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- Hedenström, Per, et al.
(author)
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Endoscopic treatment of Crohn-related strictures with a self-expandable stent compared with balloon dilation: a prospective, randomised, controlled study
- 2021
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In: Bmj Open Gastroenterology. - : BMJ. - 2054-4774. ; 8:1
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Journal article (peer-reviewed)abstract
- Objective Fibrotic strictures in the gastrointestinal tract are frequent in Crohn's disease. Endoscopic dilation is a standard treatment. However, recurrence is common after dilation and there are complications such as bleeding or perforation. Endoscopic treatment using self-expandable metal stents has shown diverging results. The aim of this study was to evaluate the outcome of endoscopic treatment with a self-expandable stent in ileocecal Crohn's disease. Design/method Patients with Crohn's disease and a symptomatic ileocecal stricture were eligible for prospective, consecutive inclusion in a single-centre setting. Patients were randomised to treatment with either 18 mm balloon dilatation (Group(DIL)) or stenting (Group(STENT)) using a 20 mm diameter, partially covered Hanarostent NCN. Patients were followed for a minimum of 24 months postendoscopy. Outcomes were technical success, adverse events and clinical success (defined as no need for repeated interventions). Results Thirteen patients (Group(DIL) n=6; Group(STENT)=7) were included with twelve patients (Group(DIL) n=5; Group(STENT)=7) being eligible for complete follow-up. Technical success was achieved in all cases. Adverse events were border-line significantly more common in the Group(STENT): 4/7 (57%) (pain: n=3; pain and rectal bleeding: n=1) compared with the Group(DIL): 0/5 (0%), p=0.08, which resulted in preterm termination of the study. The clinical success rate was Group(STENT): 6/7 (86%) vs Group(DIL): 1/5 (20%), p=0.07. Conclusion Patients with strictures related to Crohn's disease may benefit from treatment with self-expandable metal stents rather than dilatation. However, there seems to be an increased risk for patient pain after stenting, which has to be considered and handled.
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| 4. |
- Al-Dury, Samer, et al.
(author)
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Appendicitis: a rare adverse event in colonoscopy.
- 2021
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In: BMJ case reports. - : BMJ. - 1757-790X. ; 14
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Journal article (peer-reviewed)abstract
- We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.
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| 5. |
- Al-Dury, Samer, et al.
(author)
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Propranolol-induced hallucinations mimicking encephalopathy in a patient with liver cirrhosis
- 2021
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In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 56:7, s. 829-831
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Journal article (peer-reviewed)abstract
- Hepatic encephalopathy (HE) is a frequent complication of liver cirrhosis, which is mostly characterized by psychomotor slowing. However, psychotic symptoms such as visual and olfactory hallucinations may sometimes also be present. In contrast, auditory hallucinations are uncommon in chronic liver disease. In this case report, we present a patient with liver cirrhosis due to excessive alcohol consumption who presented to the emergency department with disorientation and signs of infection. Initial assessment led to the diagnosis acute on chronic liver failure exacerbated by infection leading to encephalopathy. The patient was admitted and successfully treated with antibiotics, Lactulose and Rifaximin. Gastroscopy showed varices without bleeding stigmata and Propranolol 20 mg was initiated as primary prophylaxis. Upon follow-up, the patient was clinically stable but had developed visual and auditory hallucinations which raised the suspicion that HE was not the cause. CT scan of the brain was unremarkable and the hallucinations were considered to be caused by Propranolol and disappeared shortly after switching to Carvedilol.
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| 6. |
- Andersson, K., et al.
(author)
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High-accuracy sampling of saproxylic diversity indicators at regional scales with pheromones : The case of Elater ferrugineus (Coleoptera, Elateridae)
- 2014
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In: Biological Conservation. - : Elsevier BV. - 0006-3207 .- 1873-2917. ; 171, s. 156-166
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Journal article (peer-reviewed)abstract
- The rare beetle Elater ferrugineus was sampled at 47 sites in the county of Östergötland, Sweden by means of pheromone-baited traps to assess its value as an indicator species for hollow oak stands rich in rare saproxylic beetle species. In addition, Osmoderma eremita was also sampled with pheromone baits. These data were then compared against species survey data collected at the same sites by pitfall and window traps. Both species co-occur with many Red Listed saproxylic beetles, with E. ferrugineus being a somewhat better indicator for the rarest species. The conservation value of a site (measured as Red List points or number of Red Listed species) increased with the number of specimens of E. ferrugineus and O. eremita caught. Accuracy of sampling by means of pheromone trapping turned out to be radically different for the two model species. E. ferrugineus traps put out during July obtained full accuracy after only 6. days, whereas O. eremita traps needed to be out from early July to mid-August in order to obtain full accuracy with one trap per site. By using E. ferrugineus, or preferably both species, as indicator species, accuracy would increase and costs decrease for saproxylic biodiversity sampling, monitoring and identification of hotspots. © 2014 Elsevier Ltd.
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| 7. |
- Appelstrand, Alexander, et al.
(author)
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Endoscopic ultrasound-guided side-fenestrated needle biopsy sampling is sensitive for pancreatic neuroendocrine tumors but inadequate for tumor grading: a prospective study.
- 2022
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In: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12
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Journal article (peer-reviewed)abstract
- Accurate pretreatment grading of pancreatic neuroendocrine tumors (PanNETs) is important to guide patient management. We aimed to evaluate endoscopic ultrasound-guided fine needle biopsy sampling (EUS-FNB) for the preoperative diagnosis and grading of PanNETs. In a tertiary-center setting, patients with suspected PanNETs were prospectively subjected to 22-gauge, reverse-bevel EUS-FNB. The EUS-FNB samples (Ki-67EUS) and corresponding surgical specimens (Ki-67SURG) were analyzed with Ki-67 indexing and thereafter tumor grading, (GRADEEUS) and (GRADESURG) respectively. In total 52 PanNET-patients [median age: 66years; females: 25/52; surgical resection 22/52 (42%)] were included. EUS-FNB was diagnostic in 44/52 (85%). In 42 available FNB-slides, the median neoplastic cell count was 1034 (IQR: 504-3667) with 32/42 (76%), 22/42 (52%), and 14/42 (33%) cases exceeding 500, 1000, and 2000 neoplastic cells respectively. Ki-67SURG was significantly higher compared to Ki-67EUS with a moderate correlation comparing Ki-67EUS and Ki-67SURG (Pearson r=0.60, r2=0.36, p=0.011). The GRADEEUS had a weak level of agreement (κ=0.08) compared with GRADESURG. Only 2/12 (17%) G2-tumors were correctly graded in EUS-FNB-samples. EUS-guided fine needle biopsy sampling is sensitive for preoperative diagnosis of PanNET but biopsy quality is relatively poor. Therefore, the approach seems suboptimal for pretreatment grading of PanNET.
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| 9. |
- Berglund, Per, et al.
(author)
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Enantiorecognition of Chiral Acids by Candida rugosa Lipase : Two Substrate Binding Modes Evidenced in an Organic Medium
- 2001
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In: Applied Biocatalysis in Speciality Chemicals and Pharmaceuticals. - : American Chemical Society (ACS). - 0841236798 ; 776, s. 263-273
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Conference paper (peer-reviewed)abstract
- We have identified the existence of different modes of binding the enantiomers of 2-methyl-branched carboxylic acids to a lipase active site by rational substrate engineering. Similar to hydrolysis, previously investigated, we have now evidence for differential binding modes in the Candida rugosa lipase-catalyzed esterifications in cyclohexane. The relevance of considering two different binding modes to understand lipase enantiorecognition is demonstrated by introducing bulky substituents on a chiral carboxylic acid which impose a different orientation of the substrate acyl chain in the active site of Candida rugosa lipase. With this substrate engineering approach based on molecular modeling it is thus possible to markedly alter the enantioselectivity of the lipase. Examples from hydrolysis and new results from esterifications in an organic solvent are presented and discussed.
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