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- Polesie, Sam, et al.
(author)
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Methotrexate Treatment and Risk for Cutaneous Malignant Melanoma - a Retrospective Comparative Registry-based Cohort Study.
- 2017
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In: The British journal of dermatology. - : Oxford University Press (OUP). - 1365-2133 .- 0007-0963. ; 176:6, s. 1492-1499
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Journal article (peer-reviewed)abstract
- Methotrexate (MTX) is frequently used as an immunosuppressive drug in inflammatory diseases. It is controversial and not thoroughly investigated whether MTX increases the risk of cutaneous malignant melanoma (CMM).The aim of the present study was to investigate whether MTX-exposure increases the risk for CMM.A retrospective cohort study was conducted using statistics from The National Board of Health and Welfare. All patients over 18 years in the time period August 2005 to December 2014 that were dispensed with MTX from Swedish pharmacies were registered (n=101,966). For every MTX-exposed patient, five age- and sex-matched patients who had been dispensed a random drug other than MTX, during the same time period were randomly selected (n=509,279). The lists were matched with the Swedish Cancer Registry.Overall a small but statistically significant (P < 0.001) risk increase for CMM was observed in MTX-exposed patients compared to patients without MTX-exposure. The Kaplan-Meier estimates for the 5-year risk of CMM was 0.48% (95% CI: 0.43% - 0.53%) in the MTX-exposed group and 0.41% (95% CI: 0.39% - 0.43%) in the MTX-unexposed group. However, in a subgroup analysis, the difference between the groups was only preserved in women older than 70 years at treatment start. Moreover, there was no significant difference in incidences between the MTX-exposed and MTX-unexposed patients in the time period.Our results suggest a small but significant increase in risk for CMM in patients treated with MTX. However, the risk increase observed was considerably lower than earlier observations. This article is protected by copyright. All rights reserved.
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- Sönnergren, Henrik H., et al.
(author)
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Aerosolized spread of bacteria and reduction of bacterial wound contamination with three different methods of surgical wound debridement: a pilot study.
- 2013
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In: The Journal of hospital infection. - : Elsevier BV. - 1532-2939 .- 0195-6701. ; 85:2, s. 112-7
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Journal article (peer-reviewed)abstract
- Background Debridement is essential in wound treatment to remove necrotic tissue and wound bacteria, but may lead to the transmission of bacteria by aerosolization. Aim To investigate bacterial transmission and wound bacterial reduction induced by debridement using a cold steel curette, plasma-mediated bipolar radiofrequency ablation (Coblation®) or hydrodebridement (Versajet®) using a wound model inoculated with Staphylococcus aureus. Methods A full-thickness dermal wound was created in fresh porcine joint specimens, inoculated with S. aureus and incubated at 37 °C for 24 h. The specimens were surgically debrided with a curette, Coblation or Versajet, or were left untreated. During and after each debridement, aerosolized bacteria were measured by active and passive sampling. To assess the bacterial load of the wound, three quantitative swabs and one cylinder scrub sample were taken from each wound at baseline, post incubation and post debridement. Findings Versajet debridement resulted in significant bacterial aerosolization, but this was not the case when using a curette or Coblation. Only Coblation was able to reduce the bacterial load of the wound significantly. Conclusion Extra protective means should be implemented when using Versajet debridement for infected and colonized wounds. The same precautions may be less essential when using a curette or Coblation.
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- Sönnergren, Henrik H., et al.
(author)
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Antimicrobial Effects of Plasma-mediated Bipolar Radiofrequency Ablation on Bacteria and Fungi Relevant for Wound Infection.
- 2012
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In: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555. ; 92:1, s. 29-33
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Journal article (peer-reviewed)abstract
- Infection constitutes an important part of wound pathology and impedes wound healing. Plasma-mediated bipolar radiofrequency ablation (Coblation®) is a tissue-removal technique suggested for use in wound treatment. The aims of this study were to determine the antimicrobial effect of ablation exposure on bacteria and fungi relevant to wound infection, and how exposure time, temperature and aerobic/anaerobic growth influence the effect. Suspensions of 10^6 colony-forming units/ml of Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Escherichia coli and Candida albicans were exposed to ablation or thermal control for 500, 1000 or 2000 ms, or left untreated, and incubated aerobically. E. coli was also incubated anaerobically. Ablation was significantly (p<0.0001) microbicidal on all strains compared with untreated and thermal control. The reductions compared with untreated control were 99.87-99.99% for all strains. In conclusion, plasma-mediated bipolar radio-frequency ablation has a general microbicidal effect in vitro on microbes relevant to wound infection independent of aerobic/anaerobic growth and thermal effect.
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- Sönnergren, Henrik H., et al.
(author)
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Bacteria Aerosol Spread and Wound Bacteria Reduction with Different Methods for Wound Debridement in an Animal Model.
- 2015
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In: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 95:3, s. 272-277
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Journal article (peer-reviewed)abstract
- Debridement is essential in wound treatment to remove necrotic tissue and wound bacteria but may lead to bacteria spread by aerosolization. This study investigated the wound bacterial reduction and bacterial transmission induced by debridement using curette, plasma-mediated bipolar radiofrequency ablation (Coblation®) or hydrodebridement (Versajet®). Full thickness dermal wounds in porcine joint specimens inoculated with S. aureus were debrided with curette, Coblation, Versajet, or were left untreated. During and after debridement, aerosolized bacteria were measured and to assess wound bacterial load, quantitative swab samples were taken from each wound. Only Coblation was able to reduce the bacterial load of the wound significantly. Versajet debridement resulted in a significant bacterial aerosolization, but this was not the case with Coblation and curette debridement. This study shows that Coblation is a promising wound debridement method, which effectively reduces the wound bed bacterial load without the risk of bacterial aerosolization.
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- Sönnergren, Henrik H.
(author)
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Electrosurgical plasma-mediated ablation for application in dermal wound and cartilage debridement - Biochemical, microbiological and clinical effects
- 2015
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Doctoral thesis (other academic/artistic)abstract
- The state of matter known as plasma has in the latest decades been investigated within different areas of medical treatment. The work presented in this thesis has focused on a specific type of plasma-based electrosurgical treatment modality (Coblation®) and its biochemical, microbiological and clinical effects on treatment of cartilage and of dermal wounds. Paper I investigated the biochemical effects of plasma ablation exposure of human articular chondrocytes in vitro. The plasma ablation induced a well-defined area of immediate cell death, an increased chondrocyte proliferation and up-regulation of cytokines IL-6 and IL-8. Paper II investigated the in vitro antimicrobial effect of plasma ablation on Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Escherichia coli and Candida albicans. The plasma ablation had a direct microbicidal effect on all strains compared to untreated control and a temperature control. Papers III and IV investigated the bacteria aerosol formation and wound bacteria reduction of debridement using curette, plasma ablation or hydrodebridement in an ex vivo porcine wound model inoculated with S. aureus. Plasma ablation significantly reduced the wound bacterial load, while curette and hydrodebridement resulted in minor or no reduction. Hydrodebridement gave a significant bacterial spread to the operative environment, while plasma ablation and curette debridement did not. Paper IV also used scanning electron microscopy to detect if there was a bacterial biofilm in the porcine wound model. Paper V investigated the effect of debridement using plasma ablation on ulcer healing, wound bacteria colonization, and complications to the treatment, in a clinical case series of 10 patients with venous ulcers. The procedure was fast and easy to perform and gave a clean wound bed. The wound area was significantly reduced with a mean of 44 % and 2 of 17 ulcers healed within 8 weeks. The wound bacterial load was reduced by treatment with 1.5 log CFU/ml. In conclusion, plasma ablation has a direct biochemical effect on chondrocytes indicating an onset of a tissue regeneration response. Plasma ablation can clinically be used for debridement of small ulcers in local anaesthesia. The bactericidal effect seen in vitro and ex vivo was confirmed clinically, which could be of value for the wound healing process. Further clinical studies should evaluate the plasma ablation method for use in other areas, such as in wound debridement prior to skin transplantation, diabetic foot ulcers, and burns.
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