential. To reduce reoperations due to nonradical excision, there is a need to develop a technique for identification of tumor margins preoperatively. Photoacoustic (PA) imaging is a novel imaging technology that combines the strengths of laser optics and ultrasound. Our aim was to determine the spectral signature of cSCC using PA imaging and to use this signature to visualize tumor architecture and borders. Two-dimensional PA images of 33 cSCCs and surrounding healthy skin were acquired ex vivo, using 59 excitation wavelengths from 680 to 970 nm. The spectral response of the cSCCs was compared to healthy tissue, and the difference was found to be greatest at wavelengths in the range 765 to 960 nm (P <.05). Three-dimensional PA images were constructed from spectra obtained in the y-z plane using a linear stepper motor moving along the x-plane. Spectral unmixing was then performed which provided a clear three-dimensional view of the distribution of tumor masses and their borders.
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| 44. |
- Lindmark, Mikael, et al.
(författare)
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Risk factors for surgical complications in ventral hernia repair
- 2018
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Ingår i: World Journal of Surgery. - New York : Springer. - 0364-2313 .- 1432-2323. ; 42:11, s. 3528-3536
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to identify risk factors for an adverse event, i.e. early surgical complication, need for ICU care and readmission, following ventral hernia repair. Our hypothesis was that there is an association between an increased complication rate following ventral hernia repair and specific factors, including hernia size, BMI > 35, concomitant bowel surgery, ASA-class, age, gender and method of hernia repair.METHODS: Data from a hernia database with prospectively entered data on 408 patients operated for ventral hernia between 2007 and 2014 at two Swedish university hospitals were analysed. A 3-month follow-up of complications, need for intensive care and readmission, was performed by reviewing the medical records.RESULTS: Eighty-one of 408 patients (20%) had a registered complication. Fifty-eight (14%) of these were classed as Clavien I-IIIa, and in 19 cases a Clavien IIIb-IV complication was reported. Large hernia size was associated with increased risk for early complication. A Kendall Tau test analysis revealed a proportional relationship between hernia size and modified Clavien outcome class (p < 0.001). Morbid obesity, ASA-class, method, hernia recurrence, age and concomitant bowel surgery were not statistically significant predictors of adverse events.CONCLUSIONS: Assessment of hernia aperture size is of great importance in the preoperative evaluation of ventral hernia patients to consider risk for post-operative complications. These results suggest a careful attitude when applying watchful waiting concepts and when postponing hernia surgery to achieve weight loss. A delaying attitude may result in increased risk of complications caused by increasing hernia size.
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| 45. |
- Naumovska, Magdalena, et al.
(författare)
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Mapping the architecture of the temporal artery with photoacoustic imaging for diagnosing giant cell arteritis
- 2022
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Ingår i: Photoacoustics. - : Elsevier BV. - 2213-5979. ; 27
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Tidskriftsartikel (refereegranskat)abstract
- Photoacoustic (PA) imaging is rapidly emerging as a promising clinical diagnostic tool. One of the main applications of PA imaging is to image vascular networks in humans. This relies on the signal obtained from oxygenated and deoxygenated hemoglobin, which limits imaging of the vessel wall itself. Giant cell arteritis (GCA) is a treatable, but potentially sight- and life-threatening disease, in which the artery wall is infiltrated by leukocytes. Early intervention can prevent complications making prompt diagnosis of importance. Temporal artery biopsy is the gold standard for diagnosing GCA. We present an approach to imaging the temporal artery using multispectral PA imaging. Employing minimally supervised spectral analysis, we produce histology-like images where the artery wall is clearly discernible from the lumen and further differentiate between PA spectra from biopsies diagnosed as GCA- and GCA+ in 77 patients.
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| 46. |
- Nguyen, Cu Dinh, et al.
(författare)
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Blood Perfusion in Human Eyelid Skin Flaps Examined by Laser Speckle Contrast Imaging-Importance of Flap Length and the Use of Diathermy
- 2018
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Ingår i: Ophthalmic Plastic and Reconstructive Surgery. - 1537-2677. ; 39:4, s. 361-365
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: It is well known that blood perfusion is important for the survival of skin flaps. As no study has been conducted to investigate how the blood perfusion in human eyelid skin flaps is affected by the flap length and diathermy, the present study was carried out to investigate these in patients.METHODS: Fifteen upper eyelids were dissected as part of a blepharoplastic procedure, releasing a 30-mm long piece of skin, while allowing the 5 mm wide distal part of the skin to remain attached, to mimic a skin flap (hereafter called a "skin flap"). Blood perfusion was measured before and after repeated diathermy, using laser speckle contrast imaging.RESULTS: Blood perfusion decreased from the base to the tip of the flap: 5 mm from the base, the perfusion was 69%, at 10 mm it was 40%, at 15 mm it was 20%, and at 20 mm it was only 13% of baseline values. Diathermy further decreased blood perfusion (measured 15 mm from the base) to 13% after applying diathermy for the first time, to 6% after the second and to 4% after the third applications of diathermy.CONCLUSIONS: Blood perfusion falls rapidly with distance from the base of skin flaps on the human eyelid, and diathermy reduces blood perfusion even further. Clinically, it may be advised that flaps with a width of 5 mm be no longer than 15 mm (i.e., a width:length ratio of 1:3), and that the use of diathermy should be carefully considered.
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| 47. |
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| 48. |
- Nordanskog, Pia, et al.
(författare)
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Increase in Hippocampal Volume After Electroconvulsive Therapy in Patients With Depression : A Volumetric Magnetic Resonance Imaging Study
- 2010
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Ingår i: JOURNAL OF ECT. - 1095-0680 .- 1533-4112. ; 26:1, s. 62-67
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Tidskriftsartikel (refereegranskat)abstract
- Background: Major depression has traditionally been regarded as a neurochemical disease, but findings of a decreased hippocampal volume in patients with depression have turned the pathophysiological focus toward impairments in structural plasticity. The mechanisms of action of the most effective antidepressive treatment, electroconvulsive therapy (ECT), still remains elusive, but recent animal research has provided evidence for a cell proliferative effect in the hippocampus. The aim of this prospective study was to determine if hippocampal volume changes after ECT in patients with depression.Methods: Twelve patients with depression and ongoing antidepressive pharmacological treatment were investigated with clinical ratings and 3 T magnetic resonance imaging within 1 week before and after the ECT series. Each hippocampus was manually outlined on coronal slices, and the volume was calculated.Results: The left as well as the right hippocampal volume increased significantly after ECT.Conclusions: The hippocampal volume increases after ECT, supporting the hypothesis that hippocampus may play a central role in the treatment of depression.
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| 49. |
- Näsvall, Pia, et al.
(författare)
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Quality of life in patients with a permanent stoma after rectal cancer surgery
- 2017
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Ingår i: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 26:1, s. 55-64
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Health-related quality of life (HRQoL) assessment is important in understanding the patient's perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.METHODS: 711 patients operated for rectal cancer with abdomino-perineal resection or Hartman's procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.RESULTS: 336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.CONCLUSION: Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.
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