| 1. |
- Winsnes, Annika, et al.
(författare)
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Full-thickness skin grafts to reinforce the abdominal wall: a cross-sectional histological study comparing intra- and extraperitoneal onlay positions in mice
- 2022
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Ingår i: Journal of wound care. - : Mark Allen Group. - 0969-0700 .- 2052-2916. ; 31:1, s. 48-55
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: In the repair of complex abdominal wall hernia, there can be a strong preference to avoid synthetic or biological implants as reinforcement material. Autologous full-thickness skin grafts (FTSG) have shown promising results. However, there are few clinical data on the use of FTSG in an intraperitoneal position and rudimentary knowledge about postoperative histological appearance of tissue remodelling and repair. OBJECTIVE: To investigate the histological appearance of FTSG in the intraperitoneal onlay mesh (IPOM) position. METHODS: Isogeneic FTSG was positioned in the IPOM (10 mice) and the onlay position (10 mice). After eight weeks, tissues were harvested for histological analysis. Tissue structure, inflammation and cell survival were investigated with histological and immunohistochemical staining. RESULTS: Morphology was similar in both positions. Luciferase staining indicated both onlay and IPOM graft cell survival, with microvascular networks present. In both positions, FTSG showed ongoing tissue remodelling processes and cystic formations containing hair and epidermis. Low-grade acute phase and chronic inflammation were present. Integration was observed in 50% of the mice with similar appearances in IPOM and onlay grafts. CONCLUSION: FTSG is tolerated, with comparable results either inside or outside the abdominal cavity, and in line with historic histological evaluations. The results suggest further research on FTSG as a potential future reinforcement material in selected cases of complex abdominal wall hernia repair.
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| 2. |
- Falk, Peter, 1962, et al.
(författare)
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An ex vivo model using human peritoneum to explore mesh-tissue integration.
- 2017
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Ingår i: Biology open. - : The Company of Biologists. - 2046-6390. ; 6:9, s. 1391-1395
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Tidskriftsartikel (refereegranskat)abstract
- Biological compatibility, in terms of implantation of foreign mesh material in hernia surgery, still needs experimental investigation. Present study develops an experimental model using human peritoneum to study the integration between tissue and different mesh material. The ex vivo model using peritoneal tissue was studied with different mesh material, and integration was monitored over time using microscopy.It could be demonstrated that the peritoneal model may be kept viable in culture for several weeks. Cell migration was seen after 7-10 days in culture and could be further monitored over several weeks. The use of a human artificial model environment enabling the investigation of tissue/mesh integration has, to our knowledge, not been described previously.This proof-of-concept model was developed, for the investigation of peritoneal biology and the integration between tissue and different mesh material. It has the potential to be useful in studies on other important biological mechanisms involving the peritoneum.
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| 3. |
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| 4. |
- Strigård, Karin, 1958-, et al.
(författare)
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The Easy-X magnetic stoma connector system. A future concept for stomal dressing?
- 2013
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 28:3, s. 371-374
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Tidskriftsartikel (refereegranskat)abstract
- A considerable proportion of stoma patients are disabled for various reasons and are elderly. To be able to dress their stoma themselves is of crucial importance for their integrity and social life. This study evaluates a novel stomal dressing system based on a magnetic connector-the Easy-X system. Twenty patients (8 women, mean age of 40-89 years) with a well-functioning colostomy tested the Easy-X system for 6 weeks. The system was judged by the patients using a multiple choice scale, and by the stoma nurses using a 10-grade VAS. Eighteen of 20 patients completed the trial. Ten patients rated the Easy-X as better than their ordinary system, 3 as equal to and 4 deemed it inferior. Despite this, only three were prepared to change to the Easy-X system. Eleven of 18 patients experienced discomfort with the new adhesive plate. Three patients suffered leakage less often and five patients more often than with their ordinary system. Stoma nurse ratings were available for 14 patients. Their evaluation of the magnetic connector in the Easy-X system was positive in eight cases, neutral in one case and negative in three cases. Global impression ratings were 3 positive, 3 negative and 5 neutral. The Easy-X system showed potential advantages over conventional stomal dressing systems, but the system must be improved in terms of a varied assortment of dressing products enabling individual fitting before a larger trial can be carried out on disabled patients. Furthermore, the increased use of metal has to be handled with an ecologic recycling system. A new stomal dressing system with a magnetic connector has potential advantages over conventional stomal dressings for disabled persons.
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| 5. |
- Wennerlund, Jeff, et al.
(författare)
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Acid-related complications after laparoscopic Roux-en-Y gastric bypass : risk factors and impact of proton pump inhibitors
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 16:5, s. 620-625
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Tidskriftsartikel (refereegranskat)abstract
- Background: Laparoscopic Roux-en-Y (LRYGB) gastric bypass is an effective treatment for morbid obesity. Acid-related complications after LRYGB could be prevented by prophylactic proton pump inhibition (PPI).Objective: To identify the effect of PPI prophylaxis on short-term, acid-related complications in a large cohort.Setting: National Registry, Sweden.Methods: A total of 37,301 patients who underwent LRYGB in Sweden from 2009 to 2014 were identified in the Scandinavian Obesity Surgery Registry. Patient-specific factors were cross matched with socioeconomic variables and information on PPI dispensation. A logistic regression model was used to analyze acid-related complications (e.g., marginal ulcer, stricture, and perforation) within 30 days and at 1 year postoperatively.Results: PPI prophylaxis did not reduce the rate of acid-related complications. Instead, prolonged operation time (odds ratio [OR] 2.19 [1.53–3.13]) and immigrant background (OR 1.72 [1.17–2.53]) increased the risk of marginal ulcer within 30 days. At 1 year, medical treatment for diabetes (OR 1.75 [1.14–2.67]) and dyspepsia (OR 1.71 [1.06–2.75]), larger gastric pouch (OR 2.19 [1.528–3.248]), longer operation time (OR 1.67 [1.11–2.51]), smoking (OR 2.59 [1.77–3.78]), and immigrant background (OR 1.60 [1.08–2.36]) increased the risk for marginal ulcer, while older age (OR 2.20 [1.05–4.63]) predisposed for stricture. Inferior weight loss was associated with marginal ulcer at 1 year (OR 1.50 [1.04–2.15]).Conclusion: PPI prophylaxis did not reduce the risk for marginal ulcer and stricture. The risk for these complications was increased by several co-morbidities, smoking, immigrant background, and surgical factors. Routine use of PPI prophylaxis cannot be recommended, but smoking cessation and optimal surgery could be important.
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| 6. |
- Gkekas, Ioannis, 1981-, et al.
(författare)
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Colon cancer patients with mismatch repair deficiency are more likely to present as acute surgical cases
- 2021
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Ingår i: European Journal of Cancer. - : Elsevier. - 0959-8049 .- 1879-0852. ; 157, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: The effect of the genetic imprint on the emergency presentation of colon cancer remains unclear. The disparity between tumours evolving along different carcinogenetic pathways has not been studied systematically. This retrospective multicenter cohort study evaluates the association between mismatch repair status and the risk for acute surgery of colon cancer.Patients and methods: A retrospective multicenter cohort study including in total 870 patients from three different countries. Scandinavian cohort (Finland and Sweden), including a total of 412 patients operated between January 1, 1995 and December 31, 2010, was validated against a cohort from the Czech Republic, including a total of 458 patients, operated between January 1, 2018 and December 31, 2019. The proficiency or deficiency of mismatch repair was determined by immunohistochemistry. Primary outcome was the risk for acute colon cancer surgery given as the Odds Ratio (OR) in the univariable and multivariable analyses. Acute colon cancer surgery was defined as surgery performed during the same hospital admission as when the diagnosis of colon cancer was made.Results: Of the 870 patients (399 females [46%]) included in the analyses, median age at surgery was 69 [interquartile range, 61–76] years, deficient Mismatch Repair (dMMR) status was found in 190 patients (22%), and 179 patients (21%) underwent acute surgery during the same hospital admission as when the diagnosis of colon cancer was made. In the Scandinavian cohort, a significant association between dMMR status and acute surgery was seen in both the univariable (OR 1.82, 95% CI 1.11–3.02, P = 0.017) and the multivariable (OR = 2.21, 95% CI 1.28–3.95, P = 0.005) analyses. This was confirmed in the Czech validation cohort in both the univariable (OR = 1.94, 95% CI 1.09–3.26, P = 0.022) and the multivariable (OR = 1.77, 95% CI 1.15–3.18, P = 0.021) analyses.Conclusion: This multicenter study reveals a strong association between acute colon cancer surgery and dMMR tumour status.
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| 7. |
- Gkekas, Ioannis, 1981-, et al.
(författare)
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Sporadic deficient mismatch repair in colorectal cancer increases the risk for non-colorectal malignancy : a European multicenter cohort study
- 2024
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Ingår i: Journal of Surgical Oncology. - : John Wiley & Sons. - 0022-4790 .- 1096-9098.
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: Disparities between tumors arising via different sporadic carcinogenetic pathways have not been studied systematically. This retrospective multicenter cohort study evaluated the differences in the risk for non-colorectal malignancy between sporadic colorectal cancer (CRC) patients from different DNA mismatch repair status.Methods: A retrospective European multicenter cohort study including in total of 1706 CRC patients treated between 1996 and 2019 in three different countries. The proficiency (pMMR) or deficiency (dMMR) of mismatch repair was determined by immunohistochemistry. Cases were analyzed for tumor BRAFV600E mutation, and BRAF mutated tumors were further analyzed for hypermethylation status in the promoter region of MLH1 to distinguish between sporadic and hereditary cases. Swedish and Finish patients were matched with their respective National Cancer Registries. For the Czech cohort, thorough scrutiny of medical files was performed to identify any non-colorectal malignancy within 20 years before or after the diagnosis of CRC. Poisson regression analysis was performed to identify the incidence rates of non-colorectal malignancies. For validation purposes, standardized incidence ratios were calculated for the Swedish cases adjusted for age, year, and sex.Results: Of the 1706 CRC patients included in the analysis, 819 were female [48%], median age at surgery was 67 years [interquartile range: 60–75], and sporadic dMMR was found in 188 patients (11%). Patients with sporadic dMMR CRC had a higher incidence rate ratio (IRR) for non-colorectal malignancy before and after diagnosis compared to patients with a pMMR tumor, in both uni- (IRR = 2.49, 95% confidence interval [CI] = 1.89–3.31, p = 0.003) and multivariable analysis (IRR = 2.24, 95% CI = 1.67–3.01, p = 0.004). This association applied whether or not the non-colorectal tumor developed before or after the diagnosis of CRC in both uni- (IRR = 1.91, 95% CI = 1.28–2.98, p = 0.004), (IRR = 2.45, 95% CI = 1.72–3.49, p = 0.004) and multivariable analysis (IRR = 1.67,95% CI = 1.05–2.65, p = 0.029), (IRR = 2.35, 95% CI = 1.63–3.42, p = 0.005), respectively.Conclusion: In this retrospective European multicenter cohort study, patients with sporadic dMMR CRC had a higher risk for non-colorectal malignancy than those with pMMR CRC. These findings indicate the need for further studies to establish the need for and design of surveillance strategies for patients with dMMR CRC.
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| 8. |
- Adamo, Karin, et al.
(författare)
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Prevalence and recurrence rate of perianal abscess -a population-based study, Sweden 1997-2009
- 2016
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 31:3, s. 669-673
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The aim of this study was to assess the impact of diabetes mellitus, Crohn's disease, HIV/aids, and obesity on the prevalence and readmission rate of perianal abscess.METHODS: The study cohort was based on the Swedish National Patient Register and included all patients treated for perianal abscess in Sweden 1997-2009. The prevalence and risk for readmission were assessed in association with four comorbidity diagnoses: diabetes mellitus, Crohn's disease, HIV, and/or AIDS and obesity.RESULTS: A total of 18,877 patients were admitted during the study period including 11,138 men and 4557 women (2.4:1). Crohn's disease, diabetes, and obesity were associated with a significantly higher prevalence of perianal abscess than an age- and gender-matched background population (p < 0.05). In univariate analysis, neither age nor gender had any significant impact on the risk for readmission. In a multivariate Cox proportional hazard analysis, Crohns disease was the only significant risk factor for readmission of perianal abscess.CONCLUSION: Crohn's disease, diabetes, and obesity increase the risk for perianal abscess. Of these, Crohn's and HIV has an impact on readmission. The pathogenesis and the influence of diabetes and obesity need further research if we are to understand why these diseases increase the risk for perianal abscess but not its recurrence.
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| 9. |
- Berglund, Britta, et al.
(författare)
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TENS kan lindra illamående efter kolorektal kirurgi : Men placeboeffekten är betydande
- 2011
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Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 108:3, s. 90-91
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to study if postoperative nausea after colorectal surgery could be reduced with patient-active TENS-treatment. Twenty patients with malign diagnosis, ten in a treatment group and ten in a control group, tested TENS the first two postoperative days. The patients made notes about how they used TENS and if their nausea was reduced. Nausea was diminished in both groups, which as well may indicate a placebo effect. Post-operative nausea interferes with mobilization, nutrition and rehabilitation. Since TENS is easy to use and cost-effective it is a valuable method for treatment that can be offered to patients and increase their satisfaction with care. A larger randomized study should be of value.
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| 10. |
- Blind, Niillas, et al.
(författare)
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Distance to hospital is not a risk factor for emergency colon cancer surgery.
- 2018
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 33:9, s. 1195-1200
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study is to see if the distance to a hospital performing colon cancer surgery is a risk factor for emergency surgical intervention and to determine the variability between defined but demographically divergent catchment areas.Methods: Data on patients living in Västerbotten County who underwent colon cancer surgery between 2007 and 2010 were extracted from the Swedish Colorectal Cancer Register (SCRCR). Of the 436 registrations matching these criteria, 380 patients were used in the analysis, and their distance to the nearest hospital providing care for colorectal cancer (CRC) was estimated using Google Maps™. The correlations between the risk for emergency surgery and the distance to a hospital, gender, age, income level and hospital catchment area were analysed in uni- and multivariate models.Results: Distance to the nearest hospital had no significant effect on the proportion of emergency operations for colon cancer. There was significant variability in risk for emergency surgery between hospital catchment areas, where the catchment areas of the university hospital and the most rural hospital had a higher proportion than the other local hospital catchment area (OR, 2.00 (p = 0.038) and OR, 2.97 (p = 0.005)). These results were still significant when analysed with multivariate logistic regression (OR, 2.13 (p = 0.026) and OR, 3.05 (p = 0.013)).Conclusion: Distance to a hospital performing colon cancer surgery had no effect on the proportion of emergency surgeries. However, a variability between defined catchment areas was seen. Future studies will focus on possible factors behind this variability.
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