| 11. |
- Whitaker, Iain S., et al.
(författare)
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Peritoneo-cutaneous perforators in deep inferior epigastric perforator flaps : a cadaveric dissection and computed tomographic angiography study
- 2009
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 29:2, s. 124-127
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cutaneous perforators that do not originate from the deep inferior epigastric artery (DIEA) are rare, but may significantly affect operative outcome. Peritoneal-cutaneous perforators have been described as a source for augmenting the blood flow to a deep inferior epigastric perforator (DIEP) flap, however if unrecognized, may compromise flap survival. METHODS: We reviewed 375 DIEA perforator (DIEP) flaps (325 with preoperative CTA and 50 cadaveric dissections) to investigate the incidence of this anomaly. RESULTS: We detected this variation in 3/325 (1%) of DIEP flaps following preoperative computed tomography. In 1/50 (2%) of the cadaveric specimens, a peritoneal-cutaneous perforator was found and injected with lead oxide contrast. It was shown to fill the cutaneous veins of the majority of the lower abdominal integument. CONCLUSION: Peritoneal-cutaneous perforators are rare anatomical variations (4/375: 1.1%) that may have significant ramifications for surgery utilizing the vasculature of the abdominal wall. CTA was significantly able to detect this anomaly and aid operative planning. Preoperative CTA helps to safely identify individual vascular anatomy including rare variations.
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| 12. |
- Audolfsson, Thorir, et al.
(författare)
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A Reliable and Aesthetic Technique for Cephalic Vein Harvest in DIEP Flap Surgery
- 2009
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Ingår i: Journal of reconstructive microsurgery. - : Georg Thieme Verlag KG. - 0743-684X .- 1098-8947. ; 25:5, s. 319-321
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Tidskriftsartikel (refereegranskat)abstract
- The need for a secondary source of venous drainage in deep inferior epigastric artery perforator flaps is common, with the cephalic vein Commonly utilized as an alternative venous recipient vessel. In using the cephalic vein, previous studies have described the deltopectoral groove or the infraclavicular fossa as the site for harvest. We describe the use of an anterior axillary skin crease, which can improve aesthetic outcome, reduce the time needed for harvest, enable a greater length of vein to be transposed, and minimize surgical insult to the upper breast/chest wall. An anterior axillary-line skin fold can be used as the site for cephalic vein harvest, and using the methodology described, the technique can be fast and highly reliable and result in a final scar that is barely visible.
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| 13. |
- Bergqvist, D, et al.
(författare)
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Acute ischaemia of the visceral arteries
- 2007
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Ingår i: Vascular Surgery. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 9783540309550 - 9783540309567 ; , s. 417-423
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 14. |
- Block, T, et al.
(författare)
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Diagnostic accuracy of plasma biomarkers for intestinal ischaemia
- 2008
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 0036-5513 .- 1502-7686. ; 68:3, s. 242-248
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Intestinal ischaemia is a life‐threatening condition with high mortality, and the lack of accurate and readily available diagnostic methods often results in delay in diagnosis and treatment. The aim of this study was to investigate the accuracy of different plasma biomarkers in diagnosing intestinal ischaemia. Material and methods. Prospective inclusion of patients older than 50 years with acute abdomen admitted to hospital in Karlskrona, Sweden, between 2001 and 2003. Venous blood was sampled prior to any surgery and within 24h from onset of pain. D‐lactate, alpha glutathione S‐transferase, intestinal fatty acid binding protein, creatine kinase B, isoenzymes of lactate dehydrogenase (LD) and alkaline liver phosphatase (ALP) were analysed. D‐dimer was analysed using four different commercially available test kits. Results. In‐hospital mortalities among patients with (n = 10) and without (n = 61) intestinal ischaemia were 40% and 3%, respectively (p = 0.003). D‐dimer was associated with intestinal ischaemia (p = 0.001) independently of which assay was used. No patient presenting with a normal D‐dimer had intestinal ischaemia. D‐dimer >0.9mg/L had a specificity, sensitivity and accuracy of 82%, 60% and 79%, respectively. Total LD, isoenzymes of LD 1–4 and liver isoenzyme of ALP (ALP liver) were significantly higher in patients with intestinal ischaemia, and accuracies for LD 2 (cut‐off 2.3µkat/L) and ALP liver (cut‐off 0.7µkat/L) were 69% and 66%, respectively. Conclusions. D‐dimer may be used as an exclusion test for intestinal ischaemia, but lacks specificity. The other plasma biomarkers studied had insufficient accuracy for this group of patients. Further studies are needed.
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| 15. |
- Burström, Mats, 1962-, et al.
(författare)
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Memories of a world crisis : The archaeology of a former Soviet nuclear missile site in Cuba.
- 2009
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Ingår i: Journal of social archaeology. - Los Angeles : SAGE. - 1469-6053 .- 1741-2951. ; 9:3, s. 295-318
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Tidskriftsartikel (refereegranskat)abstract
- Santa Cruz de los Pinos is a small town like most others in the Cuban countryside. But half a century ago it was the epicenter of the 1962 Missile Crisis. During that time it served as a Soviet base for middle-range nuclear missiles, and the US air reconnaissance photos of it were spread through media all around the world. The crisis was solved through negotiations without Cuban involvement, and as a result of this neglect the Missile Crisis has been an under-communicated part of history in Cuba. A Swedish-Cuban research project has now investigated what kinds of memories of the crisis remain today at the former missile base – in the ground as well as in people’s minds. Digging in the ground has proved to be an effective way to start a remembering process and to help disarm a politically loaded history and uncover other stories than those dominating ‘big history’.
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| 16. |
- Enajat, Morteza, et al.
(författare)
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Thermal injuries in the insensate deep inferior epigastric artery perforator flap : case series and literature review on mechanisms of injury
- 2009
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 29:3, s. 214-217
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Forskningsöversikt (refereegranskat)abstract
- With the increasing use of the deep inferior epigastric artery perforator (DIEP) flap, complications that are particularly rare (less than 1%) may start to become clinically relevant. During DIEP flap harvest, cutaneous nerves innervating the flap are necessarily sacrificed, resulting in reduced sensibility This impaired sensibility prevents adequate thermoregulatory reflexes, like vasodilatation, sweating, and protective behaviors, leaving the reconstructed breast considerably more susceptible to thermal insult. We present four DIEP flap cases who sustained postoperative thermal injury to the reconstructed breast. All four cases were operated on between 2001 and 2008, over the course of 600 DIEP flaps in our unit (an incidence of 0.7%). The injuries occurred between 2 and 18 months after reconstruction. Two patients sustained thermal injury while sunbathing, one while staying in a warm environment, and one sustained the injury while taking a shower. No flap losses ensued, but these were not without morbidity. A literature review discusses other similar cases in the literature and describes the mechanisms for these findings. As a majority of patients will regain both fine-touch and heat sensation by 3 years postoperatively, it is pertinent that prophylactic measures be instituted during this period, such as the avoidance of sunbathing and the use of cooler shower temperatures for the first 3 years postoperatively. While performing sensory nerve coaptation is the gold standard for maximizing the success of sensory regeneration, this is not always sought and the 0.7% incidence of thermal injury we have encountered suggest the role for greater consideration of such injury.
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| 17. |
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| 18. |
- Kalkner, Karl Mikael, et al.
(författare)
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Octreotide scintigraphy and Chromogranin A do not predict clinical response in patients with octreotide acetate-treated hormone-refractory prostate cancer
- 2006
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Ingår i: Prostate Cancer and Prostatic Diseases. - : Springer Science and Business Media LLC. - 1476-5608 .- 1365-7852. ; 9:1, s. 92-98
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Tidskriftsartikel (refereegranskat)abstract
- In this pilot study, the predictive value of Octreotide scintigraphy (Octreoscan) and/or Chromogranin-A (CgA) was investigated in patients with hormone-refractory prostate cancer treated with Octreotide acetate. In total, 20 patients with progressive disease and bone metastases entered the trial. At baseline Octreoscan, CgA, PSA, alkaline phosphates (ALP) and two self-administered questionnaires (EORTC QLQ C-30 (v3) and brief pain index) were performed and a diary of the pharmaceutical was started. The treatment consisted of Octreotide (Sandostatin LAR) acetate 30 mg intramuscular injection every month. The blood samples and questionnaires were repeated every month until 3 months. Clinical responder was defined as a patient with increased global health score more than 10 units and stable or decreased pain score without an increase in analgesic. In all, 17 patients were treated per protocol, and four were assessed as clinical responders. Six patients developed a reduction in ALP (median -26%, range -5 to -78%). All patients increased in PSA. At baseline, three patients had a negative Octreoscan and the patients with positive lesions, demonstrated uptake of low intensity. At baseline the CgA was elevated above the normal range in 15 of the patients, and during treatment five patients decreased their CgA to the normal range. Neither baseline Octreoscan nor CgA could identify the clinical reponders. A minority of patients improves their health-related quality of life. The decrease and normalization of CgA levels in five patients during therapy indicates therapeutic activity but Octreoscan and CgA could not identify clinical responders.
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| 19. |
- Nordmyr, J., et al.
(författare)
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Vacuum assisted wound closure in patients with lower extremity arterial disease
- 2009
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Ingår i: International Angiology. - 1827-1839. ; 28:1, s. 26-31
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The purpose of this investigation was to analyze predictors for wound healing, amputation and mortality after vacuum assisted closure (VAC (R)) therapy of wounds in the lower limb in patients with arterial disease. Methods. One hundred and twenty one wounds were treated and followed for 12 months at two vascular centres in Uppsala and Malmo, Sweden. VAC (R) therapy was applied in the wound at a topical negative pressure of 125 mmHg. Results. Median age of the patients was 74 years and critical lower limb ischemia was present in 87% of the patients at admission. Intestinal flora was cultivated in 74% of the wounds. VAC (R) associated bleeding occurred in four patients. Complete wound healing was achieved in 66%. Deep groin infections were associated with synthetic graft infection (P<0.001), treatment outside hospital (P<0.001), faster healing (P<0.01) and lower amputation rate (P<0.005). Diabetes mellitus (OR 2.7; [95% CI 1.2-6.2]) and foot wound (OR 3.0; (95% CI 1.2-7.4]) were independent predictors for amputation. The absence of complete wound healing was the strongest factor for both amputation (P<0.001) and death (P<0.001). Conclusion. VAC (R) therapy of complex wounds in the lower limbs in patients with vascular disease was associated with high healing rates. Non-healed wounds after VAC (R) therapy were predictors for amputation and death. [Int Angiol 2009;28:26-3 1]
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| 20. |
- Ogren, M., et al.
(författare)
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Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies
- 2006
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Ingår i: World J Gastroenterol. - 1007-9327 .- 2219-2840. ; 12:13, s. 2115-9
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess the lifetime cumulative incidence of portal venous thrombosis (PVT) in the general population. METHODS: Between 1970 and 1982, 23,796 autopsies, representing 84% of all in-hospital deaths in the Malmo city population, were performed, using a standardised protocol including examination of the portal vein. PVT patients were characterised and the PVT prevalence at autopsy, an expression of life-time cumulative incidence, assessed in high-risk disease categories and expressed in terms of odds ratios and 95% CI. RESULTS: The population prevalence of PVT was 1.0%. Of the 254 patients with PVT 28% had cirrhosis, 23% primary and 44% secondary hepatobiliary malignancy, 10% major abdominal infectious or inflammatory disease and 3% had a myeloproliferative disorder. Patients with both cirrhosis and hepatic carcinoma had the highest PVT risk, OR 17.1 (95% CI 11.1-26.4). In 14% no cause was found; only a minority of them had developed portal-hypertension-related complications. CONCLUSION: In this population-based study, PVT was found to be more common than indicated by previous clinical series. The markedly excess risk in cirrhosis and hepatic carcinoma should warrant an increased awareness in these patients for whom prospective studies of directed intervention might be considered.
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