Randomised prostate cancer screening trial: 20 year follow-up

Objective To assess whether screening for prostate cancer reduces prostate cancer specific mortality

Mesh hernia repair and male infertility: A retrospective register study.

BACKGROUND: Previous studies have suggested that the use of mesh in groin hernia repair may be associated with an increased risk for male infertility as a result of inflammatory obliteration of structures in the spermatic cord. In a recent study, we could not find an increased incidence of involuntary childlessness. The aim of this study was to evaluate this issue further. METHODS: Men born between 1950 and 1989, with a hernia repair registered in the Swedish Hernia Register between 1992 and 2007 were cross-linked with all men in the same age group with the diagnosis of male infertility according to the Swedish National Patient Register. The cumulative and expected incidences of infertility were analyzed. Separate multivariate logistic analyses, adjusted for age and years elapsed since the first repair, were performed for men with unilateral and bilateral repair, respectively. RESULTS: Overall, 34,267 men were identified with a history of at least 1 inguinal hernia repair. A total of 233 (0.7%) of these had been given the diagnosis of male infertility after their first operation. We did not find any differences between expected and observed cumulative incidences of infertility in men operated with hernia repair. Men with bilateral hernia repair had a slightly increased risk for infertility when mesh was used on either side. However, the cumulative incidence was less than 1%. CONCLUSION: Inguinal hernia repair with mesh is not associated with an increased incidence of, or clinically important risk for, male infertility

I väntan på mjukvarupatent

Främsta syftet med denna magisteruppsats har varit att undersöka om svenska utvecklingsföretag är förberedda inför ett eventuellt införande av mjukvarupatent eller ej. Vi har för att ta reda på detta, samt för att utröna utvecklingsföretagens inställning och kunskaper om mjukvarupatent, genomfört en enkätundersökning. Vi har även tagit upp och diskuterat kring de argument som motståndare och förespråkare till mjukvarupatent angivit. Detta har skett dels genom litteraturstudier, men även genom intervjuer med företrädare för de båda åsiktsgrupperna. I uppsatsen har vi även försökt avgöra huruvida mjukvarupatent kommer att befästas i lag eller ej, vilket bland annat har skett med hjälp av en åsiktsundersökning av samtliga svenska europaparlamentariker. I anslutning till analys och slutsats har vi tagit fram förslag på tänkbara verksamhetsstrategier till utvecklingsföretag, samt rekommendation till hur lagstiftare bör förhålla sig till mjukvarupatent

Episodic memory in the human prefrontal cortex

This thesis consisting of five papers examines the relationship between haemodynamicactivation in the prefrontal cortex with episodicmemoryfunction in the healthy human brain. Brain function is measured with positron emission tomography (PET) and functional magnetic resonance imaging (FMRI) and episodic memory for words as well as visuo-spatial material is examined. The first paper consists of two experiments using either verbal or visuospatial material and examines the effects of practice on episodic memory in repeated cycles of encoding and retrieval. Subjects are scanned with PET during retrieval. It is found that before practice, the tasks activate frontoparietal networks and that this activity diminishes with practice in favour of paracentral brain activity, perhaps reflecting decreasing demands on working memory. The second paper examines incidental encoding of figurative and non-figurative drawings while processing of the drawings takes place in different levels of processing (LOP). Subjects are biased toward either deep or shallow by rating agree-ability or graphical quality of the drawings respectively. A behavioural experiment is undertaken in the first part of the paper, establishing that the LOP effect extends to visuo-spatial material. PET scanning then shows increased activity for deep encoding compared to shallow encoding in left prefrontal, parietal and anterior temporal regions, while comparing shallow encoding to deep encoding yielded right prefrontal, parietal and posterior temporal activations. The third paper continues to examine effects of practice in another setting. Subjects are taught a specific aid to memory, a mnemonic known as the method of loci. They are scanned with PET while encoding a list of words both with and without use of the mnemonic as well as during acquisition of the mnemonic. Use of the mnemonic is associated with increased activity in left frontal and occipito-parietal networks. Acquisition of the mnemonic compared to baseline is associated with increased activity in lateral and medial parietal cortex while activity in the left medial Abstract temporal lobe increased with practice. In the fourth paper, FMRI is used to expand the findings from the second paper by applying the greater temporal resolution of event-related FMRI to separate activity for the figurative from the non-figurative drawings. Only some of the results from the second paper are replicated. In the last paper, the remember / know paradigm is used. This means that subjects are given a recognition test of previously seen words and asked to indicate the quality of a recognition experience as either remembered , meaning that the subject can recall the encoding event, or known , meaning that the subject finds the word familiar but has no recollection of the encoding event. The recognition test as well as the attribution of the recognition experience as remembering or knowing is scanned using event-related FMRI. Recognised words that are later remembered compared to words that are later known are associated with increased activity in the posterior part of the right hippocampus and comparing later remembered words with correct rejections revealed activations in the left inferior parietal lobule and in the right middle frontal gyrus. We conclude that practice in an episodic memory task represents a change from controlled to automatic processing; that the strong form of the hemispheric encoding retrieval asymmetry hypothesis (HERA) is not sufficient to account for the patterns of activity in the frontal cortex associated with episodic memory; that levels of processing can be shown with visuo-spatial material and that levels of processing are reflected in differently lateralised frontal and parietal activity

Male infertility after mesh hernia repair: A prospective study.

BACKGROUND: Several animal studies have raised concern about the risk for obstructive azoospermia owing to vasal fibrosis caused by the use of alloplastic mesh prosthesis in inguinal hernia repair. The aim of this study was to determine the prevalence of male infertility after bilateral mesh repair. METHODS: In a prospective study, a questionnaire inquiring about involuntary childlessness, investigation for infertility and number of children was sent by mail to a group of 376 men aged 18-55 years, who had undergone bilateral mesh repair, identified in the Swedish Hernia Register (SHR). Questionnaires were also sent to 2 control groups, 1 consisting of 186 men from the SHR who had undergone bilateral repair without mesh, and 1 consisting of 383 men identified in the general population. The control group from the SHR was matched 2:1 for age and years elapsed since operation. The control group from the general population was matched 1:1 for age and marital status. RESULTS: The overall response rate was 525 of 945 (56%). Method of approach (anterior or posterior), type of mesh, and testicular status at the time of the repair had no significant impact on the answers to the questions. Nor did subgroup analysis of the men </=40 years old reveal any significant differences. CONCLUSION: The results of this prospective study in men do not support the hypothesis that bilateral inguinal hernia repair with alloplastic mesh prosthesis causes male infertility at a significantly greater rate than those operated without mesh

Risk factors for reoperation due to chronic groin postherniorrhaphy pain.

Chronic groin postherniorrhaphy pain (CGPP) is common and sometimes so severe that surgical treatment is necessary. The aim of this study was to identify risk factors for being reoperated due to CGPP

Bättre utbyte mellan kirurgi och anestesi kan ge säkrare operation - Informationsutbytet har kartlagts inom ramen för »Säker bukkirurgi«.

Poor communication between surgical and anesthesia unit personnel may jeopardize patient safety. Review reports from a national survey on patient safety performed at 17 units 2011-2013 were analyzed in order to identify strategies to reduce risks related to the interaction between surgery and anesthesia. The reports were reviewed in this study by an independent group in order to extract findings related to communication between anesthesia and surgical unit personnel. Suggested strategies to improve patient safety included: uniform national health declaration forms; consistent use of admission notes; uniform systems for documenting medical information; multidisciplinary forum for evaluation of high-risk patients; weekly and daily scheduling of surgical programs; application of the WHO check list; open dialog during surgery; oral and written reports from the surgeon to the postoperative unit; and combined mortality and morbidity conferences

Safety hazards in abdominal surgery related to communication between surgical and anesthesia unit personnel found in a Swedish nationwide survey.

Many adverse events occur due to poor communication between surgical and anesthesia unit personnel. The aim of this study was to identify strategies to reduce risks unveiled by a national survey on patient safety

Bilirubin Levels in Neonates ≥ 35 Weeks of Gestation Receiving Delayed Cord Clamping for an Extended Time - an Observational Study

OBJECTIVE: To describe bilirubin levels in neonates ≥ 35+0 gestational weeks, receiving delayed cord clamping (CC), in relation to the updated Bhutani nomogram.STUDY DESIGN: This was a retrospective, observational study based on data from medical records and local data sheets. Singleton neonates, born vaginally at a gestational age (GA) ≥ 35+0, and with a registered time to CC and at least one registered bilirubin, were included. We excluded neonates with positive direct antiglobulin test (DAT) or hemolytic disorders. Adjusted analyses were performed using analysis of variance, and linear or logistic regression.RESULTS: We analyzed 558 neonates, mean GA (SD) 39.9 (1.3) weeks. CC was performed at a median (interquartile range (IQR)) time of 6 (5-8) minutes. The dataset contained 1330 bilirubin measurements. Median (IQR) age at bilirubin measurement was 37 (22-54) hours. Bilirubin percentiles in neonates with CC time ≥ 2 min were similar, or lower, compared with the Bhutani nomogram between 12 and 72 hours, but with higher 95 th percentile at later hours of age. Phototherapy was initiated in 13 (2.3 %) of the neonates. We found no association between time to CC and hyperbilirubinemia (β = -0.05, p=0.07). Need for phototherapy was marginally higher in neonates with shorter time to CC. CONCLUSION: Bilirubin levels were not correlated to time to CC. Our findings indicate that CC beyond 2 minutes can be performed without additional monitoring for jaundice