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- Franzén, Thomas, 1955-
(författare)
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Success and failure of conventional and laparoscopic fundoplication in gastro-oesophageal reflux disease
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The outcome of antireflux surgery in a single institution during two decades is presented.101 consecutive patients operated with open partial2 70° fundoplication and crural repair during 1982-1989 were prospectively analysed. All stages ofpreoperative oesophagitis were represented. Reflux competence, symptomatology, and postoperative side-effects were evaluated six months and ten years postoperatively. Recurrence (8%) was more common in patients who had severe oesophagitis before operation. The operative method is effective for long-term reflux control, it does not cause dysphagia, and it has few side-effect. Some months prior to the introduction oflaparoscopic fundoplication our unit had changed from partial to total fundoplication as a standard operation for gastro-oesophageal reflux disease (GORD). It was then convenient to perform the total Nissen fundoplication laparoscopically. All 50 patients operated with laparoscopic technique during a 30-months period 1992-1994 were prospectively compared with 21 patients operated with open technique. Nine patients were converted and then analysed in the open group. We tried to select patients with uncomplicated disease for laparoscopy but 7 patients in this group had severe disease diagnosed at preoperative endoscopy or/and at operation. In the open group 9 patients had severe disease. The patients were investigated six months, two years, and five years postoperatively. Early postoperative manometry was prognostic for recurrence. At long term follow-up the reflux control was similar, 10% of the patients operated with laparoscopy had recurrence and 8% of the patients operated with open technique.Summer 1994 to spring 1998 we included 93 patients with uncomplicated GORD in a randomised clinical trial between laparoscopic and open 360° floppy Nissen fundoplication with crural repair. 45 patients were operated on laparoscopically and 48 patients underwent laparotomy. Only one patient was converted and then analysed in the laparotomy group. The patients were investigated before operation, half a year after and at long-term follow-up (33-79 months postoperatively). Long-term follow up also included endoscopy. Operation time was significantly longer for laparoscopy compared to laparotomy, 155.6 (±36.5) minutes and 104.3 (±30.7) minutes respectively (p<0.05). Laparoscopy patients had significantly shorter hospital stay, 3.6 (±1.9) days, compared to 5.8 (±1. 7) days for laparotomy patients. Sick leaves were 20.7 (±9.9) days for laparoscopy patients and 28.3 (14.7) for laparotomy patients. The difference was significant (p<0.05). Early postoperative reflux control was similar for laparoscopic and conventional fundoplication. Early side-effects were more frequent after laparoscopy. Significantly less laparoscopy patients were satisfied at long-term follow-up; only 62% of the laparoscopy patients were satisfied compared to 91% of the laparotomy patients.We have investigated the mechanisms and anatomical failures in twenty-one patients reoperated after laparoscopic total fundoplication. Recurrent heartburn occurs when wrong part of the stomach is used for the fundoplication. Dysphagia after failed laparoscopic total fundoplication is caused by hiatal fibrosis or other mechanical causes rather than a normal and tight fundoplication.Also the reproducibility of an important diagnostic tool for GORD, the 24-hour pH monitoring, was evaluated. Twenty-two adult patients admitted to The Oesophageal Laboratory for 24-hour pH monitoring were investigated twice, six weeks apart, under identical conditions. The test was strictly standardised with the use of an antimony pH- probe and the patients hospitalised during 24 hours. We found that a normal 24-hour pH test should be assessed with caution because the biological variability of gastro-oesophageal reflux is not negligible from time to time.
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- Kormi-Nouri, Reza, 1954-, et al.
(författare)
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Is there memory deficit in Parkinson’s disease? Explicit and implicit memory for verbal and action events
- 2001
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Ingår i: Advances in Cognitive Sciences. - Tehran : Institute for Cognitive Science Studies, Qalam Gostaran Pajouhesh. - 1561-4174. ; 3:1-2, s. 28-39
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Tidskriftsartikel (refereegranskat)abstract
- Three experiments examined both encoding and test variable whether there is any memory deficit in patients with Parkinson's disease in comparison with normal controls. In Experiment 1, the effect of encoding enactment was tested in free recall and cued recall. In Experiment 2, the combinations of enactment/non enactment and well/poorly integration variables were used at encoding. Again, the subjects were tested by free and cued recall. In Experiment 3, recognition memory and sentence-fragment completion tests were used with the same encoding manipulations as in Experiment 2. In general, the results of all three experiments showed no difference between PD patients and normal controls indicating that there is no memory deficit for PD patients. However, it was observed that there was some recognition deficit (especially for well integrated and verbal items) in Parkins on patients. It was suggested that the similarity between encoding and retrieval and the stage of disease should be considered as important factors for any possible memory deficit in Parkinsonian patients. It was also concluded that Parkinson patients are less well able to utilize cognitive support.
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- Sandholm, Thomas, et al.
(författare)
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An OGSA-Based Accounting System for Allocation Enforcement across HPC Centers
- 2004
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Ingår i: ICSOC '04. - New York, NY, USA : ACM. ; , s. 279-288, s. 279-288
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Konferensbidrag (refereegranskat)abstract
- In this paper, we present an Open Grid Services Architecture (OGSA)-based decentralized allocation enforcement system, developed with an emphasis on a consistent data model and easy integration into existing scheduling, and workload management software at six independent high-performance computing centers forming a Grid known as SweGrid. The Swedish National Allocations Committee (SNAC) allocates resource quotas at these centers to research projects requiring substantial computer time. Our system, the SweGrid Accounting System (SGAS), addresses the need for soft real-time allocation enforcement on SweGrid for cross-domain job submission. The SGAS framework is based on state-of-the-art Web and Grid services technologies. The openness and ubiquity of Web services combined with the fine-grained resource control and cross-organizational security models of Grid services proved to be a perfect match for the SweGrid needs. Extensibility and customizability of policy implementations for the three different parties the system serves (the user, the resource manager, and the allocation authority) are key design goals. Another goal is end-to-end security and single sign-on, to allow resources-selected based on client policies-to act on behalf of the user when negotiating contracts with the bank in an environment where the six centers would continue to use their existing accounting policies and tools. We conclude this paper by showing the feasibility of SGAS, which is currently being deployed at the production sites, using simulations of reservation streams. The reservation streams are shaped using soft computing and policy-based algorithms.
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- Öberg, Stefan, et al.
(författare)
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Endoscopic surveillance of columnar-lined esophagus - Frequency of intestinal metaplasia detection and impact of antireflux surgery
- 2001
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Ingår i: Annals of Surgery. - 1528-1140. ; 234:5, s. 619-626
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Tidskriftsartikel (refereegranskat)abstract
- Objective To quantify the occurrence of intestinal metaplasia in columnar-lined esophagus (CLE) during endoscopic surveillance and to evaluate the impact of antireflux surgery on the development of intestinal metaplasia. Summary Background Data The malignant potential in segments of CLE is mainly restricted to those containing intestinal metaplasia. Patients with segments of CLE in which no intestinal metaplasia can be detected are rarely enrolled in a surveillance program but may still be at increased risk of developing esophageal adenocarcinoma because intestinal metaplasia may be missed or may develop with time. Methods The occurrence of intestinal metaplasia on biopsy samples was determined on repeated endoscopies in 177 patients enrolled in a surveillance program for CLE. The incidence of intestinal metaplasia in patients with no evidence of intestinal metaplasia on the two first endoscopies was evaluated on the subsequent endoscopies and compared in patients with medically and surgically treated gastroesophageal reflux disease. Results Intestinal metaplasia was found in 53% of the patients (94/ 177) on their first surveillance endoscopy and was more prevalent in long segments of CLE. The prevalence of intestinal metaplasia increased markedly with increasing number of surveillance endoscopies. Intestinal metaplasia tended to be detected early in patients with long segments of CLE; in patients with shorter segments, intestinal metaplasia was also detected late in the course of endoscopic surveillance. Patients with surgically treated reflux disease were 10.3 times less likely to develop intestinal metaplasia compared with a group receiving standard medical therapy. Conclusion Biopsy samples from a single endoscopy, despite an adequate biopsy protocol, are insufficient to rule out the presence of intestinal metaplasia. Patients in whom biopsy specimens from a segment of CLE show no intestinal metaplasia have a significant risk of having undetected intestinal metaplasia or of developing intestinal metaplasia with time. Sampling error is probably the reason for the absence of intestinal metaplasia in segments of CLE longer than 4 cm, whereas development of intestinal metaplasia is common in patients with shorter segments of CLE. Antireflux surgery protects against the development of intestinal metaplasia, possibly by better control of reflux of gastric contents.
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