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- Bjarnason, Thordur, et al.
(author)
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One-Year Follow-up After Open Abdomen Therapy With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction
- 2013
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 37:9, s. 2031-2038
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Journal article (peer-reviewed)abstract
- Open abdomen (OA) therapy frequently results in a giant planned ventral hernia. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) enables delayed primary fascial closure in most patients, even after prolonged OA treatment. Our aim was to study the incidence of hernia and abdominal wall discomfort 1 year after abdominal closure. A prospective multicenter cohort study of 111 patients undergoing OA/VAWCM was performed during 2006-2009. Surviving patients underwent clinical examination, computed tomography (CT), and chart review at 1 year. Incisional and parastomal hernias and abdominal wall symptoms were noted. The median age for the 70 surviving patients was 68 years, 77 % of whom were male. Indications for OA were visceral pathology (n = 40), vascular pathology (n = 22), or trauma (n = 8). Median length of OA therapy was 14 days. Among 64 survivors who had delayed primary fascial closure, 23 (36 %) had a clinically detectable hernia and another 19 (30 %) had hernias that were detected on CT (n = 18) or at laparotomy (n = 1). Symptomatic hernias were found in 14 (22 %), 7 of them underwent repair. The median hernia widths in symptomatic and asymptomatic patients were 7.3 and 4.8 cm, respectively (p = 0.031) with median areas of 81.0 and 42.9 cm(2), respectively (p = 0.025). Of 31 patients with a stoma, 18 (58 %) had a parastomal hernia. Parastomal hernia (odds ratio 8.9; 95 % confidence interval 1.2-68.8) was the only independent factor associated with an incisional hernia. Incisional hernia incidence 1 year after OA therapy with VAWCM was high. Most hernias were small and asymptomatic, unlike the giant planned ventral hernias of the past.
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| 3. |
- Lindström, Ulf, et al.
(author)
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Patients with Non-AS Axial SpA Have Similar Prevalence Compared to AS, but Worse Perceived Health. Results from a Population Based Study
- 2013
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In: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 72:Suppl. 3, s. A667-A668
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Journal article (peer-reviewed)abstract
- Background: Non-radiographic axial spondyloarthritis (SpA) is emerging as a treatable disease comparable to ankylosing spondylitis (AS), but less well studied. Previous studies have described a reversed gender distribution, with AS being more prevalent in the male population and non-radiographic axial SpA more prevalent in the female population. Recent studies have also indicated a similar benefit from treatment with TNF-inhibitors.Objectives: The aim of this study was to estimate the prevalence of non-radiographic axial SpA and compare the patient reported outcome measures (PROMS) to that of AS, in Southern Sweden.Methods: All health care seeking individuals, ≥18 years, given a SpA-diagnosis, according to the ICD-10 (M45.9, M072, M460, M461, M468, M469, M074, M705 and L405 or M071 or M073), either in primary or specialized care, (N = 5771), during 2003 - 2007, were identified through the regional health care register in Skåne, a county in Southern Sweden with 1.2 million inhabitants (SpAScania cohort). In 2009 they were all sent a questionnaire (response rate; 48%), including questions concerning inflammatory back pain (IBP), the SpA-associated comorbidities constituting the ASAS-criteria (IBD, Ps, Uveitis/tendinitis, heredity), PROMS (BAS-indices, VAS-pain/fatigue/global, EQ5D) and previous/current medication.Non-AS axial SpA was defined as having an ICD10 code supporting a diagnosis of SpA without having one of AS (M45.9), in combination with > 3 months of back pain the last year and the presence of ≥2 of the SpA associated comorbidities. Record review support the notion of using AS as a substitute for radiographic changes. For the “non imaging arm” of the ASAS criteria for axial disease, we used the ICD10 codes above as a substitute for HLA-B27 status. Assuming similar answers from the questionnaire non-responders, prevalence rates were estimated for non-AS axial SpA and AS.Results: Among responders 742 had an AS-diagnosis and 640 fulfilled the study criteria for non-AS axial SpA. The frequency of men was 60.5% in the AS group and 29.5% in the non-AS axial SpA group. The prevalence of AS was 0.13% (95% CI; 0.115-0.148) and for non-AS axial SpA 0.11 % (95% CI; 0.096-0.130), with a reverse gender distribution. The means of the PROMs and frequency of comorbidities were higher in the non-AS axial SpA vs both the AS, and the subgroup of AS individuals reporting back pain (BP) > 3months during the last year. Self-reported present use of TNF-inhibitors were similar between the groups (Image 1).Conclusions: Prevalence rates for AS and non-AS axial SpA were similar, with a reverse gender distribution. The results suggest that at a population level the proportion with non-AS axial SpA is at least as large as that of AS and report lower levels of perceived health status and similar frequencies of SpA-related comorbidities (except psoriasis) and treatment with TNF-inhibitors, supporting the validity for the used definition in future research.Disclosure of Interest: None Declared
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| 4. |
- Montgomery, Agneta, et al.
(author)
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The arcuate line hernia: operative treatment and a review of the literature.
- 2013
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In: Hernia. - : Springer Science and Business Media LLC. - 1248-9204 .- 1265-4906. ; 17:3, s. 391-396
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Research review (peer-reviewed)abstract
- PURPOSE: An arcuate line hernia (ALH) is a rare diagnosis with no consensus on how to deal with this condition either when symptomatic or when found accidentally. Suggestions for laparoscopic and open operative techniques are given together with a review of the literature and a presentation of three new cases. MATERIAL: The PubMed database was searched for publications on ALH. Identified cases, including three from our department, are reported. RESULTS: Five males and two females, with a median age of 53 years were identified. Three patients were correctly diagnosed on a preoperative CT scan and the rest at surgery. Two patients had bilateral ALHs and four had other concomitant hernias repaired. Small bowel was present in the hernia in three cases and sigmoid colon in one. In one case, an emergency operation was performed due to bowel incarceration. Five patients had laparoscopic repairs, three with mesh and two without. Two patients, one converted from laparoscopic to open operation, had open mesh repairs. The postoperative course was uneventful in all cases, and no recurrences have been reported at a median follow-up of 6 months. CONCLUSIONS: A laparoscopic approach is recommended for diagnostic purposes, for pre-peritoneal mesh placement and for repair of concomitant hernias in both elective and emergency settings. Highlighting its existence might help general surgeons in interpreting an unusual finding on a CT scan or at operation.
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- Nilsson, Sten, et al.
(author)
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Two-Year Survival Follow-Up of the Randomized, Double-Blind, Placebo-Controlled Phase II Study of Radium-223 Chloride in Patients With Castration-Resistant Prostate Cancer and Bone Metastases
- 2013
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In: Clinical Genitourinary Cancer. - : Elsevier. - 1558-7673 .- 1938-0682. ; 11:1, s. 20-26
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Journal article (peer-reviewed)abstract
- In this 24-month follow-up of a phase II study in patients with castration-resistant prostate cancer (CRPC) and bone metastases, radium-223 (4 injections of 50 kBq/kg every 4 weeks [n = 33]) improved median overall survival vs. matching placebo (n = 31) (65.3 vs. 46.4 weeks, respectively; log-rank P = .056), with no long-term safety concerns. Data suggest that treatment of bone disease with radium-223 has survival benefits. less thanbrgreater than less thanbrgreater thanBackground: This phase II randomized, placebo-controlled study was conducted to evaluate efficacy and safety of radium-223 in patients with castration-resistant prostate cancer (CRPC) and painful bone metastases. Twelve-and 18-month survival results were reported previously. Here we report 24-month overall survival (OS) and safety data from the period 12 to 24 months after the first injection of study medication. Methods: Patients with CRPC and bone pain were randomized 1: 1 to receive 4 injections of radium-223 (50 kBq/kg [n = 33]) or placebo (n = 31) after external-beam radiotherapy; each injection was given every 4 weeks. Endpoints for this report were 24-month OS, long-term safety, and treatment-related adverse events (AEs) occurring in the 12- to 24-month period. Results: After 24 months, 10 (30%) patients were alive in the radium-223 group compared with 4 patients (13%) in the placebo group. Patients who received at least 1 dose of study medication had a median OS of 65 weeks in the radium-223 group vs. 46 weeks in the placebo group (log-rank P = .056). The hazard ratio (HR) for OS, adjusted for baseline covariates, was 0.476 (95% confidence interval [CI], 0.258-0.877; Cox regression P = .017). The most frequent cause of death for both arms was disease progression. There were no reports of treatment-related AEs or long-term hematologic toxicity during the 12- to 24-month follow-up. Conclusion: Radium-223 had a highly favorable safety profile, with no evidence of second malignancies at 24-month follow-up. The significant improvement in OS observed in patients receiving radium-223 vs. placebo suggests that treatment of bone disease with radium-223 has survival benefits. Clinical Genitourinary Cancer, Vol. 11, No. 1, 20-6
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| 8. |
- Petersson, Kenneth, 1949-, et al.
(author)
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La question sociale revisitée. La configuration de la dimension sociale dans l'espace éducatif européen
- 2013
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In: Education et Societes. - Lyon : de Boeck. - 1373-847X. ; 31:1, s. 111-126
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Journal article (peer-reviewed)abstract
- La fabrication de la question sociale est problématisée ici dans deux discours historiques sur l’intégration sociale : le discours philanthropique et celui de l’Espace Européen de l’Enseignement Supérieur (EEES). De quelle manière et sous quelles circonstances, la relation entre les sujets inclus et exclus et la société se reproduit-elle et fonctionne-t-elle d’une époque à une autre ? La méthode généalogique utilisée est inspirée de la notion de gouvernementalité de Foucault. Dans le discours contemporain, des technologies d’espoir et de peur de l’avenir sont en jeu : certains groupes sociaux sont créés pour représenter les menaces vis-à-vis de l’espoir d’avenir et l’éducation est construite comme une technologie cruciale pour la bonne inclusion de ces mêmes groupes. La comparaison avec les mécanismes éducatifs de la philanthropie montre que ce n’est pas nouveau. La société européenne au début du XIXe siècle craignait une population ayant perdu son orientation religieuse, égarée dans un ordre social prédestiné. La crainte dans l’Europe contemporaine est d’être laissée en arrière dans la course mondiale pour la société de la connaissance la plus éminente et durable.
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| 9. |
- Rogmark, Peder, et al.
(author)
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Short-term outcomes for open and laparoscopic midline incisional hernia repair : a randomized multicenter controlled trial
- 2013
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In: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 258:1, s. 37-45
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Journal article (peer-reviewed)abstract
- OBJECTIVE: : The aim of the trial was to compare laparoscopic technique with open technique regarding short-term pain, quality of life (QoL), recovery, and complications.BACKGROUND: : Laparoscopic and open techniques for incisional hernia repair are recognized treatment options with pros and cons.METHODS: : Patients from 7 centers with a midline incisional hernia of a maximum width of 10 cm were randomized to either laparoscopic (LR) or open sublay (OR) mesh repair. Primary end point was pain at 3 weeks, measured as the bodily pain subscale of Short Form-36 (SF-36). Secondary end points were complications registered by type and severity (the Clavien-Dindo classification), movement restrictions, fatigue, time to full recovery, and QoL up to 8 weeks.RESULTS: : Patients were recruited between October 2005 and November 2009. Of 157 randomized patients, 133 received intervention: 64 LR and 69 OR. Measurements of pain did not differ, nor did movement restriction and postoperative fatigue. SF-36 subscales favored the LR group: physical function (P < 0.001), role physical (P < 0.012), mental health (P < 0.022), and physical composite score (P < 0.009). Surgical site infections were 17 in the OR group compared with 1 in the LR group (P < 0.001). The severity of complications did not differ between the groups (P < 0.213).CONCLUSIONS: : Postoperative pain or recovery at 3 weeks after repair of midline incisional hernias does not differ between LR and OR, but the LR results in better physical function and less surgical site infections than the OR does. (ClinicalTrials.gov Identifier: NCT00472537).
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| 10. |
- Vera-Larrucea, Constanza, 1979-
(author)
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Citizenship by citizens : First generation nationals with Turkish ancestry on lived citizenship in Paris and Stockholm
- 2013
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Doctoral thesis (other academic/artistic)abstract
- The main aim of this thesis is to study how citizens with an immigrant ancestry approach citizenship. The academically popular re-formulations that decouple citizenship from the state, such as “postnational” and “denationalised” perspectives, call for a reconfiguration of the understanding and practices of citizenship. As most of this work has been developed within a legal and institutional framework, it has become separated from the experiences and understandings of citizens. The present study pays specific attention to citizens, and especially a group that has not hitherto been central in discussions about citizenship, namely immigrants’ descendants, or so-called second-generation immigrants. According to the theory, being a descendant of immigrants presupposes a different experience of citizenship. This study focuses on experienced citizenship by embracing the concept of ‘lived citizenship’, i.e. the meaning that people attribute to citizenship. Lived citizenship is inspired by citizens’ cultural and ethnic backgrounds, life conditions and other contextual and personal factors. In this work, lived citizenship is approached from the perspective of young adults with and without Turkish ancestry in two European cities: Stockholm and Paris. These cities are located in countries with different histories and conceptions of citizenship. The analysis is based on three dimensions of citizenship: a civic, a subjective and a substantial dimension. These dimensions are problematized with the help of survey data and qualitative interviews. The results indicate that, when turning to individual perceptions, it is the daily struggles that define the experience of citizenship and not the possibility of crossing borders. The study suggests that, when studying people as citizens, their ancestry is less relevant than the practical aspects of the context in which citizenship is experienced. Moreover, citizenship is presented as a complex phenomenon when approached empirically. The definition of citizenship is influenced by the models that are offered by the national context. In contrast, lived citizenship is influenced by everyday life and the personal characteristics of the citizens. People try to include certain elements of their Turkish ancestry because this is considered as richness, rather than as a source of second class citizenship. Finally, people with Turkish ancestry cannot be classified as another kind of citizens, because this depends on the dimension of citizenship being analysed.
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