Tomosynthesis in pulmonary cystic fibrosis

The aims of this thesis were to investigate whether chest tomosynthesis might be used in pulmonary cystic fibrosis, to design and validate a tomosynthesis scoring system, and to determine the effective dose from chest tomosynthesis in children. In a prospective study starting in 2008 clinical chest radiography or computed tomography (CT) were supplemented with a tomosynthesis examination of the lungs. Tomosynthesis findings were characterized in comparison with radiography and CT findings, and used to design a scoring system for tomosynthesis. Conversion factors for paediatric chest tomosynthesis were determined by Monte Carlo simulations and used to estimate the effective dose from the registered dose-area-product from the patient examinations included in the study. The typical imaging findings of pulmonary cystic fibrosis were much better depicted with tomosynthesis compared with radiography. Most pulmonary changes visualised with computed tomography could also be evaluated well with tomosynthesis. A dedicated tomosynthesis scoring system was designed and validated, and proved to be robust. Bronchiectasis and mucus plugging are the most specific pulmonary changes of cystic fibrosis, and were in a review of commonly used radiological scoring systems generally considered the most important scoring components. For chest tomosynthesis in children the conversion factor was considerably higher for young children than previously reported for adults. The conversion factor increased with increasing tube energy and filtration. The mean paediatric effective dose from posteroanterior chest tomosynthesis was 0.17 mSv, which is about 40 times less than recently reported effective doses from paediatric chest CT. Using the previously reported conversion factor for adults the paediatric effective dose was estimated to 0.11 mSv. Consequently, when using conversion factors not adapted to children for paediatric examinations, the radiation dose may be underestimated. Anteroposterior exposures should be avoided, as the effective dose is approximately three times higher than for posteroanterior exposures. In these studies tomosynthesis has been shown to be a valuable tool for monitoring pulmonary cystic fibrosis, as typical imaging findings of this lung disease are well depicted and the radiation dose is low. The dedicated scoring system may improve diagnostic precision. At our radiology department, tomosynthesis now has to a great extent replaced radiography in the follow-up of these patients. CT is only performed in selected cases. Further studies are planned to determine the roles of tomosynthesis and CT in the evaluation of cystic fibrosis lung disease

Att återvinna eller återbära - en utredning av konkursboets möjligheter att återta egendom som frånhänts bolaget

A bankruptcy may evoke less appropriate acts from both the debtor and the creditors. A debtor may try to favour himself, or a relative, by transferring assets out of the company before the company’s bankruptcy. A creditor on the other hand may, due to his concern to suffer great financial losses, put pressure on the debtor about payment of his debts, which puts the creditor in a better position than the other creditors in the bankruptcy. To prevent disloyal actions is a consistent theme in the insolvency law. A significant part of the bankruptcy act, (konkurslagen), are therefore the rules that prevent the parts from committing unwanted acts in a bankruptcy, alternatively that corrects the damage that has been caused by an already taken act. In this context it’s usually spoken about creditor protecting rules, which mainly can be found in 17:3 in the companies act (aktiebolagslagen), and the 4th chapter of the bankruptcy act. These rules provide for equal treatment of the creditors and intend to prevent improper conducts taken by the debtor. Indirectly, even the debtor obtains protection by the creditor protecting rules since they make it easier for the debtor to resist the pressure from a single creditor about payment. This essay gives an account of the bankruptcy estate’s possibilities to, through the application of above-mentioned legislations, recover fortune that has left the company by improper or illegal acts. Initially the essay will account for the bankruptcy (insolvency) law, historically and contemporary. Thereafter the essay will focus on the parts of the legislation that concerns and provides for the possibilities to refund acts and transactions made by a company in connection with an upcoming bankruptcy, thereby referring to the 4th chapter of the bankruptcy act and the 17th chapter of the companies act. Of relevance in this context is also the term insolvency. The determination of the time of insolvency affects which transactions that can be subject to refunding. An understanding of the term insolvency is of fundamental importance to be able to assess the prospects for success with an action of refund. For this reason, this essay account for the interpretation and meaning of the term insolvency. The essay ends in an analysis of the material and the facts that have been the basis for the essay. The material and facts are commented and interpreted before it all comes to a conclusion. The conclusions that have been made concerning the two alternative methods are thereafter interlaced with the conclusions and comments about the meaning of and application of the insolvency term. The essay shows that the relevant regulations in both legal acts to some extent represent two sides of the same coin. The regulations differ at many essential points, but at the same time they operate for the same purpose and leads to, more or less, the same legal effects. The differences between the alternatives do although demand an assessment of the chances of success with each alternative. The circumstances of each case, e.g. time of insolvency, determine whether of the legal refund systems that should be invoked.En konkurs kan frammana mindre lämpliga ageranden hos både borgenär och gäldenär. En gäldenär kan för egen, eller närståendes, vinning tänkas söka undandra tillgångar från bolaget innan dess konkurs. En borgenär å sin sida kan i oron för att lida stora förluster vidta betalningspåtryckningar mot gäldenären. Detta leder till att denne borgenär gynnas i förhållande till resterande borgenärer. Att motverka illojala ageranden utgör ett genomgående tema i konkursrätten. En viktig del av konkursrätten utgörs därför av regleringar som förhindrar oönskade ageranden i en konkurs, alternativt ställer till rätta den skada som uppstått genom redan företagen rättshandling. I sammanhanget brukar det talas om borgenärsskyddsregler vilka främst återfinns i 17 kap. ABL och 4 kap. KL. Reglerna skyddar borgenärerna genom att föreskriva likabehandling mellan borgenärerna samt genom att förhindra otillbörligt agerande från gäldenärens sida. Indirekt får bestämmelserna också en gäldenärsskyddande effekt genom att säkra och stärka denne från betalningspåtryckningar från en enskild borgenär. Konkursreglerna utgår från att när flera borgenärer inte kan få full täckning för sina fordringar förlusten i princip ska fördelas proportionellt i förhållande till storleken av varje borgenärs fordran. Denna uppsats redogör för ett konkursbos möjligheter att genom ABL respektive KL ta tillbaka egendom som frånhänts bolaget genom otillbörliga eller olagliga metoder. Inledningsvis kommer uppsatsen kortfattat redogöra för konkursrätten både historiskt och idag. Fokus kommer därefter övergå till de delar av konkursrätten som behandlar möjligheten till återbäring, (återvinning), av rättshandlingar och transaktioner som företagits från ett bolag – nämligen KL och dess 4 kap. samt ABL och dess 17 kap. Av betydelse i sammanhanget är även begreppet obestånd. Fastställandet av obestånd inverkar på vilka transaktioner som kan bli föremål för återbäring. Förståelse för obeståndsbegreppet är avgörande för att kunna bedöma utsikterna till framgång med en talan om återbäring. Uppsatsen redogör av denna anledning för tolkningen och innebörden av begreppet obestånd. Uppsatsen avslutas med en sammanfattande analys av rättsläget. I analysen kommenteras och tolkas det material och den fakta som lagts till grund för uppsatsen för att sedan summeras i en slutsats. Sammanfattningen av regelsystemen sammanflätas omsider med slutsatser och kommentarer om innebörden och tillämpningen av obeståndsbegreppet. Uppsatsen påvisar att de aktuella bestämmelserna i ABL respektive KL till viss del utgör två sidor av samma mynt. Regleringarna skiljer sig åt på många väsentliga punkter samtidigt som de verkar för samma syfte och föranleder i stort sätt samma rättsverkningar. Skiljaktigheterna mellan alternativen kräver dock en bedömning av chanserna för framgång med respektive alternativ. Omständigheterna i varje enskilt fall, t.ex. obeståndstidpunkt, avgör om ABL eller KL bör åberopas i första hand

Erkännandet och jakten på sanningen - En rättsvetenskaplig utredning rörande erkännandets utveckling i processrättshistorien

Syftet med uppsatsen är att, ur ett rättshistoriskt perspektiv, granska hur erkännandet som bevismedel hanterats och värderats i den historiska rättsprocessen med fokus på processen I brottmål. I centrum för analysen står erkännandets innebörd och bevisvärde i förhållande till de bevisrättsliga principerna legal bevisteori respektive fri bevisvärdering. Ingående utreds också hur övriga historiska samhällsförändringar och händelser inverkat på bevisrätten. Erkännandets ställning i rättsprocessen har förändrats över tid, precis som de krav som uppställts för ett erkännandes giltighet. Detta framgår tydligt efter jämförelse med dåtida och nutida rättsregler, domböcker och praxis. Erkännandets utveckling och funktion I rättsprocessen genom historien har främst berott på tre centrala faktorer; Sveriges kristnande, vår samhällsutveckling samt receptionen av utländska rättsregler, principer och kulturer. Dessa tre faktorer har därför stått i fokus för utredningen och använts som utgångspunkter för att skapa en lättöverskådlig helhetsbild över erkännandets historia i rättsprocessen. Uppsatsen redogör därför för historiska händelser och ändringar av samhällsstruktur vilka påverkat svensk bevisrätt. Genom att granska utländska rättssystem och rättskulturer och jämföra dessa med den svenska bevisrätten är det tydligt att det svenska rättssystemet i betydande omfattning inspirerats av, och recipierat, rätt från system långt utanför våra egna gränser. Inledningsvis presenterar uppsatsen en översiktlig genomgång av de två bevisrättsprinciperna. Det är nödvändigt att läsaren innehar förståelse för evisrättsprincipernas innebörd innan erkännandet behandlas då det råder fundamentala skillnader mellan hantering och värdering av bevis i de olika processformerna. Den legala bevisteorin innebär strikta regler för tillåtna bevismedel och värderingen av dessa medan den fria bevisprövningen överlämnar bade prövning och värdering åt domstolen. Erkännandet kom att inta en särställning inom bevisrättsprocessen och tillerkändes ett bevisvärde betydligt högre än resterande bevismedel. En nästan manisk jakt på erkännande har därmed i perioder förekommit i domarnas strävan att avsluta mål. Denna uppsats ämnar besvara upphovet till denna särställning, hur särställningen har påverkat bevisrätten samt om denna intensiva jakt kan ha lett till felaktiga domar och maktmissbruk hos rättsutövare.The purpose of this paper is to critically review the confession as evidence in a legal and historical perspective by looking at how it has been handled and valued historically in the lawsuit, focusing on the criminal process. The core of the analysis comprises the meaning of the confession and its value as evidence in relation to the procedural principles; the legal proof theory and the principle of free evaluation, respectively how other important changes in society have affected the law of evidence. The status of the confession within a lawsuit has changed over time, just as the requirements set for a valid confession. This is evident after a comparison between present law and established praxis versus the same material in earlier days. Three key factors have primarily influenced the development and the function of the confession in the lawsuit; the Christianization of Sweden, the development of the Swedish society and the reception of foreign rules, principles and cultures. These factors will thereby be in focus in this paper and form the base for the compilation in order to obtain an overview of the history of confessions. The paper will thereby examine happenings and changes in the society that have affected the Swedish law of evidence. By analysing foreign legal systems and cultures with the Swedish system it appears obvious that the Swedish legislators significantly been inspired and influenced by laws and principles from the continent. Initially the essay gives an overall exposition of the two principles of the law of evidence. It is essential to give the reader an understanding of the content of these principles before the confession itself is examined. This understanding is required since the divergence between the two principles are fundamental for the lawsuit and the value of confession. The legal proof theory sets up strict rules for permitted evidence and how it should be valued while the principle of free evaluation leaves those decisions to the court. The confession obtained a unique position within the lawsuit and was given a value as evidence significantly higher than the other types of evidence. An intense chase for confessions has thereby taken place in the courts ambition to hold someone responsible for the charge. This paper has intended to analyse this unique position, how the position has affected the law of evidence and if this intense chase after confessions may have contributed to incorrect convictions and power abuse within the courts and judges

Radiography, tomosynthesis, CT and MRI in the evaluation of pulmonary cystic fibrosis: an untangling review of the multitude of scoring systems.

The first radiographic scoring system for pulmonary cystic fibrosis was presented in 1958. Since then a multitude of scoring systems for radiography and computed tomography (CT) have been presented, recently also for tomosynthesis and magnetic resonance imaging (MRI). The aim of the current review was to analyse and compare the plethora of scoring systems for cystic fibrosis, especially regarding which scoring components are considered most important

X-Ray Microanalysis of Epithelial and Secretory Cells in Culture

Cell cultures can be used to study ion transport processes. X-ray microanalysis of cell cultures at the cellular level gives interesting information that can complement electrophysiological and tracer studies. In this paper, methods for culturing and preparing a variety of epithelial and secretory cells (fibroblasts, insulinoma cells, bovine mammary epithelial cells, colon cancer cells) for X-ray microanalysis are presented. Results show that sometimes cell cultures are not homogeneous with respect to ion content or reaction to physiological stimuli. In colon cancer cell cultures, a high K and a low K cell subpopulation was found; these subpopulations also differed with respect to other elements. As examples of biological applications, chloride efflux was studied in fibroblasts and colon cancer cells, and strontium uptake in insulinoma cells. Chloride efflux from colon cancer cells is stimulated by cyclic AMP and vaso-active intestinal peptide (VIP), and can be inhibited by pretreatment of the cells with phorbol myristate acetate, which downregulates the cAMP-regulated chloride efflux mechanism

The Scandinavian Sarcoma Group Central Register : 6,000 patients after 25 years of monitoring of referral and treatment of extremity and trunk wall soft-tissue sarcoma

Purpose - We wanted to examine the potential of the Scandinavian Sarcoma Group (SSG) Central Register, and evaluate referral and treatment practice for soft-tissue sarcomas in the extremities and trunk wall (STS) in the Nordic countries. Background - Based on incidence rates from the literature, 8,150 (7,000-9,300) cases of STS of the extremity and trunk wall should have been diagnosed in Norway, Finland, Iceland, and Sweden from 1987 through 2011. The SSG Register has 6,027 cases registered from this period, with 5,837 having complete registration of key variables. 10 centers have been reporting to the Register. The 5 centers that consistently report treat approximately 90% of the cases in their respective regions. The remaining centers have reported all the patients who were treated during certain time periods, but not for the entire 25-year period. Results - 59% of patients were referred to a sarcoma center untouched, i.e. before any attempt at open biopsy. There was an improvement from 52% during the first 5 years to 70% during the last 5 years. 50% had wide or better margins at surgery. Wide margins are now achieved less often than 20 years ago, in parallel with an increase in the use of radiotherapy. For the centers that consistently report, 97% of surviving patients are followed for more than 4 years. Metastasis-free survival (MFS) increased from 67% to 73% during the 25-year period. Interpretation - The Register is considered to be representative of extremity and trunk wall sarcoma disease in the population of Scandinavia, treated at the reporting centers. There were no clinically significant differences in treatment results at these centers.Peer reviewe

Bone defects following curettage do not necessarily need augmentation: A retrospective study of 146 patients

Background and purpose The natural pattern of bone healing in large bony defects following curettage alone as treatment of benign bone tumors around the knee is not well reported. We analyzed the outcome in 146 patients

Frequent deletion of the CDKN2A locus in chordoma: analysis of chromosomal imbalances using array comparative genomic hybridisation

The initiating somatic genetic events in chordoma development have not yet been identified. Most cytogenetically investigated chordomas have displayed near-diploid or moderately hypodiploid karyotypes, with several numerical and structural rearrangements. However, no consistent structural chromosome aberration has been reported. This is the first array-based study characterising DNA copy number changes in chordoma. Array comparative genomic hybridisation (aCGH) identified copy number alterations in all samples and imbalances affecting 5 or more out of the 21 investigated tumours were seen on all chromosomes. In general, deletions were more common than gains and no high-level amplification was found, supporting previous findings of primarily losses of large chromosomal regions as an important mechanism in chordoma development. Although small imbalances were commonly found, the vast majority of these were detected in single cases; no small deletion affecting all tumours could be discerned. However, the CDKN2A and CDKN2B loci in 9p21 were homo- or heterozygously lost in 70% of the tumours, a finding corroborated by fluorescence in situ hybridisation, suggesting that inactivation of these genes constitute an important step in chordoma development