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  • 1.
    Adamo, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Eeg-Olofsson, Katarina
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Brännström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Södertälje Hospital, Södertälje, Sweden.
    Risk for developing perianal abscess in type 1 and type 2 diabetes and the impact of poor glycemic control2021Ingår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 36, nr 5, s. 999-1005Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The primary aim of this study was to see whether perianal abscess rate differs between patients with type 1 and type 2 diabetes. A secondary aim was to determine whether poor glycemic control increases the risk for perianal abscess.

    Methods: Data from the Swedish National Diabetes Registry and the Swedish National Patient Registry between January 2008 and June 2015 were matched. The risk for anal abscess was evaluated in univariate and multivariate analyses with type of diabetes, HbA1c level, BMI, and various diabetes complications as independent factors.

    Results: Patients with type 1 diabetes had a lower rate of perianal abscess than patients with type 2 diabetes when adjusted for HbA1c, sex, and age (OR 0.65; 95% CI 0.57–0.73). The risk for perianal abscess increased with higher HbA1c. Incidence of perianal abscess was also elevated in diabetes patients with complications related to poor glycemic control such as ketoacidosis and coma (OR 2.63; 95% CI 2.06–3.35), gastroparesis, and polyneuropathy (OR 1.81; 95% CI 1.41–2.32).

    Conclusions: The prevalence of perianal abscess was higher among patients with type 2 diabetes than those with type 1, suggesting that metabolic derangement may be more important than autoimmune factors. Poor glycemic control was associated with higher risk for perianal abscess.

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  • 2.
    Adamo, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sandblom, Gabriel
    Brännström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Prevalence and recurrence rate of perianal abscess -a population-based study, Sweden 1997-20092016Ingår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, nr 3, s. 669-673Artikel i tidskrift (Refereegranskat)
    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.

  • 3.
    Almkvist, Louise
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Improved assessment of fecal incontinence in women with previous obstetric injury combining Low Anterior Resection Syndrome and Wexner scores2023Ingår i: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 161, nr 3, s. 839-846Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of the current study was to assess whether Low Anterior Resection Syndrome (LARS) score could provide additional unique information to the Wexner score when assessing fecal incontinence (FI) in women with previous obstetric injury, thus providing a better foundation for treatment decisions.

    Methods: This was a retrospective cohort study with intraindividual comparison of two scoring systems. Women with previous obstetric injury and diagnosed with FI between January 1, 2015, and December 31, 2018, with valid LARS and Wexner scores were included. Statistical methods used were Spearman rank correlation, Kendall τ, scatterplot, and ratios.

    Results: Seventy women were included. Correlation coefficients varied from 0.42 to 0.66 (Spearman rank correlation) and 0.44 to 0.51 (Kendall τ). Cohen κ values varied from 0.33 to 0.67. No strong association was seen in the correlation analyses or the scatterplot.

    Conclusion: LARS score was shown to provide extra relevant information when assessing FI in women with previous obstetric injury. All symptoms should be considered relevant when assessing FI since it is a complex condition and should be approached accordingly. The authors suggest a combination of LARS and Wexner scores when assessing FI among women with previous obstetric injury.

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  • 4.
    Almkvist, Louise
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Response: improved assessment of fecal incontinence in women with previous obstetric injury combining low anterior resection syndrome and wexner scores2023Ingår i: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 163, nr 3, s. 1057-1058Artikel i tidskrift (Övrigt vetenskapligt)
  • 5. Beilmann-Lehtonen, Ines
    et al.
    Hagström, Jaana
    Kaprio, Tuomas
    Stenman, Ulf-Håkan
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Böckelman, Camilla
    Haglund, Caj
    The Relationship between the Tissue Expression of TLR2, TLR4, TLR5, and TLR7 and Systemic Inflammatory Responses in Colorectal Cancer Patients2021Ingår i: Oncology, ISSN 0030-2414, E-ISSN 1423-0232, Vol. 99, nr 12, s. 790-801Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Colorectal cancer (CRC) is the third most commonly diagnosed malignancy globally. CRC patients with elevated plasma C-reactive protein (CRP) levels exhibit compromised prognoses. Toll-like receptors (TLRs), activating the innate and adaptive immune systems, may contribute to pro- and antitumorigenic inflammatory responses. We aimed to identify a possible link between local and systemic inflammatory responses in CRC patients by investigating the association between tissue TLRs and plasma CRP.

    Methods: Tissue expressions of TLR2, TLR4, TLR5, and TLR7 were assessed using immunohistochemistry of tissue microarray slides from 549 CRC patients surgically treated between 1998 and 2005. Blood samples were drawn preoperatively, centrifuged, aliquoted, and stored at −80°C until analysis. Plasma CRP was determined through high-sensitivity time-resolved immunofluorometric assay. We investigated the association of TLRs to clinicopathologic variables, plasma CRP, and survival.

    Results: High TLR2 expression (hazard ratio [HR] 0.59; 95% confidence interval [CI] 0.41–0.85; p = 0.005), high TLR5 expression (HR 0.60; 95% CI 0.45–0.83; p = 0.002), positive TLR7 expression (HR 0.49; 95% CI 0.33–0.72; p < 0.001), and low CRP (HR 1.48; 95% CI 1.08–2.11; p = 0.017) were associated with a better prognosis. A high TLR2 immunoexpression was associated with a better prognosis among low-CRP patients (HR 0.53; 95% CI 0.35–0.80; p = 0.002), high TLR4 expression among high-CRP patients (HR 2.04; 95% CI 1.04–4.00; p = 0.038), high TLR5 expression among low-CRP patients (HR 0.059; 95% CI 0.37–0.92; p = 0.021), and positive TLR7 expression among low-CRP patients (HR 0.53; 95% CI 0.28–1.00; p = 0.049). In multivariate analyses, no biomarkers emerged as significant independent variables.

    Conclusions: High tissue TLR2, TLR5, and TLR7 levels were associated with a better prognosis. Among low-CRP patients, those with high TLR2, TLR5, and TLR7 immunoexpressions exhibited a better prognosis. Among high CRP patients, a high TLR4 immunoexpression was associated with a better prognosis.

  • 6. 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 betydande2011Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 3, s. 90-91Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Blind, Niillas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Brännström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    The impact of a patient's social network on emergency surgery for colon cancer2023Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, nr 2, s. 440-444Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to investigate if patients with a weak social network and colon cancer are more likely to be operated as an emergency than those with a strong social network.

    METHODS: Data from patients living in Västerbotten County, Sweden, who underwent colon cancer surgery between 2007 and 2020 were extracted from the Swedish Colorectal Cancer Registry (SCRCR). Patients identified were matched against the Västerbotten Intervention Program (VIP) and the longitudinal study Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA). These two databases include a survey that includes questions regarding quality and size of the patient's social network. Multivariable logistic regression was used for analysis.

    RESULTS: Six items from the questions on social network, and the composite variables availability of social integration (AVSI) and availability of attachment (AVAT) were analysed. Data from 801 patients were analysed. The odds ratio for emergency surgery was significantly higher for divorced patients (OR 2.01 (CI 1.03-3.91)) and for male gender (OR 1.51 (CI 1.02-2.24)). A higher OR was seen amongst those with no-one to share feelings with (OR 1.57 (CI 0.82-3.03)) or to comfort them (OR1.33 (CI 0.78-2.28)). Quantitative aspects of social life such as the number of people greater than 10 that feel relaxed at the patient's home, showed a lower OR (OR 0.71(CI 0.35-1.43)).

    CONCLUSION: The impact of social network on the risk for emergency surgery for colon cancer is limited. Divorced status and male gender were associated with an increased risk for emergency surgery.

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  • 8.
    Blind, Niillas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Brännström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Distance to hospital is not a risk factor for emergency colon cancer surgery.2018Ingår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 33, nr 9, s. 1195-1200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this study is to see if the distance to a hospital performing colon cancer surgery is a risk factor for emergency surgical intervention and to determine the variability between defined but demographically divergent catchment areas.

    Methods: Data on patients living in Västerbotten County who underwent colon cancer surgery between 2007 and 2010 were extracted from the Swedish Colorectal Cancer Register (SCRCR). Of the 436 registrations matching these criteria, 380 patients were used in the analysis, and their distance to the nearest hospital providing care for colorectal cancer (CRC) was estimated using Google Maps™. The correlations between the risk for emergency surgery and the distance to a hospital, gender, age, income level and hospital catchment area were analysed in uni- and multivariate models.

    Results: Distance to the nearest hospital had no significant effect on the proportion of emergency operations for colon cancer. There was significant variability in risk for emergency surgery between hospital catchment areas, where the catchment areas of the university hospital and the most rural hospital had a higher proportion than the other local hospital catchment area (OR, 2.00 (p = 0.038) and OR, 2.97 (p = 0.005)). These results were still significant when analysed with multivariate logistic regression (OR, 2.13 (p = 0.026) and OR, 3.05 (p = 0.013)).

    Conclusion: Distance to a hospital performing colon cancer surgery had no effect on the proportion of emergency surgeries. However, a variability between defined catchment areas was seen. Future studies will focus on possible factors behind this variability.

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  • 9.
    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 study2011Ingår i: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 15, nr 3, s. 327-330Artikel i tidskrift (Refereegranskat)
    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.

  • 10.
    Carlstedt, Anders
    et al.
    Department of Surgery, Karlstad Central Hospital, Karlstad, Sweden.
    Bringman, Sven
    Department of Surgery, Södertälje Hospital, Stockholm, Sweden.
    Egberth, Mattias
    Department of Surgery, Mora hospital, Mora, Sweden.
    Emanuelsson, Peter
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.
    Olsson, Anders
    Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Petersson, Ulf
    Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden.
    Pålstedt, Joakim
    Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
    Sandblom, Gabriel
    Department of Surgery, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Sjödahl, Rune
    Department of Surgery, Linköping University Hospital, Linköping, Sweden.
    Stark, Birgit
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Tall, Jael
    Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
    Theodorsson, Elvar
    Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Management of Diastasis of the Rectus Abdominis Muscles: Recommendations for Swedish National Guidelines2021Ingår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 10, nr 3, s. 452-459Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike. Methods: The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience. Results: The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient's symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior. Discussion: The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.

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  • 11. Carlstedt, Anders
    et al.
    Petersson, Ulf
    Stark, Birgit
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Bringman, Sven
    Egberth, Mattias
    Emanuelsson, Peter
    Olsson, Anders
    Sandblom, Gabriel
    Sjödahl, Rune
    Theodorsson, Elvar
    Abdominell rektusdiastas kan ge funktionella besvär: Indikation för behandling måste förtydligas2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, artikel-id FCL4Artikel i tidskrift (Refereegranskat)
  • 12.
    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 universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Franklin, Karl A
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. 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 trial2014Ingår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 29, nr 6, s. 715-721Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    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 universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Validation of a questionnaire for the assessment of pain following ventral hernia repair-the VHPQ2012Ingår i: Langenbeck's archives of surgery (Print), ISSN 1435-2443, E-ISSN 1435-2451, Vol. 397, nr 8, s. 1219-1224Artikel i tidskrift (Refereegranskat)
    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.

  • 14.
    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 universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study2018Ingår i: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, nr 2, s. 325-332Artikel i tidskrift (Refereegranskat)
    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.

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  • 15.
    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.1998Ingår i: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 164, nr 7, s. 489-494Artikel i tidskrift (Refereegranskat)
    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.

  • 16.
    Edin, Sofia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Kaprio, Tuomas
    Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland..
    Hagström, Jaana
    Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland. Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland..
    Larsson, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi. Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Medicinsk och klinisk genetik.
    Mustonen, Harri
    Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland..
    Böckelman, Camilla
    Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland..
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Haglund, Caj
    Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland..
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    The Prognostic Importance of CD20+ B lymphocytes in Colorectal Cancer and the Relation to Other Immune Cell subsets2019Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 9, nr 1, artikel-id 19997Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The anti-tumour immune response is critical to patient prognosis in colorectal cancer (CRC). The aim of this study was to investigate infiltration of B lymphocytes into CRC tumours, and their clinical relevance, prognostic value and relation to other immune cell subsets. We used multiplexed immunohistochemistry and multispectral imaging to assay the amount of infiltrating CD20+ B lymphocytes along with infiltration of CD8+ cytotoxic T cells, FOXP3+ T regulatory cells, CD68+ macrophages and CD66b+ neutrophils, in 316 archival CRC tissue specimens. A higher density of infiltrating CD20+ B lymphocytes was associated with tumours of the right colon (P = 0.025) and of lower stages (P = 0.009). Furthermore, patients whose tumours were highly infiltrated by CD20+ B lymphocytes had a significantly improved disease-specific survival (HR = 0.45, 95% CI 0.28-0.73, P = 0.001), which remained significant in multivariable analysis. CD20+ B lymphocytes were highly and positively associated with CD8+ T lymphocytes (P < 0.001), and part of the prognostic role was found to be a cooperative effect between these lymphocyte subsets. Our results support a favourable prognostic value of tumour-infiltrating CD20+ B lymphocytes in CRC. Furthermore, a cooperative prognostic effect between CD20+ B lymphocytes and CD8+ T lymphocytes is suggested.

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  • 17.
    Edin, Sofia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Kaprio, Tuomas
    Hagström, Jaana
    Larsson, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Mustonen, Harri
    Böckelman, Camilla
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Haglund, Caj
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    The Prognostic Importance of CD20+ B lymphocytes in Colorectal Cancer and the Relation to Other Immune Cell subsets2019Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 9, artikel-id 19997Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The anti-tumour immune response is critical to patient prognosis in colorectal cancer (CRC). The aim of this study was to investigate infiltration of B lymphocytes into CRC tumours, and their clinical relevance, prognostic value and relation to other immune cell subsets. We used multiplexed immunohistochemistry and multispectral imaging to assay the amount of infiltrating CD20(+) B lymphocytes along with infiltration of CD8(+) cytotoxic T cells, FOXP3(+) T regulatory cells, CD68(+) macrophages and CD66b(+) neutrophils, in 316 archival CRC tissue specimens. A higher density of infiltrating CD20(+) B lymphocytes was associated with tumours of the right colon (P = 0.025) and of lower stages (P = 0.009). Furthermore, patients whose tumours were highly infiltrated by CD20(+) B lymphocytes had a significantly improved disease-specific survival (HR = 0.45, 95% CI 0.28-0.73, P = 0.001), which remained significant in multivariable analysis. CD20(+) B lymphocytes were highly and positively associated with CD8(+) T lymphocytes (P < 0.001), and part of the prognostic role was found to be a cooperative effect between these lymphocyte subsets. Our results support a favourable prognostic value of tumour-infiltrating CD20(+) B lymphocytes in CRC. Furthermore, a cooperative prognostic effect between CD20(+) B lymphocytes and CD8(+) T lymphocytes is suggested.

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  • 18.
    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 universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden .
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. 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 intraoperatively2014Ingår i: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 18, nr 4, s. 465-471Artikel i tidskrift (Refereegranskat)
    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.

  • 19. Emanuelsson, Peter
    et al.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlstrand, Ursula
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    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 sutures2016Ingår i: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 160, nr 5, s. 1367-1375Artikel i tidskrift (Refereegranskat)
    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.

  • 20.
    Emanuelsson, Peter
    et al.
    Department for Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    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-up2014Ingår i: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1878-0539, Vol. 67, nr 8, s. 1082-1088Artikel i tidskrift (Refereegranskat)
    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.

  • 21. Falk, Peter
    et al.
    Ruiz-Jasbon, Fernando
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Ivarsson, Marie-Lois
    An ex vivo model using human peritoneum to explore mesh-tissue integration2017Ingår i: Biology open, ISSN 2046-6390, Vol. 6, nr 9, s. 1391-1395Artikel i tidskrift (Refereegranskat)
    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.

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  • 22.
    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.2006Ingår i: American Journal of Physiology. Endocrinology and Metabolism, ISSN 0193-1849, E-ISSN 1522-1555, Vol. 291, nr 5, s. 1044-1050Artikel i tidskrift (Refereegranskat)
    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.

  • 23.
    Gkekas, Ioannis
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Novotny, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Fabian, P.
    Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic..
    Nemecek, R.
    Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic..
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    John, S.
    Department of Medical Biology and Genetics, Faculty of Medicine Hradec Kralove, Charles University, Prague, Czech Republic..
    Pecen, L.
    Faculty Hospital Pilsen, Charles University, Prague, Czech Republic..
    Reginacova, K.
    Department of Radiotherapy and Oncology, University Hospital Kralovske Vinohrady, Prague, Czech Republic..
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Mismatch repair status predicts survival after adjuvant treatment in stage II colon cancer patients.2020Ingår i: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098, Vol. 121, nr 2, s. 392-401Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Stage II colon cancer is primarily a surgical disease. Only a still not well-defined subset of patients may benefit from postoperative adjuvant chemotherapy. The relationship between adjuvant chemotherapy and survival after relapse is furthermore still not definitely explored in this group of patients. A number of reports suggest some association between defective mismatch repair (dMMR) and colorectal cancer stage II prognosis, but due to contradictory results from existing studies, the exact predictive role is still not fully understood.

    METHODS: Retrospective multicenter study including 451 stage II colon cancer patients. The proficiency or deficiency of mismatch repair was tested using immunohistochemistry and analyzed in relationship to two survival outcomes: overall survival (OS) and postrelapse survival.

    RESULTS: Patients with dMMR (20.4%) derived no OS benefit from adjuvant chemotherapy (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.47-2.38; P = .897). Patients with proficient mismatch repair (pMMR) tumors receiving adjuvant chemotherapy had the significantly better OS in comparison to those not receiving chemotherapy (HR, 0.54; 95% CI, 0.35-0.82; P = .004). This relationship remained significant in multivariable analysis (HR, 0.42; 95% CI, 0.22-0.78; P = .007). Patients with pMMR relapsing after adjuvant treatment lived significantly longer than those relapsing without previous adjuvant treatment (HR, 0.55; 95% CI, 0.32-0.96; P = .033) and this result remained significant in the multivariable model (HR, 0.49; 95% CI, 0.26-0.93; P = .030).

    CONCLUSION: In stage II CC patients, adjuvant chemotherapy improves therapeutic outcomes only in patients with pMMR tumors. Survival after relapse in patients having received adjuvant chemotherapy is significantly longer for patients with pMMR. No survival benefit from adjuvant chemotherapy was seen among patients with dMMR tumors.

  • 24.
    Gkekas, Ioannis
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Novotny, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Fabian, Pavel
    Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.
    Nemecek, Radim
    Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Pecen, Ladislav
    Faculty Hospital Pilsen, Charles University, Prague, Czech Republic.
    Svoboda, Tomas
    Faculty Hospital Pilsen, Charles University, Prague, Czech Republic.
    Gurlich, Robert
    Department of Surgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Deficient mismatch repair as a prognostic marker in stage II colon cancer patients2019Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 45, nr 10, s. 1854-1861Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A number of reports have evaluated the relationship between deficient DNA mismatch repair (dMMR) and colorectal cancer prognosis. Unfortunately, the exact prognostic role of dMMR has not been clearly established due to contradictory results. This study aims to determine the prognostic impact of dMRR in stage II colon cancer patients only. The appropriate identification of high-risk stage II colon cancers is of paramount importance in the selection of patients who may benefit from adjuvant treatment after surgery.

    METHODS: Four hundred and fifty-two patients with curative resection of stage II colon cancer were included. Hospital records were used as data source, providing clinical, surgical, pathology, oncology and follow-up information for statistical analysis focusing on overall survival (OS) and time to progression (TTP). Mismatch repair status was determined by immunohistochemistry. Patient survival was followed-up for a mean of 77·35 months.

    RESULTS: dMMR was detected in 93 of 452 patients (20·6%). No impact on overall survival (Log-Rank, p = 0·583, 95% CI 0·76-1·67). However, the hazard ratio 0·50 for TTP was highly significant (Log-Rank, p = 0·012, 95% CI 0·28-0·87) in patients with dMMR compared with those with mismatch repair proficient tumours (pMMR).

    CONCLUSIONS: Patients with dMMR tumours have a lower risk for recurrence compared to those with pMMR tumours, but this finding did not correlate to better overall survival.

  • 25.
    Gkekas, Ioannis
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Novotny, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kaprio, Tuomas
    Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Finland.
    Beilmann-Lehtonen, Ines
    Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Finland.
    Fabian, Pavel
    Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.
    Edin, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Svoboda, Tomas
    Department of Oncology and Radiotherapy, Faculty Hospital Pilsen, Charles University, Prague, Czech Republic.
    Hagström, Jaana
    Department of Pathology, University of Helsinki, Finland; Department of Oral Pathology and Radiology, University of Turku, Finland.
    Barsova, Lucie
    Comprehensive Oncology Center, Liberec, Czech Republic.
    Jirasek, Tomas
    Department of Pathology, Liberec, Czech Republic.
    Haglund, Caj
    Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Finland.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Colon cancer patients with mismatch repair deficiency are more likely to present as acute surgical cases2021Ingår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 157, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The effect of the genetic imprint on the emergency presentation of colon cancer remains unclear. The disparity between tumours evolving along different carcinogenetic pathways has not been studied systematically. This retrospective multicenter cohort study evaluates the association between mismatch repair status and the risk for acute surgery of colon cancer.

    Patients and methods: A retrospective multicenter cohort study including in total 870 patients from three different countries. Scandinavian cohort (Finland and Sweden), including a total of 412 patients operated between January 1, 1995 and December 31, 2010, was validated against a cohort from the Czech Republic, including a total of 458 patients, operated between January 1, 2018 and December 31, 2019. The proficiency or deficiency of mismatch repair was determined by immunohistochemistry. Primary outcome was the risk for acute colon cancer surgery given as the Odds Ratio (OR) in the univariable and multivariable analyses. Acute colon cancer surgery was defined as surgery performed during the same hospital admission as when the diagnosis of colon cancer was made.

    Results: Of the 870 patients (399 females [46%]) included in the analyses, median age at surgery was 69 [interquartile range, 61–76] years, deficient Mismatch Repair (dMMR) status was found in 190 patients (22%), and 179 patients (21%) underwent acute surgery during the same hospital admission as when the diagnosis of colon cancer was made. In the Scandinavian cohort, a significant association between dMMR status and acute surgery was seen in both the univariable (OR 1.82, 95% CI 1.11–3.02, P = 0.017) and the multivariable (OR = 2.21, 95% CI 1.28–3.95, P = 0.005) analyses. This was confirmed in the Czech validation cohort in both the univariable (OR = 1.94, 95% CI 1.09–3.26, P = 0.022) and the multivariable (OR = 1.77, 95% CI 1.15–3.18, P = 0.021) analyses.

    Conclusion: This multicenter study reveals a strong association between acute colon cancer surgery and dMMR tumour status.

  • 26.
    Gkekas, Ioannis
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Novotny, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Kaprio, Tuomas
    Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Beilmann-Lehtonen, Ines
    Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Fabian, Pavel
    Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.
    Tavelin, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Böckelman, Camilla
    Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Edin, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Svoboda, Tomas
    Department of Oncology and Radiotherapy, Faculty Hospital Pilsen, Charles University, Prague, Czech Republic.
    Hagström, Jaana
    Department of Pathology, University of Helsinki, Helsinki, Finland; Department of Oral Pathology and Radiology, University of Turku, Turku, Finland.
    Barsova, Lucie
    Department of Clinical Oncology, Comprehensive Oncology Center, Liberec, Czech Republic.
    Jirasek, Tomas
    Department of Pathology, Regional Hospital of Liberec, Liberec, Czech Republic.
    Haglund, Caj
    Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sporadic deficient mismatch repair in colorectal cancer increases the risk for non-colorectal malignancy: a European multicenter cohort study2024Ingår i: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Objectives: Disparities between tumors arising via different sporadic carcinogenetic pathways have not been studied systematically. This retrospective multicenter cohort study evaluated the differences in the risk for non-colorectal malignancy between sporadic colorectal cancer (CRC) patients from different DNA mismatch repair status.

    Methods: A retrospective European multicenter cohort study including in total of 1706 CRC patients treated between 1996 and 2019 in three different countries. The proficiency (pMMR) or deficiency (dMMR) of mismatch repair was determined by immunohistochemistry. Cases were analyzed for tumor BRAFV600E mutation, and BRAF mutated tumors were further analyzed for hypermethylation status in the promoter region of MLH1 to distinguish between sporadic and hereditary cases. Swedish and Finish patients were matched with their respective National Cancer Registries. For the Czech cohort, thorough scrutiny of medical files was performed to identify any non-colorectal malignancy within 20 years before or after the diagnosis of CRC. Poisson regression analysis was performed to identify the incidence rates of non-colorectal malignancies. For validation purposes, standardized incidence ratios were calculated for the Swedish cases adjusted for age, year, and sex.

    Results: Of the 1706 CRC patients included in the analysis, 819 were female [48%], median age at surgery was 67 years [interquartile range: 60–75], and sporadic dMMR was found in 188 patients (11%). Patients with sporadic dMMR CRC had a higher incidence rate ratio (IRR) for non-colorectal malignancy before and after diagnosis compared to patients with a pMMR tumor, in both uni- (IRR = 2.49, 95% confidence interval [CI] = 1.89–3.31, p = 0.003) and multivariable analysis (IRR = 2.24, 95% CI = 1.67–3.01, p = 0.004). This association applied whether or not the non-colorectal tumor developed before or after the diagnosis of CRC in both uni- (IRR = 1.91, 95% CI = 1.28–2.98, p = 0.004), (IRR = 2.45, 95% CI = 1.72–3.49, p = 0.004) and multivariable analysis (IRR = 1.67,95% CI = 1.05–2.65, p = 0.029), (IRR = 2.35, 95% CI = 1.63–3.42, p = 0.005), respectively.

    Conclusion: In this retrospective European multicenter cohort study, patients with sporadic dMMR CRC had a higher risk for non-colorectal malignancy than those with pMMR CRC. These findings indicate the need for further studies to establish the need for and design of surveillance strategies for patients with dMMR CRC.

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  • 27.
    Gkekas, Ioannis
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. 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 universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Microsatellite instability as a prognostic factor in stage II colon cancer patients: a meta-analysis of published literature2017Ingår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, nr 12, s. 6563-6574Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 28.
    Gran, M. V.
    et al.
    Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Kjønås, D.
    Department of Gastrointestinal and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Revhaug, Arthur
    Department of Gastrointestinal and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Aahlin, E. K.
    Department of Gastrointestinal and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway.
    Antibiotic treatment for appendicitis in Norway and Sweden: a nationwide survey on treatment practices2022Ingår i: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 22, nr 1, artikel-id 229Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Appendicitis is one of the most common causes of acute abdomen. Uncomplicated appendicitis is as an inflamed appendix without perforation, gangrene or abscess formation. Recent trials show that one can safely treat uncomplicated appendicitis with antibiotics, given patient approval and appropriate follow-up. A recent study has also indicated no difference between antibiotic treatment and placebo. Our aim was to investigate if Norwegian and Swedish surgical departments treat uncomplicated appendicitis with antibiotics and to explore their opinions on this treatment practice.

    METHODS: A questionnaire was distributed to all heads of department in hospitals that treat appendicitis in Norway and Sweden. Answers were collected using a REDCap survey. Answers were compared between centers and nations and the results were presented anonymously.

    RESULTS: We sent the questionnaire to 94 eligible recipients and received 61 (65%) answers. In total, 8/61 (13%) departments stated that they have established antibiotic treatment as sole treatment for uncomplicated appendicitis. Almost half of the responders stated that they have used antibiotics sporadically to treat uncomplicated appendicitis. Lack of evidence and guidelines were noted as reasons why antibiotic treatment has not been implemented as sole treatment.

    CONCLUSIONS: Most Norwegian and Swedish departments have not implemented antibiotic treatment as the sole treatment for uncomplicated appendicitis. Despite several recent large trials on this subject, lack of evidence and guidelines was the most frequently reported reason in our survey.

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  • 29.
    Gunnarsson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Dahlstrand, Ursula
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Is robotic-assisted surgery a step in the right direction for routine inguinal hernia repair?2022Ingår i: Laparoscopic Surgery, E-ISSN 2616-4221, Vol. 6, artikel-id 10Artikel i tidskrift (Refereegranskat)
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  • 30.
    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 hernia2011Ingår i: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, nr 4, s. 417-421Artikel i tidskrift (Refereegranskat)
    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.

  • 31.
    Gunnarsson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stark, Birgit
    Stockholm, Sweden.
    Dahlstrand, Ursula
    Stockholm, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Correlation between Abdominal Rectus Diastasis Width and Abdominal Muscle Strength2015Ingår i: Digestive Surgery, ISSN 0253-4886, E-ISSN 1421-9883, Vol. 32, nr 2, s. 112-116Artikel i tidskrift (Refereegranskat)
    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.

  • 32.
    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 universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. 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 fistula2012Ingår i: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 16, nr 3, s. 233-236Artikel i tidskrift (Refereegranskat)
    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.

  • 33.
    Gunnarsson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Edin, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Gkekas, Ioannis
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Mustonen, Harri
    Department of Surgery, University of Helsinki and Helsinki University Hospital, 00114, Helsinki, Finland. Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland..
    Kaprio, Tuomas
    Department of Surgery, University of Helsinki and Helsinki University Hospital, 00114, Helsinki, Finland. Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland..
    Böckelman, Camilla
    Department of Surgery, University of Helsinki and Helsinki University Hospital, 00114, Helsinki, Finland. Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland..
    Hagström, Jaana
    Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland. Department of Pathology, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland..
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Haglund, Caj
    Department of Surgery, University of Helsinki and Helsinki University Hospital, 00114, Helsinki, Finland. Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland..
    Association between local immune cell infiltration, mismatch repair status and systemic inflammatory response in colorectal cancer2020Ingår i: Journal of Translational Medicine, ISSN 1479-5876, E-ISSN 1479-5876, Vol. 18, artikel-id 178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Systemic inflammatory response in colorectal cancer (CRC) has been established as a prognostic factor for impaired cancer-specific survival, predominantly in patients with right-sided tumors. On the other hand, defective mismatch repair (dMMR) tumors, primarily located in the right colon, are known to have favorable survival and dense local immune infiltration. The aim of this study was to see if there is any form of relationship between these seemingly diverse entities.

    METHODS: Complete clinical and long-term survival data were retrieved for 316 CRC patients operated at Helsinki University Hospital between the years 1998 and 2003. Tissue microarrays were prepared from surgical specimens and further processed and analyzed for local immune cell infiltration using multispectral imaging with a Vectra quantitative pathology imaging system and Inform software. Multiplex immunohistochemistry was applied using antibodies against CD66b, CD8, CD20, FoxP3, CD68 and pan-Cytokeratin. After exclusions, data on immune infiltration were available for 275 patients. Mismatch repair status was determined by immunohistochemistry.

    RESULTS: CRP was seen to be an independent predictor of cancer-specific survival but not overall survival in uni- and multivariable (HR 1.01 (1.00-1.02); p = 0.028) analyses of non-irradiated patients. There was no significant difference in CRP according to mismatch repair status, but all cases (n = 10) with CRP ≥ 75 mg/l had proficient mismatch repair (pMMR). There was a significant negative correlation between intratumor stromal infiltration by T-regulatory FOXP3+ cells and CRP (p = 0.006). There was significantly lower intratumor stromal infiltration by FOXP3+ cells (p = 0.043) in the right colon compared to the rectum, but no significant difference in CRP (p = 0.44). CRP was not a predictor of overall survival (HR 0.99, 95% CI 0.98-1.01) nor cancer-specific survival in irradiated patients (HR 0.94, 95% CI 0.94-1.02).

    CONCLUSIONS: There was a significant negative relationship between SIR, defined as an elevated CRP, and intratumor stromal infiltration by T-regulatory FOXP3+ cells. This and the fact that all cases with a CRP > 75 mg/l had pMMR suggests that SIR and dMMR are independent entities in CRC. Indeed, the general lack of difference in CRP between cases with dMMR and pMMR may be evidence of overlap in cases with a less pronounced SIR.

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  • 34.
    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 ultrasonography2011Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 98, nr 7, s. 1026-9Artikel i tidskrift (Refereegranskat)
    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.

  • 35.
    Holmdahl, Viktor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Sunderby Research Unit, Department of Surgical and Perioperative Sciences, Umeå University, Luleå, Sweden.
    Backman, Olof
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    The Tensile Strength of Full-Thickness Skin: A Laboratory Study Prior to Its Use as Reinforcement in Parastomal Hernia Repair2019Ingår i: Frontiers in Surgery, E-ISSN 2296-875X, Vol. 6, artikel-id 69Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Parastomal hernia is a common complication of an enterostoma. Current methods of repair have high recurrence rates and are associated with severe complications. Autologous full-thickness skin as reinforcement may reduce the recurrence and complication rates. This study aims to investigates the tensile strength of full-thickness skin; information that is essential if we are to proceed with clinical trials on humans.

    Methods: Full-thickness skin samples from 12 donors were tested for tensile strength, as well as the load tolerated by a suture through the skin. Strips of skin were cut out and stretched until breaking point. Sutures were made through skin samples and traction applied until either the tissue or the suture gave way. All done while recording the forces applied using a dynamometer. Identical tests were carried out on commercially available synthetic and biologic graft material for comparison.

    Results: The full-thickness skin strips had a median tensile strength of 604 N/cm. This tensile strength was significantly higher than that of the compared materials evaluated in this study. In full-thickness skin, the suture, or tissue endured a median force of 67 N before giving way, which was as high as, or higher than similar sutures through the compared materials.

    Conclusions: The tensile strength of full-thickness skin vastly exceeds the physiological forces affecting the abdominal wall, and sutures through skin endure high loads before giving way. The tensile strength of a full-thickness skin graft and the strength of sutures through this material will not limit its use for reinforcement in parastomal hernia repair.

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  • 36.
    Holmdahl, Viktor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Norrlands Universitetssjukhus.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Norrlands Universitetssjukhus.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Norrlands Universitetssjukhus.
    Autologous full-thickness skin graft as reinforcement in parastomal hernia repair: a feasibility study2021Ingår i: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 25, nr 1, s. 131-136Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Parastomal hernia is a common complication of stoma formation and the methods of repair available today are unsatisfactory with high recurrence and complication rates. To improve outcome after surgical repair of parastomal hernia, a surgical method using autologous full-thickness skin grafts as intraperitoneal reinforcement has been developed. The purpose of this study was to evaluate the feasibility of this novel surgical technique in the repair of parastomal hernia.

    Methods: A pilot study was conducted between January 2018 and June 2019 on four patients with symptomatic parastomal hernia. They had a laparotomy with suture reduction of the hernia and reinforcement of the abdominal wall with autologous full-thickness skin. They were then monitored for at least 1 year postoperatively for technique-related complications and recurrence.

    Results: No major technique-related complications were noted during the follow-up Two patients developed a recurrent parastomal hernia at the long term follow-up. The other two had no recurrence.

    Conclusions: Autologous full-thickness skin graft as reinforcement in parastomal hernia repair is feasible and should be evaluated in a larger clinical trial.

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  • 37.
    Holmdahl, Viktor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Autologous full-thickness skin graft as reinforcement in parastomal hernia repair: a randomised controlled trial2021Ingår i: Trials, E-ISSN 1745-6215, Vol. 22, nr 1, artikel-id 891Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Parastomal hernia is a common complication of an enterostomy and can have a significant impact on health-related quality of life. Currently used methods of repair have high recurrence rates and considerable risk for complications. We have developed a new technique for parastomal hernia repair that uses full-thickness skin graft as reinforcement.

    Methods: This study protocol describes a multicentre randomised controlled trial on parastomal hernia repair comparing a new full-thickness skin graft technique with conventional synthetic composite mesh as reinforcement of the abdominal wall. Patients with a symptomatic parastomal hernia will be included and followed up at 3, 12 and 36 months, with surgical complication as the primary outcome. Secondary outcomes will be recurrence rate and health-related quality of life assessed with VHPQ, EORTC C30 and CR29. Tissue biology and collagen metabolism will be investigated pre- and postoperatively using biopsies of the abdominal wall fascia and blood samples.

    Discussion: Parastomal hernia constitutes a major clinical problem where the prospects of a good result after hernia repair are presently poor. This new method of repair with full-thickness skin grafting could be a new alternative in our surgical toolbox, but before then, it must be evaluated properly.

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  • 38.
    Holmdahl, Viktor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stark, B.
    Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, MK1 Karolinska Institute, Stockholm, Sweden.
    Clay, L.
    Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Could full thickness skin grafts in an onlay position be the new gold standard for incisional hernia repair? Author’s reply2022Ingår i: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 26, s. 665-666Artikel i tidskrift (Refereegranskat)
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  • 39.
    Holmdahl, Viktor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Sunderby Research Unit, Södra Sunderbyn, Sweden.
    Stark, Birgit
    Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, MK1 Karolinska Institute, Stockholm, Sweden.
    Clay, Leonard
    Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Long-term follow-up of full-thickness skin grafting in giant incisional hernia repair: a randomised controlled trial2022Ingår i: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 26, s. 473-479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Conventional repair of a giant incisional hernia often requires implantation of a synthetic mesh (SM). However, this surgical procedure can lead to discomfort, pain, and potentially serious complications. Full-thickness skin grafting (FTSG) could offer an alternative to SM, less prone to complications related to implantation of a foreign body in the abdominal wall. The aim of this study was to compare the use of FTSG to conventional SM in the repair of giant incisional hernia.

    Methods: Patients with a giant incisional hernia (> 10 cm width) were randomised to repair with either FTSG or SM. 3-month and 1-year follow-ups have already been reported. A clinical follow-up was performed 3 years after repair, assessing potential complications and recurrence. SF-36, EQ-5D and VHPQ questionnaires were answered at 3 years and an average of 9 years (long-term follow-up) after surgery to assess the impact of the intervention on quality-of-life (QoL).

    Results: Fifty-two patients were included. Five recurrences in the FTSG group and three in the SM group were noted at the clinical follow-up 3 years after surgery, but the difference was not significant (p = 0.313). No new procedure-related complication had occurred since the one-year follow-up. There were no relevant differences in QoL between the groups. However, there were significant improvemnts in both physical, emotional, and mental domains of the SF-36 questionnaire in both groups.

    Conclusion: The results of this long-term follow-up together with the results from previous follow-ups indicate that autologous FTSG as reinforcement in giant incisional hernia repair is an alternative to conventional repair with SM.

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  • 40.
    Holmdahl, Viktor
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stark, Birgit
    Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden..
    Clay, Leonard
    Department of Clinical Science and Education, Karolinska Institute, Solna, Sweden..
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial2019Ingår i: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 23, nr 2, s. 355-361Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Repair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.

    METHODS: A prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.

    RESULTS: 52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.

    CONCLUSION: The outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.

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  • 41.
    Huber, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Larsson, Charlotta
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Harrysson, Mathilda
    Department of Obstetrics and Gynecology, Östersund Hospital, Östersund, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lehmann, Jan-P.
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Nordin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Tunón, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Use of endoanal ultrasound in detecting obstetric anal sphincter injury immediately after birth2023Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 102, nr 3, s. 389-395Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Obstetric anal sphincter injury (OASI) complicates around 5% of deliveries in primiparas. The study objective was to assess the utility of three-dimensional endoanal ultrasonography (3D-EAUS) in the diagnosis of OASI.

    Material and methods: The present study was designed to mirror screening settings with an unselected cohort of nulliparous women. All enrolled patients underwent clinical examination of the perineum by the caregiver, and 3D-EAUS was conducted. Post-processing of ultrasonography volume data was performed by an experienced colorectal surgeon who was blinded to all other data. The sensitivity, specificity, negative predictive value, and positive predictive value of 3D-EAUS in the diagnosis of OASI was evaluated. The trial is registered at ISCRTN: 18006769.

    Results: A total of 680 scans were performed, of which 18.5% were judged as “non-assessable”, resulting in 554 assessable recordings. Sphincter defects were observed in 12.8% of all assessable recordings on 3D-EAUS (n = 71). With clinical examination set as the reference standard, ultrasound sensitivity in the diagnosis of OASI was 30.4%, whereas its specificity was 87.9%. The negative predictive value was 96.7% and the positive predictive value was only 9.9%. Comments were left on 175 examinations, of which 74% referred to the management of the examination.

    Conclusions: Using 3D-EAUS in a maternity ward is demanding because staff generally have little experience in endoanal ultrasound, which contributes to difficulties in obtaining good image quality. When 3D-EAUS is performed to mirror screening settings, it adds no convincing diagnostic power to clinical examination in the diagnosis of OASI.

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  • 42.
    Huber, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Larsson, Charlotta
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lehmann, Jan-P
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lindam, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Tunón, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia2023Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 102, nr 10, s. 1290-1297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Pelvic floor pain and dyspareunia are both important entities of postpartum pelvic pain, often concomitant and associated with perineal tears during vaginal delivery. The association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia has not been fully established. We aimed to determine the prevalence of postpartum anal sphincter defects using three-dimensional endoanal ultrasonography (3D-EAUS) and evaluate their association with symptoms of pelvic floor pain and dyspareunia.

    Material and methods: This prospective cohort study followed 239 primiparas from birth to 12 months post delivery. Anal sphincters were assessed with 3D-EAUS 3 months postpartum, and self-reported pelvic floor function data were obtained using a web-based questionnaire distributed 1 year after delivery. Descriptive statistics were compared between the patients with and without sonographic defects, and the association between sonographic sphincter defects and outcomes were analyzed using logistic regression.

    Results: At 3 months postpartum, 48/239 (20%) patients had anal sphincter defects on 3D-EAUS, of which 43 (18%) were not clinically diagnosed with obstetric anal sphincter injury at the time of delivery. Patients with sonographic defects had higher fetal weight than those without defects, and a perineum <2 cm before the suture was a risk factor for defects (odds ratio [OR], 6.9). Patients with sonographic defects had a higher frequency of dyspareunia (OR, 2.4), and pelvic floor pain (OR, 2.3) than those without defects.

    Conclusions: Our results suggest an association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia. A perineal height <2 cm, measured by bidigital palpation immediately postdelivery, was a risk factor for sonographic anal sphincter defect. We suggest offering pelvic floor sonography around 3 months postpartum to high- risk women to optimize diagnosis and treatment of perineal tears and include perineum <2 cm prior to primary repair as a proposed indication for postpartum follow-up sonography.

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  • 43.
    Huber, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Larsson, Charlotta
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lehmann, Jan-Peter
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Lindam, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Östersund Hospital, Östersund, Sweden.
    Tunón, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    The prevalence of postpartum anal sphincter defects and the association with perineal pain and dyspareuniaManuskript (preprint) (Övrigt vetenskapligt)
  • 44.
    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.2009Ingår i: European journal of pediatric surgery, ISSN 0939-7248, E-ISSN 1439-359X, Vol. 19, nr 5, s. 290-292Artikel i tidskrift (Refereegranskat)
    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.

  • 45. Husberg, Britt
    et al.
    Salehi, Karin
    Peters, Trevor
    Gunnarsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Michanek, Margareta
    Nordenskjöld, Agneta
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Congenital intestinal malrotation in adolescent and adult patients: a 12-year clinical and radiological survey2016Ingår i: SpringerPlus, E-ISSN 2193-1801, Vol. 5, artikel-id 245Artikel i tidskrift (Refereegranskat)
    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.

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  • 46.
    Inkiläinen, Aapo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Blomqvist, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi. Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden; Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Patient-reported outcome measures of abdominal wall morbidity after flank incision for open partial nephrectomy2021Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 128, nr 4, s. 497-503Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To compare patient-reported outcome measures in patients with and without abdominal wall complications after open partial nephrectomy (OPN) via flank incision.

    Patients and Methods: Patient-reported outcome measures were collected in 2017 from all patients operated on with OPN via flank incision between 2004 and 2016 in Västerbotten County, Sweden. Patients were mailed the ventral hernia pain questionnaire (VHPQ) and an abdominal wall asymmetry (AWA) questionnaire to evaluate postoperative AWA, attributed to bulge or incisional hernia. Demographic and follow-up data were retrieved from patient records.

    Results: A total of 198 patients were eligible for the study, and 146 questionnaires were returned (74%). Forty-five patients (31%) reported postoperative AWA and 27 (18%) reported ongoing pain. Three patients who reported AWA had a known incisional hernia. Pain and abdominal wall stiffness were more common in patients with AWA than in those without (P < 0.01 and P < 0.01, respectively). Of the 45 patients with AWA, 25 (56%) reported this as being negative cosmetically and 16 (36%) as negative regarding activities. Patients that reported AWA were younger and had a higher body mass index at surgery (P = 0.03 and 0.04, respectively).

    Conclusion: Abdominal wall asymmetry is a common sequel of flank incision for OPN and is associated with a higher incidence of chronic pain and abdominal stiffness compared to absence of postoperative AWA. Some patients reported that the effect on daily activities and the cosmetic effect caused by AWA had a negative impact on their quality of life.

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  • 47.
    Inkiläinen, Aapo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Styrke, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Sundsvall Hospital, Sundsvall, Sweden .
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Strigård, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study2018Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, nr 1, s. 54-58Artikel i tidskrift (Refereegranskat)
    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.

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  • 48.
    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.1996Ingår i: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 15, nr 4, s. 192-200Artikel i tidskrift (Refereegranskat)
    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.

  • 49. 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 strength2011Ingår i: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 15, nr 1, s. 65-68Artikel i tidskrift (Refereegranskat)
    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.

  • 50.
    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.2004Ingår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 89, nr 9, s. 4601-4606Artikel i tidskrift (Refereegranskat)
    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.

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