Biomedical subjects

E Haglind

Publications and source records attributed to E Haglind.

At least 19 recordsLinked to original sources

PubMed2005

Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer.

BACKGROUND: High hospital case volume has been associated with improved outcome after open operation for colorectal malignancies. METHODS: To assess the impact of hospital case volume on short-term outcome after laparoscopic operation for colon cancer, we conducted an analysis of patients who underwent laparoscopic colon resection within the COlon Cancer Laparoscopic or Open Resection (COLOR) trial. RESULTS: A total of 536 patients with adenocarcinoma of the colon were included in the analysis. Median operating time was 240, 210 and 188 min in centers with low, medium, and high case volumes, respectively (p < 0.001). A significant difference in conversion rate was observed among low, medium, and high case volume hospitals (24% vs 24% vs 9%; p < 0.001). A higher number of lymph nodes were harvested at high case volume hospitals (p < 0.001). After operation, fewer complications (p = 0.006) and a shorter hospital stay (p < 0.001) were observed in patients treated at hospitals with high caseloads. CONCLUSIONS: Laparoscopic operation for colon cancer at hospitals with high caseloads appears to be associated with improved short-term results.

Aged↗

PubMed2004

Cost-savings achieved by eradication of epidemic methicillin-resistant Staphylococcus aureus (EMRSA)-16 from a large teaching hospital.

Methicillin-resistant Staphylococcus aureus continues to be an increasing problem worldwide, although its prevalence in the Nordic countries still is low. In 1997 an unusually readily transmissible strain of epidemic methicillin-resistant S. aureus, EMRSA-16, was introduced by a single patient into a 2,600 bed teaching hospital in Sweden. Despite the standard "search and destroy" policy (Standard MRSA Control Programme), the outbreak took on epidemic proportions. Therefore, the hospital management chose to implement vigorous and costly actions (Intensive MRSA Control Programme). These measures were successful, and the strain was completely eradicated. Whether the actions taken were cost-effective was analysed using an analytical framework in which different scenarios were simulated (decision analytic modelling). Thus, the relative costs and consequences of the Standard MRSA Control Programme and the Intensive MRSA Control Programme could be compared in a simple manner. Coefficients were developed from the observations of the transmission of the bacteria during the period preceding the study period. These were then used to simulate the outcome of the alternative programmes. The uncertainty of the results was explored in sensitivity analyses. The Intensive MRSA Control Programme was shown to be cost saving after slightly more than 24 months of implementation. In conclusion, due to vigorous control efforts, a large EMRSA-16 outbreak in a university hospital was stopped. The initial costs of the control programme were high, but future healthcare resources were saved.

Cohort Studies↗

PubMed2004

Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES).

BACKGROUND: The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on the laparoscopic resection of colon cancer during the annual congress in Lisbon, Portugal, in June 2002. METHODS: A systematic review of the current literature was combined with the opinions, of experts in the field of colon cancer surgery to formulate evidence-based statements and recommendations on the laparoscopic resection of colon cancer. RESULTS: Advanced age, obesity, and previous abdominal operations are not considered absolute contraindications for laparoscopic colon cancer surgery. The most common cause for conversion is the presence of bulky or invasive tumors. Laparoscopic operation takes longer to perform than the open counterpart, but the outcome is similar in terms of specimen size and pathological examination. Immediate postoperative morbidity and mortality are comparable for laparoscopic and open colonic cancer surgery. The laparoscopically operated patients had less postoperative pain, better-preserved pulmonary function, earlier restoration of gastrointestinal function, and an earlier discharge from the hospital. The postoperative stress response is lower after laparoscopic colectomy. The incidence of port site metastases is <1%. Survival after laparoscopic resection of colon cancer appears to be at least equal to survival after open resection. The costs of laparoscopic surgery for colon cancer are higher than those for open surgery. CONCLUSION: Laparoscopic resection of colon cancer is a safe and feasible procedure that improves short-term outcome. Results regarding the long-term survival of patients enrolled in large multicenter trials will determine its role in general surgery.

Colectomy↗

PubMed2004

Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer.

BACKGROUND: There has been no randomized clinical trial of the costs of laparoscopic colonic resection (LCR) compared with those of open colonic resection (OCR) in the treatment of colonic cancer. METHODS: A subset of Swedish patients included in the Colon Cancer Open Or Laparoscopic Resection (COLOR) trial was included in a prospective cost analysis; costs were calculated up to 12 weeks after surgery. All relevant costs to society were included. No effects of the procedures, such as quality of life or survival, were taken into account. RESULTS: Two hundred and ten patients were included in the primary analysis, 98 of whom had LCR and 112 OCR. Total costs to society did not differ significantly between groups (difference in means for LCR versus OCR euro1846; P = 0.104). The cost of operation was significantly higher for LCR than for OCR (difference in means euro1171; P < 0.001), as was the cost of the first admission (difference in means euro1556; P = 0.015) and the total cost to the healthcare system (difference in means euro2244; P = 0.018). CONCLUSION: Within 12 weeks of surgery for colonic cancer, there was no difference in total costs to society incurred by LCR and OCR. The LCR procedure, however, was more costly to the healthcare system.

Aged↗

PubMed2001

[Control of methicillin resistant staphylococci at the Sahlgrenska hospital. Successful control program against MRSA outbreak].

In 1998-1999 a strain of methicillin resistant Staphylococcus aureus (MRSA) infected 147 patients in 40 out of 160 ward units at Sahlgrenska University Hospital, Gothenburg. The strain originated from a patient who had been treated in a hospital in Cyprus. In order to control this outbreak a plan of action was decided upon and carried out, including extensive information to the hospital staff, screening for carriers, and establishing a hospital infection control committee. Furthermore, a policy for screening all patients readmitted to the hospital was established in November 1999. This screening could be discontinued on July 1, 2001.

Cross Infection↗

PubMed2001

Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study.

BACKGROUND: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation. METHODS: A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon. RESULTS: In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8). CONCLUSION: The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.

Adult↗

PubMed2001

Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study.

SUMMARY: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to gain the initial working space in totally extraperitoneal endoscopic (TEP) hernioplasty, but this increases its cost. Forty-four men with bilateral, primary or recurrent inguinal hernias were randomized to undergo TEP with or without dissection balloon. There were two conversions to transabdominal preperitoneal hernioplasty, or open herniorrhaphy, in the group with balloon and four in the group without balloon. There was no difference in the postoperative morbidity or operation time between the two groups, and there were no major complications in either group. The recurrence rate was 4.3% in the group with the balloon and 7.1% in the group without the balloon. There were no statistically significant differences between the groups. Although our study population is too small to detect small differences between the groups, it seems that the use of a dissection balloon is not beneficial in a bilateral TEP.

Adult↗

PubMed2001

Laparoscopic vertical banded gastroplasty--an effective long-term therapy for morbidly obese patients?

BACKGROUND: Vertical banded gastroplasty (VBG) has previously been documented as an effective treatment for morbid obesity. We have described a laparoscopic technique to perform this operation. Follow-up data are now presented. METHODS: A consecutive series of 139 morbidly obese patients were operated on with laparoscopic VBG. The patients were assessed with respect to peri- and postoperative morbidity, postoperative recovery and weight reduction up to 5 years thereafter. RESULTS: Conversions to an open operation (n = 6) and early reoperations (n = 3) occurred in the early part of the series. Late complications were observed in 8 patients. The average weight reduction after 1 year was 50% of excess body weight, which remained also after 2 years. The continued follow-up covering 3 to 5 years postoperatively revealed a moderate weight gain in about 20% of patients. CONCLUSION: VBG can be safely performed by use of the laparoscopic technique. The average weight reduction after 1 and 2 years was 50% of excess body weight, whereafter tendency to partial weight gain was noted, suggesting an outcome comparable to that documented after the open surgical approach.

Adult↗

PubMed2000

Blockade of the B7-CD28 pathway by CTLA4-Ig counteracts rejection and prolongs survival in small bowel transplantation.

Allograft rejection involves T-cell activation, requiring T-cell receptor interactions with major histocompatibility complex (MHC) molecules and costimulatory signals delivered through the B7-CD28 pathway. We evaluated the effect of blocking this pathway on graft rejection and survival, in a rat experimental model of small bowel transplantation. Heterotopic small bowel transplantation was performed between PVG donor rats and DA recipient rats. The recipient animals were treated with CTLA4-Ig or irrelevant immunoglobulin (Ig)G as control and followed for 18, 30 or 90 days. The survival rate and degree of inflammation and accumulation of CD4+ T cells and macrophages were determined in the transplanted bowels. We found that administration of CTLA4-Ig significantly improved the survival rate compared to control rats: after 30 days 73% of the treated rats had survived and at 90 days 5/8 rats were still living, whereas in the control group only 2/8 rats had survived. The grafts showed preserved mucosal structure with only a mild degree of subacute inflammation and the accumulation of CD4+ T cells and macrophages was noticeably reduced in treated animals as compared to control rats. Necrosis was extensive in control rats, whereas CTLA4-Ig treated animals had grafts with at least some preserved villus morphology and no necrotic tissue. Although small bowel transplantation has proven exceptionally difficult, in this study we have shown that CTLA4-Ig treatment may provide a promising strategy to prevent rejection and induce long term tolerance and graft survival.

Abatacept↗

PubMed1998

Insulin-like growth factor-I and growth hormone administration in intestinal ischemia shock in the rat.

The effect of exogenous insulin-like growth factor (IGF)-I and growth hormone (GH) was examined in a rat model of intestinal ischemia-reperfusion (I/R). Animals were anesthetized, vascular catheters were placed, and intestinal ischemia was induced for 60 min. Thereafter, the intestine was reperfused, and rats received a primed, constant infusion of either IGF-I or GH (500 microg/rat + 500 microg/day) for the remainder of the study; control rats received an equal volume of vehicle. The plasma IGF-I concentration gradually declined after I/R in the vehicle-shock group and was reduced 30% at 48 h. GH infusion completely prevented this reduction, whereas the effect of IGF-I was intermediate. The IGF-I content in liver was increased by IGF-I (78%) and further enhanced in the GH-treated group (140%). Comparable increases were seen for the abundance of IGF-I mRNA in liver in these two treatment groups, compared to the vehicle control. In contrast, while both IGF-I and GH elevated the IGF-I content in skeletal muscle similarly (80%), no increase in IGF-I mRNA expression was observed in this tissue. Neither treatment altered the IGF-I content in small intestine. At the time tissues were sampled (48 h), the plasma concentration of glucose and corticosterone was not different among the three groups. However, plasma insulin was reduced 50% in the IGF-I-infused animals, compared to values in either the shock-GH or shock-vehicle group. These data demonstrate that chronic administration of GH and, to a lesser extent, IGF-I, after intestinal I/R maintains levels of IGF-I in the blood, liver, and muscle. Thus, adjunct treatment with these anabolic agents may help blunt the increased catabolism observed in individuals following intestinal I/R.

Animals↗

PubMed1997

[Laparoscopy possible even in cholelithiasis. Results for 96 patients from three different hospitals are reviewed].

At laparoscopic cholecystectomy, a procedure routinely used at Swedish surgery departments today, common bile duct stones are found to be present in 5-10 per cent of cases. During recent years, several alternative procedures have been evolved for the management of duct stones, such as operative or postoperative endoscopic sphincterolomy, or conversion to open surgery and choledochotomy. The article gives an account of laparoscopic treatment of common bile duct stones, and results obtained in 96 patients from three surgery departments in Sweden. Three different primary techniques were used: saline flushing via the cholangiography catheter, after intravenous injection of 1 mg of glucagon (in six cases of small stones); transcystic common duct exploration (TCDE), with cholodochoscopy and a Dermia basket (68 cases); and laparoscopic choledochotomy and choledochoscopy (22 cases). The success rate was 88 per cent (84/96), and mortality zero. In many cases the postoperative course was similar to that of patients undergoing laparoscopic cholecystectomy alone. We recommend TCDE in cases of common bile duct stones of no more than 8-9 mm in diameter, and where the cystic duct is large. Single-stage laparoscopic treatment of bile duct stones seems to be a safe and effective method of dealing with two problems in the same setting, and is an important alternative in the management of duct stones.

Adult↗

PubMed1997

Migration of host and donor T cells in small bowel transplantation.

In this study migration of host and donor CD4+ and CD8+ T cells in a fully allogeneic model was described and compared with the migration pattern in a graft-versus-host reaction (GVHR) model, where the T-cell traffic in the graft served as a physiological control. Heterotopic small bowel transplantations were performed in a rat model, with animals being sacrificed on postoperative days (POD) 2, 3, 4, 5, and 7. Graft and host mesenteric lymph nodes were harvested, homogenized, and stained with monoclonal antibodies against MHC class I, CD4+, and CD8+ antigens. The host and donor T cell migration patterns were studied using a double-staining flow cytometric technique. We found that during the development of rejection, the normal physiological circulation of graft and host T cells was disrupted. In the graft of the allogeneic model, a shift from host cell to graft cell dominance occurred on POD 3-4. This change in migration pattern coincided in the host with a 6% peak in graft cell infiltration, which disappeared on POD 7. These patterns of T-cell migration may be further explored for diagnostic purposes.

Animals↗

PubMed1997

Integrated intestinal capacity and nutritional status following small bowel transplantation.

Successful small bowel transplantation requires normal functional capacity of the graft and unaltered metabolism of the host. Weight gain and wet weight of muscle groups and intra-abdominal fat pads were compared between transplanted, sham-operated, short bowel-operated, and normal rats that were fed either standard chow or fat-enriched (15%) pellets. Weight gain and wet weight of muscle groups and fat pads for the control, transplanted, and sham-operated rats were identical, while short bowel animals showed reduced weight. Transplanted rats receiving fat-enriched food had lower wet weight of fat pads than control animals on the high-fat diet. We conclude that small bowel transplantation makes it possible to overcome the intestinal failure associated with short bowel syndrome, leading to overall normal weight gain and development of the recipient. However, altered fat metabolism, reflected in changed body composition, was observed in transplanted animals on the high-fat diet.

Adipose Tissue↗

PubMed1997

Worry associated with screening for colorectal carcinomas.

BACKGROUND: We wanted to assess the worry created by a screening program for colorectal cancer with fecal occult blood testing. METHODS: Six thousand three hundred and sixty-six individuals (47% men; 53% women) were asked to what extent they were worried when they received an invitation letter including a Hemoccult II test (HII). The questionnaire was supplemented by a structured telephone interview of a selected number of individuals with different outcome of the HII. RESULTS: Three thousand four hundred and eighty-six subjects performed the HII test, and 3548 (56%) answered the questionnaire. Eighty-four per cent (n = 2932) of the participants and 21% (n = 616) of the non-participants completed the questionnaire. Half of the participants (54%) were not worried at all, but 16%, more women than men, felt severe worry, which lasted less than 1 week in 59%. In 4.7% of the participants daily life was negatively influenced by the invitation letter. In the telephone interview 19% reported severe worry before they received the result of the first test, and in 5.8% daily life was negatively affected. The worry rate increased to 60% in the groups with an initial positive HII test, and in 15% daily life was negatively influenced. After the examination the worry decreased in most but was still pronounced in 10%. One year after the work-up 96% declared that they appreciated the study. Subjects with only elementary school education expressed more worry than those with a higher level of education (P < 0.05). CONCLUSIONS: Severe worry in connection with the invitation was reported by a minority of the invited participants, more women than men. The worry increased among those who had a positive test but decreased after the examination. One year after the work-up most appreciated the study.

Anxiety↗

PubMed1996

Hepatic reticuloendothelial system dysfunction after intestinal ischemia-reperfusion.

The functional capacity of the hepatic reticuloendothelial system (RES) was studied under conditions of intestinal shock. Wistar rats underwent intestinal ischemia (60 min)-reperfusion or a sham procedure. One-half of each group received intravenous infusion of 2.6 x 10(-6) g/kg lipopolysaccharide B. Phagocytic clearance and phagocytic killing by the hepatic RES were quantitated using a double label bacteria clearance assay. Hepatic phagocytosis was unchanged 3 h after reperfusion of the ischemic intestine but hepatic killing was significantly decreased compared with the sham situation. The results were not different in animals who had received LPS B infusion. The plasma endotoxin levels correlated inversely to the hepatic killing efficiency (r = -.801) in the shocked animals given exogenous endotoxin. The decreased capacity of the hepatic RES to degrade bacteria present in the portal circulation could be an important pathophysiologic mechanism in the development of bacterial translocation.

Animals↗

PubMed1996

Met-enkephalin and catecholamine release during feline intestinal ischemia-reperfusion.

Release of met-enkephalin-like immunoreactivity (MLI) into the circulation was investigated during feline intestinal ischemia-reperfusion in relation to the mass of ischemic tissue and in correlation to the sympathoadrenergic, response as gauged by plasma norepinephrine (NE) and epinephrine (E) levels. Chloralose anesthetized cats were randomized to a control group (C, n = 7), 20 cm segmental (S, n = 7), or complete intestinal ischemia (l, n = 7) for 90 min followed by reperfusion for 180 min. MLI and NE/E concentrations were assayed by radioimmunoassay and chromatography, respectively. Severe mucosal lesions and cardiovascular decompensation were observed in l animals in association with increased MLI and NE levels in femoral venous and portal venous plasma, whereas no such responses were observed in the S or C groups. MLI and NE concentrations were consistently higher in portal venous than in femoral venous plasma in 1 animals and correlations between MLI and NE levels were found during reperfusion in the portal, but not the systemic, circulation. Concentrations of E remained unchanged in all groups and did not correlate to MLI release. We conclude that: 1) intestinal MLI release and sympathetic activation occur only when the ischemic insult is sufficient to cause circulatory collapse, characteristic of an "on-off" rather than a "dose-response" pattern; and 2) intestinal MLI and NE release at reperfusion are correlated whereas MLI and E release do not appear to be related events.

Animals↗

PubMed1996

Effects of hypoperfusion on small-intestinal mucosal morphology and intestinal barrier function.

BACKGROUND: Our aim was to evaluate in vitro perfusion of the rat small intestine as a method to study the pathophysiology of hypoperfusion and to minimize its adverse effects. METHODS: Rat small intestine was perfused for 24 h using RPMI + albumin for the lumen and RPMI + erythrocyte concentration (Hct 20%) in the vasculature, at 22 degrees C, 15 degrees C, 10 degrees C, and 6 degrees C. The outcome was evaluated by histologic grading and permeability for polyethylene glycol 900 (PEG 900). RESULTS: Perfusion of the intestine at 6 degrees C resulted in lower degree of mucosal damage and permeation of PEG 900, compared with storage and perfusion at higher temperatures. CONCLUSIONS: In vitro perfusion of the small intestine, using histologic grading of mucosal lesions and permeation of PEG 900 as indicators, is one method that can be applied to study the pathophysiology of intestinal hypoperfusion. Perfusion at 6 degrees C significantly reduced the level of damage to the intestinal mucosa.

Animals↗

PubMed1996

Laparoscopic gastric bypass. Another option in bariatric surgery.

BACKGROUND: The present report describes the technical details of laparoscopic bypass for morbid obesity. METHODS: The laparoscopic approach was attempted in eight patients and completed in six. In these latter patients the stomach was divided with an endoscopic linear cutter (ETC 60 Ethicon), and a antecolic jejunal loop was brought to the proximal pouch and anastomosed by use of manual suture technique supported with locking clips for knotting substitutes [Lapra-Ty (Ethicon)]. Distal to the gastrojejunostomy a side-to-side enteroanastomosis was also performed. RESULTS: Five patients in whom the laparoscopic procedure was completed had an uneventful postoperative period and a rapid recovery. However, one patient had a postoperative left-sided pleuropneumonia that required prolonged hospital stay. Of those who were converted, one was because of a large steatotic left liver lobe and another was due to a perforation of the small intestine. CONCLUSIONS: These early results indicate that gastric bypass for the treatment of morbid obesity can be safely performed with laparoscopic techniques. Further development in this field should be encouraged.

Adult↗