| 1. |
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| 2. |
- Olsen, Henrik, et al.
(författare)
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Subclinical hypercortisolism and CT appearance in adrenal incidentalomas: a multicenter study from Southern Sweden
- 2012
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Ingår i: Endocrine. - : Springer Science and Business Media LLC. - 1355-008X .- 1559-0100. ; 42:1, s. 164-173
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Tidskriftsartikel (refereegranskat)abstract
- Evaluation of subclinical hypercortisolism (SH) in patients with adrenal incidentaloma (AI) including its correlation to size, attenuation at unenhanced computed tomography (CT) and unilateral or bilateral adrenal disease. Nine hospitals in Southern Sweden investigated during 2005-2007 consecutively patients with AI with hormonal and CT examinations according a regional protocol. Two hundred and twenty-eight patients with AI with median size 2.0 cm were included. One mg overnight dexamethasone suppression test (DST) was performed in 223 patients and basal P-ACTH measured in 146 patients. SH was defined as cortisol >= 50 nmol/l at DST in combination with basal ACTH <2 pmol/l. In patients with unilateral AI 42% (76/180) had inadequate suppression at DST and 23% (27/115) had SH. The probability for SH and inadequate suppression at DST correlated positively to size and inversely to attenuation at CT. Bilateral AI were found in 43 patients and of these 70% (30/43) had inadequate suppression at DST and 42% (13/31) SH. The patients with SH or inadequate suppression at DST had increased frequency of hypertension which increased further in patients with post-DST cortisol >= 140 nmol/l. The applied criterion for SH is useful for initial evaluation of patients with AI. SH is common in patients with AI, particular in bilateral disease. In patients with unilateral AI the probability for SH correlated positively to size and inversely to attenuation at CT. Furthermore, SH and the post-DST cortisol concentration was associated with hypertension.
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| 3. |
- Steffenburg-Nordenström, Joachim, 1962-
(författare)
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Process chain simulation of forming, welding and heat treatment of Alloy 718
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Manufacturing of aero engine components requires attention to residual stress and final shape of the product in order to meet high quality product standards.This sets very high demands on involved manufacturing steps to meet design requirements. Simulation of manufacturing processes can therefore be animportant tool to contribute to quality assurance.The focus in this work is on simulation of a manufacturing process chain comprising of sheet metal forming, welding and a stress relief heat treatment.Simulation of sheet metal forming can be used to design a forming tool design that accounts for the material behaviour, e.g. spring back, and avoid problems such as wrinkling, thinning and cracking. Moreover, the simulation can also show how the material is stretched and work hardened. The residual stresses after forming may be of local character or global depending on the shape that is formed. However, the heat affected zone due to welding is located near the weld.The weld also causes large residual stresses with the major component along the weld. It is found that the magnitude of the residual stresses after welding is affected by remaining stresses from the previous sheet metal forming. The final stress relieve treatment will relax these residual stresses caused by e.g. forming and welding. However, this causes additional deformations.The main focus of this study is on how a manufacturing process step affects the subsequent step when manufacturing a component of the nickel-based super alloy 718. The chosen route and geometry is a simplified leading edge of an exhaust case guide vane. The simulations were validated versus experiments. The computed deformations were compared with measurements after each manufacturing step. The overall agreement between experiments and measurement was good. However, not sufficiently accurate considering the required tolerance of the component. It was found from simulations that the residual stresses after each process affects the subsequent step. After a complete manufacturing process chain which ends with a stress relief heat treatment the residual stresses were not negligible. VIII Special experiments were performed for studying the stress relief in order to understand how the stresses evolve through the heat treatment cycle during relaxation. It was found that the stresses were reduced already during the beginning of the heating up sequence due to decreasing Young´s modulus and yield stress with increasing temperature. Relaxation due to creep starts when a certain temperature was reached which gave a permanent stress relief.
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| 4. |
- Albers, Max B., et al.
(författare)
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Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias
- 2020
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Ingår i: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2443 .- 1435-2451. ; 405:2, s. 137-143
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Surgery is recommended for most patients with gastro-entero-pancreatic neuroendocrine neoplasias (GEP-NENs). Rates of complications and perioperative mortality have been reported in few mostly retrospective single-center series, but there has been no detailed analysis on risk factors for perioperative complications and mortality to date. Methods: Data of patients with GEP-NENs operated between January 2015 and September 2018 were retrieved from EUROCRINE©, a European online endocrine surgical quality registry, and analyzed regarding rate and risk factors of surgical complications. Risk factors were assessed by logistic regression. Results: Some 376 patients (211 female, 167 male; age median 63, range 15–89 years) were included. Most NENs were located in the small intestine (SI) (n = 132) or pancreas (n = 111), the rest in the stomach (n = 34), duodenum (n = 30), appendix (n = 30), colon, and rectum (n = 22), or with unknown primary (n = 15). Of the tumors, 320 (85.1%) were well or moderately differentiated, and 147 (39.1%) of the patients had distant metastases at the time of operation. Severe complications (Dindo-Clavien ≥ 3) occurred in 56 (14.9%) patients, and 4 (1.1%) patients died perioperatively. Severe complications were more frequent in surgery for duodenopancreatic NENs (n = 31; 22.0%) compared with SI-NENs (n = 15; 11.4%) (p = 0.014), in patients with lymph node metastases operated with curative aim of surgery (n = 24; 21.4%) versus non-metastasized tumors or palliative surgery (n = 32; 12.1%) (p = 0.020), and in functioning tumors (n = 20; 23.0%) versus non-functioning tumors (n = 30; 13.5%) (p = 0.042). Complication rates were not significantly associated with tumor stage or grade. Conclusions: Severe complications are frequent in GEP-NEN surgery. Besides duodenopancreatic tumor location, curative resection of nodal metastases and functioning tumors are risk factors for complications.
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| 5. |
- Albers, Max B., et al.
(författare)
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Sentinel Lymph Node Biopsy in Thyroid Cancer
- 2020
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 44, s. 142-147
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prophylactic central neck dissection in patients with papillary thyroid carcinoma is controversial. Sentinel node biopsy might be an adjunct to optimize surgical treatment for these patients. Earlier studies reported inconsistent detection rates and diagnostic value of this technique, and the role of sentinel lymph node biopsy in thyroid cancer needs to be established. Patients and methods: During a single-center prospective interventional study between 2010 and 2017, sentinel lymph node biopsy using 99mTc-nanocolloidal albumin tracer was performed on patients undergoing thyroid surgery for suspected thyroid cancer by fine needle aspiration cytology. All eligible patients without clinical lymph node involvement were invited to participate. Central neck dissection was performed on all patients after the detection of sentinel lymph nodes. Results: Ninety-six patients participated in the study. The detection rates of the sentinel node were 67% and 45% by scintigraphy and intraoperative gamma probe, respectively. The detection rate was not associated with Bethesda score, malignancy, or presence of lymph node metastases. Sensitivity, negative predictive value, and accuracy were 80%, 97%, and 98%, respectively, for the sentinel node to represent the status of lymph node metastasis in the central neck compartment. The false negative rate was 20%. Conclusion: Sentinel lymph node biopsy had a low detection rate and only moderate sensitivity in patients with suspected thyroid carcinoma and is not a useful adjunct to surgery in the context of current treatment concepts.
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| 6. |
- Almquist, Martin, et al.
(författare)
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Changing biochemical presentation of primary hyperparathyroidism.
- 2010
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Ingår i: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2451 .- 1435-2443. ; 395, s. 925-928
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Patients with primary hyperparathyroidism, pHPT, present with milder symptoms than previously. Some, but not all studies, suggest that this change in clinical pattern also implies lower preoperative parathyroid hormone (PTH) and/or calcium levels and smaller adenomas. This is important since reports indicate that smaller adenomas are more difficult to detect on preoperative imaging, possibly increasing the risk of surgical failure. METHODS: There were 640 patients with histologically confirmed single-gland pHPT identified in a prospectively collected database. Median values of preoperative calcium, PTH, as well as adenoma weight were compared in three different time periods: 1990-1995, 1996-2000, and 2000-2007. Correlation between the preoperative levels of calcium and PTH and adenoma weight was calculated. RESULTS: Preoperative ionized calcium decreased significantly over time (p < 0.001). There was a positive correlation between preoperative PTH and adenoma weight (r = 0.32, p < 0.001). The magnitude of this correlation decreased over time. In women, adenoma weight decreased significantly over time (p = 0.03). Median (25th-75th percentile) adenoma weight in women was 750 (400-1,380) mg, 650 (350-1,205) mg, and 520 (305-1,065) mg in the first, second, and third period, respectively. CONCLUSION: From 1990 to 2007, there was a significant trend to operate pHPT patients with lower preoperative serum ionized calcium levels. In women, the adenoma weight decreased. This trend could potentially lead to decreased sensitivity in preoperative localization procedures.
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| 7. |
- Almquist, Martin, et al.
(författare)
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Management of the exterior branch of the superior laryngeal nerve among thyroid surgeons - Results from a nationwide survey.
- 2015
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Ingår i: International Journal of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 20, s. 46-51
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Tidskriftsartikel (refereegranskat)abstract
- The external branch of the superior laryngeal nerve is important for the voice. However, it is unknown how thyroid surgeons manage this nerve during operations. We hypothesised that this management is related to the surgeon's age, gender, the surgeons' annual number of thyroid operations, i.e volume, and surgical specialisation.
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| 8. |
- Almquist, Martin, et al.
(författare)
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Prediction of Permanent Hypoparathyroidism after Total Thyroidectomy.
- 2014
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 38:10, s. 2613-2620
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Tidskriftsartikel (refereegranskat)abstract
- Hypoparathyroidism is a common complication with thyroid surgery. The ability to predict a high risk of permanent hypoparathyroidism is important for individual prognosis and follow-up.
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| 9. |
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| 10. |
- Annebäck, Matilda
(författare)
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Hypoparathyroidism after thyroid surgery- rates, risks, prevention and consequences
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hypoparathyroidism is the most common complication after thyroid surgery and associated with short- and long-term consequences. The lack of a consensus on the definition of hypoparathyroidism has led to a broad range in the rates reported in the literature. The overall aim of this thesis was to study different aspects of hypoparathyroidism, in terms rates, risks and long-term impact. Paper I is a case control study, investigating prophylactic, preoperative treatment with active vitamin D and early hypocalcemia after total thyroidectomy. The study showed that patients with preoperative treatment had a lower risk of early hypocalcemia and a reduced length of stay in hospital, compared to patients without treatment. No adverse outcomes were found. Paper II is a population-based retrospective cohort study on the rate and risks for permanent hypoparathyroidism after total thyroidectomy for benign thyroid disease. Data was retrieved from The Swedish National Patient Register, The Swedish Quality Register for Thyroid, Parathyroid and Adrenal Surgery and The Swedish Prescribed Drug Registry. Permanent hypoparathyroidism was defined as dispensation of calcium and/or active vitamin D >12 months after surgery. Among 7852 patients, 12.5% developed permanent hypoparathyroidism. Surgery at low volume centers, parathyroid autotransplantation, female gender and high age were independent risk factors. In Paper III the aim was to validate the high rate of permanent hypoparathyroidism found in Paper II. A regional cohort was extrapolated from the national cohort. A retrospective chart review, of 1636 patients, was performed. Using a strict definition, 6.2 % were found to have definitive permanent hypoparathyroidism. Additionally, 2.5 % were found to have possible permanent hypoparathyroidism. Of these, at least 1.7 % might have been overtreated due to lacking attempts to unwind the treatment. The study also proposed that the rate of low early PTH in a cohort might be useful to predict the rate of permanent hypoparathyroidism. Paper IV investigated health related quality of life (HRQoL) in patients with and without permanent hypoparathyroidism using the same cohort as in Paper III and SF-36 v.2. No impact of definitive hypoparathyroidism on HRQoL could be found. In conclusion, the use of preoperative active vitamin D may be useful as a tool to lower the risk of early hypocalcemia. The risk of permanent hypoparathyroidism after total thyroidectomy is high and there is a need for improved follow up. Permanent hypoparathyroidism may not have a negative effect on HRQoL in most patients.
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| 11. |
- Bergenfelz, Anders, et al.
(författare)
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Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy
- 2020
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Ingår i: Surgery (United States). - : Elsevier BV. - 0039-6060. ; 167:1, s. 124-128
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Tidskriftsartikel (refereegranskat)abstract
- Background: Permanent hypoparathyroidism is common after thyroidectomy. The present study evaluated the risk for morbidity in patients operated with total thyroidectomy with and without permanent hypoparathyroidism. Methods: Data was retrieved from the Scandinavian Quality Register for Thyroid, Parathyroid, and Adrenal Surgery and cross-linked with the Swedish National Prescription Registry for Pharmaceuticals, the National Data Inpatient Registry, and Causes of Death Registry. Patients with benign thyroid disease were included. Permanent hypoparathyroidism was defined as treatment with active vitamin D for more than 6 months after thyroidectomy. Analyzed morbidity was evaluated by multivariable Cox's regression analysis and presented as hazard ratio and 95% confidence interval. Results: There were 4,828 patients. The mean (standard deviation) follow-up was 4.5 (2.4) years. Some 239 (5.0 %) patients were medicated for permanent hypoparathyroidism. Patients with permanent hypoparathyroidism had an increased risk for renal insufficiency, hazard ratio 4.88 (2.00–11.95), and an increased risk for any malignancy, hazard ratio 2.15 (1.08–4.27). Patients with permanent hypoparathyroidism and known cardiovascular disease at the time of thyroidectomy had an increased risk for cardiovascular events during follow-up, hazard ratio 1.88 (1.02–3.47). Conclusion: Patients with permanent hypoparathyroidism after total thyroidectomy have an increased risk of long-term morbidity. These results are a cause of great concern.
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| 12. |
- Carlander, Johan, et al.
(författare)
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Risk of Complications with Energy-Based Surgical Devices in Thyroid Surgery : A National Multicenter Register Study
- 2016
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 40:1, s. 117-123
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEnergy-based surgical devices (EBD) combining cutting and coagulation are increasingly used in thyroid surgery. However, there is a lack of information about potential benefits and risk of complications outside controlled trials. The aims of this national multicenter register study were to describe the use of EDB, their potential effect on complication rates, and on operation time.Materials and methodsThe Scandinavian Quality Register for Thyroid and Parathyroid surgery includes 35 surgical units in Sweden and covered 88 % of the thyroid procedures performed during 2008–2009. The use of the EBD was specifically registered for 12 months, and 1297 patients were included. Surgically related complications and operation time were evaluated. The clamp-and-tie group (C-A-T) constituted the control group for comparison with procedures where EBD was used.ResultsThe thyroid procedures performed included C-A-T (16.6 %), bipolar electrosurgery (ES: 56.5 %), electronic vessel sealing (EVS: 12.2 %), and ultrasonic dissection (UD: 14.5 %). Mean operative time was longer with EVS (p < 0.001) and shorter with UD (p < 0.05) than in the other groups. The bipolar ES group and the EVS group had higher incidence of calcium treatment at discharge and after 6 weeks than the UD group. No significant difference in nerve injury was found between the groups. There was a significant more frequent use of topical hemostatic agents in the EBD group compared to C-A-T.ConclusionIn this national multicenter study, the use of UD shortened and EVS increased operating time. There was a higher risk of calcium treatment at discharge and after 6 weeks after use of EVS and bipolar ES than after UD use. There was a significant more frequent use of topical hemostatic agents in the EBD groups compared to C-A-T.
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| 13. |
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| 14. |
- Hallgrimsson, Palli, et al.
(författare)
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Hypocalcaemia after total thyroidectomy for Graves' disease and for benign atoxic multinodular goitre.
- 2012
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Ingår i: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2451 .- 1435-2443. ; 397:7, s. 1133-1137
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Postoperative hypocalcaemia has been reported to be more common after total thyroidectomy (TT) for Graves' disease than after TT for benign atoxic multinodular goitre (MNG). The reasons for this potential association are not clear. In the present study, the frequency and risk factors of hypocalcaemia after TT for Graves' vs MNG were compared. METHODS: Between January 1999 and October 2009, patients with first-time surgery for Graves' disease or MNG treated with a TT were included in the study. Postoperative hypocalcaemia was defined by symptoms, calcium levels and treatment with calcium and/or vitamin D analogues during postoperative hospital stay, at discharge, and at the 6-week and 6-month follow-ups. Outcomes were compared with Mann-Whitney, chi(2) and Fishers' exact test where appropriate and by multivariable logistic regression analysis. RESULTS: There were 128 patients with Graves' disease and 81 patients with MNG. Patients with Graves' disease were younger than patients with MNG (median age, 35 vs 51 years, p < 0.001). Symptoms of hypocalcaemia were more common in patients with Graves' disease (p < 0.001; OR, 95 % CI 3.26, 1.48-7.14), but the frequency of biochemical hypocalcaemia, postoperative levels of parathyroid hormone (PTH) and treatment with calcium and vitamin D did not differ between groups of patients. CONCLUSION: Apart from more frequent symptoms of hypocalcaemia in patients with Graves' disease, there was no difference in the overall frequency of biochemical hypocalcaemia, low levels of PTH and/or treatment with calcium and vitamin D.
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| 15. |
- Hallgrimsson, Palli, et al.
(författare)
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Risk Factors for Medically Treated Hypocalcemia after Surgery for Graves' Disease: A Swedish Multicenter Study of 1,157 Patients.
- 2012
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 36:8, s. 1933-1942
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: For reasons that remain unclear, surgery for Graves' disease is associated with a higher risk of hypocalcemia than surgery for benign atoxic goiter. In the present study, we evaluated risk factors for postoperative hypocalcemia in patients undergoing operation for Graves' disease. METHODS: Data from 1,157 patients who underwent operation for Graves' disease between 2004 and 2008 were extracted from the Scandinavian database for Thyroid and Parathyroid Surgery. Risk factors for postoperative hypocalcemia (in-hospital i. v. calcium; treatment with vitamin D analog at discharge, at 6 weeks, and at 6 months postoperatively) were evaluated by logistic regression analysis. RESULTS: Risk factors for i. v. calcium were low hospital volume of thyroid surgery (odds ratio [OR]: 95 % confidence interval [95 % CI], 0.99: 0.99-1.00), age (0.95: 0.91-1.00), operative time (1.02: 1.01-1.02), university hospital (12.91: 2.68-62.30), and reoperation for bleeding (10.32: 1.51-70.69). The risk for treatment with vitamin D at discharge increased with operative time (1.01: 1.00-1.02), excised gland weight (1.01: 1.00-1.01), parathyroid autotransplantation (5.19: 2.28-11.84), and reoperation for bleeding (12.00: 2.43-59.28). At 6 weeks, vitamin D medication was associated with gland weight (1.00: 1.00-1.01), and preoperative medication with β-blockers (4.20: 1.67-10.55). At 6 months, vitamin D medication was associated with gland weight (1.00: 1.00-1.01) and reoperation for bleeding (10.59: 1.58-71.22). CONCLUSIONS: Risk factors for medically treated hypocalcemia varied at different times of follow-up. Young age, operative time, type of hospital, and parathyroid autotransplantation were associated with early postoperatively hypocalcemia. Preoperative β-blocker treatment was a risk factor at the first follow-up. At early and late follow-up, gland weight and reoperation for bleeding were associated with medically treated hypocalcemia.
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| 16. |
- Hirvikoski, Tatja, et al.
(författare)
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Deficient cardiovascular stress reactivity predicts poor executive functions in adults with attention-deficit/hyperactivity disorder
- 2011
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Ingår i: Journal of Clinical and Experimental Neuropsychology. - : Informa UK Limited. - 1380-3395 .- 1744-411X. ; 33:1, s. 63-73
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Tidskriftsartikel (refereegranskat)abstract
- Associations between cardiovascular stress markers, subjective stress reactivity, and executive functions were studied in 60 adults (30 with attention-deficit/hyperactivity disorder, ADHD, and 30 controls) using the Paced Auditory Serial Addition Test (PASAT, a test of executive functions) as a cognitive stressor. Despite higher self-perceived stress, the adults with ADHD showed lower or atypical cardiovascular stress reactivity, which was associated with poorer performance on PASAT. Using cardiovascular stress markers, subjective stress, and results on PASAT as predictors in a logistic regression, 83.3% of the ADHD group and 86.9% of the controls could be classified correctly.
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| 17. |
- Lind, Patrik, 1985-, et al.
(författare)
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Impact of fine-needle aspiration cytology in thyroidectomy extent and associated surgical morbidity in thyroid cancer
- 2024
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Ingår i: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 409:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To assess the impact of fine-needle aspiration cytology (FNAC) in the extent of surgery in patients with thyroid cancer (TC) and the associated surgical morbidity in primary and completion setting.METHODS: A Swedish nationwide cohort of patients having surgery for TC (n = 2519) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal surgery between 2004 and 2013 was obtained. Data was validated through scrutinizing FNAC and histology reports.RESULTS: Among the 2519 cases operated for TC, the diagnosis was substantiated and validated through the histology report in 2332 cases (92.6%). Among these, 1679 patients (72%) were female, and the median age at TC diagnosis was 52.3 years (range 18-94.6). Less than total thyroidectomy (LTT) was undertaken in 944 whereas total thyroidectomy (TT) in 1388 cases. The intermediate FNAC categories of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/ FLUS), as well as suspicion for follicular neoplasm (SFN) lesions were more often encountered in LTT (n = 314, 33.3%) than TT (n = 63, 4.6%), whereas FNACs suspicion for malignancy and/or malignancy were overrepresented in TT (n = 963, 69.4%). Completion thyroidectomies were undertaken in 553 patients out of 944 that initially had LTT. In 201 cases with cancer lesions > 1 cm, other than FTC (Follicular TC)/ HTC (Hürthle cell TC) subjected to primary LTT, inadequate procedures were undertaken in 81 due to absent, Bethesda I or II FNAC categories, preoperatively. Complications at completion of surgery in this particular setting were 0.5% for RLN palsy (n = 1) and 1% (n = 2) for hypoparathyroidism 6 months postoperatively. The overall postoperative complication rate was higher in primary TT vs. LTT for RLN palsy (4.8% [n = 67] vs. 2.4% [n = 23]; p = 0.003) and permanent hypoparathyroidism (6.8% [n = 95] vs. 0.8% [n = 8]; p < 0.0001).CONCLUSIONS: FNAC results appear to affect surgical planning in TC as intermediate FNAC categories lead more often to LTT. Overall, inadequate procedures necessitating completion surgery are encountered in up to 15% of TC patients subjected to LTT due to absent, inconclusive, or misleading FNAC, preoperatively. However, completion of thyroidectomy in this setting did not yield significant surgical morbidity. Primary LTT is a safer primary approach compared to TT in respect of RLN palsy and permanent hypoparathyroidism complication rates; therefore, primary TT should probably be reserved for lesions > 1 cm or even larger with suspicion for malignancy or malignant FNAC.
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| 18. |
- Lundstam, Karolina, et al.
(författare)
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Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism
- 2015
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Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 100:4, s. 1359-1367
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Tidskriftsartikel (refereegranskat)abstract
- Context: Mild primary hyperparathyroidism (PHPT) is a common disease especially in middle-aged and elderly women. The diagnosis is frequently made incidentally and treatment strategies are widely discussed. Objective: To study the effect of parathyroidectomy (PTX) compared with observation (OBS) on biochemistry, safety, bone mineral density (BMD), and new fractures. Design: Prospective, randomized controlled study (SIPH study), 5-year follow-up. Setting: Multicenter, tertiary referral centers. Patients: Of 191 randomized patients with mild PHPT, biochemical data were available for 145 patients after 5 years, mean age at inclusion 62.8 years (OBS group, 9 males) and 62.1 years (PTX group, 10 males). Intervention: Parathyroidectomy vs observation. Main outcome measures: Biochemistry, BMD and new radiographic vertebral fractures. Results: Serum-calcium and PTH-levels normalized after surgery and did not deteriorate by observation. BMD Z-scores were normal at inclusion in the lumbar spine (LS) and femoral neck (FN). For LS, BMD Z-scores were stable for 5 years with observation, but decreased in FN (P<0.02). After surgery, BMD Z-scores increased significantly in both compartments (P<0.02 for both), with a highly significant treatment effect of surgery compared to observation (P<0.001). During follow-up, 5 new clinically unrecognized vertebral fractures were found in 5 females, all in the OBS group (P=0.058). Conclusion: Even though new vertebral fractures occurred only in the observation group, the frequency was not significantly different from the surgery group. Longer follow-up is needed before firm conclusions can be drawn about the long-term safety of observation, as opposed to surgery.
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| 19. |
- Milanetto, Anna Caterina, et al.
(författare)
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Health-Related Quality of Life After Surgery for Small Intestinal Neuroendocrine Tumours
- 2018
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 42:10, s. 3231-3239
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Tidskriftsartikel (refereegranskat)abstract
- Background: Overall survival for patients with small intestinal neuroendocrine tumours (siNETs) is long, even with metastatic disease, making quality of life issues relevant. The impact of surgery on quality of life is not known. We investigated determinants of health-related quality of life in patients who had undergone surgery for a siNET. Methods: Patients operated for a siNET between 1998 and 2016 at Skåne University Hospital (Lund, Sweden), who were alive in February 2017, were sent two questionnaires constructed by the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30, EORTC QLQ-GINET21). Global quality of life, physical function, disease-related worries, diarrhoea and endocrine symptoms were evaluated with linear and logistic regression in relation to patient-, tumour- and treatment-related factors. Statistical analysis was performed using STATA 11®. Results: One hundred patients (84%) completed the questionnaires. Women had worse global quality of life (p = 0.019), more disease-related worries (p < 0.001) and endocrine symptoms (p = 0.017) than men. Older age was associated with more disease-related worries (p = 0.007), but fewer endocrine symptoms (p = 0.034). Non-symptomatic tumour versus symptomatic tumour (p = 0.002), and treatment with somatostatin analogues versus no treatment (p = 0.040) were associated with less diarrhoea. Small versus large bowel resection was associated with better global quality of life (p = 0.036) and physical function (p = 0.035). Conclusions: Male gender, younger age, treatment with somatostatin analogues, non-symptomatic tumour, and small intestinal surgery rather than large bowel surgery were associated with better quality of life.
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| 20. |
- Nilsson, Martin, et al.
(författare)
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Reduced fracture incidence in patients having surgery for primary hyperparathyroidism
- 2022
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Ingår i: Clinical Endocrinology. - : Wiley. - 0300-0664 .- 1365-2265. ; 97:3, s. 276-283
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The indication of surgery in primary hyperparathyroidism has been controversial, as many patients experience mild disease. The primary aim was to evaluate fracture incidence in a contemporary population-based cohort of patients having surgery for primary hyperparathyroidism. The secondary aim was to investigate whether preoperative serum calcium, adenoma weight or multiglandular disease influence fracture incidence. Design: A retrospective cohort study with population controls. Primary outcomes, defined by discharge diagnoses and prescriptions, were any fracture and fragility fracture, secondary outcomes were multiple fractures anytime and osteoporosis. Subjects were followed 10 years pre- and up to 10 years postoperatively (or 31 December 2015). Multiple events per subject were allowed. Fracture incidence rate ratios (IRRs) for patients pre- and postoperatively were tabulated and evaluated with mixed-effects Poisson regression. Secondary outcomes were evaluated using conditional logistic regression. Patients: A Swedish nationwide cohort of patients having surgery for primary hyperparathyroidism (n = 5009) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery between 2003 and 2013 was matched with population controls (n = 14,983). Data were cross-linked with Statistics Sweden and the National Board of Health and Welfare. Measurements: Preoperative serum calcium and adenoma weight at pathological examination. Results: Patients had an increased incidence rate of any fracture preoperatively, IRR 1.27 (95% confidence interval: 1.11–1.46), highest in the last year before surgery. Fracture incidence was not increased postoperatively. Serum calcium, adenoma weight and multiglandular disease were not associated with fracture incidence. Conclusions: Fracture incidence is higher in patients with primary hyperparathyroidism but is normalized after surgery.
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| 21. |
- Nordenström, Erik, et al.
(författare)
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Biochemical diagnosis of primary hyperparathyroidism: Analysis of the sensitivity of total and ionized calcium in combination with PTH.
- 2011
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Ingår i: Clinical Biochemistry. - : Elsevier BV. - 1873-2933 .- 0009-9120. ; 44, s. 849-852
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the accuracy of the biochemical diagnosis of primary hyperparathyroidism (pHPT) in a consecutive series of patients with operatively verified disease. DESIGN AND SUBJECTS: Four hundred thirty-six patients with pHPT, 340 women and 96 men, were reviewed. Biochemical variables, including total calcium (Ca), ionized calcium (Cai) and PTH were analyzed and registered in a prospective database. RESULTS: In the subgroup of patients with more mild hypercalcemia (Ca below 2.70mmol/L) the correlation between Ca and Cai was poor. 19 respectively 18 patients had preoperatively a Ca respectively Cai level within the reference range. Further 35 patients had preoperatively a normal level of PTH. The diagnostic sensitivities for Ca, Cai and the combination of Ca and Cai were 96%, 96% and 99%. CONCLUSION: If calcium and ionized calcium are not used in the diagnostic workup of pHPT some 4% of the patients will be overlooked. We recommend analyzing both Ca and Cai in the diagnostic workup of pHPT.
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| 22. |
- Nordenström, Erik, et al.
(författare)
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Effect of thyroid hormone replacement therapy on mortality rate in patients undergoing total or hemithyroidectomy for benign multinodular goitre
- 2024
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Ingår i: BJS Open. - 2474-9842. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Thyroid surgery for benign non-toxic nodular goitre is a common endocrine surgical procedure. It is not known whether thyroid hormone replacement therapy following surgery for benign thyroid disease influences mortality or morbidity rates. Methods: A retrospective observational study was conducted using national registries in Sweden. Overall mortality and morbidity rates were compared for patients with or without thyroid hormone replacement therapy in patients operated on with hemithyroidectomy or total thyroidectomy for a diagnosis of benign non-toxic nodular goitre. Results: Between 1 July 2006 and 31 December 2017, 5573 patients were included, 1644 (29.5%) patients were operated on with total thyroidectomy and 3929 patients with hemithyroidectomy. In the hemithyroidectomy group, 1369 (34.8%) patients were prescribed thyroid hormone replacement therapy in the follow-up. The patients who underwent hemithyroidectomy and did not use thyroid hormone replacement therapy in the follow-up had a standard mortality ratio of 1.31 (95% confidence interval, 1.09-1.54). The mortality ratio was not increased in patients who underwent total thyroidectomy or hemithyroidectomy and used thyroid hormone replacement therapy. The risk of death analysed by multivariable Cox regression for patients operated on with hemithyroidectomy without later thyroid hormone replacement therapy, adjusted for age and sex, showed an increased hazard ratio of 1.65 (1.19-2.30) compared with hemithyroidectomy with hormone replacement therapy. Conclusion: Patients subjected to hemithyroidectomy without later hormone replacement therapy had a 30% higher risk of death compared with the normal Swedish population and a 65% increased risk of death compared with patients undergoing hemithyroidectomy with postoperative hormone replacement therapy.
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| 23. |
- Nordenström, Erik, et al.
(författare)
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Effect on bone density of postoperative calcium and vitamin-D supplementation in patients with primary hyperparathyroidism: A retrospective study.
- 2009
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Ingår i: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2451 .- 1435-2443. ; Jun 11, s. 461-467
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Primary hyperparathyroidism (pHPT) is associated with decreased bone density and increased fracture risk. A significant number of pHPT patients have low calcium intake and suffer from vitamin deficiency. Thus, we adopted a policy of postoperative supplements with calcium and vitamin D after parathyroid surgery. In this study, we investigated if this policy enhanced the postoperative increase in bone density. PATIENTS/METHODS: Forty-two consecutive patients (83% female) were studied. The first 21 patients received no supplements, whereas the following 21 patients received 1,000 g calcium and 800 IU hydroxy D: -vitamin daily (Ca-D group) for 1 year postoperatively. The patients were monitored with bone density and biochemistry pre- and at 1 year postoperatively. RESULTS: Preoperatively, the patients without vitamin D supplementation (non-Ca-D group) did neither differ in biochemistry, clinical features, nor in bone density from patients in Ca-D group. Postoperatively, there was a tendency that patients in Ca-D group increased their bone density, at all sites measured, in a greater extent than patients that did not receive calcium and vitamin D supplementation. CONCLUSION: In conclusion, based on our results, it is difficult to give a recommendation of vitamin D supplementation in routine use following surgery for primary hyperparathyroidism. Based on the present data, a calculation of sample size for a future randomized controlled trial is presented.
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| 24. |
- Nordenström, Erik, et al.
(författare)
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Fellowship framgångssaga i Lund
- 2014
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Ingår i: Läkartidningen. - 0023-7205. ; 111:41, s. 1787-1787
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 25. |
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| 26. |
- Nordenström, Erik, et al.
(författare)
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LCA OF LOCAL BIO-CHP FUELLED GREENHOUSES VERSUS MEDITERRANEAN OPEN FIELD TOMATOES FOR CONSUMPTION IN NORTHERN SCANDINAVIA
- 2010
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Ingår i: ECO-TECH´10, 22-24 November 2010, Kalmar, Sweden.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Tomatoes are a commonly used product in the Scandinavian countries, where locally grown tomatoes generally have to be cultivated in greenhouses, heated for most part of the year. Tomatoes imported from the Mediterranean area will not need heated greenhouses, but are transported a longer distance. Earlier studies have shown imported tomatoes over long distances are environmentally preferable when compared to tomatoes produced in greenhouses. In this study, tomatoes for the Trøndelag market in Norway locally grown in greenhouses with heat from biofuelled CHP generation have been studied using life cycle assessment (LCA). An LCA model for the biofuel heated greenhouse tomatoes was created and compared to a model of field grown tomatoes in Spain. In a sensitivity analysis a fossil energy scenario for the greenhouse tomatoes was studied. The biofuelled greenhouse tomatoes was found to be better in all studied life cycle impact categories compared to the long-distance transported field grown tomatoes. The scenario with fossil energy to the greenhouse give much higher impacts compared to the long distance transported tomatoes in most categories studied. A shift towards more renewable energy systems is one important task for a more sustainable agriculture.
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| 27. |
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| 28. |
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| 29. |
- Nordenström, Erik, et al.
(författare)
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Permanent Hypoparathyroidism After Total Thyroidectomy in Children : Results from a National Registry
- 2018
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 42:9, s. 2858-2863
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Hypoparathyroidism is the most common complication following thyroidectomy. There are few population-based reports on the rate of hypoparathyroidism in children. The incidence of medical treatment of permanent hypoparathyroidism in children is reported using a national registry. Methods: The study population included patients below 18 years of age undergoing total thyroidectomy reported to the Scandinavian Quality Registry for Thyroid, Parathyroid and Adrenal Surgery 2004–2014. Patients with previous thyroid or parathyroid surgery or treatment with vitamin D before surgery were excluded from analysis. Permanent postoperative hypoparathyroidism was defined as treatment with vitamin D for more than 6 months after thyroidectomy. Risk factors for permanent hypoparathyroidism were calculated with uni- and multivariable logistic regression. Using data from the Swedish Inpatient Registry, rates of readmissions and annual number of days in hospital after total thyroidectomy were compared between patients with and without permanent hypoparathyroidism. Results: Some 274 children (215 girls and 59 boys) underwent total thyroidectomy. The median age was 14 (range 0–17) years. Indications for surgery were Graves’ disease (214, 78.1%), other benign disease (27, 9.9%) and thyroid cancer (33, 12%). Median follow-up was 4.8 years. Twenty (7.3%) children developed permanent hypoparathyroidism. No statistically significant risk factors for permanent hypoparathyroidism were identified. Rates of readmission and annual number of days in hospital after discharge were similar in patients with and without permanent hypoparathyroidism. Conclusions: The rate of permanent hypoparathyroidism following total thyroidectomy in children was high and is a cause of concern.
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| 30. |
- Nordenström, Erik
(författare)
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Primary Hyperparathyroidism - Aspects on skeletal Involvemnt and PTH levels after Surgery.
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to evaluate risk factors for fractures in patients with primary hyperparathyroidism (pHPT), to study the association between preoperative variables and postoperative changes in bone density and to investigate long-term changes and peripheral PTH sensitivity in patients with elevated PTH levels after surgery. 203 pHPT patients were investigated with regard to clinical and biochemical variables and bone density. Serum levels of 25(OH)D3 and PTH, were the only variables independently associated with a risk of bone fracture. Thirteen patients with pHPT were investigated with a PTH infusion test six weeks after surgery. During the PTH-infusion test we found that patients with raised PTH had signs of decreased peripheral sensitivity to PTH with attenuated calcemic response. 99 pHPT patients were followed five years after surgery. 16% of the patients had elevated PTH levels. One group of patients that demonstrated fluctuation between normal and elevated PTH levels showed signs of renal insufficiency. In this group of patients, an increased risk for recurrent disease is postulated and long time surveillance could be suggested. Bone mass was investigated before and one year after surgery in 126 pHPT patients. Postmenopausal women had lower bone density compared to premenopausal women. 40-50% of all patients improved in bone density after surgery. It was not possible to predict the increase in bone mass. Considering that 18 % respectively 61% of patients had signs of vitamin D and calcium deficiency, we suggest that pHPT patients could be considered for calcium and vitamin D supplement postoperatively.
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| 31. |
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| 32. |
- Nordenström, Erik, et al.
(författare)
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Vitamin d status in patients operated for primary hyperparathyroidism: comparison of patients from southern and northern europe.
- 2013
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Ingår i: International Journal of Endocrinology. - : Hindawi Limited. - 1687-8337 .- 1687-8345. ; 2013
-
Tidskriftsartikel (refereegranskat)abstract
- Aim. The interaction between vitamin D deficiency and primary hyperparathyroidism (PHPT) is not fully understood. The aim of this study was to investigate whether patients with PHPT from Spain and Sweden differed in vitamin D status and PHPT disease activity before and after surgery. Methods. We compared two cohorts of postmenopausal women from Spain (n = 126) and Sweden (n = 128) that had first-time surgery for sporadic, uniglandular PHPT. Biochemical variables reflecting bone metabolism and disease activity, including levels of 25-hydroxy vitamin D3 (25(OH)D) and bone mineral density, BMD, were measured pre- and one year postoperatively. Results. Median preoperative 25(OH)D levels were lower, and adenoma weight, PTH, and urinary calcium levels were higher in the Spanish cohort. The Spanish patients had higher preoperative levels of PTH (13.5 versus 11.0 pmol/L, P < 0.001), urinary calcium (7.3 versus 4.1 mmol/L, P < 0.001), and heavier adenomas (620 versus 500 g, P < 0.001). The mean increase in BMD was higher in patients from Spain and in patients with vitamin D deficiency one year after surgery. Conclusion. Postmenopasual women with PHPT from Spain had a more advanced disease and lower vitamin 25(OH)D levels. Improvement in bone density one year after surgery was higher in patients with preoperative vitamin D deficiency.
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| 33. |
- Ohlsson, Håkan, et al.
(författare)
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Impact of Specific Bowel Symptoms on Quality of Life in Patients with Midgut Neuroendocrine Tumours
- 2021
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 45, s. 2793-2803
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Patients with midgut neuroendocrine tumours (NETs) suffer from decreased health-related quality of life (HRQoL), in large part due to bowel symptoms. However, it is unknown which bowel symptoms affect HRQoL the most. An enhanced understanding of this is essential to better focus treatment on this aspect of the disease. This study aimed to determine which bowel symptoms affect HRQoL the most in patients with midgut NETs. Methods: Consenting patients with midgut NET completed the Memorial Sloan Kettering Bowel Function Instrument and the HRQoL questionnaire (EORTC QLQ-C30). The correlation between bowel symptoms and HRQoL was analysed using multiple linear regression, adjusting for age, Charlson Comorbidity Index score, presence of metastatic disease, chromogranin A, and BMI yielding ß-coefficients with 95% confidence intervals. Results: Totally, 119 patients with midgut NET completed the questionnaires and were included in the study. Loose stool and bowel frequency ≥ 3/day were the most common bowel symptoms, reported by 47% and 56% of patients, respectively. However, sensitivity to certain types of food and beverages, a feeling of incomplete emptying of the bowel, and soiling were the symptoms most strongly correlated with decreased HRQoL, especially within domains concerning role and social function, with ß-coefficients for the strongest correlated symptoms of 15.0 and 14.6, respectively. Discussion: While symptoms concerning stool consistency and frequency are common in patients with midgut NET, our study suggests that other, more socially stigmatising symptoms affect patients’ HRQoL more. Our findings could help caregivers understand patients’ perceptions of the disease and provide avenues for more directed therapies.
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| 34. |
- Pålsson, Birger, et al.
(författare)
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Elective splenectomy in the elderly - perioperative and long-term course
- 2001
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Ingår i: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2451 .- 1435-2443. ; 386:5, s. 339-345
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Tidskriftsartikel (refereegranskat)abstract
- Background: The hazards of elective splenectomy in the elderly have not been thoroughly investigated. The aim was to assess such a well-defined cohort with respect to perioperative and long-term outcome. Methods: Fifty-two consecutively splenectomised patients during the period 1971-1995, aged 65 years or older, were followed until death (44 cases) or the end of 1999 (8 cases). Results: No intraoperative deaths occurred, while three patients (5.8%) died postoperatively in the 1970s. Twenty-four patients suffered from thirty-four postoperative complications, dominated by infections and haematomas. No differences were seen comparing patients with and without complications related to the American Society of Anesthesiologists' classes, total transfusion rate, steroid medication, preoperative risk diseases, "giant spleens" or the time period during which the operations were performed. In 69% of the patients, the splenectomy was beneficial. During the long-term followup, 25 patients suffered from 59 infectious and thromboembolic episodes and 1 surgical complication. The dominating causes of death were the primary disease (29%), myocardial infarction (20%), sepsis (12%) and cerebrovascular lesions (12%), i.e. not directly related to late effects of the operation. Conclusion: Highrisk patients older than 65 years with haematological disorders can safely undergo splenectomy with a low mortality rate and a reasonable rate of morbidity. The long-term course demonstrates a fair response rate, minimal surgically related complications, but thromboembolic and infectious events, and the majority of deaths unrelated to late effects of the splenectomy.
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| 35. |
- Steffenburg-Nordenström, Joachim, 1962-, et al.
(författare)
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Comparison of forming, welding and heat treatment simulations in LS-DYNA and MSC Marc
- 2016
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Ingår i: Proceedings of 10th International Conference on Trends in Welding Research & 9th International Welding Symposium of Japan Welding, American Welding Society (AWS) & Japan Welding Society (JWS). - : American Welding Society (AWS) & Japan Welding Society (JWS). - 9781510844032 ; , s. 660-663, s. 660-663
-
Konferensbidrag (refereegranskat)abstract
- The manufacturing of components for aero engine structures from a flat sheet to the final shape usually requires several steps that may introduce residual stresses and shape distortions in the part. Depending on the magnitude, sign and distribution with respect to the stresses induced by the service load, the remaining stresses may affect the service life of a component, especially when submitted to cyclic loading. Nowadays, several types of software that have the ability to predict the residual stresses and the final shape of a component subjected to various process steps are available. However, literature shows a lack of comparison studies among different software tools for multi-step simulations of a manufacturing process. In this study, the manufacturing process chain of an aerospace component including forming, welding and heat treatment in the nickel-based superalloy 718 is modelled and simulated using the two finite element software codes LS-DYNA and MSC.Marc. The results from the displacement of the blank in the punch stroke direction, the equivalent plastic strain and the von Mises stress are compared between both FE codes. The displacement of the blank after forming is slightly higher in LS-DYNA compared to MSC.Marc, as well as the equivalent plastic strain and the von Mises stress values. This tendency is also observed after trimming and welding. It can also be noted that the distribution of both strains and stresses on the trimmed and welded parts varies between the two compared codes, presumably due to the choice of different solver options, explicit and implicit.
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| 36. |
- Steffenburg-Nordenström, Joachim, 1962-, et al.
(författare)
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Simulation and validation of forming, edge milling, welding and heat treatment of an alloy 718 component
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper describes finite element simulations of a manufacturing process chain consisting of forming, weld preparation by milling, laser welding and stress relief heat treatment of an alloy718 aero-engine part. The work also includes experimental validation with optical measurements of the part after each process step. Approximation and discretization errors were avoided by keeping the same mesh and constitutive model. The results show that the remaining stresses affect the subsequent manufacturing process step and therefore, simulation of the process chain is essential. The accuracy with respect to the geometry showed relatively good agreement between measurement and simulation.
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| 37. |
- Steffenburg-Nordenström, Joachim, 1962-, et al.
(författare)
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Simulation and Validation of Forming, Milling, Welding and Heat Treatmentof an Alloy 718 Component
- 2017
-
Ingår i: International Journal of Materials Forming and Machining Processes IJMFMP). - Aveiro : IGI Global. - 2334-4563 .- 2334-4571. ; 4:2, s. 15-28
-
Tidskriftsartikel (refereegranskat)abstract
- This paper describes finite element simulations of a manufacturing process chain consisting offorming, weld preparation by milling, laser welding and stress relief heat treatment of an alloy 718aero-engine part. The work also includes experimental validation with optical measurements of thepart after each process step. Approximation and discretization errors were avoided by keeping thesame mesh and constitutive model. The results show that the remaining stresses affect the subsequentmanufacturing process step and therefore, simulation of the process chain is essential. The accuracywith respect to the geometry showed relatively good agreement between measurement and simulation.
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| 38. |
- Thier, Mark, et al.
(författare)
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Presentation and Outcomes After Surgery for Primary Hyperparathyroidism During an 18-Year Period.
- 2016
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 40:2, s. 356-364
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study is to analyze whether the trend towards operating on patients with less severe primary hyperparathyroidism (pHPT) than earlier is reflected in a change of preoperative presentation and surgical outcome.
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| 39. |
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| 40. |
- Thier, Mark, et al.
(författare)
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Surgery for patients with primary hyperparathyroidism and negative sestamibi scintigraphy--a feasibility study
- 2009
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Ingår i: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2451 .- 1435-2443. ; 394:5, s. 4-881
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We report the surgical treatment of a consecutive series of scan negative patients with the intention of unilateral parathyroid exploration with the aid of intraoperative quick PTH (qPTH).MATERIALS AND METHODS: The study included 35 consecutive sestamibi scan negative patients (27 women, eight men) with sporadic pHPT subjected to first time surgery. Median age was 70 years and median preoperative calcium level 2.8 mmol/L.RESULTS: Thirty-three patients had a histological diagnosis of a parathyroid adenoma (median weight 0.48 g [range 0.12 g-2.5 g]). Nineteen patients were explored bilaterally and 16 patients (46%) were operated unilaterally. The median operation time was 40 min in the unilateral group and 95 min in the bilateral group (p < 0.001). Three patients were treated for postoperative hypocalcemia after bilateral exploration versus none in the unilateral group (p = 0.23). With a minimum of 12 months of follow-up, 33 patients (94.3%) were cured. One case of recurrent HPT presented after bilateral exploration with visualization of four glands. One case of persistent HPT was observed after unilateral exploration. qPTH was predictive of operative failure in both patients.CONCLUSION: Forty-six percent of the patients in our study could be operated unilaterally with a total cure rate of 94%. Patients in the unilateral group had a significant shorter operation time and a lower incidence of postoperative hypocalcemia. In conclusion our investigation shows that limited parathyroid exploration can safely be performed on patients with negative sestamibi scintigraphy by the aid of qPTH.
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| 41. |
- Thompson, Lo Hallin, et al.
(författare)
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Impact of Adrenalectomy on Morbidity in Patients with Non-Functioning Adrenal Cortical Tumours, Mild Hypercortisolism and Cushing’s Syndrome as Assessed by National and Quality Registries
- 2021
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 45:10, s. 3099-3107
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The impact of adrenalectomy on morbidity in patients with mild hypercortisolism and non-functioning adrenocortical adenoma is unclear. The present study evaluated morbidity before and after adrenalectomy in patients with benign adrenocortical tumour with Cushing´s syndrome (CS), autonomous cortisol secretion (ACS) and non-functioning adrenocortical adenoma as assessed by national and quality registries. Methods: Patients registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009–2017 with CS, ACS or non-functioning adrenocortical adenoma, were included in this retrospective study and analysed with age- and sex-matched controls, 1:3. Morbidity associated with CS was assessed pre- and postoperatively by analysing data from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Results: Some 271 patients were included, CS (127), ACS (45) and non-functioning adrenocortical adenoma (99), with 813 matched controls. The frequency of hypertension was almost 50% in all tumour groups. Antihypertensive medication preoperatively was more frequent in all tumour groups compared with controls. No preoperative differences in medication were detected between patients with CS and ACS. A decrease in the use of hypertensive drugs was noticed annually for all patient groups after adrenalectomy. Conclusions: Hypertension is common in patients with benign adrenocortical tumours regardless of cortisol hypersecretion. The use of antihypertensive drugs in patients with CS, ACS and non-functioning adrenocortical adenoma was reduced after adrenalectomy. These findings highlight the need for a randomized controlled trial to investigate the impact of adrenalectomy on morbidity in patients with mild hypercortisolism.
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| 42. |
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| 43. |
- Van Den Heede, Klaas, et al.
(författare)
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Effect of primary tumour resection without curative intent in patients with metastatic neuroendocrine tumours of the small intestine and right colon : meta-analysis
- 2022
-
Ingår i: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 109:2, s. 191-199
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with small intestinal neuroendocrine tumours (siNETs) usually present with advanced disease. Primary tumour resection without curative intent is controversial in patients with metastatic siNETs. The aim of this meta-analysis was to investigate survival after primary tumour resection without curative intent compared with no resection in patients with metastatic siNETs. METHODS: A systematic literature search was performed, using MEDLINE® (PubMed), Embase®, Web of Science, and the Cochrane Library up to 25 February 2021. Studies were included if survival after primary tumour resection versus no resection in patients with metastatic siNETs was reported. Results were pooled in a random-effects meta-analysis, and are reported as hazard ratios (HRs) with 95 per cent confidence intervals. Sensitivity analyses were undertaken to enable comment on the impact of important confounders. RESULTS: After screening 3659 abstracts, 16 studies, published between 1992 and 2021, met the inclusion criteria, with a total of 9428 patients. Thirteen studies reported HRs adjusted for important confounders and were included in the meta-analysis. Median overall survival was 112 (i.q.r. 82-134) months in the primary tumour resection group compared with 60 (74-88) months in the group without resection. Five-year overall survival rates were 74 (i.q.r. 67-77) and 44 (34-45) per cent respectively. Primary tumour resection was associated with improved survival compared with no resection (HR 0.55, 95 per cent c.i. 0.47 to 0.66). This effect remained in sensitivity analyses. CONCLUSION: Primary tumour resection is associated with increased survival in patients with advanced, metastatic siNETs, even after adjusting for important confounders.
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| 44. |
- Van Den Heede, Klaas, et al.
(författare)
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Long-term survival of metastatic small intestine neuroendocrine tumors : a meta-analysis
- 2022
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Ingår i: Endocrine-Related Cancer. - 1479-6821. ; 29:3, s. 163-173
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Tidskriftsartikel (refereegranskat)abstract
- This meta-analysis aims to evaluate the long-term survival and prognostic factors in patients with metastatic small intestine neuroendocrine tumors (siNETs). Patients with siNETs usually present with advanced disease, limiting curative treatment options. The overall survival seems favorable compared to other cancers, but differences in terminology, lack of consistent coding, conflicting results from smaller cohorts, and recent developments of new treatment options make (reliable) survival data difficult to achieve. Nevertheless, accurate survival data are essential for many facets of health care. A systematic literature search was performed using MEDLINE®(PubMed), EMBASE®, Web of Science, and Cochrane Library up to June 30, 2021. Studies were included if the overall survival data in patients with metastatic siNETs were reported. The results were pooled in a random-effects meta-analysis and are reported as hazard ratios and 95% CIs. Subgroup analyses and meta-regression were performed to assess the observed heterogeneity and the impact of important prognostic factors. After screening 9065 abstracts, there were 23 studies, published between 1995 and 2021, that met the inclusion criteria, with a total of 8636 patients. The weighted 5- and 10-year overall survival was 67 and 37%, respectively. Meta-regression identified younger age and primary tumor resection to be associated with better prognosis. Subgroup analyses showed similar results. This study confirms that in an advanced, metastatic setting, the weighted 5- and 10-year overall survival reveal a favorable prognosis, improving over the last few decades. Meta-regression showed that age at diagnosis is an important prognostic factor.
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| 45. |
- Vatansever, Safa, et al.
(författare)
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Robot-assisted versus conventional laparoscopic adrenalectomy : Results from the EUROCRINE Surgical Registry
- 2022
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Ingår i: Surgery (United States). - : Elsevier BV. - 0039-6060. ; 171:5, s. 1224-1230
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adrenalectomy is routinely performed via the minimally invasive approach. Safety of adrenalectomy using the robot-assisted technique has been widely demonstrated by several series, but the literature is scarce regarding the comparison of conventional laparoscopic versus robot-assisted approach. We decided to carry out a multicenter study to compare clinical and surgical outcomes between laparoscopic and robotic adrenalectomy. Methods: This is a retrospective case-control study, including data from centers affiliated to the Surgical Registry EUROCRINE. Patients undergoing laparoscopic surgery for adrenal tumors and registered between 2015 and 2018 were included. Robot-assisted versus laparoscopic adrenalectomy was compared. All comparisons were carried out in terms of complication rate, conversion rate and duration of stay. Results: A total of 1,005 patients from 46 clinics underwent robotic or conventional laparoscopic adrenalectomy. Median age was 55 (interquartile range: 45−65) years. Robotic adrenalectomy was performed in 189 (18.8%) patients. According to Clavien-Dindo classification, complication rate was lower in the robotic surgery group (1.6% vs 16.5%, P <.001). Laparoscopic surgery and active hormonal status were significantly correlated with complications, both in univariate and multivariate analysis. There was no significant difference between laparoscopic and robotic surgery groups, in terms of conversion rate (2.1% vs 0.5%, respectively, P =.147). Duration of stay was shorter in the robotic adrenalectomy group (82.1% vs 28.8%, P <.001). Conclusion: Analysis of the EUROCRINE database supports that robotic adrenalectomy resulted in a lower complication rate and shorter duration of stay, compared with laparoscopic adrenalectomy. Granular data to support this is warranted.
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| 46. |
- Winberg, Johanna, et al.
(författare)
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Chimerism Resulting From Parthenogenetic Activation and Dispermic Fertilization
- 2010
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Ingår i: American Journal of Medical Genetics, Part A. - : Wiley. - 1552-4825 .- 1552-4833. ; 152A:9, s. 2277-2286
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Tidskriftsartikel (refereegranskat)abstract
- Whole-body human chimerism is the result of two zygotes giving rise to one individual, and is a rarely detected condition. We have studied the molecular background and discuss the likely mechanism for the chimerism in a patient with a 46,XX/47,XY,+14 karyotype and ambiguous genitalia, cryptorchidism, pigment anomalies, and normal psychomotor development. We have used karyotyping, interphase-FISH and array-CGH analysis as well as molecular analysis of polymorphic markers from 48 loci in order to define the origin and percentage of 47,XY,+14 cells in different tissues. Based on the findings of two paternal alleles and the detection of homozygous maternal alleles without evidence of crossing-over, and the fact that four alleles were never detected, our results indicate that the chimerism in our patient is the result of dispermic fertilization of a parthenogenetically activated oocyte. Our report underlines that cytogenetic findings suggesting mosaicism might actually indicate chimerism as an underlying mechanism in patients. It also highlights the difficulties in predicting the clinical outcome in patients with genetic aberrations in mosaic or chimeric form.
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| 47. |
- Wright, Lucie, et al.
(författare)
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Determinants for malignancy in surgically treated adrenal lesions.
- 2012
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Ingår i: Langenbeck's Archives of Surgery. - : Springer Science and Business Media LLC. - 1435-2451 .- 1435-2443. ; 397, s. 217-223
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: It is difficult to definitively rule out or establish malignancy pre-operatively in patients with adrenal lesions referred for adrenal surgery. The aim of this study was to identify risk factors for a malignant diagnosis in patients treated with adrenalectomy. METHODS: Consecutive adrenalectomies at the Department of Surgery, Lund University Hospital between 2000 and 2009 were identified. Pre-operative clinical, radiological and biochemical data, as well as details on the operation and histology, were retrieved from patients' medical records. RESULTS: There were 175 adrenal operations in 172 patients (98 female and 77 male). There were 28 malignancies. Malignant tumours were larger than in benign cases (p = 0.003), had radiological signs of malignancy more often (p = 0.001) and the patients were more likely to have a history of malignancy (p = 0.001). There were no differences regarding age, gender, body mass index or mode of detection (incidental vs. clinical) between patients with benign and malignant diagnoses. A unilateral uptake on fluorine-18 deoxyglucose positron emission tomography was more frequent in malignant cases than in benign; however, this association did not reach statistical significance. CONCLUSIONS: Size of adrenal lesion, suspicious radiological findings and history of malignancy were factors associated with malignancy.
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| 48. |
- Zäll, Erik, et al.
(författare)
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Electroplating of selective surfaces for concentrating solar collectors
- 2018
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Ingår i: PROCEEDINGS OF THE ISES EUROSUN 2018 CONFERENCE - 12TH INTERNATIONAL CONFERENCE ON SOLAR ENERGY FOR BUILDINGS AND INDUSTRY. - Freiburg, Germany : International Solar Energy Society. - 9783982040806 ; , s. 1086-1095
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Konferensbidrag (refereegranskat)abstract
- A spectrally selective surface is produced by electrodeposition of a Co-Cr coating on a stainless steel substrate. The plating bath consisted of CrCl3 center dot 6H(2)O and CoCl2 center dot 6H(2)O dissolved in a deep eutectic solvent (DES) of choline chloride and ethylene glycol. This DES enables the use of trivalent (Cr(III)) instead of hexavalent chromium (Cr(XI)) which significantly reduces health risks associated with chromium electroplating. The selective surface exhibits an absorptance (alpha) of 0.96 and an emittance (epsilon) of 0.13 at 100 degrees C making it well adapted for mid- to lowtemperature concentrating solar collectors. The 1.8 mu m thick coating exhibits a porous structure on the surface as well as throughout the entire coating. The surface of the coating comprises of Co oxides and hydroxides, while the bulk consists of metallic and oxidized Co and only small fractions of Cr compounds. Initial tests of the thermal stability indicate that the coating does not maintain optical properties at an acceptable level over a lifetime of 25 years. At approximately 438 degrees C significant parts of the coating is oxidized in an oxygen rich environment.
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| 49. |
- Zäll, Erik, et al.
(författare)
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Environmentally sustainable electroplating of selective cobalt-chromium coating on stainless steel for efficient solar collectors
- 2022
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Ingår i: Solar Energy Materials and Solar Cells. - : Elsevier. - 0927-0248 .- 1879-3398. ; 245
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Tidskriftsartikel (refereegranskat)abstract
- Half of today's global energy consumption is in the form of heating and cooling. Solar collectors are the most promising sustainable alternative to fossil fuels in this sector. The most important component in a solar collector is the receiver, which by use of a selective surface absorbs and converts solar irradiance to thermal energy. Herein, a novel selective surface for low-to mid-temperature solar collectors is developed, studied and presented. The surface is produced by electroplating a cobalt-chromium coating on a stainless steel substrate using an electrolyte based on a deep eutectic solvent. Our method makes use of trivalent instead of traditionally used hexavalent chromium, which significantly reduces health-related issues and makes it more environmentally benign. We obtain a coating of chromium doped cobalt where the surface exhibits an absorptance and emittance of 0.96 and 0.14, respectively, giving it a solar-to-thermal efficiency of 0.95. An observed loss in optical efficiency, is shown to correlate to an oxidation of the metallic cobalt to Co3O4 at elevated temperatures. We further show that this oxidation can be mitigated by dip-coating a protective silica top coating, which concurrently improves the optical selectivity of the surface. The present selective surface is efficient, cheap, scalable, and easy to produce sustainably, making it competitive to industry standards. We foresee that our method will have impact on the advancement of improved low-to mid-temperature solar collectors, assisting a faster transition towards a sustainable society.
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