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- Abd El-Gawad, Gamal, 1959
(författare)
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Urologic and metabolic consequences of continent urostomy (Kock reservoir) in children and adolescents
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the last decades, urinary diversion using an intestinal segment has been commonly used in children and adolescents. Kock pouch is a feasible alternative for the children in need of a continent diversion where other alternatives such as Mitrofanoff are excluded for various reasons. The present study focused on the evaluation of the urologic and metabolic consequences after continent urinary diversion (Kock reservoir) and the assessment of the quality of life after surgery in children and adolescents. Twenty patients with congenital urinary incontinence were operated and followed for 3-12 years. The reservoir and upper urinary tract were studied through enterocystometry, enterocystoscopy, enterocystography, intravenous urography and clinical history. Acid-base status, serum electrolytes, vitamin B12, folate, methylmalonic acid (MMA) and homocystine were measured. Renal function was assessed by Cr51 EDTA clearance and serum creatinine and the split renal function by (99m) Tc-MAG 3 renoscintigraphy. Patients answered a questionnaire that covered medical, physical, social and body image aspects. The follow-up was divided into different periods: early -EFU (3 months - 2 or 5 years), and late -LFU (2-10 or 5-12 years after surgery).A low reservoir pressure was accompanied by high capacity and compliance. Nipple malfunction (angled nipple, prolapsed or stenosed stoma) occurred in 35% and stones in 40% of patients. Reservoir perforation was observed in 2 patients. An excellent continence was reported in 90% and a good one in the rest of patients. Angled efferent nipple seen on enterocystoscopy or enterocystography coincided with nipple malfunction, reservoir mal-position or infrequent emptying (= 4 times/day). Ureteral dilatation was detected in 84% of patients 3 months after surgery. The dilatation was improved in 56% and unchanged in 25% of patients after one year, and then it continued to improve at the LFU. New focal renal scars were radiologically detected in 2 patients. Three patients had metabolic acidosis and 8 had hyperchloremia. Serum creatinine level was increased in 82% of patients with infrequent emptying at the LFU (P<0.05). GFR was below normal in 4 patients preoperatively, in 6 at the EFU and in 8 at the LFU. Two patients developed low B12 values and 2 had elevated MMA with normal B12 values. Blood folate was low in 5 patients at the EFU and in different 5 at the LFU. There was no correlation between the resected ileal segment length and B12 value.Physical activities were not hampered by the operation in any patient. Instead, some activities as full day outside home and friend at home over night were increased in some patients. More than half of patients had excellent positive self-esteem and body image and the rest had good one. However, some patients were concerned about how they looked and felt that life was unfair to them.Conclusion: Kock reservoir remains a viable alternative to other forms of continent urinary diversion. The stability of the reservoir volume and low internal pressures was achieved early after operation depending on the frequency of the reservoir emptying. Efferent nipple malfunction is common during the first 2 years after surgery. The Kock pouch provided a satisfactory continence to all patients, although a revisional operation was necessary in some patients to get a permanent continence. Urinary tract dilatation is a frequent finding postoperatively, but it subsides in most cases 3-12 months after surgery. Long-term afferent nipple dysfunction may be the result of angulation, reservoir stones, mal-position and/or over-distension. Permanent renal damage may be due to pyelonephritis, stones, infrequent reservoir emptying, urinary obstruction, or metabolic acidosis. A strict regime of reservoir evacuation to decrease the possibility of metabolic alterations and of renal function deterioration is strongly advisable in these patients. Vitamin B12 and folate values should be monitored regularly. B12 deficiency is neither correlated with the time elapsed since surgery, nor with the resected ileal length. Serum MMA and homocystine may offer increased detection of occult B12 deficiency. The patients were physically active and declared a positive perspective regarding self-esteem and body image. The medical problems related to the operation did not have any negative influence on the self-esteem or body image. The choice of the operation can only be determined on the basis of an attentive dialogue between surgeon, child and parents.
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- Abrahamsson, Hans, 1949
(författare)
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En annan värld är möjlig : [kapitel i]
- 2001
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Ingår i: En annan värld är möjlig, Jens Ergon (red.). - Stockholm : Manifest kulturproduktion. - 9189291123
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- [Boken:] Den här boken tar avstamp i bildandet av svenska Attac. Den tar avstamp i ett växande engagemang för samtiden - och en vilja till förändring. Här trängs 24 röster med vitt skilda bakgrunder och utgångspunkter. De diskuterar globalisering, sociala klyftor, Tobinskatten, WTO, IMF, Världsbanken, genmodifierade grödor, pensionsfonder, frihandel, kvinnorörelsen, reklam, nyliberalism, demonstrationerna i Seattle och Attacs framväxt. Bland annat. Det är ett lapptäcke som kastas ut, med en uttalad förhoppning och övertygelse: En annan värld är möjlig.
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- Abrahamsson, Kajsa H., 1956, et al.
(författare)
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Phobic avoidance and regular dental care in fearful dental patients: a comparative study.
- 2001
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Ingår i: Acta odontologica Scandinavica. - 0001-6357 .- 1502-3850. ; 16, s. 188-196
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Tidskriftsartikel (refereegranskat)abstract
- The present investigation was a comparative study of 169 highly fearful dental patients, some of whom received regular dental care (n = 28) and some who never, or only when absolutely necessary, utilized dental care (n = 141). It was hypothesized that phobic avoidance is related to anticipatory stress and anxiety reactions, negative oral health effects, psychological distress, and negative social consequences. Background factors (sex, age, education, and dental attendance pattern), dental anxiety, general fears, general state and trait anxiety, mood states, depression, and quality of life effects were studied. Data were analyzed with descriptive statistics and with exploratory factor and multiple logistic regression analysis. It was shown that dental anxiety is significantly higher among the avoiders and this is in particular evident for anticipatory dental anxiety. Oral health differed between the groups, and it was shown that avoiders had significantly more missing teeth, whereas regular attenders had significantly more filled teeth. The avoiders reported a stronger negative impact on their daily life, whereas there were no significant differences between the groups with regard to general emotions. The logistic regression analysis showed that phobic avoidance was predicted only by anticipated dental anxiety and missing teeth. It was concluded that differences between high dental fear patients with regular dental care and phobic avoidance were mainly related to anticipated fear and anxiety, oral health effects, and concomitant negative life consequences. These results are discussed in terms of subjective stress, negative cognitions, social support, and coping-strategies.
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- Adler, Johan, 1970
(författare)
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From closed to open door policy: An empirical study of Chinas international capital mobility, 1958-98
- 2001
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This paper employs the intertemporal consumption smoothing approach to the current account to measure the effective degree of Chinas international capital mobility during the period 1958-98. In contrast to all previous known country studies using this framework, the hypothesis that capital has been at least mobile enough to allow for full consumption smoothing behavior is rejected. Also, although there is clear evidence of a drastic increase in mobility following the introduction of the open door policy in teh late 1970s, the result indicate that there remain effective barriers to Chinas international capital movements.
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