| 1. |
|
|
| 2. |
- Alian, Wael A, 1970, et al.
(författare)
-
Prosthetic Reconstruction from the Tympanic Membrane to the Stapes Head or to the Stapes Footplate? A Laser Doppler Study
- 2012
-
Ingår i: Journal of Otolaryngology-Head & Neck Surgery. - 1916-0216. ; 41:2, s. 84-93
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In the absence of the incus, many surgeons believe that reconstruction from the tympanic membrane to the stapes head is more effective than reconstruction to the stapes footplate. This has rarely been tested empirically. Published better clinical results with reconstruction to the stapes head might simply reflect less underlying disease in ears with an intact stapes superstructure. Objective: To compare vibration transmission of these two forms of prosthetic reconstruction. Methods: A fresh human cadaveric temporal bone model was used. Round window vibrations in response to sound in the ear canal were measured with a laser Doppler vibrometer. After incus removal, the discontinuity was repaired using a titanium prosthesis. Reconstruction from the tympanic membrane to the stapes head was compared to reconstruction to the stapes footplate. Results: Reconstruction of both types decreased round window vibrations by 10 to 15 dB between 500 and 3000 Hz compared to the intact middle ear. Reconstruction to the stapes head performed 5 to 10 dB better at lower frequencies (500-2000 Hz), but this was only statistically significant at 1 and 2 kHz. Conclusions: There is only a 5 to 10 dB mechanical advantage gained by reconstruction from the tympanic membrane to the stapes head compared to reconstruction to the footplate for frequencies between 1 and 2 kHz.
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Berg, Malin, 1976, et al.
(författare)
-
Replacement of a Tracheal Stenosis with a Tissue-Engineered Human Trachea Using Autologous Stem Cells: A Case Report
- 2014
-
Ingår i: Tissue Engineering. Part A. - 1937-3341 .- 1937-335X. ; 20:1-2, s. 389-397
-
Tidskriftsartikel (refereegranskat)abstract
- Cell-based therapies, involving tissue engineering represent interesting and potentially important strategies for treatment of patients with various disorders. Here, using a detergent-enzymatic method we prepared an intact 3-dimensional scaffold of an extracellular matrix (ECM) derived from a human cadaver donor trachea, which we repopulated with autologous stem cells and implanted into a 76-year old patient with tracheal stenosis including lower part of the larynx. Although the graft provided the patient with an open airway, a week after surgery, the mucous membrane of the graft was covered by a 1-2mm thick fungal infection, which was treated with local and systemic anti-fungal therapy. The airway lumen was postoperatively controlled by fiberbrandoscopy and found stable and sufficient. However, twenty-three days later the patient died due to cardiac arrest but with a patent, open, stable tracheal transplant and intact anastomoses. Histopathological results of the transplanted tracheal graft at autopsy showed a squamous but not ciliated epithelium, neovascularization, bundles of -sma positive muscle cells, serous glands and nerve fibres with S-100 positive nerve cells in the submucosa and intact chondrocytes in the cartilage. Our findings suggest that although autologous stem cells- engineered tracheal matrices may represent a tool for clinical tracheal replacement. Further preclinical studies are required for generating functional airway grafts and long term effects of such grafts.
|
|
| 6. |
- Bergquist, Henrik, 1969, et al.
(författare)
-
Combined stent insertion and single high-dose brachytherapy in patients with advanced esophageal cancer - results of a prospective safety study.
- 2011
-
Ingår i: Diseases of the esophagus. - : Oxford University Press (OUP). - 1442-2050 .- 1120-8694. ; Early View
-
Tidskriftsartikel (refereegranskat)abstract
- Previous randomized studies comparing the two commonly used palliative treatments for incurable esophageal cancer, i.e. stent insertion and intraluminal brachytherapy, have revealed the pros and cons of each therapy. While stent treatment offers a more prompt effect, brachytherapy results in more long-lasting relief of dysphagia and a better health-related quality of life (HRQL) in those living longer. This prospective pilot study aimed to explore the feasibility and safety of combining these two regimes and incorporating a single high dose of internal radiation. Patients with newly diagnosed, incurable cancer of the esophagus and dysphagia were eligible for inclusion, and stent insertion followed by a single dose (12Gy) of brachytherapy was performed as a two-stage procedure. Clinical parameters including HRQL and adverse events were registered at inclusion, and 1, 2, 3, 6, and 12 months later. Twelve patients (nine males) with a median age of 73 years (range 54-85) were included. Stent insertion followed by a single dose of brachytherapy was successfully performed in all but one patient who was treated with stent only. Relief of dysphagia was achieved in the majority of cases (10/11, P < 0.05), but HRQL did not improve except for dysphagia-related items. Only minor adverse events, including chest pain, reflux, and restenosis, were reported. The median survival time after inclusion was 6.6 months. Our conclusion is that the combination of stent insertion and single high-dose brachytherapy seems to be a feasible and safe palliative regime in patients with advanced esophageal cancer. Randomized trials comparing the efficacy of this strategy to stent insertion or brachytherapy alone are warranted.
|
|
| 7. |
- Bergquist, Henrik, 1969, et al.
(författare)
-
Functional and radiological evaluation of free jejunal transplant reconstructions after radical resection of hypopharyngeal or proximal esophageal cancer
- 2007
-
Ingår i: World J Surg. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 31:10, s. 1988-95
-
Tidskriftsartikel (refereegranskat)abstract
- Cancer of the pharyngoesophageal junction (PEJ) is associated with late onset of symptoms, high morbidity, and a dismal prognosis. Radical surgery with pharyngolaryngectomy and reconstruction with a free vascularized jejunal transplant has been increasingly practiced in the treatment of these patients. This strategy is not devoid of challenges, and the present study is aimed at evaluating the long-term functional outcome among patients who have undergone such surgical treatment. Ten patients (mean age 59 years) with a mean follow-up time of 54 months were included. Clinical assessment, health-related quality of life (HRQL) questionnaires, and a standardized radiography examination were used for evaluation. The Karnofsky index ranged from 60 to 90 (mean 82). Global QL scores (EORTC QLQ-C30) had a mean value of 74, and the mean scores for dysphagia-related items of the EORTC QLQ OES-18 questionnaire were within the lower range. Radiographic signs of disturbed bolus transport through the jejunal transplant were found in all patients examined despite the grading of dysphagia from 0 to 1. The Watson dysphagia score varied between 0.5 and 45.0 (mean 16.2). No correlations were found between radiographic findings and the clinical evaluations or the outcomes assessed by the HRQL questionnaires. HRQL was found to be generally good after cancer of the PEJ and jejunal transplant insertion. Most patients reported mild dysphagia. Radiologic signs of disturbed bolus passage were common, but their clinical impact seemed questionable.
|
|
| 8. |
- Bergquist, Henrik, 1969, et al.
(författare)
-
Functional long-term outcome of a free jejunal transplant reconstruction following chemoradiotherapy and radical resection for hypopharyngeal and proximal oesophageal carcinoma
- 2004
-
Ingår i: Digestive surgery. ; :21, s. 426-433
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: To evaluate the functional outcome of a reconstruction by a free vascularized jejunal transplant combined with a voice prosthesis after chemoradiotherapy and surgery for proximal oesophageal or hypopharyngeal cancer. METHODS: Seven patients (6 men, mean age 52 years, range 28-70) with squamous cell cancer in the proximal oesophagus (n = 6) or the hypopharynx received preoperative chemoradiotherapy (40.8 Gy, cisplatinum and 5-FU) followed by a circumferential pharyngolaryngectomy and resection of the proximal oesophagus. A single-stage reconstruction was carried out with a free jejunal transplant using a microsurgical technique. A tracheojejunal puncture and insertion of a voice prosthesis (Provox I) was performed after 3 months in suitable cases. RESULTS: All operations had a per- and postoperative uneventful course. Five patients were alive after a mean follow-up time of 5 years and 7 months after surgery (range 3 years 4 months to 7 years 10 months), while 2 patients died from metastases within 2 years after surgery. Postoperative examination showed histopathological down-staging in all cases. Relief of dysphagia was achieved in most cases. Good or average speech was recorded in 3 patients. CONCLUSION: Reconstruction after radical resection for proximal oesophageal and hypopharyngeal cancer can be carried out with low mortality, acceptable morbidity and a promising functional outcome.
|
|
| 9. |
|
|
| 10. |
- Bidarian-Moniri, Armin, et al.
(författare)
-
A NEW AUTOINFLATION DEVICE FOR TREATMENT OF OTITIS MEDIA WITH EFFUSION
- 2016
-
Ingår i: World Summit on Pediatrics. Porto 23-26 June, 2016.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Otitis media with effusion (OME) is caused by accumulation of fluid in the middle ear, without the signs or symptoms of an acute inflammation or infection. OME is the most common cause of hearing impairment in children and the most common cause of surgical intervention under general anaesthesia in children. Autoinflation is an alternative treatment based on the opening of the Eustachian tube, by forced introduction of air either by the Valsalva manoeuvre or the Politzer method. Methods:A new autoinflation device (Moniri‐Otovent ®, Abigo Medical, Askersund, Sweden) for home treatment of children with persistent OME was used in this study. Forty‐four children, aged between two and eight years, with persistent bilateral OME for at least three months and history of subjective hearing loss, waiting for grommet surgery were treated with the autoinflation device during four weeks. Another forty‐five children, aged between three and eight years, submitted to grommet surgery were compared to the autoinflation group. Both groups underwent otomicroscopy, tympanometry and audiometry at inclusion. The exams were repeated at one, six and twelve months in both groups with the exception of tympanometry in the grommet group. Results: In the autoinflation group after four weeks of treatment, the mean hearing level improved from 22 to 16 dB and the number of ears with hearing thresholds of≥20 dB was reduced from 60 (77%) to 16 (22%). During the follow‐up period, 12 children were treated at least one more time with the device, of which seven were subjected to further follow‐up at the end of the study and five were submitted to grommet surgery. No complications were reported. In the grommet groups the mean hearing threshold improved from 24 to 15 dB and the number of ears with hearing threshold of≥20 dB was reduced from 82 (91%) to 15 (18%). During the follow‐up period a total of 31 (34%) complications were reported related to the grommets. Fourteen ears (16%) presented otorrhea, six ears (7%) early extrusion, four tubes (4%) were obstructed, 12 ears (13%) had recurrence of effusion and one ear (1%) presented persistent perforation after tube extrusion. Conclusions: This study reveals that autoinflation may reduce middle ear effusion and improve hearing in children with OME. Given the non‐invasive character of autoinflation therapy, it may be reasonable to apply this method as a first‐line treatment before considering surgery in children with OME.
|
|
| 11. |
|
|
| 12. |
- Bidarian-Moniri, Armin, et al.
(författare)
-
Autoinflation for treatment of persistent otitis media with effusion in children: A cross-over study with a 12-month follow-up
- 2014
-
Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876. ; 78:8, s. 1298-1305
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aims of the present study were to evaluate the efficacy of and compliance with a new device for autoinflation in the treatment of persistent otitis media with effusion (OME) in young children. Methods: Forty-five children with persistent OME with a bilateral type B or C2 tympanogram for at least three months and history of subjective hearing loss, waiting for grommet surgery, were randomised to a treatment and a control group. Twenty-three children aged between three and eight years started as the treatment group with the new device for autoinflation. Another 22 children, aged between two and eight years were included as controls. After a period of four weeks, a cross-over was performed. Both groups underwent otomicroscopy, tympanometry and audiometry at inclusion and after one and two months for the evaluation of treatment efficiency. The primary outcome measurements were improvement in middle-ear pressure and hearing thresholds at eight weeks. Both groups were then followed up for another 10 months. Results: In the treatment group, the mean middle-ear pressure for both ears and the mean hearing thresholds for the best ear improved by 166 daPa (p <0.0001) and 6 dB (p <0.0001), respectively after four weeks, while in the control group, non-significant alterations were observed. After the cross-over of the control group to treatment, equivalent improvements in the mean middle-ear pressure and the mean hearing thresholds of 187 daPa (p <0.0001) and 7 dB (p <0.01), respectively were achieved also in this group. After treatment in both groups at eight weeks, four of 45 children were submitted to grommet surgery. During the long-term follow-up another five children were submitted to surgery due to recurrence of disease. All the children managed to perform the manoeuvre and no side-effects were detected. Conclusion: The device demonstrated efficiency in improving both middle-ear pressure and hearing thresholds in most children after four weeks of treatment. It might therefore be possible to consider this method of autoinflation in children with persistent OME during the watchful waiting period. (C) 2014 Published by Elsevier Ireland Ltd.
|
|
| 13. |
|
|
| 14. |
- Bidarian-Moniri, Armin, et al.
(författare)
-
Mattress and pillow for prone positioning for treatment of obstructive sleep apnoea.
- 2015
-
Ingår i: Acta oto-laryngologica. - : Informa UK Limited. - 1651-2251 .- 0001-6489. ; 135:3, s. 271-6
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Conclusion: The new mattress and pillow for prone positioning (MPP) is efficient in reducing the apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI) in most patients with obstructive sleep apnoea (OSA), with satisfactory compliance.
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
- Bidarian-Moniri, Armin, et al.
(författare)
-
The effect of the prone sleeping position on obstructive sleep apnoea.
- 2015
-
Ingår i: Acta oto-laryngologica. - : Informa UK Limited. - 1651-2251 .- 0001-6489. ; 135:1, s. 79-84
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Conclusions: Prone positioning reveals promising results in improving the apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI) in patients with obstructive sleep apnoea (OSA). Objective: To evaluate the effect of the prone position on OSA. Methods: Thirty-two patients with mild to severe OSA were included in the study. This was a two-night study to evaluate the effect of the prone position on OSA; a first night in a normal bed with optional positioning and a second night on a mattress and pillow facilitating prone positioning. Results: A total of 27 patients, 22 males and 5 females, with a mean age of 51 years, 15 patients with positional OSA (POSA) and 12 patients with non-POSA with a total median AHI of 23 (min 5, max 93) completed the study protocol. The median AHI decreased from 23 to 7 (p < 0.001) and the median ODI from 21 to 6 (p < 0.001). The median time spent in the supine position decreased from 142 to <1 min (p < 0.0001) and the median time in the prone position increased from <1 to 330 min (p < 0.0001). In all, 17 of 27 patients (63%) were considered to be responders to prone positioning, 12 of 15 (80%) with POSA and 5 of 12 (42%) with non-POSA. Five patients did not complete the study protocol due to sleep time <4 h.
|
|
| 18. |
|
|
| 19. |
- Haugen, Hedda, 1970, et al.
(författare)
-
Accelerated radiotherapy for advanced laryngeal cancer.
- 2005
-
Ingår i: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 44:5, s. 481-9
-
Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to evaluate a single institution's outcome for patients with advanced laryngeal cancer treated with accelerated radiotherapy (RT). Fifty-eight patients with advanced laryngeal cancer (T3/T4N0/N + M0) were treated with curative intent with accelerated RT during the period 1990-1998. Patients received radiotherapy alone or with induction chemotherapy. The 5-year local control (LC) and loco-regional control (LRC) probabilities were both 49% for T3 and 75% for T4 tumors. The 5-year disease-free survival probability was 46% and 68% and overall survival probability was 30% and 39% for T3 and T4 tumors respectively. No significant statistical difference in outcome was found, either between T3 and T4 tumors, or between patients who received induction chemotherapy and those who did not. The treatment results for advanced laryngeal cancer at this institution were comparable to those reported in the literature. The results for T3 and T4 were similar. T4 classification alone should not be an exclusion criterion for larynx preservation. Overall survival was poor, partly because of a high incidence of deaths from intercurrent diseases.
|
|
| 20. |
|
|
| 21. |
|
|
| 22. |
- Olausson, Michael, 1956, et al.
(författare)
-
Transplantation of an allogeneic vein bioengineered with autologous stem cells: a proof-of-concept study.
- 2012
-
Ingår i: Lancet. - 1474-547X. ; 380:9838, s. 230-237
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Extrahepatic portal vein obstruction can have severe health consequences. Variceal bleeding associated with this disorder causes upper gastrointestinal bleeding, leading to substantial morbidity and mortality. We report the clinical transplantation of a deceased donor iliac vein graft repopulated with recipient autologous stem cells in a patient with extrahepatic portal vein obstruction. METHODS: A 10 year old girl with extrahepatic portal vein obstruction was admitted to the Sahlgrenska University Hospital in Gothenburg, Sweden, for a bypass procedure between the superior mesenteric vein and the intrahepatic left portal vein (meso Rex bypass). A 9 cm segment of allogeneic donor iliac vein was decellularised and subsequently recellularised with endothelial and smooth muscle cells differentiated from stem cells obtained from the bone marrow of the recipient. This graft was used because the patient's umbilical vein was not suitable and other strategies (eg, liver transplantation) require lifelong immunosuppression. FINDINGS: The graft immediately provided the recipient with a functional blood supply (25-30 cm/s in the portal vein and 40 mL/s in the artery was measured intraoperatively and confirmed with ultrasound). The patient had normal laboratory values for 9 months. However, at 1 year the blood flow was low and, on exploration, the shunt was patent but too narrow due to mechanical obstruction of tissue in the mesocolon. Once the tissue causing the compression was removed the graft dilated. We therefore used a second stem-cell populated vein graft to lengthen the previous graft. After this second operation, the portal pressure was reduced from 20 mm Hg to 13 mm Hg and blood flow was 25-40 cm/s in the portal vein. With restored portal circulation the patient has substantially improved physical and mental function and growth. The patient has no anti-endothelial cell antibodies and is receiving no immunosuppressive drugs. INTERPRETATION: An acellularised deceased donor vein graft recellularised with autologous stem cells can be considered for patients in need of vascular vein shunts without the need for immunosuppression. FUNDING: Swedish Government.
|
|
| 23. |
|
|
