SwePub - search: WFRF:(Andersson Roland)

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1.	Andersson, Bodil, et al. (author) Fatal Acute Pancreatitis Occurring Outside of the Hospital: Clinical and Social Characteristics. 2010 In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; Jul 1, s. 2286-2291 Journal article (peer-reviewed)abstract BACKGROUND: Mortality caused by acute pancreatitis in patients admitted to the hospital has been thoroughly investigated, but knowledge regarding outpatient fatalities is far from complete. The purpose of this study was to assess the incidence and clinical characteristics of patients who have died due to acute pancreatitis occurring outside the hospital. METHODS: Deaths caused by acute pancreatitis in the southern part of Sweden during 1994-2008 were identified at the Department of Forensic Medicine, Lund. A retrospective review of all cases was performed. RESULTS: A total of 50 patients were included, representing approximately 50 of 292 (17%) of all deaths due to acute pancreatitis in the region during this period of time. Median age was 54 (47-69) years and the majority-37 (74%)-were men. The main etiology was alcohol, seen in at least 35 (70%) patients. Twelve (24%) patients were obese. The duration of abdominal pain, in evaluable cases, was 3.0 (1.6-6.2) days. Profound signs of pancreatitis were seen in all patients; 35 (70%) had a necrotising disease according to histopathological examination. Pulmonary changes were common, e.g., bronchopneumonia, pleural effusion, or edema, and all but four had fatty liver. Massive intra-abdominal bleeding was seen in one patient. At least eight patients had a mental disorder, and three were homeless. CONCLUSIONS: Fatal acute pancreatitis occurring outside the hospital accounts for a substantial part of all deaths due to the disease. The incidence seems to decline, and no variation in season was seen. Alcohol was the predominant etiology. Many of the patients lived alone and in poor social conditions.
2.	Andersson, Roland, et al. (author) Acute pancreatitis - from cellular signalling to complicated clinical course. 2007 In: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 9:6, s. 414-420 Journal article (peer-reviewed)abstract Acute pancreatitis (AP) is a common disease that has a mild to moderate course in most cases. During the last decade, a change in diagnostic facilities as well as improved intensive care have influenced both morbidity and mortality in AP. Still, however, a number of controversies and unresolved questions remain regarding AP. These include prognostic factors and how these may be used to improve outcome, diagnostic possibilities, their indications and optimal timing, and the systemic inflammatory reaction (systemic inflammatory response syndrome - SIRS) and its effect on the concomitant course of the disease and potential development of organ failure. The role of the gut has been suggested to be important in severe AP, but has recently been somewhat questioned. Despite extensive research, pharmacological and medical intervention of proven clinical value is scarce. Various aspects on surgical interventions, including endoscopic sphincterotomy, cholecystectomy and necrosectomy, as regards indications and timing, will be reviewed. Last, but not least, are the management of late complications and long-term outcome for patients with especially severe AP.
3.	Andersson, Roland, et al. (author) Akut buk 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 102-102 Book chapter (other academic/artistic)
4.	Andersson, Roland, et al. (author) Appendicit 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 144-144 Book chapter (other academic/artistic)
5.	Andersson, Roland, et al. (author) Bråck 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 156-156 Book chapter (other academic/artistic)
6.	Andersson, Roland, et al. (author) Bukhålan - peritonit, abscess och ileus 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 107-107 Book chapter (other academic/artistic)
7.	Andersson, Roland, et al. (author) Gallvägssjukdomar 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 119-119 Book chapter (other academic/artistic)
8.	Andersson, Roland, et al. (author) Immunomodulation in surgical practise 2006 In: HPB. - : Elsevier BV. - 1477-2574 .- 1365-182X. ; 8:2, s. 116-123 Journal article (peer-reviewed)abstract Background. Immunomodulation may represent a potential way to improve surgical outcome. These types of interventions should be based on detailed knowledge of the underlying mechanisms involved. The aim of the present review is to summarize some experience on the acute phase response, potential ways of intervention and experiences from critical illness and HPB disease. Discussion. Mechanisms of the acute phase response are discussed including the individual parameters and local changes that take part. Mechanisms involved in failure of the gut barrier are presented and include changes in gut barrier permeability, effects on gut-associated immunocompetent cells, and systemic implications. As examples of HPB disease, mechanisms of the acute phase response and potential ways of intervention in obstructive jaundice and acute pancreatitis are discussed. Nutritional pharmacology and lessons learned from immunomodulation and immunonutrition in critical illness and major abdominal surgery, including upper GI and HPB surgery, are referred to. Overall, immunomodulation represents a potential tool to improve results but requires a thorough mapping of underlying mechanisms in order to achieve individualized treatment or prevention based on patients' specific needs.
9.	Andersson, Roland, et al. (author) Inflammation 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 29-29 Book chapter (other academic/artistic)
10.	Andersson, Roland, et al. (author) Interventionell radiologi 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 78-78 Book chapter (other academic/artistic)
11.	Andersson, Roland, et al. (author) Kirurgisk intensivvård 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 415-415 Book chapter (other academic/artistic)
12.	Andersson, Roland, et al. (author) Komplikationer hos kirurgiska patienter 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 408-408 Book chapter (other academic/artistic)
13.	Andersson, Roland, et al. (author) Pankreas 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 130-130 Book chapter (other academic/artistic)
14.	Andersson, Roland, et al. (author) Perioperativ vård 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 82-82 Book chapter (other academic/artistic)
15.	Andersson, Roland, et al. (author) Tunntarmssjukdomar 2004 In: Kirurgiska sjukdomar: patofysiologi, behandling, specifik omvårdnad. - 9144024185 ; , s. 139-139 Book chapter (other academic/artistic)
16.	Ansari, Daniel, et al. (author) Chronic pancreatitis: potential future interventions. 2010 In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 45:9, s. 1022-1028 Research review (peer-reviewed)abstract Chronic pancreatitis is a common disorder of which the underlying pathogenic mechanisms still are incompletely understood. In the last decade, increasing evidence has shown that activated pancreatic stellate cells play a key role in the fibrosis development associated with chronic pancreatitis as well as pancreatic cancer. During pancreatic injury or inflammation, quiescent stellate cells undergo a phenotypic transformation, characterized by smooth muscle alpha-actin expression and increased synthesis of extracellular matrix proteins. Hitherto, specific therapies to prevent or reverse pancreatic fibrosis are unavailable. This review addresses current insights into pathological mechanisms underlying chronic pancreatitis and their applicability as concerns the development of potential future therapeutic approaches.
17.	Abdalla, Maie, et al. (author) Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients 2020 In: Digestive Diseases and Sciences. - : Springer-Verlag New York. - 0163-2116 .- 1573-2568. ; , s. 250-259 Journal article (peer-reviewed)abstract BACKGROUND: With a lifelong perspective, 12% of ulcerative colitis patients will need a colectomy. Further reconstruction via ileo-rectal anastomosis or pouch can be affected by patients' perspective of their quality of life after surgery.AIM: To assess the function and quality of life after restorative procedures with either ileo-rectal anastomosis or ileal pouch-anal anastomosis in relation to the inflammatory activity on endoscopy and in biopsies.METHOD: A total of 143 UC patients operated with subtotal colectomy and ileo-rectal anastomosis or pouches between 1992 and 2006 at Linköping University Hospital were invited to participate. Those who completed the validated questionnaires (Öresland score, SF-36, Short Health Scale) were offered an endoscopic evaluation including multiple biopsies. Associations between anorectal function and quality of life with type of restorative procedure and severity of endoscopic and histopathologic grading of inflammation were evaluated.RESULTS: Some 77 (53.9%) eligible patients completed questionnaires, of these 68 (88.3%) underwent endoscopic evaluation after a median follow-up of 12.5 (range 3.5-19.4) years after restorative procedure. Patients with ileo-rectal anastomosis reported better overall Öresland score: median = 3 (IQR 2-5) for ileo-rectal anastomosis (n = 38) and 10 (IQR 5-15) for pouch patients (n = 39) (p < 0.001). Anorectal function (Öresland score) and endoscopic findings (Baron-Ginsberg score) were positively correlated in pouch patients (tau: 0.28, p = 0.006).CONCLUSION: Patients operated with ileo-rectal anastomosis reported better continence compared to pouches. Minor differences were noted regarding the quality of life. Ileo-rectal anastomosis is a valid option for properly selected ulcerative colitis patients if strict postoperative endoscopic surveillance is carried out.
18.	Abdalla, Maie, et al. (author) Risk of Rectal Cancer After Colectomy for Patients With Ulcerative Colitis: A National Cohort Study 2017 In: Clinical Gastroenterology and Hepatology. - : Elsevier. - 1542-3565 .- 1542-7714. ; 15:7, s. 1055-1060 Journal article (peer-reviewed)abstract BACKGROUND amp; AIMS: Patients with ulcerative colitis (UC) have an increased risk of rectal cancer, therefore reconstruction with an ileal pouch-anal anastomosis (IPAA) generally is preferred to an ileorectal anastomosis (IRA) after subtotal colectomy. Similarly, completion proctectomy is recommended for patients with ileostomy and a diverted rectum, although this approach has been questioned because anti-inflammatory agents might reduce cancer risk. We performed a national cohort study in Sweden to assess the risk of rectal cancer in patients with UC who have an IRA, IPAA, or diverted rectum after subtotal colectomy.METHODS: We collected data from the Swedish National Patient Register for a cohort of 5886 patients with UC who underwent subtotal colectomy with an IRA, IPAA, or diverted rectum from 1964 through 2010. Patients who developed rectal cancer were identified from the Swedish National Cancer Register. The risk of rectal cancer was compared between this cohort and the general population by standardized incidence ratio analysis.RESULTS: Rectal cancer occurred in 20 of 1112 patients (1.8%) who received IRA, 1 of 1796 patients (0.06%) who received an IPAA, and 25 of 4358 patients (0.6%) with a diverted rectum. Standardized incidence ratios for rectal cancer were 8.7 in patients with an IRA, 0.4 in patients with an IPAA, and 3.8 in patients with a diverted rectum. Risk factors for rectal cancer were primary sclerosing cholangitis in patients with an IRA (hazard ratio, 6.12), and colonic severe dysplasia or cancer before subtotal colectomy in patients with a diverted rectum (hazard ratio, 3.67).CONCLUSIONS: In an analysis of the Swedish National Patient Register, we found that the risk for rectal cancer after colectomy in patients with UC is low, in relative and absolute terms, after reconstruction with an IPAA. An IRA and diverted rectum are associated with an increased risk of rectal cancer, compared with the general population, but the absolute risk is low. Patients and their health care providers should consider these findings in making decisions to leave the rectum intact, perform completion proctectomy, or reconstruct the colon with an IRA or IPAA.
19.	Akbarshahi, Hamid, et al. (author) Perioperative Nutrition in Elective Gastrointestinal Surgery - Potential for Improvement? 2008 In: Digestive Surgery. - : S. Karger AG. - 0253-4886 .- 1421-9883. ; 25:3, s. 165-174 Research review (peer-reviewed)abstract Nutritional concern is one of the most important issues to be addressed in the perioperative care given to gastrointestinal patients. Not at least, malnutrition may be detrimental and relate to postoperative morbidity. Perioperative nutritional management, integrated with other modern perioperative care policies, allows the establishment of multimodal strategies with an attempt to optimize the patients' course of disease. The present review evaluates available data regarding pre- and postoperative nutrition, nutritional supplements, including immunonutrition, and their clinical role. It is to be concluded that pre- and postoperative prolonged fasting has no routine role in management. Instead, for example, early postoperative feeding administered perorally or enterally may reduce postoperative complications and length of hospital stay. There are also indications that perioperative immunonutrition may reduce postoperative infectious complications and length of hospital stay, though further studies in this field are needed.
20.	Akselsson, Roland, et al. (author) Particle Emission at Friction and Bending of Fibre Rowings and Yarns 1993 In: Journal of Aerosol Science. - 0021-8502. ; 24:Supplement 1, s. 17-18 Journal article (peer-reviewed)
21.	Andersson, Bodil, et al. (author) Acute pancreatitis - costs for healthcare and loss of production. 2013 In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 48:12, s. 1459-1465 Journal article (peer-reviewed)abstract Abstract Objective. Severity of acute pancreatitis (AP) can vary from a mild to a fulminant disease with high morbidity and mortality. Cost analysis has, however, hitherto been sparse. The aim of this study was to calculate the cost of acute pancreatitis, both including hospital costs and costs due to loss of production. Material and methods. All adult patients treated at Skane University Hospital, Lund, during 2009-2010, were included. A severity grading was conducted and cost analysis was performed on an individual basis. Results. Two hundred and fifty-two patients with altogether 307 admissions were identified. Mean age was 60 ± 19 years, and 121 patients (48%) were men. Severe AP (SAP) was diagnosed in 38 patients (12%). Thirteen patients (5%) died. Acute biliary pancreatitis was more costly than alcohol induced AP (p < 0.001). Total costs for treating mild AP (MAP) in patients ≤65 years old was lower (p = 0.001) and costs for SAP was higher (p = 0.024), as compared to older patients. The overall hospital cost and cost for loss of production was per person in mean €5,100 ± 2,400 for MAP and €28,200 ± 38,100 for SAP (p < 0.001). The costs for treating AP during the two-year-long study period were in mean €9,762 ± 19,778 per patient. Extrapolated to a national perspective, the annual financial burden for AP in Sweden would be ∼ €38,500,000; corresponding to €4,100,000 per million inhabitants. Conclusions. The costs of treating AP are high, especially in severe cases with a long ICU stay. These results highlight the need to optimize care and continue the identification and focus on SAP, in order to try to limit organ failure and infectious complications.
22.	Andersson, Bodil, et al. (author) Aktuella behandlingsprinciper vid pseudocystor i pankreas. Ultraljud och datortomografi har revolutionerat handläggningen 2006 In: Läkartidningen. - 0023-7205. ; 103:7, s. 456-459 Journal article (peer-reviewed)abstract Pancreatic pseudocysts often complicate the course of both acute and chronic pancreatitis. The management, if the pseudocysts are symptomatic, still remains a substantial clinical problem. Surgical drainage was prior to the introduction of ultrasound and CT more or less the treatment of choice. A vide variety of other treatments have, however, been described that aim to achieve at least as good short and long-term results as surgery, but with reduced trauma, hospital stay and costs. Etiology, anatomy and patients’ preferences are examples of parameters that influence treatment decision making. Different treatment options, including conservative management, different techniques of percutaneus drainage, endoscopic drainage and open and laparoscopic surgery are reviewed.
23.	Andersson, Bodil, et al. (author) Diagnostik och behandling av pseudocystor i pankreas 2007 In: Svensk kirurgi. - 0346-847X. ; 65:1, s. 8-8 Journal article (peer-reviewed)
24.	Andersson, Bodil, et al. (author) Gastrointestinal complications after cardiac surgery - improved risk stratification using a new scoring model. 2010 In: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 10:3, s. 366-370 Journal article (peer-reviewed)abstract Gastrointestinal (GI) complications are serious consequences of cardiac surgery. The aim of this study was to develop, evaluate and validate a new risk score model for GI complications after cardiac surgery. The risk score model, named gastrointestinal complication score (GICS), was developed using prospectively collected data from 5593 patients who underwent 5636 cardiac surgical procedures between 1996 and 2001. The model was validated on 1031 cardiac surgery patients between 2005 and 2006. The scoring system's ability to predict GI complications was estimated by receiver operating characteristic (ROC)-curves and Hosmer-Lemeshow test. Fifty GI complications were identified in 47 patients (0.8%) in the developmental data set and eight (0.8%) in the validation data set. The ROC area in the developmental data set was 0.81 with a good calibration estimated by Hosmer-Lemeshow test (p=0.89). In the validation data set, the area under the curve was 0.83. The estimated probability for the patient to develop a GI complication after cardiac surgery at a GICS >/=15 is >20% and at a GICS
25.	Andersson, Bodil, et al. (author) Gemcitabine Treatment in Pancreatic Cancer – Prognostic Factors and Outcome. 2007 In: Annals of Gastroenterology. - 1108-7471. ; 20:2, s. 130-137 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
26.	Andersson, Bodil, et al. (author) Pancreatic function, quality of life and costs at long-term follow-up after acute pancreatitis. 2010 In: World Journal of Gastroenterology. - : Baishideng Publishing Group Inc.. - 1007-9327. ; 16:39, s. 4944-4951 Journal article (peer-reviewed)abstract AIM: To evaluate long-term endocrine and exocrine pancreatic function, quality of life and health care costs after mild acute pancreatitis and severe acute pancreatitis (SAP). METHODS: Patients prospectively included in 2001-2005 were followed-up after 42 (36-53) mo. Pancreatic function was evaluated with laboratory tests, the oral glucose tolerance test (OGTT), fecal elastase-1 and a questionnaire. Short Form (SF)-36, was completed. RESULTS: Fourteen patients with a history of SAP and 26 with mild acute pancreatitis were included. Plasma glucose after OGTT was higher after SAP (9.2 mmol/L vs 7.0 mmol/L, P = 0.044). Diabetes mellitus or impaired glucose tolerance in fasting plasma glucose and/or 120 min plasma glucose were more common in SAP patients (11/14 vs 11/25, P = 0.037). Sick leave, time until the patients could take up recreational activities and time until they had recovered were all longer after SAP (P < 0.001). No significant differences in SF-36 were seen between the groups, or when comparing with age and gender matched reference groups. Total hospital costs, including primary care, follow-up and treatment of complications, were higher after SAP (median €16 572 vs €5000, P < 0.001). CONCLUSION: Endocrine pancreatic function was affected, especially after severe disease. SAP requires greater resource use with long recovery, but most patients regained a good quality of life.
27.	Andersson, Bodil, et al. (author) Postoperativt inflammatoriskt och metabolt svar efter elektivt kirurgiskt trauma - en kartläggningsstudie 2006 In: Svensk Kirurgi. - 0346-847X. ; , s. 64-64 Conference paper (peer-reviewed)
28.	Andersson, Bodil, et al. (author) Prediction of Severe Acute Pancreatitis at Admission to Hospital Using Artificial Neural Networks. 2011 In: Pancreatology. - : Elsevier BV. - 1424-3903. ; 11:3, s. 328-335 Journal article (peer-reviewed)abstract Background/Aims: Artificial neural networks (ANNs) are non-linear pattern recognition techniques, which can be used as a tool in medical decision-making. The aim of this study was to construct and validate an ANN model for early prediction of the severity of acute pancreatitis (AP). Methods: Patients treated for AP from 2002 to 2005 (n = 139) and from 2007 to 2009 (n = 69) were analyzed to develop and validate the ANN model. Severe AP was defined according to the Atlanta criteria. Results: ANNs selected 6 of 23 potential risk variables as relevant for severity prediction, including duration of pain until arrival at the emergency department, creatinine, hemoglobin, alanine aminotransferase, heart rate, and white blood cell count. The discriminatory power for prediction of progression to a severe course, determined from the area under the receiver-operating characteristic curve, was 0.92 for the ANN model, 0.84 for the logistic regression model (p = 0.030), and 0.63 for the APACHE II score (p < 0.001). The numbers of correctly classified patients for a sensitivity of 50 and 75% were significantly higher for the ANN model than for logistic regression (p = 0.002) and APACHE II (p < 0.001). Conclusion: The ANN model identified 6 risk variables available at the time of admission, including duration of pain, a finding not being presented as a risk factor before. The severity classification developed proved to be superior to APACHE II. and IAP.
29.	Andersson, Bodil, et al. (author) Pseudocystor i pankreas - resultat vid olika behandlingsalternativ 2005 In: Svensk Kirurgi. ; , s. 63-63 Conference paper (peer-reviewed)
30.	Andersson, Bodil, et al. (author) Riskbedömning för gastrointestinal komplikation efter hjärtkirurgi 2007 In: Svensk kirurgi. - 0346-847X. ; , s. 65-65 Conference paper (peer-reviewed)
31.	Andersson, Bodil, et al. (author) Severe Acute Pancreatitis - Outcome following a Primarily Non-Surgical Regime. 2006 In: Pancreatology. - : Elsevier BV. - 1424-3903. ; 6:6, s. 536-541 Journal article (peer-reviewed)abstract Background/Aims: Severe acute pancreatitis ( SAP) is associated with a high morbidity and mortality. The aim was to evaluate treatment, risk factors and outcome in SAP in a centre with a restrictive attitude to surgery. Methods: All cases of acute pancreatitis admitted 1994 - 2003 were analysed retrospectively. SAP was defined as organ failure and/or hospital stay > 7 days together with one or more of: C-reactive protein > 150 mg/l within 72 h after admission, necrosis on computed tomography and need for treatment in the intensive care unit. Results: 185 (22%) of patients with acute pancreatitis fulfilled the criteria for SAP. 175 patients were included, mean age 61 +/- 17 years. Hospital stay was in median 13 days. Forty-six patients had some surgical intervention, in 14 cases directed at the pancreas (8%). Hospital mortality was 9% (n = 16), in 88% ( n = 14) associated with multiple organ dysfunction and 50% ( n = 8) of the deaths occurred within the first week after admission. Of the parameters registered on admission, age and hypotension (systolic blood pressure < 100 mm Hg) were identified as risk factors for death. Conclusion: The present treatment regime for SAP as defined above resulted in a 9% mortality rate, with age and hypotension at admission as predictive factors for death.
32.	Andersson, Bodil, et al. (author) Surgical stress response after colorectal resection. 2013 In: International Surgery. - 0020-8868. ; 98:4, s. 292-299 Journal article (peer-reviewed)abstract Abstract The human body's response to surgery is correlated with the extent of tissue damage. The aim of the present study was to, over time, map out parameters concerning inflammation, metabolism, nutrition, breathing function, muscle strength, and well-being in elective colorectal surgery. Eighteen patients were prospectively included: colon resection (n = 9) and rectum resection/amputation (n = 9). Postoperative interleukin 10 (IL-10) rose more in the rectum surgery group on day 0 (P = 0.007) and day 3 (P = 0.025). Furthermore, significant differences between groups were detected regarding albumin, prealbumin, and total iron-binding capacity (TIBC). For albumin and TIBC, this difference was seen even on day 7. C-reactive protein, IL-6, IL-8, glucose, cortisol, insulin, pain, fatigue, nausea, grip strength, and forced expiratory volume in 1 second did not show any differences. No correlation was revealed between measured parameters and postoperative complications. Postoperative levels of IL-10, albumin, prealbumin, and TIBC may be used as determinants of surgical stress after colorectal surgery.
33.	Andersson, Bodil, et al. (author) Survey of the management of acute pancreatitis in surgical departments in Sweden. 2012 In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 47:8-9, s. 1064-1070 Journal article (peer-reviewed)abstract Objective: Several international guidelines concerning the treatment of acute pancreatitis has been published during the last decades. However, Scandinavian guidelines are still lacking. The aim of the present study is to identify current treatment strategies for acute pancreatitis in Sweden and to evaluate if there is a need for improvement and the role of guidelines. Material and methods: A questionnaire was e-mailed to the surgical departments at all Swedish hospitals (n = 58) managing patients with acute pancreatitis. Comparisons were made both between university and non-university hospitals, and between hospitals with more versus less than 150,000 persons in the primary catchment population. Results: Fifty-one hospitals responded (88%). In median, 65 (12-200) patients with acute pancreatitis are treated yearly at each hospital. Of 51 hospitals, 18 perform a severity classification, with APACHE II being the most commonly used. A majority are of the opinion that a scoring system is not better than the judgment of a senior consultant. In severe acute pancreatitis, 29/48 routinely administer antibiotics, 29/48 use enteral nutrition, and 25/49 have a standardized follow-up plan. The majority considered administration of intravenous fluids as the most important treatment in severe acute pancreatitis. After mild gallstone-induced acute pancreatitis, the corresponding response was cholecystectomy, especially at larger hospitals (p = 0.002). Of 47, 42 are interested in developing a Scandinavian quality register. Conclusions: The results from this first Swedish national survey provide an insight into current traditions of treatment of acute pancreatitis and points, for example, at the lack of early severity stratification. A majority of hospitals are interested in developing a quality register in acute pancreatitis.
34.	Andersson, Bodil, et al. (author) Survey of the management of pancreatic pseudocysts in Sweden. 2009 In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 44, s. 1252-1258 Journal article (peer-reviewed)abstract Objective . The management of pancreatic pseudocysts varies, based mainly on local traditions, resources and expertise. No prospective, randomized study has been done comparing different approaches to treatment. The aim of the present study was to identify current treatment strategies in Sweden. Material and methods. A questionnaire comprising 12 questions was e-mailed to the surgical departments of all hospitals (n=58) treating patients with pancreatitis. Comparisons were made between university and non-university hospitals and between hospitals with 150 000 or more persons versus less in the primary catchment area. Results. Fifty-one hospitals responded (88%). In median, 4 (0-25) patients were treated yearly due to pancreatic pseudocysts at each hospital. Five hospitals had written guidelines. Multidisciplinary team conferences were held at 36/48 centres. Treatment strategies for acute compared to chronic pancreatitis associated pseudocysts differed significantly depending on the underlying diagnosis in the major hospitals (p=0.005). Overall, 21/49 hospitals refer some of these patients and 15/50 of the departments state that they regularly assist in taking care of patients with pancreatic pseudocysts from other hospitals. The chosen treatment modalities vary widely, above all concerning endoscopic drainage, which is more common for symptomatic non-infected pseudocysts (p=0.005) as well as infected pseudocysts (p=0.004) in university hospitals. Conclusions . The lack of protocols and management strategies for pancreatic pseudocysts is reflected by the heterogeneity in treatment strategies, as seen in the present survey. Therefore patients may be at risk of receiving suboptimal treatment. A tailored therapeutic approach that takes into consideration patient preferences and involves a multidisciplinary team should be considered in all cases.
35.	Andersson, Bodil, et al. (author) Treatment and outcome in pancreatic pseudocysts 2006 In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 41:6, s. 751-756 Journal article (peer-reviewed)abstract Objective. Pancreatic pseudocyst is a common complication of both acute and chronic pancreatitis. The aim of the present study was to evaluate the efficacy and complications of different treatment regimens. Material and methods. All patients >= 15 years of age admitted to Lund University Hospital from 1994 to 2003 with pancreatic pseudocysts were analysed retrospectively. Pseudocysts were defined according to the Atlanta classification. Results. Forty-four patients (29 M (66%), mean age 559/14 years) were included in the study, and all were subjected to treatment on totally 88 occasions. Mean size of pseudocysts at diagnosis was 9.69 +/- 6.8 cm (1.5-40 cm). Recurrence after treatment was 1.0 +/- 1.1 times (range 0-4). No difference was found in recurrence rate or pseudocyst size when comparing conservative versus interventional treatment, but patient weight was higher (p=0.013) and acute pancreatitis was more frequent (p=0.046) in conservatively treated patients. Surgical treatment tended to be associated with a lower recurrence rate as compared with percutaneous treatments. The rate of hospital admissions was in median 3 (0-16) and median length of stay (LOS) was 12 days (0-141 days). Six patients (14%) had complications and 3 died (7%). Pseudocysts >= 8 cm did not differ significantly from smaller pseudocysts regarding the choice of conservative treatment, LOS, recurrence and gastrointestinal obstruction, but there was a trend towards more complications in the group with larger pseudocysts ( 5 versus 1). Conclusions. Patients with pancreatic pseudocysts require frequent hospital admissions and repeated treatments. Larger pseudocysts do not imply more recurrences. The lowest recurrence rate overall was seen after open surgery.
36.	Andersson, Ellen, et al. (author) Antikoagulation - ett framtida behandlingsalternativ vid svår akut pankreatit? Anti-inflammatorisk effekt av anti-faktor VII på råtta 2007 In: Svensk Kirurgi. ; , s. 65-65 Conference paper (peer-reviewed)
37.	Andersson, Ellen, et al. (author) Exocrine insufficiency in acute pancreatitis 2004 In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 39:11, s. 1035-1039 Research review (peer-reviewed)
38.	Andersson, Ellen, et al. (author) Major haemorrhagic complications of acute pancreatitis. 2010 In: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; Jul 1, s. 1379-1384 Journal article (peer-reviewed)abstract BACKGROUND:: Haemorrhage is a rare, potentially fatal complication in acute pancreatitis (AP). The aim was to investigate the incidence, management and outcome related to this complication. METHODS:: The medical records of all patients with AP who presented to a single hospital between January 1994 and July 2009 were reviewed retrospectively. Patients who developed at least one in-hospital episode of major haemorrhage were selected. The aetiology, patient characteristics, occurrence of sentinel bleeding, clinical management and outcome were recorded. RESULTS:: Fourteen (1.0 per cent) of 1356 patients diagnosed with AP developed major haemorrhage. Angiography established the diagnosis in four of six patients. Embolization was successful in one patient. Surgery was performed in two patients. Sentinel bleeding occurred in three of four patients with major postoperative bleeding. The overall mortality rate was 36 per cent (5 of 14 patients). Haemorrhage presenting after more than 7 days was associated with a higher mortality rate of 80 per cent (4 of 5 patients). A fatal outcome was at least three times more likely in patients with severe AP and haemorrhagic complications than in those with severe AP but no bleeding. CONCLUSION:: Major haemorrhagic complications of AP are rare, but clinically important. Major postoperative bleeding is often preceded by sentinel bleeding. Intra-abdominal haemorrhage presenting more than 1 week after disease onset is a highly fatal complication. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
39.	Andersson, Ellen, et al. (author) Pancreatic dysfunction in acute pancreatitis 2006 In: Journal of Organ Dysfuntion. - : Informa UK Limited. - 1747-1060 .- 1747-1079. ; 2:3, s. 135-141 Journal article (peer-reviewed)abstract In the normal setting, the release of digestive substances and hormones from the pancreas is closely regulated. However, a variety of diseases, such as acute pancreatitis (AP), may disturb this balance. A limited number of studies on exocrine function in the acute phase of pancreatitis have been performed, most of them in animals. In the convalescent phase of AP, a substantial number of patients will have abnormal results of pancreatic function tests. Many patients with AP develop temporary hyperglycemia requiring insulin treatment and some will end up requiring long-term insulin therapy. The aim of this review is to summarize current knowledge of exocrine and endocrine dysfunction of the pancreas during both the acute and recovery phases of AP. Pancreatic function in the normal setting, dysfunction associated with AP and follow-up studies are presented.
40.	Andersson, Ellen, et al. (author) Tissue factor in predicted severe acute pancreatitis. 2010 In: World Journal of Gastroenterology. - : Baishideng Publishing Group Inc.. - 1007-9327. ; 16:48, s. 6128-6134 Journal article (peer-reviewed)abstract To study tissue factor (TF) in acute pancreatitis and evaluate the role of TF as a predictive marker of severity.
41.	Andersson, Ellen, et al. (author) Treatment with anti-factor VIIa in acute pancreatitis in rats: Blocking both coagulation and inflammation? 2007 In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 42:6, s. 765-770 Journal article (peer-reviewed)abstract Objective. Acute pancreatitis starts as an autodigestive process restricted to the pancreas and progresses to a systemic inflammation via cytokine release into the blood stream. Several inhibitors of the coagulation cascade, including active- siteinactivated factor VIIa, have shown anti- inflammatory properties in other inflammatory models than acute pancreatitis. Free radical scavengers have proven useful in reducing the oxidative damage during hyperinflammatory conditions. The aim of this study was to investigate whether pretreatment with FVIIai would have any effect on the multiple organ dysfunction syndrome ( MODS) in severe acute pancreatitis. Material and methods. Experimental acute pancreatitis was induced by intraductal infusion of taurodeoxycholate in the pancreatic duct. The animals were pretreated with N- acetyl- cysteine and active- site- inactivated factor VIIa. Neutrophil infiltration in the lungs, ileum and colon was quantified by myeloperoxidase activity. Inflammatory markers, IL- 6 and MIP- 2, were measured using ELISA. Results. Tissue infiltration of neutrophils in the lungs, ileum and colon significantly increased during acute pancreatitis as compared to sham operation. These levels were reduced by pretreatment with N- acetylcysteine and active- site- inactivated factor VIIa. Levels of interleukin- 6 and macrophage inflammatory protein- 2 increased significantly during acute pancreatitis. Pretreatment with NAC and FVIIai reduced these levels. Conclusions. Both N- acetylcysteine and active- site- inactivated factor VIIa showed powerful antiinflammatory properties in experimental acute pancreatitis. As they exert their effects through different physiological mechanisms, they represent potential candidates for future multimodal treatment of acute pancreatitis.
42.	Andersson, Martin, et al. (author) A 4.75-34.75 MHz Digitally Tunable Active-RC LPF for > 60 dB RX IRR in 65 nm CMOS 2012 In: 2012 Proceedings of the ESSCIRC (ESSCIRC). - 9781467322126 ; , s. 470-473 Conference paper (peer-reviewed)
43.	Andersson, Manne, et al. (author) Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis? 2014 In: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 38:11, s. 2777-2783 Journal article (peer-reviewed)abstract The diagnosis of appendicitis is difficult and resource consuming. New inflammatory markers have been proposed for the diagnosis of appendicitis, but their utility in combination with traditional diagnostic variables has not been tested. Our objective is to explore the potential of new inflammatory markers for improving the diagnosis of appendicitis. The diagnostic properties of the six most promising out of 21 new inflammatory markers (interleukin [IL]-6, chemokine ligand [CXCL]-8, chemokine C-C motif ligand [CCL]-2, serum amyloid A [SAA], matrix metalloproteinase [MMP]-9, and myeloperoxidase [MPO]) were compared with traditional diagnostic variables included in the Appendicitis Inflammatory Response (AIR) score (right iliac fossa pain, vomiting, rebound tenderness, guarding, white blood cell [WBC] count, proportion neutrophils, C-reactive protein and body temperature) in 432 patients with suspected appendicitis by uni- and multivariable regression models. Of the new inflammatory variables, SAA, MPO, and MMP9 were the strongest discriminators for all appendicitis (receiver operating characteristics [ROC] 0.71) and SAA was the strongest discriminator for advanced appendicitis (ROC 0.80) compared with defence or rebound tenderness, which were the strongest traditional discriminators for all appendicitis (ROC 0.84) and the WBC count for advanced appendicitis (ROC 0.89). CCL2 was the strongest independent discriminator beside the AIR score variables in a multivariable model. The AIR score had an ROC area of 0.91 and could correctly classify 58.3 % of the patients, with an accuracy of 92.9 %. This was not improved by inclusion of the new inflammatory markers. The conventional diagnostic variables for appendicitis, as combined in the AIR score, is an efficient screening instrument for classifying patients as low-, indeterminate-, or high-risk for appendicitis. The addition of the new inflammatory variables did not improve diagnostic performance further.
44.	Andersson, Manne, et al. (author) Correction: The Appendicitis Inflammatory Response Score: A Tool for the Diagnosis of Acute Appendicitis that Outperforms the Alvarado Score (vol 32, pg 1843–1849, 2008, DOI 10.1007/s00268-008-9649-y 2012 In: World Journal of Surgery. - : Springer Verlag (Germany). - 0364-2313 .- 1432-2323. ; 36:9, s. 2269-2270 Journal article (peer-reviewed)abstract n/a
45.	Andersson, Manne, et al. (author) Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis 2017 In: British Journal of Surgery. - : WILEY. - 0007-1323 .- 1365-2168. ; 104:11, s. 1451-1461 Journal article (peer-reviewed)abstract BackgroundThe role of imaging in the diagnosis of appendicitis is controversial. This prospective interventional study and nested randomized trial analysed the impact of implementing a risk stratification algorithm based on the Appendicitis Inflammatory Response (AIR) score, and compared routine imaging with selective imaging after clinical reassessment. MethodPatients presenting with suspicion of appendicitis between September 2009 and January 2012 from age 10years were included at 21 emergency surgical centres and from age 5years at three university paediatric centres. Registration of clinical characteristics, treatments and outcomes started during the baseline period. The AIR score-based algorithm was implemented during the intervention period. Intermediate-risk patients were randomized to routine imaging or selective imaging after clinical reassessment. ResultsThe baseline period included 1152 patients, and the intervention period 2639, of whom 1068 intermediate-risk patients were randomized. In low-risk patients, use of the AIR score-based algorithm resulted in less imaging (192 versus 345 per cent; Pamp;lt;0001), fewer admissions (295 versus 428 per cent; Pamp;lt;0001), and fewer negative explorations (16 versus 32 per cent; P=0030) and operations for non-perforated appendicitis (68 versus 97 per cent; P=0034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (64 versus 67 per cent respectively; P=0884), number of admissions, number of perforations and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for appendicitis (534 versus 463 per cent; P=0020). ConclusionAIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( ). Reduces imaging and admissions
46.	Andersson, Manne, et al. (author) Routine versus selective diagnostic imaging in patients with intermediate probability of acute appendicitis : A randomised controlled multicentre study 2015 Other publication (other academic/artistic)abstract BackgroundDiagnostic imaging is increasingly used in patients with suspected appendicitis, with increased costs and concerns about exposure to ionising radiation. Indications suggest that routine imaging is associated with a higher detection rate and treatment of potentially resolving appendicitis. The efficiency of routine imaging compared with in-hospital observation and selective imaging is not well studied.MethodsThe proportions of negative appendectomy and treatments for appendicitis are studied in 1068 patients with intermediate suspicion of appendicitis, indicated by an Appendicitis Inflammatory Response (AIR) score sum of five to eight points, randomly allocated by opaque sealed envelopes to early routine diagnostic imaging (Imaging group, n=543) or re-assessment after 4–8 hours inhospital observation followed by selective diagnostic imaging (Observation group, n=525). Some 21 hospitals in Sweden participated in this multicentre study.FindingsThe Imaging and Observation groups had the same proportion of negative appendectomies (6·5% in both, difference 0·03%, CI –3·0%–3·1%, p=0·98) but routine imaging was associated with an increased proportion of patients treated for appendicitis (53·4% vs 46·3%, difference 7·1%, CI 1·0–13·2%, p=0·020). As secondary outcomes, the Imaging group had shorter time to surgery (median 13·7 hours vs 15·5 hours, p<0·01), but no difference in admissions, number of perforations or length of hospital stay.InterpretationPatients with suspected appendicitis and equivocal clinical findings do not benefit from early routine diagnostic imaging compared with re-assessment after observation and selective imaging. The latter is associated with fewer operations for non-perforated appendicitis which supports the hypothesis of resolving appendicitis.
47.	Andersson, Manne (author) Structured management of patients with suspected acute appendicitis 2015 Doctoral thesis (other academic/artistic)abstract Background. Acute appendicitis (“appendicitis”) is one of the most common abdominal surgical emergencies worldwide. In spite of this, the diagnostic pathways are highly variable across countries, between centres and physicians. This has implications for the use of resources, exposure of patients to ionising radiation and patient outcome. The aim of this thesis is to construct and validate a diagnostic appendicitis score, to evaluate new inflammatory markers for inclusion in the score, and explore the effect of implementing a structured management algorithm for patients with suspected appendicitis. Also, we compare the outcome of management with routine diagnostic imaging versus observation and selective imaging in equivocal cases.Methods. In study I, the Appendicitis Inflammatory Response (AIR) score was constructed from eight variables with independent diagnostic value (right lower quadrant pain, rebound tenderness or muscular defence, WBC count, proportion of polymorphonuclear granulocytes, CRP, body temperature and vomiting). Its diagnostic properties were evaluated and compared with the Alvarado score. In study II, we performed an external validation and evaluation of novel inflammatory markers for inclusion in the score on patients with suspected appendicitis at two Swedish hospitals. In study III we externally validated and evaluated the impact of an AIR-scorebased algorithm assigning patients to a low or high risk of having appendicitis in an interventional multicentre study involving 25 Swedish hospitals and 3791 patients. In study IV, we compared the efficiency of routine diagnostic imaging with repeated clinical assessment followed by selective imaging in a randomised trial of 1028 patients with equivocal signs of appendicitis, as indicated by an intermediate AIR score, from study III.Main results. In study I we found that the AIR score could assign 63% of the patients to either a high- or low-risk group of appendicitis with an accuracy of 97%, which compared favourably with the Alvarado score. In study II, the diagnostic properties of the AIR score proved to be reproducible, but the inclusion of novel inflammatory markers did not improve the diagnostic accuracy. In study III, the AIR-score-based algorithm led to a reduction in negative explorations, operations for nonperforated appendicitis and hospital admissions in the low-risk group and reduced use of imaging in both low- and high-risk groups. In study IV, routine imaging led to more operations for nonperforated appendicitis but had no effect on negative explorations or perforated appendicitis.Conclusions. The AIR score was found to have promising diagnostic properties that were not improved further with the inclusion of novel inflammatory variables. Structured management of patients with suspected appendicitis according to an AIR-score-based algorithm may improve outcome while reducing hospital admissions and use of imaging. Patients with equivocal signs of appendicitis do not benefit from routine imaging which may lead to an increased detection of, and treatment for, uncomplicated cases of appendicitis that are otherwise allowed to resolve spontaneously.
48.	Andersson, Manne, et al. (author) Structured Management of Patients with Suspected Acute Appendicitis Using a Clinical Score and Selective Imaging (STRAPPSCORE) 2015 Other publication (other academic/artistic)abstract BackgroundThe management of patients with suspected appendicitis is highly variable with implications for the rate of diagnostic errors, unnecessary admissions and resource consumption. We hypothesise that a structured management algorithm based on the Appendicitis Inflammatory Response (AIR) score can improve diagnostic accuracy, limit the use of diagnostic imaging, and reduce the number of hospital admissions for patients with suspected appendicitis.MethodsProspective interventional multicentre study. Patients at 25 Swedish hospitals over the age of five, presenting with suspected appendicitis at the emergency department were considered for inclusion. After an initial period of routine management and registration of the AIR score parameters (baseline period), an AIR-score-based management algorithm was implemented (intervention period). The study analyses the discriminating capacity and predictive value of the AIR score and the impact of implementing the AIR-score-based algorithm.ResultsIn total, 3791 patients were included. Advanced appendicitis is unlikely at an AIR score <5 points (sensitivity 0.96), and appendicitis is likely at an AIR score >8 (specificity 0.98). The implementation of the AIR-score-based algorithm resulted in fewer negative explorations and operations for phlegmonous appendicitis (1.6% vs 3.4%, p=0.019 and 5.5% vs 9.4%, p=0.003, respectively), a reduction in admissions to hospital and use of imaging (29.5% vs 42.8%, p<0.001 and 19.2% vs 34.5%, respectively), and no difference with regard to advanced appendicitis in the low-risk group, and a decrease in the use of diagnostic imaging in the high-risk group (38.5% vs 53.1%, p=0.021).ConclusionsThe AIR score has high discriminating capacity. Implementing an AIR-score-based algorithm increased diagnostic accuracy and lowered the use of diagnostic imaging and in-hospital observation.
49.	Andersson, Manne, et al. (author) Validation of the Appendicitis Inflammatory Response (AIR) Score 2021 In: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 45:7, s. 2081-2091 Journal article (peer-reviewed)abstract Background Patients with suspicion of appendicitis present with a wide range of severity. Score-based risk stratification can optimise the management of these patients. This prospective study validates the Appendicitis Inflammatory Response (AIR) score in patients with suspicion of appendicitis. Method Consecutive patients over the age of five with suspicion of appendicitis presenting at 25 Swedish hospitals emergency departments were prospectively included. The diagnostic properties of the AIR score are estimated. Results Some 3878 patients were included, 821 with uncomplicated and 724 with complicated appendicitis, 1986 with non-specific abdominal pain and 347 with other diagnoses. The score performed better in detecting complicated appendicitis (ROC area 0.89 (95% confidence interval (CI) 0.88-0.90) versus 0.83 (CI 0.82-0.84) for any appendicitis, p < 0.001), in patients below age 15 years and in patients with >47 h duration of symptoms (ROC area 0.93, CI 0.90-0.95 for complicated and 0.87, CI 0.84-0.90 for any appendicitis in both categories). Complicated appendicitis is unlikely at AIR score <4 points (Negative Predictive Value 99%, CI 98-100%). Appendicitis is likely at AIR score >8 points, especially in young patients (positive predictive value (PPV) 96%, CI 90-100%) and men (PPV 89%, CI 84-93%). Conclusions The AIR score has high sensitivity for complicated appendicitis and identifies subgroups with low probability of complicated appendicitis or high probability of appendicitis. The discriminating capacity is high in children and patients with long duration of symptoms. It performs equally well in both sexes. This verifies the AIR score as a valid decision support.
50.	Andersson, Roland E, et al. (author) Appendiceal abscess: Uncertainty concerning the therapeutic principles. A survey indicates the need of randomized controlled trials. 2010 In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 107:6, s. 325-327 Journal article (peer-reviewed)

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