| 1. |
- Lundin, Margareta
(författare)
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Aspects on Image Quality in Radiologic Evaluation of the Urinary Tract
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The focus of this document is on image quality as one of the factors fundamental for the diagnostic process. With the rising number of procedures and the trend towards more complicated examinations, urinary tract investigations was chosen in this work as a good clinical model for evaluation of the factors influencing image quality and of the ways of evaluating image quality.In paper I, a method is described for optimisation during the introduction of a new imaging system, with a focus on the maintenance of image quality relative to the older already optimised system. Image quality was assessed using the image criteria of the European guidelines for IVU with visual grading analysis. Equivalent image quality in image pairs was achieved at 30% of the dose. The CDRAD contrast-detail phantom makes it possible to find dose levels that give equal image quality using different imaging systems.In paper II, the influence of bowel purgation on image quality in urography is questioned. The aim of this study was to compare bowel purgation and two other preparation methods; dietary restrictions and no preparation at all. Image quality was assessed according to European Commission criteria for excretory urography. The effectiveness of bowel purgation and the amount of residual gas were scored separately. The results of our study show that the preparation methods are of equal value and further use of bowel purgation before excretory urography cannot be justified.In paper III, the image quality of the non-enhanced series is compared to a virtual noncontrast series obtained using two generations of dual-energy CT scanners and taking CT of the urinary tract as a model. The image quality of the VNC images was rated inferior to the single-energy variant for both scanners, the OR range being 11.5–67.3 for the Definition and 2.1–2.8 for the Definition Flash. Visual noise and overall quality were regarded as better with Flash than with Definition. Image quality of VNC images obtained with the new generation of DECT is still slightly inferior compared to native images.In paper IV, the accuracy of measurement of renal calculi in a dual-energy, virtual, nonenhanced-image series is compared to actual stone size and a single-energy image series in the phantom study. This study shows that detection of small stones is not reliable, despite better image quality, with the new DECT and that small stones will be missed with VNC imaging. With larger stones, the inherent measurement error with CT is magnified with VNC imaging.
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| 2. |
- Essving, Per, 1960-, et al.
(författare)
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Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty using local infiltration analgesia A randomized controlled trial with 40 patients
- 2012
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Ingår i: Acta Orthopaedica. - New York, USA : Informa Healthcare. - 1745-3674 .- 1745-3682. ; 83:6, s. 634-641
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: There has recently been interest in the advantages of minimally invasive surgery (MIS) over conventional surgery, and on local infiltration analgesia (LIA) during knee arthroplasty. In this randomized controlled trial, we investigated whether MIS would result in earlier home-readiness and reduced postoperative pain compared to conventional unicompartmental knee arthroplasty (UKA) where both groups received LIA.Patients and methods: 40 patients scheduled for UKA were randomized to a MIS group or a conventional surgery (CON) group. Both groups received LIA with a mixture of ropivacaine, ketorolac, and epinephrine given intra-and postoperatively. The primary endpoint was home-readiness (time to fulfillment of discharge criteria). The patients were followed for 6 months.Results: We found no statistically significant difference in home-readiness between the MIS group (median (range) 24 (21-71) hours) and the CON group (24 (21-46) hours). No statistically significant differences between the groups were found in the secondary endpoints pain intensity, morphine consumption, knee function, hospital stay, patient satisfaction, Oxford knee score, and EQ-5D. The side effects were also similar in the two groups, except for a higher incidence of nausea on the second postoperative day in the MIS group.Interpretation: Minimally invasive surgery did not improve outcome after unicompartmental knee arthroplasty compared to conventional surgery, when both groups received local infiltration analgesia. The surgical approach (MIS or conventional surgery) should be selected according to the surgeon's preferences and local hospital policies.
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| 3. |
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| 4. |
- Gustavsson, Anders, 1964-, et al.
(författare)
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Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn's disease
- 2013
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Ingår i: Alimentary Pharmacology and Therapeutics. - : Wiley-Blackwell. - 0269-2813 .- 1365-2036. ; 37:4, s. 430-437
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Endoscopic balloon dilation is an efficacious and safe alternative to surgery as treatment of short intestinal strictures in Crohn's disease (CD). Factors predicting outcome of the procedure are not well described.AIM: To evaluate whether smoking at diagnosis, treatment with azathioprine, or other clinical variables may affect clinical outcome after endoscopic dilation. The endpoint was requirement of a new intervention such as dilation or surgery with intestinal resection or strictureplasty.METHODS: Retrospective study of 83 patients with CD who underwent endoscopic balloon dilation of an intestinal stricture between 1987 and 2009.RESULTS: After index dilation 55/83 patients underwent a new intervention. Among current smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) among never smokers (adjusted HR: 2.50, 95% CI: 1.14-5.50, P = 0.022). After 5 years, cumulative probability of new intervention was 0.81 in smokers compared to 0.52 in never smokers; difference 0.29 (95% CI: 0.07-0.52, P = 0.01). In 16 patients, therapy with azathioprine was initiated before or shortly after the index dilation; 7/16 underwent a new intervention compared to 48/67 of those without azathioprine (HR: 0.46, 95% CI: 0.21-1.03, P = 0.06). After adjustment for other variables, the association was even weaker (HR: 0.80, 95% CI: 0.29-2.18, P = 0.668). Sex, age at diagnosis, age at first dilation, balloon size, location of stricture, and treatment period did not influence outcome.CONCLUSIONS: Smoking doubles the risk of recurrent stricture formation requiring a new intervention after index dilation. Maintenance therapy with azathioprine did not influence the subsequent course and need for a new intervention.
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| 5. |
- Makdoumi, Karim, 1977-, et al.
(författare)
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Comparison of UVA- and UVA/riboflavin-induced growth inhibition of Acanthamoeba Castellanii
- 2013
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Ingår i: Graefe's Archives for Clinical and Experimental Ophthalmology. - New York, USA : Springer. - 0721-832X .- 1435-702X. ; 251:2, s. 509-514
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To investigate whether ultraviolet light (UVA) at 365 nm can inhibit/eliminate Acanthamoeba growth and if riboflavin would potentiate such an association.Method: Acanthamoeba castellanii in a fluid medium with a concentration of approximately 1.7 x 10(4) protozoa/ml were prepared with (0.01 %) and without riboflavin. Exposure of UVA (dose 5.475 J/cm(2)) took place twice, with each illumination period followed by culturing of 10 mu l in peptone yeast-extract glucose (PYG) medium for 7 days. Every suspension prepared had a non-exposed control solution. Determination of Acanthamoeba was conducted daily, by count in Burker chamber days 4 through 7 after exposure. Statistical analysis was done by repeated-measurement ANOVA and post-hoc analysis for unpaired samples.Results: The exposure of ultraviolet light resulted in an inhibited growth of Acanthamoeba compared to the non-exposed solutions, with a statistically significant reduction over time (p = 0.0003). The addition of riboflavin did not amplify the effect, and there were no tendencies for an interaction effect between UVA and riboflavin. The antiprotozoal effect of the UVA wavelength, utilized in CXL, is solely mediated by ultraviolet light, and riboflavin does not seem to amplify the antimicrobial efficacy.
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| 7. |
- Sjöberg, Mats, 1965-, et al.
(författare)
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Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis : a retrospective observational study
- 2012
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Ingår i: Inflammatory Bowel Diseases. - : John Wiley & Sons. - 1078-0998 .- 1536-4844. ; 18:2, s. 212-218
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives. Methods: Outcome of rescue therapy was retrospectively studied in two cohorts of patients hospitalized due to steroid-refractory moderate to severe UC: 1) a Swedish-Danish cohort (n 49) treated with a single infusion of IFX; 2) an Austrian cohort (n 43) treated with intravenous CsA. After successful rescue therapy, maintenance immunomodulator treatment was given to 27/33 (82%) of IFX patients and to 31/40 (78%) of CsA patients. Endpoints were colectomy-free survival at 3 and 12 months. Kaplan-Meier and Cox regression models were used to evaluate the association between treatment groups and colectomy. Results: At 15 days, colectomy-free survival in the IFX cohort was 36/49 (73%) versus 41/43 (95%) in the CsA cohort (P = 0.005), at 3 months 33/49 (67%) versus 40/43 (93%) (P = 0.002), and at 12 months 28/49 (57%) versus 33/43 (77%) (P = 0.034). After adjusting for potential confounding factors, Cox regression analysis yielded adjusted hazard ratios for risk of colectomy in IFX-treated patients of 11.2 (95% confidence interval [CI] 2.4-53.1, P = 0.002) at 3 months and of 3.0 (95% CI 1.1-8.2, P = 0.030) at 12 months in comparison with CsA-treated patients. There were no opportunistic infections or mortality. Conclusions: Colectomy frequencies were significantly lower after rescue therapy with CsA than with a single infusion of IFX both at 3 and 12 months' follow-up. The superiority of CsA was seen principally during the first 15 days.
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| 8. |
- Andersson, Eva, 1955, et al.
(författare)
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Cancer incidence among Swedish pulp and paper mill workers: a cohort study of sulphate and sulphite mills.
- 2013
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Ingår i: International archives of occupational and environmental health. - : Springer Science and Business Media LLC. - 1432-1246 .- 0340-0131. ; 86:5, s. 529-40
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Tidskriftsartikel (refereegranskat)abstract
- Associations between various malignancies and work in the pulp and paper industry have been reported but mostly in analyses of mortality rather than incidence. We aimed to study cancer incidence by main mill pulping process, department and gender in a Swedish cohort of pulp and paper mill workers.The cohort (18,113 males and 2,292 females, enrolled from 1939 to 1999 with >1year of employment) was followed up for cancer incidence from 1958 to 2001. Information on the workers' department and employment was obtained from the mills' personnel files, and standardized incidence ratios (SIRs) were calculated using the Swedish population as reference.Overall cancer incidence, in total 2,488 cases, was not increased by work in any department. However, risks of pleural mesothelioma were increased among males employed in sulphate pulping (SIR, 8.38; 95% CI, 3.37-17) and maintenance (SIR, 6.35; 95% CI, 3.47-11), with no corresponding increase of lung cancer. Testicular cancer risks were increased among males employed in sulphate pulping (SIR, 4.14; 95% CI, 1.99-7.61) and sulphite pulping (SIR, 2.59; 95% CI, 0.95-5.64). Female paper production workers showed increased risk of skin tumours other than malignant melanoma (SIR, 2.92; 95% CI, 1.18-6.02).Incidence of pleural mesothelioma was increased in the cohort, showing that asbestos exposure still has severe health consequences, and highlighting the exigency of strict asbestos regulations and elimination. Testicular cancer was increased among pulping department workers. Shift work and endocrine disruptors could be of interest in this context.
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| 9. |
- Andersson, Eva, 1955, et al.
(författare)
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Cancer mortality in a Swedish cohort of pulp and paper mill workers.
- 2010
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Ingår i: International archives of occupational and environmental health. - : Springer Science and Business Media LLC. - 1432-1246 .- 0340-0131. ; 83:2, s. 123-32
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study cancer mortality among Swedish pulp and paper mill workers by main mill pulping process and department, and to present the Swedish part of an international exposure measurements database. METHODS: A cohort of 18,163 male and 2,290 female workers at four sulfate and four sulfite mills, enrolled from 1939 to 1999, was followed up for mortality during 1952-2001. Standardized mortality ratios (SMRs) relative to the general Swedish population were calculated. RESULTS: There were 1,340 malignant cases out of 5,898 deaths. Total cancer mortality was not increased in either sulfate or sulfite mill workers, or by gender. Lung cancer mortality was increased among female workers (SMR 1.70, 95% CI 1.04-2.63), especially in paper production, but not among male workers (SMR 0.91, 95% CI 0.79-1.04). Exposure to wood dust and sulfur dioxide frequently exceeded occupational exposure limits. CONCLUSIONS: Female paper production workers had an increased mortality from lung cancer.
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| 10. |
- Andersson, Tommy, 1970-, et al.
(författare)
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All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008 : a Swedish nationwide long-term case-control study
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 34:14, s. 1061-1067
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Tidskriftsartikel (refereegranskat)abstract
- Aims To evaluate long-term all-cause risk of mortality in women and men hospitalized for the first time with atrial fibrillation (AF) compared with matched controls. Methods and results A total of 272 186 patients (44% women) <= 85 years at the time of hospitalization with incidental AF 1995-2008 and 544 344 matched controls free of in-hospital diagnosis of AF were identified. Patients were followed via record linkage of the Swedish National Patient Registry and the Cause of Death Registry. Using Cox regression models, the long-term relative all-cause mortality risk, adjusted for concomitant diseases, in women vs. controls was 2.15, 1.72, and 1.44 (P < 0.001) in the age categories <= 65, 65-74, and 75-85 years, respectively. The corresponding figures for men were 1.76, 1.36, and 1.24 (P < 0.001). Among concomitant diseases, neoplasm, chronic renal failure, and chronic obstructive pulmonary disease contributed most to the increased all-cause mortality vs. controls. In patients with AF as the primary diagnosis, the relative risk of mortality was 1.63, 1.46, and 1.28 (P < 0.001) in women and 1.45, 1.17, and 1.10 (P < 0.001) in men. Conclusion Atrial fibrillation was an independent risk factor of all-cause mortality in patients with incident AF. The concomitant diseases that contributed most were found outside the thromboembolic risk scores. The highest relative risk of mortality was seen in women and in the youngest patients compared with controls, and the differences between genders in each age category were statistically significant.
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