| 1. |
- Jonsson, Magnus, et al.
(författare)
-
Carotid Endarterectomy After Intracranial Endovascular Thrombectomy for Acute Ischaemic Stroke in Patients with Carotid Artery Stenosis
- 2022
-
Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 63:3, s. 371-378
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Recent randomised controlled trials demonstrated the benefit of intracranial endovascular thrombectomy (EVT) in acute ischaemic stroke. There is no consensus, however, on how to treat concomitant extracranial carotid artery stenosis after EVT. The aim of this study was to evaluate the outcome in patients treated with carotid endarterectomy (CEA) after EVT, comparing complication rates among patients undergoing CEA for stroke without previous EVT.Methods: This was a registry study of all patients (n = 3 780) treated with CEA after stroke in Sweden and the capital Helsinki region, Finland, from January 2011 to September 2020. Sixty three patients (1.7%; 0.5% 2011, 4.3% 2019) underwent EVT prior to CEA. The primary outcome was 30 day stroke and death rate.Results: The EVT+CEA group had major stroke as the qualifying neurological event (QNE) in 79%, but just 5.9% had this in the CEA only group (p < .001). Intravenous thrombolysis was administered before EVT in 54% of patients in the EVT+CEA group, but in just 12% in those receiving CEA only (p < .001). The combined stroke and death rate at 30 days for EVT+CEA was 0.0% (95% confidence interval [CI] 0.0 - 5.7). One patient had a post-operative TIA, none had post-operative intracerebral or surgical site haemorrhage. CEA was performed within a median of seven days (interquartile range 4, 15) after QNE, and 75% had CEA <= 14 days from QNE. The main reason to postpone CEA was an infarct larger than one third of the middle cerebral artery territory. The stroke and death rate in patients treated with CEA only was 3.7% (95% CI 3.2 - 4.4), CEA was performed a median of eight days after QNE, and in 79.7% in <= 14 days. The three year survival after EVT+CEA was 93% (95% CI 85 - 100), compared with 87% (95% CI 86 - 88) after CEA only. Cox regression analysis adjusting for age showed no increased all cause mortality after EVT+CEA (HR 1.3, 95% CI 0.6 - 2.7, p = .52).Conclusion: These results indicate that CEA is safe to perform after previous successful EVT for acute ischaemic stroke. Results were comparable with those undergoing CEA only, despite the EVT+CEA patients having more severe stroke symptoms prior to surgery, and timing was similar.
|
|
| 2. |
- Alsterholm, Mikael, 1977, et al.
(författare)
-
Establishment and utility of SwedAD : a nationwide Swedish registry for patients with atopic dermatitis receiving systemic pharmacotherapy
- 2023
-
Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 103
-
Tidskriftsartikel (refereegranskat)abstract
- SwedAD, a Swedish nationwide registry for patients with atopic dermatitis receiving systemic pharmacotherapy, was launched on 1 September 2019. We describe here the establishment of a user-friendly registry to the benefit of patients with atopic dermatitis. By 5 November 2022, 38 clinics had recorded 931 treatment episodes in 850 patients with an approximate national coverage rate of 40%. Characteristics at enrolment included median Eczema Area and Severity Index (EASI) 10.2 (interquartile range 4.0, 19.4), Patient-Oriented Eczema Measure (POEM) 18.0 (10.0, 24.0), Dermatology Life Quality Index (DLQI) 11.0 (5.0, 19.0) and Peak Itch Numerical Rating Scale-11 (NRS-11) 6.0 (3.0, 8.0). At 3 months, median EASI was 3.2 (1.0, 7.3) and POEM, DLQI, and NRS-11 were improved. Regional coverage varied, reflecting the distribution of dermatologists, the ratio of public to private healthcare, and difficulties in recruiting certain clinics. This study highlights the importance of a nationwide registry when managing systemic pharmacotherapy of atopic dermatitis.
|
|
| 3. |
- Berglund, Annika, et al.
(författare)
-
Higher prehospital priority level of stroke improves thrombolysis frequency and time to stroke unit : the Hyper Acute STroke Alarm (HASTA) study
- 2012
-
Ingår i: Stroke. - New York : American Heart Association. - 0039-2499 .- 1524-4628. ; 43:10, s. 2666-2670
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Early initiated treatment of stroke increases the chances of a good recovery. This randomized controlled study evaluates how an increased priority level for patients with stroke, from level 2 to 1, from the Emergency Medical Communication Center influences thrombolysis frequency, time to stroke unit, and whether other medical emergencies reported negative consequences.METHODS: Patients aged 18 to 85 years in Stockholm, Sweden, with symptoms of stroke within 6 hours were randomized from the Emergency Medical Communication Center or emergency medical services to an intervention group, priority level 1, immediate call of an ambulance, or to a control group with standard priority level, that is, priority level 2 (within 30 minutes). Before study start, an educational program on identification of stroke and importance of early initiated treatment was directed to all medical dispatchers and ambulance and emergency department personnel.RESULTS: During 2008, 942 patients were randomized of which 53% (n=496) had a final stroke/transient ischemic attack diagnosis. Patients in the Emergency Medical Communication Center randomized intervention group reached the stroke unit 26 minutes earlier than the control group (P<0.001) after the emergency call. Thrombolysis was given to 24% of the patients in the intervention group compared with 10% of the control subjects (P<0.001). The higher priority level showed no negative effect on other critical ill patients requiring priority level 1 prehospital attention.CONCLUSIONS: This randomized study shows negligible harm to other medical emergencies, a significant increase in thrombolysis frequency, and a shorter time to the stroke unit for patients with stroke upgraded to priority level 1 from the Emergency Medical Communication Center and through the acute chain of stroke care.
|
|
| 4. |
- Boldrup, Linda, et al.
(författare)
-
Subsite-based alterations in miR-21, miR-125b, and miR-203 in squamous cell carcinoma of the oral cavity and correlation to important target proteins.
- 2012
-
Ingår i: Journal of Carcinogenesis. - : National Center for Biotechnology Information, USA. - 0974-6773 .- 1477-3163. ; 11, s. 18-
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: MicroRNAs (miRNAs) are small noncoding RNA molecules with an essential role in regulation of gene expression. miRNA expression profiles differ between tumor and normal control tissue in many types of cancers and miRNA profiling is seen as a promising field for finding new diagnostic and prognostic tools.MATERIALS AND METHODS: In this study, we have analyzed expression of three miRNAs, miR-21, miR-125b, and miR-203, and their potential target proteins p53 and p63, known to be deregulated in squamous cell carcinoma of the head and neck (SCCHN), in two distinct and one mixed subsite in squamous cell carcinoma in the oral cavity.RESULTS: We demonstrate that levels of miRNA differ between tumors of different subsites with tongue tumors showing significant deregulation of all three miRNAs, whereas gingival tumors only showed significant downregulation of miR-125b and the mixed group of tumors in tongue/floor of the mouth showed significant deregulation of miR-21 and miR-125b. In the whole group of oral squamous cell carcinoma (SCC), a significant negative correlation was seen between miR-125b and p53 as well as a significant correlation between TP53 mutation status and miR-125b.CONCLUSION: The present data once again emphasize the need to take subsite into consideration when analyzing oral SCC and clearly show that data from in vitro studies cannot be transferred directly to the in vivo situation.
|
|
| 5. |
|
|
| 6. |
- Gånemo, Agneta, et al.
(författare)
-
Quality of life in Swedish children with eczema
- 2007
-
Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 87:4, s. 345-349
-
Tidskriftsartikel (refereegranskat)abstract
- The burdens of childhood eczema are many and some can be assessed with quality of life (QoL) questionnaires. Seventy-eight Swedish children with mild-to-severe eczema ("atopic dermatitis", prurigo Besnier), fulfilling established diagnostic criteria, were investigated for the effect of eczema on QoL. This was measured with validated questionnaires: the Infants' Dermatitis Quality of Life Index (IDQOL), the Children's Dermatology Life Quality Index (CDLQI), and the Dermatitis Family Impact Questionnaire (DFI). The study also included scoring of eczema severity. The median score was 7.0 (range 1-18) for IDQOL, 6.0 (range 2-18) for the CDLQI, and 8.0 (range 0-27) for DFI. There was no significant difference in scores between boys and girls. The DFI scores were higher for younger than for older children, and also higher for those with both eczema and asthma, food allergy/intolerance, allergic rhinoconjunctivitis or urticaria. The QoL scores correlated significantly with the Rajka & Langeland score, but not with objective SCORAD. The outcome of the QoL instruments in this study clearly demonstrates that childhood eczema affects the children's and their families' QoL. QoL data offers a patient-oriented outcome measure of importance for understanding the patients' and their families' situation. Such information can also be used in intervention studies and in the allocation of healthcare resources to eczema care.
|
|
| 7. |
- Hammo, Sari, et al.
(författare)
-
Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm : A National Multicentre Study
- 2019
-
Ingår i: European Journal of Vascular and Endovascular Surgery. - : Saunders Elsevier. - 1078-5884 .- 1532-2165. ; 57:6, s. 788-794
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this multicentre study was to analyse the outcome of thoracic endovascular aortic repair (TEVAR) in patients with ruptured descending thoracic aortic aneurysm (rDTAA).Methods: This is a nationwide retrospective study including all patients who underwent TEVAR for rDTAA at six major vascular university centres in Sweden between January 2000 and December 2015. Outcome measures were analysed using Kaplan-Meier estimator and multivariable Cox regression.Results: There were 140 patients (age [mean +/- SD] 74.1 +/- 8.8 years; 56% men; aneurysm size 64.8 +/- 19 mm), with rDTAA. In 53 patients (37.9%), the left subclavian artery was covered, and in 25 patients (17.9%) arch vessel revascularisation was performed. In total, 61/136 patients (45%) had a major complication within 30 days post TEVAR. Stroke (n = 20; 14.7%) was the most common complication, followed by paraplegia (n = 13; 9.6%) and major bleeding (n = 13; 9.6%). TEVAR related complications during follow up included endoleaks 22.1% (30/136; 14 type 1a, six type 1b, 10 not defined). In total, re-interventions (n = 31) were required in 27/137 (19.7%) patients. The median follow up time was 17.0 months (range 0-132 months). The Kaplan-Meier estimated survival was 80.0% at one month, 71.7% at three months, 65.3% at one year, 45.9% at three years, and 31.9% at five years. Age (HR 1.03; 95% CI 1.00-1.07; p = .046), history of stroke (HR 2.35; 95% CI 1.194.63; p = .014), previous aortic surgery (HR 2.11; 95% CI 1.15-3.87; p = .016) as well as post-operative major bleeding (HR 4.40; 95% CI 2.20-8.81; p = .001), stroke (HR 2.63; 95% CI 1.37-5.03; p = .004), and renal failure (HR 8.25; 95% CI 2.69-25.35; p = .001) were all associated with mortality.Conclusions: This nationwide multicentre study of patients with rDTAA undergoing TEVAR showed acceptable short- but poor long-term survival. Adequate proximal and distal aortic sealing zones are important for technical success. High risk patients and post-operative complications need to be further addressed in an effort to improve outcome.
|
|
| 8. |
- Holmberg, Lina, et al.
(författare)
-
Penetrating Trauma on the Rise – Nine-year Trends of Severe Trauma in Sweden
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- PurposeSweden has an established trauma system involving national trauma criteria and a registry, SweTrau, since over a decade. Meanwhile, the injury panorama has evolved, with an increase in gang-related violence in the Swedish community. In this study, we aimed to investigate long-term trends in mortality, management and trauma type in two major Swedish trauma centers over a nine-year period. MethodsAll trauma patients with a New Injury Score (NISS)>15 or a Trauma Alert call during 2013-2021 were identified in the participating centers’ SweTrau registries. Data were analysed regarding mortality, proportion of emergency interventions, intensive care unit (ICU) admissions, mechanism of injury and type of trauma (penetrating or blunt). To assess trends, Chi-Squared test for trend and JoinPoint regression method were used. ResultsA total of 10585 patients were included in the study. Mortality remained unchanged over time in patients with NISS>15 (10.0% - 10.9%, p=0.963) but increased in NISS<15 (1.3% - 2.7%, p=0.005), partly comprising penetrating trauma, suicides and traumatic cardiac arrests. For NISS>15, the proportion undergoing emergency interventions was stable (53.9%-48.8%, p=0.297) while ICU admissions declined (62.1%-45.7%, p<0.001). Penetrating trauma increased (12.4%-19.6%, p<0.001), including knife (10.0%-15.7%, p<0.001) and gunshot wounds (2.3%-3.8%, p<0.001), whereas accidents involving motorcycles (8.8%-7.0%, p=0.004) and pedestrians (5.3%-2.2%, p<0.001) decreased. ConclusionsIn this trend analysis at two major Swedish trauma centers during 2013-2021, penetrating trauma increased with over 50% while traffic injuries decreased. The rise in mortality in patients with NISS<15 is concerning and requires further evaluation, as do the reduction in ICU admissions.
|
|
| 9. |
|
|
| 10. |
- Jansson, Magnus, et al.
(författare)
-
Efficient Implementation of a Submodel for Composite Materials to be Combined with the FDTD-Algorithm
- 1994
-
Ingår i: IEEE Transactions on Magnetics. - : IEEE Magnetics Society. - 0018-9464 .- 1941-0069. ; 30:5, s. 3188-3191
-
Tidskriftsartikel (refereegranskat)abstract
- A submodel to be used for thin sheets of semiconducting materials in combination with the finite difference time domain algorithm for solving Maxwell's equations is derived. Emphasis is concentrated on accomplishing an efficient and robust algorithm. Stability properties of the combined model are also investigated
|
|
| 11. |
- Johansson, Christer, et al.
(författare)
-
Impacts of air pollution and health by changing commuting from car to bicycle
- 2017
-
Ingår i: Science of the Total Environment. - : Elsevier. - 0048-9697 .- 1879-1026. ; 584-585, s. 55-63
-
Tidskriftsartikel (refereegranskat)abstract
- Our study is based on individual data on people’s home and work addresses, as well as their age, sex and physical capacity, in order to establish realistic bicycle-travel distances. A transport model is used to single out data on commuting preferences in the County Stockholm. Our analysis shows there is a very large potential for reducing emissions and exposure if all car drivers living within a distance corresponding to a maximum of a 30 minute bicycle ride to work would change to commuting by bicycle. It would result in more than 111 000 new cyclists, corresponding to an increase of 209% compared to the current situation.Mean population exposure would be reduced by about 7% for both NOx and black carbon (BC) in the most densely populated area of the inner city of Stockholm. Applying a relative risk for NOx of 8% decrease in all-cause mortality associated with a 10 µg m-3 decrease in NOx, this corresponds to more than 449 (95% CI: 340 - 558) years of life saved annually for the Stockholm county area with 2.1 million inhabitants. This is more than double the effect of the reduced mortality estimated for the introduction of congestion charge in Stockholm in 2006. Using NO2 or BC as indicator of health impacts, we obtain 395 (95% CI: 172 - 617) and 185 (95% CI: 158 - 209) years of life saved for the population, respectively. The calculated exposure of BC and its corresponding impacts on mortality are likely underestimated. With this in mind the estimates using NOx, NO2 and BC show quite similar health impacts considering the 95% confidence intervals.
|
|
| 12. |
- Koraen, Linn, et al.
(författare)
-
Thrombolysis for lower extremity bypass graft occlusion
- 2011
-
Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 54:5, s. 1339-1344
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Thrombolysis is a common method in the treatment of lower extremity bypass graft occlusion. The purpose of this study was to investigate the results of thrombolytic therapy in the management of acute bypass graft occlusion and to identify risk factors for technical failure and amputation. Methods: All patients at two tertiary referral centers undergoing thrombolysis for acute graft occlusion in the lower limb between January 1, 2000 and December 31, 2008 were retrospectively reviewed. Factors associated with technical failure of thrombolytic therapy, major amputation, and mortality were determined with multivariate analysis, and long-term outcomes were assessed with the IC-plan-Meier method and log-rank test. Results: During the study period, 123 patients underwent thrombolysis for acute bypass graft occlusion. Mean age was 69 years (range, 27-91 years); 38% were women. Sixty-seven percent had synthetic grafts. Acute critical leg ischemia (74%) was the dominating symptom preceding thrombolytic treatment. In 29% of cases, no adjunctive interventions were required, whereas 21% underwent open surgery, 39% endovascular intervention, and 11% underwent a hybrid procedure. Technical failure of thrombolysis occurred in 18 patients. Presence of ischemic heart disease (P = .013), older grafts (P = .014), and synthetic grafts (trend; P = .092) were associated with success of thrombolysis, and ischemic heart disease remained as an independent factor in the multivariate analysis for technical success of thrombolysis (P = .04; odds ratio 4.0; 95% confidence interval [CI; 1.1-15.1]), whereas there was a trend for older grafts (P = .089). Mean follow-up was 38 months (range, 0-119 months). The major amputation rate was 11% (14/123) at 1 month and 25% (31/122) at 1 year. In a Cox regression model, technical failure (P = .031; hazard ratio [FIR] 2.58, 95% CI [1.0-6.08]), higher age (P = .004; HR 1.06,95% CI [1.02-1.10]), and synthetic graft as opposed to vein graft (P = .050; HR 2.63, 95% CI [1.0-6.9]) remained as independent factors associated with major amputation. The amputation-free survival rate was 89% and 75% at 1 and 12 months, respectively. Higher age (P < .001; HR 1.06, 95% CI [1.03-1.09]) and acute limb ischemia (P = .007; HR 2.40, 95% CI [1.26-4.56]) remained as independent adverse factors associated with amputation-free survival. Conclusions: Our findings support the use of thrombolysis in the treatment of acute bypass graft occlusion in the lower limb given its acceptable short- and long-term amputation-free survival rates. Technical failure and higher age were factors associated with major amputation. Synthetic grafts appeared to have a somewhat increased likelihood of technically successful thrombolysis compared with vein grafts, but on the other hand, they exhibited an increased risk of amputation during follow-up. (J Vase Surg 2011;54:1339-44.)
|
|
| 13. |
- Koraen-Smith, Linn, et al.
(författare)
-
Urgent carotid surgery and stenting may be safe after systemic thrombolysis for stroke
- 2014
-
Ingår i: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 45:3, s. 776-780
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Early carotid surgery or stenting after thrombolytic treatment for stroke has become more common during recent years. It is unclear whether this carries an increased risk of postoperative complications and death. The aim of this nationwide population-based study was, therefore, to investigate the safety of urgently performed carotid procedures in patients treated with thrombolysis for stroke.METHODS: Using the national Vascular and Stroke registries, we identified 3998 patients who had undergone carotid endarterectomy or carotid artery stenting for symptomatic carotid stenosis between May 2008 and December 2012. Among these, 2% (79 of 3998) had undergone previous thrombolysis for stroke. We conducted a retrospective review of registry data and individual case records with regard to postoperative complications, including surgical-site bleeding, stroke, and death. The outcome was compared with the results for the remaining patient cohort (3919 of 3998) undergoing carotid surgery and stenting during the study period.RESULTS: The median time between thrombolysis and the carotid procedure was 10 days. Seventy-one patients underwent carotid endarterectomy, and 6 patients underwent carotid artery stenting. The 30-day death and stroke rate for the thrombolysis cohort was 2.5% (2 of 79), and for the whole cohort, it was 3.8% (139 of 3626; P=0.55). The postoperative bleeding rates requiring reoperation were not significantly different between the groups (3.8% [3 of 79] in the thrombolysis group versus 3.3% [119 of 3626] in the whole cohort; P=0.79). There was no correlation between time from lysis to surgery or stenting and complications at 30 days postoperatively.CONCLUSIONS: Urgent carotid endarterectomy or carotid artery stenting after thrombolysis for stroke may be safe without increased risk of serious complications.
|
|
| 14. |
|
|
| 15. |
- Lilford, Robert D., et al.
(författare)
-
Increased Incidence and Mortality of Civilian Penetrating Traumatic Brain Injury in Sweden : A Single-Center Registry-Based Study
- 2024
-
Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 182, s. e493-e505
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundPenetrating trauma to the head and neck has increased during the past decade in Sweden. The aim of this study was to characterize these injuries and evaluate the outcomes for patients treated at a tertiary trauma center.MethodsSwedish trauma registry data were extracted on patients with head and neck injuries admitted to Karolinska University Hospital (Stockholm, Sweden) between 2011 and 2019. Outcome information was extracted from hospital records, with the primary endpoints focusing on the physiological outcome measures and the secondary endpoints on the surgical and radiological outcomes.ResultsOf 1436 patients with penetrating trauma, 329 with penetrating head and neck injuries were identified. Of the 329 patients, 66 (20%) had suffered a gunshot wound (GSW), 240 (73%) a stab wound (SW), and 23 (7%) an injury from other trauma mechanisms (OTMs). The median age for the corresponding 3 groups of patients was 25, 33, and 21 years, respectively. Assault was the primary intent, with 54 patients experiencing GSWs (81.8%) and 158 SWs (65.8%). Patients with GSWs had more severe injuries, worse admission Glasgow coma scale, motor, scores, and a higher intubation rate at the injury site. Most GSW patients underwent major surgery (59.1%) as the initial procedure and were more likely to have intracranial hemorrhage (21.2%). The 30-day mortality was 45.5% (n = 30) for GSWs, 5.4% (n = 13) for SWs, and 0% (n = 0) for OTMs. There was an annual increase in the incidence and mortality for GSWs and SWs.ConclusionsBetween 2011 and 2019, an increasing annual trend was found in the incidence and mortality from penetrating head and neck trauma in Stockholm, Sweden. GSW patients experienced more severe injuries and intracranial hemorrhage and underwent more surgical interventions compared with patients with SWs and OTMs.
|
|
| 16. |
- Lindskog, Magnus, et al.
(författare)
-
Overall survival in Swedish patients with renal cell carcinoma treated in the period 2002 to 2012: Update of the RENCOMP study with subgroup analysis of the synchronous metastatic and elderly populations
- 2017
-
Ingår i: Urologic Oncology-Seminars and Original Investigations. - : Elsevier BV. - 1078-1439 .- 1873-2496. ; 35:9, s. 541.e15-541.e22
-
Tidskriftsartikel (refereegranskat)abstract
- Background: This retrospective study investigated overall survival (OS) and factors influencing OS in Swedish patients with metastatic renal cell carcinoma (mRCC) during the pre- (2002-2005), early (2006-2008), and late (2009-2012) targeted therapy (TT) era. Methods: Three national Swedish registries identified patients with mRCC. Median OS was estimated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. Subgroup analysis was conducted for patients with synchronous metastases (Ml) and the elderly (aged >= 75 y). Results: A total of 4,217 patients with mRCC were identified, including 1,533 patients with Ml and 1,275 elderly patients. For patients with mRCC diagnosed in 2002 to 2005, 2006 to 2008, and 2009 to 2012, median OS was 10.0, 13.0, and 18.0 months. Similarly, median OS improved in the M1 and elderly populations. Elderly patients were less likely to be prescribed TT (>= 75 vs. <75 y): 18.3 vs. 63.5% (in 2006-2008) and 28.6% vs. 55.9% (in 2009-2012). Diagnosis of mRCC in 2009 to 2012, nephrectomy and TT prescription were associated with improved OS in the total mRCC, Ml, and elderly populations. Conclusion: This real-world study showed continued significant improvement in mRCC OS during the late TT era, including in Ml and elderly populations. TT should be considered for all patients with mRCC based on tolerability, regardless of age. (C) 2017 Elsevier Inc. All rights reserved.
|
|
| 17. |
|
|
| 18. |
- Lindström, David, et al.
(författare)
-
Disintegration of the Top Stent on Zenith Abdominal Aortic Stent-Grafts.
- 2016
-
Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1545-1550 .- 1526-6028.
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To describe a heretofore unreported complication involving the Zenith Low Profile (LP) stent-graft. CASE REPORT: Two men, aged 75 and 67 years, respectively, underwent abdominal aortic aneurysm repair with a Zenith LP device. At 4 and 3 years, respectively, computed tomography angiography revealed separation of the proximal fixation stent from the stent-graft. In the first patient, there was stent-graft migration but no evidence of an endoleak; however, the aneurysm had grown. A fenestrated cuff was placed, sealing distally in the previous LP graft. The second patient had a type I endoleak. Open surgery was performed, and the main body of the graft was explanted. Postoperative examination of the device revealed that the fixation sutures on the suprarenal stent were still attached to the stent and had eroded through the graft material. CONCLUSION: Physicians should be aware of the potential for top stent separation from the Zenith LP stent-graft as a cause of endoleak and migration.
|
|
| 19. |
- Loljung, Lotta, et al.
(författare)
-
High expression of p63 is correlated to poor prognosis in squamous cell carcinoma of the tongue
- 2014
-
Ingår i: Journal of Oral Pathology & Medicine. - : John Wiley & Sons. - 0904-2512 .- 1600-0714. ; 43:1, s. 14-19
-
Tidskriftsartikel (refereegranskat)abstract
- Backgroundp63 proteins are important in formation of the oral mucosa. Normal oral mucosa shows a balance between the six protein isoforms, whereas an imbalance between them is seen in squamous cell carcinomas (SCC). There is controversy over the clinical impact of p63 in SCC, which may relate to different expression in different areas. In addition, p63 isoforms can act as p53-like molecules (TAp63) or can inhibit p53 functions (Np63) and expression of these isoforms varies in different tumours. Here, we chose to concentrate on the most common intra-oral sub-site, SCC of the mobile tongue. MethodsTotal p63, Np63 and TAp63 were analysed separately using immunohistochemistry. The percentage of cells and intensity of expression of different isoforms of p63 was evaluated using a quick score method and correlated with clinical data in a group of 87 patients with tongue SCC. ResultsAll tumours expressed p63 in at least 60% of the cells when using two different antibodies detecting all 6 isoforms. p63 expression correlated significantly with 2-year survival (P=0.018), with fewer patients surviving 2years if their tumours expressed p63 with strong intensity in at least 80% of the cells (quick score 18). Looking at 5-year survival, this was even more emphasized. Np63 was expressed in all tumours, whereas expression of TAp63 was seen only in 59/87 patients, usually at very low levels. ConclusionsBased on the present data, we recommend using expression of p63 as an additional factor contributing prognostic information in analysis of SCC in the tongue.
|
|
| 20. |
- Nordanstig, Joakim, et al.
(författare)
-
Mortality with Paclitaxel-Coated Devices in Peripheral Artery Disease.
- 2020
-
Ingår i: The New England journal of medicine. - : Massachusetts Medical Society. - 1533-4406 .- 0028-4793. ; 383, s. 2538-46
-
Tidskriftsartikel (refereegranskat)abstract
- The results of a recent meta-analysis aroused concern about an increased risk of death associated with the use of paclitaxel-coated angioplasty balloons and stents in lower-limb endovascular interventions for symptomatic peripheral artery disease.We conducted an unplanned interim analysis of data from a multicenter, randomized, open-label, registry-based clinical trial. At the time of the analysis, 2289 patients had been randomly assigned to treatment with drug-coated devices (the drug-coated-device group, 1149 patients) or treatment with uncoated devices (the uncoated-device group, 1140 patients). Randomization was stratified according to disease severity on the basis of whether patients had chronic limb-threatening ischemia (1480 patients) or intermittent claudication (809 patients). The single end point for this interim analysis was all-cause mortality.No patients were lost to follow-up. Paclitaxel was used as the coating agent for all the drug-coated devices. During a mean follow-up of 2.49 years, 574 patients died, including 293 patients (25.5%) in the drug-coated-device group and 281 patients (24.6%) in the uncoated-device group (hazard ratio, 1.06; 95% confidence interval, 0.92 to 1.22). At 1 year, all-cause mortality was 10.2% (117 patients) in the drug-coated-device group and 9.9% (113 patients) in the uncoated-device group. During the entire follow-up period, there was no significant difference in the incidence of death between the treatment groups among patients with chronic limb-threatening ischemia (33.4% [249 patients] in the drug-coated-device group and 33.1% [243 patients] in the uncoated-device group) or among those with intermittent claudication (10.9% [44 patients] and 9.4% [38 patients], respectively).In this randomized trial in which patients with peripheral artery disease received treatment with paclitaxel-coated or uncoated endovascular devices, the results of an unplanned interim analysis of all-cause mortality did not show a difference between the groups in the incidence of death during 1 to 4 years of follow-up. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT02051088.).
|
|
| 21. |
- Nyberger, Karolina, et al.
(författare)
-
Management and outcomes of firearm-related vascular injuries.
- 2023
-
Ingår i: Scandinavian journal of trauma, resuscitation and emergency medicine. - 1757-7241. ; 31:1
-
Tidskriftsartikel (refereegranskat)abstract
- Violence due to firearms is a major global public health issue and vascular injuries from firearms are particularly lethal. The aim of this study was to analyse population-based epidemiology of firearm-related vascular injuries.This was a retrospective nationwide epidemiological study including all patients with firearm injuries from the national Swedish Trauma Registry (SweTrau) from January 1, 2011 to December 31, 2019. There were 71,879 trauma patients registered during the study period, of which 1010 patients were identified with firearm injuries (1.4%), and 162 (16.0%) patients with at least one firearm-related vascular injury.There were 162 patients admitted with 238 firearm-related vascular injuries, 96.9% men (n=157), median age 26.0years [IQR 22-33]. There was an increase in vascular firearm injuries over time (P<0.005). The most common anatomical vascular injury location was lower extremity (41.7%) followed by abdomen (18.9%) and chest (18.9%). The dominating vascular injuries were common femoral artery (17.6%, 42/238), superficial femoral artery (7.1%, 17/238), and iliac artery (7.1%, 17/238). Systolic blood pressure (SBP)<90mmHg or no palpable radial pulse in the emergency department was seen in 37.7% (58/154) of patients. The most common vascular injuries in this cohort with hemodynamic instability were thoracic aorta 16.5% (16/97), femoral artery 10.3% (10/97), inferior vena cava 7.2% (7/97), lung vessels 6.2% (6/97) and iliac vessels 5.2% (5/97). There were 156 registered vascular surgery procedures including vascular suturing (22%, 34/156) and bypass/interposition graft (21%, 32/156). Endovascular stent was placed in five patients (3.2%). The 30-day and 90-day mortality was 29.9% (50/162) and 33.3% (54/162), respectively. Most deaths (79.6%; 43/54) were within 24-h of injury. In the multivariate regression analysis, vascular injury to chest (P<0.001) or abdomen (P=0.002) and injury specifically to thoracic aorta (P<0.001) or femoral artery (P=0.022) were associated with 24-h mortality.Firearm-related vascular injuries caused significant morbidity and mortality. The lower extremity was the most common injury location but vascular injuries to chest and abdomen were most lethal. Improved early hemorrhage control strategies seem critical for better outcome.
|
|
| 22. |
- Olsson, Karl-Gunnar, 1955, et al.
(författare)
-
Architecture and Engineering - education of Form and Force
- 2019
-
Ingår i: IASS Symposium 2019 - 60th Anniversary Symposium of the International Association for Shell and Spatial Structures; Structural Membranes 2019 - 9th International Conference on Textile Composites and Inflatable Structures, FORM and FORCE. - 9788412110104 ; , s. 145-152
-
Konferensbidrag (refereegranskat)abstract
- Inspired by the work and attitudes of architects and engineers like Jorg Schlaich, Renzo Piano, Piero Luigi Nervi, Sverre Fehn, Ted Happold, and environments like ILEK in Stuttgart and ETH in Zurich, a vision of a new kind of architects and engineers arose at Chalmers University of Technology in the early 2000. With support from the university and the branch, a double degree Architecture and Engineering programme was developed. Since the programme started in 2006 it has been a very popular programme, and among all Swedish MSc in Engineering and Master of Architecture programmes it has almost every year been the most difficult programme to get admitted to. The concept of the programme is a 180 ects (European Credit Transfer and Accumulation System) bachelor's degree, where the fundamentals from the engineering science: mathematics, mechanics, physics and materials, is combined with history of architecture and engineering, artistic explorative courses, and the fundamentals of the architectural design process. After three years the students can choose to continue for a Master of Science in Engineering with different possible directions, from mathematics and data science to industrial ecology, acoustics, management, structural engineering, and building technology, or to continue for a Master of Architecture. For the latter they need 150 etcs minimum in pure architectural design projects. In this paper the basic concepts of the programme, the culture developed around it and the strengths we can experience in the examined students will be discussed and reflected. Today students from the programme can be found at architecture and engineering companies all over the world and are appreciated for their ability to address complex architectural and engineering design issues with attitudes, insights and skills from the both professions.
|
|
| 23. |
- Redig, Josefine, et al.
(författare)
-
Real-world cost-effectiveness of targeted therapy in metastatic renal cell carcinoma in Sweden : a population-based retrospective analysis
- 2019
-
Ingår i: Cancer Management and Research. - Auckland : Dove medical press. - 1179-1322. ; 11, s. 1289-1297
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore cost-effectiveness of targeted therapies (TTs) in the treatment of metastatic renal cell carcinoma (mRCC) in a real-world context using a nationwide population-based approach.Methods: Data on patients diagnosed with mRCC between 2002 and 2012 were extracted from Swedish national health data registers. To facilitate comparisons of patients diagnosed before and after TT introduction to the market, three cohorts were derived: pre-TT introduction (preTT), patients diagnosed 2002-2005; early TT introduction (TTi), patients diagnosed 2006-2008; and late TT introduction (TTii), which was limited to patients diagnosed 2009-2010 to ensure availability of total health care resource utilization (HCRU) data. Patients were followed until end of 2012. The value of TTs across cohorts was estimated using mean HCRU costs per life-year (LY) gained. Data on HCRU were obtained through national health registers for dispensed medication and inpatient and outpatient care, and the associated costs were estimated using the Lin method to account for censoring. LYs gained were defined as the difference in mean survival over the study period.Results: The preTT, TTi, and TTii cohorts consisted of 1,366, 1,158, and 806 patients, respectively. Mean survival in years from mRCC diagnosis was 1.45 in the preTT cohort, 1.62 in the TTi cohort, and 1.83 in the TTii cohort. The respective mean total HCRU cost per patient over the study period was US$16,894, US$29,922, and US$30,037. The cost per LY gained per cohort was US$78,656 for TTi vs preTT, US$34,132 for TTii vs preTT, and US$523 for TTii vs TTi.Conclusion: Given common willingness-to-pay per LY gained thresholds, this study in a real-world population suggests the use of TTs in the Swedish mRCC population is increasingly cost-effective over time.
|
|
| 24. |
|
|
| 25. |
- Rudström, Håkan, 1966-
(författare)
-
Iatrogenic Vascular Injuries
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Iatrogenic vascular injuries (IVIs) and injuries associated with vascular surgery can cause severe morbidity and death. The aims of this thesis were to study those injuries in the Swedish vascular registry (Swedvasc), the Swedish medical injury insurance where insurance claims are registered, the Population and Cause of death registries, and in patient records, in order to explore preventive strategies.Among 87 IVIs during varicose vein surgery 43 were venous, mostly causing bleeding in the groin. Among 44 arterial injuries, only 1/3 were detected intraoperatively. Accidental arterial stripping predominated, with poor outcome. Four patients died, all after venous injuries.IVIs increased over time, and constitute more than half of the vascular injuries registered in the Swedvasc. Lethal outcome was more common (4.9%) among patients suffering IVIs than among non-iatrogenic vascular injuries (2.5%). Risk factors for death were age, diabetes, renal insufficiency and obstructive lung-disease.Fifty-two patients died within 30 days after IVI. The most common lethal IVIs were puncture during endovascular procedures (n=24, 46%), penetrating trauma during open surgery (11) and occlusion after compression (6). Symptoms were peripheral ischemia (n=19), external bleeding (14), and hypovolemic chock without external bleeding (10). Most died within two weeks (n=36, 69%). After >2 weeks the IVI as a cause of death was uncertain.Among 193 insurance claims after vascular surgery during 2002-2007, nerve injuries (91) and wound infections (22) dominated. Most patients suffered permanent injuries, three died. Patients with insurance claims were correctly registered in the Swedvasc in 82%.In 32 cases of popliteal artery injury during knee arthroplasty symptoms were bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Only twelve injuries (38%) were detected intraoperatively. Patency at 30 days was 97%, but only seven (22%) patients had complete recovery. Six of those had intraoperative diagnosis of popliteal injury and immediate vascular repair.In conclusion, registration of IVIs is increasing and outcome is often negatively affected by diagnostic and therapeutic delay. Not all fatalities after IVIs are attributable to the injury itself. The most common causes of insurance claims after vascular surgery were nerve injuries, and 82% were correctly registered in Swedvasc.
|
|
| 26. |
- Strömberg, Dan, 1959, et al.
(författare)
-
Non-relativistic and relativistic calculations on some Zn, Cd and Hg complexes
- 1989
-
Ingår i: Chemical Physics. - 0301-0104. ; 133:2, s. 207-219
-
Tidskriftsartikel (refereegranskat)abstract
- A number of species containing Hg, Cd and Zn have been studied at the CI level using non-relativistic and relativistic techniques. Effective core potentials were used for Hg and Cd, while an all-electron description was used for Zn. Spectroscopic constants have been calculated for the positive hydride ions and the dichlorides of the three metals. The agreement with experiment was good in all cases. Calculations have also been carried out on Hg (OH)2, HgO and ZnO. The Hg (OH)2 molecule is predicted to be covalently bound by two σ bonds formed between a metal sp hybrid with small but significant 5d contribution and the OH. The binding energy of Hg(OH)2 is significant although smaller than the binding energy of HgCl2 by 20 kcal/mol. The near UV spectra of HgCl2 and Hg(OH)2 are calculated to be quite similar except for excitations involving the O---H bond. The calculated dissociation energies of HgO and ZnO are severely underestimated.
|
|
| 27. |
- Strömberg, Dan, 1959, et al.
(författare)
-
Theoretical calculations on the structure of the hexahydrated divalent zinc
- 1990
-
Ingår i: Chem Phys Lett. - 0009-2614. ; 172:1, s. 49-54
-
Tidskriftsartikel (refereegranskat)abstract
- SCF calculations have been performed on the title compounds in order to study the possible reasons for the anomalously large spread in the mean Hg---O bond distance previously obtained for hydrate mercury (II) ions in solution. An energy minimum is found for all three complexes, [M(H2O)6]2+, M = Zn, Cd or Hg, for a regular Th ground-state nuclear configuration. The larger spread of the Hg---O distances can be explained in terms of a weak second-order Jahn—Teller effect. An enhanced vibronic coupling leads in the mercury case to larger vibrational amplitudes of the coupling mode without invoking a static distortion. The longer mean Hg---O distance found for the hydrated mercury (II) ion in solution than in a solid hexahydrate can be explained by assuming a larger asymmetry in the distribution of the Hg---O bonds. Calculations on the [Hg(H2S)6]2+ complex also show an energy minimum for the Th configuration, although in this case the adiabatic potential surface is very flat, and more refined methods of calculation could yield a distored ground-state configuration.
|
|
| 28. |
|
|
| 29. |
- Sääf, Annika, et al.
(författare)
-
Characterization of EGFR and ErbB2 expression in atopic dermatitis patients.
- 2012
-
Ingår i: Archives of Dermatological Research. - : Springer Science and Business Media LLC. - 0340-3696 .- 1432-069X. ; 304:10, s. 773-80
-
Tidskriftsartikel (refereegranskat)abstract
- Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases in industrialized countries. To identify candidate genes involved in the pathogenesis of AD, we previously undertook a genome-wide approach using DNA microarrays. A transcript encoding the epidermal growth factor receptor (EGFR) was found to be among the down-regulated transcripts in AD skin. Here, we further investigated the expression pattern of two EGFR family members (EGFR and ErbB2) in AD skin on a protein level. Immunohistochemical (IHC) analysis of EGFR and ErbB2 showed decreased expression of EGFR and ErbB2 proteins in AD lesional skin as compared to skin from healthy individuals. Interestingly, we found that EGFR and ErbB2 were reciprocally expressed in an in vitro model of keratinocyte proliferation and differentiation, paralleling the expression patterns found in epidermis of healthy skin. The highest levels of EGFR transcripts were found in proliferating cells, while ErbB2 was found in differentiated cells. We show that blocking EGFR activity combined with co-stimulation of the Th2-cytokine IL4 in keratinocytes leads to induction of the inflammatory chemokine CCL26/eotaxin-3 in vitro. Accordingly, increased CCL26 transcriptional levels were observed in AD lesional skin. Taken together, suppression of EGFR may contribute to the pathogenesis of AD via the regulation of inflammatory chemokines.
|
|
| 30. |
- Sörelius, Karl, et al.
(författare)
-
Endovascular treatment of mycotic aortic aneurysms: a European multicenter study.
- 2014
-
Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 1524-4539 .- 0009-7322. ; 130:24, s. 2136-42
-
Tidskriftsartikel (refereegranskat)abstract
- Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival.
|
|
| 31. |
- Sörelius, Karl, 1981-, et al.
(författare)
-
Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms
- 2019
-
Ingår i: European Journal of Vascular and Endovascular Surgery. - : Saunders Elsevier. - 1078-5884 .- 1532-2165. ; 57:2, s. 239-246
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs). Methods: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010-16) and local patient registries (2000-09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations. Results: Fifty-two patients (median age 71 +/- 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88-96) at 30 days, 88% (95% CI 84-93) at three months, 78% (73-84) at one year, and 71% (64-77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4-216 months). Antibiotics were administered for a median of 15 weeks (range 0-220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%). Conclusions: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.
|
|
| 32. |
|
|
| 33. |
- Valadkhani, Arman, et al.
(författare)
-
Postoperative complications and myocardial injury in patients receiving air or oxygen. Prospective, randomised and pilot study
- 2022
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 66:10, s. 1185-1192
-
Tidskriftsartikel (refereegranskat)abstract
- Background Supplementary oxygen is administered during anaesthesia to increase oxygen delivery and prevent hypoxia. Recent studies have questioned this routine. In this pilot study, our main aim was to investigate if 21% oxygen compared to >= 50% reduces the risk of postoperative complications and myocardial injury. Methods In this pragmatic, multicentre, single-blind study, patients undergoing vascular surgery were randomised to receive a fraction of inspired oxygen (FiO2) >= 0.50 and oxygen saturation determined by pulse oximetry (SpO(2)) >= 98% (group H) or FiO2 of 0.21 and SpO(2) > 90% (group N) oxygen perioperatively. The primary outcome was a composite outcome of major pre-defined postoperative complications assessed at 30 days. Myocardial injury was determined by serial troponin measurements. Data were analysed using generalised estimating equation, Mann-Whitney U test or chi-squared test, as appropriate. Results The 191 patients were randomised, and per-protocol principle was used for analyses. At 30-day follow-up, 43 out of 94 patients (46%) had a postoperative complication in group H and 36 out of 90 patients (40%) in group N, p = .46. New myocardial injury was seen in 27% versus 22% in Groups H and N respectively (p = .41). No differences in other outcomes were observed between the groups. Twelve patients (13%) in Group N had SpO(2) < 90%, six recovered spontaneously and six required supplemental oxygen. At 1-year follow-up, one patient in group H had died. Conclusion In this pilot study, postoperative complications were similar between the groups in patients randomised to FiO2 of 0.21 or >= 0.50 and no difference was found in the incidence of new myocardial injury. Larger, prospective adequately powered studies are needed.
|
|
| 34. |
- Wahlgren, Carl-Magnus, et al.
(författare)
-
Endovascular Treatment in Postthrombotic Syndrome
- 2010
-
Ingår i: Vascular and Endovascular Surgery. - : Sage Publications. - 1538-5744 .- 1938-9116. ; 44:5, s. 356-360
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The postthrombotic syndrome is a chronic complication of deep venous thrombosis that leads to considerable pain and suffering to patients. We evaluated our experience of endovascular treatment for patients with chronic postthrombotic femoroiliocaval venous disease.Materials and Methods: From January 2003 through December 2007, 50 patients (51 limbs; 60% women; mean age 45 years; range: 24-74 years) with chronic postthrombotic venous disease were referred to our institution for interventional assessment. All patients underwent duplex ultrasonography as well as ascending and descending venography. The CEAP (clinical, etiologic, anatomic, and pathophysiologic classification) clinical scores were class 0 (no signs) in 2% of limbs, class 3 (edema) in 63%, class 4a (pigmentation or eczema) in 18%, class 5 (healed venous ulcer) in 14%, and class 6 (active venous ulcer) in 4%. The etiology was secondary (postthrombotic) in all patients. The anatomical distribution of reflux and obstruction were deep veins in 63% and a combination of deep and superficial veins in 37%. The underlying pathophysiology due to obstruction of the deep venous outflow with no reflux was found in 25% of limbs, only reflux was found in 14%, and a combination of obstruction and reflux was found in 61%.Results: There were 21 limbs in 20 (38%) patients that underwent endovascular and/or surgical treatment. One limb underwent femoral endovenectomy and 1 limb superficial femoral vein to deep femoral vein transposition. In all, 19 limbs were scheduled for endovascular treatment. The technical success rate was 84%, 3 limbs with iliac vein occlusions could not be recanalized. A total of 11 patients (11 limbs) underwent solely endovascular intervention and 4 patients (5 limbs) underwent endovascular intervention combined with femoral endovenectomy. The endovascular and surgical procedures were performed with no perioperative or postoperative mortality as well as no major bleeding or cardiac, pulmonary, or renal 30-day complications. Early thrombosis (<30 days) of the stented iliac veins occurred in 3 limbs which were lysed and restented successfully. The mean follow-up time was 23 months (range: 1-69 months). Primary and assisted-primary/secondary patency rates at 12 months were 61% and 81%, respectively. The Venous Clinical Severity score was 9.1 (range: 5-15) before endovascular treatment and 6.0 (range: 3-13) after the treatment (P < .0001). There were 30 patients (62%) with symptoms attributable to venous dysfunction or with deep venous pathology that did not undergo interventional treatment after workup. These patients continued with appropriate thromboprophylaxis and elastic compression stockings.Conclusion: Endovascular treatment of chronic postthrombotic femoroiliocaval venous disease is a safe technique that can be performed with acceptable patency rates in this challenging patient population.
|
|
| 35. |
- Wahlgren, Carl-Magnus, et al.
(författare)
-
Management and outcome of pediatric vascular injuries
- 2015
-
Ingår i: Journal of Trauma and Acute Care Surgery. - 2163-0755 .- 2163-0763. ; 79:4, s. 563-567
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Vascular injuries in children are relatively uncommon. The objective of this population-based study was to investigate the epidemiology, management, and early outcomes of pediatric vascular injuries. METHODS A nationwide survey of prospectively collected data on pediatric vascular injuries in children 15 years or younger between 1987 and 2013 was conducted. Data were retrieved from the National Vascular Surgery registry (Swedvasc) and cross-matched with the National Population Register for mortality data. Demographics, operative techniques, and outcomes were analyzed. RESULTS There were 222 children (boys, n = 148; girls, n = 74) included in this study, with a mean (SD) age of 9.6 (4.1) years (range, 0.5-15 years; <6 years, 18 %; 6-10 years, 39%; >10 years, 42%). Blunt trauma mechanism (n = 146, 66%) was dominant, followed by penetrating (n = 51, 23%) and iatrogenic trauma (n = 21, 9%). Anatomic locations of vascular injuries were primarily upper extremities (n = 134, 60%) and lower extremities (n = 65, 29%), followed by the abdomen (n = 16, 7.2%). Upper extremity injuries were most common in the age group of 10 years or younger (78%, 100 of 128), and lower extremity injuries were most common in the age group of 11 years to 15 years (48%, 45 of 94). Major repair techniques included interposition graft (n = 54, 24%), patch (n = 43, 19%), primary repair (lateral suture/direct anastomosis) (n = 27, 12%), bypass (n = 21, 9.5%), and endovascular techniques (n = 8, 3.7%). Exploration or release of artery was performed in 51 cases (23%). Vein (n = 110) was the dominant graft material, and synthetic grafts (polytetrafluoroethylene/dacron) were only used in four open cases. The most common postoperative complication was arterial occlusion/thrombosis (n = 12). At 30-day follow-up, there was one above-knee and two below-knee amputations as well as one death. No more deaths at 1-year follow-up did occur. CONCLUSION This nationwide population-based study shows that traumatic vascular injuries in children are associated with high limb salvage rates and low mortality. Blunt trauma mechanism is dominant, and injuries are primarily located to the upper and lower extremities. The preferred repair techniques are venous patch angioplasty and interposition graft, and the frequency of endovascular repair is still low. LEVEL OF EVIDENCE Epidemiologic study, level III.
|
|
| 36. |
- Wahlgren, Carl Magnus
(författare)
-
Mechanisms of thrombosis and restenosis after vascular injury
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Atherosclerosis is the underlying cause of about 50% of all deaths in the western world. Peripheral vascular disease commonly affects the arteries supplying the leg and is mostly caused by atherosclerosis. When medical treatment of lower extremity ischemia has failed, percutaneous transluminal angioplasty (PTA) and bypass surgery are two major therapeutic options. The advances in vascular surgery and endovascular techniques over the past half-century have greatly expanded the number of arterial lesions that can be treated. The major limitations of a successful revascularisation are thrombosis and the later development of restenosis. This thesis has explored the mechanisms of thrombosis and restenosis after vascular injury, focusing on the interaction between coagulation, inflammation, and oxidative stress. The long-term outcome of infrainguinal PTA was evaluated in 77 patients. Cumulative primary and secondary patency rates, respectively, were 81% and 86% at 1 year, 65% and 73% at 5 years, and 12% and 17% at 10 years. Patency rates were better for patients with claudication than critical ischemia. Stenoses had better primary patency than occlusions. Generalised femoral artery disease and diabetes mellitus predicted poor survival. Although the overall long-term patency of infrainguinal PTA is poor, the technique has a low morbidity and can be performed in selected patients with a reasonable long-term result. If conservative treatment has failed infrainguinal PTA should be considered, when lesions and patients are suitable, because of its minimal invasive nature. It is also important when treating patients with peripheral arterial disease to give attention to their general cardiovascular condition. In an experimental study a specific direct thrombin inhibitor, inogatran, reduced neointimal hyperplasia after arterial injury in rats. A more prolonged administration of the thrombin inhibitor gave a further reduction of the neointimal hyperplasia. It seems that inhibition of thrombin activity is not only important early after injury, but also later. This could have clinical implications in the treatment of restenosis. Inflammation and oxidative stress in the vessel wall may play important roles in the development of restenosis after angioplasty. In patients with peripheral arterial disease, a much more prolonged inflammatory response than previously noted was observed after angioplasty, but only minor changes in coagulation activity. C-reactive protein was elevated the day after angioplasty and peaked after one week. Coagulation and inflammatory markers were not significantly related to restenosis. The redox-active protein, thioredoxin, was significantly elevated 4 hours after angioplasty and returned to baseline within 24 hours. Circulating thioredoxin could theoretically impair the chemotactic response at local sites of inflammation. An association in patients with elevated levels of thioredoxin after angioplasty and reduced restenosis needs to be further evaluated. This thesis has discussed the intimate relation between thrombosis, inflammation, oxidative stress, and restenosis. Further studies are needed to delineate the molecular mechanisms behind these observations and their involvement in thrombosis and restenosis. It is not only important to be able to understand the individual pathways of these processes, but also the ways they intersect and interact. If these pathways are further defined, improved treatment strategies, including antithrombotic treatments, statins, and thioredoxin, to modulate postprocedure inflammation could be tailored.
|
|
| 37. |
- Wahlgren, Carl, et al.
(författare)
-
Prevalence of discomplete sensorimotor spinal cord injury as evidenced by neurophysiological methods : A cross-sectional study
- 2021
-
Ingår i: Journal of Rehabilitation Medicine. - Uppsala, Sweden : Stiftelsen Rehabiliteringsinformation. - 1650-1977 .- 1651-2081. ; 53:2
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess the prevalence of residual trans-lesion connectivity in persons with chronic clinically complete spinal cord injury (discompleteness) by neurophysiological methods.PARTICIPANTS: A total of 23 adults with chronic sensorimotor complete spinal cord injury, identified through regional registries the regional spinal cord registry of Östergötland, Sweden.METHODS: Diagnosis of clinically complete spinal cord injury was verified by standardized neurological examination. Then, a neurophysiological examination was performed, comprising electroneurography, electromyography, sympathetic skin response and evoked potentials (sensory, laser and motor). Based on this assessment, a composite outcome measure, indicating either strong, possible or no evidence of discomplete spinal cord injury, was formed.RESULTS: Strong neurophysiological evidence of discomplete spinal cord injury was found in 17% (4/23) of participants. If also accepting "possible evidence", the discomplete group comprised 39% (9/23). The remaining 61% showed no neurophysiological evidence of discompleteness. However, if also counting reports of subjective sensation elicited during neurophysiological testing in the absence of objective findings, 52% (12/23) showed indication of discomplete spinal cord injury.CONCLUSION: Evidence of discomplete spinal cord injury can be demonstrated using standard neurophysiological techniques in a substantial subset of individuals with clinically complete spinal cord injury. This study adds to the evidence base indicating the potential of various modes of cross-lesional sensorimotor functional restoration in some cases of chronic clinically complete spinal cord injury.
|
|
| 38. |
- Wahlgren, Paula, 1976-
(författare)
-
De laglydiga : Om skolans brottsförebyggande fostran
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Politicians and scholars often frame schooling as one of society’s most important crime preventive measures. The object of the study is to examine and problematize the hopes and ambitions that have evolved around what the study conceptualizes as the crime preventive educational task of public schooling and its historical trajectory as articulated in government publications. Drawing on governmentality theory, the study focuses on the liberal conception of the autonomous and self-regulating subject, and how the liberal mode of government works through the governing of freedom. The study identifies three discourses on crime preventive education: The emancipatory (1970s onwards), the deterrence (late 1980s onwards) and the safety/security discourse (21st century). The discursive shifts identified are further analysed in respect to how i) the explanation of crime, and the relationship between the deviant and the law-abiding subject, ii) control and iii) freedom and responsibility, are conceptualized over time. The conceptualization of criminal behaviour goes from being caused by social deprivation, becoming instead a calculated rational act. Subsequently, the deviant is altered from a person in need of reintegration to a deterrent example and a risk. The problematization of control has a trajectory from being a matter of social control and integration, ending instead as a matter of risk control and prudentialism. The conceptualization of the kind of freedom and responsibility the crime preventive education should foster is also reframed, from a strategy to counter a lack of democracy and influence, to a way of making prudent citizens. In this, the notion of a collective responsibility has been superseded by a belief in individual responsibility. The key problematization vindicating the process has gone from how to integrate youths into a society in constant flux, to how to restore control if lost and how to protect a pre-given social order.
|
|
| 39. |
|
|
| 40. |
- Wanhainen, Anders, et al.
(författare)
-
Misleading study in The Lancet on the outcome of the Swedish AAA screening program : Stor enighet om att screening för bukaortaaneurysm räddar liv.
- 2018
-
Ingår i: Läkartidningen. - 1652-7518. ; 115
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- In a recent publication in The Lancet Johansson and colleagues claim no effect on aneurysm mortality among men participating in the Swedish AAA screening program, and question its justification. The study is, however, limited by a corrupt study design and incorrect data, making the publication misleading. On the contrary, several RCTs and contemporary nationwide data with sufficient follow-up clearly show that AAA screening saves lives and is highly cost-effective. The program has so far identified about 6000 men with an AAA, of whom 1500 have been operated on to prevent rupture. Thus, more than 750 men have experienced a longer life (by a mean of 8 years) as a result of the program. Continuous evaluation of the program is important but requires a scientifically sound methodology.
|
|
| 41. |
- Wanhainen, Anders, et al.
(författare)
-
[Misleading study in The Lancet on the outcome of the Swedish AAA screening program].
- 2018
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 115
-
Tidskriftsartikel (refereegranskat)abstract
- In a recent publication in The Lancet Johansson and colleagues claim no effect on aneurysm mortality among men participating in the Swedish AAA screening program, and question its justification. The study is, however, limited by a corrupt study design and incorrect data, making the publication misleading. On the contrary, several RCTs and contemporary nationwide data with sufficient follow-up clearly show that AAA screening saves lives and is highly cost-effective. The program has so far identified about 6000 men with an AAA, of whom 1500 have been operated on to prevent rupture. Thus, more than 750 men have experienced a longer life (by a mean of 8 years) as a result of the program. Continuous evaluation of the program is important but requires a scientifically sound methodology.
|
|
| 42. |
|
|
| 43. |
|
|
| 44. |
- Wennerberg, Johan, et al.
(författare)
-
Results from a prospective, randomised study on (accelerated) preoperative versus (conventional) postoperative radiotherapy in treatment of patients with resectable squamous cell carcinoma of the oral cavity : The ARTSCAN 2 study
- 2022
-
Ingår i: Radiotherapy and Oncology. - : Elsevier. - 0167-8140 .- 1879-0887. ; 166, s. 26-32
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purposeAn earlier prospective randomised multicentre study (ARTSCAN) in head and neck cancer patients that compared conventionally fractionated radiotherapy (CF) with accelerated radiotherapy (AF) was inconclusive. In the subgroup of oral cavity squamous cell cancer (OCSCC) a large absolute, but not statistically significant, difference in local control was seen in favour of AF. This difference was more pronounced in resectable tumours. The finding raised the hypothesis that AF could be beneficial for OCSCC patients. In addition, the longstanding controversy on pre- or postoperative radiotherapy was addressed.Materials and methodsPatients with OCSCC, judged to withstand and likely benefit from combined therapy, were recruited. Subjects were randomised to either preoperative AF with 43 fractions given as a concomitant boost with two fractions/day to the tumour bearing volume to a total dose of 68 Gy in 4.5 weeks followed by surgery, or primary surgery with postoperative CF, total dose 60 or 66 Gy in 6–7 weeks. For patients whose tumours had high-risk features, 66 Gy and concomitant cisplatin was prescribed.Results250 patients were randomised. Median follow-up was 5 years for locoregional control (LRC) and 9 years for overall survival (OS). There were no statistically significant differences between the two treatment arms regarding LRC and OS. LRC at five years was 73% (95% CI, 65–82) in preoperative AF and 78% (95% CI, 70–85) in postoperative CF.Toxicity was more pronounced in preoperative AF.ConclusionThis study does not support that AF prior to surgery improves outcome in oral cavity cancer compared with postoperative CF.
|
|
| 45. |
|
|
