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  • 1.
    Adamo, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sandblom, Gabriel
    Brännström, Fredrik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Prevalence and recurrence rate of perianal abscess -a population-based study, Sweden 1997-20092016In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, no 3, p. 669-673Article in journal (Refereed)
    Abstract [en]

    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.

  • 2. Berglund, Britta
    et al.
    Strigård, Karin
    Karolinska universitetssjukhuset, Huddinge; institutionen för klinisk vetenskap, intervention och teknik (CLINTEC), Karolinska institutet, Stockholm.
    TENS kan lindra illamående efter kolorektal kirurgi: Men placeboeffekten är betydande2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 3, p. 90-91Article in journal (Refereed)
    Abstract [en]

    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.

  • 3.
    Blom, J
    et al.
    Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden and Division of Coloproctology, Center of Surgical Gastroenterology, K53, Karolinska University Hospital, 141 86, Stockholm, Sweden .
    Nyström, P O
    Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden .
    Gunnarsson, Ulf
    Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden .
    Strigård, Karin
    Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Endoanal ultrasonography may distinguish Crohn's anal fistulae from cryptoglandular fistulae in patients with Crohn's disease: a cross-sectional study2011In: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 15, no 3, p. 327-330Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of the study was a cross-sectional investigation into the types of anal fistulae in patients with Crohn's disease using 3-dimensional endoanal ultrasonography.

    METHODS: The study population consisted of 45 patients with established Crohn's disease referred in a 2-year period for treatment of anal fistula. The fistulae were classified according to the presence of three criteria: 1. bifurcation or secondary extension; 2. cross-sectional width ≥ 3 mm; and 3. content of hyperechoic secretions.

    RESULTS: The fistulae of 24 patients (53%) satisfied two or three criteria and were classified as true Crohn's fistulae, while the fistulae of 21 patients satisfied one or none of the criteria and were the cryptoglandular type. The fistulae in the two or three criteria group had been in existence for 8.4 years on average and those in the cryptoglandular group for 4.5 years on average (P = 0.283). The corresponding numbers of previous operations for fistula were 5.7 (range 0-32) and 1.5 (range 0-6), respectively (P = 0.0211). The presence of colitis or proctitis was similar across the groups, but the perianal Crohn's disease activity index was higher with a Crohn's type of fistula (P = 0.0097). Also, a larger proportion had been treated with anti-TNF-monoclonal antibody (0.0169).

    CONCLUSIONS: Endoanal ultrasonography was capable of discerning two subgroups of fistula in Crohn's patients. These groups were clinically different indicating that the prospect of surgical cure is also different.

  • 4.
    Clay, L
    et al.
    Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden .
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Franklin, Karl A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Effect of an elastic girdle on lung function, intra-abdominal pressure, and pain after midline laparotomy: a randomized controlled trial2014In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 29, no 6, p. 715-721Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Girdles and abdominal binders may reduce pain and stabilize the abdominal wall after laparotomy, but a risk for increased intra-abdominal pressure and decreased lung function is also hypothesized. The aim of this study was to investigate the effect of an abdominal girdle after midline laparotomy in a randomized controlled trial. METHODS: Twenty-three patients undergoing laparotomy were randomized to wear an elastic girdle postoperatively and 25 were randomized to no girdle. Pulmonary function was evaluated with; forced vital capacity (FVC), forced expiratory volume during one second (FEV1), peak expiratory flow (PEF), and cough PEF. Pain was recorded using a visual analog scale (VAS). All patients completed the ventral hernia pain questionnaire (VHPQ) before surgery and at the end of the study. Intra-abdominal pressure was measured via an indwelling urinary catheter. Wound healing was assessed from photographs. RESULTS: FVC, FEV1, PEF, and cough PEF were reduced by about 30 % after surgery, but there were no differences between patients with or without a girdle (ANOVA). Intra-abdominal pressure and wound healing were the same in both groups. Pain was significantly lower on day 5 in the girdle group (p = 0.004). CONCLUSIONS: An individually fitted elastic girdle used after midline laparotomy was found to be safe, as this did not affect lung function, coughing, intra-abdominal pressure, or wound healing. The immediate decline in lung function after surgery is restrictive and due to anesthesia and the surgical procedure. Pain was significantly decreased in the girdle group. The study is registered at ClinicalTrials.gov, number NCT01517217.

  • 5.
    Clay, Leonard
    et al.
    Department of Clinical Science, Intervention and Technique, Division of Surgery, Karolinska Institutet, 171 86 Stockholm, Sweden.
    Franneby, Ulf
    Department of Clinical Research and Education, Division of Surgery, Karolinska Institutet, Södersjukhuset, 118 83 Stockholm, Sweden.
    Sandblom, Gabriel
    Department of Clinical Science, Intervention and Technique, Division of Surgery, Karolinska Institutet, 171 86 Stockholm, Sweden.
    Gunnarsson, Ulf
    Department of Clinical Science, Intervention and Technique, Division of Surgery, Karolinska Institutet, 171 86 Stockholm, Sweden.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Validation of a questionnaire for the assessment of pain following ventral hernia repair-the VHPQ2012In: Langenbeck's archives of surgery (Print), ISSN 1435-2443, E-ISSN 1435-2451, Vol. 397, no 8, p. 1219-1224Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to create and evaluate the validity and reliability of a novel ventral hernia pain questionnaire (VHPQ) to assess pain following surgery for ventral hernia. The questionnaire was constructed using focus groups and patient interviews. Validity was tested on 51 patients who responded to the VHPQ and brief pain inventory (BPI) 1 and 4 weeks following surgery. Reliability and internal consistency was tested on 74 patients who had surgery 3 years earlier and received the VHPQ and BPI on two separate occasions. Pain not related to surgery was examined on one occasion using the VHPQ on 100 non-operated people. For pain intensity items, a significant decrease was seen from week 1 to week 4 postoperative (p < 0.05). Spearman rank correlations were significant between the pain intensity items of the VHPQ and the BPI, tested 1 week postoperative (p < 0.05). Kappa levels for test-retest of items for interference with daily activities were higher than 0.5 for all items except one. Intra-class correlation was significant for pain intensity items (p < 0.05) in the test-retest group. Three years after surgery, the operated group stated more pain in the pain intensity items (p < 0.05) and more interference with daily activities (p < 0.05) than a non-operated group from the general population. The validity and reliability of the VHPQ make it a useful tool in assessing postoperative pain and patient satisfaction.

  • 6.
    Clay, Leonard
    et al.
    Department of Clinical Science, Intervention and Technology (CLINTEC), H9, Karolinska Institutet, 171 64, Stockholm, Sweden.
    Stark, Birgit
    Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 64, Stockholm, Sweden..
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study.2017In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Repair of large incisional hernias includes the implantation of a synthetic mesh, but this may lead to pain, stiffness, infection and enterocutaneous fistulae. Autologous full-thickness skin graft as on-lay reinforcement has been tested in eight high-risk patients in a proof-of-concept study, with satisfactory results. In this multicenter randomized study, the use of skin graft was compared to synthetic mesh in giant ventral hernia repair.

    METHODS: Non-smoking patients with a ventral hernia > 10 cm wide were randomized to repair using an on-lay autologous full-thickness skin graft or a synthetic mesh. The primary endpoint was surgical site complications during the first 3 months. A secondary endpoint was patient comfort. Fifty-three patients were included. Clinical evaluation was performed at a 3-month follow-up appointment.

    RESULTS: There were fewer patients in the skin graft group reporting discomfort: 3 (13%) vs. 12 (43%) (p = 0.016). Skin graft patients had less pain and a better general improvement. No difference was seen regarding seroma; 13 (54%) vs. 13 (46%), or subcutaneous wound infection; 5 (20%) vs. 7 (25%). One recurrence appeared in each group. Three patients in the skin graft group and two in the synthetic mesh group were admitted to the intensive care unit.

    CONCLUSION: No difference was seen for the primary endpoint short-term surgical complication. Full-thickness skin graft appears to be a reliable material for ventral hernia repair producing no more complications than when using synthetic mesh. Patients repaired with a skin graft have less subjective abdominal wall symptoms.

  • 7.
    Colliander, Erland B
    et al.
    Department of Orthopaedics, Huddinge University Hospital, Karolinska Institutet, Sweden.
    Strigård, Karin
    Department of Surgery, Huddinge University Hospital, Karolinska Institutet, Huddinge, Sweden .
    Westblad, Pär
    Department of Orthopaedics, Huddinge University Hospital, Karolinska Institutet, Sweden.
    Rolf, Christer
    Department of Orthopaedics, Huddinge University Hospital, Karolinska Institutet, Sweden.
    Nordenström, Jörgen
    Department of Surgery, Huddinge University Hospital, Karolinska Institutet, Huddinge, Sweden.
    Muscle strength and endurance after surgery for primary hyperparathyroidism.1998In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 164, no 7, p. 489-494Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effect of surgery on muscular strength and endurance in patients with primary hyperparathyroidism (HPT).

    DESIGN: Prospective open study.

    SETTING: University hospital, Sweden.

    SUBJECTS: Nine patients undergoing HPT surgery and nine matched patients undergoing thyroid resection who acted as controls.

    INTERVENTIONS: Concentric and eccentric endurance was evaluated with a test comprising 100 repeatedly executed muscle action at 90 degrees.s-1. Blood samples obtained before and after operation were analysed for calcium, phosphate, thyroid stimulating hormone (TSH), and parathyroid hormone (PTH) concentrations.

    MAIN OUTCOME MEASURES: Peak torque during maximum voluntary concentric and eccentric muscle actions at 90 degrees.s-1 before, three months and one year after operation.

    RESULTS: There were no differences in concentric and eccentric peak torque before and after operation either within or between groups. Concentric and eccentric endurance were similar in the HPT group and controls before as well as after operation. The return of calcium and PTH concentrations to their reference ranges after parathyroidectomy did not correlate with changes in concentric and eccentric peak torque.

    CONCLUSIONS: The subjective improvement in muscle endurance which is often encountered in patients with HPT after operation is not associated with an objective increase in muscle strength or endurance as measured by isokinetic muscle performance.

  • 8.
    Emanuelsson, Peter
    et al.
    Department for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden and Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, 117 76, Stockholm, Sweden .
    Dahlstrand, Ursula
    Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Strömsten, U.
    Department of Clinical Sciences Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden .
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden .
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm.
    Stark, Birgit
    Department for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden .
    Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively2014In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 18, no 4, p. 465-471Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate and compare the consistency of agreement of two methods for measuring abdominal rectus diastasis (ARD), preoperative computed tomography (CT) scanning and preoperative clinical assessment were compared with direct measurement intraoperatively.

    METHODS: Fifty-five consecutive patients were retrieved from an ongoing prospective randomised trial comparing two operative techniques for the repair of ARD. All patients underwent a preoperative clinical assessment and CT scan, and the results were compared with intraoperative measurement of the ARD width. Agreement between methods was described with Bland-Altman plots (BA plots) and calculated using Lin's Concordance Correlation Coefficient (CCC).

    RESULTS: The median width of the diastasis was 4.0 cm in the upper midline and 3.0 cm in the lower midline for the intraoperative measurement. BA plots showed that measurements on CT and intraoperatively are not in agreement in the lower midline, whereas the agreement was stronger between the clinical and the intraoperative method. The CCC was higher for clinical vs. intraoperative measurement (0.479) than for CT vs. intraoperative measurement (-0.002) in the lower midline, although the agreement was over all low. CT scanning underestimated the width of the ARD when compared to 87 % of preoperative clinical assessments, and 83 % of intraoperative measurements. Preoperative clinical assessment overestimated ARD in 35 % when compared with intraoperative measurements.

    CONCLUSION: Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.

  • 9. Emanuelsson, Peter
    et al.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Dahlstrand, Ursula
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stark, Birgit
    Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures2016In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 160, no 5, p. 1367-1375Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only.

    METHODS: Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4.

    RESULTS: One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up.

    CONCLUSION: There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain.

  • 10.
    Emanuelsson, Peter
    et al.
    Department for Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stark, Birgit
    Department for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis: a 3-month follow-up2014In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 67, no 8, p. 1082-1088Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to evaluate early complications following retromuscular mesh repair with those after dual layer suture of the anterior rectus sheath in a randomised controlled clinical trial for abdominal rectus muscle diastasis (ARD).

    METHODS: Patients with an ARD wider than 3 cm and clinical symptoms related to the ARD were included in a prospective randomised study. They were assigned to either retromuscular inset of a lightweight polypropylene mesh or to dual closure of the anterior rectus fascia using Quill self-locking technology. All patients completed a validated questionnaire for pain assessment (Ventral Hernia Pain Questionnaire, VHPQ) and for quality of life (SF36) prior to and 3 months after surgery.

    RESULTS: The most frequently seen adverse event was minor wound infection. Of the patients, 14/57 had a superficial wound infection; five related to Quill and nine to mesh repair. No deep wound infections were reported. Patient rating for subjective muscular improvement postoperatively was better in the mesh technique group with a mean of 6.9 (range 0-10) compared to a mean of 4.8 (range 0-10) in the Quill group (p=0.01). The pre- and post-operative SF36 scores improved in both groups.

    CONCLUSIONS: There was no significant difference between the two surgical techniques in terms of early complications and perceived pain at the 3-month follow-up. Both techniques may be considered equally reliable for ARD repair in terms of adverse outcomes during the early postoperative phase, even though patients operated with a mesh experienced better improvement in muscular strength.

  • 11. Falk, Peter
    et al.
    Ruiz-Jasbon, Fernando
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Ivarsson, Marie-Lois
    An ex vivo model using human peritoneum to explore mesh-tissue integration2017In: Biology open, ISSN 2046-6390, Vol. 6, no 9, p. 1391-1395Article in journal (Refereed)
    Abstract [en]

    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.

  • 12.
    Fredriksson, Katarina
    et al.
    Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden.
    Hammarqvist, Folke
    Gastrocentrum, Department of Surgery, Karolinska University Hospital, Huddinge, Sweden.
    Strigård, Karin
    Gastrocentrum, Department of Surgery, Karolinska University Hospital, Huddinge, Sweden.
    Hultenby, Kjell
    Clinical Research Center at Karolinska University Hospital, Huddinge, Sweden.
    Ljungqvist, Olle
    Center for Gastrointestinal Disease at Ersta Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
    Wernerman, Jan
    Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden.
    Rooyackers, Olav
    Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden.
    Derangements in mitochondrial metabolism in intercostal and leg muscle of critically ill patients with sepsis-induced multiple organ failure.2006In: American Journal of Physiology. Endocrinology and Metabolism, ISSN 0193-1849, E-ISSN 1522-1555, Vol. 291, no 5, p. 1044-1050Article in journal (Refereed)
    Abstract [en]

    Critically ill patients treated for multiple organ failure often develop muscle dysfunction. Here we test the hypothesis that mitochondrial and energy metabolism are deranged in leg and intercostal muscle of critically ill patients with sepsis-induced multiple organ failure. Ten critically ill patients suffering from sepsis-induced multiple organ failure and requiring mechanical ventilation were included in the study. A group (n = 10) of metabolically healthy age- and sex-matched patients undergoing elective surgery were used as controls. Muscle biopsies were obtained from the vastus lateralis (leg) and intercostal muscle. The activities of citrate synthase and mitochondrial respiratory chain complexes I and IV and concentrations of ATP, creatine phosphate, and lactate were analyzed. Morphological evaluation of mitochondria was performed by electron microscopy. Activities of citrate synthase and complex I were 53 and 60% lower, respectively, in intercostal muscle of the patients but not in leg muscle compared with controls. The activity of complex IV was 30% lower in leg muscle but not in intercostal muscle. Concentrations of ATP and creatine phosphate were, respectively, 40 and 34% lower, and lactate concentrations were 43% higher in leg muscle but not in intercostal muscle. We conclude that both leg and intercostal muscle show a twofold decrease in mitochondrial content in intensive care unit patients with multiple organ failure, which is associated with lower concentrations of energy-rich phosphates and an increased anaerobic energy production in leg muscle but not in intercostal muscle.

  • 13.
    Gkekas, Ioannis
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sunderby hospital Luleå, Luleå, Sweden.
    Novotny, Jan
    Department of Surgery, Sunderby hospital Luleå, Luleå, Sweden..
    Pecen, Ladislav
    Faculty Hospital Pilsen, Charles University, Prague, Czech Republic.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Microsatellite instability as a prognostic factor in stage II colon cancer patients: a meta-analysis of published literature2017In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, no 12, p. 6563-6574Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND/AIM: The prognostic role of microsatellite instability (MSI) in stage II colon cancer patients remains controversial despite the fact that it has been investigated in a number of studies. Hazard ratios differ considerably among these studies. We performed a meta-analysis to define the significance of MSI in this group of patients.

    MATERIALS AND METHODS: Studies indexed in PubMed presenting separate data on MSI status and survival outcomes for stage II colon cancer patients have been analyzed using fixed-effect meta-analysis of hazard ratio (HR) according to the method of Peto.

    RESULTS: Analysis was performed on 19 studies including 5,998 patients. A 47.3% of patients received postoperative chemotherapy and included 52.8% males and 47.2% females. Eight studies included some rectal cancer patients although this cohort was not clearly defined in 3 of these. MSI observed in 20.8% (mean) of patients (median 19.9%). HR for overall survival (OS) of MSI vs. microsatellite stable (MSS) tumors for the entire population: 0.73 (95% confidence interval (CI)=0.33-1.65); HR for disease-free survival (DFS):0.60 (95%CI=0.27-1.32). No statistical significant difference was found when studies analyzing MSI with genotyping (MG) and immunohistochemistry (IHC) were compared separately (MG vs. IHC: HR OS 0.45, 95%CI=0.10-2.05 vs. 0.95, 95%CI=0.57-1.58; HR DFS 0.51, 95%CI=0.14-1.85 vs. 0.67, 95%CI=0.26-1.70). However, numerically MSI determination with genotyping shows significantly lower hazard ratios for both DFS and OS. Separate analysis of studies describing colon cancer patients only showed HR OS 0.72 (95%CI=0.31-1.71); HR DFS 0.60 (95%CI=0.27-1.31).

    CONCLUSION: No significant relation was found between MSI status and OS or DFS. Routine determination of MSI status to guide postoperative management of stage II colon cancer patients cannot be recommended. New large scale high quality studies are needed to answer this question definitively, since currently analyzed studies vary considerably.

  • 14.
    Gunnarsson, Ulf
    et al.
    Department of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Gastrocentrum K53, 141 86, Huddinge, Stockholm, Sweden .
    Johansson, M
    Department of Physiotherapy, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden .
    Strigård, Karin
    Department of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Assessment of abdominal muscle function using the Biodex System-4. Validity and reliability in healthy volunteers and patients with giant ventral hernia2011In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 4, p. 417-421Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The decrease in recurrence rates in ventral hernia surgery have led to a redirection of focus towards other important patient-related endpoints. One such endpoint is abdominal wall function. The aim of the present study was to evaluate the reliability and external validity of abdominal wall strength measurement using the Biodex System-4 with a back abdomen unit.

    MATERIAL AND METHOD: Ten healthy volunteers and ten patients with ventral hernias exceeding 10 cm were recruited. Test-retest reliability, both with and without girdle, was evaluated by comparison of measurements at two test occasions 1 week apart. Reliability was calculated by the interclass correlation coefficients (ICC) method. Validity was evaluated by correlation with the well-established International Physical Activity Questionnaire (IPAQ) and a self-assessment of abdominal wall strength.

    RESULTS: One person in the healthy group was excluded after the first test due to neck problems following minor trauma. The reliability was excellent (>0.75), with ICC values between 0.92 and 0.97 for the different modalities tested. No differences were seen between testing with and without a girdle. Validity was also excellent both when calculated as correlation to self-assessment of abdominal wall strength, and to IPAQ, giving Kendall tau values of 0.51 and 0.47, respectively, and corresponding P values of 0.002 and 0.004.

    CONCLUSION: Measurement of abdominal muscle function using the Biodex System-4 is a reliable and valid method to assess this important patient-related endpoint. Further investigations will be made to explore the potential of this technique in the evaluation of the results of ventral hernia surgery, and to compare muscle function after different abdominal wall reconstruction techniques.

  • 15.
    Gunnarsson, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stark, Birgit
    Stockholm, Sweden.
    Dahlstrand, Ursula
    Stockholm, Sweden.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Correlation between Abdominal Rectus Diastasis Width and Abdominal Muscle Strength2015In: Digestive Surgery, ISSN 0253-4886, E-ISSN 1421-9883, Vol. 32, no 2, p. 112-116Article in journal (Refereed)
    Abstract [en]

    Background: Surgery for Abdominal Rectus Diastasis (ARD) is a controversial topic and some argue that it is solely an aesthetic problem. Many symptoms in these patients are indefinite, and no objective criteria have been established, indicating which patients are likely to benefit from surgery. This study investigated the correlation between preoperative assessment and intraoperative measurement of ARD width, and objective measurements of muscle strength. Methods: 57 patients undergoing surgery for ARD underwent preoperative assessment of ARD width by clinical measurement and CT scan, and thereafter intraoperative measurement. Abdominal muscle strength was investigated using the Biodex System 4 including flexion, extension and isometric measurements. Correlations were calculated by the Spearman test. Results: Intraoperative ARD width between the umbilicus and the symphysis correlated strongly with Biodex measurements during flexion (p = 0.007, R = -0.35) and isometric work load (p = 0.01, R = -0.34). The following measurements showed no correlation: between muscle strength and BMI; muscle strength and waistline; or between muscle strength and ARD width above the umbilicus, assessed preoperatively at the outpatient clinic, by CT scan, or measured intraoperatively. Conclusion: There is a strong correlation between intraoperatively measured ARD width below the umbilicus and flexion and isometric abdominal muscle strength measured with the Biodex System 4.

  • 16.
    Gunnarsson, Ulf
    et al.
    Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet at the Karolinska University Hospital/Huddinge, Stockholm, Sweden.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet at the Karolinska University Hospital/Huddinge, Stockholm, Sweden.
    3D intrastomal ultrasonography, an instrument for detecting stoma-related fistula2012In: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 16, no 3, p. 233-236Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to evaluate the recently developed 3D intrastomal ultrasonography in diagnosing stoma-associated complaints and suspected complications after parastomal hernia repair such as peristomal fistula and abscesses. 3D intrastomal ultrasonography was used to image peristomal tissue in two patients with complaints after parastomal hernia repair performed with IPOM (intraperitoneal onlay mesh). One patient had ulcerative colitis and one Crohn's disease. Both patients were investigated because of pain and in one case also signs of a subcutaneous abscess. Intrastomal ultrasonography revealed fistulas connected to the intestinal segment leading to the stoma in both cases. Both cases also showed signs of a fistula descending to the abdominal cavity. In one case, a subcutaneous abscess was identified and in the other a small abscess adjacent to the fistula and the edge of the fascia. Stoma complaints after surgery for parastomal hernia with implantation of IPOM mesh can be diagnosed using 3D intrastomal ultrasonography. This new 3D technique for imaging intrastomal hernia can be used to complement traditional methods in the detection of stoma-associated abscesses and fistulas with or without foreign material such as mesh.

  • 17.
    Gurmu, A
    et al.
    Department of Surgery, CLINTEC, Karolinska Institute at the Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Gunnarsson, Ulf
    Department of Surgery, CLINTEC, Karolinska Institute at the Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Strigård, Karin
    Department of Surgery, CLINTEC, Karolinska Institute at the Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Imaging of parastomal hernia using three-dimensional intrastomal ultrasonography2011In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 98, no 7, p. 1026-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parastomal hernia is common in patients with a permanent stoma. At present there is no standard method for imaging a parastomal hernia. The aim of this study was to investigate the value of three-dimensional intrastomal ultrasonography in differentiating between a parastomal hernia and a bulge.

    METHODS: Twenty patients were divided into four groups according to ultrasonography setting and probe cover. All patients were tested using three different ultrasound probe frequencies (9, 13 and 16 MHz). The intrastomal examination was performed during provocation in both the supine and upright positions, with a protector or water-containing balloon surrounding the probe.

    RESULTS: The sharpest images were obtained using the rectal setting with a water-containing balloon surrounding the probe at 9 MHz in supine and erect positions, for evaluation of both fascia and muscle; in some instances even implanted mesh was detectable. When switched to render mode, the pictures improved in sharpness and it was easier to identify anatomical landmarks.

    CONCLUSION: Intrastomal ultrasonography using the rectal setting and a frequency of 9 MHz is a feasible method for imaging a parastomal hernia and differentiating it from an abdominal bulge. The image quality improves when render mode is used.

  • 18.
    Husberg, Britt
    et al.
    Karolinska University Hospital Huddinge, Department of Surgical Gastroenterology, Stockholm, Sweden.
    Malmborg, P
    Karolinska University Hospital Huddinge, Department of Surgical Gastroenterology, Stockholm, Sweden.
    Strigård, Karin
    Karolinska University Hospital Huddinge, Department of Surgical Gastroenterology, Stockholm, Sweden.
    Treatment with botulinum toxin in children with chronic anal fissure.2009In: European journal of pediatric surgery, ISSN 0939-7248, E-ISSN 1439-359X, Vol. 19, no 5, p. 290-292Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Chronic anal fissures with painful defecation and bloodstained stools can be seen in children of all ages. Constipation may precede or appear in connection with the symptoms. Adult patients with anal fissures have been treated successfully with the injection of botulinum toxin into both the internal and external sphincter. The effect of botulinum toxin is reversible and lasts for 3-4 months. This pilot study attempted to examine whether botulinum toxin is also effective in paediatric cases of anal fissure, a treatment which not yet has been reported in the literature.

    MATERIAL AND METHODS: Six boys and seven girls aged 1-10 years were treated with botulinum toxin (Botox ((R))) during 2002-2005 due to chronic anal fissure. Conventional treatment with laxatives and local anaesthetics had been unsuccessful in all cases. The treatment was given to five children under 2 years of age in a dosage of 1.25 Ux2. Eight children over 2 years of age were given 2.5 Ux2. The injections were given in the external sphincter on both sides of the fissure using EMG-stimulation for guidance and were performed under light anaesthetics (Diprivan ((R))). Follow-up was conducted at 1 and 3 months after treatment.

    RESULTS: Within one week, 11 of the children were free from pain and blood stained stools, according to their parent's observations. One 10-year old patient initially showed some improvement but soon experienced a recurrence. After another injection with a higher dosage 2 months later, the fissure healed. One 4-year old patient did not show any signs of improvement. The laxatives, which had been withdrawn after the injection treatment, were then reinstated. At the 3 month post-treatment examination the patient was finally symptom-free with no signs of a fissure. There were no negative side-effects detected in any of the cases. Seven recurrences were noted in 6 of the patients after 3-30 months, often in connection with an episode of constipation. Repeat injections were offered and accepted by four of these patients, once more producing good immediate results.

    CONCLUSION: Treatment with botulinum toxin in the external sphincter produces a quick and effective alleviation of pain with healing of chronic anal fissures in children. The treatment is not considered to carry any risks but requires light anaesthesia. Recurrences are common after the pharmacological effect has receded but can be cured with an additional injection.

  • 19. Husberg, Britt
    et al.
    Salehi, Karin
    Peters, Trevor
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Michanek, Margareta
    Nordenskjöld, Agneta
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Congenital intestinal malrotation in adolescent and adult patients: a 12-year clinical and radiological survey2016In: SpringerPlus, E-ISSN 2193-1801, Vol. 5, article id 245Article in journal (Refereed)
    Abstract [en]

    Congenital intestinal malrotation is mainly detected in childhood and caused by incomplete rotation and fixation of the intestines providing the prerequisites for life-threatening volvulus of the midgut. The objective of this study was to evaluate a large cohort of adult patients with intestinal malrotation. Thirty-nine patients, 15-67 years, were diagnosed and admitted to a university setting with congenital intestinal malrotation 2002-2013. The patients were divided into three age groups for stratified evaluation. Medical charts were scrutinized, and clinical outcome of surgery was reviewed. Twelve patients presented as emergency cases, whereas 27 were admitted as elective cases. Diagnosis was established in 33 patients who underwent radiological investigation and in the remaining 6 during surgery. A Ladd's operation was performed in 31 symptomatic patients; a conservative strategy was chosen in eight cases. Volvulus was more common in the younger age group. Twenty-six surgically treated patients were available for telephone interview, 1-12 years after surgery. All patients, except one, regarded their general condition improved to a high degree (n = 18) or with some reservation (n = 7). Twelve patients suffered remaining abdominal pain of a chronic and diffuse character. Due to recurrence of malrotation six patients were reoperated. Symptomatic malrotation occurs in both children and the adult population. Improved awareness and an accurately performed CT scan can reveal the malformation and enable surgical treatment. A Ladd's procedure relieved most patients from their severe complaints even when a history of several years of suffering existed.

  • 20.
    Inkiläinen, Aapo
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Styrke, Johan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Sundsvall Hospital.
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study2017In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, no 1, p. 54-58Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Abdominal bulging and incisional hernia are known sequelae after open partial nephrectomy (OPN) via a flank incision. Precise rates are not known. The aims of this study were to determine the rates of bulging and hernia after OPN, and to examine potential risk factors.

    MATERIALS AND METHODS: A retrospective review was undertaken of 197 consecutive patients operated on with OPN via a flank incision between 2004 and 2014. After exclusion, 184 patients remained. Medical records and radiological images from the preoperative work-up, and follow-up after surgery at 3, 12 and 24 months, were reviewed.

    RESULTS: A visible bulge was noted in 36 of the 184 patients at clinical examination. Only 20 cases (12%) remained at the last follow-up. Radiological changes interpreted as a bulge were initially seen in 50 patients, while only 35 (19%) remained at the last radiological examination. Clinical incisional hernia was reported in five patients (3%), and radiological hernia was seen in 10 patients (5%). Patients who developed a hernia had a higher body mass index (30 vs 26 kg/m(2), p = 0.02). Other demographic variables showed no significant correlation.

    CONCLUSIONS: Bulging is a common sequela after flank incision. The rate of incisional hernia after flank incision is comparable to rates after other forms of abdominal surgery. Further studies are required to evaluate the psychological and physiological effects of bulging, the pain and weakness caused, and the cosmetic embarrassment suffered by the patient.

  • 21.
    Jiang, G X
    et al.
    Division of Neurology, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden.
    de Pedro-Cuesta, J
    Division of Neurology, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden. Department of Applied Epidemiology, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
    Strigård, Karin
    Department of Surgery, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Olsson, T
    Division of Neurology, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden.
    Link, H
    Division of Neurology, Department of Clinical Neuroscience and Family Medicine, Huddinge University Hospital, Huddinge, Sweden.
    Pregnancy and Guillain-Barré syndrome: a nationwide register cohort study.1996In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 15, no 4, p. 192-200Article in journal (Refereed)
    Abstract [en]

    In this study, we determined the relationship between Guillain-Barré syndrome (GBS) and pregnancy. By taking advantage of several nationwide registers and the availability of personal identification numbers, we calculated person-years for Swedish females aged 15-49 years in the following categories: (1) neither pregnant nor postpartum; (2) pregnant; (3) in the first month postpartum, or (4) in the first 3 months postpartum during 1973-1983. For these women, we determined the corresponding exposure status of hospital-registered GBS cases. Medical records were examined for GBS cases hospitalized during the 2-week period postpartum and 1-month period after the last menstruation. Poisson regression analysis yielded age-adjusted relative risks (RRs) of 0.86 (95% CI 0.40-1.84) for pregnant women, and 1.47 (0.54-3.99) and 2.21 (0.55-8.94) for females during the 3-month and the 30-day period after delivery. The risk for GBS seems to be lower during pregnancy and increases after delivery.

  • 22. Johansson, M
    et al.
    Gunnarsson, Ulf
    Department of Surgery, CLINTEC, Karolinska Institute, Karolinska University Hospital, Gastrocentrum K53, 141 86, Huddinge, Stockholm, Sweden .
    Strigård, Karin
    Department of Surgery, CLINTEC, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Different techniques for mesh application give the same abdominal muscle strength2011In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, no 1, p. 65-68Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study investigates abdominal muscle strength after surgery for giant hernia with the onlay, sublay or intraperitoneal (IPOM) method. Theoretically, placement of the mesh may result in different possibilities regarding function and postoperative physical activity related to abdominal muscle function.

    METHOD: Twenty-four patients operated for large ventral hernias using the onlay, sublay or IPOM technique were evaluated 1 year following surgery for abdominal wall strength using Biodex system 4.

    RESULTS: Despite the different surgical techniques used, no differences were observed in abdominal wall strength between the groups.

    CONCLUSION: The postoperative strength of abdominal wall muscles is independent of the method used for reconstruction of large abdominal wall hernia, and the choice of surgical technique should be directed by anatomical circumstances.

  • 23.
    Kamel, Ashraf F
    et al.
    Department of Pediatrics, Huddinge University Hospital, Huddinge, Sweden.
    Norgren, Svante
    Department of Pediatrics, Huddinge University Hospital, Huddinge, Sweden.
    Strigård, Karin
    Department of Surgery, Huddinge University Hospital, Huddinge, Sweden.
    Thörne, Anders
    Endocrine Research Unit, Huddinge University Hospital, Huddinge, Sweden.
    Fakhrai-Rad, Hossein
    Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Galli, Joakim
    Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Marcus, Claude
    Department of Pediatrics, Huddinge University Hospital, Huddinge, Sweden.
    Age-dependent regulation of lipogenesis in human and rat adipocytes.2004In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 89, no 9, p. 4601-4606Article in journal (Refereed)
    Abstract [en]

    The regulation of adipocyte metabolism is of importance for adipose tissue growth and therefore also for the development of obesity. This study was designed to investigate the regulation of basal and insulin-induced lipogenesis, glucose transport, and glucose transporter protein expression in human and rat adipocytes from different age groups. The study included 21 infants, 21 children, nine adults, and 80 male weaned and 20 male adult Fischer rats. The lipogenesis experiments were performed under conditions at which glucose transport is rate limiting. Basal lipogenesis was approximately three times higher in infants and children than in adults, whereas insulin-induced lipogenesis was two times higher in infants than in children and adults. In rats, basal lipogenesis, insulin-induced lipogenesis, and insulin sensitivity were two times higher in weaned than in adult animals. Moreover, basal and insulin-induced glucose transport were two times higher in weaned than in adult rats. No differences were detected in GLUT1 or GLUT4 content between any of the age groups in human or in rat adipocytes. In conclusion, basal and insulin-stimulated lipogenesis are increased in adipocytes early in life. This may promote adipose tissue growth in early age. The data indicate that age-dependent variation in basal and insulin-stimulated lipogenesis is differently regulated.

  • 24.
    Lindmark, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Löwenmark, Thyra
    Dahlstrand, Ursula
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Risk Factors for Surgical Complications in Ventral Hernia Repair.2018In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to identify risk factors for an adverse event, i.e. early surgical complication, need for ICU care and readmission, following ventral hernia repair. Our hypothesis was that there is an association between an increased complication rate following ventral hernia repair and specific factors, including hernia size, BMI > 35, concomitant bowel surgery, ASA-class, age, gender and method of hernia repair.

    METHODS: Data from a hernia database with prospectively entered data on 408 patients operated for ventral hernia between 2007 and 2014 at two Swedish university hospitals were analysed. A 3-month follow-up of complications, need for intensive care and readmission, was performed by reviewing the medical records.

    RESULTS: Eighty-one of 408 patients (20%) had a registered complication. Fifty-eight (14%) of these were classed as Clavien I-IIIa, and in 19 cases a Clavien IIIb-IV complication was reported. Large hernia size was associated with increased risk for early complication. A Kendall Tau test analysis revealed a proportional relationship between hernia size and modified Clavien outcome class (p < 0.001). Morbid obesity, ASA-class, method, hernia recurrence, age and concomitant bowel surgery were not statistically significant predictors of adverse events.

    CONCLUSIONS: Assessment of hernia aperture size is of great importance in the preoperative evaluation of ventral hernia patients to consider risk for post-operative complications. These results suggest a careful attitude when applying watchful waiting concepts and when postponing hernia surgery to achieve weight loss. A delaying attitude may result in increased risk of complications caused by increasing hernia size.

  • 25.
    Lindquist, Bo
    et al.
    Barnens sjukhus, Huddinge Universitetssjukhus.
    Söderström, Ulf
    Barnens sjukhus, Huddinge Universitetssjukhus.
    Nyström, Hans
    Strigård, Karin
    Gastrocentrum, Huddinge Universitetssjukhus.
    Husberg, Britt
    Barnkirurgen, Astrid Lindgrens barnsjukhus, Stockholm.
    [Report from a meeting of the Swedish Medical Society. Interdisciplinary cooperation can be necessary to manage constipation and encopresis in children].2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, no 28-29, p. 3035-3037Article in journal (Refereed)
  • 26.
    Nordenström, J
    et al.
    Department of Surgery, Huddinge University Hospital, Sweden.
    Strigård, Karin
    Department of Surgery, Huddinge University Hospital, Sweden.
    Perbeck, L
    Willems, J
    Bågedahl-Strindlund, M
    Linder, J
    Hyperparathyroidism associated with treatment of manic-depressive disorders by lithium.1992In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 158, no 4, p. 207-211Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To clarify the association between treatment of affective psychiatric disorders with lithium, and the development of secondary hyperparathyroidism.

    DESIGN: Retrospective review of medical records, 1973-89.

    SUBJECTS: 17 patients with affective psychiatric disorders who were treated with lithium (n = 6) or with tricyclic antidepressant, or neuroleptic, drugs (n = 11) all of whom were operated on for hyperparathyroidism.

    MAIN OUTCOME MEASURE: Duration of lithium therapy and parathyroid histology.

    RESULTS: Parathyroid hyperplasia was present in 5 patients who had taken lithium during a median period of 13 years. A parathyroid adenoma was found in one patient treated with lithium for three years. Ten of the 11 patients who had been treated with tricyclic antidepressant, or neuroleptic drugs had a parathyroid adenoma and the remaining one had an adenoma as an underlying cause of hyperparathyroidism.

    CONCLUSION: Hyperparathyroidism in patients who have undergone long term treatment with lithium is associated with parathyroid hyperplasia. This indicates that lithium may exert a chronic stimulus that results in secondary hyperparathyroidism.

  • 27.
    Näsvall, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sunderby Hospital/Umeå University, 97180 Luleå, Sweden.
    Dahlstrand, Ursula
    Löwenmark, Thyra
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Quality of life in patients with a permanent stoma after rectal cancer surgery2017In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, no 1, p. 55-64Article in journal (Refereed)
    Abstract [en]

    AIM: Health-related quality of life (HRQoL) assessment is important in understanding the patient's perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.

    METHODS: 711 patients operated for rectal cancer with abdomino-perineal resection or Hartman's procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.

    RESULTS: 336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.

    CONCLUSION: Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.

  • 28.
    Näsvall, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Dahlstrand, Ursula
    Löwenmark, Thyra
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Quality of life with permanent stoma after rectal cancer surgeryManuscript (preprint) (Other academic)
  • 29.
    Näsvall, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sunderby Hospital, Luleå, Sweden.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Dahlberg, Michael
    Department of Surgery, Sunderby Hospital, Luleå, Sweden.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Parastomal hernia repair with intraperitoneal mesh2017In: Surgery Research and Practice, ISSN 2356-7759, Vol. 2017, p. 51+4article id 8597463Article in journal (Refereed)
    Abstract [en]

    Purpose. Parastomal hernia is a common complication following a stoma and may cause leakage or incarceration. No optimal treatment has been established, and existing methods using mesh repair are associated with high recurrence rates and a considerable risk for short- and long-term complications including death. A double-layer intraperitoneal on-lay mesh (IPOM), the Parastomal Hernia Patch (BARD™), consisting of ePTFE and polypropylene, has been developed and tailored to avoid recurrence. To evaluate the safety of and recurrence rate using this mesh, a nonrandomised prospective multicentre study was performed. Method. Fifty patients requiring surgery for parastomal hernia were enrolled. Clinical examination and CT scan prior to surgery were performed. All patients were operated on using the Parastomal Hernia Patch (BARD). Postoperative follow-up at one month and one year was scheduled to detect complications and hernia recurrence. Results. The postoperative complication rate at one month was 15/50 (30%). The parastomal hernia recurrence rate at one year was 11/50 (22%). The reoperation rate at one month was 7/50 (14%), and further 5/50 (10%) patients were reoperated on during the following eleven months.

  • 30.
    Näsvall, Pia
    et al.
    Department of Surgery, Sunderby Hospital, Luleå, Sweden.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Reply to 'Preventing parastomal herniation in 2014 and beyond'2014In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 16, no 10, p. 831-832Article in journal (Refereed)
  • 31.
    Näsvall, Pia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sunderby Hospital/Umeå University, 97180, Luleå, Sweden .
    Wikner, F
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    A comparison between intrastomal 3D ultrasonography, CT scanning and findings at surgery in patients with stomal complaints2014In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 29, no 10, p. 1263-1266Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Since there are no reliable investigative tools for imaging parastomal hernia, new techniques are needed. The aim of this study was to assess the validity of intrastomal three-dimensional ultrasonography (3D) as an alternative to CT scanning for the assessment of stomal complaints.

    METHOD: Twenty patients with stomal complaints, indicating surgery, were examined preoperatively with a CT scan in the supine position and 3D intrastomal ultrasonography in the supine and erect positions. Comparison with findings at surgery, considered to be the true state, was made.

    RESULTS: Both imaging methods, 3D ultrasonography and CT scanning, showed high sensitivity (ultrasound 15/18, CT scan 15/18) and specificity (ultrasound 2/2, CT scan 1/2) when judged by a dedicated radiologist. Corresponding values for interpretation of CT scans in routine clinical practice was for sensitivity 17/18 and for specificity 1/2.

    CONCLUSION: 3D ultrasonography has a high validity and is a promising alternative to CT scanning in the supine position to distinguish a bulge from a parastomal hernia.

  • 32.
    Odensten, Christoffer
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Dahlberg, Michael
    Ståhle, Ulrika
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Näsvall, Pia
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Response to ANNSURG-D-17-02433.2018In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed)
  • 33.
    Odensten, Christoffer
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Dahlberg, Michael
    Ståhle, Ulrika
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Näsvall, Pia
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH2017In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

    Background: Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.

    Methods: Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.

    Results: After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.

    Conclusions: The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.

  • 34. Olsson, Tomas
    et al.
    Strigård, Karin
    Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
    Larsson, Per
    Holmdahl, Rikard
    Klareskog, Lars
    Effects on experimental allergic neuritis in rats by in vivo treatment with monoclonal anti-T-cell antibodies.1988In: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 540, p. 560-562Article in journal (Refereed)
  • 35.
    Renman, David
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lundberg, Erik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Statin consumption as a risk factor for developing colorectal cancer: a retrospective case study2017In: World Journal of Surgical Oncology, ISSN 1477-7819, E-ISSN 1477-7819, Vol. 15, article id 222Article in journal (Refereed)
    Abstract [en]

    Background: Statins are the backbone of lipid-lowering therapy and are among the most commonly prescribed drugs in the elderly population in Sweden today. Colorectal cancer is the second most common cancer in men and women, after prostate and breast cancer, respectively, with a median age of 72 years at diagnosis. Statins induce mitochondrial damage leading to accumulation of reactive oxygen species in the cell. Reactive oxygen species can cause mutations in mitochondrial as well as nuclear DNA leading to the development of cancer. Our hypothesis was that statins increase the risk for colorectal cancer.

    Methods: A case study was performed on consecutive cases of colorectal cancer diagnosed at Norrlands University Hospital (NUS) in Umeå between 2012 and 2015 (n = 325). Patients diagnosed with diabetes mellitus type II (DM II n = 65) were excluded in the primary endpoint analysis (occurrence of colorectal cancer). As control, three databases were used to create an age-matched population in order to calculate the proportion of inhabitants using statins in the county of Västerbotten, Sweden. A secondary endpoint was cancer-specific survival among our study group of colorectal cancer patients, including those with DM II, investigating whether there was a difference if the patient was a 'recent' statin user or not at the time of diagnosis.

    Results: Statin use at the time of colorectal cancer diagnosis in the study group was 23.8%. The corresponding figure in an age-matched population in Västerbotten was 24.6%. Using a one-proportional one-sided z test, there was no significant difference between these (23.8%, 95% CI 18.6-29.0%, p = 0.601). When comparing groups 20-64 years of age, the difference was greater with recent statin use in 17.8% in the study population and 11.9% in Västerbotten (17.8%, 95% CI 9.0-26.6%, p = 0.059). When considering cancer-specific survival, no significant difference in survival was seen when comparing 'former/never' statin users as reference category with 'recent' users diagnosed with colorectal cancer (HR 1.39, 95% CI 0.89-2.16).

    Conclusions: No significant increase in risk for developing colorectal cancer among patients (type II diabetics excluded) medicated with statins was found. We found no correlation between 'recent' statin use at the time of diagnosis and cancer-specific survival.

  • 36. Samanci, Ali
    et al.
    Yi, Qing
    Fagerberg, Jan
    Strigård, Karin
    Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
    Smith, Gale
    Rudén, Ulla
    Wahren, Britta
    Mellstedt, Håkan
    Pharmacological administration of granulocyte/macrophage-colony-stimulating factor is of significant importance for the induction of a strong humoral and cellular response in patients immunized with recombinant carcinoembryonic antigen.1998In: Cancer Immunology and Immunotherapy, ISSN 0340-7004, E-ISSN 1432-0851, Vol. 47, no 3, p. 131-142Article in journal (Refereed)
    Abstract [en]

    Eighteen colorectal carcinoma patients without macroscopic disease after surgery were immunized using recombinant (r) human (h) carcinoembryonic antigen (CEA) with (n=9) or without (n=9) the addition of soluble granulocyte/macrophage-colony-stimulating factor (GM-CSF). The dose of rhCEA per immunization was 100 microg (n=6), 316 microg (n=6) or 1000 microg (n=6). rhCEA was given s.c. on day 1 and 80 microg/day of GM-CSF s.c. on days 1-4. The schedule was repeated six times during a period of 9 months. All patients in the GM-CSF group developed a strong rhCEA-dose-dependent IgG antibody response while only one-third of the non-GM-CSF patients mounted a weak antibody response. All patients (9/9) in the GM-CSF group developed a strong rhCEA-specific proliferative T cell response as well as type I T cells (interferon gamma secretion). In 45% of the patients also a weak type II T cell response (interleukin-4 secretion) was evoked. Both MHC-class-I- and -II restricted rhCEA-specific T cells were noted. A specific cellular response (proliferation and/or cytokine secretion) against native hCEA could be found in 8/9 patients in the GM-CSF group, although at a significantly lower level than against rhCEA. In the non-GM-CSF group a weak rhCEA-specific T cell response was induced. Three patients had a proliferative response, 4 patients type I T cells and 6 patients type II T cells. No signs of autoimmune reactions were noted. Local pharmacological administration of GM-CSF seemed to be a prerequisite for the induction of a strong immunity against baculovirus-produced hCEA protein. However, the cellular response against native CEA was of a significantly lower magnitude.

  • 37. Stark, Birgit
    et al.
    Emanuelsson, Peter
    Gunnarsson, Ulf
    Department of Surgery, CLINTEC, Karolinska Institute, Stockholm , Sweden.
    Strigård, Karin
    Department of Surgery, CLINTEC, Karolinska Institute, Stockholm , Sweden.
    Validation of Biodex system 4 for measuring the strength of muscles in patients with rectus diastasis2012In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 46, no 2, p. 102-105Article in journal (Refereed)
    Abstract [en]

    To investigate the validity and reliability of the Biodex system 4 in the assessment of abdominal strength in patients with rectus diastasis, we studied 10 healthy volunteers and 10 patients with rectus diastasis of more than 3 cm. We assessed test-retest reliability at 30(o) and 60(o) of extension/flexion spinal angles, respectively, and isometric muscle strength with and without the abdominal girdle. Reliability was calculated using the interclass correlation coefficient (ICC). Validity was evaluated by correlation with the International Physical Activity Questionnaire (IPAQ) and a visual analogue scale (VAS) for self-assessment of abdominal muscular strength. The Kendall-Tau and Spearman tests were used. Reliability was excellent with ICC values ranging between 0.77 and 0.97. There was no significant difference in muscular strength for tests with or without a girdle except with 60(o) extension. The internal validity assessed as the correlation between VAS and isometric strength (p = 0.008) was excellent, whereas there was no correlation with IPAQ. The Biodex system 4 is a valuable and reliable instrument to measure abdominal wall strength in patients with rectus diastasis. The internal validity is excellent. The incongruence between abdominal muscle strength, as measured using the Biodex system 4, and IPAQ indicates that there is no relation between general physical activity (IPAQ) and muscular strength in patients with rectus diastasis.

  • 38.
    Stark, Birgit
    et al.
    Department of Reconstructive Plastic Surgery, Institution of Molecular, Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Strigård, Karin
    Department of Surgery, CLINTEC, Karolinska Institute at the Karolinska University Hospital/Huddinge, Stockholm, Sweden.
    Definitive reconstruction of full-thickness abdominal wall defects initially treated with skin grafting of exposed intestines2007In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 11, no 6, p. 533-536Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The reconstruction of wide, full-thickness abdominal wall defects of the midline presents a continuing challenge, and consensus concerning the appropriate surgical treatment is lacking.

    METHOD: In this retrospective review, we describe a simple method of reconstruction in full-thickness defects initially treated with skin grafting directly on to the surface of the intestines. Instead of removing the split-thickness grafts from the surface of the intestines, the abdominal wall was reconstructed by inverting the grafted area and advancing the rectus muscles towards the midline.

    RESULTS: Four patients with full-thickness transverse defects larger than 10 cm at the level of the waist and extending from the xiphoid to the suprapubic region were operated with this method. All healed uneventfully. In one case, microscopic examination of the inverted skin showed transformation to normal connective tissue.

    CONCLUSION: Reconstruction of abdominal wall defects previously treated with skin grafting directly on to the intestines can be safely done by reposition of the skin-grafted intestines into the abdominal cavity and realignment of the rectus muscles in the midline.

  • 39.
    Strigard, Karin
    et al.
    Department of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Öresland, T
    Department of GI Surgery, Akerhus University Hospital, University of Oslo, Lörenskog, Norway.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnarsson, Ulf
    Department of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Transcutaneous implant evacuation system: a new approach to continent stoma construction2011In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 13, no 11, p. E379-E382Article in journal (Refereed)
    Abstract [en]

    Aim: Several attempts have been made to construct a mechanical continent stoma without success. A system based on a titanium implant has been developed in an animal model. Following evaluation of this device in animals, the transcutaneous implant evacuation system (TIES) has now been tested in humans.

    Method: The implant consists of a titanium cylinder including a mesh and a plastic cap. This design allows the intestine and subcutaneous tissue to grow into the device. Four patients with inflammatory bowel disease underwent surgery. The indications for surgery were malfunctioning pouches or skin problems around the stoma. Following abdominal surgery, implantation of the device was made behind the external fascia with diversion of the ileum through the device to create a permanent stoma.

    Results: Primary surgery was uncomplicated. Skin tissue growth into the implant was delayed in one case and one patient had impaired healing between intestine and the device. In these cases minor surgical correction was necessary. The tested cap design in the current device was inconvenient and needs to be further developed. No local infections occurred.

    Conclusion: This first clinical study of the TIES device has shown few device-related complications and no significant safety concerns. In our experience bridging of connective tissue between the intestine and skin is crucial for healing. Further development of the lid, the implant and the implantation method within clinical trials is necessary before the device can be introduced in general practice.

  • 40.
    Strigård, Karin
    Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden..
    Experimental allergic neuritis; studies on pathogenesis and immunoregulation.1989In: Acta Neurologica Scandinavica, Supplementum, ISSN 0065-1427, E-ISSN 1600-5449, Vol. 123, p. 1-29Article in journal (Refereed)
  • 41.
    Strigård, Karin
    Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
    Mjälten brast vid koloskopi1995In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 92, no 46, p. 4337-4337Article in journal (Other academic)
  • 42.
    Strigård, Karin
    Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm.
    Tumor recurrence associated with use of a percutaneous bladder catheter after surgery for large bowel carcinoma.1996In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 11, no 3, p. 122-Article in journal (Refereed)
  • 43.
    Strigård, Karin
    et al.
    Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
    Brismar, Tom
    Olsson, Tomas
    Kristensson, Krister
    Klareskog, Lars
    T-lymphocyte subsets, functional deficits, and morphology in sciatic nerves during experimental allergic neuritis1987In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 10, no 4, p. 329-337Article in journal (Refereed)
    Abstract [en]

    Conduction velocities, demyelination, "macrophage/dendritic" cells, different sets of T-lymphocytes, and immunoglobulins were estimated in sciatic nerves during various phases of experimental allergic neuritis in Lewis rats. Demyelination was minimal day 15 postimmunization (p.i.) when conduction velocity already was reduced, somewhat more pronounced day 17 p.i. when nerve conduction was blocked, and most pronounced day 23 p.i. when nerve conduction partially had recovered. This suggests a dissociation between the degree of demyelination and the functional deficits. Decrease of sciatic nerve conduction velocities coincided with endoneurial appearance of T-lymphocytes and "macrophage/dendritic" cells, as well as endoneurial immunoglobulins, day 15 p.i. Later partial functional recovery occurred in parallel with the disappearance of T-cells. The degree of functional deficits thus correlated with the number of endoneurial T-lymphocytes. T-cells may, directly or indirectly, initiate several of the disease components in experimental allergic neuritis, including the nerve conduction deficit.

  • 44.
    Strigård, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Clay, L.
    Stark, B.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Falk, P.
    Giant ventral hernia-relationship between abdominal wall muscle strength and hernia area2016In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 16, article id 50Article in journal (Refereed)
    Abstract [en]

    Background: Symptoms arising from giant ventral hernia have been considered to be related to weakening of the abdominal muscles. The aim of this study was to investigate the relationship between the area of the abdominal wall defect and abdominal wall muscle strength measured by the validated BioDex system together with a back/ abdominal unit.

    Methods: Fifty-two patients with giant ventral hernia (> 10 cm wide) underwent CT scan, clinical measurement of hernia size and BioDex measurement of muscle strength prior to surgery. The areas of the hernia derived from CT scan and from clinical measurement were compared with BioDex forces in the modalities extension, flexion and isometric contraction. The Spearman rank test was used to calculate correlations between area, BMI, gender, age, and muscle strength.

    Result: The hernia area calculated from clinical measurements correlated to abdominal muscle strength measured with the Biodex for all modalities (p-values 0.015-0.036), whereas no correlation was seen with the area calculated by CT scan. No relationship was seen between BMI, gender, age and the area of the hernia.

    Discussion: The inverse correlation between BioDex abdominal muscle strength and clinically assessed hernia area, seen in all modalities, was so robust that it seems safe to conclude that the area of the hernia is an important determinant of the degree of loss of abdominal muscle strength. Results using hernia area calculated from the CT scan showed no such correlation and this would seem to concur with the results from a previous study by our group on patients with abdominal rectus diastasis. In that study, defect size assessed clinically, but not that measured by CT scan, was in agreement with the size of the diastasis measured intra-operatively.

    The point at which the area of a hernia begins to correlate with loss of abdominal wall muscle strength remains unknown since this study only included giant ventral hernias.

  • 45.
    Strigård, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Clay, Leonard
    Stark, Birgit
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Predictive Factors in the Outcome of Surgical Repair of Abdominal Rectus Diastasis2016In: Plastic and Reconstructive Surgery - Global Open, ISSN 2169-7574, Vol. 4, no 5, article id e702Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to define the indicators predicting improved abdominal wall function after surgical repair of abdominal rectus diastasis (ARD). Preoperative subjective assessment quantified by the validated Ventral Hernia Pain Questionnaire (VHPQ) was related to relative postoperative functional improvement in abdominal muscle strength.

    METHODS: Fifty-seven patients undergoing surgery for ARD completed the VHPQ before surgery. Preoperative pain assessment results were compared with the relative improvement in muscle strength measured with the BioDex system 4.

    RESULTS: There was a correlation between the relative improvement in muscle strength measured by the BioDex System 4 for flexion at 30 degrees (P = 0.046) and 60 degrees per second (P = 0.004) and the preoperative question, "Do you find it painful to sit for more than 30 minutes?" There was also a correlation between BioDex improvement for flexion at 30 degrees (P = 0.022) and for isometric work load (P = 0.038) and the preoperative question, "Has abdominal pain limited your ability to perform sports activities?" The VHPQ responses also formed a pattern with a fairly good correlation between other BioDex modalities (with the exception of extension at 60 degrees per second) and the response to the question regarding complaints when performing sports. Postoperative visual analog scale ratings of abdominal wall stability correlated to the questions regarding complaints when sitting (P = 0.040) and standing (P = 0.047). No other correlation was seen.

    CONCLUSION: VHPQ ratings concerning pain while being seated for more than 30 minutes and pain limiting the ability to perform sports are promising indicators in the identification of patients likely to benefit from surgical correction of their ARD.

  • 46.
    Strigård, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Folkesson, J
    Dept of Surgical Science, Division of Surgery, Uppsala University, Uppsala, Sweden .
    Påhlman, Lars
    Dept of Surgical Science, Division of Surgery, Uppsala University, Uppsala, Sweden .
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. CLINTEC, Division of Surgery, Karolinska Institutet, Stockholm, Sweden .
    The Easy-X magnetic stoma connector system. A future concept for stomal dressing?2013In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 28, no 3, p. 371-374Article in journal (Refereed)
    Abstract [en]

    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.

  • 47.
    Strigård, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gurmu, A.
    Department of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital/Huddinge, Stockholm, Sweden.
    Näsvall, Pia
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sunderby Hospital/Umeå University, Luleå, Sweden.
    Pahlman, P.
    Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital/Huddinge, Stockholm, Sweden.
    Intrastomal 3D ultrasound: an inter- and intra-observer evaluation2013In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 28, no 1, p. 43-47Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine intra- and interobserver reliability in 3D intrastomal ultrasound imaging of parastomal hernia and protrusion. A total of 40 patients were investigated. Two or three physicians evaluated the images twice, 1 month apart. Inter-observer agreement was 72 % with a kappa value 0.59. For the last 10 patients there was an agreement of 80 % with a kappa value of 0.70. Intraobserver agreement was 80 % for one observer and 95 % for the other. The learning curve levelled out at around 30 patients. Considering the learning curve of 30 patients, 3D intrastomal ultrasound is a reliable investigation method. 3D intrastomal ultrasonography has the potential to be the investigation of choice to differentiate between a bulge, a hernia, or a protrusion.

  • 48.
    Strigård, Karin
    et al.
    Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
    Holmdahl, Rikard
    Olsson, Tomas
    Oestrogen treatment reduces duration of experimental allergic neuritis in rats and suppresses T cell responses to myelin.1990In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 81, no 5, p. 436-442Article in journal (Refereed)
    Abstract [en]

    The effects of oestrogen and pregnancy on the disease course of experimental allergic neuritis (EAN) in rats were investigated. Pregnant rats were totally protected from EAN and long term 17-beta-oestradiol treatment significantly shortened the disease duration. Lymph node cells from oestrogen treated rats had a suppressed proliferative response when stimulated with myelin or PPD, both when the response was measured immediately after cell preparation and after 72 h cell culture in vitro. Serum levels of IgG antibodies against myelin, P2 or PPD did not differ between treated and non-treated rats although oestrogen treated rats had significantly higher levels of total IgG. Immunohistochemical stainings of nerve roots showed less intensive invasion of T lymphocytes in the oestrogen treated group while immunoreactivity to both class I and II major histocompatibility complex antigens did not differ in between the groups. These findings show that oestrogen ameliorates EAN and suggest that this effect is mediated by suppression of T cell dependent immunity. Factors in addition to oestrogen may be operative during pregnancy when a total protection from EAN is obtained.

  • 49.
    Strigård, Karin
    et al.
    Division of Surgery, CLINTEC, Karolinska Institutet, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Sweden.
    Holmdahl, Rikard
    van der Meide, P H
    Klareskog, Lars
    Olsson, Tomas
    In vivo treatment of rats with monoclonal antibodies against gamma interferon: effects on experimental allergic neuritis.1989In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 80, no 3, p. 201-207Article in journal (Refereed)
    Abstract [en]

    To elucidate the role of gamma interferon in experimental allergic neuritis (EAN) a mouse monoclonal antibody (DB-1) directed against rat gamma interferon was used to treat rats during different phases of the development of experimental allergic neuritis (EAN). The effects of this treatment were followed by clinical evaluation, and in some instances by immunohistochemical analysis of lymphoid organs and affected nerves for presence of MHC class II antigens and various T cell subsets. DB-1 treatment given after onset of clinical symptoms (Day 15 after immuniozation with myelin) shortened disease duration, compared with non-treated EAN controls. Affected nerves of DB-1 treated animals showed reduced expression of MHC class II antigens and lower numbers of T lymphocytes within the affected nerves. In contrast, when DB-1 treatment was given on the day of immunization (Day 0), the disease duration increased, and when given before onset of the disease (Day 9) the clinical course was not significantly affected. The results support an important role for gamma interferon in the pathogenesis of EAN.

  • 50.
    Strigård, Karin
    et al.
    Kolorektalsektionen, Gastrocentrum, Huddinge Universitetssjukhus.
    Jansson, Martin
    Kolorektalsektionen, Gastrocentrum, Huddinge Universitetssjukhus.
    Dolk, Anders
    Kolorektalsektionen, Gastrocentrum, Huddinge Universitetssjukhus.
    [Laparoscopic colorectal surgery. Five-year experience at Huddinge University Hospital].2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, no 35, p. 3396-3399Article in journal (Refereed)
    Abstract [en]

    By education of one to two surgeons at the time we limit the learning curve and reduce the complications. 250 patients have been operated for both benign and malignant colorectal diseases. The operation time is still longer than with the open technique. Conversion rate is 18 per cent, no mortality and few serious complications are seen. The blood loss is in mean 150 ml. With shorter time at the operation theatre through optimal education of the hole operation team, the costs for laparoscopic colorectal surgery will diminish. In the future with better laparoscopic technique, we believe there will be increased numbers of total colectomies and operations in the small pelvic.

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