Wendelius teckningar föreställande Esters historia. En kommentar till Bengtsson och Vahlne samt en nytolkning av de så kallade Gripsholmstavlorna

Title: Wendelius’ Drawings Depicting the Story of Esther. A Comment on Bengtsson and Vahlne with a New Interpretation of the so called Gripsholm PaintingsA few drawings at the Royal Library in Stockholm have aroused considerable debate among Swedish art historians (figs. 2, 3, 5, 6 & 7). According to sources contemporary with their production in 1722, they reproduce large paintings kept at Gripsholm castle representing the story of king Erik XIV. Twentieth-century art historians have suggested a number of alternative iconographies, mostly alternative sequences of Swedish history or classical motifs. The drawings have been addressed recently in ICO by Herman Bengtsson and Bo Vahlne. The present article argues that the motifs are from the Book of Esther. The claim is supported by the juxtaposition of two scenes representing a woman before a throne and a triumphal scene (Esther before Ahasuerus & Mordecai’s triumph), the bright yellow dress of the female protagonist (a common symbol for her Jewishness) and her swooning before the throne. Comparisons are made with the Alfta hanging representing Esther (fig. 1) and a painting by Artemisia Gentileschi (fig. 4). The iconography of the drawings is based on Catholic sources, suggesting they were produced in Poland in the 1540s and could have come with Catherine Jagelleonica’s entourage to Åbo and then to Gripsholm in the early 1560s

The development of direct extrusion-injection moulded zein matrices as novel oral controlled drug delivery systems

Purpose: To evaluate the potential of zein as a sole excipient for controlled release formulations prepared by hot melt extrusion. Methods: Physical mixtures of zein, water and crystalline paracetamol were hot melt extruded (HME) at 80°C and injection moulded (IM) into caplet forms. HME-IM Caplets were characterised using differential scanning calorimetry, ATR-FTIR spectroscopy, scanning electron microscopy and powder X-ray diffraction. Hydration and drug release kinetics of the caplets were investigated and fitted to a diffusion model. Results: For the formulations with lower drug loadings, the drug was found to be in the non-crystalline state, while for the ones with higher drug loadings paracetamol is mostly crystalline. Release was found to be largely independent of drug loading but strongly dependent upon device dimensions, and predominately governed by a Fickian diffusion mechanism, while the hydration kinetics shows the features of Case II diffusion. Conclusions: In this study a prototype controlled release caplet formulation using zein as the sole excipient was successfully prepared using direct HME-IM processing. The results demonstrated the unique advantage of the hot melt extruded zein formulations on the tuneability of drug release rate by alternating the device dimensions

Body site of cutaneous malignant melanoma : Primary tumor location in relation to phenotypic and prognostic factors

The main purpose of this thesis was to analyze the primary body site of cutaneous malignant melanoma (CMM) in relation to phenotypic traits and prognosis. It is clear that several characteristics of CMM are different, and vary with the skin location where the tumor originated. The different types of sun exposure (chronic/occupational and/or intermittent/recreational) on different parts of the skin could be one of the reasons for this. A new computer program, EssDoll©, developed for detailed studies of site of CMM was used in this thesis. A cohort of 756 patients, with head-neck CMM was analyzed. The CMM density was 3.4 times higher in the face compared to skin surfaces outside the head-neck area. Similarly, nodular melanoma (NM) was 2.3- and lentigo maligna melanoma (LMM) 74 times more dense in the face. It is known that chronic exposure to UV-fadiation is a risk factor for LMM, and our findings suggest such a relationship for NM as well. 'Me mean age at diagnosis was 12 years higher for CMM in the head-neck compared to sites outside the head-neck (66 vs. 54 yr.). Ibis relatively later diagnose supports the view of a natural tan to be somewhat protective for CMM. We found tumor thickness to be the only statistically significant prognostic factor for patients with head-neck CMM. The surgical resection margin at operation of the primary tumor (1-10 vs. 2: 11 mm) had no impact on patient outcome. A software, EssDoll©, was developed and used in a cohort of 2517 patients with 2608 primary CMMs. The primary sites of CMMs was plotted on a movable doll and linked to patient ID. With this software one or more skin area(s) can be chosen for analysis. Using this type of analysis we confirmed that the predominant site for CMM in men was the trunk, and in women the lower extremities. Superficial spreading melanoma (SSM) and NM were most common on the trunk while LMM was most common in the head-neck. Patients with hereditary CMM (HCMM) and patients who have been treated for a sporadic CMM have an increased risk to develop new CMM. The anatomic sites of CMM in these patient groups were analyzed separately. in the database there were 104 patients with HCMM and 69 patients with more than one sporadic CMM (MCMM). For patients with sporadic MCMM, the second tumor often arose in the same body field as the first. The concordance was statistically significant (p<0.0001). This might imply that the skin surrounding a CMM has undergone predisposing changes for yet another CMM ("field effect"). Furthermore, the patients with HCMM had significantly less CMM on the head-neck and more on the trunk compared to patients with one sporadic CMM (p=0.05). The reason for this could be an increased sensitivity to intermittent sun exposure in HCMM patients. The site-specific prognosis was analyzed in a cohort of 1,891 patients. The body surface was divided into 48 separate areas (which, for reasons of statistical power, were combined into 24 areas) with no consideration taken to outcome. The multivariate analyzes, adjusted for previously established prognostic factors for patents with localized disease, showed a significantly elevated risk for CMM death in patients with primary CMM site in the middle and lower back (odds ratio 2.0, p=0.03) compared to those with tumors in the reference area. In another model, where all areas were analyzed in pairs also the middle and lower back and, in addition, the dorsal shoulders, clavicular areas superior back, supra mammary and mammary areas were associated with an adverse prognosis. Tumors on the arms, calves, achilles, knee and poplitea. area were associated with a more favorable prognosis. In conclusion, a number of different characteristics of CMM have been connected to the primary anatomical site

Sentinel Node Location in Trunk and Extremity Melanomas: Uncommon or Multiple Lymph Drainage Does Not Affect Survival

Patients with cutaneous melanoma (CM) on the trunk have a worse prognosis than those with extremity CM. One reason could be multiple or uncommon (outside axilla or groin) sentinel node locations (SNLs). We identified 859 patients who underwent sentinel node biopsy for trunk (n = 465) or extremity (n = 394) CM in three Swedish healthcare regions from 2000 to 2008. We collected patient, tumor, and sentinel node characteristics through clinical registers and medical records. We investigated the distribution of SNLs in a logistic regression model, and risk of overall and melanoma-specific death through 2011 in a multivariable Cox regression model. Trunk CM was associated with multiple SNLs (31 vs. 7 %; odds ratio [OR] 7.1; 95 % confidence interval [CI] 4.6-11.5; p < 0.001) but not uncommon SNLs (8 vs. 7 %; OR 1.1; 95 % CI 0.6-1.9; p = 0.75) compared with extremity CM. The increased risk of melanoma-specific death was confirmed for trunk CM (hazard ratio [HR] 1.9; 95 % CI 1.3-2.9; p = 0.003), especially on the upper back (HR 2.3; 95 % CI 1.4-3.6; p < 0.001) compared with extremity CM. Uncommon SNLs (HR 0.5; 95 % CI 0.2-1.4; p = 0.21) or multiple SNLs (HR 1.1; 95 % CI 0.4-2.9; p = 0.81) were not associated with melanoma-specific death compared with those with common/single SNL. Trunk melanomas were associated with multiple lymph drainage, but the worse prognosis of trunk melanomas could not be explained by the increased frequency of multiple or uncommon SNLs

Risk Factors for Abdominal Compartment Syndrome After Endovascular Repair for Ruptured Abdominal Aortic Aneurysm : A Case Control Study

Objective: Ruptured abdominal aortic aneurysms (rAAA) are treated by endovascular aneurysm repair (rEVAR) increasingly often. Despite rEVAR being a minimally invasive method, abdominal compartment syndrome (ACS) remains a significant post-operative threat. The aim of this study was to investigate risk factors for ACS after rEVAR, including aortic morphological features. Methods: The Swedish vascular registry (Swedvasc) was assessed for ACS after rEVAR in the period 2008 - 2015. All patients identified were compared with controls (i.e., patients who did not develop ACS after rEVAR), matched by centre and repair date. Case records were reviewed, and radiology images analysed in a core laboratory. Comparisons were performed with respect to physiological and radiological risk factors. Results: The study population consisted of 40 patients with ACS and 68 controls. Pre-operatively, patients with ACS had a lower blood pressure (BP) than controls (median 70 mmHg vs. 97 mmHg; p &lt;.001). Intra-operatively, they had aortic balloon occlusion more often (55.0% vs. 10.3%; p &lt;.001) and received more transfusions than controls (median nine units of packed red blood cells [pRBC] vs. two units; p &lt;.001). Ninety-seven per cent of those who developed ACS had a pre-operative BP &lt; 70 mmHg, aortic balloon occlusion, or received more than five pRBC unit transfusions. Treatment outside the instructions for use did not differ between patients and controls (57.5% vs. 54.4%; p=.84), and neither did the pre-operative patency of the inferior mesenteric artery (57.1% vs. 63.9%; p=.52) nor the number of visible lumbar arteries on pre-operative imaging (2 vs. 4; p=.014). In multivariable logistic regression, the number of intra-operative transfusions were predictive of ACS (p &lt;.001), while pre-operative hypotension (p=.32) and aortic balloon occlusion (p=.018) were not. Conclusion: ACS after rEVAR is mainly associated with physiological factors and is unlikely to develop without the presence of a pre-operative BP &lt; 70 mmHg, the need for an aortic occlusion balloon, or more than five intraoperative pRBC unit transfusions. Treatment outside the IFU or any other morphological factor were not associated with a risk of ACS

Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment

Objective: Aortic prosthesis infection is a devastating complication of aortic surgery. In situ reconstruction with the neo-aorto-iliac system (NAIS) bypass technique has become increasingly used and is recommended in recent treatment guidelines. The main aim was to evaluate NAIS procedural outcomes when undertaken after previous open or endovascular aortic repair in Sweden. Methods: In this retrospective study, The National Quality Registry for Vascular Surgery (Swedvasc) was used to identify Swedish centres that offered the NAIS bypass procedure for aortic prosthesis infection between 2008 and 2018. Variables of special interest were procedural details, short and long term survival, renal and other complications, and the durtion of antimicrobial treatment. Results: Forty patients (36 males, four females [mean age 69 years], 32 open repairs, seven endovascular aortic repairs [EVAR] and one fenestrated EVAR; 21 presented with aorto-enteric fistula) operated on with NAIS bypass were reviewed. The median time from the primary aortic intervention to the NAIS bypass procedure was 32 months (range 0 – 252 months). Mean ± standard deviation operating time was 645 ± 160 minutes, mean blood loss was 6 277 ± 6 525 mL, mean length of intensive care unit stay was 5.3 ± 3.7 days, and mean length of overall hospital stay was 21.2 ± 11.4 days. Thirty-five patients (88%) had a positive microbial culture; the most commonly isolated pathogen was Candida spp. The majority of patients survived for 30 days (n = 35 [88%]), and 33 (83%) and 32 (80%) patients survived for 90 days and one year, respectively. The number of surviving patients free from antimicrobial treatment at 90 days, six months, and one year was 19 (58%), 29 (88%), and 30 (94%). After a mean long term follow up of 69.9 ± 44.7 months, 20 patients were still alive. Conclusion: The NAIS bypass procedure offered reasonable survival and functional outcomes, and was associated with a high cure rate, defined as freedom from any antimicrobial treatment