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- Lepsenyi, Mattias, et al.
(författare)
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Self-expanding metal stents in malignant colonic obstruction: experiences from Sweden.
- 2011
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Ingår i: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Acute surgery in the management of malignant colonic obstruction is associated with high morbidity and mortality. The use of self-expanding metal stents (SEMS) is an alternative method of decompressing colonic obstruction. SEMS may allow time to optimize the patient and to perform preoperative staging, converting acute surgery into elective. SEMS is also proposed as palliative treatment in patients with contraindications to open surgery. Aim: To review our experience of SEMS focusing on clinical outcome and complications. The method used was a review of 75 consecutive trials at SEMS on 71 patients based on stent-protocols and patient charts. FINDINGS: SEMS was used for palliation in 64 (85%) cases and as a bridge to surgery in 11 (15%) cases. The majority of obstructions, 53 (71%) cases, were located in the recto-sigmoid. Technical success was achieved in 65 (87%) cases and clinical decompression was achieved in 60 (80%) cases. Reasons for technical failure were inability to cannulate the stricture in 5 (7%) cases and suboptimal SEMS placement in 3 (4%) cases. Complications included 4 (5%) procedure-related bowel perforations of which 2 (3%) patients died in junction to post operative complications. Three cases of bleeding after SEMS occurred, none of which needed invasive treatment. Five of the SEMS occluded. Two cases of stent erosion were diagnosed at the time of surgery. Average survival after palliative SEMS treatment was 6 months. CONCLUSION: Our results correspond well to previously published data and we conclude that SEMS is a relatively safe and effective method of treating malignant colonic obstruction although the risk of SEMS-related perforations has to be taken into account.
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| 2. |
- Syk, Jörgen, et al.
(författare)
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Anti-inflammatory Treatment of Atopic Asthma Guided by Exhaled Nitric Oxide : A Randomized, Controlled Trial
- 2013
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Ingår i: Journal of Allergy and Clinical Immunology. - : Elsevier BV. - 0091-6749 .- 1097-6825 .- 2213-2198 .- 2213-2201. ; 1:6, s. 639-648
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAtopic asthma is characterized by Th2 cytokine–driven inflammation of the airway mucosa, which is signaled by the fraction of exhaled nitric oxide (FENO).ObjectiveWe tested whether an FENO-guided anti-inflammatory treatment algorithm could improve asthma-related quality of life and asthma symptom control, and reduce exacerbations in atopic asthmatics within primary care.MethodsAltogether, 187 patients with asthma and who were nonsmokers (age range, 18-64 years) with perennial allergy and who were on regular inhaled corticosteroid treatment were recruited at 17 primary health care centers, randomly assigned to 2 groups and followed up for 1 year. For the controls (n = 88), FENO measurement was blinded to both operator and patient, and anti-inflammatory treatment was adjusted according to usual care. In the active group (n = 93), treatment was adjusted according to FENO. Questionnaires on asthma-related quality of life (Mini Asthma Quality of Life Questionnaire) and asthma control (Asthma Control Questionnaire) were completed, and asthma events were noted.ResultsThe Asthma Control Questionnaire score change over 1 year improved significantly more in the FENO-guided group (–0.17 [interquartile range {IQR}, −0.67 to 0.17] vs 0 [−0.33 to 0.50]; P = .045), whereas the Mini Asthma Quality of Life Questionnaire score did not (0.23 [IQR, 0.07-0.73] vs 0.07 [IQR, −0.20 to 0.80]; P = .197). The change in Asthma Control Questionnaire was clinically important in subpopulations with poor control at baseline (P = .03). Furthermore, the exacerbation rate (exacerbations/patient/y) was reduced by almost 50% in the FENO-guided group (0.22 [CI, 0.14-0.34] vs 0.41 [CI, 0.29-0.58]; P = .024). Mean overall inhaled corticosteroid use was similar in both groups (P = .95).ConclusionUse of FENO to guide anti-inflammatory treatment within primary care significantly reduced the exacerbation rate and improved asthma symptom control without increasing overall inhaled corticosteroid use.
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| 3. |
- Syk, Jörgen
(författare)
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Treatment of atopic asthma in primary health care guided by exhaled nitric oxide measurement
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aims of this thesis were to increase knowledge about how patients with asthma rate their health and investigate if we can improve asthma management, with focus on asthma as a chronic inflammatory disease, by use of measurement of the fraction of exhaled nitric oxide (FENO) in monitoring of asthma in primary health care. Methods: Study I included data from a public health questionnaire, which was sent to 8,200 persons (age > 18 years) randomly selected from the population register in Stockholm County. After two reminders, 5,355 persons had responded (67.5 %). Study II was a longitudinal, non-controlled study. Twenty patients with physician-diagnosed atopic asthma and perennial asthma symptoms (age 18 - 50 years) were consecutively recruited from Runby primary health care centre and examined four times during eight weeks (baseline, 2, 4 and 8 weeks). Data for study III and IV were collected in a randomised, controlled study, conducted at 17 primary health care centres in the middle and south of Sweden. A total of 187 non-smoking participants with physician-diagnosed asthma, verified perennial allergy and ongoing inhaled corticosteroid (ICS) treatment (age 18 – 64 years) were randomised to FENO-guided treatment or usual care and were followed up for five visits during one year. Results: Respondents with asthma in study I had approximately three times higher odds of fair/poor self-rated health (SRH) than those in the corresponding sex and age groups who did not have asthma, excepting younger women (18 – 44 years). SRH was associated at least as strong as quality of life to asthma. Study II showed a significant correlation between FENO and IgE-antibody levels against perennial allergens at baseline (r = 0.47, p = 0.04), which disappeared after a step-up in ICS treatment. Nine patients had persistently elevated FENO at last visit (mean 35 ppb vs. 16 ppb). This group was more frequently exposed to relevant allergens or colds (89 % vs. 27 %, p < 0.05) and had higher perennial IgE levels compared with the normalised group (mean 28.9 vs. 10.7 kU/l, p < 0.05). Results from study III showed that total and specific IgE levels decreased 10 – 36 % (p < 0.05 all, except for mugwort) over one year. The changes were not related to any change in allergen exposure, and specific IgG4 levels remained unaltered. The decrease in IgE against perennial allergens related to mean ICS dose (p = 0.030), ii months on leukotriene-receptor antagonist (LTRA) (p = 0.013) and change in FENO (p = 0.003), and interestingly also to change in the Asthma Control Questionnaire (ACQ) score (p = 0.012) and Mini-Asthma Quality of Life Questionnaire (mAQLQ) score (p = 0.009), as well as change in SRH rating (p = 0.041). In study IV, the change in mAQLQ score over one year (primary endpoint) did not differ between the groups (p = 0.197), whereas the mAQLQ symptom domain score (p = 0.041) and the ACQ score (p = 0.045) both improved significantly more in the FENO-guided group. Furthermore, the moderate exacerbation rate was reduced by almost 50 % in the FENO-guided group (p = 0.024). Mean overall ICS use was similar in the two groups (p = 0.95). Conclusions: In Sweden, men > 18 years and women > 45 years with asthma score SRH worse compared with people in corresponding sex and age groups without asthma, which indicates that there is a need to improve asthma management. Exposure to relevant allergens, and type and degree of sensitisa-tion, are important factors to consider when assessing the FENO value. Optimised anti-inflammatory treatment with ICS and LTRA in asthma patients with ongoing treatment at baseline resulted in reduced total and specific IgE levels which were unrelated to the degree of allergen exposure. Using FENO to guide anti-inflammatory treatment within primary care significantly improved asthma symptom control and reduced exacerbation rate in adults with atopic asthma without increasing overall ICS use. FENO-guided anti-inflammatory treatment appears useful to improve the management of patients with atopic asthma.
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