Practice patterns in diagnostics, staging, and management strategies of gallbladder cancer among Nordic tertiary centers

Background and objective: Gallbladder cancer (GBC) is a rare malignancy in the Nordic countries and no common Nordic treatment guidelines exist. This study aimed to characterize the current diagnostic and treatment strategies in the Nordic countries and disclose differences in these strategies. Methods: This was a survey study with a cross-sectional questionnaire of all 19 university hospitals providing curative-intent surgery for GBC in Sweden, Norway, Denmark, and Finland. Results: In all Nordic countries except Sweden, neoadjuvant/downstaging chemotherapy was used in GBC patients. In T1b and T2, majority of the centers (15–18/19) performed extended cholecystectomy. In T3, majority of the centers (13/19) performed cholecystectomy with resection of segments 4b and 5. In T4, majority of the centers (12–14/19) chose palliative/oncological care. The centers in Sweden extended lymphadenectomy beyond the hepatoduodenal ligament, whereas all other Nordic centers usually limited lymphadenectomy to the hepatoduodenal ligament. All Nordic centers except those in Norway used adjuvant chemotherapy routinely for GBC. There were no major differences between the Nordic centers in diagnostics and follow-up. Conclusions: The surgical and oncological treatment strategies of GBC vary considerably between the Nordic centers and countries.publishedVersio

Matters of fact and matters of law : a study of borderlines, differences and relationships between fact and law

Avhandling.</p

Matters of fact and matters of law : a study of borderlines, differences and relationships between fact and law

<p>Avhandling.</p

Good inter- and intraobserver reliability for assessment of the slip angle in 77 hip radiographs of children with a slipped capital femoral epiphysis

Background and purpose — The decision on and the outcome of treatment for a slipped capital femoral epiphysis (SCFE) depend on the severity of the slip. In 2015, web-based registration was introduced into the Swedish Pediatric Orthopedic Quality (SPOQ) register. To determine whether the inclusion of commonly used methods in Sweden for radiographic measurement of SCFE (the calcar femorale [CF] method and the Billing method) is justified, we measured the inter- and intraobserver reliability of these 2 measurements. We also evaluated the internationally more commonly used head-shaft angle (HSA) method. Material and methods — 4 observers with different levels of experience with radiographic measurements analyzed 77 routine preoperative hip radiographs of children with SCFE. Inter- and intraobserver reliability was evaluated. Results — The interobserver reliability analysis for the 4 observers showed for CF an ICC of 0.99 (CI 0.97–0.99) and for Billing an ICC of 0.99 (CI 0.98–0.99). The interobserver reliability analysis for 2 observers showed for HSA an ICC of 0.98 (CI 0.97–0.99). Intraobserver reliability (2 observers) showed a mean difference below 1° for all 3 methods and with a 95% limit of agreement not exceeding ±6.8°. Interpretation — We found good reliability for both intra- and interobserver measurements of all 3 methods used for the assessment of the slip angle on routine preoperative lateral hip radiographs

Application of the integrated hydrological modelling system IHMS-HBV to pilot basin in Estonia

This report describes calibration and application of the IHMS-HBV model on a daily time step to Kasari River basin in Estonia. The Swedish Meteorological and Hydrological Institute (SMHI) have as consultant been responsible for the set-up, calibration, training and delivery of the Integrated Hydrological Model System with the HBV-model (IHMSHBV). The Swedish Board for lnvestment and Technical Support (BITS) financed the project. The training and transfer of technology were addressed to the Estonian Meteorological and Hydrological Institute (EMHI)

The contralateral hip in slipped capital femoral epiphysis : Is there an easy-to-use algorithm to support a decision for prophylactic fixation?

Purpose: To identify a specific factor that can support the decision for prophylactic fixation in unilateral slipped capital femoral epiphysis. Methods: This retrospective cohort study included a total national population of 379 children diagnosed with slipped capital femoral epiphysis from 2007 to 2013. Regression analysis used information on slip severity, clinical classification of the index hip, age, sex, age-adjusted body mass index, the difference in epiphyseal-diaphyseal angle, and comorbidity to identify any risk factor for the subsequent development of a slip in the contralateral hip. Four observers evaluated the triradiate cartilage following the modified Oxford bone score grade. The occurrence of later development of a contralateral slip in different stage of physeal closure was used to analyze the sensitivity and specificity for this method. Results: This studys only predictor for a subsequent contralateral slip was chronological age. At age 13 years or older, 1/15 in girls and 3/65 in boys suffered from a slip in the contralateral hip. Thus, when using age &amp;lt;13 years as a test for deciding when to do prophylactic fixation, the sensitivity would be 88% and specificity 51% for preventing contralateral slip. However, the correlation between the four different observers was too low to be considered useful when assessing the triradiate cartilage for skeletal maturity. Conclusion: We would advocate a prophylactic fixation for children &amp;lt;13 years diagnosed with a unilateral slipped capital femoral epiphysis as an easy-to-use algorithm.Funding Agencies|Academy for Healthcare; Region Jonkoping County [FUTURUM-964258]; Medical Research Council of Southeast Sweden [FORSS-906641]</p

The impact of post-hepatectomy liver failure on mortality : a population-based study

Background: Post-hepatectomy liver failure (PHLF) is considered a main reason for death after major hepatectomy. The reported PHLF-related mortality differs largely and the data mainly originate from single centers. Aim: A retrospective, population-based register study was designed to evaluate the impact of PHLF on 90-day mortality after hepatectomy. Method: All patients who underwent liver resection in Sweden between 2005 and 2009 were retrospectively identified using the Swedish Hospital Discharge Registry. 30- and 90-day mortality were identified by linkage to the Registry of Causes of Death. Additional clinical data were obtained from the medical charts in all seven university hospitals in Sweden. PHLF was defined according to Balzan criteria (Bilirubin &gt;50 µg/L and international normalized ratio &gt;1.5) on postoperative day 5. Results: A total of 2461 liver resections were performed (2194 in university hospitals). 30- and 90-day mortality were 1.3% and 2.5%, respectively. 90-day mortality at university hospitals was 2.1% (n = 46). In 41% (n = 19) of these patients, PHLF alone or in combination with multi-organ failure was identified as cause of death. Between the PHLF and non-PHLF group, there was no significant difference regarding age, sex, American Society of Anesthesiologists-classification, or preoperative chemotherapy. Cholangiocarcinoma as indication for surgery, need for vascular reconstruction and an extended resection were significantly overrepresented in the PHLF-group. Between groups, the incidence of 50:50 criteria differed significantly already on postoperative day 3. Conclusion: Overall mortality is very low after hepatectomy in Sweden. PHLF represents the single most important cause of death even in a population-based setting

Sepsis-associated cholestasis is critically dependent on P-selectin-dependent leukocyte recruitment in mice.

Cholestasis is a major complication in sepsis although the underlying mechanisms remain elusive. The aim of this study was to evaluate the role of P-selectin and leukocyte recruitment in endotoxemia- associated cholestasis. C57BL/6 mice were challenged intraperitoneally with endotoxin ( 0.4 mg/ kg), and 6 h later the common bile duct was cannulated for determination of bile flow and biliary excretion of bromosulfophthalein. Mice were pretreated with an anti-P-selectin antibody or an isotype- matched control antibody. Leukocyte infiltration was determined by measuring hepatic levels of myeloperoxidase. Tumor necrosis factor-alpha and CXC chemokines in the liver was determined by ELISA. Liver damage was monitored by measuring serum levels of alanine aminotransferase and aspartate aminotransferase. Apoptosis was quantified morphologically by nuclear condensation and fragmentation using Hoechst 33342 staining. Endotoxin induced a significant inflammatory response with increased TNF-alpha and CXC chemokine concentrations, leukocyte infiltration, liver enzyme release, and apoptotic cell death. This response was associated with pronounced cholestasis indicated by a > 70% decrease of bile flow and biliary excretion of bromosulfophthalein. Immunoneutralization of P-selectin significantly attenuated endotoxin- induced leukocyte infiltration reflected by a > 60% reduction of hepatic myeloperoxidase levels. Interference with P-selectin decreased endotoxin- mediated hepatocellular apoptosis and necrosis, but did not affect hepatic levels of tumor necrosis factor-alpha and CXC chemokines. Of interest, inhibition of P- selectin restored bile flow and biliary excretion of bromosulfophthalein to normal levels in endotoxin- challenged animals. Our study demonstrates for the first time that P-selectin-mediated recruitment of leukocytes, but not the local production of proinflammatory mediators, is the primary cause of cholestasis in septic liver injury