| 1. |
- Aho Fält, Ursula, et al.
(author)
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Long-term outcome of the Surgisis® (Biodesign®) anal fistula plug for complex cryptoglandular and Crohn’s fistulas
- 2021
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In: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 23:1, s. 178-185
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Journal article (peer-reviewed)abstract
- Aim: To evaluate the long-term success rate of treatment with the Surgisis® (Biodesign®) anal fistula plug for complex anal fistulas, assess fistula plug failure over time and compare success rates for fistula plug between a group of patients with cryptoglandular fistula and another group with Crohn's fistula. Method: This is a single-centre study of consecutive patients treated with the Surgisis® (Biodesign®) anal fistula plug between May 2006 and October 2009. All patients had complex anal fistulas in need of surgical treatment. The patients were assessed preoperatively by physical examination and three-dimensional (3D) endoanal ultrasound, and treated with a loose seton. Postoperative assessment by clinical examination and 3D endoanal ultrasound was performed at 2 weeks, 3 months and 6–12 months. Long-term follow-up was carried out in 2017 using a questionnaire, and clinical examination combined with 3D endoanal ultrasound was performed if the questionnaire indicated any signs of fistula recurrence. Results: A total of 95 patients were included; 30 had quiescent Crohn's disease. Overall, 151 plug procedures were performed. Long-term follow-up was undertaken in 90 (95%) patients; the results showed that after a median period of 110 months, the overall healing rate after one to five plug procedures was 38%. No statistically significant difference in success rate was found between the cryptoglandular fistula group and the Crohn's fistula group (P = 0.37). No further healing was observed after the use of three plugs. Conclusion: Considering its low morbidity in a complex disease with high recurrence rates over time, the anal fistula plug may still be considered as one of the first-line treatments for patients with complex anal fistulas.
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| 2. |
- Aho Fält, Ursula, et al.
(author)
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Percutaneous tibial nerve stimulation - PTNS: an alternative treatment option for chronic therapy resistant anal fissure
- 2019
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In: Techniques in Coloproctology. - : Springer Science and Business Media LLC. - 1123-6337 .- 1128-045X. ; 23:4, s. 361-365
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Journal article (peer-reviewed)abstract
- BackgroundThe aim of the present study was to evaluate percutaneous tibial nerve stimulation (PTNS) for treatment resistant chronic anal fissure.MethodsConsecutive patients with chronic anal fissure were treated with neuromodulation via the posterior tibial nerve between October 2013 and January 2014. Patients had PTNS for 30 min on 10 consecutive days. All patients had failed conventional medical treatment. The visual analogue scale (VAS) score, St. Marks score, Wexner’s constipation score, Brief Pain Inventory (BPI-SF), bleeding and mucosal healing were evaluated before treatment, at termination, after 3 months, and then yearly for 3 years.ResultsTen patients (4 males and 6 females; mean age 49.8 years) were identified but only 9 were evaluated as one patient’s fissure healed before PTNS was started. At 3-year follow-up, fissures had remained completely healed in 5 out of 9 patients. All patients stopped bleeding and were almost completely pain-free at 3 years (VAS p = 0.010) and pain relief improved from 50% at completion to 90% at 3 years. The patients’ Wexner constipation scores improved significantly (p = 0.007).ConclusionsIn this small series, PTNS enhanced healing of chronic anal fissure and reduced pain and bleeding with an associated improvement in bowel function.
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| 3. |
- Aho Fält, Ursula, et al.
(author)
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Postoperative three-dimensional endoanal ultrasound findings and relation to anal fistula plug failure
- 2023
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In: Scandinavian Journal of Gastroenterology. - 1502-7708. ; 58:10, s. 1200-1206
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Journal article (peer-reviewed)abstract
- ObjectivesTo explore the utilization of three-dimensional (3D) endoanal ultrasound (EAUS) for the follow-up of the anal fistula plug (AFP), describe morphological findings in postoperative 3D EAUS, and evaluate if postoperative 3D EAUS combined with clinical symptoms can predict AFP failure.Materials and methodsA retrospective analysis of 3D EAUS examinations performed during a single-centre study of prospectively included consecutive patients treated with the AFP between May 2006 and October 2009. Postoperative assessment by clinical examination and 3D EAUS was performed at 2 weeks, 3 months and 6–12 months (“late control”). Long-term follow-up was carried out in 2017. The 3D EAUS examinations were blinded and analysed by two observers using a protocol with defined relevant findings for different follow-up time points.ResultsA total of 95 patients with a total of 151 AFP procedures were included. Long-term follow-up was completed in 90 (95%) patients. Inflammation at 3 months, gas in fistula and visible fistula at 3 months and at late control, were statistically significant 3D EAUS findings for AFP failure. The combination of gas in fistula and clinical finding of fluid discharge through the external fistula opening 3 months postoperatively was statistically significant (p
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| 6. |
- Andersson, Bodil, et al.
(author)
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Gemcitabine Treatment in Pancreatic Cancer – Prognostic Factors and Outcome.
- 2007
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In: Annals of Gastroenterology. - 1108-7471. ; 20:2, s. 130-137
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Journal article (peer-reviewed)abstract
- Background: Pancreatic cancer is generally associated with a poor prognosis and often diagnosed in an advanced stage. The aim of the present study was to evaluate gemcitabine treatment concerning prognostic factors, clinical benefit, tolerance/ toxicity and survival. Methods: Patients with surgically nonresectable, locally advanced or metastatic pancreatic cancer treated with gemcitabine were included. Different parameters, including clinical benefit, toxicity (WHO΄s criteria) and survival were registered. Kaplan-Meier and Cox regression analysis were performed. Results: Forty-two consecutive patients were included. Median age was 62.5 years, 42% were men. Gemcitabine treatment lasted in median for 5 months (0.5-29 months). Median survival from diagnosis was 9.4 months and from start of treatment 8.1 months. Thirteen patients (32%) were alive 12 months after treatment start. The treatment was overall well tolerated concerning toxicity. Seven patients had transient grade 4 reactions. Of 8 parameters selected from the univariate analysis, 3 were identified as independent predictors for longer survival: age >60 years, ≤5 % weight loss at diagnosis and absence of metastases. Conclusions: Gemcitabine treatment in locally advanced and metastatic pancreatic cancer showed to be of potential benefit and well tolerated. Age, weight loss and metastases were independent prognostic factors for survival. The median survival time was longer than previously reported. Keywords: pancreatic cancer; locally advanced; gemcitabine; treatment outcome; prognostic factors
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| 7. |
- Andersson, Roland, et al.
(author)
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Gemcitabine chemoresistance in pancreatic cancer: Molecular mechanisms and potential solutions.
- 2009
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In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 44, s. 782-786
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Journal article (peer-reviewed)abstract
- Ductal pancreatic adenocarcinoma is associated with a very poor prognosis and most patients are given palliative care. Chemotherapy in the form of gemcitabine has been found to reduce disease-related pain, and the otherwise frequently occurring weight changes, to increase Karnofsky performance status and quality of life and has also resulted in a modest improvement in survival time. The intracellular uptake of gemcitabine is dependent on nucleoside transporters, predominantly human equilibrative nucleoside transporter-1 (hENT-1), which is over-expressed in human pancreatic adenocarcinoma cells. Cellular resistance to gemcitabine can be intrinsic or acquired during gemcitabine treatment. One of the mechanisms is a decrease in hENT-1 expression. Modifications of gemcitabine not rendering it dependent on the nucleoside transporter may be a successful future mode of chemotherapy treatment, and determination of the nucleoside receptor status at the time of diagnosis could potentially also contribute to a more targeted therapy in the future.
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| 8. |
- Bartosch-Härlid, Anna, et al.
(author)
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Artificial neural networks in pancreatic disease.
- 2008
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 95:7, s. 817-826
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Journal article (peer-reviewed)abstract
- BACKGROUND: An artificial neural network (ANNs) is a non-linear pattern recognition technique that is rapidly gaining in popularity in medical decision-making. This study investigated the use of ANNs for diagnostic and prognostic purposes in pancreatic disease, especially acute pancreatitis and pancreatic cancer. METHODS: PubMed was searched for articles on the use of ANNs in pancreatic diseases using the MeSH terms 'neural networks (computer)', 'pancreatic neoplasms', 'pancreatitis' and 'pancreatic diseases'. A systematic review of the articles was performed. RESULTS: Eleven articles were identified, published between 1993 and 2007. The situations that lend themselves best to analysis by ANNs are complex multifactorial relationships, medical decisions when a second opinion is needed and when automated interpretation is required, for example in a situation of an inadequate number of experts. CONCLUSION: Conventional linear models have limitations in terms of diagnosis and prediction of outcome in acute pancreatitis and pancreatic cancer. Management of these disorders can be improved by applying ANNs to existing clinical parameters and newly established gene expression profiles.
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| 9. |
- Bartosch-Härlid, Anna, et al.
(author)
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Artificiella neurala nätverk underlättar svåra medicinska beslut. Exempel från pankreatologin.
- 2009
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In: Läkartidningen. - 0023-7205. ; 106:39, s. 2446-2448
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Journal article (peer-reviewed)abstract
- Artificial neural networks (ANNs) is a nonlinear pattern recognition technique inspired by the function of the human brain. ANNs have been used successfully in analysis of complex medical relationships, for example prognostic predictions of various forms of cancer. Acute pancreatitis and pancreatic cancer are commonly recognized to be extremely difficult conditions in making diagnostic and prognostic predictions with traditional methods. The two pancreatic disorders thus represent suitable candidates for analysis by ANNs. We hereby present a systematic review of the applications of ANNs in the treatment of acute pancreatitis and pancreatic cancer.
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| 10. |
- Lankinen, Maria A., et al.
(author)
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Dietary carbohydrate modification alters serum metabolic profiles in individuals with the metabolic syndrome
- 2010
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In: NMCD. Nutrition Metabolism and Cardiovascular Diseases. - : Elsevier. - 0939-4753 .- 1590-3729. ; 20:4, s. 249-57
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIMS: Whole-grain cereals and diets with a low glycemic index may protect against the development of type 2 diabetes and heart disease, but the mechanisms are poorly understood. We studied the effect of carbohydrate modification on serum metabolic profiles, including lipids and branched chain amino acids, and dependencies between these and specific gene expression pathways in adipose tissue.METHODS AND RESULTS: Twenty subjects with metabolic syndrome were selected from the larger FUNGENUT study population, randomized either to a diet high in oat and wheat bread and potato (OWP) or rye bread and pasta (RP). Serum metabolomics analyses were performed using ultra-performance liquid chromatography coupled to electrospray ionization mass spectrometry (UPLC/MS), gas chromatography (GC) and UPLC. In the OWP group multiple proinflammatory lysophosphatidylcholines increased, while in the RP group docosahexaenoic acid (DHA 22:6n-3) increased and isoleucine decreased. mRNA expression of stress reactions- and adipose tissue differentiation-related genes were up-regulated in adipose tissue in the OWP group. In the RP group, however, pathways related to stress reactions and insulin signaling and energy metabolism were down-regulated. The lipid profiles had the strongest association with the changes in the adipose tissue differentiation pathway when using the elastic net regression model of the lipidomic profiles on selected pathways.CONCLUSION: Our results suggest that the dietary carbohydrate modification alters the serum metabolic profile, especially in lysoPC species, and may, thus, contribute to proinflammatory processes which in turn promote adverse changes in insulin and glucose metabolism.
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