| 1. |
- Slotte, Christer, 1954, et al.
(författare)
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Four-Millimeter Implants Supporting Fixed Partial Dental Prostheses in the Severely Resorbed Posterior Mandible: Two-Year Results.
- 2011
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Ingår i: Clinical implant dentistry and related research. - : Wiley. - 1708-8208 .- 1523-0899.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reduced alveolar bone volume complicates implant dentistry. Purpose: In this prospective multicenter study, a new, 4-mm long Straumann SLActive implant (Ø 4.1mm) supporting a fixed dental prosthesis (FDP) in the severely resorbed posterior mandible was evaluated for two years. Material and Methods: Thirty-two patients (11 men, 21 women; mean age 64.1 years) participated. Ten to 12 weeks after single-stage surgery, a screw-retained FDP was attached to three or four 4-mm implants. Results and Discussion: One hundred implants were inserted. Three failed at surgery and four were lost before loading. Twenty-eight patients received FDPs (93 implants). Two patients were discontinued because of secondary exclusion criteria; therefore, 26 patients were followed up from baseline (BL). After 1 year, one patient insisted on removal of all implants and one patient died because of nonstudy-related complications. Twenty-four patients (87 implants) were eligible for examination 2 years post-loading. All implants were found to be stable [survival rate 95.7% (confidence interval, CI 88.8-98.3) after 1 year and 92.3% (CI 84.5-96.2) after 2 years]. The mean change from BL to 12 months was - 0.43mm (CI 0.31-0.59; p<.001) and from 12 to 24 months - 0.11mm (CI -0.01-0.23; p=.056). The survival rate is only slightly lower than in similar studies on 6 to 8.5mm implants. This may be related to high initial stability and effective use of the residual bone volume with high primary bone-to-implant contact in dense bone structures. The surgical handling of the tested implant was found to be similar to that of implants of common length. However, the preparation procedure must be done with great care to avoid overdrilling. Careful planning and design of the prosthetic construction is mandatory to prevent unfavorable occlusion and avoid harmful shear forces. Conclusion: This study showed that 4mm implants can support an FDP in severely resorbed posterior mandibles for at least 2 years and with healthy peri-implant conditions.
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| 2. |
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| 3. |
- Backman, Helena, et al.
(författare)
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Severe asthma : A population study perspective
- 2019
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Ingår i: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 49:6, s. 819-828
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSevere asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.ObjectiveTo describe characteristics and estimate the prevalence of severe asthma in a large adult population‐based asthma cohort followed for 10‐28 years.MethodsN=1006 subjects with asthma participated in a follow‐up during 2012‐14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well‐known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.ResultsThe prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.Conclusions and clinical relevanceSevere asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4‐6%, corresponding to approximately 0.5% of the general population.
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| 4. |
- Backman, Helena, et al.
(författare)
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Severe asthma among adults : Prevalence and clinical characteristics
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Severe asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.Methods: We estimated the prevalence and studied characteristics of severe asthma in a large adult population-based asthma cohort followed for 10-28 years in northern Sweden: 1006 subjects participated in a follow-up during 2012-14, when 830 (82.5%) still had current asthma (mean age 59y, 32-92y, 56% women). Severe asthma was defined according to three internationally well-known criteria: the US SARP, ATS/ERS and GINA. All subjects with severe asthma were undergoing respiratory specialist care, and were also contacted by telephone to verify adherence to treatment.Results: The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma and <10% had controlled asthma according to the ACT. Severe asthma was related to age >50 years, nasal polyposis, decreased FEV1, not fully reversible airway obstruction, sensitization to aspergillus, elevated neutrophils and partly to eosinophils, and tended to be more common in women.Conclusion: The prevalence of severe asthma in this asthma cohort was 4-6%, corresponding to approximately 0.5% of the population in northern Sweden. A substantial proportion of those with severe asthma had uncontrolled disease, and severe asthma differed significantly from other asthma in terms of both clinical and inflammatory characteristics.
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| 5. |
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| 6. |
- Eklund, Arne, 1957-, et al.
(författare)
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A cost-minimisation analysis comparing TEP with Lichtenstein for treatment of inguinal hernia in Sweden
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Laparoscopic surgery has emerged as a new treatment modality for inguinal hernia. It is important to analyse its long-term costs in relation to other methods.Methods: A randomized multicenter study comparing totally extraperitoneal laparoscopic repair (TEP) with open repair according to Lichtenstein was performed on men with a primary inguinal hernia. Long-term follow-up collecting data on recurrences and complications up to five years after operation was carried out. Taking treatment costs into consideration, a cost-minimisation analysis was conducted.Results: Altogether 1370 patients were operated, 665 in the TEP and 705 in the Lichtenstein group. The total hospital cost for the index operation was €710.6 higher for TEP (P<0.001). Including costs for recurrences and complications, this difference increased to €795.1 (P<0.001). Taking community costs into account, the difference decreased with €503.1 to €292.0 (P=0.024).Conclusion: With five-year follow-up including complication, reoperation and community costs, there was a small but significant difference in total costs between the two methods.
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| 7. |
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| 8. |
- Eklund, Arne, 1957-
(författare)
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Laparoscopic or Open Inguinal Hernia Repair - Which is Best for the Patient?
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Inguinal hernia repair is the most common operation in general surgery. Its main challenge is to achieve low recurrence rates. With the introduction of mesh implants, first in open and later in laparoscopic repair, recurrence rates have decreased substantially. Therefore, the focus has been shifted from clinical outcome, such as recurrence, towards patient-experienced endpoints, such as chronic pain. In order to compare the results of open and laparoscopic hernia repair, a randomised multicentre trial - the Swedish Multicentre trial of Inguinal hernia repair by Laparoscopy (SMIL) - was designed by a study group from 11 hospitals. Between November 1996 and August 2000, 1512 men aged 30-70 years with a primary inguinal hernia were randomised to either laparoscopic (TEP, Totally ExtraPeritoneal) or open (Lichtenstein) repair. The primary endpoint was recurrence at five years. Secondary endpoints were short-term results, frequency of chronic pain and a cost analysis including complications and recurrences up to five years after surgery. In total, 1370 patients, 665 in the TEP and 705 in the Lichtenstein group, underwent operation. With 94% of operated patients available for follow-up after 5.1 years, the recurrence rate was 3.5% in the TEP and 1.2% in the Lichtenstein group. Postoperative pain was lower in the TEP group up to 12 weeks after operation, resulting in five days less sick leave and 11 days shorter time to full recovery. Patients in the TEP group had a slightly increased risk of major complications. Chronic pain was reported by 9-11% of patients in the TEP and 19-25% in the Lichtenstein group at the different follow-up points. Hospital costs for TEP were higher than for Lichtenstein, while community costs were lower due to shorter sick leave. By avoiding disposable laparoscopic equipment, the cost for TEP would be almost equal compared with Lichtenstein. In conclusion, both TEP and Lichtenstein repair have advantages and disadvantages for the patient. Depending on local resources and expertise both methods can be used and recommended for primary inguinal hernia repair.
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| 9. |
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| 10. |
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| 11. |
- Eklund, Arne, 1957-, et al.
(författare)
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Low Recurrence Rate After Laparoscopic (TEP) and Open(Lichtenstein) Inguinal Hernia RepairA Randomized, Multicenter Trial With 5-Year Follow-Up
- 2009
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 249:1, s. 33-38
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence. Summary Background Data: Laparoscopic hernia repair has been introduced as an alternative to open repair. Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques; ie, less postoperative pain and a shorter convalescence period. Long-term results, however, are less well known. Methods: The study was conducted as a multicenter randomized trial with a 5-year follow-up. A total of 1512 men aged 30 to 70 years, with a primary unilateral inguinal hernia, were randomized to either TEP or Lichtenstein repair. Results: Overall, 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable. The cumulative recurrence rate was 3.5% in the TEP group and 1.2% in the Lichtenstein group (P = 0.008). Test for heterogeneity revealed significant differences between individual surgeons. The exclusion of 1 surgeon, who was responsible for 33% (7 of 21) of all recurrences in the TEP group, lowered the cumulative recurrence rate to 2.4% in this group, which was not statistically different from that of the Lichtenstein group. Conclusions: The recurrence rate for both TEP and Lichtenstein repair was low. A higher cumulative recurrence rate in the TEP group was seen at 5 years. Further analysis revealed that this could be attributable to incorrect surgical technique.
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| 12. |
- Eklund, Arne, et al.
(författare)
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Recurrent inguinal hernia : randomized multicenter trial comparing laparoscopic and Lichtenstein repair
- 2007
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 21:4, s. 634-640
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimal treatment for recurrent inguinal hernia is of concern due to the high frequency of recurrence. METHODS: This randomized multicenter study compared the short- and long-term results for recurrent inguinal hernia repair by either the laparoscopic transabdominal preperitoneal patch (TAPP) procedure or the Lichtenstein technique. RESULTS: A total of 147 patients underwent surgery (73 TAPP and 74 Lichtenstein). The operating time was 65 min (range, 23-165 min) for the TAPP group and 64 min (range, 25-135 min) for the Lichtenstein group. Patients who underwent TAPP reported significantly less postoperative pain and shorter sick leave (8 vs 16 days). The recurrence rate 5 years after surgery was 19% for the TAPP group and 18% for the Lichtenstein group. CONCLUSION: The short-term advantage for patients who undergo the laparoscopic technique is less postoperative pain and shorter sick leave. In the long term, no differences were observed in the chronic pain or recurrence rate.
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| 13. |
- Eklund, Arne, 1957-, et al.
(författare)
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Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair
- 2006
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 93:9, s. 1060-1068
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Tidskriftsartikel (refereegranskat)abstract
- Background: Laparoscopic herniorrhaphy has emerged as a recognized operative method for inguinal hernia repair. This study compared the short-term results of two tension-free methods of repair: totally extraperitoneal (TEP) laparoscopic patch repair and the open Lichtenstein mesh technique. Methods: A total of 1513 men from 11 hospitals who presented with a primary unilateral inguinal hernia were randomized to one of the two methods. Operating time, short-term complications, reoperations, postoperative pain, consumption of analgesics, sick leave and time to resumption of normal physical activities were recorded. Results: Some 1371 of the 1513 men underwent surgery, 665 in the TEP group and 706 in the Lichtenstein group. The median duration of operation was 55 min for both procedures and 91.0 per cent of die patients in both groups were discharged on the day of operation. Patients in the TEP group experienced less postoperative pain (P < 0.001), consumed fewer analgesics (P < 0.001), had a shorter period of sick leave (7 versus 12 days; P < 0.001) and a shorter time to resumption of normal physical activity (20 versus 31 days; P < 0.001). Conclusion: The TEP technique took no longer to perform, and was associated with less postoperative pain, a shorter period of sick leave and a faster recovery, compared with open Lichtenstein hernia repair.
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| 14. |
- Jansson, Sven-Arne, et al.
(författare)
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Societal costs of severe asthma in Sweden
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Severe asthma is a disabling and costly disease, often poorly controlled despite high-dosage controller medications.Aims: We estimated societal costs from an adult severe asthma cohort, derived from a large-scale population survey in northern Sweden.Methods: Severe asthma was defined by US SARP criteria, and high-dosage inhaled corticosteroids (ICS) were defined by GINA 2014 criteria. The study sample was identified from general population cohorts examined within the OLIN (Obstructive Lung Disease in Northern Sweden) studies (n=1,006). Patient reported asthma-related direct (outpatient care, medicines, hospitalisations) and indirect (sick leave, early retirement) resource consumption were collected by quarterly pre-defined telephone interviews during one year. Unit costs from 2017 were applied.Results: In total, 32 patients with severe asthma (mean age 60.7y, 13 patients >65) were included. The mean annual total cost per patient was approximately €6,300. Two thirds of the costs (63%) was indirect costs (approximately €4,000). The main cost drivers in direct costs were hospitalisations and drugs: approximately €1,000 and €700, respectively. The main cost driver of indirect costs was productivity loss due to early retirement: €3,400. Patients who had received regular oral corticosteroid (OCS) treatment had greater costs compared with those without regular OCS treatment. In comparison with a previous Swedish study based on a sample of all asthmatics from the general population, a greater mean annual total cost per patient was observed.Conclusions: In this severe asthma population in Sweden, societal costs were substantial. The results indicate a need for improved treatment regimens for patients with severe asthma.
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| 15. |
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| 16. |
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| 17. |
- Kingsnorth, A, et al.
(författare)
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Randomized controlled multicenter international clinical trial of self-gripping Parietex (TM) ProGrip (TM) polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months
- 2012
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Ingår i: Hernia. - : Springer Verlag (Germany). - 1265-4906 .- 1248-9204. ; 16:3, s. 287-294
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Tidskriftsartikel (refereegranskat)abstract
- To compare clinical outcomes following sutureless Parietex (TM) ProGrip (TM) mesh repair to traditional Lichtenstein repair with lightweight polypropylene mesh secured with sutures. less thanbrgreater than less thanbrgreater thanThis is a 3-month interim report of a 1-year multicenter international study. Three hundred and two patients were randomized; 153 were treated with Lichtenstein repair (L group) and 149 with Parietex (TM) ProGrip (TM) precut mesh (P group) with or without fixation. The primary outcome measure was postoperative pain using the visual analog scale (VAS, 0-150 mm); other outcomes were assessed prior to surgery and up to 3 months postoperatively. less thanbrgreater than less thanbrgreater thanCompared to baseline, pain score was lower in the P group at discharge (-10%) and at 7 days (-13%), while pain increased in the L group at discharge (+39%) and at 7 days (+21%). The difference between groups was significant at both time points (P = 0.007 and P = 0.039, respectively). In the P group, patients without fixation suffered less pain compared to those with single-suture fixation (1 month: -20.9 vs. -6.15%, P = 0.02; 3 months: -24.3 vs. -7.7%, P = 0.01). The infection rate was significantly lower in the P group during the 3-month follow-up (2.0 vs. 7.2%, P = 0.032). Surgery duration was significantly shorter in the P group (32.4 vs. 39.1 min; P andlt; 0.001). No recurrence was observed at 3 months in both groups. less thanbrgreater than less thanbrgreater thanSurgery duration, early postoperative, pain and infection rates were significantly reduced with self-gripping polyester mesh compared to Lichtenstein repair with polypropylene mesh. The use of fixation increased postoperative pain in the P group. The absence of early recurrence highlights the gripping efficiency effect.
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| 18. |
- Kronstrand, Robert, et al.
(författare)
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Toxicological Findings of Synthetic Cannabinoids in Recreational Users
- 2013
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Ingår i: Journal of Analytical Toxicology. - : Oxford University Press. - 0146-4760 .- 1945-2403. ; 37:8, s. 534-541
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Tidskriftsartikel (refereegranskat)abstract
- In recent years, several synthetic cannabinoid compounds have become popular recreational drugs of abuse because of their psychoactive properties. This paper presents toxicological findings of synthetic cannabinoids in whole blood from some cases of severe intoxication including quantitative data from recreational users and a fatal intoxication. Samples were analyzed by liquid chromatography-tandem mass spectrometry in a scheduled multiple reaction mode after a basic liquid extraction. Twenty-nine synthetic cannabinoids were included in the method. In our data set of similar to 3000 cases, 28% were found positive for one or more synthetic cannabinoid(s). The most common finding was AM-2201. Most of the analytes had median concentrations of andlt;0.5 ng/g in agreement with other published data. The emerging drugs MAM-2201 (n = 151) and UR-144 (n = 181) had mean (median) concentrations of 1.04 (0.37) and 1.26 (0.34), respectively. The toxicity of the synthetic cannabinoids seems to be worse than that of natural cannabis, probably owing to the higher potency and perhaps also to the presence of several different cannabinoids in the smoked incense and the difficulties of proper dosing. The acute toxic effects may under certain circumstances contribute to death.
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| 19. |
- Kugelberg, Fredrik, et al.
(författare)
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Forensic toxicology findings in deaths involving gamma-hydroxybutyrate
- 2010
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Ingår i: International journal of legal medicine. - : Elsevier. - 0937-9827 .- 1437-1596. ; 124:1
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Tidskriftsartikel (refereegranskat)abstract
- Concentrations of the illicit drug gamma-hydroxybutyrate (GHB) were determined in femoral venous blood and urine obtained at autopsy in a series of GHB-related deaths (N = 49). The analysis of GHB was done by gas chromatography after conversion to gamma-butyrolactone and quantitation of the latter with a flame ionization detector. The cutoff concentration of GHB in femoral blood or urine for reporting positive results was 30 mg/L. The deceased were mainly young men (86%) aged 26.5 +/- 7.2 years (mean +/- SD), and the women (14%) were about 5 years younger at 21.4 +/- 5.0 years. The mean, median, and highest concentrations of GHB in femoral blood (N = 37) were 294, 190, and 2,200 mg/L, respectively. The mean urine-to-blood ratio of GHB was 8.8, and the median was 5.2 (N = 28). In 12 cases, the concentrations of GHB in blood were negative (less than 30 mg/L) when the urine contained 350 mg/L on average (range 31-1,100 mg/L). Considerable poly-drug use was evident in these GHB-related deaths: ethanol (18 cases), amphetamine (12 cases), and various prescription medications (benzodizepines, opiates, and antidepressants) in other cases. Interpreting the concentrations of GHB in postmortem blood is complicated because of concomitant use of other psychoactive substances, variable degree of tolerance to centrally acting drugs, and the lack of reliable information about survival time after use of the drug.
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| 20. |
- Lood, Yvonne, et al.
(författare)
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Anabolic androgenic steroids in police cases in Sweden 1999-2009
- 2012
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Ingår i: Forensic Science International. - : Elsevier. - 0379-0738 .- 1872-6283. ; 219:1-3, s. 199-204
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Tidskriftsartikel (refereegranskat)abstract
- Anabolic Androgenic Steroids (AAS) are considered drugs of abuse and are controlled substances in Sweden since 1999. Traditionally AAS have been used by elite athletes to enhance performance, but in recent years it has become an increasing problem outside elite sport among athletes, bodybuilders and criminals. Use of AAS is associated with psychiatric side effects such as aggression, depression and violent behavior. Supraphysiological doses and long term use can cause serious physical harm such as cardiovascular toxicity and even premature death. We investigated and evaluated the drug analytical findings in forensic cases from suspected perpetrators in cases from the police where a screening for AAS was requested to get information about the prevalence of AAS use and the occurrence of poly-drug abuse. The study was based on samples submitted from the police authorities to the Department of Forensic Toxicology in Sweden during the period 1999-2009. Urines were analyzed by methods based on GC-MS and LC-MS-MS. We also analyzed the prevalence of AAS use at the prison and probation services. A total number of 12,141 urine samples (6362 police cases and 5779 inmates) were analyzed and 33.5% of the cases from the police and 11.5% of the inmates were tested positive for AAS. The users of AAS were mainly in 99.2% men with a mean age of 26.2 +/- 6.2 years whereas the women were 29.5 +/- 6.5 years old. The most frequently used AAS was nandrolone followed by testosterone and methandienone. Other illicit and licit drugs were detected in 60% of the cases from the police, strongly indicating a frequent poly-drug abuse among users of AAS.
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| 21. |
- Rayner, Manny, et al.
(författare)
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A web-deployed Swedish spoken CALL systembased on a large shared English/Swedish feature grammar
- 2012
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Ingår i: Proceedings of the SLTC 2012 workshop on NLP for CALL. - : Linköping University Electronic Press. ; , s. 37-46
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Konferensbidrag (refereegranskat)abstract
- We describe a Swedish version of CALL-SLT,a web-deployed CALL system that allows beginner/intermediate students to practise generativespoken language skills. Speech recognitionis grammar-based, with language modelsderived, using the Regulus platform, fromsubstantial domain-independent feature grammars.The paper focusses on the Swedishgrammar resources, which were developedby generalising the existing English featuregrammar into a shared grammar for Englishand Swedish. It turns out that this can be donevery economically: all but a handful of rulesand features are shared, and English grammaressentially ends up being treated as a reducedform of Swedish. We conclude by presentinga simple evaluation which compares theSwedish and French versions of CALL-SLT.
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| 22. |
- Rogmark, Peder, et al.
(författare)
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Short-term outcomes for open and laparoscopic midline incisional hernia repair : a randomized multicenter controlled trial
- 2013
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Ingår i: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 258:1, s. 37-45
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: : The aim of the trial was to compare laparoscopic technique with open technique regarding short-term pain, quality of life (QoL), recovery, and complications.BACKGROUND: : Laparoscopic and open techniques for incisional hernia repair are recognized treatment options with pros and cons.METHODS: : Patients from 7 centers with a midline incisional hernia of a maximum width of 10 cm were randomized to either laparoscopic (LR) or open sublay (OR) mesh repair. Primary end point was pain at 3 weeks, measured as the bodily pain subscale of Short Form-36 (SF-36). Secondary end points were complications registered by type and severity (the Clavien-Dindo classification), movement restrictions, fatigue, time to full recovery, and QoL up to 8 weeks.RESULTS: : Patients were recruited between October 2005 and November 2009. Of 157 randomized patients, 133 received intervention: 64 LR and 69 OR. Measurements of pain did not differ, nor did movement restriction and postoperative fatigue. SF-36 subscales favored the LR group: physical function (P < 0.001), role physical (P < 0.012), mental health (P < 0.022), and physical composite score (P < 0.009). Surgical site infections were 17 in the OR group compared with 1 in the LR group (P < 0.001). The severity of complications did not differ between the groups (P < 0.213).CONCLUSIONS: : Postoperative pain or recovery at 3 weeks after repair of midline incisional hernias does not differ between LR and OR, but the LR results in better physical function and less surgical site infections than the OR does. (ClinicalTrials.gov Identifier: NCT00472537).
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| 23. |
- Romero, H E, et al.
(författare)
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Atom collision-induced resistivity of carbon nanotubes
- 2005
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Ingår i: SCIENCE. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 307:5706, s. 89-93
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Tidskriftsartikel (refereegranskat)abstract
- We report the observation of unusually strong and systematic changes in the electron transport in metallic single-walled carbon nanotubes that are undergoing collisions with inert gas atoms or small molecules. At fixed gas temperature and pressure, changes in the resistance and thermopower of thin films are observed that scale as roughly M-1/3, where M is the mass of the colliding gas species (He, Ar, Ne, Kr, Xe, CH4, and N-2). Results of molecular dynamics simulations are also presented that show that the maximum deformation of the tube wall upon collision and the total energy transfer between the colliding atom and the nanotube also exhibit a roughly M-1/3 dependence. it appears that the transient deformation (or dent) in the tube wait may provide a previously unknown scattering mechanism needed to explain the atom collision-induced changes in the electrical transport.
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| 24. |
- Syrén, Eva-Lena, et al.
(författare)
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Cardiovascular complications after common bile duct stone extractions
- 2021
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Ingår i: Surgical Endoscopy. - : Springer. - 0930-2794 .- 1432-2218. ; 35:7, s. 3296-3302
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Tidskriftsartikel (refereegranskat)abstract
- Background: Common bile duct stone (CBDS) is a common condition the rate of which increases with age. Decision to treat in particular elderly and frail patients with CBDS is often complex and requires careful assessment of the risk for treatment-related cardiovascular complications. The aim of this study was to compare the rate of postoperative cardiovascular events in CBDS patients treated with the following: ERCP only; cholecystectomy only; cholecystectomy followed by delayed ERCP; cholecystectomy together with ERCP; or ERCP followed by delayed cholecystectomy.Methods: The study was based on data from procedures for gallstone disease registered in the Swedish National Quality Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 2006–2014. ERCP and cholecystectomy procedures performed for confirmed or suspected CBDS were included. Postoperative events were registered by cross-matching GallRiks with the National Patient Register (NPR). A postoperative cardiovascular event was defined as an ICD-code in the discharge notes indicating myocardial infarct, pulmonary embolism or cerebrovascular disease within 30 days after surgery. In cases where a patient had undergone ERCP and cholecystectomy on separate occasions, the 30-day interval was timed from the first intervention.Results: A total of 23,591 underwent ERCP or cholecystectomy for CBDS during the study period. A postoperative cardiovascular event was registered in 164 patients and death within 30 days in 225 patients. In univariable analysis, adverse cardiovascular event and death within 30 days were more frequent in patients who underwent primary ERCP (p < 0.05). In multivariable analysis, adjusting for history of cardiovascular disease or events, neither risk for cardiovascular complication nor death within 30 days remained statistically significant in the ERCP group.Conclusions: Primary ERCP as well as cholecystectomy may be performed for CBDS with acceptable safety. More studies are required to provide reliable guidelines for the management of CBDS.
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| 25. |
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| 26. |
- Syrén, Eva-Lena, et al.
(författare)
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Outcome of ERCP related to case-volume
- 2022
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Ingår i: Surgical Endoscopy. - : Springer. - 0930-2794 .- 1432-2218. ; 36, s. 5339-5347
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: In some studies, high endoscopic retrograde cholangiopancreatography (ERCP) case-volume has been shown to correlate to high success rate in terms of successful cannulation and fewer adverse events. The aim of this study was to analyze the association between ERCP success and complications, and endoscopist and centre case-volumes.METHODS: Data were obtained from the Swedish National Register for Gallstone Surgery and ERCP (GallRiks) on all ERCPs performed for Common Bile Duct Stone (CBDS) (n = 17,873) and suspected or confirmed malignancy (n = 6152) between 2009 and 2018. Successful cannulation rate, procedure time, intra- and postoperative complication rates and post-ERCP pancreatitis (PEP) rate, were compared with endoscopist and centre ERCP case-volumes during the year preceding the procedure as predictor.RESULTS: In multivariable analyses of the CBDS group adjusting for age, gender and year, a high endoscopist case-volume was associated with higher successful cannulation rate, lower complication and PEP rates, and shorter procedure time (p < 0.05). Centres with a high annual case-volume were associated with high successful cannulation rate and shorter procedure time (p < 0.05), but not lower complication and PEP rates. When indication for ERCP was malignancy, a high endoscopist case-volume was associated with high successful cannulation rate and low PEP rates (p < 0.05), but not shorter procedure time or low complication rate. Centres with high case-volume were associated with high successful cannulation rate and low complication and PEP rates (p < 0.05), but not shorter procedure time.CONCLUSIONS: The results suggest that higher endoscopist and centre case-volumes are associated with safer ERCP and successful outcome.
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| 27. |
- Syrén, Eva-Lena, et al.
(författare)
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Postoperative rendezvous endoscopic retrograde cholangiopancreaticography as an option in the management of choledocholithiasis
- 2020
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Ingår i: Surgical Endoscopy. - : Springer. - 0930-2794 .- 1432-2218. ; 34:11, s. 4883-4889
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Rendezvous endoscopic retrograde cholangiopancreaticography (ERCP) is a well-established method for treatment of choledocholithiasis. The primary aim of this study was to determine how different techniques for management of common bile duct stone (CBDS) clearance in patients undergoing cholecystectomy have changed over time at tertiary referral hospitals (TRH) and county/community hospitals (CH). The secondary aim was to see if postoperative rendezvous ERCP is a safe, effective and feasible alternative to intraoperative rendezvous ERCP in the management of CBDS.METHODS: Data were retrieved from the Swedish registry for cholecystectomy and ERCP (GallRiks) 2006-2016. All cholecystectomies, where CBDS were found at intraoperative cholangiography, and with complete 30-day follow-up (n = 10,386) were identified. Data concerning intraoperative and postoperative complications, readmission and reoperation within 30 days were retrieved for patients where intraoperative ERCP (n = 2290) and preparation for postoperative ERCP were performed (n = 2283).RESULTS: Intraoperative ERCP increased (7.5% 2006; 43.1% 2016) whereas preparation for postoperative ERCP decreased (21.2% 2006; 17.2% 2016) during 2006-2016. CBDS management differed between TRHs and CHs. Complications were higher in the postoperative rendezvous ERCP group: Odds Ratio [OR] 1.69 (95% confidence interval [CI] 1.16-2.45) for intraoperative complications and OR 1.50 (CI 1.29-1.75) for postoperative complications. Intraoperative bleeding OR 2.46 (CI 1.17-5.16), postoperative bile leakage OR 1.89 (CI 1.23-2.90) and postoperative infection with abscess OR 1.55 (CI 1.05-2.29) were higher in the postoperative group. Neither post-ERCP pancreatitis, postoperative bleeding, cholangitis, percutaneous drainage, antibiotic treatment, ICU stay, readmission/reoperation within 30 days nor 30-day mortality differed between groups.CONCLUSIONS: Techniques for management of CBDS found at cholecystectomy have changed over time and differ between TRH and CH. Rendezvous ERCP is a safe and effective method. Even though intraoperative rendezvous ERCP is the preferred method, postoperative rendezvous ERCP constitutes an acceptable alternative where ERCP resources are lacking or limited.
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| 28. |
- Syrén, Eva-Lena
(författare)
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Risk factors for and Strategies to Prevent Complications of Endoscopic Retrograde Cholangiopancreatography
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to study risk factors for and strategies to prevent complications of Endoscopic Retrograde Cholangiopancreatography (ERCP). Methods: Prospectively registered data from the Swedish National Quality Register for Gallstone Surgery and ERCP (GallRiks) 2006-2018 were retrospectively retrieved and reviewed. In Study I, ERCP procedures performed for common bile duct stones (CBDS), were analysed and cross-checked with the National Patient Register (NPR) in order to assess risk factors for post-ERCP pancreatitis (PEP). In Study II, different techniques for CBDS clearance over time at different hospital levels and the effectiveness and safety of postoperative rendezvous ERCP compared to intraoperative rendezvous ERCP were studied. In Study III, the rate of postoperative cardiovascular events in CBDS-patients treated with ERCP only, cholecystectomy only, cholecystectomy followed by delayed ERCP, cholecystectomy together with ERCP, or ERCP followed by delayed cholecystectomy were analysed. In Study IV, associations between ERCP success and complications, and endoscopist- and centre case-volumes regarding procedures for CBDS, and suspected or confirmed malignancy were analysed. Results: Women, patients<65 years, patients with hyperlipidaemia, and those with a previous history of recent acute pancreatitis had a higher risk for PEP, while patients with diabetes had a lower risk (all p<0.05). Intraoperative ERCP increased during the period of the study, whereas preparation for postoperative ERCP decreased. CBDS management differed between different hospital levels. Total rate of intra- and postoperative complications as well as intraoperative bleeding, postoperative bile leakage, and postoperative infection with abscess were higher in the postoperative rendezvous ERCP group (all p<0.05). However, PEP, postoperative bleeding, cholangitis, percutaneous drainage, antibiotic treatment, ICU stay, readmission/reoperation within 30 days, and 30-day mortality did not differ between the groups. Nor did risk for cardiovascular complication or death within 30 days differ between patients treated for CBDS by cholecystectomy and/or ERCP. A high endoscopist case-volume was associated with higher successful cannulation rate and lower PEP rate (p<0.05). Centres with a high annual case-volume were associated with higher successful cannulation rates (p<0.05). Conclusions: Age, sex, hyperlipidaemia, and previous history of recent acute pancreatitis all increased the risk for PEP while diabetes reduced the risk. Techniques for management of CBDS discovered at cholecystectomy have changed over time and differ between hospitals levels. Though intraoperative rendezvous ERCP is the method of choice, postoperative rendezvous ERCP is an acceptable alternative when adequate ERCP resources are lacking or limited. Primary ERCP as well as cholecystectomy for CBDS may be performed with acceptable safety. Higher endoscopist- and centre case-volumes lead to safer and more successful ERCP.
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| 29. |
- Syrén, Eva-Lena, et al.
(författare)
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Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography
- 2019
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Ingår i: BJS Open. - : JOHN WILEY & SONS LTD. - 2474-9842. ; 3:4, s. 485-489
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Tidskriftsartikel (refereegranskat)abstract
- Background: The risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) could be related to technical or patient-related factors. The aim of this study was to assess whether clinical variables and co-morbidities influence the risk of developing PEP.Methods: Data were retrieved from the Swedish GallRiks registry, including all ERCP procedures performed in 2006-2014 for common bile duct stones. A total of 15 800 procedures were identified and cross-checked. Univariable and multivariable logistic regression analyses were conducted with the endpoint of PEP using the following co-variables: age, sex, ASA grade, previous history of acute pancreatitis, diabetes, hyperlipidaemia, hypercalcaemia, kidney disease and liver cirrhosis.Results: Women (odds ratio (OR) 1.33, 95 per cent c. i. 1.14 to 1. 55), patients aged less than 65 years (OR 1. 68, 1. 45 to 1. 94), patients with hyperlipidaemia (OR 1. 32, 1. 02 to 1. 70) and those with a previous history of acute pancreatitis (OR 5. 44, 4. 68 to 6. 31) had a significantly increased risk of PEP. In a subgroup analysis of patients with a previous history of acute pancreatitis, the mean time from previous pancreatitis to ERCP 4423 days in patients who developed PEP vs 6990 days in patients who did not (P = 0. 037). However, when the previous episode of pancreatitis had occurred more than 30 days before ERCP, this association was no longer significant (P = 0. 858). Patients with diabetes had a decreased risk of PEP (OR 0. 64, 0. 48 to 0. 85).Conclusion: Age, sex, hyperlipidaemia and previous history of recent acute pancreatitis increase the risk of PEP. The reduced risk of PEP in patients with diabetes should be explored in future studies.
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| 30. |
- Örtegren, Jonas, et al.
(författare)
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Inkjet Printing Dynamics : Influence on Ink Distribution in Paper and Print Quality
- 2007
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Ingår i: NIP 23: 23RD INTERNATIONAL CONFERENCE ON DIGITAL PRINTING TECHNOLOGIES, TECHNICAL PROGRAM AND PROCEEDINGS/DIGITAL FABRICATION 2007. - : The Society for Imaging Science and Technology. - 9780892082735 ; , s. 595-598
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Konferensbidrag (refereegranskat)abstract
- Inkjet technology is becoming established as a production method and emerges as a printing technology for printing functionalities on various media. The development has encouraged intensified research in the fields of inkjet technology and paper media. The work presented here is pail of a research program that attempts to bridge the gap between the two disciplines. The overall objective is to control and improve the print quality and print functionality by observing and controlling the dynamic processes that occur in paper media in the inkjet printing process. Detailed information about the dynamic processes is however not available with the experimental methods present today, and improvements of experimental techniques is consequently a prerequisite for a better understanding. Therefore, inkjet printing machines were built and tested The printers allow for inkjet printing with various types of inks and print heads at freely chosen paper feeding speed Methods to study the inkjet printing process in-situ by use of camera and high-speed video camera were developed It is shown that the in-situ methods capture spreading and absorption processes of inkjet droplets on still-standing paper and paper fed at high speed The in-situ measurements and analysis are discussed in terms of relevant print quality parameters.
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