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Biomedical subjects

P Nordin

Publications and source records attributed to P Nordin.

At least 19 recordsLinked to original sources
PubMed2006

Incisional hernia repair in Sweden 2002.

Incisional hernia is a common problem after abdominal surgery. The complication and recurrence rates following the different repair techniques are a matter of great concern. Our aim was to study the results of incisional hernia repair in Sweden. A questionnaire was sent to all surgical departments in Sweden requesting data concerning incisional hernia repair performed during the year 2002. Eight hundred and sixty-nine incisional hernia repairs were reported from 40 hospitals. Specialist surgeons performed the repair in 782 (83.8%) patients. The incisional hernia was a recurrence in 148 (17.0%) patients. Thirty-three per cent of the hernias were subsequent to transverse, subcostal or muscle-splitting incisions or laparoscopic procedures. Suture repair was performed in 349 (40.2%) hernias. Onlay mesh repair was more common than a sublay technique. The rate of wound infection was 9.6% after suture repair and 8.1% after mesh repair. The recurrence rate was 29.1% with suture repair, 19.3% with onlay mesh repair, and 7.3% with sublay mesh repair. This survey revealed that there is room for improvement regarding the incisional hernia surgery in Sweden. Suture repair, with its unacceptable results, is common and mesh techniques employed may not be optimal. This study has led to the instigation of a national incisional hernia register.

Adult↗
PubMed2006

Association between low concentrations of antibodies to protein alpha and Rib and invasive neonatal group B streptococcal infection.

BACKGROUND: Infection with group B streptococci (GBS) is a serious neonatal disease. The GBS cell surface proteins alpha and Rib elicit protective immunity in animal models and have been suggested as potential antigens in a vaccine against human GBS disease. AIMS: To test the hypothesis that transplacentally transferred maternal antibodies to GBS proteins contribute to the protection of the neonate from GBS infection. METHODS: Thirty neonates with invasive infection were included in a case-control study. IgG antibody concentrations were measured in sera from these neonates, their mothers, and from 60 non-infected controls, neonates as well as mothers. RESULTS: A clear association was found between concentrations of antibody to proteins alpha and Rib in neonatal and maternal sera, indicating that transplacental transfer had occurred. Moreover, low concentrations of antibodies to alpha and Rib in neonatal sera were associated with invasive GBS infection caused by strains expressing the Rib protein. The odds ratio was 0.0007 (95% confidence interval 0.000 to 0.54) for antibodies to alpha and 0.002 (95% confidence interval 0.000 to 0.57) for antibodies to Rib. CONCLUSION: These findings support the notion that antibodies to GBS surface proteins contribute to the protection against neonatal infection.

Adult↗
PubMed2005

Prospective evaluation of 6895 groin hernia repairs in women.

BACKGROUND: Although 8 per cent of groin hernia repairs are performed in women, there is little published literature relating specifically to women. This study compared differences in outcome between women and men after groin hernia repair. METHODS: Data collected prospectively in the Swedish Hernia Register between 1992 and 2003 were analysed, including 6895 groin hernia repairs in women and 83 753 in men. RESULTS: A higher proportion of emergency operations was carried out in women (16.9 per cent) than men (5.0 per cent), leading to bowel resection in 16.6 and 5.6 per cent respectively. During reoperation femoral hernias were found in 41.6 per cent of the women who were diagnosed with a direct or indirect inguinal hernia at the primary operation. The corresponding proportion for men was 4.6 per cent. The hernia repair was not classified as a standard operation (e.g. Shouldice, Lichtenstein, Plug/Mesh, TAPP/TEP) in 38.2 per cent of women and 11.2 per cent of men. Women had a significantly higher risk of reoperation for recurrence than men, and techniques associated with the lowest risk for reoperation in men had the highest risk in women. CONCLUSION: A greater proportion of women than men require emergency groin hernia repair, with consequently higher rates of bowel resection, complications and death. Surgical techniques developed for use in men may put women at unnecessary risk.

Adolescent↗
PubMed2004

Type of anaesthesia and patient acceptance in groin hernia repair: a multicentre randomised trial.

BACKGROUND: Groin hernia repair can be performed under general (GA), regional (RA), or local (LA) anaesthesia. This multicentre randomised trial evaluates patient acceptance, satisfaction, and quality of life with these three anaesthetic alternatives in hernia surgery. METHODS: One hundred and thirty-eight patients at three hospitals were randomised to one of three groups, GA, RA, or LA. Upon discharge, they were asked to complete a specially designed questionnaire with items focusing on pain, discomfort, recovery, and overall satisfaction with the anaesthetic method used. The global quality-of-life instrument EuroQol was used for estimation of health perceived. RESULTS: Significantly more patients in the LA group than in the RA group felt pain during surgery ( P<0.001). This pain was characterised as light or moderate and for the majority of LA patients was felt during infiltration of the anaesthetic agent. Postoperatively, patients in the LA group first felt pain significantly later than patients in the other two groups ( P=0.012) and significantly fewer LA patients consumed analgesics more than three times during the first postoperative day ( P=0.002). The results concerning nausea, vomiting, and time to first meal all favour LA. No difference was found among the three groups concerning overall satisfaction and quality of life. CONCLUSION: In a general surgical setting, we found LA to be well tolerated and associated with significant advantages compared to GA and RA.

Adult↗
PubMed2004

Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males.

BACKGROUND: Chronic pain is common after herniorrhaphy, but the effect of surgical technique (mesh versus non-mesh repair) and the social consequences of the pain have not been established. The aim of this study was to analyse chronic postherniorrhaphy pain and its social consequences in young males operated on for an indirect inguinal hernia with a Lichtenstein mesh repair, Shouldice or Marcy (annulorrhaphy) repair. METHODS: This was a postal questionnaire study carried out within the Danish and Swedish Hernia Database Collaboration. Some 2612 patients responded (response rate 80.9 per cent), of whom 1250 had undergone a Lichtenstein, 630 a Shouldice and 732 a Marcy repair. RESULTS: Chronic pain had been experienced within the previous month by 22.9 per cent of the patients who responded. There was an overall decrease in pain with time, from 29.7 per cent at 6-12 months to 18.1 per cent at 37-48 months after surgery, with no overall differences between the three types of repair. Pain was more common in patients younger than 40 years of age. Some 3.9 per cent of patients described the pain as moderate to severe and as frequent or constant. Of all patients with pain, 10.7 per cent experienced it as worse after than before surgery, and 56.6 per cent stated that it interfered with social activities. CONCLUSION: Chronic pain is common after primary inguinal hernia repair in young males, but there is no difference in the pain associated with open mesh and non-mesh repair.

Adolescent↗
PubMed2003

Influence of suture material and surgical technique on risk of reoperation after non-mesh open hernia repair.

BACKGROUND: Although mesh techniques are used with increasing frequency, sutured repair still has a place in groin hernia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh technique on the risk of reoperation in open groin hernia repair using data from the Swedish Hernia Register. METHODS: The relative risk of reoperation after sutured repair using non-absorbable, late absorbable and early absorbable sutures was compared in multivariate analyses, taking into account known confounding factors. RESULTS: Between 1992 and 2000, 46,745 hernia repairs were recorded in the Swedish Hernia Register. Of these, 18,057 repairs were performed with open non-mesh methods and were included in the analysis. Using non-absorbable suture as reference, the relative risk of reoperation after repair with early absorbable suture and late absorbable suture was 1.50 (95 per cent confidence interval (c.i.) 1.22 to 1.83) and 1.03 (95 per cent c.i. 0.83 to 1.28) respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk of reoperation (1.22, 95 per cent c.i. 1.03 to 1.44). CONCLUSION: A non-absorbable or a late absorbable suture is recommended for open non-mesh groin hernia repair. The Shouldice technique was found to be superior to other open methods.

Adolescent↗
PubMed2002

Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice.

BACKGROUND: The aim of the present randomized trial was to compare the Shouldice procedure and the Lichtenstein hernia repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice were able to reproduce the excellent results reported from specialist hernia centres. METHODS: Three hundred patients with primary inguinal hernia were randomized to either a Shouldice repair or to a tension-free Lichtenstein repair. In a pretrial training programme the five participating general surgeons were taught to perform the two techniques in a standard manner. Follow-up was performed after 8 weeks, 1 year and 3 years. The last examination was performed by an independent blinded assessor. RESULTS: There was a significant difference in operating time in favour of the Lichtenstein technique. After a follow-up of 36-77 months seven recurrences were found in the Shouldice group (95 per cent confidence interval (c.i.) 1.3 to 8.1) and one in the mesh group (95 per cent c.i. 0.0 to 2.0). Chronic groin pain was reported by 4.2 and 5.6 per cent in the Shouldice and Lichtenstein groups respectively. It was characterized as mild or moderate in all except two patients who had the Shouldice operation. CONCLUSION: Lichtenstein hernia repair was easier to learn, took less time and resulted in fewer recurrences. It was possible to achieve excellent results with this technique in a general surgical unit.

Adult↗
PubMed2001

Operative findings in recurrent hernia after a Lichtenstein procedure.

BACKGROUND: Recurrence after inguinal herniorraphy continues to be a problem, although the Lichtenstein technique (anterior, open fixated sheet mesh) is associated with reduced recurrence rates. Recurrence after Lichtenstein repair is suspected to be caused by insufficient fixation and overlap at the pubic tubercle. METHODS: A review was made of 87 records from operations for recurrence after a previous Lichtenstein procedure, based upon national and large area data bases, recording 95% (Denmark) and 50% (Sweden) of all inguinal hernia operations. RESULTS: Direct recurrences were found in 62%, whereas the remaining recurrences were either indirect (17%), femoral (13%), or other/unclassified (8%). CONCLUSION: The most plausible explanation for the development of the direct recurrences is an insufficient medial mesh fixation and overlap over the pubic tubercle. Avoidance of more than half of the recurrences after the Lichtenstein repair may be obtained by increased attention to this specific technical aspect of the operation.

Hernia, Inguinal↗
PubMed2001

Borrelia burgdorferi antibodies in outdoor and indoor workers in south-west Sweden.

Two hundred and fifty-three farmers and forest workers and 249 clerks from south-west Sweden were recruited to a cross-sectional seroprevalence study to find out if individuals working outdoors are more prone to acquire Borrelia burgdorferi infection than indoor workers and to find undiagnosed cases of Lyme borreliosis. The participants answered a questionnaire and blood specimens were collected to estimate the prevalence of antibodies to B. burgdorferi in each group. Sera were analysed with an enzyme-linked immunoassay technique to determine IgG antibodies to B. burgdorferi flagellum. The prevalence of B. burgdorferi antibodies was 7.6% in the farmers and forest workers vs. 5.3% in the clerks (adjusted odds ratio [age, sex] = 1.2 [95% confidence interval = 0.5-2.8]). One case of Lyme borreliosis was diagnosed. The positive predictive value of the antibody test was estimated to be 3% in the studied populations. B. burgdorferi infection is of low endemicity in south-west Sweden and is probably not an occupational risk among outdoor workers. Undiagnosed cases of Lyme borreliosis are uncommon. The test used is not acceptable for screening purposes.

Adult↗
PubMed2001

Reoperation after recurrent groin hernia repair.

OBJECTIVE: To analyze reoperation rates for recurrent and primary groin hernia repair documented in the Swedish Hernia Register from 1996 to 1998, and to study variables associated with increased or decreased relative risks for reoperation after recurrent hernia. METHODS: Data were retrieved for all groin hernia repairs prospectively recorded in the Swedish Hernia register from 1996 to 1998. Actuarial analysis adjusted for patients' death was used for calculating the cumulative incidence of reoperation. Relative risk for reoperation was estimated using the Cox proportional hazards model. RESULTS: From 1996 to 1998, 17,985 groin hernia operations were recorded in the Swedish Hernia Register, 15% for recurrent hernia and 85% for primary hernia. At 24 months the risk for having had a reoperation was 4.6% after recurrent hernia repair and 1.7% after primary hernia repair. The relative risk for reoperation was significantly lower for laparoscopic methods and for anterior tension-free repair than for other techniques. Postoperative complications and direct hernia were associated with an increased relative risk for reoperation. Day-case surgery and local infiltration anesthesia were used less frequently for recurrent hernia than for primary hernia. CONCLUSIONS: Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community. This study supports the use of mesh by laparoscopy or anterior tension-free repair for recurrent hernia operations.

Hernia, Inguinal↗
PubMed2000

Mucosal human papillomavirus types in squamous cell carcinomas of the uterine cervix and subsequently on fingers.

Human papillomavirus (HPV), especially type 16, is causally involved in the pathogenesis of anogenital cancer. There is an increasing number of reports of HPV infections in squamous cell carcinoma (SCC) of the fingers. A search of the Swedish cancer register covering the period 1958-94 inclusive for women with a history of genital and upper extremity SCC revealed 63 cases. Archival material from both cervical and cutaneous lesions was traced and analysed for the presence of HPV DNA in 32 of these patients. A newly developed 'neighbour primer' polymerase chain reaction (PCR) for HPV 16 DNA, aimed at overcoming the obstacle of cross-linked target DNA, was shown to be superior to conventional general and type-specific HPV PCR tests. HPV DNA was significantly more frequently found in digital tumours than in tumours at other cutaneous sites of the upper extremities [67% (10 of 15) vs. 7% (three of 43); P < 0.001]. Among 13 patients with a history of both cervical and finger SCC, HPV 16 was found in cervical samples from seven patients. From five of these seven patients, HPV 16 was also present in the corresponding finger lesions. The results support the hypothesis of a possible transmission of patients' genital HPV infections to fingers.

Aged↗
PubMed2000

An open study of efficacy and safety of long-term treatment with mometasone furoate fatty cream in the treatment of adult patients with atopic dermatitis.

BACKGROUND: Atopic dermatitis is a severe chronic skin disease often deteriorated by the presence of microorganisms and often responds well to treatment with potent corticosteroids. However, the long-term use of potent topical corticosteroids are accompanied by side-effects such as skin atrophy. OBJECTIVE: To study the effect and safety of prophylactic treatment with mometasone furoate fatty cream (contains hexylene glycol) for 6 months in patients with atopic dermatitis. RESULTS: Sixty-one of 68 (90%) patients were still free of their disease after 6 months of twice weekly treatment and only one showed possible treatment related signs of skin atrophy. The number of Staphylococcus aureus and Pityrosporum ovale were significantly reduced in cleared patients. CONCLUSIONS: Mometasone furoate fatty cream is effective and safe both for treatment and as a prophylaxis in patients with atopic dermatitis.

Administration, Topical↗
PubMed1999

Curettage-cryosurgery for non-melanoma skin cancer of the external ear: excellent 5-year results.

In this 5-year follow-up study, 60 auricular non-melanoma skin cancers, selected at a skin tumour clinic, were treated by a thorough curettage with different sized curettes followed by cryosurgery in a double freeze-thaw cycle. Tumours of the external auditory canal were excluded. Forty-seven basal cell carcinomas (BCCs), nine squamous cell carcinomas (SCCs), three Bowen's disease and one basisquamous cancer were included. The mean diameter of the malignancies was 18 mm (range 5-70). Morphoeiform BCCs, recurrent BCCs with fibrotic component and most of the SCCs were selected for Mohs' micrographic surgery. Forty-two patients with 47 tumours were followed-up for at least 5 years with only one recurrence. Thirteen patients, followed-up for 2-4 years, died from other causes with no sign of recurrence at their last visit. No major problems after treatment were registered and the cosmetic result was good or acceptable in all patients.

Adult↗
PubMed1997

Influence of infant feeding and gluten intake on coeliac disease.

OBJECTIVES: To study the impact of infant feeding habits and actual gluten intake on gluten induced enteropathy. METHODS: A case-referent design, controlling for the HLA alleles conferring increased genetic risk, was used. All 164 siblings of 97 probands were investigated. Eighty five of the siblings, carrying the genes DQA1*0501-DQB1*02 conferring susceptibility for the disease, were investigated by interview, food recording, and taking a small intestinal biopsy sample. Eight cases of silent coeliac disease were found and these were compared with the 73 siblings in whom the diagnosis was excluded. RESULTS: No statistically significant differences were found between cases and referents in terms of duration of breast feeding, age at introduction of cows' milk products, frequency of breast feeding after gluten introduction, and gluten consumption. CONCLUSIONS: The studies factors may be of less importance for the development of gluten induced enteropathy.

Adolescent↗
PubMed1997

Pityriasis versicolor: clinical experience with Lamisil cream and Lamisil DermGel.

Pityriasis versicolor is a chronic superficial fungal disease usually located on the upper trunk, neck or upper arms. Terbinafine is an orally and topically active allylamine antifungal derivative with a broad antifungal spectrum. Several studies have documented the high activity of terbinafine (Lamisil) cream in the treatment of pityriasis versicolor, with cure rates of 79-100% after 2-4 weeks of treatment. Lamisil emulsion gel (Lamisil DermGel) is a new topical formulation that remains in the skin in high concentrations for several months after just 1 week of application. Recently, in a prospective, double-blind, placebo-controlled, randomised, parallel-group, comparative, multicentre study, we have treated patients with pityriasis versicolor with either terbinafine 1% emulsion gel (Lamisil DermGel) or placebo gel. Sixty-one patients were included, 31 in the Lamisil DermGel group and 30 in the placebo gel group. The gel was applied once daily for 7 days and the patients were followed up for 8 weeks. Twenty-eight patients in the active and 29 patients in the placebo group were evaluable for efficacy. Using the intent-to-treat efficacy analysis, 21/28 (75%) were cured in the Lamisil-DermGel-treated group compared to 4/29 (14%) in the placebo group. No side-effects were seen. In conclusion, Lamisil DermGel was well tolerated and superior to placebo in the treatment of pityriasis versicolor when applied once daily for 7 days.

Administration, Topical↗
PubMed1997

Five-year results of curettage-cryosurgery of selected large primary basal cell carcinomas on the nose: an alternative treatment in a geographical area underserved by Mohs' surgery.

Mohs' micrographic surgery (MMS) is the recommended treatment for large basal cell carcinomas (BCCs) of the nose. This 5-year follow-up study attempts to evaluate whether curettage-cryosurgery (CC) could be an alternative therapy in a country where optimal resources for MMS are lacking. All patients with a primary nasal or perinasal BCC, 10 mm or larger in diameter, were assessed at a skin tumour clinic. Sixty-one BCCs of non-morphoeiform type were treated with CC. Most of the tumour was removed by careful curettage with different sized curettes. The tumour area was then frozen with liquid nitrogen in a double freeze-thaw cycle. Fifty patients were followed for at least 5 years with only one recurrence. The cosmetic result was good or acceptable in all patients. A thorough curettage followed by cryosurgery could be a safe and inexpensive alternative therapy even for large primary non-morphoeiform BCCs of the nose.

Adult↗
PubMed1997

DNA analysis indicates patient-specific human papillomavirus type 16 strains in Bowen's disease on fingers and in archival samples from genital dysplasia.

Human papillomavirus (HPV) type 16 is casually involved in the pathogenesis of anogenital cancer and has also been demonstrated in some patients with Bowen's disease (BD) on the fingers. From two women with HPV 16 in BD on the fingers, and in archival samples from genital dysplasia, collected as long as 26 years ago, the non-coding region of the virus was amplified by the polymerase chain reaction and sequenced. The HPV 16 DNA sequences found in the finger lesions and in the genital archival samples showed no diversities within single patients. Compared with an HPV 16R reference sequence, one patient showed a unique T nucleotide at position 78, whereas the other patient exhibited T and A nucleotides at positions 7193 and 7521, respectively. In one of the patients, the same strain of HPV 16 was found in a digital tumour 26 years after its clearance from the genital tract. DNA sequence analysis indicated patient-specific HPV 16 strains. Auto-inoculation from the genital tract was favoured as a plausible explanation of why HPV 16 caused BD on the fingers.

Adult↗