| 1. |
- Carrwik, Christian, 1977-
(författare)
-
Surgical treatment of spinal metastasis
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to study surgical treatment of spinal metastasis from several points of view, with a focus on predictive tools and survival after surgery. Study I includes 315 patients treated surgically at Uppsala University Hospital 2006-2012 due to spinal metastatic disease. Based on the data known at the time of surgery, predictive scores were calculated using four different scoring systems (Tokuhashi, revised Tokuhashi, Tomita and modified Bauer scores). The predictions were then compared with true survival data. All of the scores had a statistically significant correlation to survival but all of them tended to underestimate rather than overestimate survival. Study II focused on patients with an unknown primary tumour (UPT). We reviewed 393 cases treated at Uppsala University Hospital, where 122 (31%) had an unknown primary tumour at the time of surgery. A survival analysis showed that the patients with an UPT had a longer estimated survival compared to the group with a known primary tumour (KPT). The estimated median survival time in the UPT group was 15.6 months, compared to 7.4 months in the KPT group. The mean estimated survival time was 48.1 months in the UPT group and 21.6 months in the KPT group. The difference was statistically significant (p=0.001).Study III is a retrospective multi-registry study linking the Swedish spine surgery database Swespine with the Swedish Cause of Death (CoD) Register. The analysis included 1820 patients who underwent surgery due to spinal metastatic disease at 19 hospitals in Sweden 2006-2016. The study showed that both the mean and the median estimated survival time after surgery are well above the recommended three months threshold for surgery, suggesting that surgical treatment could be indicated in even more cases. In study IV, prognostic tools were revisited with a validation study of PathFx 3.0, an online open-source tool to estimate survival for patients with skeletal metastases. A cohort of 668 patients treated at Uppsala University Hospital and Karolinska University Hospital were included in the study and the results indicate that PathFx 3.0 could predict survival after treatment with good reliability, especially for patients with long expected survival. As PathFx can be updated to reflect advancements in oncological treatment, this type of tool is probably more useful than the rigid point-based scoring systems evaluated in study I.
|
|
| 2. |
- Carrwik, Christian, 1977-, et al.
(författare)
-
Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study.
- 2021
-
Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:11
-
Tidskriftsartikel (refereegranskat)abstract
- To evaluate survival after surgery and indications for surgery due to spinal metastatic disease.A retrospective longitudinal multiregistry nationwide cohort study.19 public hospitals in Sweden with spine surgery service, where 6 university hospitals account for over 90% of the cases.1820 patients 18 years or older undergoing surgery due to spinal metastatic disease 2006-2018 and registered in Swespine, the Swedish national spine surgery registry.Decompressive and/or stabilising spine surgery due to spinal metastatic disease.Survival (median and mean) after surgery.Indications for surgery, types of surgery and causes of death.The median estimated survival after surgery was 6.2 months (95% CI: 5.6 to 6.8) and the mean estimated survival time was 12.2 months (95% CI: 11.4 to 13.1). Neurologic deficit was the most common indication for surgery and posterior stabilisation was performed in 70.5% of the cases. A neoplasm was stated as the main cause of death for 97% of the patients.Both median and mean survival times were well above the generally accepted thresholds for surgical treatment for spinal metastases, suggesting that patient selection for surgical treatment on a national level is adequate. Further research on quality of life after surgery and prognostication is needed.
|
|
| 3. |
- Robinson, Anna-Lena, 1971-, et al.
(författare)
-
C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age : A Retrospective Cohort Study of 233 Consecutive Cases
- 2017
-
Ingår i: BioMed Research International. - : HINDAWI LTD. - 2314-6133 .- 2314-6141.
-
Tidskriftsartikel (refereegranskat)abstract
- The currently available data on the distribution of C2 fracture subtypes is sparse. This study was designed to identify the proportions of the second cervical vertebra (C2) fracture subtypes and to present age and gender specific incidences of subgroups. A dataset of all patients treated between 2002 and 2014 for C2 fractures was extracted from the regional hospital information system. C2 fractures were classified into odontoid fractures types 1, 2, and 3, Hangman's fractures types 1, 2, and 3, and atypical C2 fractures. 233 patients (female 51%, age 72 +/- 19 years) were treated for a C2 fracture. Odontoid fractures were found in 183 patients, of which 2 were type 1, 127 type 2, and 54 type 3, while 26 of C2 fractures were Hangman's fractures and 24 were atypical C2 fractures. In the geriatric subgroup 89% of all C2 fractures were odontoid, of which 71% were type 2 and 29% type 3. There was an increasing incidence of odontoid fractures types 2 and 3 from 2002 to 2014. 40% of C2 fractures were treated surgically. This study presents reliable subset proportions of C2 fractures in a prospectively collected regional cohort. Knowledge of these proportions facilitates future epidemiological studies of C2 fractures.
|
|
| 4. |
- Robinson, Anna-Lena, 1971-, et al.
(författare)
-
Epidemiology of C2 Fractures in the 21st Century : A National Registry Cohort Study of 6,370 Patients from 1997 to 2014
- 2017
-
Ingår i: Advances in Orthopedics. - : Hindawi Publishing Corporation. - 2090-3464 .- 2090-3472.
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. C2 fractures are a common injury in the elderly population. Treatment is often complicated due to osteoporosis and patient comorbidity. This study aims to investigate the incidence and treatment trend of C2 fractures in Sweden. Methods. Patients with the principal and secondary diagnosis of fracture of the second vertebrae (ICD-10: S12.1) between 1997 and 2014 were identified in the Swedish National Patient Registry (NPR). Results. Between 1997 and 2014, 6,370 patients with a C2 fracture (51% male; age: ) were identified in the NPR. The incidence of C2 fractures increased from 3 to 6 per 100,000 (; ), mainly due to an increase of incidence in the geriatric subgroup (≥70 years). The percentage of surgically treated patients decreased from 1997 to 2014 (; ). Younger age, male gender, spinal cord injury, and earlier year of admission were associated with surgical treatment assignment.Discussion. This study documents a rising incidence of C2 fractures in the elderly during the last two decades in Sweden. Greater awareness of fractures, improved diagnostics, coding, and a higher activity level of the patients are plausible causes. The declining trend of surgical treatment warrants further study.
|
|
| 5. |
|
|
| 6. |
- Robinson, Anna-Lena, 1971-, et al.
(författare)
-
Surgical treatment improves survival of elderly with axis fracture : a national population-based multi-registry cohort study
- 2018
-
Ingår i: The spine journal. - : Elsevier BV. - 1529-9430 .- 1878-1632. ; 18, s. 1853-1860
-
Tidskriftsartikel (refereegranskat)abstract
- Background ContextFractures of the axis (C2) are the most common cervical spinal injuries in the elderly population. Several authors have reported improved survival among elderly patients with C2 fractures when treated surgically.PurposeWe aimed to analyze whether surgery improves survival of elderly with C2 fractures.Study Design/SettingAn observational population-based longitudinal multi-registry study was carried out.Patient SampleSwedish Patient Registry 1997 to 2014 and Swedish Cause of Death Registry 1997 to 2014 served as source of patient sample.Outcome measuresSurvival after C2 fracture according to non-surgical and surgical treatment was the outcome measure.MethodsWe included all patients treated for the primary diagnosis of C2 fracture (10th revision of the International Statistical Classification of Diseases and Related Health Problems or ICD-10: S12.1) at an age ≥70 years and receiving treatment at a health-care facility. Non-surgical treatment comprises cervical collar or halo-vest treatment. Surgical treatment was identified in the Swedish patient registry extract using the Swedish classification of procedural codes. Survival was determined using the Kaplan-Meier method. Comorbidity was determined using the Charlson Comorbidity Index.ResultsOf the included 3,375 elderly patients with C2 fractures (43% men, aged 83±7 years), 22% were treated surgically. Surgical treatment was assigned based on age, gender, and year of treatment. The 1-year survival of 2,618 non-surgically treated patients was 72% (n=1,856), and 81% (n=614) for the 757 surgically treated (p<.001, relative risk reduction=11%). Adjusted for age, gender, comorbidity, and year of injury, surgically treated patients had greater survival than non-surgically treated patients (hazard ratio=0.88, 95% confidence interval: 0.79–0.97). Among those above 88 years of age (95% confidence interval: 85–92), surgical treatment lost its effect on survival.ConclusionsDespite the frailty of elderly patients, the morbidity of cervical external immobilization with a rigid collar seemingly weighs greater than surgical morbidity, even in octogenarians. For those above 88 years of age, non-surgical treatment should be primarily attempted.
|
|
| 7. |
- Robinson, Anna-Lena, 1971-, et al.
(författare)
-
Surgical vs. non-surgical management of displaced type-2 odontoid fractures in patients aged 75 years and older : study protocol for a randomised controlled trial
- 2018
-
Ingår i: Trials. - : BMC. - 1745-6215. ; 19
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1-C2 fusion. Due to the paucity of evidence, the treatment decision is often left to the discretion of the expert surgeon.Methods: The Uppsala Study on Odontoid Fracture Treatment (USOFT) is a multicentre, open-label, randomised controlled superiority trial evaluating the clinical superiority of the surgical treatment of type-2 odontoid fractures, with a 1-year Neck Disability Index (NDI) as the primary endpoint. Fifty consecutive patients aged >= 75 years, with displaced type-2 odontoid fracture, are randomised to non-surgical or surgical treatment. Excluded are patients with an American Society of Anaesthesiologists (ASA) score >= 4, dementia nursing care or anatomical cervical anomalies. The minimal clinically important difference of the NDI is 3.5 points. A minimum of 16 patients are needed in each group to test the superiority with 80% power. By considering a 1-year mortality forecast of 29%, up to 25 participants are recruited in each group. The non-surgical group is fitted with a rigid cervical collar for 12 weeks. The surgical group is treated with a posterior C1-C2 fusion. All participants are monitored with regard to the NDI, EuroQol score (EQ-5D), socio-demographics and computed tomography (CT) at the time of injury, at 6 weeks, 3 months and 12 months. At 12 months, a dynamic radiographical investigation of upper cervical stability is performed. The secondary endpoints are: EQ-5D score, activities of daily living (ADL), bony union, upper cervical stability and mortality.Discussion: USOFT is the first randomised controlled trial comparing non-surgical and surgical management of type-2 odontoid fractures in the elderly. Using the NDI and EQ-5D as endpoints, future value-based decisions may consider quality-adjusted life years gained. Major limitations are (1) the allocation bias of the open-label study design, (2) that only higher training levels of all core specialties of spine surgery are included in the surgical treatment arm and (3) that only one type of surgical stabilisation is investigated (posterior C1-C2 fusion), while other methods are not included in this study.
|
|
| 8. |
- Robinson, Yohan, 1977-, et al.
(författare)
-
Complications and Survival after long Posterior Instrumentation of Cervical and Cervicothoracic Fractures related to Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis
- 2015
-
Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 40:4, s. E227-E233
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective cohort study.OBJECTIVE: This study investigates the results of long posterior instrumentation with regard to complications and survival.SUMMARY OF BACKGROUND DATA: Fractures of the cervical spine and the cervicothoracic junction related to ankylosing spinal disease (ASD) endanger both sagittal profile and spinal cord. Both anterior and posterior stabilization methods are well established, and clear treatment guidelines are missing.METHODS: Forty-one consecutive patients with fractures of the cervicothoracic junction related to ASD were treated by posterior instrumentation. All patients were followed prospectively for 2 years using a standardized protocol.RESULTS: Five patients experienced postoperative infections, 3 patients experienced postoperative pneumonia, 2 patients required postoperative tracheostomy, and 1 patient had postoperative cerebrospinal fluid leakage due to accidental durotomy. No patient required reoperation due to implant failure or nonunion. Mean survival was 52 months (95% confidence interval: 42-62 mo). Survival was affected by patient age, sex, smoking, and spinal cord injury.CONCLUSION: Patients with ASD experiencing a fracture of the cervicothoracic region are at high risk of developing complications. The posterior instrumentation of cervical spinal fractures related to ASD is recommended due to biomechanical superiority. Level of Evidence: 4.
|
|
| 9. |
|
|
| 10. |
- Robinson, Yohan, 1977-, et al.
(författare)
-
Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly
- 2014
-
Ingår i: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141. ; 2014, s. 231948-
-
Forskningsöversikt (refereegranskat)abstract
- Odontoid fractures type II according to Anderson and d’Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.
|
|
| 11. |
- Alruwaili, Abdullah, et al.
(författare)
-
Supporting the Frontlines: A Scoping Review Addressing the Health Challenges of Military Personnel and Veterans
- 2023
-
Ingår i: Healthcare (Switzerland). - 2227-9032. ; 11:12
-
Tidskriftsartikel (refereegranskat)abstract
- (1) Background: Military personnel and veterans meet unique health challenges that stem from the complex interplay of their service experiences, the nature of warfare, and their interactions with both military and civilian healthcare systems. This study aims to examine the myriad of injuries and medical conditions specific to this population, encompassing physical and psychological traumas. (2) Methods: A scoping review (systematic search and non-systematic review) was performed to evaluate the current landscape of military healthcare. (3) Results: A significant change in the injury profile over time is identified, linked to shifts in combat strategies and the integration of advanced technologies in warfare. Environmental exposures to diverse chemical or natural agents further complicate the health of service members. Additionally, the stressors they face, ranging from routine stress to traumatic experiences, lead to various mental health challenges. A major concern is the gap in healthcare accessibility and quality, worsened by challenges in the civilian healthcare system’s capacity to address these unique needs and the military healthcare system’s limitations. (4) Conclusions: This review underscores the need for holistic, integrated approaches to care, rigorous research, and targeted interventions to better serve the health needs of military personnel and veterans.
|
|
| 12. |
- Alruwaili, Abdullah, et al.
(författare)
-
The Use of Prehospital Intensive Care Units in Emergencies—A Scoping Review
- 2023
-
Ingår i: Healthcare (Switzerland). - 2227-9032. ; 11:21
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Amidst a rising tide of trauma-related emergencies, emergency departments worldwide grapple with the challenges of overcrowding and prolonged patient wait times. Addressing these challenges, the integration of prehospital intensive care units has appeared as a promising solution, streamlining trauma care and enhancing patient safety. Nevertheless, the feasibility of such an initiative becomes murky when considered globally. This review delves into the intricacies of prehospital intensive care units’ deployment for trauma care, scrutinizing their configurations, operational practices, and the inherent challenges and research priorities. Methods: A scoping review was performed for eligible studies. The result was uploaded to the RAYYAN research platform, facilitating simultaneous evaluation of the studies by all researchers. Results: A total of 42 studies were initially selected. Four studies were duplicates, and 25 studies were unanimously removed as irrelevant. The remaining studies (n = 13) were included in the review, and the outcomes were categorized into diverse subgroups. Conclusions: A country’s emergency medical services must achieve specific milestones in education, competency, resource availability, and performance to effectively harness the potential of a prehospital intensive care unit. While certain nations are equipped, others lag, highlighting a global disparity in readiness for such advanced care modalities.
|
|
| 13. |
|
|
| 14. |
- Atesok, Kivanc, et al.
(författare)
-
Posttraumatic Spinal Cord Injury without Radiographic Abnormality
- 2018
-
Ingår i: Advances in Orthopedics. - London : Hindawi Publishing Corporation. - 2090-3464 .- 2090-3472. ; 2018
-
Forskningsöversikt (refereegranskat)abstract
- “Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.
|
|
| 15. |
|
|
| 16. |
- Blimark, Magnus, 1963, et al.
(författare)
-
Swedish emergency hospital surgical surge capacity to mass casualty incidents
- 2020
-
Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 28:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background In Sweden the surgical surge capacity for mass casualty incidents (MCI) is managed by county councils within their dedicated budget. It is unclear whether healthcare budget constraints have affected the regional MCI preparedness. This study was designed to investigate the current surgical MCI preparedness at Swedish emergency hospitals. Methods Surveys were distributed in 2015 to department heads of intensive care units (ICU) and surgery at 54 Swedish emergency hospitals. The survey contained quantitative measures as the number of (1) surgical trauma teams in hospital and available after activating the disaster plan, (2) surgical theatres suitable for multi-trauma care, and (3) surgical ICU beds. The survey was also distributed to the Armed Forces Centre for Defence Medicine. Results 53 hospitals responded to the survey (98%). Included were 10 university hospitals (19%), 42 county hospitals (79%), and 1 private hospital (2%). Within 8 h the surgical capacity could be increased from 105 to 399 surgical teams, while 433 surgical theatres and 480 ICU beds were made available. The surgical surge capacity differed between university hospitals and county hospitals, and regional differences were identified regarding the availability of surgical theatres and ICU beds. Conclusions The MCI preparedness of Swedish emergency care hospitals needs further attention. To improve Swedish surgical MCI preparedness a national strategy for trauma care in disaster management is necessary.
|
|
| 17. |
- Bobinski, Lukas, et al.
(författare)
-
Early Versus Delayed Surgery for Cervical Disc Herniation
- 2019
-
Ingår i: Evidence for Neurosurgery - Effective Procedures and Treatment. - Cham, Schweiz : Springer International Publishing. - 9783030163228 ; , s. 175-171
-
Bokkapitel (refereegranskat)
|
|
| 18. |
- Carrwik, Christian, et al.
(författare)
-
Does knowledge of the primary tumour affect survival after surgery for spinal metastatic disease? : A retrospective longitudinal cohort study
- 2021
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:8
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare survival after surgery for patients with spinal metastatic disease with known primary tumour (KPT) versus patients with unknown primary tumour (UPT).PARTICIPANTS: 393 patients 18 years or older (270 men and 123 women, mean age 67.3 years) undergoing surgery at Uppsala University Hospital in Swedenbetween 2006 and 2016due to spinal metastatic disease . 271 patients (69%) had a KPT at the time of surgery and 122 (31%) had an UPT.INTERVENTIONS: Decompressive and/or stabilising spine surgery due to spinal metastatic disease.PRIMARY OUTCOME: Survival (median and mean) after surgery.RESULTS: The estimated median survival time after surgery for patients with KPT was 7.4 months (95% CI 6.0 to 8.7) and mean survival time was 21.6 months (95% CI 17.2 to 26.0). For patients with UPT, the median estimated survival time after surgery was 15.6 months (95% CI 7.5 to 23.7) and the mean survival time was 48.1 months (95% CI 37.3 to 59.0) (Breslow, p=0.001). Unknown primary cancer was a positive predictor of survival after surgery (Cox regression, HR=0.58, 95% CI 0.46 to 0.73).CONCLUSION: In this study, patients with spinal metastasis and UPT had a longer expected survival after surgery compared with patients with KPT. This suggests that patients with UPT and spinal metastasis should not be withheld from surgery only based on the fact that the primary tumour is unknown.
|
|
| 19. |
- Carrwik, Christian, et al.
(författare)
-
Potential harms of interventions for spinal metastatic disease
- 2017
-
Ingår i: Cochrane Database of Systematic Reviews. - : John Wiley and Sons Ltd. - 1469-493X. ; :7
-
Tidskriftsartikel (refereegranskat)abstract
- This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:The primary objective of this review is to compare the potential harms of treatment for spinal metastatic disease for the following treatments:1. Surgical intervention.2. Surgical intervention with radiation therapy.3. Radiation therapy alone.Our secondary objectives are:1. comparing the harms of different surgical methods;2. comparing the harms between different radiation protocols.
|
|
| 20. |
- Carrwik, Christian, et al.
(författare)
-
Predicting survival of patients with spinal metastatic disease using PathFx 3.0 – A validation study of 668 patients in Sweden
- 2022
-
Ingår i: Brain and Spine. - : Elsevier BV. - 2772-5294. ; 2
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction PathFx is a computer-based prediction model for estimating survival of patients with bone metastasis. The model has been validated in several studies, but this is the first validation using exclusively patients with spinal metastases. Research question Is PathFx 3.0 a tool useful for predicting survival for patients with spinal metastatic disease? Material and methods 668 patients (67% male, median age 67 years) presenting with spinal metastases at two university hospitals in Sweden 1991–2014 were included. Of those, the majority (82%, n=551) underwent surgery. Data on all patients was analyzed with PathFx version 3.0, generating a probability of survival at 1, 3, 6, 12, 18 and 24 months. The predictions were compared to real survival data and the precision in estimation was evaluated with Receiver-Operating Characteristic curve (ROC) analysis where the Area Under Curve (AUC) was calculated. Brier score and decision curve analyses were also assessed. Results The AUC for 1-, 3-, 6- and 12 months survival predictions were 0.64 (95% CI 0.5–0.71), 0.71 (95% CI 0.67–0.75), 0.70 (95% CI 0.66–0.77) and 0.74 (95% CI 0.70–0.78). For 18- and 24 months survival the AUC were 0.74 (95% CI 0.69–0.78) and 0.76 (95% CI 0.72–0.81). The Brier scores were all 0.23 or lower depending on the estimated survival time. Discussion and conclusion PathFx 3.0 is a reasonably reliable tool for predicting survival in patients with spinal metastatic disease. As the PathFx computer model can be updated to reflect advancements in oncology, we suggest this type of model, rather than rigid point-based scoring systems, to be used for estimating survival in patients with metastatic spinal disease in the future.
|
|
| 21. |
- Carrwik, Christian, et al.
(författare)
-
Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease : A Retrospective Study of 315 Patients in Sweden
- 2020
-
Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 45:6, s. 414-419
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Retrospective cohort study.OBJECTIVE: To validate the precision of four predictive scoring systems for spinal metastatic disease and evaluate whether they underestimate or overestimate survival.SUMMARY OF BACKGROUND DATA: Metastatic spine disease is a common complication to malignancies. Several scoring systems are available to predict survival and to help the clinician to select surgical or nonsurgical treatment.METHODS: Three hundred fifteen adult patients (213 men, 102 women, mean age 67 yr) undergoing spinal surgery at Uppsala University Hospital, Sweden, due to metastatic spine disease 2006 to 2012 were included. Data were collected prospectively for the Swedish Spine Register and retrospectively from the medical records. Tokuhashi scores, Revised Tokuhashi Scores, Tomita scores, and Modified Bauer Scores were calculated and compared with actual survival data from the Swedish Population Register.RESULTS: The mean estimated survival time after surgery for all patients included was 12.4 months (confidence interval 10.6-14.2) and median 5.9 months (confidence interval 4.5-7.3). All four scores had significant correlation to survival (P < 0.0001) but tended to underestimate rather than overestimate survival. Modified Bauer Score was the best of the four scores to predict short survival, both regarding median and mean survival. Tokuhashi score was found to be the best of the scores to predict long survival, even though the predictions were inaccurate in 42% of the cases.CONCLUSION: Predictive scores underestimate survival for the patients which might affect important clinical decisions.LEVEL OF EVIDENCE: 3.
|
|
| 22. |
-
Cervical Spine Surgery: Standard and Advanced Techniques : Cervical Spine Research Society - Europe Instructional Surgical Atlas
- 2019
-
Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- This comprehensive, up-to-date textbook of modern cervical spine surgery describes the standard and advanced techniques recommended by the Cervical Spine Research Society – European Section (CSRS-E) with a view to enabling both young and experienced surgeons to further develop their skills and improve their surgical outcomes. Success in cervical spine surgery depends on the surgeon’s awareness of the main challenges posed by distinct cervical spine diseases, theoretical understanding of treatment concepts, and knowledge of technical options and the related potential for complications. It is the surgeon who has to merge theory and practice to achieve the desired outcome, in each case appraising the details of surgical anatomy and weighing the challenges and complications associated with a surgical technique against the skills that he or she possesses. This excellently illustrated book, written by key opinion makers from the CSRS-E with affiliated surgeons as co-authors, presents the full range of approaches and techniques and clearly identifies indications, precautions, and pitfalls. It will be a superb technical reference for all cervical spine surgeons, whether orthopaedic surgeons or neurosurgeons.
|
|
| 23. |
- Chevalley, Karl, et al.
(författare)
-
Civilt skadepanorama i krig: En litteraturanalys över ett halvt sekel av krig
- 2023
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The Centre for Disaster Medicine at the University of Gothenburg has been tasked by the National Board of Health and Welfare (Socialstyrelsen) to compile a knowledge base regarding civilian injury patterns in warfare. This assignment falls within the framework of reestablished planning and the reconstruction of the civilian defense. The assignment also included highlighting potential differences between children and adults, as well as addressing the risk of infections. The systematic review aimed at identifying civilian injury patterns in modern warfare between 1973 and 2023. Out of 2,228 screened search results, 62 scientific articles and reports about civilian injury patterns have been included. The civilian injury pattern is presented as injury distribution per body region: 26% head injuries, 18% chest injuries, 10% abdomen and pelvis injuries, 4% spinal injuries, 32% upper extremity injuries, 18% lower extremity injuries and 16% burn injuries. There is no standardized way or method to report and describe civilian injury outcomes and injury patterns. We observed that there was no consistent reporting of injury distribution in the included studies. Variations in how injuries were reported complicated the synthesis of results. However, it appears that the civilian injury panorama remains relatively constant in its distribution over time despite differing conflicts, geographical spread, and the varying nature of wars. Knowledge about civilian injury patterns in warfare constitutes a part of the dimensioned planning prerequisites in preparedness planning for medical care in times of war.
|
|
| 24. |
- Covaro, Augusto Atilio, et al.
(författare)
-
The importance of the occipitocervical area in patients with ankylosing spondylitis : analysis of a cohort of 86 cervical fractures in surgically treated patients.
- 2017
-
Ingår i: Journal of Craniovertebral Junction and Spine. - : Wolters Kluwer. - 0974-8237 .- 0976-9285. ; 8:4, s. 374-377
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design: This was a retrospective analysis of prospectively collected data.Objective: The effect of C0-C1-C2 cervical ankylosis in patients with ankylosing spondylitis (AS) is not documented. The objective of this study is to describe the radiological characteristics of the occipitocervical junction in patients with AS operated for a cervical fracture and to correlate them with their clinical evolution.Materials and Methods: Analysis of patients with ankylosing spondylitis (AS) treated in a single institution of a cervical vertebral fracture between 2007 and 2014 who were prospectively followed through the SWESPINE registry. The integrity of the C0-C1-C2 joints was determined and classified into fused and nonfused joints. By determining the angle between C0-C1 and C1-C2 joints in the coronal view of the computed tomography scan (X-angle), the progressive degeneration of these joints was described. Intra- and inter-observer reliability of this test was determined. The instruments of health-related quality of life (QOL) and disability were EQ5D and Oswestry disability index (ODI), respectively.Results: A total of 86 patients with AS treated surgically for cervical fracture had complete facet ankylosis between C3 and T1 due to their pathology. Mean age 69.2 years (standard deviation [SD]: 11.7). The most common level of fracture was in C5-C6. In 24 patients, the C0-C1 joint was fused, and in 15 patients, C1-C2 joint was fused. The intra- and inter-class reliabilities for X-angle measurement were very high (intraclass correlation coefficients = 0.94; 0.92). The mean X-angle was 125° (SD: 12) in nonfused patients and 136° (SD: 14) in fused patients (P < 0.001). There were no differences in QOL and disability at 2 years between the two groups: EQ5D-index of 0.54 and 0.55 (P = 0.5), ODI of 26.4 and 24, (P = 0.35) respectively.Conclusions: X-angle is a reliable measure for joint integrity C0-C1-C2 in patients with AS. Total cervical ankylosis including the C0-C1-C2 segments is not related to poorer QOL and disability in these patients.
|
|
| 25. |
- Cristancho, Edgar, et al.
(författare)
-
Arterial oxygen saturation and hemoglobin mass in postmenopausal untrained and trained altitude residents.
- 2007
-
Ingår i: High altitude medicine & biology. - : Mary Ann Liebert Inc. - 1527-0297 .- 1557-8682. ; 8:4, s. 296-306
-
Tidskriftsartikel (refereegranskat)abstract
- Because of lacking ventilatory stimulation by sex hormones in postmenopausal women (PW), one might expect a lowered arterial oxygen saturation (S(O(2))) in hypoxia and therefore a stronger erythropoietic reaction than in young women (YW). Nine untrained (UTRPW) and 11 trained (TRPW) postmenopausal altitude residents (2600 m) were compared to 16 untrained (UTRYW) and 16 trained young women (TRYW) to check this hypothesis and to study the combined response to hypoxia and training. S(O(2)) was decreased in PW (89.2% +/- 2.2 vs. 93.6 +/- 0.7% in YW, p < 0.01). Hb mass, however, was similar in UT (UTRYW: 9.2 +/- 0.9 g/kg(1), UTRPW: 8.7 +/- 1.0 g/kg). But if body fat rise with age was excluded by relation to fat-free mass, Hb mass was increased in UTRPW (+1.2 g/kg, p < 0.05) compared to UTRYW. Training caused a similar rise of Hb mass in PW and YW (0.3 g/kg per mL/kg x min(1) rise in V(O(2peak))). There was no difference in erythropoietin among the groups. Ferritin was higher in PW than YW. The results show that female hormones and fitness level have to be considered in studies on erythropoiesis at altitude. The role of erythropoietin during chronic hypoxia still has to be clarified.
|
|
| 26. |
- Elmekaty, Mohamed, et al.
(författare)
-
Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degenerative Spondylolisthesis : Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Surgical Transforaminal Lumbar Interbody Fusion versus Midline Lumbar Fusion
- 2018
-
Ingår i: Asian Spine Journal. - : KOREAN SOC SPINE SURGERY. - 1976-1902 .- 1976-7846. ; 12:5, s. 870-879
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design: Retrospective cohort study.Purpose: Comparison between three different minimally invasive surgical (MIS) fusion techniques for single-level lumbar spondylolisthesis.Overview of Literature: There has been an increase in the development and utilization of MIS techniques for lumbar spine fusion. No study has compared the efficacy of MIS-posterolateral fusion (MIS-PLF), MIS-transforaminal lumbar interbody fusion (MIS-TLIF), and midline lumbar fusion (MIDLF) with modified cortical bone trajectory screws for lumbar spondylolisthesis.Methods: Fifty-nine patients with single-level lumbar spondylolisthesis and a minimum follow-up period of 1 year were included in this study. The MIS-PLF, MIS-TLIF, and MIDLF groups included 22, 15, and 22 patients, respectively. The average age of the groups was 70.6, 49.3, and 62.7 years, respectively. The evaluation parameters were operation time, intraoperative bleeding, serum C-reactive protein (CAP) value, creatine kinase (CK) value, and overall functional outcome as per the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score. The changes in the lumbar lordosis angle (LLA), segmental disc angle (SDA), and disc height were measured. Fusion rate, screw loosening, and loss of correction were also assessed.Results: MIDLF showed a significantly shorter operation time (111 min), less bleeding amount (112.5 mL), and lower values of CRP and CK than the other two techniques. There was no significant difference in the JOABPEQ scores of the three groups. MIDLF resulted in a greater increase in the LLA and SDA postoperatively. MIDLF and MIS-TLIF resulted in a significant increase in the middle disc height compared with MIS-PLF. MIDLF showed a lower loss of correction after 6 months postoperatively (2.6%) than MIS-PLF (5.2%) and MIS-TLIF (4.2%). The fusion rate was 100% in the MIDLF and MIS-TLIF groups and 90% in the MIS-PLF group. Screw loosening occurred in 10% of the MIS-PLF cases, 7.14% of the MIS-TLIF cases, and 4.76% of the MIDLF cases.Conclusions: MIDLF was the least invasive, and there was no significant difference between the three groups in terms of fusion, screw loosening, and clinical outcomes.
|
|
| 27. |
- Elmekaty, Mohamed, et al.
(författare)
-
Safety of a novel modular cage for transforaminal lumbar interbody fusion : clinical cohort study in 20 patients with degenerative disc disease
- 2018
-
Ingår i: SICOT-J. - : EDP SCIENCES S A. - 2426-8887. ; 4
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation. Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence. Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone(PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan. Results: 20 patients (age 66 +/- 10 years, 65% female, BMI 28 +/- 5 kg/m(2)) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 +/- 14.5 and 7.3 +/- 3.6 to 52.7 +/- 9.1 and 10.5 +/- 3.5 (p=0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred. Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage.
|
|
| 28. |
|
|
| 29. |
- Gulle, Eva, et al.
(författare)
-
Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery - a prospective randomized trial in 150 patients.
- 2011
-
Ingår i: Patient safety in surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 5:1
-
Tidskriftsartikel (refereegranskat)abstract
- Epidural analgesia with bupivacain, epinephrine and fentanyl provides excellent pain control after lumbar fusion surgery, but pruritus and motor block are frequent side effects. Theoretically epidural ropivacain combined with oral oxycodone could decrease the incidence of these side effects. The two regimens were compared in a prospective randomized trial.150 patients (87 women) treated with posterior instrumented lumbar fusion were included. The mean age was 51 +/- 11 years. 76 were randomized to bupivacain, epinephrine and fentanyl (group B) and 74 to ropivacain and oxycodone (group R). Pruritus, motor block and pain were measured 6 hours after surgery, thereafter 6 times per day for 5 days. Any pain breakthrough episode was registered whenever it occurred.The epidural treatment could be performed in 143 patients (72 in group B and 71 in group R). Disturbing pruritus occurred in 53 patients in group B compared to 12 in group R (p < 0.0001). Motor blockade was most frequent on day 1, occurring in 45% of the patients with no difference between the groups. Both regimes gave good pain control with average VAS under 40, but the pain relief was statistically better in group B. The number of pain breakthrough episodes did not differ between the groups.Pruritus could be reduced with a combination of epidural ropivacain and oral oxycodone, at the price of a slightly higher pain level. Ropivacaine was not found to be superior to bupivacaine with regard to motor blocks.
|
|
| 30. |
- Heyde, Christoph-E., et al.
(författare)
-
C1 Lateral Mass Screw Fixation
- 2019
-
Ingår i: Koller H., Robinson Y. (eds) Cervical Spine Surgery: Standard and Advanced Techniques.. - Cham, Schweiz : Springer. - 9783319934310
-
Bokkapitel (refereegranskat)abstract
- C1 lateral mass screws according to Goel and Harms represent a safe and stable stabilization of the atlas within posterior constructs. Those constructs avoiding transarticular C1-C2 screws allow for different reduction manoeuvers after screw insertion. By preoperative planning, the course of the vertebral artery has to be visualized to avoid potentially disastrous injuries. Proper subperiosteal preparation is necessary to avoid copious bleeding from the venous plexus below the C1 arch. Under lateral visualization, screws can be placed in the C1 lateral mass without the necessity of sacrificing the C2 root. C1 screws should converge about 10–20°, and bicortical screw placement is preferred.
|
|
| 31. |
- Heyde, C E, et al.
(författare)
-
[Fatal complex fracture of the cervical spine in a patient with ankylosing spondylitis after a fall from a racing bicycle]. : Fatale komplexe HWS-Verletzung bei M. Bechterew nach Sturz mit dem Rennrad.
- 2007
-
Ingår i: Sportverletzung Sportschaden : Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin. - : Georg Thieme Verlag KG. - 0932-0555. ; 21:3, s. 148-51
-
Forskningsöversikt (refereegranskat)abstract
- Patients with ankylosing spondylitis are endangered suffering from cervical spine fractures following falls caused by kyphosis, stiffness and osteoporotic bone quality of the spine. Risk sustaining neurological deficits is higher than average. We present a patient with ankylosing spondylitis, who was admitted to our hospital with a complex fracture pattern of the cervical spine after a fall from a racing cycle. In spite of early operative treatment the patient died in the follow up because of severe hypoxic brain damage. We discuss the area of conflict between the recommendation for sport activities in patients with ankylosing spondylitis and the resulting risks for the diseased spine.
|
|
| 32. |
- Heyde, Christoph E, et al.
(författare)
-
Fatale komplexe HWS-Verletzung bei M. Bechterew nach Sturz mit dem Rennrad
- 2007
-
Ingår i: Sportverletzung, Sportschaden. - : Georg Thieme Verlag KG. - 0932-0555 .- 1439-1236. ; 21:3, s. 148-151
-
Tidskriftsartikel (refereegranskat)abstract
- Patienten mit ankylosierender Spondylitis sind durch die Kyphose, die Einsteifung und den häufig osteoporotischen Knochen der Wirbelsäule im Rahmen von Stürzen für Verletzungen der Halswirbelsäule besonders prädestiniert. Dabei besteht ein überdurchschnittlich hohes Risiko für neurologische Komplikationen. Vorgestellt wird ein Patient mit M. Bechterew, der bei einem Sturz mit dem Rennrad eine komplexe HWS-Verletzung erlitt. Trotz umgehender operativer Versorgung kam es im weiteren Verlauf zum Tod des Patienten durch einen schweren hypoxischen Hirnschaden. Vor dem Hintergrund dieses fatalen Verlaufes sollen die Empfehlungen zur sportlichen Betätigung bei M. Bechterew und die sich daraus für die veränderte Wirbelsäule ergebenden Gefahren diskutiert werden.
|
|
| 33. |
- Heyde, Christoph-Eckhard, et al.
(författare)
-
Kyphoplastie : Indikation und Durchführung
- 2013
-
Ingår i: Chirurgische Praxis. - 0009-4846. ; 76:1, s. 63-74
-
Tidskriftsartikel (refereegranskat)abstract
- The minimally invasive procedure of kyphoplasty has become an established method of treatment in both osteoporotic compression fractures and malignant osteolytic lesions of the spine. In cautious consideration of the correct indication and technical implementation, kyphoplasty is a safe procedure with low risk of complications. In comparison to conservative treatment regimens, postoperative clinical outcome parameters have shown promising results in pain reduction and the improvement of function and quality of life in both short-term and mid-term evaluations. However, kyphoplasty as a surgical procedure shall always be considered a component within the overall therapeutic concept. Thus, a comprehensive medical attendance and the consistent treatment of the underlying disease are essential to a successful therapeutic outcome.
|
|
| 34. |
|
|
| 35. |
- Heyde, Christoph-Eckhard, et al.
(författare)
-
Kyphoplastie: Indikation und praktische Durchführung. [Kyphoplasty. Indication and practical guidelines]
- 2012
-
Ingår i: Tägliche Praxis. - : Hans Marseille Vertrieb. - 0494-464X. ; 53:4, s. 799-810
-
Tidskriftsartikel (refereegranskat)abstract
- The minimally invasive procedure of kyphoplasty has become an established method of treatment in both osteoporotic compression fractures and malignant osteolytic lesions of the spine. In cautious consideration of the correct indication and technical implementation, kyphoplasty is a safe procedure with low risk of complications. In comparison to conservative treatment regimens, postoperative clinical outcome parameters have shown promising results in pain reduction and the improvement of function and quality of life in both short-term and mid-term evaluations. However, kyphoplasty as a surgical procedure shall always be considered a component within the overall therapeutic concept. Thus, a comprehensive medical attendance and the consistent treatment of the underlying disease are essential to a successful therapeutic outcome.
|
|
| 36. |
- Heyde, Christoph-E, et al.
(författare)
-
Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis.
- 2008
-
Ingår i: Patient safety in surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 2
-
Forskningsöversikt (refereegranskat)abstract
- Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries.
|
|
| 37. |
- Heyde, C E, et al.
(författare)
-
[Treatment options for problematic thoracic and lumbar osteoporotic fractures]. : Behandlungsmöglichkeiten bei thorakalen und lumbalen osteoporotischen Problemfrakturen.
- 2008
-
Ingår i: Der Orthopade. - : Springer Science and Business Media LLC. - 0085-4530 .- 1433-0431. ; 37:4, s. 307-20
-
Forskningsöversikt (refereegranskat)abstract
- Most osteoporotic sintering fractures are treated conservatively. However, persistent pain and consecutive spinal deformity may require certain cement-augmenting interventions. These procedures have proven their intermediate-term efficacy in pain reduction, prevention of progressive sintering and improvement of the overall quality of life in the majority of patients. In fractures with relevant spinal stenosis, persisting instability, gross deformity and trauma-associated osteoporotic fractures with or without neurological deficits, the therapeutic options may call for more extensive surgical procedures. In this regard, poor bone quality, age and respective comorbidities of the individual patient must be considered during preoperative planning and management. This article provides an overview of the diverse problem-solving strategies discussed in today's literature. It is generally acknowledged that any decision to perform surgery on an osteoporotic fracture is strongly case-dependent. Treating physicians must therefore master the complete therapeutic spectrum in order to meet this complex orthopedic challenge appropriately.
|
|
| 38. |
- Heyde, Christoph-E., et al.
(författare)
-
Ätiologie und Pathogenese der Spondylodiszitis
- 2017
-
Ingår i: Die Wirbelsäule. - Stuttgart : Georg Thieme Verlag KG. - 2509-8241 .- 2509-825X. ; 01:04, s. 237-244
-
Tidskriftsartikel (refereegranskat)abstract
- Die Häufigkeit der unspezifischen „pyogenen“ und der verschiedenen Formen der spezifischen Spondylodiszitiden nimmt zu. Die Gründe dafür sind vielfältig. Diese Erkrankungen sind auch heute noch mit einer relevanten Morbidität und Mortalität vergesellschaftet. Die Diagnose erfolgt aufgrund der unspezifischen klinischen Manifestation häufig verzögert. Die Kenntnis der Epidemiologie, der Ätiologie und der Pathogenese der verschiedenen Formen der Spondylodiszitis kann die frühzeitige Diagnose und damit den Beginn der Therapie als auch die Therapie an sich erleichtern. In diesem Artikel werden deshalb epidemiologische Daten und wesentliche Aspekte der Ätiologie und Pathogenese der unspezifischen pyogenen Spondylodiszitis sowie der verschiedenen Formen der spezifischen Spondylodiszitis bei Tuberkulose, bei Brucellose und bei Pilzinfektionen diskutiert.
|
|
| 39. |
- Hirasawa, Atsuhiko, et al.
(författare)
-
Regional Differences in Diffuse Idiopathic Skeletal Hyperostosis : A Retrospective Cohort Study from Sweden and Japan
- 2018
-
Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 43:24, s. E1474-E1478
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design: We retrospectively reviewed computed tomography (CT) records of patients in Japan and Sweden, which are both aging populations. Objective. To research the influence of ethnicity and region on diffuse idiopathic skeletal hyperostosis (DISH) prevalence.Summary of Background Data_ DISH can complicate nonsurgical treatment of spinal fractures and often requires surgical intervention. We previously reported a prevalence of DISH in Japan that was higher than that reported in other studies.Methods: We retrospectively reviewed CT records of patients in Japan and Sweden, which have both aging populations. Patients undergoing whole body CT during trauma examinations at an acute outpatient clinic in Uppsala University Hospital in a 1-year period were eligible for inclusion. Excluded were those less than 40 and more than or equal to 90 years old, and those with previous spinal surgery. The prevalence of DISH by sex and age was determined according to radiographic criteria by Resnick. Results from Sweden were compared with the Japan data, which we previously reported.Results: Age of the eligible subjects (265 men and 153 women) ranged from 40 to 89 years, with a mean age of 63.4 years. Among men, 86 (32.5%) were diagnosed with DISH, and the results by age (40s, 50s, 60s, 70s, and 80s) were: 6 (10.7%), 13 (22%), 35 (46.1%), 17 (34%), and 15 (62.5%) patients, respectively. Among women, 16 (10.5%) had DISH, and the results by age were as follows: 1 (2.6%), 1 (3.3%), 2 (6.7%), 6 (22.2%), and 6 (22.2%) patients, respectively. These results did not differ from those previously published for Japan (Fisher exact test, men: P = 1, 0.27, 0.12, 0.06, and 1, respectively; women: P = 0.49, 0.62, 0.5, 0.8, and 0.3, respectively).Conclusion: The presented cohort study revealed that ethnicity and region may not be notable factors of DISH prevalence, since patients from both Japan and Sweden had similar DISH prevalence.Level of Evidence: 3
|
|
| 40. |
- Hostmann, Arwed, et al.
(författare)
-
Biphasic onset of splenic apoptosis following hemorrhagic shock: critical implications for Bax, Bcl-2, and Mcl-1 proteins.
- 2008
-
Ingår i: Critical care (London, England). - : Springer Science and Business Media LLC. - 1466-609X .- 1364-8535. ; 12:1
-
Tidskriftsartikel (refereegranskat)abstract
- The innate immune response to trauma hemorrhage involves inflammatory mediators, thus promoting cellular dysfunction as well as cell death in diverse tissues. These effects ultimately bear the risk of post-traumatic complications such as organ dysfunction, multiple organ failure, or adult respiratory distress syndrome. In this study, a murine model of resuscitated hemorrhagic shock (HS) was used to determine the apoptosis in spleen as a marker of cellular injury and reduced immune functions.Male C57BL-6 mice were subjected to sham operation or resuscitated HS. At t = 0 hours, t = 24 hours, and t = 72 hours, mice were euthanized and the spleens were removed and evaluated for apoptotic changes via DNA fragmentation, caspase activities, and activation of both extrinsic and intrinsic apoptotic pathways. Spleens from untreated mice were used as control samples.HS was associated with distinct lymphocytopenia as early as t = 0 hours after hemorrhage without regaining baseline levels within the consecutive 72 hours when compared with sham and control groups. A rapid activation of splenic apoptosis in HS mice was observed at t = 0 hours and t = 72 hours after hemorrhage and predominantly confirmed by increased DNA fragmentation, elevated caspase-3/7, caspase-8, and caspase-9 activities, and enhanced expression of intrinsic mitochondrial proteins. Accordingly, mitochondrial pro-apoptotic Bax and anti-apoptotic Bcl-2 proteins were inversely expressed within the 72-hour observation period, thereby supporting significant pro-apoptotic changes. Solely at t = 24 hours, expression of the anti-apoptotic Mcl-1 protein shows a significant increase when compared with sham-operated and control animals. Furthermore, expression of extrinsic death receptors were only slightly increased.Our data suggest that HS induces apoptotic changes in spleen through a biphasic caspase-dependent mechanism and imply a detrimental imbalance of pro- and anti-apoptotic mitochondrial proteins Bax, Bcl-2, and Mcl-1, thereby promoting post-traumatic immunosuppression.
|
|
| 41. |
- Hugelius, Karin, et al.
(författare)
-
Katastrofmedicin måste bli obligatorisk utbildning
- 2020
-
Ingår i: Dagens Nyheter. - 1101-2447. ; 2020:13 JULI
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Experter inom svensk katastrof- och försvarsmedicin: Svenska läkare och sjuksköterskor får otillräcklig utbildning för att kunna ge vård i kris och krig. Ämnesområdet måste bli en obligatorisk del i grundutbildningen så att vi står rustade även inför nästa kris, oavsett om det är en pandemi, naturkatastrof eller ett terrordåd.
|
|
| 42. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
-
Civilian-Military Collaboration before and during COVID-19 Pandemic—A Systematic Review and a Pilot Survey among Practitioners
- 2022
-
Ingår i: Sustainability. - : MDPI AG. - 2071-1050. ; 14:2
-
Tidskriftsartikel (refereegranskat)abstract
- Due to the similarity in skills and assets, Civilian-Military collaboration has emerged as one of the most reliable partnerships during the disaster and public health emergency management to address all necessary elements of surge capacity, i.e., staff, stuff, structure (space), and systems. This study aimed to evaluate this collaboration before and during the coronavirus 2019 pandemic. The outcomes of the systematic review revealed several published reports on successful civilian-military collaboration and proposed a need for further improvement. One hundred sixty-six individuals from 19 countries responded to nine questions, included in an online survey with the possibility to leave comments if necessary. The questionnaire referred to elements such as command and control, safety, communication, assessment, triage, treatment, and transport, as the crucial components of emergency management. The comprehensive examination of the survey results together with registered comments revealed a possible improvement in collaboration particularly on the strategic levels, i.e., meetings at the command-and-control level, safety, communication, and networking issues. While logistic collaboration seemed to be unchanged, the practical parts of the collaboration, i.e., clinical and non-clinical operational partnership (Triage and Treatment), mutual education, training, and operational understanding of each organization remained unchanged. In conclusion, although the current pandemic may have facilitated a more intense collaboration between civilian and military healthcare organizations, it lacks practical partnership and operative engagement, representing two crucial elements necessary for harmony and compatibility of both systems. Such collaboration may require a political will and perhaps a mutual civilian-military authority.
|
|
| 43. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
-
Estimating the Number of Civilian Casualties in Modern Armed Conflicts–A Systematic Review
- 2021
-
Ingår i: Frontiers in Public Health. - : Frontiers Media SA. - 2296-2565. ; 9
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the possibility of estimating the number of civilian casualties in modern armed conflicts. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Scopus, and Web of Science search engines. The outcome was analyzed using a qualitative inductive thematic analysis. The scientific evidence of selected article was assessed, using the Health Evidence Quality Assessment Tool. Findings: The review of 66 included articles in this study indicates that with an increasing number of public health emergencies and the lack of vital elements of life such as water and food, emerging armed conflicts seem to be inevitable. In contrast to military-led cross-border traditional wars, modern armed conflicts affect internally on local communities and take civilian lives. Consequently, the measures and tools used in traditional military-led cross-border wars to adequately tally wounded and dead for many decades under the mandates of the International Humanitarian Law, is insufficient for modern warfare. While casualty counting during modern conflicts is deficient due to organizational, political or strategic reasons, the international organizations responsible for collecting such data (the International Federation of Red Cross and Red Crescent and International Institute of Humanitarian Law) face difficulties to access the conflict scene, resulting in under-reported, unreliable or no-reported data. Conclusion: There are challenges in estimating and counting the number of civilian casualties in modern warfare. Although the global need for such data is evident, the risks and barriers to obtaining such data should be recognized, and the need for new international involvement in future armed conflicts should be emphasized.
|
|
| 44. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
-
Management of COVID-19 Pandemic - The Swedish Perspective
- 2020
-
Ingår i: HealthManagement.Org: The Journal. - 1377-7629. ; 20:7, s. 516-19
-
Tidskriftsartikel (refereegranskat)abstract
- Among all countries affected by COVID-19, the Swedish pandemic strategy has polarised the political and global media response, where both condemning and acknowledging voices are heard. The question thus arises whether the Swedish approach is unique, and what reasoning leads to this strategy. This report does not discuss the outcome or validity of this strategy but aims to explain the current Swedish approach to COVID-19 management, which is not medically unique but requires a specific socio-political setting. Irrespective of the approach, the world needs to be ready for the next pandemic or public health emergency through investing in social development, community empowerment, and educational initiatives.
|
|
| 45. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
-
Review of Military Casualties in Modern Conflicts-The Re-emergence of Casualties From Armored Warfare.
- 2022
-
Ingår i: Military medicine. - : Oxford University Press (OUP). - 1930-613X .- 0026-4075. ; 187:3-4
-
Tidskriftsartikel (refereegranskat)abstract
- The re-emergence of armored warfare in modern conflicts has resulted in a higher number of extremity injuries, burns, and brain injuries. Despite this dramatic increase, little is reported on the type of injuries caused and their management. This review summarizes the publicly available literature and reports on the rate and type of injuries related to armored warfare, their medical outcomes, and management limitations.This rapid evidence review involves a systematic literature search, followed by a non-systematic literature review. The reason for choosing this approach was the inherent lack of quantitative outcome data in the literature to satisfy the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study also used content analysis to study all peer-reviewed articles, focusing on similarities and differences in the findings necessary to formulate tentative results. The electronic search included PubMed, Scopus, and Web of Science, using the following search string: "Armored; Injuries; Mechanized; Morbidity; Mortality; War; Warfare", alone or in combination.Modern conflicts are associated with higher number of extremity injuries, burns, and brain injuries among military casualties. Several publications claim that the characteristics of armored warfare and anticipated injuries in this type of warfare might require the far forward deployment of medical support supported by a reliable casualty evacuation chain. Still the quality of the available casualty data is low.Because of the limited availability of reliable data or military trauma registries, up-to-date military casualty estimation remains a recognized knowledge gap, which needs to be addressed by armed forces worldwide. The future management of modern war casualties requires professional and well-trained staff in all levels, indicating a need for educational initiatives to provide both nurses and medics a greater proportion of medical care and management capabilities and responsibilities than in past conflicts.
|
|
| 46. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
-
The Development of Swedish Military Healthcare System: Part II-Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners.
- 2021
-
Ingår i: Military medicine. - : Oxford University Press (OUP). - 1930-613X .- 0026-4075. ; 186:3-4
-
Tidskriftsartikel (refereegranskat)abstract
- Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian-military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military's involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated.A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model.The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies.As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.
|
|
| 47. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
-
The History of Swedish Military Healthcare System and Its Path Toward Civilian-Military Collaboration From a Total Defense Perspective.
- 2020
-
Ingår i: Military medicine. - : Oxford University Press (OUP). - 1930-613X .- 0026-4075. ; 185:9-10
-
Tidskriftsartikel (refereegranskat)abstract
- The interaction between military and civilian healthcare systems has contributed to the development of medical care. Swedish innovations such as the Seldinger technique for angiography, Leksell Gamma Knife for cranial surgery, and the introduction of pacemakers and ultrasound have contributed to the global development of medicine. Several authors have described the Swedish civilian healthcare system and its development. However, the development and history of its military healthcare system and its influence on the civilian healthcare system remain untold. This review aims to describe the historical development of the Swedish military healthcare system and its path toward civilian-military collaboration and a total defense healthcare system.A search for all published scientific papers in Swedish and English, along with available legal documents and directives, was made. We used CINAHL, PubMed, Scopus, and Gothenburg University's databases and search engines. The following keywords, Swedish, military, civilian, healthcare, collaboration, and development, were searched for, alone or in combination, using a PRISMA flow chart. Duplicates, abstracts, and nonscientific publications were excluded.Each of the four distinct periods of historical development in the Swedish military healthcare system can be characterized by the changes necessary for transforming Sweden from an aggressive to a defensive and collaborative nation, with national and international engagement. Collaboration not only encompasses readiness and willingness to share resources and information, and to adjust routines and guidelines, but also needs a culture of consensus and respect for each other's limitations and capabilities. The definition of military medicine and the military physician's role in Sweden is imperative for further civilian-military collaboration.Recent global sociopolitical changes necessitate civilian-military healthcare collaboration. Although civilian-military healthcare partnerships in various medical fields have been reported earlier, the Swedish concept of total defense's healthcare system integration and collaboration may be a more fruitful approach. The collaboration within the total defense healthcare system will result in technical achievements, innovations, and medical advancements for the benefit of the whole nation.
|
|
| 48. |
- Koller, Heiko, et al.
(författare)
-
Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK) : results of the CSRS-Europe multi-centre study project
- 2018
-
Ingår i: European spine journal. - : Springer Nature. - 0940-6719 .- 1432-0932. ; 28:2, s. 324-344
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND PURPOSE: Little information exists on surgical characteristics, complications and outcomes with corrective surgery for rigid cervical kyphosis (CK). To collate the experience of international experts, the CSRS-Europe initiated an international multi-centre retrospective study.METHODS: Included were patients at all ages with rigid CK. Surgical and patient specific characteristics, complications and outcomes were studied. Radiographic assessment included global and regional sagittal parameters. Cervical sagittal balance was stratified according to the CSRS-Europe classification of sagittal cervical balance (types A-D).RESULTS: Eighty-eight patients with average age of 58 years were included. CK etiology was ankylosing spondlitis (n = 34), iatrogenic (n = 25), degenerative (n = 9), syndromatic (n = 6), neuromuscular (n = 4), traumatic (n = 5), and RA (n = 5). Blood loss averaged 957 ml and the osteotomy grade 4.CK-correction and blood loss increased with osteotomy grade (r = 0.4/0.6, p < .01). Patients with different preop sagittal balance types had different approaches, preop deformity parameters and postop alignment changes (e.g. C7-slope, C2-7 SVA, translation). Correction of the regional kyphosis angle (RKA) was average 34° (p < .01). CK-correction was increased in patients with osteoporosis and osteoporotic vertebrae (POV, p = .006). 22% of patients experienced a major long-term complication and 14% needed revision surgery. Patients with complications had larger preop RKA (p = .01), RKA-change (p = .005), and postop increase in distal junctional kyphosis angle (p = .02). The POV-Group more often experienced postop complications (p < .0001) and revision surgery (p = .02). Patients with revision surgery had a larger RKA-change (p = .003) and postop translation (p = .04). 21% of patients had a postop segmental motor deficit and the risk was elevated in the POV-Group (p = .001).CONCLUSIONS: Preop patient specific, radiographic and surgical variables had a significant bearing on alignment changes, outcomes and complication occurrence in the treatment of rigid CK.
|
|
| 49. |
- MacDowall, Anna, et al.
(författare)
-
Anxiety and depression affect pain drawings in cervical degenerative disc disease
- 2017
-
Ingår i: Upsala Journal of Medical Sciences. - : TAYLOR & FRANCIS LTD. - 0300-9734 .- 2000-1967. ; 122:2, s. 99-107
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Pain drawings have been frequently used in the preoperative evaluation of spine patients. Until now most investigations have focused on low back pain patients, even though pain drawings are used in neck pain patients as well. The aims of this study were to investigate the pain drawing and its association to preoperative demographics, psychological impairment, and pain intensity. Methods: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. Preoperatively the patients completed a pain drawing, the Hospital Anxiety and Depression Scale (HADS), and a visual analogue scale (VAS). The pain drawing was evaluated according to four established methods, now modified for cervical conditions. Comparisons were made between the pain drawing and age, sex, smoking, and employment status as well as HADS and VAS. Results: Included were 151 patients, mean age of 47 years, female/male: 78/73. Pain drawing results were not affected by age, sex, smoking, and employment status. Patients with non-neurogenic pain drawings according to the modified method by Ransford had higher points on HADS-anxiety, HADS-depression, and HADS-total. Patients with markings in the head region had higher score on HADS-depression. Markings in the neck and lower arm region were associated with high values of VAS-neck and VAS-arm. Conclusions: Pain drawings were affected by both pain intensity and anxiety/depression in cervical spine patients. Therefore, the pain drawing can be a useful tool when interpreting the patients' pain in correlation to psychological impairment and pain location.
|
|
| 50. |
- MacDowall, Anna, et al.
(författare)
-
Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy : a randomized controlled trial with 5-year outcomes
- 2019
-
Ingår i: Journal of Neurosurgery. - 1547-5654 .- 1547-5646. ; 30:3, s. 323-331
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVEThe method of artificial disc replacement (ADR) has been developed as an alternative treatment to fusion surgery after decompression for cervical degenerative disc disease (DDD) with radiculopathy. Preserving the motion of ADR devices aims to prevent immobilization side effects such as adjacent-segment pathology (ASP). However, long-term follow-up evaluations using MRI are needed to investigate if this intent is achieved.METHODSThe authors performed a randomized controlled trial with 153 patients (mean age 47 years) undergoing surgery for cervical radiculopathy. Eighty-three patients received an ADR and 70 patients underwent fusion surgery. Outcomes after 5 years were assessed using patient-reported outcome measures using the Neck Disability Index (NDI) score as the primary outcome; motion preservation and heterotopic ossification by radiography; ASP by MRI; and secondary surgical procedures.RESULTSScores on the NDI were approximately halved in both groups: the mean score after 5 years was 36 (95% confidence interval [CI] 31–41) in the ADR group and 32 (95% CI 27–38) in the fusion group (p = 0.48). There were no other significant differences between the groups in six other patient-related outcome measures. Fifty-four percent of the patients in the ADR group preserved motion at the operated cervical level and 25% of the ADRs were spontaneously fused. Seventeen ADR patients (21%) and 7 fusion patients (10%) underwent secondary surgery (p = 0.11), with 5 patients in each group due to clinical ASP.CONCLUSIONSIn patients with cervical DDD and radiculopathy decompression as well as ADR, surgery did not result in better clinical or radiological outcomes after 5 years compared with decompression and fusion surgery.
|
|
