SwePub
Sök i SwePub databas

  Utökad sökning

Träfflista för sökning "WFRF:(Sjödahl Rune) "

Sökning: WFRF:(Sjödahl Rune)

  • Resultat 1-50 av 102
Sortera/gruppera träfflistan
   
NumreringReferensOmslagsbildHitta
1.
  • Adell, Gunnar, et al. (författare)
  • Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes' B colorectal carcinoma : an immunohistochemical study
  • 1996
  • Ingår i: European Journal of Surgery. - 1102-4151 .- 1741-9271. ; 162:8, s. 637-642
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To evaluate the incidence and prognostic importance of micrometastatic disease in regional lymph nodes from Dukes' B colorectal carcinomas.DESIGN: Retrospective study.SETTING: University hospital, Sweden.SUBJECTS: 100 patients operated on for primary colorectal carcinoma, classified as Dukes' B lesions.INTERVENTIONS: The regional lymph nodes were re-examined immunohistochemically using monoclonal antibodies against cytokeratin.OUTCOME MEASURES: Incidence and prognostic importance of micrometastases.RESULTS: Micrometastases were found in 39% (39/100) of the patients. The number of positive cells in the lymph nodes examined varied from 1 to over 100. They appeared as single cells or small clusters of cells located within the capsule or in the peripheral sinus of the lymph node. At least three sections from each of three lymph nodes had to be examined to identify 95% of the patients with lymph node micrometastases. The outcome of the patients with micrometastases was not significantly different from that of patients with no epithelial cells in the lymph nodes.CONCLUSION: Micrometastases in regional lymph nodes are a interesting phenomenon but clinically seem to be of only weak prognostic value.
  •  
2.
  • Adell, Gunnar, 1953-, et al. (författare)
  • p53 status : an indicator for the effect of preoperative radiotherapy of rectal cancer.
  • 1999
  • Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 51:2, s. 169-174
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Rectal carcinoma is a common malignancy, with a history of high local recurrence rates following surgery. In recent years. preoperative radiotherapy and refined surgical technique have improved local control rates.AIM: To investigate the relationship between expression of nuclear p53 protein and the outcome in rectal carcinoma, with and without short-term preoperative radiotherapy.MATERIAL: Specimens from 163 patients from the Southeast Swedish Health Care region included in the Swedish rectal cancer trial between 1987-1990.METHOD: New sections from the paraffin blocks of the preoperative biopsy and the surgical specimen were examined immunohistochemically using a p53 antibody (PAb 1801).RESULT: Expression of nuclear p53 protein was seen in 41% of the tumours. The p53 negative patients treated with preoperative radiotherapy had a significant reduction of local failure compared with the non-irradiated p53 negative patients (P = 0.0008). In contrast, p53 positive patients showed no benefit from preoperative radiotherapy. The interaction between p53 status and the benefit of radiotherapy was statistically significant (P = 0.018).CONCLUSION: Expression of nuclear p53 protein in rectal carcinoma seems to be a significant predictive factor for local treatment failure after preoperative radiotherapy. Further investigations are necessary to select patients for preoperative treatment based on analysis of the preoperative biopsies.
  •  
3.
  • Ahlberg, Eva-Lena, et al. (författare)
  • Learning From Incident Reporting? : Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care
  • 2020
  • Ingår i: Journal of patient safety. - : Wolters Kluwer. - 1549-8417 .- 1549-8425. ; 16:4, s. 264-268
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives Incident reporting (IR) systems have the potential to improve patient safety if they enable learningfrom the reported risks and incidents. The aim of this study was to investigate incidents registered in an IR system in a Swedish county council.Methods The study was conducted in the County Council of Östergötland, Sweden. Data were retrieved from the IR system, which included 4755 incidents occurring in somatic care that resulted in patient injuries from 2004 to 2012. One hundred correctly classified patient injuries were randomly sampled from 3 injury severity levels: injuries leading to deaths, permanent harm, and temporary harm. Three aspects were analyzed: handling of the incident, causes of the incident, and actions taken to prevent its recurrence.Results Of the 300 injuries, 79% were handled in the departments where they occurred. The department head decided what actions should be taken to prevent recurrence in response to 95% of the injuries. A total of 448 causes were identified for the injuries; problems associated with procedures, routines, and guidelines were most common. Decisions taken for 80% of the injuries could be classified using the IR system documentation and root cause analysis. The most commonly pursued type of action was change of work routine or guideline.Conclusions The handling, causes, and actions taken to prevent recurrence were similar for injuries of different severity levels. Various forms of feedback (information, education, and dialogue) were an integral aspect of the IR system. However, this feedback was primarily intradepartmental and did not yield much organizational learning.
  •  
4.
  • Andersson, Christer, et al. (författare)
  • Mortalitet bland sjukhusvårdade tycktes inte öka under sommaren [Mortality among hospitalized patients did not appear to increase during the summer]
  • 2019
  • Ingår i: Läkartidningen. - Stockholm, Sweden : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 116
  • Tidskriftsartikel (refereegranskat)abstract
    • A retrospective review of medical records (2017-2018) at Linköping University Hospital compared hospital mortality for the 2-month period of summer vacations (group A) with two months of regular activity (group B). The mortality was 163 patients in group A and 216 in group B. Emergency admittance dominated (95%) in both groups. Comorbidity was found in 81%, and at admittance the risk for death during the hospital stay was estimated to more than 50% in three out of four patients. There was no difference between the groups regarding demography, hospital stay, or diagnosis. Due to a 30% reduction of hospital beds during the summer some patients were relocated to other specialties. No relocated patient died in group A but six in group B. Eight deaths were judged as probably preventable, but none definitely preventable. The similarity between the groups regarding mortality does not allow estimations of differences in adverse events in general. Low mortality among relocated patients is probably due to identification of high-risk patients not suitable for relocation.
  •  
5.
  • Andersson, Peter, et al. (författare)
  • Continent Ileostomy
  • 2008
  • Ingår i: Seminars in Colon and Rectal Surgery. - Maryland Heights, MO, United States : W.B. Saunders Co.. - 1043-1489. ; 19:3, s. 124-131
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Continent ileostomy reservoir is today still an alternative to a standard (conventional) ileostomy in patients where ileal pouch-anal anastomosis is contraindicated or malfunctioning. It eliminates a protruding stoma, obviates the need for a stoma bag, and permits controlled evacuation of bowel contents. A well-functioning continent ileostomy also is entirely continent for gas and feces in the elderly. The reservoir is emptied three to five times a day. Obvious benefits are improved sexual life and facilitated leisure activities. The main drawbacks are frequent complications requiring reoperations in about 50% of the patients. Slippage of the nipple valve occurs in about one-third but in the majority of patients reoperations are successful in the long run. Other complications are pouchitis, enterocutaneous fistula, and stomal stricture. Modifications of the original Kock pouch have been developed as the Barnett pouch and the T-pouch to reduce complications associated with dysfunction of the nipple valve. Cancer of a continent ileostomy reservoir has been reported only in one patient and there seems to be no risk of high-grade dysplasia even after long-term follow-up. At present there are few indications for creating a continent ileostomy reservoir but it is still recommended in very select patients. © 2008 Elsevier Inc. All rights reserved.
  •  
6.
  • Andersson, Peter, 1957-, et al. (författare)
  • Crohn´s Disease
  • 2008. - 1
  • Ingår i: Coloproctology. - Berlin : Springer. - 9783540712176 - 354071216X ; , s. 145-158
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
    • EMM: Coloproctology presents the state-of-the-art in coloproctology. The topics covered include anatomy, physiology, anal disorders, dermatology, functional disorders, inflammatory bowel disease, benign and malignant tumours, endoscopy, emergencies and pain syndromes. All chapters give a comprehensive overview of aetiology, incidence, epidemiology, diagnostics, medical and surgical treatment, complications and individual special considerations. This work presents surgical trainees with a comprehensive and condensed guide to the core knowledge required for the European Board of Surgery Qualification (EBSQ) examination. The manual will also be of assistance to practising coloproctologists across Europe and beyond who have an interest in continued professional development. Written by an international team of experts who have each made noteworthy contributions in their field, the coverage of most aspects of coloproctology in an easy-to-follow format also makes this manual valuable to other specialists.
  •  
7.
  • Andersson, Peter, 1957-, et al. (författare)
  • Health related quality of life in Crohn's proctocolitis does not differ from a general population when in remission
  • 2003
  • Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 5:1, s. 56-62
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective  All treatment in Crohn's disease, although palliative, aims at restoring full health. The objective of this study was to compare health-related quality of life and psychosocial conditions in patients with Crohn's proctocolitis with a general population.Patients and methods  One hundred and twenty-seven patients with Crohn's proctocolitis (median age 44 years, 44.1% men) were compared with 266 controls (median age 45 years, 50.7% men). A questionnaire consisting of the Short Form-36 (SF-36), the Psychological General Well-Being Index (PGWB) and a visual analogue scale (VAS) evaluating general health as well as questions regarding psychosocial conditions was used. Disease activity was evaluated by Best's modification of the classical Crohn's Disease Activity Index.Results  Patients in remission had a health related quality of life similar to controls according to the SF-36 apart from general health where scores were lower (P < 0.01). Patients with active disease scored lower in all aspects of the SF-36 (P < 0.001 or P < 0.0001) as well as the PGWB (P < 0.0001). In a model for multiple regression including age, gender, concomitant small bowel disease, permanent stoma, previous colonic surgery, disease activity, duration, and aggressiveness, disease activity was the only variable negatively predicting all 8 domains of the SF-36 in the patient group (P < 0.001). The mean annual sick-leave for patients and controls were 33.9 and 9.5 days (P < 0.0001), respectively. Sixty-eight percent of the patients and 78.4% of the controls (P = 0.04) were married or cohabited, 67.7% and 78.0% (P = 0.04), respectively, had children.Conclusion  The health related quality of life for patients with Crohn's proctocolitis in remission does not differ from the general population. The disease has, however, a negative impact on parenthood, family life and professional performance.
  •  
8.
  • Andersson, Peter, 1957-, et al. (författare)
  • Increased anal resting pressure and rectal sensitivity in Crohn's disease
  • 2003
  • Ingår i: Diseases of the Colon & Rectum. - 0012-3706 .- 1530-0358. ; 46:12, s. 1685-1689
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: Anal pathology occurs in 20 to 80 percent of patients with Crohn's disease in which abscesses, fistulas, and fissures account for considerable morbidity. The etiology is not clearly defined, but altered anorectal pressures may play a role. This study was designed to investigate anorectal physiologic conditions in patients with Crohn's disease compared with healthy controls.METHODS: Twenty patients with Crohn's disease located in the ileum (n = 9) or the colon (n = 11) without macroscopic proctitis or perianal disease were included. All were subjected to rectal examination, anorectal manometry, manovolumetry, and rectoscopy. Comparison was made with a reference group of 173 healthy controls of whom 128 underwent anorectal manometry, 29 manovolumetry, and 16 both examinations.RESULTS: Maximum resting pressure and resting pressure area were higher in patients than in controls (P = 0.017 and P = 0.011, respectively), whereas maximum squeeze pressure and squeeze pressure area were similar. Rectal sensitivity was increased in patients expressed as lower values both for volume and pressure for urge (P = 0.013 and P = 0.014, respectively) as well as maximum tolerable pressure (P = 0.025).CONCLUSIONS: This study demonstrates how patients with Crohn's disease without macroscopic proctitis have increased anal pressures in conjunction with increased rectal sensitivity. This may contribute to later development of anal pathology, because increased intra-anal pressures may compromise anal circulation, causing fissures, and also discharging of fecal matter into the perirectal tracts, which may have a role in infection and fistula development.
  •  
9.
  • Andersson, Peter, et al. (författare)
  • Low symptomatic load in Crohn's disease with surgery and medicine as complementary treatments
  • 1998
  • Ingår i: Scandinavian Journal of Gastroenterology. - : Informa Healthcare. - 0036-5521 .- 1502-7708. ; 33:4, s. 423-429
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The treatment of Crohn's disease has changed owing to the recognition of its chronicity. Medical maintenance treatment and limited resections have evolved as major concepts of management, regarded as complementary, and both aim at reducing the symptoms.Methods: We investigated the symptomatic load in Crohn's disease as reflected in a cross-sectional study of the symptom index, physicians' assessment, and the patients' perception of health. A cohort of 212 patients from the primary catchment area and 125 referred patients were studied.Results: Of catchment area patients, 83% were receiving medication, and the annual rate of abdominal surgery was 5.7%. Corresponding figures for the referred patients were 82% and 10.3%. According to the symptom index, 87% of catchment area patients were in remission or had only mild symptoms; according to the physicians' assessment, 90% were. The patients' median perception of health was 90% of perfect health according to the visual analogue scale. The figures were similar for referred patients, except that referrals were considered more diseased by the physician.Conclusion: The great majority of patients with Crohn's disease are able to live in remission or experience only mild symptoms.
  •  
10.
  • Andersson, Peter, 1957-, et al. (författare)
  • Segmental resection or subtotal colectomy in Crohn's colitis?
  • 2002
  • Ingår i: Diseases of the Colon & Rectum. - : Ovid Technologies (Wolters Kluwer Health). - 0012-3706 .- 1530-0358. ; 45:1, s. 47-53
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: Segmental resection for Crohn's colitis is controversial. Compared with subtotal colectomy, segmental resection is reported to be associated with a higher rate of re-resection. Few studies address this issue, and postoperative functional outcome has not been reported previously. This study compared segmental resection to subtotal colectomy with anastomosis with regard to re-resection, postoperative symptoms, and anorectal function.METHODS: Fifty-seven patients operated on between 1970 and 1997 with segmental resection (n = 31) or subtotal colectomy (n = 26) were included. Reoperative procedures were analyzed by a life-table technique. Segmentally resected patients were also compared separately with a subgroup of subtotally colectomized patients (n = 12) with similarly limited colonic involvement. Symptoms were assessed according to Best's modified Crohn's Disease Activity Index and an anorectal function score.RESULTS: The re-resection rate did not differ between groups in either the entire study population (P = 0.46) or the subgroup of patients with comparable colonic involvement (P = 0.78). Segmentally resected patients had fewer symptoms (P = 0.039), fewer loose stools (P = 0.002), and better anorectal function (P = 0.027). Multivariate analysis revealed the number of colonic segments removed to be the strongest predictive factor for postoperative symptoms and anorectal function (P = 0.026 and P = 0.013, respectively).CONCLUSION: Segmental resection should be considered in limited Crohn's colitis.
  •  
11.
  • Andersson, Peter, 1957-, et al. (författare)
  • Surgery for Crohn colitis over a twenty-eight-year period : fewer stomas and the replacement of total colectomy by segmental resection
  • 2002
  • Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 37:1, s. 68-73
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: This study describes how surgery for Crohn colitis developed between 1970 and 1997, towards the end of which period limited resection and medical maintenance treatment was introduced.Methods: A cohort of 211 patients with Crohn colitis (115 population-based), of which 84 had a primary colonic resection (42 population-based), was investigated regarding indication for surgery, the time from diagnosis to operation, type of primary colonic resection, risk for permanent stoma and medication over four 7-year periods.Results: Comparison of the periods 1970-90 and 1991-97 revealed that active disease as an indication for surgery decreased from 64% to 25% ( P < 0.01) while stricture as an indication increased from 9% to 50% ( P < 0.001). Median time from diagnosis to operation increased from 3.5 to 11.5 years ( P < 0.01). Proctocolectomy or colectomy fell from 68.8% to 10% of the primary resections, whereas segmental resection increased from 31.2% to 90%. At the end of the first 7-year period, 26% had medical maintenance treatment, steroids or azathioprine taken by 7%. Corresponding figures for the last period were 70% and 49%. Patients diagnosed during the last two time-periods had less risk for surgery ( P = 0.017), permanent stoma ( P < 0.01) and total colectomy ( P < 0.01). Findings were similar in the population-based cohort.Conclusions: Current management of Crohn colitis implies a longer period between diagnosis and surgery, a reduced risk for surgery and permanent stoma, and the replacement of total colectomy by segmental resection.
  •  
12.
  • Arber, N, et al. (författare)
  • Sporadic adenomatous polyp regression with exisulind is effective but toxic : A randomised, double blind, placebo controlled, dose-response study
  • 2006
  • Ingår i: Gut. - : BMJ. - 0017-5749 .- 1468-3288. ; 55:3, s. 367-373
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aim: A 12 month, multicentre, randomised, double blind, placebo controlled, phase 3, dose-response study was carried out. Exisulind inhibits tumour growth by induction of apoptosis. The aim of our study was to investigate if exisulind induces regression of sporadic colonic adenomas. Patients and methods: A 12 month multicentre randomised double blind placebo controlled phase 3 dose response study was carried out. At baseline colonoscopy, left sided polyps (3-10 mm) were tattooed, measured, and left in place. Subjects received exisulind 200 or 400 mg, or placebo daily. Follow up sigmoidoscopy was performed after six months, and removal of any remaining polyps at the 12 month colonoscopy. The primary efficacy variable was change in polyp size from baseline. Results: A total of 281 patients were enrolled and randomised, 155 (55%) fulfilled the criteria for the intention to treat (ITT) analysis and 114 (41%) fulfilled the criteria for the efficacy evaluation analysis (patients who underwent the 12 month colonoscopy). The decrease in median polyp size was significantly greater (p = 0.03) in patients who received exisulind 400 mg (-10 mm2) compared with those who received placebo (-4 mm2). Complete or partial response was significantly higher in the exisulind 400 mg group (54.6%) compared with the placebo group (30.2%), and disease progression was significantly lower (6.1% v 27.9%) (p = 0.04 and 0.02, respectively). Increased liver enzymes (8.4%) and abdominal pain (14.7%) were also reported at a greater frequency in the exisulind 400 mg group. Conclusion: Exisulind caused significant regression of sporadic adenomatous polyps but was associated with more toxicity. This model of polyp regression, short in its term and involving a comparatively small patient sample size, may be the best available tool to assess a therapeutic regimen before launching into large preventive clinical studies.
  •  
13.
  • Ariander, Annaclara, et al. (författare)
  • Ethical challenges causing moral distress: nursing home staff's experiences of working during the COVID-19 pandemic
  • 2024
  • Ingår i: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724.
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveTo investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic.DesignIndividual interviews. Latent qualitative content analysis.SettingTen nursing homes in Sweden.SubjectsPhysicians, nurses and nurse assistants working in Swedish nursing homes.Main outcome measuresParticipants' experiences of working in nursing homes during the COVID-19 pandemic.ResultsFour manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover - a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories.ConclusionDuring the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce. The COVID-19 pandemic has affected both patients and staff in nursing homes, in Sweden and worldwide.Our study highlights that during the COVID-19 pandemic, nursing home staff encountered several ethical challenges which caused moral distress.Moral distress stemmed from not being given adequate conditions to perform their work, thus not giving the residents appropriate care.Moral distress could also originate from nursing home staff's feeling of being forced to act against their moral values.
  •  
14.
  •  
15.
  •  
16.
  •  
17.
  • Carlstedt, Anders, et al. (författare)
  • Management of Diastasis of the Rectus Abdominis Muscles : Recommendations for Swedish National Guidelines
  • 2021
  • Ingår i: Scandinavian Journal of Surgery. - : Sage Publications. - 1457-4969 .- 1799-7267. ; 10:3, s. 452-459
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike. Methods: The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience. Results: The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient's symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior. Discussion: The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.
  •  
18.
  • Clinchy, Birgitta, 1957-, et al. (författare)
  • Preoperative interleukin-6 production by mononuclear blood cells predicts survival after radical surgery for colorectal carcinoma
  • 2007
  • Ingår i: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 109:9, s. 1742-1749
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND. Colorectal cancer is one of the most common forms of cancer in the Western world. Staging based on histopathology is currently the most accurate predictor of outcome after surgery. Colorectal cancer is curable if treated at an early stage (stage I-III). However, for tumors in stages II and III there is a great need for tests giving more accurate prognostic information defining the patient population in need of closer follow-up and/or adjuvant therapy. Furthermore, tests that provide prognostic information preoperatively could provide a guide both for preoperative oncologic treatment and the surgical procedure. METHODS. Peripheral blood mononuclear cells (PBMCs) were isolated preoperatively, within a week before primary surgery, from 39 patients undergoing surgery for colorectal cancer. The PBMCs were cultured in vitro for 24 hours in the presence of autologous serum and lipopolysaccharide (LPS). Interleukin-6 (IL-6) production was measured with enzyme-linked immunosorbent assay (ELISA). Staging based on histopathology was performed in all patients. Patients were followed for at least 54 months. RESULTS. A production of >5000 pg/mL of IL-6 identified colorectal cancer patients with a poor prognosis. Eight out of 13 patients with >5000 pg/mL IL-6 died from cancer within the follow-up period, whereas no cancer-related deaths were recorded among 21 patients with 5000 pg/mL IL-6 or less. A multivariate Cox regression analysis, stratified for T- and N-stage, identified IL-6 production as an independent prognostic factor. CONCLUSIONS. IL-6 production in vitro by PBMC can predict survival after radical surgery for colorectal cancer. © 2007 American Cancer Society.
  •  
19.
  •  
20.
  • Davidson, Thomas, et al. (författare)
  • Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes
  • 2023
  • Ingår i: Scandinavian Journal of Surgery. - : SAGE PUBLICATIONS LTD. - 1457-4969 .- 1799-7267.
  • Forskningsöversikt (refereegranskat)abstract
    • Background and aim: The purpose of this study was to evaluate clinical experiences and cost-effectiveness by comparing robot-assisted surgery with laparoscopic- or open surgery for pelvic and renal operations. Methods: A narrative review was carried out. Results: When using robotic-assisted surgery, oncological and functional results are similar to after laparoscopic or open surgery. One exception may be a shorter survival in cancer of the cervix uteri. In addition, postoperative complications after robotic-assisted surgery are similar, bleeding and transfusion needs are less, and the hospital stay is shorter but the preparation of the operating theater before and after surgery and the operation times are longer. Finally, robot-assisted surgery has, in several studies, been reported to be not cost-effective primarily due to high investment costs. However, more recent studies provide improved cost-effectiveness estimates due to more effective preparation of the operating theater before surgery, improved surgeon experience, and decreased investment costs. Conclusions: Complications and functional and oncological outcomes after robot-assisted surgery are similar to open surgery and laparoscopic surgery. The cost-effectiveness of robot-assisted surgery is likely to equal or surpass the alternatives.
  •  
21.
  • Divanoglou, Anestis, et al. (författare)
  • Rehabilitation needs and mortality associated with the Covid-19 pandemic : a population-based study of all hospitalised and home-healthcare individuals in a Swedish healthcare region
  • 2021
  • Ingår i: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 36
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: This first report of the Linkoping Covid-19 Study (LinCoS) aimed at determination of Covid-19-associated mortality, impairments, activity and participation limitations denoting rehabilitation needs four months after discharge from hospital. Methods: An ambidirectional population-based cohort study including all confirmed Covid-19 cases admitted to hospital during 1/03-31/05 and those living in home healthcare settings identified through a regional registry and evaluated through medical records, including WHO Clinical Progression Scale (CPS). All patients discharged from hospital were followed-up by structured telephone interview at 4 months post-discharge. Respondents indicated any new or aggravated persisting problems in any of 25 body functions and 12 activity/participation items and rated them for impact on daily life. Findings: Out of 734 hospitalised patients, 149 were excluded, 125 died, and 460 were alive at 4-month follow-up of whom 433 (94.1%) were interviewed. In total, 40% reported impairments and activity/participation limitations affecting daily life and warranted further multi-professional rehabilitation assessment, predominantly those with severe disease and a considerable proportion of those with moderate disease. Cognitive and affective impairments were equally common in all groups and were reported by 20-40% of cases. Limb weakness was reported by 31%, with CPS 7-9 being four times more likely to report this problem as compared to CPS 4-5. 26% of those working or studying reported difficulties returning to these activities, this being 3.5 times more likely in CPS 7-9 as compared to CPS 4-5. 25% reported problems walking >1 km, with CPS 7-9 over three times more likely to report this as compared to the other two sub-groups. 90-day mortality rate of Covid-19 associated deaths was 15.1%. Interpretation: Most rehabilitation needs after Covid-19 involved higher cerebral dysfunction both in patients with moderate and severe disease. This should be considered when designing services aiming at minimizing long-term disability. (C) 2021 The Author(s). Published by Elsevier Ltd.
  •  
22.
  • Ekelund, Göran, et al. (författare)
  • Bruno Samenius
  • 2008
  • Ingår i: Svensk Kirurgi. - 0346-847X. ; 66:1, s. 23-24
  • Tidskriftsartikel (populärvet., debatt m.m.)
  •  
23.
  • Falk, Magnus, et al. (författare)
  • Modifierad brittisk modell kortade ledtid till datortomografi av kolon
  • 2015
  • Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 112
  • Tidskriftsartikel (refereegranskat)abstract
    • The British national Institute for Health and Care Excellence (NICE) has presented guidelines based on signs and symptoms which should raise a suspicion of colorectal cancer. A slightly modified version of these guidelines, adapted to Swedish conditions, named Swedish NICE (sNICE) criteria, was implemented at eight primary care centres. By following the sNICE criteria, cases with higher degree of suspicion of colorectal cancer were advised for computer tomography (CT) of the colon, whereas cases of low degree of suspicion were advised for the considerably less time and patient demanding CT of the abdomen. For patients with isolated anal symptoms without presence of sNICE criteria, active expectancy for six weeks was recommended, followed by renewed consideration. Results showed that the ratio between CT colon and CT abdomen was reduced from 2.2 to 1.1 after introduction of the sNICE criteria. Also, the proportion of patients undergoing CT colon within two weeks from admittance was increased from 3 to 25 %. We conclude that the sNICE criteria may be a useful supportive tool for the primary care physician.
  •  
24.
  • Floodeen, Hannah, 1981-, et al. (författare)
  • Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities?
  • 2013
  • Ingår i: Colorectal Disease. - : Wiley-Blackwell. - 1462-8910 .- 1463-1318. ; 15:3, s. 334-340
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim The aim of the study was to compare patients with symptomatic anastomotic leakage following low anterior resection of the rectum (LAR) for cancer diagnosed during the initial hospital stay with those in whom leakage was diagnosed after hospital discharge. Method Forty-five patients undergoing LAR (n=234) entered into a randomized multicentre trial (NCT 00636948), who developed symptomatic anastomotic leakage, were identified. A comparison was made between patients diagnosed during the initial hospital stay on median postoperative day 8 (early leakage, EL; n=27) and patients diagnosed after hospital discharge at median postoperative day 22 (late leakage, LL; n=18). Patient characteristics, operative details, postoperative course and anatomical localization of the leakage were analysed. Results Leakage from the circular stapler line of an end-to-end anastomosis was more common in EL, while leakage from the stapler line of the efferent limb of the J-pouch or side-to-end anastomosis tended to be more frequent in LL (P=0.057). Intra-operative blood loss (P=0.006) and operation time (P=0.071) were increased in EL compared with LL. On postoperative day 5, EL performed worse than LL with regard to temperature (P=0.021), oral intake (P=0.006) and recovery of bowel activity (P=0.054). Anastomotic leakage was diagnosed most often by a rectal contrast study in EL and by CT scan in LL. The median initial hospital stay was 28days for EL and 10days for LL (Pandlt;0.001). Conclusion The present study has demonstrated that symptomatic anastomotic leakage can present before and after hospital discharge and raises the question of whether early and late leakage after LAR may be different entities.
  •  
25.
  • Gerdin, Linda, et al. (författare)
  • The Swedish Crohn Trial: A Prematurely Terminated Randomized Controlled Trial of Thiopurines or Open Surgery for Primary Treatment of Ileocaecal Crohns Disease
  • 2016
  • Ingår i: Journal of Crohn's & Colitis. - : OXFORD UNIV PRESS. - 1873-9946 .- 1876-4479. ; 10:1, s. 50-54
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aims: The importance of efficient and safe treatment of Crohns disease is highlighted by its chronicity. Both medical and surgical treatments have shown good results in the symptomatic control of limited ileocaecal Crohns disease. The aim of this study was to compare medical treatment with surgical treatment of ileocaecal Crohns disease. Methods: Thirty-six patients from seven hospitals with primary ileocaecal Crohns disease were randomized to either medical or surgical treatment. The medical treatment was induction of remission with budesonide and thereafter maintenance treatment with azathioprine. The surgical treatment was open ileocaecal resection. Crohns disease activity index over time, expressed as area under the curve at 1, 3 and 5 years, was the primary endpoint. Subjective health measured with the 36-item Short Form Survey Instrument (SF36) and a visual analogue scale (VAS) were secondary endpoints. Results: There were no differences between the treatment groups in Crohns disease activity index over time. General health, measured as SF36 score, was higher in patients receiving surgical treatment than in those receiving medical treatment at 1 year, but there was no corresponding difference in VAS. Due to the slow inclusion rate and changes in clinical practice, the study was t = erminated prematurely. Conclusion: The study ended up being underpowered and should be interpreted with caution, but there was no clinically significant difference between the two treatment arms. Further studies are needed to address this important clinical question.
  •  
26.
  • Gerjy, Roger, 1969- (författare)
  • Outcome After Haemorrhoidopexy
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: This dissertation is composed of five individual studies of the stapled haemorrhoidopexy operation. The operation was launched to an international audience in 1998 by the Italian surgeon Antonio Longo. In conventional surgery the prolapsed piles are excised from the anodermal part of the prolapse up through the anal canal into the lower rectal mucosa where the pile is divided with diathermy or suture ligated and excised. It leaves open wounds throughout the anal canal. These wounds can be very painful, especially at defecation, and will take from three to six weeks to heal. In the stapled haemorrhoidopexy operation symptomatic haemorrhoids are seen as a disease of anodermal, haemorrhoidal and rectal mucosal prolapse of varying degree. The main component of the prolapse is the redundancy of rectal mucosa. By pushing back the prolapse into the anal canal followed by excision of the mucosal redundancy above the anal canal with a circular stapler devise a mucosal anastomosis is fashioned. This anastomosis is situated immediately above the haemorrhoids and will attach them to the rectal muscular wall to prevent further prolapse. The operation is associated with substantially less pain and a quicker recovery.Methods: For the five studies, a total of 334 patients were operated for haemorrhoidal prolapse. The first operations were performed in February 1998. All patients were assessed preoperatively and postoperatively with the same set of protocols as follows. The symptoms of haemorrhoids were scored with a questionnaire to patients to obtain their independent statements of the frequency of each of five cardinal symptoms: pain, bleeding, pruritus, soiling and prolapse in need of manual reduction. A diary was used by patients to report daily pain scores, use of pain medication and speed of recovery within the first 14 postoperative days. The surgeon rated the deranged anal anatomy before and after surgery. We also developed an algorithm based on the patients’ statement of digital reduction of prolapse (grade 3) and the surgeon’s assessment of lesser prolapse at proctoscopy (grade 2). Absence of prolapse was grade 1. The surgeon also provided statements about the conduct of the operation and rated the technical complexity. The information, for all patients, was entered into an electronic data base.Results: One registry based study and one prospective randomised controlled trial assessed the advantage of performing the operation under perianal local anaesthetic block. The postoperative pain and surgical outcome was independent of the type of anaesthesia. No operation under local block had to be converted to general anaesthesia. Anodermal prolapse is seen in 70 percent of the patients. In a registry-based study we found that excision of the anodermal folds did not increase the postoperative pain provided the excision stopped at the anal verge. In 270 patients with precise preoperative and postoperative classification we found that the symptomatic load was identical for grades 2 and 3. The symptoms were independent of the anodermal prolapse. The symptoms were greatly reduced when the operation turned out grade 1 prolapse. The long-term result was assessed in 153 patients operated 1 year to 6 years previously. The need for early re-intervention was 6.2 percent representing technical error to reduce the prolapse. At the final evaluation 12 patients (8.2 percent) complained of a mucoanal prolapse in need of digital reduction. The mean symptom burden had been reduced from 8.1 to 2.5 points but 17 percent had at least one cardinal symptom with a weekly frequency.Conclusions: Stapled haemorrhoidopexy should be performed as day surgery under local anaesthesia. Any remaining anodermal prolapse should be excised. The optimal long-term outcome is grade 1A or 1B with low symptom score. There was an 87 percent chance of cure of the prolapse with the first haemorrhoidopexy. About half the failures were insufficient primary surgery and half a relapse of the prolapse.
  •  
27.
  • Gerjy, Roger, et al. (författare)
  • Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia
  • 2008
  • Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 95:11, s. 1344-1351
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim was to assess the feasibility of performing stapled haemorrhoidopexy under local anaesthesia. Methods: Fifty-eight patients with haemorrhoid prolapse were randomized to receive local or general anaesthesia. The perianal block was applied immediately peripheral to the external sphincter. Submucosal block was added after applying the purse-string suture. Patients reported average and peak pain daily for 14 days using a visual analogue scale (VAS). They also completed anal symptom questionnaires before the operation and at follow-up. The surgeon assessed the restoration of the anal anatomy 3-6 months after surgery. Results: The anal block was sufficient in all patients. The mean accumulated VAS score for average pain was 23·1 in the general anaesthesia group and 29·4 in the local anaesthesia group (P = 0·376); mean peak pain scores were 42·1 and 47·9 respectively (P = 0·537). Mean change in symptom load was also similar between the groups, with score differences of 7·0 in the general anaesthesia group and 6·1 in the local anaesthesia group. No patient had a recurrence of prolapse. Conclusion: Perianal local block is easy to apply with a high degree of acceptability among patients. Postoperative pain, restoration of anatomy and symptom resolution were similar to that of stapled haemorrhoidopexy performed under general anaesthesia.
  •  
28.
  • Gustavsson, Erik, 1982-, et al. (författare)
  • The ethical dilemma ofgranulocyte transfusions
  • 2020
  • Ingår i: Clinical Ethics. - : Sage Publications. - 1477-7509 .- 1758-101X. ; 15:3, s. 156-161
  • Tidskriftsartikel (refereegranskat)abstract
    • Granulocyte transfusions have been administered to patients with life-threatening infections for more than five decades. However, to what extent this should be the case is far from established. On the one hand, the clinical effects of these transfusions are difficult to prove in clinical studies, and the donors of granulocytes may be exposed to certain risks. On the other hand, clinical experience seems to support the idea that granulocyte transfusions do play an important role for severely ill patients, and the donors are primarily motivated by altruistic reasons. In this paper, we first discuss the ethical issues that arise from the fact that there is a conflict between clinical experience and the results from the attempts to perform randomized control trials, and second, the risk/benefit assessment that has to be made between two different parties, namely the recipient and the donor of granulocyte transfusions.
  •  
29.
  • Hallböök, Olof, 1954-, et al. (författare)
  • Långvarigt Trendelenburgs läge kan orsaka ögonskador : Kortad operationstid i tippat läge och justering av tippningsvinkeln kan minska risken
  • 2018
  • Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 115
  • Tidskriftsartikel (refereegranskat)abstract
    • Risk of optic nerve injury after prolonged Trendelenburgs position Postoperative loss of vision due to acute ischaemic optic nerve injury is a rare complication following pelvic surgery. A steep Trendelenburgs position of the patient, high intraabdominal pressure and a long operative time in Trendelenburgs position are recognised risk factors associated with robot-assisted pelvic surgery. This manuscript presents the underlying pathophysiologic mechanism. Practical tips and tricks for prevention are discussed.
  •  
30.
  • Hallböök, Olof, 1954-, et al. (författare)
  • Safety of the temporary loop ileostomy
  • 2002
  • Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 4:5, s. 361-364
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To evaluate the complications of the temporary loop ileostomy. Method. A retrospective study of 222 consecutive patients with low anterior resection, ileal pouch-anal anastomosis or continent ileostomy and a diverting loop ileostomy routinely fashioned during the primary operation. The loop ileostomy was closed in 213 patients (96%) during the minimum follow-up period of 15 months. Results. Four patients (2%) required preterm closure of the ostomy due to stomal retraction (n = 3) or bowel obstruction (n = 1). Four patients were readmitted due to transient bowel obstruction that resolved without surgery. After closure of the loop ileostomy a total of 27 patients (13%) had complications. In 7 patients emergency re-operation was done due to small bowel obstruction (n = 5) or intra-abdominal abscess (n = 2). Elective re-operation was done in 5 patients for hernia at the site of the previous stoma. Despite the use of a loop ileostomy there was 1 postoperative death after the initial operation in consequence of anastomotic leakage. There was 1 death in consequence of closure of the loop ileostomy after 3 weeks due to intra-abdominal sepsis and heart failure. Conclusion. In this series closure of the ostomy was associated with one death (0.5%) and overall ostomy-related morbidity included the need to re-operate in 6%.
  •  
31.
  • Hallböök, Olof, 1954-, et al. (författare)
  • Surgical approaches to obtaining optimal bowel function
  • 2000
  • Ingår i: Seminars in surgical oncology. - 8756-0437 .- 1098-2388. ; 18:3, s. 249-258
  • Tidskriftsartikel (refereegranskat)abstract
    • Approximately 50% of patients have an unsatisfactory functional result after traditional restorative rectal resection, and an even higher percentage, at least in the early postoperative period, suffers from urgency, frequent bowel movements, and occasional faecal incontinence. The rectal reservoir function is disturbed after restorative surgery. This is related to the size of the rectal remnant, the viscero-elastic properties, and the motility pattern of the neorectal wall, because segments of the remaining colon can only substitute for the rectum to a limited extent. A straight anastomosis is recommended when the rectal remnant (measured from the anal verge) is at least 7 to 8 cm. The side-to-end anastomosis is probably preferable to the end-to-end anastomosis. In contrast, a straight anastomosis at the levator plane cannot be recommended. If straight anastomosis is still considered, the descending colon should be used rather than the sigmoid colon. The colonic pouch was introduced to increase the neorectal volume and eliminate some of the functional disturbance associated with the reduced neorectal volume occurring after a straight colo-anal anastomosis. To obtain optimal functional results soon after surgery, a pouch should be used when the anastomosis is located 3 to 5 cm from the anal verge. The size of the pouch should not be too small. A staple line of 6 to 7 cm is a fair compromise between the low anterior resection syndrome and problems with evacuation. Since the descending colon has a thinner wall and often is healthier than the sigmoid colon, it should be the first choice for the anastomosis.
  •  
32.
  • Hedin, Christina, et al. (författare)
  • Intraoperativ strålbehandling vid primar operation for bröstcancer : TARGIT-A-studien ej konklusiv
  • 2018
  • Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 115
  • Forskningsöversikt (refereegranskat)abstract
    • The TARGIT-A (TARGeted Intraoperative radioTherapy) multicentre study of early breast cancer compared intraoperative radiotherapy with external radiotherapy. While the intraoperative radiotherapy was standardised, the external postoperative comparison treatment followed established routines in the participating treatment centres resulting in substantial variations in dosages and treatment durations. The uncertainties in the interpretation of the study results created by the design of the TARGIT-A study constitute substantial obstacles to the possible introduction of intraoperative radiotherapy for early breast cancer.
  •  
33.
  • Heedman, Per-Anders, et al. (författare)
  • Palliation of Malignant Biliary Obstruction: Adverse Events are Common after Percutaneous Transhepatic Biliary Drainage
  • 2018
  • Ingår i: Scandinavian Journal of Surgery. - : SAGE PUBLICATIONS LTD. - 1457-4969 .- 1799-7267. ; 107:1, s. 48-53
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Endoscopic stents in the common bile duct is the first treatment choice to alleviate symptoms of biliary obstruction due to malignant disease. When endoscopic stenting fails in palliative patients, one option is to use a percutaneous transhepatic biliary drainage, but it is not clear whether and how it can reduce the symptom load. The aim of this study was to evaluate benefits and disadvantages of percutaneous transhepatic biliary drainage in palliative care. Material and Methods: Inclusion criteria were malignant disease and bilirubin 26 mu mol/L in plasma. A structured protocol for obtaining data from the medical records was used. Data were collected from the time of last computed tomography scan before the percutaneous transhepatic biliary drainage was placed and during 14days afterward. Results and Conclusion: Inclusion criteria were fulfilled in 140 patients. Median age was 70years (33-91years). Some 126 patients had a remaining external percutaneous transhepatic biliary drainage. Jaundice was the initial symptom in 62 patients (44%). Within the first week after percutaneous transhepatic biliary drainage, the bilirubin decreased from 237 mu mol/L (31-634) to 180 mu mol/L (17-545). Only 25% reached a level below the double upper reference value. Pruritus occurred in 27% before the percutaneous transhepatic biliary drainage, but the bilirubin value did not differ from patients without pruritus. However, the pruritus was relieved in 56% with percutaneous transhepatic biliary drainage. Antibiotic prophylaxis protected to some extent from infectious complications. Adverse events were common and early mortality was high (16% within 14days). Jaundice should not by itself be an indication for percutaneous transhepatic biliary drainage for palliation except when the aim is to prepare the patient for chemotherapy. It is mandatory that the patients are informed carefully about what can be expected regarding the positive effects and the risks of adverse events.
  •  
34.
  • Heedman, Per-Anders, et al. (författare)
  • Standardiserade vårdförlopp kan ge svårt cancersjuka bättre stöd [High prevalence of advanced cancer disease in patients with serious non-specific symtoms. Experience of a diagnostic pathway in a defined population area in Sweden]
  • 2019
  • Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 116
  • Tidskriftsartikel (refereegranskat)abstract
    • The Swedish fast-track diagnostic pathway was applied during 2017 for 146 patients with serious non-specific symptoms including weight loss, fatigue and anemia. Within five days all patients had a physical examination and a decision was made of radiologic investigations. The waiting time was short for e.g. CT-scan of the abdomen and thorax. A diagnosis of a malignant condition was made in 38 patients (26%) with a median age of 75 (48-91) years. There were 24 men and 14 women. Most common diagnoses were lung cancer and colorectal cancer. Hematologic malignancy was diagnosed in 8 patients. Stage IV disease occurred in 17 of the patients with carcinoma (57%). About 60 benign main diagnoses were made in 108 patients without malignant disease. Two of them have developed cancer during 2018 (breast cancer, pancreatic cancer).
  •  
35.
  • Heedman, P. A., et al. (författare)
  • Variation at presentation among colon cancer patients with metastases: a population-based study
  • 2015
  • Ingår i: Colorectal Disease. - : Wiley: 12 months. - 1462-8910 .- 1463-1318. ; 17:5, s. 403-408
  • Tidskriftsartikel (refereegranskat)abstract
    • AimThe study aimed to describe and follow a 2year cohort of colon cancer patients with Stage IV disease from presentation to long-term outcome. MethodThe records of 177 colon cancer patients diagnosed in southeast Sweden during 2009-2010 with disseminated disease at presentation were reviewed retrospectively. ResultsThe patients were heterogeneous with respect to age, performance status and survival. Despite metastatic disease, local symptoms from the primary tumour dominated the initial clinical picture. Forty-one per cent had anaemia. The time from suspicion of colon cancer to established diagnosis of disseminated disease varied from 0 to 231days (emergency cases included, median 12days). The majority (77%) were diagnosed in hospital. In 53% the primary tumour and the metastases were not diagnosed on the same occasion which may increase the risk for misinformation or delays in the care process. The possibility of simultaneous diagnosis was doubled when the patient was investigated as an inpatient. Patients were seen by one to 12 physicians (median three) in the investigation phase, and one to 47 (median 11) from diagnosis until the last record in the hospital notes. The 1-year survival was 46%. ConclusionPatients with metastatic colon cancer at presentation are heterogeneous and warrant an adapted multidisciplinary approach to achieve the goal of individualized treatment for each patient in accordance with the Swedish national cancer strategy.
  •  
36.
  •  
37.
  • Kald, Anders, et al. (författare)
  • Mesh repair of parastomal hernias : New aspects of the Onlay technique
  • 2001
  • Ingår i: Techniques in Coloproctology. - : Springer Science and Business Media LLC. - 1123-6337 .- 1128-045X. ; 5:3, s. 169-171
  • Tidskriftsartikel (refereegranskat)abstract
    • When a hernia becomes symptomatic with pain, obstruction, or mechanical distortion, need for a repair is likely. In this short note are new aspects on the Onlay mesh repair technique of parastomal hernias presented. The satisfactory results achieved in 5 patients are reported. One recurrence required a further successful repair.
  •  
38.
  • Kald, Anders, 1958-, et al. (författare)
  • Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy
  • 2008
  • Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 43:5, s. 627-633
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Peristomal bulging caused by hernia or prolapse is common in patients with a sigmoidostomy. It is not known whether and to what extent peristomal bulging influences various daily activities. The purpose of this study was to evaluate the effects of bulging by using a general and disease-specific health scale (Short Health Scale, SHS) and a stoma-specific quality of life (Stoma-QoL) questionnaire in patients with and without peristomal bulging. Material and methods. Seventy patients with sigmoidostomies were examined to identify peristomal bulging. The mean (SD) age was 71.7 (13.7) years and the patients had had their sigmoidostomies for a mean of 8.1 (7.9) years. Bulging was noticed in 46 patients (66%) while 24 had no bulging. Results. It was found that patients with bulging were at a disadvantage. In the SHS, patients with bulging reported significantly impaired QoL in 3 out of 4 scales regarding symptom load, worry and general sense of well-being. Also, in the Stoma-QoL questionnaire there was a significant difference between patients with and those without bulging. Conclusions. QoL evaluated with a general and disease-specific instrument (SHS) was significantly impaired in patients with bulging around a sigmoidostomy. The Stoma-QoL questionnaire showed a small but statistically significant difference between patients with and those without bulging but the clinical significance is uncertain. Further studies are required to evaluate the role of some of the individual items in the Stoma-QoL questionnaire. © 2008 Taylor & Francis.
  •  
39.
  • Kressner, Marit, et al. (författare)
  • The impact of hospital volume on surgical outcome in patients with rectal cancer.
  • 2009
  • Ingår i: Diseases of the colon and rectum. - 1530-0358 .- 0012-3706. ; 52:9, s. 1542-9
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: This study was designed to investigate, in a population-based setting, the surgical outcome in patients with rectal cancer according to the hospital volume. METHODS: Since 1995 all patients with rectal cancer have been registered in the Swedish Rectal Cancer Registry. Hospitals were classified, according to number treated per year, as low-volume, intermediate-volume, or high-volume hospitals (<11, 11-25, or >25 procedures per year). Postoperative mortality, reoperation rate within 30 days, local recurrence rate, and overall five-year survival were studied. For postoperative morbidity and mortality the whole cohort from 1995 to 2003 (n = 10,425) was used. For cancer-related outcome only, those with five-year follow-ups, from 1995 to 1998, were used (n = 4,355). RESULTS: In this registry setting the postoperative mortality rate was 3.6% in low-volume hospitals, and 2.2% in intermediate-volume and high-volume hospitals (P = 0.002). The reoperation rate was 10%, with no differences according to volume. The overall local recurrence rates were 9.4%, 9.3%, and 7.5%, respectively (P = 0.06). Significant difference was found among the nonirradiated patients (P = 0.004), but not among the irradiated patients (P = 0.45). No differences were found according to volume in the absolute five-year survival. CONCLUSION: Postoperative mortality and local recurrence in nonirradiated patients were lower in high-volume hospitals. No difference was seen between volumes in reoperation rates, overall local recurrence, or absolute five-year survival.
  •  
40.
  • Laurell, Helena, 1965- (författare)
  • Acute Abdominal Pain
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim was to identify diagnostic difficulties for acute abdominal pain at the emergency department and during hospital stay. A total of 3349 patients admitted to Mora Hospital with acute abdominal pain of up to seven days duration, were registered prospectively for history and clinical signs according to a structured schedule. The preliminary diagnosis from the attending physician at the emergency department, any investigations or surgery and final diagnosis were registered at a follow-up after at least one year. There were no differences in diagnostic performance between physicians with 0.5 to 5 years of medical experience. The information collected and a careful examination of the patient was more important than formal competence. The main differential diagnostic problem was non-specific abdominal pain; this was the same for diagnoses requiring surgery. Patients originally diagnosed as not needing surgery had a median delay before operation of 22 hours (mean 40 hours, with 95% confidence interval of 30-50 hours), compared to 8 hours (mean 15 hours, 95% confidence interval of 12-28 hours) for patients with the same final follow-up diagnosis as the preliminary diagnosis. Constipation was a diagnostic pitfall, as 9% of the patients considered constipated required surgery for potentially life threatening reasons and 8% were later found to have an abdominal malignancy. Both the preliminary diagnosis and the discharge diagnosis were less reliable for elderly patients than for younger patients. Elderly patients often had specific organ disease and arrived at the emergency department after a longer history of abdominal pain. This study confirms that assessment of suspected appendicitis can still be based on clinical judgements combined with laboratory tests. Classical clinical findings indicating localised inflammation, such as isolated pain in the right iliac fossa, rebound tenderness, right-sided rectal tenderness, pain migration to the right iliac fossa, local guarding and aggravation of pain when moving, were reliable for predicting acute appendicitis. A CT scan can be saved for the more equivocal cases of acute abdominal pain. A generous strategy regarding CT scan among elderly patients with acute abdominal pain, even in the absence of pronounced signs of an inflammatory intra-abdominal process, is recommended.
  •  
41.
  • Lilja, I, et al. (författare)
  • Presence of group IIa secretory phospholipase A(2) in mast cells and macrophages in normal human ileal submucosa and in Crohn's disease
  • 2000
  • Ingår i: Clinical Chemistry and Laboratory Medicine. - 1434-6621 .- 1437-4331. ; 38:12, s. 1231-1236
  • Tidskriftsartikel (refereegranskat)abstract
    • Secretory group IIa phospholipase A(2) (PLA(2)-II) is an important regulator of proinflammatory lipid mediator production and may play a role in ileal inflammation in Crohn's disease. The enzyme has previously only been detected in epithelial Paneth cells. However, one characteristic feature of Crohn's disease is the transmural inflammation. Full thickness ileal sections from nine patients with Crohn's disease, and histologically normal sections from patients with colonic cancer (n=7) and chronic severe constipation (n=1) as controls, were used in this study. PLA(2)-II-positive cells were detected by immunofluorescence and in situ hybridization. Metachromatic staining and esterase staining were used to identify mast cells and macrophages, respectively. It was shown that mast cells and macrophages in the ileal submucosa in both patients and controls showed positive PLA(2)-II staining. The number of PLA(2)-II-labeled cells that did not react with metachromasia, e.g. macrophages, was significantly greater in inflamed Crohn's disease compared to controls. This is, to our knowledge, the first study that has described the presence in healthy, while presence and upregulation of PLA(2)-II-positive cells in inflamed human ileal submucosa. Our findings suggest a proinflammatory potential for secretory PLA(2)-II in submucosa, while proinflammatory stimulation of mast cells and macrophages in vitro has shown that the enzyme is responsible for delayed prostaglandin formation.
  •  
42.
  • Lilja, Ingela, et al. (författare)
  • Tumor necrosis factor-alpha in ileal mast cells in patients with Crohn's disease
  • 2000
  • Ingår i: Digestion. - : S. Karger AG. - 0012-2823 .- 1421-9867. ; 61:1, s. 68-76
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Reports that both intestinal and extraintestinal Crohn's disease (CD) had healed successfully after treatment with anti-tumor necrosis factor-alpha (TNF-a) antibody have strengthened the hypothesis that it has a role in the treatment of CD. The macrophage is one source of TNF-a. Intestinal mast cells are also thought to have a role in CD, but it is not known if human ileal mast cells express TNF-a. Aim: To find out whether TNF-a is expressed by mast cells in the ileal wall in CD patients and controls. Methods: TNF-a was sought immunohistochemically in full thickness specimens of ileal wall from patients with CD (histologically normal, n = 9, inflamed, n = 6) and controls (patients with colonic cancer, n = 8). Mast cells were identified by metachromasia and anti-mast cell tryptase immunoreactivity. Results: In all layers of the ileal wall, and in every specimen investigated, mast cells were the main cell type that expressed TNF-a immunoreactivity out of the TNF-a-labelled cells. The number of TNF-a-labelled mast cells was greater in the muscularis propria in patients compared with controls, both in uninflamed (1.7-fold, p < 0.05) and in inflamed bowel (4.6-fold, p < 0.002), greater in the submucosa in inflamed compared with uninflamed CD (1.6-fold, p < 0.01), and less in the lamina propria in inflamed compared with uninflamed CD (0.4-fold, p < 0.05). Conclusion: Mast cells are an important source of TNF-a in all layers of the ileal wall, and the increased density of TNF-a-positive mast cells in the submucosa and muscularis propria may contribute to the tissue changes and symptoms in CD.
  •  
43.
  • Lindgren, Rickard, et al. (författare)
  • Does a Defunctioning Stoma Affect Anorectal Function After Low Rectal Resection? Results of a Randomized Multicenter Trial
  • 2011
  • Ingår i: DISEASES OF THE COLON and RECTUM. - : Springer Science Business Media. - 0012-3706 .- 1530-0358. ; 54:6, s. 747-752
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Anorectal function is often impaired after low anterior resection of the rectum. Many factors affect the functional outcome and not all are known. OBJECTIVE: This trial aimed to assess whether a temporary defunctioning stoma affected anorectal function after the patients had been stoma-free for a year. DESIGN: Multicenter randomized controlled trial. SETTING: Twenty-one Swedish hospitals performing surgery for rectal cancer participated. PATIENTS: Patients who had undergone low anterior resection for adenocarcinoma of the rectum were eligible. INTERVENTIONS: Patients were randomly assigned to receive a defunctioning stoma or no stoma. MAIN OUTCOME MEASURES: Anorectal function was evaluated with a questionnaire after patients had been without a stoma for 12 months. Questions pertained to stool frequency, urgency, fragmentation of bowel movements, evacuation difficulties, incontinence, lifestyle alterations, and whether patients would prefer a permanent stoma. RESULTS: After exclusion of patients in whom stomas became permanent, a total of 181 (90%) of 201 patients answered the questionnaire (90 in the stoma group and 91 in the no-stoma group). The median number of stools was 3 during the day and 0 at night in both groups. Inability to defer defecation for 15 minutes was reported in 35% of patients in the stoma group and 25% in the no stoma group (P = .15). Median scores were the same in each group regarding need for medication, evacuation difficulties, fragmentation of bowel movements, incontinence, and effects on well-being. Two patients (2.2%) in the stoma group and 3 patients (3.3%) in the no-stoma group would have preferred a permanent stoma. LIMITATIONS: Because this study was an analysis of secondary end points of a randomized trial, no prestudy power calculation was performed. CONCLUSIONS: A defunctioning stoma after low anterior resection did not affect anorectal function evaluated after 1 year. Many patients experienced impaired anorectal function, but nearly all preferred having impaired anorectal function to a permanent stoma.
  •  
44.
  • Lindgren, Rickard, et al. (författare)
  • What Is the Risk for a Permanent Stoma After Low Anterior Resection of the Rectum for Cancer? A Six-Year Follow-Up of a Multicenter Trial
  • 2011
  • Ingår i: DISEASES OF THE COLON and RECTUM. - : Springer Science Business Media. - 0012-3706 .- 1530-0358. ; 54:1, s. 41-47
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The aim of this study was to assess the risk for permanent stoma after low anterior resection of the rectum for cancer. METHODS: In a nationwide multicenter trial 234 patients undergoing low anterior resection of the rectum were randomly assigned to a group with defunctioning stomas (n = 116) or a group with no defunctioning stomas (n = 118). The median age was 68 years, 45% of the patients were women, 79% had preoperative radiotherapy, and 4% had International Union Against Cancer cancer stage IV. The patients were analyzed with regard to the presence of a permanent stoma, the type of stoma, the time point at which the stoma was constructed or considered as permanent, and the reasons for obtaining a permanent stoma. Median follow-up was 72 months (42-108). One patient with a defunctioning stoma who died within 30 days after the rectal resection was excluded from the analysis. RESULTS: During the study period 19% (45/233) of the patients obtained a permanent stoma: 25 received an end sigmoid stoma and 20 received a loop ileostomy. The end sigmoid stomas were constructed at a median of 22 months (1-71) after the low anterior resection of the rectum, and the loop ileostomies were considered as permanent at a median of 12.5 months (1-47) after the initial rectal resection. The reasons for loop ileostomy were metastatic disease (n = 6), unsatisfactory anorectal function (n = 6), deteriorated general medical condition (n = 3), new noncolorectal cancer (n = 2), patient refusal of further surgery (n = 2), and chronic constipation (n = 1). Reasons for end sigmoid stoma were unsatisfactory anorectal function (n = 22) and urgent surgery owing to anastomotic leakage (n = 3). The risk for permanent stomas in patients with symptomatic anastomotic leakage was 56% (25/45) compared with 11% (20/188) in those without symptomatic anastomotic leakage (P andlt; .001). CONCLUSION: One patient of 5 ended up with a permanent stoma after low anterior resection of the rectum for cancer, and half of the patients with a permanent stoma had previous symptomatic anastomotic leakage.
  •  
45.
  • Lundqvist, Martina, et al. (författare)
  • Patient benefit of dog-assisted interventions in health care: a systematic review
  • 2017
  • Ingår i: BMC Complementary and Alternative Medicine. - : BIOMED CENTRAL LTD. - 1472-6882. ; 17
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Dogs are the most common companion animal, and therefore not surprisingly a popular choice for animal-assisted interventions. Dog-assisted interventions are increasingly used in healthcare. The aim of the review was to conduct a systematic literature review of quantitative studies on dog-assisted interventions in healthcare, with the intention of assessing the effects and cost-effectiveness of the interventions for different categories of patients. Methods: A systematic review of the scientific literature reporting results of studies in healthcare, nursing home or home care settings, was conducted. The inclusion criteria applied for this review were: quantitative studies, inclusion of at least 20 study subjects, existence of a control and performed in healthcare settings including nursing homes and home care. The electronic databases PubMed, AMED, CINAHL and Scopus were searched from their inception date through January 2017, for published articles from peer-reviewed journals with full text in English. Results: Eighteen studies that fulfilled the inclusion criteria, and were judged to be of at least moderate quality, were included in the analysis. Three of them showed no effect. Fifteen showed at least one significant positive effect but in most studied outcome measures there was no significant treatment effect. Dog-assisted therapy had the greatest potential in treatment of psychiatric disorders among both young and adult patients. Dog-assisted activities had some positive effects on health, wellbeing, depression and quality of life for patients with severe cognitive disorders. Dog-assisted support had positive effects on stress and mood. Conclusions: The overall assessment of the included studies indicates minor to moderate effects of dog-assisted therapy in psychiatric conditions, as well as for dog-assisted activities in cognitive disorders and for dog-assisted support in different types of medical interventions. However, the majority of studied outcome measures showed no significant effect.
  •  
46.
  • Machado, Mikael, et al. (författare)
  • Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer : A comparison between two hospitals with a different policy
  • 2002
  • Ingår i: Diseases of the Colon & Rectum. - : Ovid Technologies (Wolters Kluwer Health). - 0012-3706 .- 1530-0358. ; 45:7, s. 940-945
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The aim of this study was to compare surgical outcome, after low anterior resection for rectal cancer with colonic J-pouch, at two departments with a different policy regarding the use of a routine diverting stoma. METHODS: A total of 161 consecutive patients with invasive rectal carcinomas operated on between 1990 and 1997 with a total mesorectal excision and a colonic J-pouch were included in the study. Eighty patients were operated on in a surgical unit using routine defunctioning stomas (96 percent), whereas 81 were operated on in a department in which diversion was rarely used (5 percent). Recorded data with respect to surgical outcome were analyzed and compared. RESULTS: There was no difference between the two centers in postoperative mortality in connection with the primary resection and subsequent stoma reversal (3.7 vs. 3.8 percent). No significant difference could be found in the number of patients with pelvic sepsis (anastomotic leaks, 9 vs. 12 percent). Surgical outcome in patients with pelvic sepsis was also similar. The frequency of reoperations associated with the anterior resection and subsequent stoma reversal was identical (14 percent). The total hospital stay (primary operation and stoma reversal) was significantly longer with than without a routine stoma (17 (range, 2-59) vs. 12 (range, 5-55) days, respectively, P < 0.001). CONCLUSION: This study suggests that the routine use of diversion does not protect the patient from anastomotic complications or pelvic sepsis and its use requires a second admission for closure.
  •  
47.
  • Matthiessen, P, et al. (författare)
  • Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer - occurrence and risk factors
  • 2010
  • Ingår i: COLORECTAL DISEASE. - : Wiley. - 1462-8910 .- 1463-1318. ; 12:4, s. 351-357
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective The aim of the study was to assess recto-vaginal fistula (RVF) after anterior resection of the rectum for cancer with regard to occurrence and risk factors. Method All female patients [median age 69.5 years, Union Internationale centre le Cancer (UICC) cancer stage IV in 10%] who developed a symptomatic RVF (n = 20) after anterior resection of the rectum for cancer from three separate cohorts of patients were identified and compared with those who developed conventional symptomatic leakage (n = 32), and those who did not leak (n = 338). Patient demography and perioperative data were compared between these three groups. Fourteen patient-related and surgery-related variables thought to be possible risk factors for RVF (anastomotic-vaginal fistula) were analysed. Results Symptomatic anastomotic leakage occurred in 52 (13.3%) of 390 patients. Twenty (5.1%) had an anastomotic-vaginal fistula (AVF) and 32 (8.2%) conventional leakage (CL). Patients with AVF required unscheduled re-operation and defunctioning stoma as often as those with CL. AVF was diagnosed later and more often after discharge from hospital compared with CL. Patients with AVF had lower anastomoses and decreased BMI compared with those with CL. Risk factors for AVF in multivariate analysis were anastomosis andlt; 5 cm above the anal verge (P = 0.001), preoperative radiotherapy (P = 0.004), and UICC cancer stage IV (P = 0.005). Previous hysterectomy was a risk factor neither for AVF nor for CL. Conclusion Anastomotic-vaginal fistula forms a significant part of all symptomatic leakages after low anterior resection for cancer in women. Although diagnosed later, the need for abdominal re-operation and defunctioning stoma was not different from patients with CL. Risk factors for AVF included low anastomosis, preoperative radiotherapy and UICC cancer stage IV.
  •  
48.
  •  
49.
  • Matthiessen, Peter, 1957-, et al. (författare)
  • Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer : A randomized multicenter trial
  • 2007
  • Ingår i: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 246:2, s. 207-214
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were intraoperatively randomized to a defunctioning stoma or not. SUMMARY BACKGROUND DATA: The introduction of total mesorectal excision surgery as the surgical technique of choice for carcinoma in the lower and mid rectum has led to decreased local recurrence and improved oncological results. Despite these advances, perioperative morbidity remains a major issue, and the most feared complication is symptomatic anastomotic leakage. The role of the defunctioning stoma in regard to anastomotic leakage is controversial and has not been assessed in any randomized trial of sufficient size. METHODS: From December 1999 to June 2005, a total of 234 patients were randomized to a defunctioning loop stoma or no loop stoma. Loop ileostomy or loop transverse colostomy was at the choice of the surgeon. Inclusion criteria for randomization were expected survival >6 months, informed consent, anastomosis ≤7 cm above the anal verge, negative air leakage test, intact anastomotic rings, and absence of major intraoperative adverse events. RESULTS: The overall rate of symptomatic leakage was 19.2% (45 of 234). Patients randomized to a defunctioning stoma (n = 116) had leakage in 10.3% (12 of 116) and those without stoma (n = 118) in 28.0% (33 of 118) (odds ratio = 3.4, 95% confidence interval, 1.6-6.9, P < 0.001). The need for urgent abdominal reoperation was 8.6% (10 of 116) in those randomized to stoma and 25.4% (30 of 118) in those without (P < 0.001). After a follow-up of median 42 months (range, 6-72 months), 13.8% (16 of 116) of the initially defunctioned patients still had a stoma of any kind, compared with 16.9% (20 of 118) those not defunctioned (not significant). The 30-day mortality after anterior resection was 0.4% (1 of 234) and after elective reversal a defunctioning stoma 0.9% (1 of 111). Median age was 68 years (range, 32-86 years), 45.3% (106 of 234) were females, 79.1% (185 of 234) had preoperative radiotherapy, the level of anastomosis was median 5 cm, and intraoperative blood loss 550 mL, without differences between the groups. CONCLUSION: Defunctioning loop stoma decreased the rate of symptomatic anastomotic leakage and is therefore recommended in low anterior resection for rectal cancer.
  •  
50.
  •  
Skapa referenser, mejla, bekava och länka
  • Resultat 1-50 av 102
Typ av publikation
tidskriftsartikel (87)
forskningsöversikt (6)
doktorsavhandling (5)
bokkapitel (2)
annan publikation (1)
konferensbidrag (1)
visa fler...
visa färre...
Typ av innehåll
refereegranskat (84)
övrigt vetenskapligt/konstnärligt (14)
populärvet., debatt m.m. (4)
Författare/redaktör
Sjödahl, Rune (51)
Sjödahl, Rune, 1938- (47)
Hallböök, Olof, 1954 ... (15)
Hallböök, Olof (12)
Olaison, Gunnar, 194 ... (9)
Myrelid, Pär (7)
visa fler...
Nilsson, Lena (7)
Andersson, Peter (6)
Andersson, Peter, 19 ... (6)
Söderholm, Johan D., ... (6)
Påhlman, Lars (6)
Matthiessen, Peter (5)
Matthiessen, Peter, ... (5)
Andersson, Christer (5)
Nyström, Per-Olof, 1 ... (5)
Rutegård, Jörgen, 19 ... (5)
Myrelid, Pär, 1970- (4)
Theodorsson, Elvar (4)
Theodorsson, Elvar, ... (4)
Magnusson, Martin (3)
Matthiessen, P. (3)
Lindgren, Rickard (3)
Borgstedt Risberg, M ... (3)
Bohe, Måns (3)
Rutegård, Jörgen (3)
Olaison, Gunnar (3)
Söderholm, Johan D (3)
Nyström, Per-Olof (3)
Walter, Susanna, 196 ... (3)
Damber, Lena (3)
Franzen, L (2)
Lindmark, Gudrun (2)
Andersson, M (2)
Strigård, Karin (2)
Timpka, Toomas (2)
Heedman, Per-Anders (2)
Olsson, Anders (2)
Carlsson, Per (2)
Rutberg, Hans (2)
Ström, Magnus (2)
Almer, Sven (2)
Spreco, Armin (2)
Bringman, Sven (2)
Kastbom, Lisa (2)
Gustavsson, Erik, 19 ... (2)
Juhlin, Claes (2)
Davidson, Thomas, 19 ... (2)
Nyström, P O (2)
Cedermark, Björn (2)
Rutegård, J (2)
visa färre...
Lärosäte
Linköpings universitet (97)
Umeå universitet (11)
Karolinska Institutet (7)
Uppsala universitet (6)
Örebro universitet (5)
Lunds universitet (4)
visa fler...
Göteborgs universitet (2)
Linnéuniversitetet (2)
Jönköping University (1)
visa färre...
Språk
Engelska (90)
Svenska (12)
Forskningsämne (UKÄ/SCB)
Medicin och hälsovetenskap (40)
Samhällsvetenskap (1)

År

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy