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Selin D, Maret-Ouda J, Oskarsson V, Lindblad M, Arnelo U, Holmberg M, Yang B, Sema K, Nilsson M, Sadr-Azodi O. Exploring the association between acute pancreatitis and biliary tract cancer: A large-scale population-based matched cohort study. United European Gastroenterol J 2024. [PMID: 38581617 DOI: 10.1002/ueg2.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/08/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Biliary tract cancer (BTC) often goes undetected until its advanced stages, resulting in a poor prognosis. Given the anatomical closeness of the gallbladder and bile ducts to the pancreas, the inflammatory processes triggered by acute pancreatitis might increase the risk of BTC. OBJECTIVE To assess the association between acute pancreatitis and the risk of BTC. METHODS Using the Swedish Pancreatitis Cohort (SwePan), we compared the BTC risk in patients with a first-time episode of acute pancreatitis during 1990-2018 to a 1:10 matched pancreatitis-free control group. Multivariable Cox regression models, stratified by follow-up duration, were used to calculate hazard ratios (HRs), adjusting for socioeconomic factors, alcohol use, and comorbidities. RESULTS BTC developed in 0.94% of 85,027 acute pancreatitis patients and in 0.23% of 814,993 controls. The BTC risk notably increased within 3 months of hospital discharge (HR 82.63; 95% CI: 63.07-108.26) and remained elevated beyond 10 years of follow-up (HR 1.82; 95% CI: 1.35-2.47). However, the long-term risk of BTC subtypes did not increase with anatomical proximity to the pancreas, with a null association for gallbladder and extrahepatic tumors. Importantly, patients with acute pancreatitis had a higher occurrence of early-stage BTC within 2 years of hospital discharge than controls (13.0 vs. 3.6%; p-value <0.01). CONCLUSION Our nationwide study found an elevated BTC risk in acute pancreatitis patients; however, the risk estimates for BTC subtypes were inconsistent, thereby questioning the causality of the association. Importantly, the amplified detection of early-stage BTC within 2 years after a diagnosis of acute pancreatitis underscores the necessity for proactive BTC surveillance in these patients.
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Affiliation(s)
- Daniel Selin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden
| | - John Maret-Ouda
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Oskarsson
- Department of Public Health and Clinical Medicine, Piteå Research Unit, Umeå University, Umeå, Sweden
| | - Mats Lindblad
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Urban Arnelo
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Marcus Holmberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden
| | - Bei Yang
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Kristiana Sema
- Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden
| | - Omid Sadr-Azodi
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden
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Sparrelid E, Ghorbani P, Holmberg M. Lymph node ratio in resected pancreatic head cancers: time for a broader clinical implementation? Hepatobiliary Surg Nutr 2024; 13:374-375. [PMID: 38617491 PMCID: PMC11007331 DOI: 10.21037/hbsn-23-670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Ernesto Sparrelid
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Poya Ghorbani
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Holmberg
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgery and Oncology, Sankt Görans Hospital, Stockholm, Sweden
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Subramanian N, Wiik A, Rullman E, Melin M, Lundberg TR, Flanagan J, Holmberg M, Dekanski A, Dhejne C, Arver S, Gustafsson T, Laurencikiene J, Andersson DP. Adipokine secretion and lipolysis following gender-affirming treatment in transgender individuals. J Endocrinol Invest 2024:10.1007/s40618-024-02323-4. [PMID: 38460092 DOI: 10.1007/s40618-024-02323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/28/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND The organ-specific effects of gender-affirming sex hormone treatment (GAHT) in transgender women (TW) and transgender men (TM) are insufficiently explored. This study investigated the effects of GAHT on adipose tissue function. METHODS In a single-center interventional prospective study, 32 adults undergoing GAHT, 15 TW and 17 TM, were examined with anthropometry and abdominal subcutaneous adipose tissue biopsies obtained before initiation of treatment, 1 month after endogenous sex hormone inhibition and three and 11 months after initiated GAHT. Fat cell size, basal/stimulated lipolysis and cytokine secretion in adipose tissue were analyzed. RESULTS TW displayed an increase in complement component 3a and retinol-binding protein 4 (RBP4) secretion after sex hormone inhibition, which returned to baseline following estradiol treatment. No changes in lipolysis were seen in TW. TM showed downregulation of RBP4 after treatment, but no changes in basal lipolysis. In TM, the estrogen suppression led to higher noradrenaline stimulated (NA) lipolysis that was normalized following testosterone treatment. At 11 months, the ratio of NA/basal lipolysis was lower compared to baseline. There were no significant changes in fat cell size in either TW or TM. CONCLUSION In TW, gonadal hormone suppression results in transient changes in cytokines and in TM there are some changes in NA-stimulated lipolysis following testosterone treatment. However, despite the known metabolic effects of sex hormones, the overall effects of GAHT on adipose tissue function are small and likely have limited clinical relevance, but larger studies with longer follow-up are needed to confirm these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02518009, Retrospectively registered 7 August 2015.
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Affiliation(s)
- N Subramanian
- Lipid Laboratory, Department of Medicine Huddinge (H7), Karolinska Institutet, C2:94, Karolinska University Hospital Huddinge, 141 86, Huddinge, Sweden
| | - A Wiik
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - E Rullman
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Melin
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - T R Lundberg
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - J Flanagan
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Holmberg
- Lipid Laboratory, Department of Medicine Huddinge (H7), Karolinska Institutet, C2:94, Karolinska University Hospital Huddinge, 141 86, Huddinge, Sweden
- ANOVA, Andrology, Sexual Medicine and Transgender Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - A Dekanski
- Lipid Laboratory, Department of Medicine Huddinge (H7), Karolinska Institutet, C2:94, Karolinska University Hospital Huddinge, 141 86, Huddinge, Sweden
| | - C Dhejne
- ANOVA, Andrology, Sexual Medicine and Transgender Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - S Arver
- ANOVA, Andrology, Sexual Medicine and Transgender Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - T Gustafsson
- Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - J Laurencikiene
- Lipid Laboratory, Department of Medicine Huddinge (H7), Karolinska Institutet, C2:94, Karolinska University Hospital Huddinge, 141 86, Huddinge, Sweden
| | - D P Andersson
- Lipid Laboratory, Department of Medicine Huddinge (H7), Karolinska Institutet, C2:94, Karolinska University Hospital Huddinge, 141 86, Huddinge, Sweden.
- Department of Endocrinology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Perri G, Romandini E, Marchegiani G, Ghorbani P, Sahakyan M, Holmberg M, Cattelani A, Fretland Å, Montorsi R, Rodrigues ID, Kleive D, Bannone E, Edwin B, Gilg S, Labori K, Sparrelid E, Salvia R. Postoperative Hyperamylasemia (POH) is an Early Predictor of Pancreatic Fistula Occurrence and Severity after Distal Pancreatectomy: Results from a European Multicentric Study. Ann Surg 2024:00000658-990000000-00766. [PMID: 38305035 DOI: 10.1097/sla.0000000000006222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVES The aim of this international multicentric study is to characterize postoperative hyperamylasemia (POH) after distal pancreatectomy (DP), with particular focus on its relationship with postoperative pancreatic fistula (POPF) occurrence and severity. BACKGROUND The clinical relevance of POH after DP and its relationship with the occurrence and severity of POPF have not been explored yet. METHODS All patients undergoing DP for any indication between 2015 and 2021 at three European referral Centers for pancreatic surgery were retrospectively analyzed. Drain fluid amylase (DFA), C-reactive protein (C-RP), and serum amylase were examined from postoperative-day (POD) 1 to 3. Biochemical leak (BL), POPF, POH, and post-pancreatectomy hemorrhage (PPH) were defined and graded according to ISGPS definitions. RESULTS In total 1192 patients were included. Overall rates of POH and POPF were 18% (n= 210) and 29% (n= 344), respectively. The presence of DFA ≥2000 U/L on POD 1 (OR=2.11, 95% CI 1.68-2.86), C-RP ≥200 mg/L on POD 3 (OR=2.19, 95% CI 1.68-2.86), and POH (OR=1.58, 95% CI 1.14-2.19) were all independent early predictors of POPF (all P< 0.01). The presence of POH almost doubled the rate of POPF (43% vs. 26%, P<0.001), and higher POPF severity presented also higher POH rates (no POPF= 12%; BL= 19%; B POPF= 24%; C POPF= 52%). Among patients developing POPF, patients with POH had higher rates of PPH (22% vs 9%, P= 0.001), sepsis (24% vs 13%; P=0.011), re-operation (21% vs 8%; P< 0.01), and mortality (3% vs 0.3%; P= 0.025). CONCLUSIONS The occurrence of POH is an early predictor of POPF and its severity after DP. The diagnosis of POH might define patients at higher risk for a complicated course, targeting them for prevention / mitigation strategies against pancreas specific complications.
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Affiliation(s)
- Giampaolo Perri
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
| | - Elisa Romandini
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Giovanni Marchegiani
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
- University of Padua, Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepato-pancreato-biliary and Liver Transplant Surgery (Padua, Italy)
| | - Poya Ghorbani
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
| | - Musheg Sahakyan
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Marcus Holmberg
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
- St Görans Hospital, Emergency, Upper GI, Bariatric and Abdominal wall surgery (Stockholm, Sweden)
| | - Alice Cattelani
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| | - Åsmund Fretland
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Roberto Montorsi
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| | - Isabella D Rodrigues
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| | - Dyre Kleive
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Elisa Bannone
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| | - Bjørn Edwin
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Stefan Gilg
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
| | - Knut Labori
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Ernesto Sparrelid
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
| | - Roberto Salvia
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
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5
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Linder S, Holmberg M, Agopian-Dahlenmark L, Zhao H, Åkerström JH, Sparrelid E, Ghorbani P. Endoscopic main duct stenting in refractory postoperative pancreatic fistula after distal pancreatectomy - a friend or a foe? BMC Surg 2024; 24:33. [PMID: 38267861 PMCID: PMC10809585 DOI: 10.1186/s12893-023-02233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/16/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Clinically relevant (CR) postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) are common. Endoscopic treatment (ET) has only scarcely been explored. The aim of this study was to evaluate risk factors for CR POPF after DP and the efficacy of ET in adjunct to standard therapy. METHODS Consecutive patients without previous pancreatic surgery who underwent DP between 2011 and 2020 were evaluated, analyzing risk factors for CR POPF. The choice and performance of ET, main pancreatic duct (MPD) stenting, was not standardized. Healing time and complications after ET were registered. RESULTS 406 patients underwent DP, CR POPF occurred in 29.6%. ET was performed in 17 patients 27 days (median) after index surgery. Risk for CR POPF was increased in ASA-PS 1-2 patients, MPD ≤ 3 mm, procedure time ≥ 3 h, and CRP ≥ 180 on postoperative day 3. POPF resolved with standard treatment after 32 days and 59 days in the ET group (p < 0.001). There was one mortality in the ET-group (not procedure related). Mild post-ERCP pancreatitis occurred in three patients. CONCLUSIONS CR POPF is common after DP. Long operating time, a narrow MPD, low ASA score, and high postoperative CRP were risk factors for CR POPF. ET was not beneficial but proper evaluation was not possible due to few patients and non-standardized treatment. Complications after ET appeared mild.
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Affiliation(s)
- Stefan Linder
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
- Karolinska University Hospital, Stockholm, Sweden.
| | - Marcus Holmberg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden
| | | | - Helena Zhao
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Hardvik Åkerström
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
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Swartling O, Evans M, Larsson P, Perri G, Yarbakht D, Al-Kamil H, Gilg S, Holmberg M, Sparrelid E, Ghorbani P. Preoperative chronic kidney disease and complications after pancreatoduodenectomy: a retrospective cohort study. ANZ J Surg 2023; 93:2492-2498. [PMID: 37654154 DOI: 10.1111/ans.18677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Chronic kidney disease is a prevalent condition in surgical patients. Possible associations with increased postoperative morbidity and mortality have not been clearly demonstrated in patients undergoing pancreatoduodenectomy. The aim of this study was to assess the risk of postoperative complications in patients with reduced kidney function undergoing pancreatoduodenectomy. METHODS All patients undergoing pancreatoduodenectomy at Karolinska University Hospital between 2008 and 2019 were retrospectively included. The variable of interest was chronic kidney disease, based on preoperative estimated glomerular filtration rate measurements. Unadjusted and adjusted logistic regression analyses were performed for standardized postoperative complications. RESULTS A total of 971 patients were included in the study, of whom 92 (10%) had an estimated glomerular filtration rate < 60 mL/min/1.73m2 , equivalent to chronic kidney disease Stage 3a or worse. Patients with chronic kidney disease had a higher odds of longer hospital stay (adjusted odds ratio 1.58, 95% confidence interval 1.00-2.50) and postoperative weight increase (adjusted odds ratio 2.02, 1.14-3.56). A 10 unit increase of preoperative estimated glomerular filtration rate was associated to lower odds of intensive care unit admission (adjusted odds ratio 0.81, 0.69-0.95), delayed gastric emptying (adjusted odds ratio 0.90, 0.81-0.99), and post-operative pancreatic fistula (adjusted odds ratio 0.83, 0.74-0.94). CONCLUSION Patients undergoing pancreatoduodenectomy with decreased preoperative kidney function are more likely to experience major postoperative complications, and also postoperative weight increase. Preoperative kidney function assessment is important in risk stratification before pancreatoduodenectomies.
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Affiliation(s)
- Oskar Swartling
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Evans
- Renal Unit, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Larsson
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Giampaolo Perri
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Danial Yarbakht
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Hussein Al-Kamil
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Gilg
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Holmberg
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ernesto Sparrelid
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Poya Ghorbani
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
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Strijbos RM, Straatman LV, Stegeman I, Holmberg M, Johansson ML, Stokroos RJ. Health Economic Cost Analysis for Percutaneous Bone Conduction Devices: The Minimally Invasive Ponto Surgery Versus Linear Incision Technique with Tissue Preservation. Otol Neurotol 2023:00129492-990000000-00325. [PMID: 37400140 DOI: 10.1097/mao.0000000000003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVES To identify differences in mean cost per patient between the Minimally Invasive Ponto Surgery (MIPS) and the linear incision technique with tissue preservation (LITT-P). STUDY DESIGN Health economic cost analysis. SETTING The analysis was performed in a randomized multicenter controlled trial cohort. PATIENTS Adult patients eligible for unilateral bone conduction device surgery. INTERVENTIONS MIPS versus LITT-P surgery for bone conduction device implantation. MAIN OUTCOME MEASURES Perioperative and postoperative costs were identified and compared. RESULTS The difference in mean cost per patient between both techniques was €77.83 in favor of the MIPS after 22 months follow-up. The mean costs per patient were lower in the MIPS cohort for surgery (€145.68), outpatient visits (€24.27), systemic antibiotic therapy with amoxicillin/clavulanic acid (€0.30) or clindamycin (€0.40), abutment change (€0.36), and abutment removal (€0.18). The mean costs per patient were higher for implant and abutment set (€18.00), topical treatment with hydrocortison/oxytetracycline/polymyxine B (€0.43), systemic therapy with azithromycin (€0.09) or erythromycin (€1.15), local revision surgery (€1.45), elective explantation (€1.82), and implant extrusion (€70.42). Additional analysis of scenarios in which all patients were operated under general or local anesthesia or with recalculation when using current implant survival rates showed that differences in mean cost per patient were also in favor of the MIPS. CONCLUSION The difference between the MIPS and the LITT-P in mean cost per patient was €77.83 in favor of the MIPS after 22 months of follow-up. The MIPS is an economically responsible technique and could be promising for the future.
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Djoumi Y, Sadr-Azodi O, Vujasinovic M, Del Chiaro M, Sparrelid E, Ghorbani P, Holmberg M. Pre-emptive resection for intraductal papillary mucinous neoplasia - Long-term outcome is similar between non-invasive and early invasive lesions in a tertiary single center. Pancreatology 2023; 23:389-395. [PMID: 37002181 DOI: 10.1016/j.pan.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Pre-emptive resection for intraductal papillary mucinous neoplasm (IPMN) aims to reduce the risk before invasive transformation has taken place. Pancreatic resections are highly associated with major morbidity and mortality. Long-term overall survival (OS) after resection for invasive IPMN (inv-IPMN) in early stages is favorable. Comparison of long-term OS for resected non-invasive IPMN and early staged inv-IPMN is poorly delineated. This study aims to compare outcomes for resected non-invasive IPMN and T1-staged inv-IPMN. METHODS All patients ≥18 years of age resected for IPMN up to stage T1 at Karolinska University Hospital between 2008 and 2020 were included. Two-year OS were compared between groups by chi-squared test, and 5-year OS was estimated using Kaplan-Meier method. Covariates associated with death was assessed in multivariable Cox regression model. RESULTS We included 284 patients, 264 (93%) non-invasive IPMN and 20 (7%) T1-staged inv-IPMN. Dysplasia of low grade (LGD) and high grade, i.e., tumor in situ (Tis) were present in 190 (67%) and 75 (26%) patients respectively. The 2-year OS for the entire cohort was 96%, and there were no differences between non-invasive and inv-IPMN (96% vs 92%, p = 0.203), nor between IPMN with LGD and Tis-T1b-staged IPMN (96% vs 95%, p = 0.734). CONCLUSION Two thirds of the specimen from pre-emptive resections were of LGD and did not involve superior OS than in situ or early cancer. Due to high complication burden, efforts should be made to avoid resection when LGD is probable and rather identify more accurate predictors for surgery.
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Affiliation(s)
- Yasmine Djoumi
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Omid Sadr-Azodi
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Gastrointestinal Surgery, Capio S.t Görans Hospital, Stockholm, Sweden
| | - Miroslav Vujasinovic
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado, Anschutz Medical Campus, Denver, USA
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Poya Ghorbani
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Holmberg
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Gastrointestinal Surgery, Capio S.t Görans Hospital, Stockholm, Sweden.
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Swartling O, Evans M, Larsson P, Gilg S, Holmberg M, Klevebro F, Löhr M, Sparrelid E, Ghorbani P. Risk factors for acute kidney injury after pancreatoduodenectomy, and association with postoperative complications and death. Pancreatology 2023; 23:227-233. [PMID: 36639282 DOI: 10.1016/j.pan.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with increased morbidity and mortality after general surgery, although little is known among patients undergoing pancreatoduodenectomy. The objective was to investigate the association between AKI and postoperative complications and death after pancreatoduodenectomy. METHODS All patients ≥18 years who underwent a pancreatoduodenectomy 2008-2019 at the Karolinska University Hospital, Stockholm, Sweden, were included. Standardized criteria for AKI, including estimated glomerular filtration rate (eGFR) and urine volume measurements, were used to grade postoperative AKI. RESULTS In total, 970 patients were included with a median age of 68 years (IQR 61-74) of whom 517 (53.3%) were men. There were 137 (14.1%) patients who developed postoperative AKI. Risk factors for AKI included lower preoperative eGFR, cardiovascular disease and treatment with renin-angiotensin system inhibitors or diuretics. Those who developed AKI had a higher risk of severe postoperative complications, including Clavien-Dindo score ≥ IIIa (adjusted OR 3.35, 95% CI 2.24-5.01) and ICU admission (adjusted OR 7.83, 95% CI 4.39-13.99). In time-to-event analysis, AKI was associated with an increased risk for both 30-day mortality (adjusted HR 4.51, 95% CI 1.54-13.27) and 90-day mortality (adjusted HR 4.93, 95% CI 2.37-10.26). Patients with benign histology and AKI also had an increased 1-year mortality (HR 4.89, 95% CI 1.88-12.71). CONCLUSIONS Postoperative AKI was associated with major postoperative complications and an increased risk of postoperative mortality. Monitoring changes in serum creatinine levels and urine volume output could be important in the immediate perioperative period to improve outcomes after pancreatoduodenectomy.
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Affiliation(s)
- Oskar Swartling
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Evans
- Renal Unit, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Larsson
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Gilg
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Holmberg
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Klevebro
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Matthias Löhr
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
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Holmberg M, Radkiewicz C, Strömberg C, Öman M, Ghorbani P, Löhr JM, Sparrelid E. Outcome after surgery for invasive intraductal papillary mucinous neoplasia compared to conventional pancreatic ductal adenocarcinoma - A Swedish nationwide register-based study. Pancreatology 2023; 23:90-97. [PMID: 36522260 DOI: 10.1016/j.pan.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/08/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The clinical importance of intraductal papillary mucinous neoplasm (IPMN) have increased last decades. Long-term survival after resection for invasive IPMN (inv-IPMN) compared to conventional pancreatic ductal adenocarcinoma (PDAC) is not thoroughly delineated. OBJECTIVE This study, based on the Swedish national pancreatic and periampullary cancer registry aims to elucidate the outcome after resection of inv-IPMN compared to PDAC. METHODS All patients ≥18 years of age resected for inv-IPMN and PDAC in Sweden between 2010 and 2019 were included. Clinicopathological variables were retrieved from the national registry. The effect on death was assessed in two multivariable Cox regression models, one for patients resected 2010-2015, one for patients resected 2016-2019. Median overall survival (OS) was estimated using the Kaplan-Meier method. RESULTS We included 1909 patients, 293 inv-IPMN and 1616 PDAC. The most important independent predictors of death in multivariable Cox regressions were CA19-9 levels, venous resection, tumour differentiation, as well as T-, N-, M-stage and surgical margin. Tumour type was an independent predictor for death in the 2016-2019 cohort, but not in the 2010-2015 cohort. In Kaplan-Meier survival analysis, inv-IPMN was associated with longer median OS in stage N0-1 and in stage M0 compared to PDAC. However, in stage T2-4 and stage N2 median OS was similar, and in stage M1 even shorter for inv-IPMN compared to PDAC. CONCLUSION In this population-based nationwide study, outcome after resected inv-IPMN compared to PDAC is more favourable in lower stages, and similar to worse in higher.
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Affiliation(s)
- Marcus Holmberg
- Department of Upper Digestive Diseases, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden.
| | - Cecilia Radkiewicz
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Cecilia Strömberg
- Department of Upper Digestive Diseases, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Mikael Öman
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Sweden
| | - Poya Ghorbani
- Department of Upper Digestive Diseases, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - J-Matthias Löhr
- Department of Upper Digestive Diseases, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Ernesto Sparrelid
- Department of Upper Digestive Diseases, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
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Larsson P, Feldt K, Holmberg M, Swartling O, Sparrelid E, Klevebro F, Ghorbani P. Preoperative heart disease and risk for postoperative complications after pancreatoduodenectomy. HPB (Oxford) 2022; 24:1854-1860. [PMID: 35872123 DOI: 10.1016/j.hpb.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/11/2022] [Accepted: 07/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Comorbidities increase the risk for postoperative complications after pancreatoduodenectomy. The importance of different categories of heart disease on postoperative outcomes has not been thoroughly studied. METHODS Patients aged ≥18 years undergoing pancreatoduodenectomy between 2008 and 2019 at Karolinska University Hospital, Sweden were included. Heart disease was defined as a preoperatively established diagnosis, and subcategorized into ischaemic, valvular, heart failure and atrial fibrillation. Postoperative outcome was analysed by multivariable regression. RESULTS Out of 971 patients, 225 (23.3%) had heart disease. Heart disease was associated with an increased risk for complications; Clavien-Dindo score ≥ IIIa (Odds Ratio [OR] 1.53, 95% confidence interval [CI] 1.07-2.18; p = 0.019), intensive care unit admissions (OR 3.20, 95% CI 1.81-5.66; p < 0.001) and longer hospitalizations (median 14 vs. 11 days; p < 0.001). Although heart disease was not associated with 90-day mortality, it conferred a shorter median overall survival (22 vs. 32 months; p < 0.001). Atrial fibrillation and heart failure were each associated with increased risk for postoperative complications, whereas ischaemic and valvular heart disease were not. CONCLUSION Atrial fibrillation and heart failure were independently associated with increased risk for postoperative complications. Despite no association with early postoperative mortality, heart disease negatively affected long-term survival.
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Affiliation(s)
- Patrik Larsson
- Department of Surgery, Skelleftea County Hospital, Skelleftea, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Kari Feldt
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Holmberg
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Oskar Swartling
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Klevebro
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Poya Ghorbani
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
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12
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Perri G, Bortolato C, Marchegiani G, Holmberg M, Romandini E, Sturesson C, Bassi C, Sparrelid E, Ghorbani P, Salvia R. Pure biliary leak vs. pancreatic fistula associated: non-identical twins following pancreatoduodenectomy. HPB (Oxford) 2022; 24:1474-1481. [PMID: 35367129 DOI: 10.1016/j.hpb.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/23/2022] [Accepted: 03/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary leak (BL) after pancreatoduodenectomy (PD) may have diffrent severity depending on its association with postoperative pancreatic fistula (POPF). METHODS Data of 2715 patients undergoing PD between 2011 and 2020 at two European third-level referral Centers for pancreatic surgery were retrospectively reviewed. These included BL incidences, grading, outcomes, specific treatments, and association with POPF. RESULTS BL occurred in 6% of patients undergoing PD. Among 143 BL patients, 47% had an associated POPF and 53% a pure BL. Major morbidity (64% vs 36%) and mortality (19% vs 4%) were higher in POPF-associated BL group (all P< 0.01). Day of BL onset was similar between groups (POD 2 vs 3; P = 0.2), while BL closure occurred earlier in pure BL (POD 12 vs 23; P < 0.01). Conservative treatment was more frequent (55% vs 15%; P < 0.01), and the rate of percutaneous and/or trans-hepatic drain placement was lower (30% vs 16%; P = 0.04) in pure BL group. Relaparotomy was more common in POPF-associated BL group (42% VS 17%; P < 0.01) but was performed earlier in pure BL (POD 2 vs 10; P = 0.02). CONCLUSIONS Pure BL represents a more benign entity, managed conservatively in half of the cases.
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Affiliation(s)
- Giampaolo Perri
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Cecilia Bortolato
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy; Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.
| | - Marcus Holmberg
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Romandini
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Christian Sturesson
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
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13
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Holmberg M, Linder S, Kordes M, Liljefors M, Ghorbani P, Löhr JM, Sparrelid E. Impact of spatio-temporal recurrence pattern on overall survival for invasive intraductal papillary mucinous neoplasia - A comparison with pancreatic ductal adenocarcinoma. Pancreatology 2022; 22:598-607. [PMID: 35501218 DOI: 10.1016/j.pan.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Resections for intraductal papillary mucinous neoplasia (IPMN) have increased dramatically during the last decade. Recurrence pattern and impact of adjuvant chemotherapy for solid pancreatic ductal adenocarcinoma (PDAC) is well known, but not for invasive IPMN (inv-IPMN). OBJECTIVES To elucidate the impact of spatio-temporal recurrence pattern and adjuvant chemotherapy on overall survival for inv-IPMN compared with PDAC. METHODS We conducted a retrospective single-center observational study of consecutive patients ≥18 years of age who underwent resection for inv-IPMN or PDAC at Karolinska University Hospital, between 2009 and 2018. Different initial recurrence sites and time frames as well as predictors for death were assessed with multivariable Cox and logistic regressions. Survival analyses were performed using the Kaplan-Meier model and log rank test. RESULTS Of 396 resected patients, 92 were inv-IPMN and 304 PDAC. Both recurrence rate and death rate within three-years were lower for inv-IPMN compared to PDAC (p = 0.006 and p = 0.007 respectively). Across the whole cohort, the most common recurrence patterns were multi-site (25%), single-site liver (21%) and single-site locoregional (10%) recurrence. The most prominent predictors for death in multivariable Cox regression, especially if occurred within the first year, were multi-site (HR 17.0), single-site peritoneal (HR 13.6) and single-site liver (HR 13.1) recurrence. These predictors were less common in inv-IPMN compared to PDAC (p = 0.007). The effect of adjuvant chemotherapy was similar in the two groups. CONCLUSION Resected inv-IPMN exhibits a less aggressive recurrence pattern than PDAC that translates into a more favorable overall survival.
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Affiliation(s)
- Marcus Holmberg
- Division of Upper Gastrointestinal Diseases, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
| | - Stefan Linder
- Division of Upper Gastrointestinal Diseases, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Maximilian Kordes
- Division of Upper Gastrointestinal Diseases, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Maria Liljefors
- Division of Upper Gastrointestinal Diseases, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Poya Ghorbani
- Division of Upper Gastrointestinal Diseases, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - J-Matthias Löhr
- Division of Upper Gastrointestinal Diseases, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Upper Gastrointestinal Diseases, Karolinska University Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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14
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Linder S, Holmberg M, Engstrand J, Ghorbani P, Sparrelid E. Prognostic impact of para-aortic lymph node status in resected pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous neoplasm - Time to consider a reclassification? Surg Oncol 2022; 41:101735. [PMID: 35287096 DOI: 10.1016/j.suronc.2022.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Para-aortic lymph node (PALN) metastases in pancreatic ductal adenocarcinoma (PDAC) correlates with poor prognosis. The role of PALN in invasive intraductal papillary mucinous neoplasms (inv-IPMN) has not been well explored. The present study investigated the rate of metastatic PALN, lymph node ratio (LNR) and the overall nodal (N) status as prognostic factors in PDAC and inv-IPMN. METHODS This consecutive single-center series included patients with PDAC or inv-IPMN in the pancreatic head who underwent pancreatoduodenectomy or total pancreatectomy, including PALN resection between 2009 and 2018. Median overall survival (mOS) and impact of clinicopathological factors, including PALN status on survival, were evaluated. RESULTS 403 patients were included, 314 had PDAC and 89 inv-IPMN. PALN were metastatic in 16% of PDAC and 17% of inv-IPMN. N0 status was present in 6% of the patients with PDAC and 16% of inv-IPMN patients (p = 0.007). LNR >15% was more common in PDAC (52%) than in inv-IPMN (34%) (p = 0.004). mOS was 12.7 months in the presence of PALN metastases and 22.7 months without (p < 0.0001). Age >70 years, CA19-9 >200 U/mL, PDAC and N2 status were significantly associated with worse survival in a multivariable analysis. PALN status and LNR were not independent prognostic factors. In N2 status mOS was similar regardless the presence of PALN metastases. CONCLUSION The frequency of PALN metastases was similar in PDAC and inv-IPMN. Although PALN positive status entailed a shorter mOS, it was not an independent risk factor for death, and did not influence survival in N2-staged disease. The M1-status for PALN positivity may need reconsideration.
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Affiliation(s)
- Stefan Linder
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Marcus Holmberg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.
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15
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Osborne MS, Child-Hymas A, Holmberg M, Thomsen P, Johansson ML, McDermott AL. Clinical Evaluation of a Novel Laser-Ablated Titanium Implant System for Bone Anchored Hearing Systems in a Pediatric Population and the Relationship of Resonance Frequency Analysis With Implant Survival. Otol Neurotol 2022; 43:219-226. [PMID: 34816808 PMCID: PMC8746879 DOI: 10.1097/mao.0000000000003435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the clinical outcomes of pediatric patients implanted a novel 4.5 mm wide laser ablated titanium bone anchored implant system and to evaluate the implant stability over the first 12-month period. STUDY DESIGN A prospective, single-subject, repeated measure, cohort study. Participants served as their own controls. SETTING Community and tertiary referral hospital pediatric assessment center. PATIENTS A total of 115 consecutive pediatric patients aged 4 to 15 years were implanted with 176 laser ablated titanium bone anchored implants from January 2016 to January 2019. MAIN OUTCOME MEASURE Clinical outcomes, implant failure rates, and post implantation implant stability quotient (ISQ) scores were studied over the first 12-month period. Data were analyzed for statistical significance through mixed effect modeling, with the significance level p = 0.01. RESULTS A median 12-month survival of 96.6% was observed. Six implants (3.5%) were lost in total, one of these (0.6%) was lost due to trauma. Adverse skin reactions (Holgers grade 2-4) were observed in 4.4% of all postoperative visits, occurring in 22 individuals (19.1%). Neither the ISQ high (ISQH) nor ISQ low (ISQL) values increased significantly between the stage 1 and 2 surgeries. In contrast, the ISQ results, irrespective of abutment size, demonstrated an increasing trend from 49.1 to 57 over the 12 months review period. A statistically significant change was only demonstrated from the 3 months follow up onwards. CONCLUSION The use of 4.5 mm wide laser-ablated titanium bone anchored hearing implants resulted in superior survival rates and excellent clinical outcomes compared with previous implant systems.
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Affiliation(s)
| | | | | | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin L. Johansson
- Oticon Medical AB, Askim
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Holmberg M, Koppatz H, Jansson A, Hillingsø JG, Noergaard Larsen P, Lassen K, Sallinen V, Yaqub S, Sparrelid E. Secondary effects of the COVID-19 pandemic on surgical management of hepatopancreatobiliary malignancies in the Nordic capitals. Br J Surg 2021; 109:e8-e9. [PMID: 34850850 PMCID: PMC8690271 DOI: 10.1093/bjs/znab405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Marcus Holmberg
- Karolinska University Hospital, Department of Upper Gastrointestinal Diseases, and Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Hanna Koppatz
- Gastroenterological Surgery/Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anders Jansson
- Karolinska University Hospital, Department of Upper Gastrointestinal Diseases, and Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Jens Georg Hillingsø
- Copenhagen University Hospital, Department of Surgery and Transplantation, Department of Clinical Medicine, and University of Copenhagen, Copenhagen, Denmark
| | - Peter Noergaard Larsen
- Copenhagen University Hospital, Department of Surgery and Transplantation, Department of Clinical Medicine, and University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Lassen
- Department of Hepatopancreatobiliary Surgery, and Institute of Clinical Medicine, Oslo University Hospital at Rikshospitalet, University of Oslo, Oslo, Norway
| | - Ville Sallinen
- Gastroenterological Surgery/Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sheraz Yaqub
- Department of Hepatopancreatobiliary Surgery, and Institute of Clinical Medicine, Oslo University Hospital at Rikshospitalet, University of Oslo, Oslo, Norway
| | - Ernesto Sparrelid
- Karolinska University Hospital, Department of Upper Gastrointestinal Diseases, and Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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17
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Holmberg M, Ghorbani P, Gilg S, Del Chiaro M, Arnelo U, Löhr JM, Sparrelid E. Outcome after resection for invasive intraductal papillary mucinous neoplasia is similar to conventional pancreatic ductal adenocarcinoma. Pancreatology 2021; 21:1371-1377. [PMID: 34426077 DOI: 10.1016/j.pan.2021.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/31/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Resections for intraductal papillary mucinous neoplasm (IPMN) have increased last decades. Overall survival (OS) for conventional pancreatic ductal adenocarcinoma (PDAC) is well known but OS for invasive IPMN (inv-IPMN) is not as conclusive. This study aims to elucidate potential differences in clinicopathology and OS between these tumor types and to investigate if the raised number of resections have affected outcome. METHODS Consecutive patients ≥18 years of age resected for inv-IPMN and PDAC at Karolinska University Hospital between 2009 and 2018 were included. Clinicopathological variables were analyzed in multivariable regression models. Outcome was assessed calculating two-year OS, estimating OS using the Kaplan-Meier model and comparing survival functions with log-rank test. RESULTS 513 patients were included, 122 with inv-IPMN and 391 with PDAC. During the study period both the proportion resected inv-IPMN and two-year OS, irrespective of tumor type, increased (2.5%-45%; p < 0.001 and 44%-57%; p = 0.005 respectively). In Kaplan-Meier survival analysis inv-IPMN had more favorable median OS (mOS) compared to PDAC (33.6 months vs 19.3 months, p = 0.001). However, in multivariable Cox Regression analysis, tumor type was not a predictor for death, but so were resection period, tumor subtype and N-stage (all p < 0.001). CONCLUSION In this large single center observational cohort study, inv-IPMN seemed to have favorable survival outcome compared to PDAC, but after adjusting for predictors for death this benefit vanished. The combination of a pronounced increase in resected inv-IPMN and a concurrent hazard abatement for death within 2 years during the study period proved to be a principal factor.
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Affiliation(s)
- Marcus Holmberg
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden.
| | - Poya Ghorbani
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Stefan Gilg
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Denver, USA
| | - Urban Arnelo
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - J-Matthias Löhr
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Ernesto Sparrelid
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
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Sgarbura O, Mackenzie G, Holmberg M, Wigmore SJ, Søreide K. Social Media for the Hepato-Pancreato-Biliary community (#SoMe4HPB): connecting a specialized online group for scientific and clinical knowledge dissemination. HPB (Oxford) 2021; 23:1448-1455. [PMID: 33824082 DOI: 10.1016/j.hpb.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/10/2020] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Social media has an increasingly important role in scientific communication, clinical discussions and knowledge distribution. While several surgical disciplines have taken to internet for increased connectivity, there is currently little knowledge about the social media activity in the field of hepatopancreatobiliary surgery. We aimed to evaluate the implementation and use of a specific HPB hashtag and Twitter handle. METHODS The hashtag and Twitter handle (#SoMe4HPB; @hpb_so) were initiated on February 2019. We evaluated the response during the initial 15 months by applying NodeXL to trace activity. RESULTS The Twitter handle had 1388 followers (by May 7, 2020) and had generated 855 tweets and retweets. A total of 1120 mentions of 182 accounts were recorded in original tweets by @hpb_so. The largest global reach was recorded in December 2019 (254.000 people). Pancreatic cancer was the subject of 15% of all posts, liver malignancies of 12% of all posts and minimally invasive surgery of 8%. CONCLUSION The Social Media for the Hepato-Pancreato-Biliary community (#SoMe4HPB) and its associated Twitter handle @hpb_so had a well-built inception followed by a progressive development connecting individuals interested in HPB Surgery internationally. The involvement of more actors is required in order to fully attain its scientific dissemination role.
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Affiliation(s)
- Olivia Sgarbura
- Surgical Oncology Department, Cancer Institute of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France; IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, F-34298, France.
| | - Graham Mackenzie
- NHS Education for Scotland, 102 West Port, Edinburgh, EH3 9DN, UK
| | - Marcus Holmberg
- Department for Upper Gastrointestinal Diseases, Unit for Hepatobiliary and Pancreatic Surgery, Karolinska University Hospital, Sweden
| | - Stephen J Wigmore
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, N-4068, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Strijbos RM, Straatman LV, Calon TGA, Johansson ML, de Bruijn AJG, van den Berge H, Wagenaar M, Eichhorn E, Janssen M, Jonhede S, van Tongeren J, Holmberg M, Stokroos R. Long-Term Outcomes of the Minimally Invasive Ponto Surgery vs. Linear Incision Technique With Soft Tissue Preservation for Installation of Percutaneous Bone Conduction Devices. Front Neurol 2021; 12:632987. [PMID: 33716934 PMCID: PMC7945693 DOI: 10.3389/fneur.2021.632987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Comparing the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with the linear incision technique with soft tissue preservation (LITT-P) for bone conduction devices after a follow-up of 22 months. Methods: In this multicenter randomized controlled trial, there was the inclusion of 64 adult patients eligible for unilateral surgery. There was 1:1 randomization to the MIPS (test) or the LITT-P (control) group. The primary outcome was an (adverse) soft tissue reaction. Secondary outcomes were pain, loss of sensibility, soft tissue height/overgrowth, skin sagging, implant loss, Implant Stability Quotient measurements, cosmetic scores, and quality of life questionnaires. Results: Sixty-three subjects were analyzed in the intention-to-treat population. No differences were found in the presence of (adverse) soft tissue reactions during complete follow-up. Also, there were no differences in pain, wound dehiscence, skin level, soft tissue overgrowth, and overall quality of life. Loss of sensibility (until 3-month post-surgery), cosmetic scores, and skin sagging outcomes were better in the MIPS group. The Implant Stability Quotient was higher after the LITT-P for different abutment lengths at various points of follow-up. Implant extrusion was nonsignificantly higher after the MIPS (15.2%) compared with LITT-P (3.3%). Conclusion: The long-term results show favorable outcomes for both techniques. The MIPS is a promising technique with some benefits over the LITT-P. Concerns regarding nonsignificantly higher implant loss may be overcome with future developments and research. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02438618.
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Affiliation(s)
- Ruben M Strijbos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.,University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
| | - Louise V Straatman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.,University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
| | - Tim G A Calon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.,University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
| | - Martin L Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Oticon Medical AB, Askim, Sweden
| | | | - Herbert van den Berge
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Mariette Wagenaar
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Edwin Eichhorn
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Miranda Janssen
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Joost van Tongeren
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Robert Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.,University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
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Lagerkvist H, Carvalho K, Holmberg M, Petersson U, Cremers C, Hultcrantz M. Ten years of experience with the Ponto bone-anchored hearing system-A systematic literature review. Clin Otolaryngol 2020; 45:667-680. [PMID: 32386454 PMCID: PMC7496709 DOI: 10.1111/coa.13556] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/18/2020] [Indexed: 12/17/2022]
Abstract
Background Bone‐anchored hearing systems (BAHSs) are widely used for hearing rehabilitation and are indicated in cases of conductive and mixed hearing loss and in single‐sided deafness. The Ponto system, that is one available option, has been on the market since 2009. Objective of review The aim of this study is to systematically review the literature reporting on the Ponto system, with regard to audiological and surgical outcomes and patient's quality‐of‐life scores. Type of review A systematic literature search was performed in the PubMed database 2009‐July 2019. Search strategy Search term: ((osseointegrated hearing aid) OR (bone conduction implant) OR (bone anchored hearing) OR BAHA OR BAHS OR BAHI). Pre‐defined inclusion and exclusion criteria were applied. Evaluation method English‐language articles reporting original clinical data (audiological, surgical or quality‐of‐life outcomes) on the Ponto system were included. Articles reporting on Ponto and another BAHS system where the results on Ponto constituted less than 50% of the patient population or including only results on testband or softband devices were excluded. Results Audiological outcomes were discussed in 20 publications. Improvement against the unaided thresholds was demonstrated. The functional improvement was on average 33.9 dB. The effective gain or remaining air‐bone gap was on average 6.7 dB. All evaluated data showed aided speech reception thresholds significantly below normal speech level. Twenty‐seven publications reported surgical and follow‐up data for the Ponto system. Implant survival was 97.7%, adverse skin reactions (Holgers ≥ 2) were 5% across visits and 15% across patients. No complications were life‐threatening, causing permanent disability/damage or requiring a hospitalisation. Five studies reported quality of life using the Glasgow benefit inventory, 98% reported an improvement when analysing the score on an individual level. Conclusions The outcomes of this systematic review confirm that percutaneous systems provide consistent audiological benefits and improved quality of life for patients. Further, the review demonstrates that the percutaneous systems are safe, with relatively low complication rates. Skin‐related complications are the most common complication type and are experienced by approximately one patient out of seven, or in less than one of 20 follow‐up visits.
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Affiliation(s)
| | | | | | | | - Cor Cremers
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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21
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Calon TG, Johansson ML, de Bruijn AJ, van den Berge H, Wagenaar M, Eichhorn E, Janssen MM, Hof JR, Brunings JW, Joore MA, Jonhede S, van Tongeren J, Holmberg M, Stokroos RJ. Minimally Invasive Ponto Surgery Versus the Linear Incision Technique With Soft Tissue Preservation for Bone Conduction Hearing Implants: A Multicenter Randomized Controlled Trial. Otol Neurotol 2018; 39:882-893. [PMID: 29995008 PMCID: PMC6075882 DOI: 10.1097/mao.0000000000001852] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with those of the linear incision technique with soft-tissue preservation for bone-anchored hearing systems (BAHS). DESIGN Sponsor-initiated multicenter, open, randomized, controlled clinical trial. SETTING Maastricht University Medical Centre, Ziekenhuisgroep Twente and Medisch Centrum Leeuwarden, all situated in The Netherlands. PARTICIPANTS Sixty-four adult patients eligible for unilateral BAHS surgery.Interventions Single-stage BAHS surgery with 1:1 randomization to the linear incision technique with soft-tissue preservation (control) or the MIPS (test) group. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS Primary objective: compare the incidence of inflammation (Holgers Index ≥ 2) during 12 weeks' follow-up after surgery. Secondary objectives: skin dehiscence, pain scores, loss of sensibility around the implant, soft-tissue overgrowth, skin sagging, implant extrusion, cosmetic results, surgical time, wound healing and Implant Stability Quotient measurements. RESULTS Sixty-three subjects were analyzed in the intention-to-treat population. No significant difference was found for the incidence of inflammation between groups. Loss of skin sensibility, cosmetic outcomes, skin sagging, and surgical time were significantly better in the test group. No statistically significant differences were found for dehiscence, pain, and soft-tissue overgrowth. A nonsignificant difference in extrusion was found for the test group. The Implant Stability Quotient was statistically influenced by the surgical technique, abutment length, and time. CONCLUSION No significant differences between the MIPS and the linear incision techniques were observed regarding skin inflammation. MIPS results in a statistically significant reduction in the loss of skin sensibility, less skin sagging, improved cosmetic results, and reduced surgical time. Although nonsignificant, the implant extrusion rate warrants further research.
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Affiliation(s)
- Tim G.A. Calon
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martin L. Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg
- Oticon Medical AB, Askim, Sweden
| | | | | | - Mariet Wagenaar
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden
| | - Edwin Eichhorn
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden
| | - Miranda M.L. Janssen
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University
| | - Janny R. Hof
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan-Wouter Brunings
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Joost van Tongeren
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Robert-Jan Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Angeras O, Petursson P, Gabel J, Ioanes D, Holmberg M, Damen T, Reinsfelt B, Wallinder A, Albertsson P, Omerovic E, Ramunddal T. P3295Short and long term prognosis of patients undergoing urgent TAVI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Von Seth M, Hillered L, Otterbeck A, Hanslin K, Larsson A, Sjölin J, Lipcsey M, Cove ME, Chew NS, Vu LH, Lim RZ, Puthucheary Z, Hanslin K, Wilske F, Skorup P, Tano E, Sjölin J, Lipcsey M, Derese I, Thiessen S, Derde S, Dufour T, Pauwels L, Bekhuis Y, Van den Berghe G, Vanhorebeek I, Khan M, Dwivedi D, Zhou J, Prat A, Seidah NG, Liaw PC, Fox-Robichaud AE, Von Seth M, Skorup P, Hillered L, Larsson A, Sjölin J, Lipcsey M, Otterbeck A, Hanslin K, Lipcsey M, Larsson A, Von Seth M, Correa T, Pereira J, Takala J, Jakob S, Skorup P, Maudsdotter L, Tano E, Lipcsey M, Castegren M, Larsson A, Sjölin J, Xue M, Xu JY, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB, Kuzovlev A, Moroz V, Goloubev A, Myazin A, Chumachenko A, Pisarev V, Takeyama N, Tsuda M, Kanou H, Aoki R, Kajita Y, Hashiba M, Terashima T, Tomino A, Davies R, O’Dea KP, Soni S, Ward JK, O’Callaghan DJ, Takata M, Gordon AC, Wilson J, Zhao Y, Singer M, Spencer J, Shankar-Hari M, Genga KR, Lo C, Cirstea MS, Walley KR, Russell JA, Linder A, Boyd JH, Sedlag A, Riedel C, Georgieff M, Barth E, Debain A, Jonckheer J, Moeyersons W, Van zwam K, Puis L, Staessens K, Honoré PM, Spapen HD, De Waele E, de Garibay APR, Bracht H, Ende-Schneider B, Schreiber C, Kreymann B, Bini A, Votino E, Giuliano G, Steinberg I, Vetrugno L, Trunfio D, Sidoti A, Essig A, Brogi E, Forfori F, Conroy M, Marsh B, O’Flynn J, Henne-Bruns D, Gebhard F, Orend K, Halatsch M, Weiss M, Chase M, Freinkman E, Uber A, Liu X, Cocchi MN, Donnino MW, Peetermans M, Liesenborghs L, Claes J, Vanassche T, Hoylaerts M, Jacquemin M, Vanhoorelbeke K, De Meyer S, Verhamme P, Vögeli A, Ottiger M, Meier M, Steuer C, Bernasconi L, Huber A, Christ-Crain M, Henzen C, Hoess C, Thomann R, Zimmerli W, Müller B, Schütz P, Hoppensteadt D, Walborn A, Rondina M, Tsuruta K, Fareed J, Tachyla S, Ikeda T, Ono S, Ueno T, Suda S, Nagura T, Damiani E, Domizi R, Scorcella C, Tondi S, Pierantozzi S, Ciucani S, Mininno N, Adrario E, Pelaia P, Donati A, Andersen MS, Lu S, Lopez G, Lassen AT, Ghiran I, Shapiro NI, Trahtemberg U, Sviri S, Beil M, Agur Z, Van Heerden P, Jahaj E, Vassiliou A, Mastora Z, Orfanos SE, Kotanidou A, Wirz Y, Sager R, Amin D, Amin A, Haubitz S, Hausfater P, Huber A, Kutz A, Mueller B, Schuetz P, Sager RS, Wirz YW, Amin DA, Amin AA, Hausfater PH, Huber AH, Haubitz S, Kutz A, Mueller B, Schuetz P, Gottin L, Dell’amore C, Stringari G, Cogo G, Ceolagraziadei M, Sommavilla M, Soldani F, Polati E, Meier M, Baumgartner T, Zurauskaité G, Gupta S, Mueller B, Devendra A, Schuetz P, Mandaci D, Eren G, Ozturk F, Emir N, Hergunsel O, Azaiez S, Khedher S, Maaoui A, Salem M, Chernevskaya E, Beloborodova N, Bedova A, Sarshor YU, Pautova A, Gusarov V, Öveges N, László I, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Spanuth E, Ebelt H, Ivandic B, Thomae R, Werdan K, El-Shafie M, Taema K, El-Hallag M, Kandeel A, Tayeh O, Taema K, Eldesouky M, Omara A, Winkler MS, Holzmann M, Nierhaus A, Mudersbach E, Schwedhelm E, Daum G, Kluge S, Zoellner C, Greiwe G, Sawari H, Schwedhelm E, Nierhaus A, Kluge S, Kubitz J, Jung R, Daum G, Reichenspurner H, Zoellner C, Winkler MS, Groznik M, Ihan A, Andersen LW, Chase M, Holmberg MJ, Wulff A, Cocchi MN, Donnino MW, Balci C, Haliloglu M, Bilgili B, Bilgin H, Kasapoglu U, Sayan I, Süzer M, Mulazımoglu L, Cinel I, Patel V, Shah S, Parulekar P, Minton C, Patel J, Ejimofo C, Choi H, Costa R, Caruso P, Nassar P, Fu J, Jin J, Xu Y, Kong J, Wu D, Yaguchi A, Klonis A, Ganguly S, Kollef M, Burnham C, Fuller B, Mavrommati A, Chatzilia D, Salla E, Papadaki E, Kamariotis S, Christodoulatos S, Stylianakis A, Alamanos G, Simoes M, Trigo E, Silva N, Martins P, Pimentel J, Baily D, Curran LA, Ahmadnia E, Patel BV, Adukauskiene D, Cyziute J, Adukauskaite A, Pentiokiniene D, Righetti F, Colombaroli E, Castellano G, Wilske F, Skorup P, Lipcsey M, Hanslin K, Larsson A, Sjölin J, Man M, Shum HP, Chan YH, Chan KC, Yan WW, Lee RA, Lau SK, Dilokpattanamongkol P, Thirapakpoomanunt P, Anakkamaetee R, Montakantikul P, Tangsujaritvijit V, Sinha S, Pati J, Sahu S, Adukauskiene D, Valanciene D, Dambrauskiene A, Adukauskiene D, Valanciene D, Dambrauskiene A, Hernandez K, Lopez T, Saca D, Bello M, Mahmood W, Hamed K, Al Badi N, AlThawadi S, Al Hosaini S, Salahuddin N, Cilloniz CC, Ceccato AC, Bassi GLL, Ferrer MF, Gabarrus AG, Ranzani OR, Jose ASS, Vidal CGG, de la Bella Casa JPP, Blasi FB, Torres AT, Adukauskiene D, Ciginskiene A, Dambrauskiene A, Simoliuniene R, Giuliano G, Triunfio D, Sozio E, Taddei E, Brogi E, Sbrana F, Ripoli A, Bertolino G, Tascini C, Forfori F, Fleischmann C, Goldfarb D, Schlattmann P, Schlapbach L, Kissoon N, Baykara N, Akalin H, Arslantas MK, Gavrilovic SG, Vukoja MV, Hache MH, Kashyap RK, Dong YD, Gajic OG, Ranzani O, Shankar-Hari M, Harrison D, Rabello L, Rowan K, Salluh J, Soares M, Markota AM, Fluher JF, Kogler DK, Borovšak ZB, Sinkovic AS, László I, Öveges N, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Fareed J, Siddiqui Z, Aggarwal P, Iqbal O, Hoppensteadt D, Lewis M, Wasmund R, Abro S, Raghuvir S, Tsuruta K, Barie PS, Fineberg D, Radford A, Tsuruta K, Casazza A, Vilardo A, Bellazzi E, Boschi R, Ciprandi D, Gigliuto C, Preda R, Vanzino R, Vetere M, Carnevale L, Kyriazopoulou E, Pistiki A, Routsi C, Tsangaris I, Giamarellos-Bourboulis E, Kyriazopoulou E, Tsangaris I, Routsi C, Pnevmatikos I, Vlachogiannis G, Antoniadou E, Mandragos K, Armaganidis A, Giamarellos-Bourboulis E, Allan P, Oehmen R, Luo J, Ellis C, Latham P, Newman J, Pritchett C, Pandya D, Cripps A, Harris S, Jadav M, Langford R, Ko B, Park H, Beumer CM, Koch R, Beuningen DV, Oudelashof AM, Vd Veerdonk FL, Kolwijck E, VanderHoeven JG, Bergmans DC, Hoedemaekers C, Brandt JB, Golej J, Burda G, Mostafa G, Schneider A, Vargha R, Hermon M, Levin P, Broyer C, Assous M, Wiener-Well Y, Dahan M, Benenson S, Ben-Chetrit E, Faux A, Sherazi R, Sethi A, Saha S, Kiselevskiy M, Gromova E, Loginov S, Tchikileva I, Dolzhikova Y, Krotenko N, Vlasenko R, Anisimova N, Spadaro S, Fogagnolo A, Remelli F, Alvisi V, Romanello A, Marangoni E, Volta C, Degrassi A, Mearelli F, Casarsa C, Fiotti N, Biolo G, Cariqueo M, Luengo C, Galvez R, Romero C, Cornejo R, Llanos O, Estuardo N, Alarcon P, Magazi B, Khan S, Pasipanodya J, Eriksson M, Strandberg G, Lipsey M, Larsson A, Rajput Z, Hiscock F, Karadag T, Uwagwu J, Jain S, Molokhia A, Barrasa H, Soraluce A, Uson E, Rodriguez A, Isla A, Martin A, Fernández B, Fonseca F, Sánchez-Izquierdo JA, Maynar FJ, Kaffarnik M, Alraish R, Frey O, Roehr A, Stockmann M, Wicha S, Shortridge D, Castanheira M, Sader HS, Streit JM, Flamm RK, Falsetta K, Lam T, Reidt S, Jancik J, Kinoshita T, Yoshimura J, Yamakawa K, Fujimi S, Armaganidis A, Torres A, Zakynthinos S, Mandragos C, Giamarellos-Bourboulis E, Ramirez P, De la Torre-Prados M, Rodriguez A, Dale G, Wach A, Beni L, Hooftman L, Zwingelstein C, François B, Colin G, Dequin PF, Laterre PF, Perez A, Welte R, Lorenz I, Eller P, Joannidis M, Bellmann R, Lim S, Chana S, Patel S, Higuera J, Cabestrero D, Rey L, Narváez G, Blandino A, Aroca M, Saéz S, De Pablo R, Thiessen S, Vanhorebeek I, Derde S, Derese I, Dufour T, Albert CN, Langouche L, Goossens C, Peersman N, Vermeersch P, Vander Perre S, Holst J, Wouters P, Van den Berghe G, Liu X, Uber AU, Holmberg M, Konanki V, McNaughton M, Zhang J, Donnino MW, Demirkiran O, Byelyalov A, Luengo C, Guerrero J, Cariqueo M, Scorcella C, Domizi R, Damiani E, Tondi S, Pierantozzi S, Rossini N, Falanga U, Monaldi V, Adrario E, Pelaia P, Donati A, Cole O, Scawn N, Balciunas M, Blascovics I, Vuylsteke A, Salaunkey K, Omar A, Salama A, Allam M, Alkhulaifi A, Verstraete S, Vanhorebeek I, Van Puffelen E, Derese I, Ingels C, Verbruggen S, Wouters P, Joosten K, Hanot J, Guerra G, Vlasselaers D, Lin J, Van den Berghe G, Haines R, Zolfaghari P, Hewson R, Offiah C, Prowle J, Park H, Ko B, Buter H, Veenstra JA, Koopmans M, Boerma EC, Veenstra JA, Buter H, Koopmans M, Boerma EC, Taha A, Shafie A, Hallaj S, Gharaibeh D, Hon H, Bizrane M, El Khattate AA, Madani N, Abouqal R, Belayachi J, Kongpolprom N, Sanguanwong N, Sanaie S, Mahmoodpoor A, Hamishehkar H, Biderman P, Van Heerden P, Avitzur Y, Solomon S, Iakobishvili Z, Carmi U, Gorfil D, Singer P, Paisley C, Patrick-Heselton J, Mogk M, Humphreys J, Welters I, Pierantozzi S, Scorcella C, Domizi R, Damiani E, Tondi S, Casarotta E, Bolognini S, Adrario E, Pelaia P, Donati A, Holmberg MJ, Moskowitz A, Patel P, Grossestreuer A, Uber A, Andersen LW, Donnino MW, Malinverni S, Goedeme D, Mols P, Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W, Manzanares W, Szwec C, Langlois P, Aramendi I, Heyland D, Stankovic N, Nadler J, Uber A, Holmberg M, Sanchez L, Wolfe R, Chase M, Donnino M, Cocchi M, Atalan HK, Gucyetmez B, Kavlak ME, Aslan S, Kargi A, Yazici S, Donmez R, Polat KY, Piechota M, Piechota A, Misztal M, Bernas S, Pietraszek-Grzywaczewska I, Saleh M, Hamdy A, Hamdy A, Elhallag M, Atar F, Kundakci A, Gedik E, Sahinturk H, Zeyneloglu P, Pirat A, Popescu M, Tomescu D, Van Gassel R, Baggerman M, Schaap F, Bol M, Nicolaes G, Beurskens D, Damink SO, Van de Poll M, Horibe M, Sasaki M, Sanui M, Iwasaki E, Sawano H, Goto T, Ikeura T, Hamada T, Oda T, Mayumi T, Kanai T, Kjøsen G, Horneland R, Rydenfelt K, Aandahl E, Tønnessen T, Haugaa H, Lockett P, Evans L, Somerset L, Ker-Reid F, Laver S, Courtney E, Dalton S, Georgiou A, Robinson K, Lam T, Haas B, Reidt S, Bartlett K, Jancik J, Bigwood M, Hanley R, Morgan P, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Zampieri FG, Liborio AB, Besen BA, Cavalcanti AB, Dominedò C, Dell’Anna AM, Monayer A, Grieco DL, Barelli R, Cutuli SL, Maddalena AI, Picconi E, Sonnino C, Sandroni C, Antonelli M, Gucyetmez B, Atalan HK, Tuzuner F, Cakar N, Jacob M, Sahu S, Singh YP, Mehta Y, Yang KY, Kuo S, Rai V, Cheng T, Ertmer C, Czempik P, Hutchings S, Watts S, Wilson C, Burton C, Kirkman E, Drennan D, O’Prey A, MacKay A, Forrest R, Oglinda A, Ciobanu G, Casian M, Oglinda C, Lun CT, Yuen HJ, Ng G, Leung A, So SO, Chan HS, Lai KY, Sanguanwit P, Charoensuk W, Phakdeekitcharoen B, Batres-Baires G, Kammerzell I, Lahmer T, Mayr U, Schmid R, Huber W, Spanuth E, Bomberg H, Klingele M, Thomae R, Groesdonk H, Bernas S, Piechota M, Mirkiewicz K, Pérez AG, Silva J, Ramos A, Acharta F, Perezlindo M, Lovesio L, Antonelli PG, Dogliotti A, Lovesio C, Baron J, Schiefer J, Baron DM, Faybik P, Shum HP, Yan WW, Chan TM, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Vicka V, Gineityte D, Ringaitiene D, Sipylaite J, Pekarskiene J, Beurskens DM, Van Smaalen TC, Hoogland P, Winkens B, Christiaans MH, Reutelingsperger CP, Van Heurn E, Nicolaes GA, Schmitt FS, Salgado ES, Friebe JF, Fleming TF, Zemva JZ, Schmoch TS, Uhle FU, Kihm LK, Morath CM, Nusshag CN, Zeier MZ, Bruckner TB, Mehrabi AM, Nawroth PN, Weigand MW, Hofer SH, Brenner TB, Fotopoulou G, Poularas I, Kokkoris S, Brountzos E, Zakynthinos S, Routsi C, Saleh M, Elghonemi M, Nilsson KF, Sandin J, Gustafsson L, Frithiof R, Skorniakov I, Varaksin A, Vikulova D, Shaikh O, Whiteley C, Ostermann M, Di Lascio G, Anicetti L, Bonizzoli M, Fulceri G, Migliaccio ML, Sentina P, Cozzolino M, Peris A, Khadzhynov D, Halleck F, Staeck O, Lehner L, Budde K, Slowinski T, Slowinski T, Kindgen-Milles D, Khadzhynov D, Huysmans N, Laenen MV, Helmschrodt A, Boer W. 37th International Symposium on Intensive Care and Emergency Medicine (part 3 of 3). Crit Care 2017. [PMCID: PMC5374592 DOI: 10.1186/s13054-017-1629-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Johansson ML, Stokroos RJ, Banga R, Hol MK, Mylanus EA, Savage Jones H, Tysome JR, Vannucchi P, Hof JR, Brunings JW, van Tongeren J, Lutgert RW, Banerjee A, Windfuhr JP, Caruso A, Giannuzzi AL, Bordin S, Hanif J, Schart-Morén N, Singam S, Jonhede S, Holmberg M, Cremers CW, Hultcrantz M. Short-term results from seventy-six patients receiving a bone-anchored hearing implant installed with a novel minimally invasive surgery technique. Clin Otolaryngol 2017; 42:1043-1048. [PMID: 27930877 DOI: 10.1111/coa.12803] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M L Johansson
- Oticon Medical AB, Askim, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R J Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - R Banga
- Queen Elizabeth Hospital, Birmingham, UK
| | - M K Hol
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E A Mylanus
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - J R Tysome
- Department of Skull Base Surgery, Addenbrookes Hospital, Cambridge University Teaching Hospitals NHS Trust, Cambridge, UK
| | - P Vannucchi
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - J R Hof
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J W Brunings
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J van Tongeren
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - A Banerjee
- Department of Otolaryngology, James Cook University Hospital, Middlesbrough, UK
| | - J P Windfuhr
- Department of Otolaryngology, Head and Neck Surgery, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - A Caruso
- Gruppo Otologico, Piacenza, Italy
| | | | - S Bordin
- Venice International Otolaryngology Network, Venice, Italy
| | - J Hanif
- Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - N Schart-Morén
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - S Singam
- Department of ENT and Audiology, Torbay Hospital, Devon, UK
| | | | | | - C W Cremers
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Hultcrantz
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
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Calon TGA, van Hoof M, van den Berge H, de Bruijn AJG, van Tongeren J, Hof JR, Brunings JW, Jonhede S, Anteunis LJC, Janssen M, Joore MA, Holmberg M, Johansson ML, Stokroos RJ. Minimally Invasive Ponto Surgery compared to the linear incision technique without soft tissue reduction for bone conduction hearing implants: study protocol for a randomized controlled trial. Trials 2016; 17:540. [PMID: 27829464 PMCID: PMC5103483 DOI: 10.1186/s13063-016-1662-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last years, less invasive surgical techniques with soft tissue preservation for bone conduction hearing implants (BCHI) have been introduced such as the linear incision technique combined with a punch. Results using this technique seem favorable in terms of rate of peri-abutment dermatitis (PAD), esthetics, and preservation of skin sensibility. Recently, a new standardized surgical technique for BCHI placement, the Minimally Invasive Ponto Surgery (MIPS) technique has been developed by Oticon Medical AB (Askim, Sweden). This technique aims to standardize surgery by using a novel surgical instrumentation kit and minimize soft tissue trauma. METHODS A multicenter randomized controlled trial is designed to compare the MIPS technique to the linear incision technique with soft tissue preservation. The primary investigation center is Maastricht University Medical Center. Sixty-two participants will be included with a 2-year follow-up period. Parameters are introduced to quantify factors such as loss of skin sensibility, dehiscence of the skin next to the abutment, skin overgrowth, and cosmetic results. A new type of sampling method is incorporated to aid in the estimation of complications. To gain further understanding of PAD, swabs and skin biopsies are collected during follow-up visits for evaluation of the bacterial profile and inflammatory cytokine expression. The primary objective of the study is to compare the incidence of PAD during the first 3 months after BCHI placement. Secondary objectives include the assessment of parameters related to surgery, wound healing, pain, loss of sensibility of the skin around the implant, implant extrusion rate, implant stability measurements, dehiscence of the skin next to the abutment, and esthetic appeal. Tertiary objectives include assessment of other factors related to PAD and a health economic evaluation. DISCUSSION This is the first trial to compare the recently developed MIPS technique to the linear incision technique with soft tissue preservation for BCHI surgery. Newly introduced parameters and sampling method will aid in the prediction of results and complications after BCHI placement. TRIAL REGISTRATION Registered at the CCMO register in the Netherlands on 24 November 2014: NL50072.068.14 . Retrospectively registered on 21 April 2015 at ClinicalTrials.gov: NCT02438618 . This trial is sponsored by Oticon Medical AB.
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Affiliation(s)
- Tim G A Calon
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Marc van Hoof
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Herbert van den Berge
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Arthur J G de Bruijn
- Department of Otorhinolaryngology, ZiekenhuisGroep Twente, Almelo, The Netherlands
| | - Joost van Tongeren
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Janny R Hof
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Wouter Brunings
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Lucien J C Anteunis
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Miranda Janssen
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Martin L Johansson
- Oticon Medical AB, Askim, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Bartfay S, Lidén H, Holmberg M, Karason K, Gäbel J, Redfors B, Dellgren G. Biventricular Support as Bridge to Heart Transplantation - A Valid Option in Advanced Heart Failure. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Andersen LW, Holmberg M, Patel P, Berg KM, Cocchi M, Doherty M, Khabbaz K, Donnino MW. Lactate levels after major cardiac surgery are associated with hospital length of stay. Crit Care 2015. [PMCID: PMC4471938 DOI: 10.1186/cc14273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Soini E, Holmberg M, Asseburg C, Sumelahti ML. Modelling the Persistence of Disease-Modifying Drug Treatment (DMT) and its Independent Drivers in Finnish Multiple Sclerosis (MS) Patients: Parametric Survival Modelling. Value Health 2014; 17:A400. [PMID: 27200954 DOI: 10.1016/j.jval.2014.08.911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - M Holmberg
- School of Medicine, University of Tampere, Finland
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Volz S, Holmberg M, Redfors B, Dellgren G. Acute tamponade of the left paracorporeal pump house due to membrane defect in a patient with a Berlin Heart EXCOR(C) biventricular assist device. Eur J Cardiothorac Surg 2014; 46:743-4. [DOI: 10.1093/ejcts/ezt651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bartfay SE, Liden H, Holmberg M, Karason K, Gabel J, Selimovic N, Dellgren G. The BiVAD experience at the university hospital, results from the years 2010 to 2012 and comparison with contemporary LVAD patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oudard S, Kramer G, Creppy L, Loriot Y, Steinbjoern H, Holmberg M, Rolland F, Machiels J, Krainer M. 7049 POSTER Management of Metastatic Castration-resistant Prostate Cancer (mCRPC) After an Initial Good Response to First-line Docetaxel (D) -a Retrospective Study on 270 Patients (pts). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72000-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boyd AR, Burke GA, Duffy H, Holmberg M, O' Kane C, Meenan BJ, Kingshott P. Sputter deposited bioceramic coatings: surface characterisation and initial protein adsorption studies using surface-MALDI-MS. J Mater Sci Mater Med 2011; 22:71-84. [PMID: 21104194 DOI: 10.1007/s10856-010-4180-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 10/25/2010] [Indexed: 05/30/2023]
Abstract
Protein adsorption onto calcium phosphate (Ca-P) bioceramics utilised in hard tissue implant applications has been highlighted as one of the key events that influences the subsequent biological response, in vivo. This work reports on the use of surface-matrix assisted laser desorption ionisation mass spectrometry (Surface-MALDI-MS) as a technique for the direct detection of foetal bovine serum (FBS) proteins adsorbed to hybrid calcium phosphate/titanium dioxide surfaces produced by a novel radio frequency (RF) magnetron sputtering method incorporating in situ annealing between 500°C and 700°C during deposition. XRD and XPS analysis indicated that the coatings produced at 700°C were hybrid in nature, with the presence of Ca-P and titanium dioxide clearly observed in the outer surface layer. In addition to this, the Ca/P ratio was seen to increase with increasing annealing temperature, with values of between 2.0 and 2.26 obtained for the 700°C samples. After exposure to FBS solution, surface-MALDI-MS indicated that there were significant differences in the protein patterns as shown by unique peaks detected at masses below 23.1 kDa for the different surfaces. These adsorbates were assigned to a combination of growth factors and lipoproteins present in serum. From the data obtained here it is evident that surface-MALDI-MS has significant utility as a tool for studying the dynamic nature of protein adsorption onto the surfaces of bioceramic coatings, which most likely plays a significant role in subsequent bioactivity of the materials.
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Affiliation(s)
- A R Boyd
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), University of Ulster at Jordanstown, Newtownabbey, Co, Antrim, Northern Ireland, UK.
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Clarke JL, Ennis MM, Lamborn KR, Prados MD, Puduvalli VK, Penas-Prado M, Gilbert MR, Groves MD, Hess KR, Levin VA, de Groot J, Colman H, Conrad CA, Loghin ME, Hunter K, Yung WK, Chen C, Damek D, Liu A, Gaspar LE, Waziri A, Lillehei K, Kavanagh B, Finlay JL, Haley K, Dhall G, Gardner S, Allen J, Cornelius A, Olshefski R, Garvin J, Pradhan K, Etzl M, Goldman S, Atlas M, Thompson S, Hirt A, Hukin J, Comito M, Bertolone S, Torkildson J, Joyce M, Moertel C, Letterio J, Kennedy G, Walter A, Ji L, Sposto R, Dorris K, Wagner L, Hummel T, Drissi R, Miles L, Leach J, Chow L, Turner R, Gragert MN, Pruitt D, Sutton M, Breneman J, Crone K, Fouladi M, Friday BB, Buckner J, Anderson SK, Giannini C, Kugler J, Mazurczac M, Flynn P, Gross H, Pajon E, Jaeckle K, Galanis E, Badruddoja MA, Pazzi MA, Stea B, Lefferts P, Contreras N, Bishop M, Seeger J, Carmody R, Rance N, Marsella M, Schroeder K, Sanan A, Swinnen LJ, Rankin C, Rushing EJ, Hutchins LF, Damek DM, Barger GR, Norden AD, Lesser G, Hammond SN, Drappatz J, Fadul CE, Batchelor TT, Quant EC, Beroukhim R, Ciampa A, Doherty L, LaFrankie D, Ruland S, Bochacki C, Phan P, Faroh E, McNamara B, David K, Rosenfeld MR, Wen PY, Hammond SN, Norden AD, Drappatz J, Phuphanich S, Reardon D, Wong ET, Plotkin SR, Lesser G, Mintz A, Raizer JJ, Batchelor TT, Quant EC, Beroukhim R, Kaley TJ, Ciampa A, Doherty L, LaFrankie D, Ruland S, Smith KH, Wen PY, Chamberlain MC, Graham C, Mrugala M, Johnston S, Kreisl TN, Smith P, Iwamoto F, Sul J, Butman JA, Fine HA, Westphal M, Heese O, Warmuth-Metz M, Pietsch T, Schlegel U, Tonn JC, Schramm J, Schackert G, Melms A, Mehdorn HM, Seifert V, Geletneky K, Reuter D, Bach F, Khasraw M, Abrey LE, Lassman AB, Hormigo A, Nolan C, Gavrilovic IT, Mellinghoff IK, Reiner AS, DeAngelis L, Omuro AM, Burzynski SR, Weaver RA, Janicki TJ, Burzynski GS, Szymkowski B, Acelar SS, Mechtler LL, O'Connor PC, Kroon HA, Vora T, Kurkure P, Arora B, Gupta T, Dhamankar V, Banavali S, Moiyadi A, Epari S, Merchant N, Jalali R, Moller S, Grunnet K, Hansen S, Schultz H, Holmberg M, Sorensen MM, Poulsen HS, Lassen U, Reardon DA, Vredenburgh JJ, Desjardins A, Janney DE, Peters K, Sampson J, Gururangan S, Friedman HS, Jeyapalan S, Constantinou M, Evans D, Elinzano H, O'Connor B, Puthawala MY, Goldman M, Oyelese A, Cielo D, Dipetrillo T, Safran H, Anan M, Seyed Sadr M, Alshami J, Sabau C, Seyed Sadr E, Siu V, Guiot MC, Samani A, Del Maestro R, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine VE, Parfenov VE, Poverennova IE, Hau P, Jachimczak P, Heinrichs H, Schlingensiepen KH, Shibui S, Kayama T, Wakabayashi T, Nishikawa R, de Groot M, Aronica E, Vecht CJ, Toering ST, Heimans JJ, Reijneveld JC, Batchelor T, Mulholland P, Neyns B, Nabors LB, Campone M, Wick A, Mason W, Mikkelsen T, Phuphanich S, Ashby LS, DeGroot JF, Gattamaneni HR, Cher LM, Rosenthal MA, Payer F, Xu J, Liu Q, van den Bent M, Nabors B, Fink K, Mikkelsen T, Chan M, Trusheim J, Raval S, Hicking C, Henslee-Downey J, Picard M, Reardon D, Kaley TJ, Wen PY, Schiff D, Karimi S, DeAngelis LM, Nolan CP, Omuro A, Gavrilovic I, Norden A, Drappatz J, Purow BW, Lieberman FS, Hariharan S, Abrey LE, Lassman AB, Perez-Larraya JG, Honnorat J, Chinot O, Catry-Thomas I, Taillandier L, Guillamo JS, Campello C, Monjour A, Tanguy ML, Delattre JY, Franz DN, Krueger DA, Care MM, Holland-Bouley K, Agricola K, Tudor C, Mangeshkar P, Byars AW, Sahmoud T, Alonso-Basanta M, Lustig RA, Dorsey JF, Lai RK, Recht LD, Reardon DA, Paleologos N, Groves M, Rosenfeld MR, Meech S, Davis T, Pavlov D, Marshall MA, Sampson J, Slot M, Peerdeman SM, Beauchesne PD, Faure G, Noel G, Schmitt T, Kerr C, Jadaud E, Martin L, Taillandier L, Carnin C, Desjardins A, Reardon DA, Peters KB, Herndon JE, Kirkpatrick JP, Friedman HS, Vredenburgh JJ, Nayak L, Panageas KS, Deangelis LM, Abrey LE, Lassman AB. Ongoing Clinical Trials. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vainio K, Noraas S, Holmberg M, Fremstad H, Wahlstrøm M, Anestad G, Dudman S. Fatal and mild primary dengue virus infections imported to Norway from Africa and south-east Asia, 2008-2010. ACTA ACUST UNITED AC 2010; 15. [PMID: 20929653 DOI: 10.2807/ese.15.38.19666-en] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between 2008 and 2010, eight cases of viraemic dengue fever in travellers were diagnosed in Norway. They had returned from Eritrea, Thailand and Indonesia. All cases were primary dengue infections, seven non-complicated dengue fever and one dengue shock syndrome with a fatal outcome. Four patients were infected with dengue virus serotype 1, one with type 2 and three with type 3. Two cases from Thailand, the fatal case and the two imported from Eritrea were infected with type 1.
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Affiliation(s)
- K Vainio
- Norwegian Institute of Public Health, Department of Virology, Oslo, Norway
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Burggraaff R, van Ham T, Holmberg M, van der Goot A, Teuling E, Garcia-Arencibia M, Kim HE, Du D, Thijssen K, Wiersma M, van Bergeijk P, van Rheenen J, van Veluw J, Hofstra R, Rubinsztein DC, Nollen E. A30 Identification of MOAG-4/SERF as a regulator of age related proteotoxicity. J Neurol Neurosurg Psychiatry 2010. [DOI: 10.1136/jnnp.2010.222570.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mazick A, Gergonne B, Wuillaume F, Danis K, Vantarakis A, Uphoff H, Spiteri G, van 't Klooster T, Junker C, Holmberg M, Molbak K. Higher all-cause mortality in children during autumn 2009 compared with the three previous years: pooled results from eight European countries. Euro Surveill 2010; 15:19480. [PMID: 20144446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The paper describes weekly fluctuations of all-cause mortality observed in eight European countries during the period between week 27 and 51, 2009, in comparison with three previous years. Our preliminary data show that the mortality reported during the 2009 influenza pandemic did not reach levels normally seen during seasonal influenza epidemics. However, there was a cumulative excess mortality of 77 cases (1 per 100,000 population) in 5-14-year-olds, and possibly also among 0-4-year-olds.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark.
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Mazick A, Gergonne B, Wuillaume F, Danis K, Vantarakis A, Uphoff H, Spiteri G, van 't Klooster T, Junker C, Holmberg M, Mølbak K. Higher all-cause mortality in children during autumn 2009 compared with the three previous years: pooled results from eight European countries. Euro Surveill 2010. [DOI: 10.2807/ese.15.05.19480-en] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The paper describes weekly fluctuations of all-cause mortality observed in eight European countries during the period between week 27 and 51, 2009, in comparison with three previous years. Our preliminary data show that the mortality reported during the 2009 influenza pandemic did not reach levels normally seen during seasonal influenza epidemics. However, there was a cumulative excess mortality of 77 cases (1 per 100,000 population) in 5-14-year-olds, and possibly also among 0-4-year-olds.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark
| | - B Gergonne
- The National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden
- Statens Serum Institut, Copenhagen, Denmark
| | - F Wuillaume
- Scientific Institute of Public Health, Brussels, Belgium
| | - K Danis
- Department for Surveillance and Intervention, Hellenic Centre for Disease Control and Prevention, Greece
| | - A Vantarakis
- Department of Public Health, Medical School, University of Patras, Greece
| | - H Uphoff
- Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen, Dillenburg, Germany
| | - G Spiteri
- Infectious Disease Prevention and Control Unit, Department of Health Promotion and Disease Prevention, Msida, Malta
| | - T van 't Klooster
- Rijksinstituut voor Volksgezondheid en Milieu (RIVM, National Institute for Public Health and Environment), Bilthoven, Netherlands
| | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - M Holmberg
- The National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden
| | - K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
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Minde J, Andersson T, Fulford M, Aguirre M, Nennesmo I, Remahl IN, Svensson O, Holmberg M, Toolanen G, Solders G. A novel NGFB point mutation: a phenotype study of heterozygous patients. J Neurol Neurosurg Psychiatry 2009; 80:188-95. [PMID: 18420729 DOI: 10.1136/jnnp.2007.136051] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A family with neurological findings similar to hereditary sensory and autonomic neuropathy type V having a point mutation in the nerve growth factor beta (NGFB) gene was recently described. The homozygous genotype gives disabling symptoms. The purpose of the present study was to evaluate the symptoms in heterozygous patients. METHODS 26 patients heterozygous for the NGFB mutation (12 men, mean age 50 (13-90) years) were examined clinically and answered a health status questionnaire, including the Michigan Neuropathy Screening Instrument (MNSI). 28 relatives (15 men, mean age 44 (15-86) years) without the mutation served as controls in the clinical examination part. 23 of the heterozygotes were examined neurophysiologically and six heterozygous patients underwent a sural nerve biopsy. RESULTS The heterozygous phenotype ranged from eight patients with Charcot arthropathy starting in adult age and associated with variable symptoms of neuropathy but without complete insensitivity to pain, anhidrosis or mental retardation, to 10 symptom free patients. There was no difference in MNSI between the young heterozygous cases (<55 years old) and the controls. Six of 23 heterozygous patients had impaired cutaneous thermal perception and 11 of 23 had signs of carpal tunnel syndrome. Sural nerve biopsies showed a moderate reduction of both small myelinated (Adelta) and unmyelinated (C) fibres. No apparent correlation of small fibre reduction to symptoms was found. CONCLUSIONS The NGFB mutation in its heterozygous form results in a milder disease than in homozygotes, with a variable clinical picture, ranging from asymptomatic cases to those with Charcot arthropathy appearing in adult age. Particularly age, but perhaps lifestyle factors also, may influence the development of clinical polyneuropathy.
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Affiliation(s)
- J Minde
- Department of Orthopaedics, Kallgatan 14, Gällivare Hospital, SE- 982 82 Gällivare, Sweden.
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Lassen U, Hasselbalch B, Sørensen M, Holmberg M, Hansen S, Kosteljanetz M, Laursen H, Poulsen HS. A phase II trial with cetuximab, bevacizumab, and irinotecan for patients with primary glioblastomas and progression after radiation therapy and temozolamide. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.2056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Olsson A, Lind L, Thornell LE, Holmberg M. Myopathy with lactic acidosis is linked to chromosome 12q23.3-24.11 and caused by an intron mutation in the ISCU gene resulting in a splicing defect. Hum Mol Genet 2008; 17:1666-72. [DOI: 10.1093/hmg/ddn057] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Holmberg M, Sahana G, Andersson-Eklund L. Fine mapping of a quantitative trait locus on chromosome 9 affecting non-return rate in Swedish dairy cattle. J Anim Breed Genet 2007; 124:257-63. [PMID: 17868077 DOI: 10.1111/j.1439-0388.2007.00669.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We previously mapped a quantitative trait locus (QTL) affecting the trait non-return rate at 56 days in heifers to bovine chromosome 9. The purpose of this study was to confirm and refine the position of the QTL by using a denser marker map and fine mapping methods. Five families that previously showed segregation for the QTL were included in the study. The mapping population consisted of 139 bulls in a granddaughter design. All bulls were genotyped for 25 microsatellite markers surrounding the QTL on chromosome 9. We also analysed the correlated trait number of inseminations per service period in heifers. Both traits describe the heifer's ability to become pregnant after insemination. Linkage analysis, linkage disequilibrium and combined linkage and linkage disequilibrium analysis were used to analyse the data. Analysis of the families jointly by linkage analysis resulted in a significant but broad QTL peak for non-return rate. Results from the combined analysis gave a sharp QTL peak with a well-defined maximum in between markers BMS1724 and BM7209, at the same position as where the highest peak from the linkage disequilibrium analysis was found. One of the sire families segregated clearly at this position and the difference in effects between the two sire haplotypes was 2.9 percentage units in non-return rate. No significant results were found for the number of inseminations in the combined analysis.
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Affiliation(s)
- M Holmberg
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden.
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Abstract
Impaired fertility is the main reason for involuntary culling of dairy cows in Sweden. The objective of this study was to map quantitative trait loci (QTL) influencing fertility and calving traits in the Swedish dairy cattle population. The traits analyzed were number of inseminations, 56-d nonreturn rate, interval from calving to first insemination, fertility treatments, heat intensity score, stillbirth, and calving performance. A genome scan covering 20 bovine chromosomes was performed using 145 microsatellite markers. The mapping population consisted of 10 sires and their 417 sons in a granddaughter design. Nine of the sires were of the Swedish Red Breed, and one was a Swedish Holstein. Least squares regression was used to map loci affecting the analyzed traits, and permutation tests were used to set significance thresholds. Cofactors were used in the analyses of individual chromosomes to adjust for QTL found on other chromosomes. The use of cofactors increased both the number of QTL found and the significance level. In the initial analysis, we found 13 suggestive QTL that were mapped to chromosomes 6, 7, 9, 11, 13, 15, 20, and 29. When cofactors were included, 30 QTL were detected on chromosomes 1, 3, 4, 18, 19, 22, and 25, in addition to the 8 previously mentioned chromosomes. Some of the results from the cofactor analysis may be false positives and require further validation. In conclusion, we were able to map several QTL affecting fertility and calving traits in Swedish dairy cattle.
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Affiliation(s)
- M Holmberg
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Box 7023, 75007 Uppsala, Sweden.
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Lennernäs B, Hedner T, Holmberg M, Bredenberg S, Nyström C, Lennernäs H. Pharmacokinetics and tolerability of different doses of fentanyl following sublingual administration of a rapidly dissolving tablet to cancer patients: a new approach to treatment of incident pain. Br J Clin Pharmacol 2005; 59:249-53. [PMID: 15676050 PMCID: PMC1884753 DOI: 10.1111/j.1365-2125.2004.02264.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS It is estimated that two-thirds of cancer patients will at some point during their illness experience breakthrough pain. In this study, the pharmacokinetics of a novel sublingual dosage form of fentanyl developed for breakthrough pain was evaluated. METHODS Eleven Caucasian patients (seven male and 4 female, aged 34-75 years, median 60 years) with metastatic malignant disease were recruited initially, but three patients withdrew. Prior to the study all patients were on continuous nonfentanyl opiate medication. The study was a double-blind, cross-over trial, consisting of three 1-day treatment periods. A new rapidly dissolving preparation of fentanyl, was administered sublingually in single doses of 100, 200 and 400 microg, respectively, on three separate occasions. Plasma fentanyl concentrations were determined using liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS). Pharmacokinetic parameters were calculated by noncompartment analysis. Tolerability and the occurrence of adverse events were monitored throughout the study by patient questionnaire. RESULTS The data from nine subjects who completed at least two periods were used in the analysis of variance. There were no significant differences between doses (100, 200 and 400 microg) for dose adjusted AUC (F = 0.42, P = 0.6660), dose adjusted C(max) (F = 0.08, P = 0.9206) and Tmax (F = 0.94, P = 0.4107). Thus, these parameters showed dose proportionality. The differences (400-100microg) in dose adjusted AUC from the three-period crossover analysis was -0.016 min.ng/ml (t = 0.71, P = 0.8718). Interindividual variability in systemic exposure to fentanyl was fairly small (25-40%), which may be related to a good in vivo biopharmaceutical performance of the sublingual tablet, and a relatively small fraction of the dose being swallowed. The first detectable plasma concentration of fentanyl was observed between 8 and 11 min after administration. t(max) increased from 39.7 +/- 17.4 to 48.7 +/- 26.3 and 56.7 +/- 24.6 min for the 100, 200 and 400 microg doses, respectively. Adverse events were few and did not increase with increasing dose. CONCLUSION With this rapidly dissolving fentanyl formulation, the first detectable plasma concentration of fentanyl was observed at 8-11 min after administration. The pharmacokinetics of the drug showed dose proportionately. This formulation of fentanyl seemed to be well tolerated by the patients.
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Affiliation(s)
- B Lennernäs
- Department of Oncology, Karolinska Hospital, Stockholm, Sweden
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Abstract
The purpose of this study was to map quantitative trait loci (QTL) affecting health traits in Swedish dairy cattle. A genome scan covering 17 chromosomes was performed. Ten grandsire families were used in a granddaughter design. Nine of the families belonged to the Swedish Red and White breed, which is related to other Nordic Ayrshire breeds, and one family was of the Swedish Holstein breed. A total of 417 bulls were genotyped for 116 microsatellite markers distributed over 17 chromosomes. Daughter yield deviations for clinical mastitis, somatic cell count (SCC), and other diseases (OD) were included in the analysis. Least squares interval mapping using putative QTL as cofactors was applied both within and across grandsire families. Significance thresholds were set by permutation tests. In the across-family analysis, we detected 8 suggestive QTL and 3 QTL significant at the genome level. The QTL affecting clinical mastitis were found on 3 chromosomes (9, 11, and 25), 4 QTL for SCC were found (on chromosomes 5, 9, 11, and 23), and we detected 4 QTL for OD (on chromosomes 9, 11, 15, and 25). In addition, we found several QTL that segregated within single families but where the QTL effect was not significant in the across-family analysis. In conclusion, we were able to locate QTL for all 3 analyzed traits, and overlapping QTL for several traits were observed.
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Affiliation(s)
- M Holmberg
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, S-750 07 Uppsala, Sweden.
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Nilsson S, Holmberg M, Ljung G, Pettersson-Skjold D, Blom R, Ullén A, Westberg R, Nilsson I, Lennernas B. Phase II study of single agent gemcitabine in patients with hormone refractory prostate cancer (HRPC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Nilsson
- Swedish Prostate Cancer Study Group, Stockholm, Sweden
| | - M. Holmberg
- Swedish Prostate Cancer Study Group, Stockholm, Sweden
| | - G. Ljung
- Swedish Prostate Cancer Study Group, Stockholm, Sweden
| | | | - R. Blom
- Swedish Prostate Cancer Study Group, Stockholm, Sweden
| | - A. Ullén
- Swedish Prostate Cancer Study Group, Stockholm, Sweden
| | - R. Westberg
- Swedish Prostate Cancer Study Group, Stockholm, Sweden
| | - I. Nilsson
- Swedish Prostate Cancer Study Group, Stockholm, Sweden
| | - B. Lennernas
- Swedish Prostate Cancer Study Group, Stockholm, Sweden
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