http://hdl.handle.net/1956/955 Search the Channel search http://bora.uib.no/simple-search http://hdl.handle.net/1956/2328 Title: The use of prosthetic grafts in above-knee femoropopliteal bypass surgery : a clinical study of long-term results and risk factors for failure <br/> <br/>Authors: Pedersen, Gustav <br/> <br/>Abstract: Purpose: The purpose of this study has been to investigate the results of above-knee prosthetic femoropopliteal bypass surgery and to identify risk factors for complications and graft failure. The influence of comorbidity, degree of chronic leg ischaemia, preoperative angiographic run-off score and intraoperative flow measurements on long-term results were investigated. Furthermore, local infections and the outcome of treating occluded prosthetic grafts were studied. Methods: Two-hundred-and-thirty-seven patients (156 men, 81 women) were subjected to 252 above-knee prosthetic femoropopliteal bypass operations at Haukeland University Hospital between Jan 1990 and Dec 2001. One hundred and forty-one graft implantations (129 patients) were done for intermittent claudication and 111 (108 patients) for critical ischaemia. Patient data were prospectively recorded in a database registry. Some data were supplemented from patients records. Occlusion dates, complications, re-operations including amputations, and mortality were also recorded. Patient characteristics, anatomical risk factors and intraoperative flow measurements were analysed for impact on results after surgery. Survival, limb salvage and patency rates were analysed with the Product limit method and illustrated as Kaplan-Meier curves. The risk factors were subjected to univariate analysis using the log rank test for impact on survival, limb salvage and patency rates. Variables approaching significance were included in multivariate analysis performed with the Cox proportional hazard model. Results: Paper I. Surgical site infection was recorded after 7.8 % of the operations and graft infection after 12 %. The risk of developing a local infection was significantly correlated with postoperative lymph fistula. Redo surgery was associated with graft infection. Graft infections caused by Staph. Aur. always warranted surgery, either local revision or graft excision. Paper II. For grafts implanted for intermittent claudication, the assisted primary patency rates were 62 % at 2 years and 44 % at 5 years. The 5-year patency rate for smokers was 24 % versus 67 % for non-smokers (p < 0.01). A previous history of cerebral infarction was significantly associated with reduced graft patency. Preoperative s-creatinine > 125 mmol/L was significantly associated with reduced survival. Paper III. The 30-day mortality rate of patients operated for critical ischaemia was 5.5 %. The 2- and 5-year survival was 72 % and 42 %, whereas the limb salvage rates at 2 and 5 years were 83 % and 73 %, respectively. The 2-year primary patency rate for smokers was 38 % versus 62 % for non-smokers (p = 0.018, hazard ratio 2.18). Smoking and tissue loss were significantly associated with reduced secondary patency. Paper IV. Basal flow measurements were not related to patency. The 2- and 5-year patency rates for grafts with a papaverine flow < 500 ml/min were 48 % and 18 % compared with 66 % and 52 % for grafts with a papaverine flow ≥ 500 ml/min (p = 0.012, hazard ratio 2.6). Two and 5-year patency rates for smokers vs non-smokers were 44 % and 18 % vs 69 % and 54 %. Smoking (p = 0.008, hazard ratio 2.38) and poor run-off score (p = 0.009, hazard ratio 2.38) were independent risk factors for reduced patency. Poor run-off score did not correlate with low values of measured basal or papaverine flow. Paper V. Half the 24 initial procedures to restore patency of occluded grafts originally implanted for critical ischaemia failed within a month. Outcome of second or third-time redo procedures were similar. Primary patency rates of all 55 redo procedures were 32 % at three months, 28 % at six months and 12 % at 12 months. The results of thrombectomy and thrombolysis were similar. Re-opened grafts additionally treated for an underlying anastomotic stenosis had significantly better patency, as compared with re-opened grafts without a pre-existing stenosis (p = 0.027, hazard ratio 2.813). Conclusions: The results regarding survival, limb salvage and patency are comparable to previous reports. The results underline that a long observation period is necessary to achieve full overview of complications and the impact of risk factors. Infectious complications after prosthetic femoropopliteal bypass in the study group were higher than previously reported. The results suggest that a selective approach should be taken towards excision of infected femoropopliteal prostheses according to the clinical presentation of the graft infection and the type of bacteriae involved. A conservative attitude is recommended towards placing a prosthetic graft in the above-knee femoropopliteal position for intermittent claudication. The finding of reduced patency rates in patients with a history of a cerebral insult operated for intermittent claudication need further studies to be verified. Patients with intermittent claudication and renal impairment reveal poor survival, indicating renal impairment as a relative contraindication for surgical treatment. Smokers have inferior patency rates when operated for intermittent claudication as well as for critical ischaemia. Poor angiographic run-off score was also associated with inferior patency rates. These findings indicate that prosthetic femoropopliteal bypass is not very suitable for these groups of patients. Furthermore, the poor secondary patency rates of smokers as well as for patients with tissue loss suggest that these patients may benefit from alternative treatment modalities to re-opening an occluded bypass. A papaverine flow of < 500 ml/min is associated with reduced patency. Additional antithrombotic medication and frequent follow-up may be considered for these grafts. Redo procedures for occluded grafts originally implanted for critical ischaemia are of limited value and cannot be recommended except in cases with a proven graft-related stenosis. Other cases in need of re-intervention should be treated with either a new arterial reconstruction or an amputation. Based on the findings in this study, the following issues must be evaluated when offering an above-knee prosthetic femoropopliteal bypass for chronic limb ischaemia: patient comorbidity, smoking, degree of ischaemia and angiographic runoff score. Careful selection of patients subjected to above-knee prosthetic bypass surgery for chronic ischaemia is mandatory to achieve the optimal gain of the operation. Wed, 23 May 2007 22:58:59 GMT http://hdl.handle.net/1956/2320 Title: A 3-D post-mortem model provides rationale for complications in gastrointestinal surgery : a post-mortem corrosion-cast model <br/> <br/>Authors: Ignjatovic, Dejan Thu, 07 Jun 2007 22:58:59 GMT http://hdl.handle.net/1956/2166 Title: Wear, fixation, and revision of hip prostheses <br/> <br/>Authors: Hallan, Geir Thu, 18 Jan 2007 22:58:59 GMT http://hdl.handle.net/1956/2166 Title: Wear, fixation, and revision of hip prostheses <br/> <br/>Authors: Hallan, Geir Thu, 18 Jan 2007 22:58:59 GMT http://hdl.handle.net/1956/2138 Title: Expression of biomarkers (p53, transforming growth factor alpha, epidermal growth factor receptor, c-erbB-2/neu and the proliferative cell nuclear antigen) in oropharyngeal squamous cell carcinomas <br/> <br/>Authors: Ibrahim, Salah Osman; Lillehaug, Johan R.; Johannessen, Anne Christine; Liavaag, P. G.; Nilsen, Rune; Vasstrand, Endre N. <br/> <br/>Abstract: Using immunohistochemistry, expression of p53, transforming growth factor-alpha (TGF-α), epidermal growth factor receptor (EGFR), c-erbB-2/neu and proliferating cell nuclear antigen (PCNA) was examined in 26 fresh frozen tissue specimens of oropharyngeal squamous cell carcinomas (SCCs). p53 gene mutations were examined by polymerase chain reaction (PCR)/DNA sequencing methods in 22 carcinomas. The findings were examined for correlations with patients’ clinicopathological parameters. Expressions of p53 and PCNA were also examined in 21 formalin-fixed corresponding tissues. Of the fresh frozen tissue specimens, 77% (20/26) showed expression and 68% (15/22) showed mutations (substitutions) of the p53, with significant clustering of the mutations in exons 5 (8/22; 36%), 7 (4/22; 18%) and 8 (5/22; 23%). No mutations were found in exon 6. There was a discordance between expression of p53 protein and mutations of the gene. Parallel to expression and mutations of the p53 found in most of the specimens, expression of TGF-α, EGFR, c-erbB-2/neu and PCNA was found in 88% (22/25), 92% (23/25), 58% (14/24) and 91% (21/23) of the specimens, respectively. For the formalin-fixed tissue specimens, 62% (13/21) and 90% (19/21) expressed p53 and PCNA, respectively. Examining for correlations with patients’ clinicopathological parameters, expression of p53, TGF-α, EGFR and c-erbB-2/neu seemed to negatively correlate with the increase of the tumour grade. The present work suggests that: (1) lack of negative growth regulation due to inactivation of the p53 gene together with activation of other proto-oncogenes are necessary genetic events in the carcinogenesis of oropharyngeal SCCs; (2) in oropharyngeal SCCs, p53 gene mutations were clustered in exons 5 (codons 130–186), 7 (codons 230–248) and 8 (codons 271–282) which perhaps suggests that tobacco carcinogens probably affect the mutational hot spots of the p53 gene at codons 157, 175, 186, 248, 273 and 282; and (3) fresh frozen and formalin-fixed tissue specimens give similar results when an immunohistochemical method is applied. The importance of p53, TGF-α, EGFR, c-erbB-2/neu and PCNA as biomarkers in oropharyngeal SCCs deserves particular attention because it might offer further understanding of the development of these carcinomas. Thu, 29 Oct 1998 22:58:59 GMT http://hdl.handle.net/1956/2075 Title: Identifying high-risk groups and activity specific injuries <br/> <br/>Authors: Brudvik, Christina <br/> <br/>Abstract: Sammendrag (Norwegian summary) Formålet med denne studien var å undersøke forekomsten av barneulykker i Bergen sammenliknet med forekomsten andre steder innenlands og utenlands. Vi ønsket å undersøke hvilke barn, karakterisert ved alder, kjønn eller andre faktorer, som oftest pådro seg ulike skader. Det var også et mål å analysere hvilke skader som oftest oppsto under ulike typer aktiviteter, og om nye aktiviteter medførte nye skadetyper. Det var en målsetting at undersøkelsen ville gi velbegrunnete anbefalinger vedrørende forebygging av skader på barn. Det var også av interesse å se på utfallet av vår behandling av en vanlig, men komplisert skade, nemlig underarms- og håndleddsbrudd med feilstilling. Hovedregistreringen har foregått ved Bergen Legevakt og Haukeland Universitetssykehus i løpet av 1998 og danner grunnlaget for artikkel I, II, III og IV. I denne registreringen ble det brukt elektroniske påminnere til legevaktens helsepersonell for å sikre at den ble mest mulig komplett. Mer detaljerte og avgrensete registreringer av både gamle og nye aktiviteter har foregått ved Bergen Legevakts røntgen- og såravdeling fra 2000 til 2002 og danner grunnlaget for artikkel V og VI. Det ble registrert rundt 7.000 nye skader på barn under 16 år, hvorav 1.725 var bruddskader. Den totale årlige skadeinsidens var 9 per 100 barn under 6 år og 13 per 100 barn mellom 6 og 15 år. De yngste barna pådro seg oftest hodeskader mens de eldste fikk mest armskader. De fleste skader var av mild eller moderat alvorlighetsgrad, men 4 barn døde. De alvorligste skadene oppsto i trafikken. Hodeskade, inklusiv hjernerystelse, var den hyppigste innleggelsesdiagnosen i sykehus. De fleste skader oppsto hjemme eller nær hjemmet. Brannskader var hyppigst blant barn under 4 år og skyldtes oftest skolding fra varm drikke. Jenter fra etniske minoriteter hadde en høy andel av de alvorligste brannskader i dette registreringsåret. Skoleskader, inklusiv voldsskader, oppsto oftest i friminuttene og når barna var uten voksent tilsyn. Blant aktiviteter hadde fotball den høyeste årlige skadeinsidens (11 per 1000 barn), fulgt av sykling (8 per 1000 barn). Den årlige insidensen av brudd blant barn i Bergen kommune (245 per 10.000) var betydelig høyere enn tidligere påvist i andre norske byer (Harstad, Stavanger, Drammen og Trondheim). Gutter i alderen 13-15 år hadde en dobbelt så høy forekomst av brudd sammenliknet med jenter i samme alder. Mens 1/3 av fotball- og sykkelskadene var brudd, utgjorde de hele 2/3 av rulleskøyte- og snøbrettskadene og rammet oftest håndleddet. To spesielle bruddtyper forekom hyppigere i nye aktiviteter. Det gjaldt bruddskader i håndrotens skafoidbein, som ellers forekommer svært sjelden hos barn og unge, men som forekom i en høyere andel av bruddskadene ved bruk av rulleskøyter og rullebrett enn i andre aktiviteter. En høy andel underarms- og håndleddsbrudd med volar vinkling ble identifisert i forbindelse med bruk av sparkesykler. I begge tilfellene må det vurderes om vanlig håndleddsbeskyttelse også kan forebygge disse bruddtypene. Sparkesykler ble svært populære i 2000 og medførte mange skader dette første året, men skadeantallet begynte å falle allerede året etter. Det var ellers interessant å merke seg at håndleddet også var det vanligste bruddsted hos unge fotballspillere, og harde ballskudd var årsaken i hele 40% av tilfellene. Dette gjør det logisk å skulle beskytte håndleddet så vel som skinneleggen under denne aktiviteten. Vi vurderte også funksjonen i håndledd og underarm til barn og unge som syv år tidligere hadde hatt brudd med feilstillinger som måtte korrigeres. Våre behandlingsresultater var svært gode, selv der det var en resterende feilstilling på 15 grader eller mer ved gipsfjerning. Kontrollene indikerte en stor evne til remodellering av disse barnebruddene. Kun noen få med høyere underarmsbrudd hadde redusert funksjon til tross for normale røntgenbilder. Thu, 23 Nov 2006 22:58:59 GMT http://hdl.handle.net/1956/1942 Title: Hepatic cysts : occurrence and effect of single-session alcohol sclerotherapy <br/> <br/>Authors: Larssen, Trond Bjerke Thu, 12 Oct 2006 22:58:59 GMT http://hdl.handle.net/1956/1935 Title: Evidence and methodology in clinical pain trials with special focus on ketamine <br/> <br/>Authors: Bell, Rae Frances <br/> <br/>Abstract: Aims: To establish the evidence base for the use of the NMDA receptor antagonist ketamine in the treatment of acute postoperative pain and cancer pain, and in doing so, to assess the methodology used in acute pain and cancer pain trials. Methods: In paper I a clinical model was developed and tested. Paper II is a quantitative and qualitative Cochrane systematic review on perioperative ketamine for acute postoperative pain. Paper III is a qualitative Cochrane systematic review on ketamine as adjuvant to opioid for cancer pain. Paper IV is a qualitative systematic review of the methodology used in clinical trials of oral opioids for cancer pain. Results: The model developed in Paper I was tested and found to be sensitive. Thirty-seven randomised, controlled trials (RCTs) were included in paper II. The meta-analysis found that perioperative ketamine reduced 24 hr PCA morphine consumption and reduced PONV. In paper III, four RCT’s concerning ketamine as adjuvant to opioid for cancer pain were identified. Two were excluded due to flawed methodology. Both trials found that ketamine improved morphine analgesia. Meta-analysis was not appropriate. Thirty- four RCT’s were included in paper IV. Significant limitations in the trial methodology were identified. Conclusions: There is level 1 (strong) evidence that perioperative ketamine reduces 24 hr PCA morphine consumption, and post-operative nausea and vomiting. Adverse effects were mild or absent.There is currently insufficient evidence to permit conclusions regarding the benefits and harms of ketamine as adjuvant to opioid for cancer pain. Randomised, controlled trials are needed. Clinical pain trials require rigorous methodology if they are to produce reliable results. Recommendations for future analgesic trials in acute and cancer pain are made. Thu, 02 Nov 2006 22:58:59 GMT