NU Hospital Group

Trollhättan, Sweden

NU Hospital Group

Trollhättan, Sweden
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Mansson O.,NU Hospital Group | Sernert N.,Gothenburg University | Ejerhed L.,Gothenburg University | Kartus J.,NU Hospital Group
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2016

PURPOSE: The aims were to evaluate the results 10 to 20 years after anterior cruciate ligament (ACL) reconstruction performed in adolescents in terms of bone mineral density (BMD) in the calcanei using the dual-energy x-ray absorptiometry (DXA) technique, activity level, and quality of life.METHODS: A case-control study of adolescents who underwent ACL reconstruction between 1992 and 2002 was performed. The inclusion criterion was a unilateral ACL injury. The exclusion criteria were bilateral ACL injury, contralateral ACL reconstruction, posterior cruciate ligament injury, and previous or present fractures of either lower extremity. The BMD was measured in both calcanei using the DXA technique and compared with a control group of adult ACL-reconstructed patients and with a DXA reference database. The age of the control group was similar to that of the patient group at the time of BMD assessment, performed 60 months after reconstruction. Activity was measured with the Tegner activity scale. The EQ-5D was used to evaluate quality of life.RESULTS: Thirty-two adolescents (11 boys and 21 girls), aged 12 to 16 years, with a symptomatic unilateral ACL rupture, underwent reconstruction at near skeletally mature age. Of these patients, 29 (91%) took part in the follow-up examination. The BMD values for the male patients were lower on the injured and non-injured sides (-15.2% [P = .02] and -11.8% [P = .05], respectively) compared with the control group. The values for the female patients were -0.8% (P = .84) and -2.2% (P = .69), respectively. Correspondingly, the BMD values for the male patients were lower on the injured and non-injured sides (-8.2% and -4.9%, respectively) compared with the male reference database. The BMD values for the female patients were higher on the injured and non-injured sides (4.1% and 4.3%, respectively) compared with the female reference database. In the control group, female patients had a significantly lower value for the Tegner activity scale preoperatively (median, 2.0; range, 0 to 5) than the female patients in the study group (median, 3.0; range, 2 to 8) (P = .006). In the study group, the Tegner activity scale at follow-up showed a significant correlation with the BMD on the injured side for male patients (ρ = 0.67, P = .03) but not on the non-injured side (ρ = 0.50, P = .14). In the control group, the Tegner activity scale at follow-up showed a significant correlation with the BMD on the non-injured side for female patients (ρ = 0.61, P = .03) but not on the injured side (ρ = 0.34, P = .25). The Tegner activity scale and EQ-5D showed no significant differences between the study groups.CONCLUSIONS: In the long-term, the BMD in the calcanei of patients who were adolescents at the time of ACL reconstruction differed from that of a control group and a reference database. This study indicates that boys with an ACL injury and subsequent ACL reconstruction run a subsequent risk of a significantly lower BMD in their calcanei as adults and, consequently, an increased future fracture risk.LEVEL OF EVIDENCE: Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Rocchietta I.,Gothenburg University | Simion M.,University of Milan | Hoffmann M.,Gothenburg University | Trisciuoglio D.,University of Milan | And 3 more authors.
Clinical Implant Dentistry and Related Research | Year: 2016

Background: Vertical ridge augmentation with the use of solid bone blocks or particulate bone autograft, exposed or covered by a nonresorbable expanded polytetrafluoroethylene (ePTFE) membrane, are well known in the literature and have been shown to be effective in treating bone atrophy. Purpose: The aim of our study was to assess the two techniques in respect to biological properties of transplanted bone in graft revascularization and bone remodeling in conjunction with dental implants. Materials and Methods: Ten patients were treated within the study, with a total of 12 sites with posterior mandibular edentulous ridges with insufficient bone to allow implant placement. Bone regeneration was performed using autogenous intraoral block graft or autogenous particulate graft with an ePTFE barrier membrane. At 6-10 months, reentry surgery was performed; bone biopsies, including microscrews, were harvested; and implants were placed. Results: Eleven sites out of 12 healed uneventfully. A mean height gain of 5.03mm was achieved. Mean bone-to-implant contact and bone fill were assessed by means of histomorphometric analysis. The block specimens revealed a bone-to-implant contact of 42.34%, and the particulate grafts had a bone-to-implant contact of 26.62% (p<.012). Bone fill values reported were 68.32% and 48.28% (p<.019) for block specimens versus particulate grafts. Conclusions: The results clearly showed that both techniques were clinically successful for subsequent implant placement and prosthetic rehabilitation. The histological outcomes, including revascularization and bone remodeling, of the two techniques differed significantly. The block grafts outperformed the particulate grafts in terms of bone-to-implant contact and bone fill values; however, the morbidity associated with the donor site of the block must be considered. © 2014 Wiley Periodicals, Inc.

Tancredi M.,Gothenburg University | Tancredi M.,NU Hospital Group | Rosengren A.,Gothenburg University | Kosiborod M.,Saint Lukes Mid America Heart Institute | And 8 more authors.
New England Journal of Medicine | Year: 2015

BACKGROUND The excess risks of death from any cause and death from cardiovascular causes among persons with type 2 diabetes and various levels of glycemic control and renal complications are unknown. In this registry-based study, we assessed these risks according to glycemic control and renal complications among persons with type 2 diabetes. METHODS We included patients with type 2 diabetes who were registered in the Swedish National Diabetes Register on or after January 1, 1998. For each patient, five controls were randomly selected from the general population and matched according to age, sex, and county. All the participants were followed until December 31, 2011, in the Swedish Registry for Cause-Specific Mortality. RESULTS The mean follow-up was 4.6 years in the diabetes group and 4.8 years in the control group. Overall, 77,117 of 435,369 patients with diabetes (17.7%) died, as compared with 306,097 of 2,117,483 controls (14.5%) (adjusted hazard ratio, 1.15; 95% confidence interval [CI], 1.14 to 1.16). The rate of cardiovascular death was 7.9% among patients versus 6.1% among controls (adjusted hazard ratio, 1.14; 95% CI, 1.13 to 1.15). The excess risks of death from any cause and cardiovascular death increased with younger age, worse glycemic control, and greater severity of renal complications. As compared with controls, the hazard ratio for death from any cause among patients younger than 55 years of age who had a glycated hemoglobin level of 6.9% or less (≤52 mmol per mole of nonglycated hemoglobin) was 1.92 (95% CI, 1.75 to 2.11); the corresponding hazard ratio among patients 75 years of age or older was 0.95 (95% CI, 0.94 to 0.96). Among patients with normoalbuminuria, the hazard ratio for death among those younger than 55 years of age with a glycated hemoglobin level of 6.9% or less, as compared with controls, was 1.60 (95% CI, 1.40 to 1.82); the corresponding hazard ratio among patients 75 years of age or older was 0.76 (95% CI, 0.75 to 0.78), and patients 65 to 74 years of age also had a significantly lower risk of death (hazard ratio, 0.87; 95% CI, 0.84 to 0.91). CONCLUSIONS Mortality among persons with type 2 diabetes, as compared with that in the general population, varied greatly, from substantial excess risks in large patient groups to lower risks of death depending on age, glycemic control, and renal complications. © 2015 Massachusetts Medical Society.

Boman A.,University College West | Povlsen L.,Nordic School of Public Health | Dahlborg-Lyckhage E.,University College West | Hanas R.,NU Hospital Group | Borup I.,Nordic School of Public Health
Health and Social Care in the Community | Year: 2013

The purpose of this grounded theory study was to explore and discuss how fathers involved in caring for a child with type 1 diabetes experienced support from Swedish paediatric diabetes teams (PDTs) in everyday life with their child. Eleven fathers of children with type 1 diabetes, living in Sweden and scoring high on involvement on the Parental Responsibility Questionnaire, participated. Data were collected from January 2011 to August 2011, initially through online focus group discussions in which 6 of 19 invited fathers participated. Due to high attrition, the data collection continued in eight individual interviews. A semi-structured interview guide was used, and the fathers were asked to share experiences of their PDT's support in everyday life with their child. A simultaneous and constant comparison approach to data collection and analysis allowed the core category to emerge: the tension between general recommendations and personal experience. This core category illuminates how the fathers experienced tension between managing their unique everyday life with their child and balancing this to meet their PDT's expectations with regard to blood glucose levels. The core category was supported by two categories: the tension between the fathers'and their PDT's knowledge, whereby fathers reported discrepancies between their PDT's medical knowledge and their own unique knowledge of their child; and the tension between the fathers'and their PDT's goals, whereby the fathers identified differences between the familys' and their PDT's goals. As a dimension of the core category, fathers felt trust or distrust in their PDT. We conclude that to achieve high-quality support for children with diabetes and to enhance their health and well-being, involved fathers' knowledge of their unique family situation needs to be integrated into the diabetes treatment. © 2012 Blackwell Publishing Ltd.

Pettersson H.,NU hospital group | Knutsen H.,Ulleval Hospital | Holmberg E.,Regional Oncology Center | Andreasson B.,NU hospital group | Andreasson B.,Sahlgrenska University Hospital
European Journal of Haematology | Year: 2015

Several studies have reported an increased incidence of coexistent cancer in patients with myeloproliferative neoplasms (MPN), and myelosuppressive treatment has been speculated to be one of the causes. In this study, we have concentrated on malignancies diagnosed before the MPN diagnosis to eliminate the possible influence of MPN treatment. The patients were recruited from the Swedish and Norwegian cancer registries. One thousand seven hundred and 45 patients from the Swedish MPN Quality Registry and 468 patients from the Norwegian National Cancer Registry were included in this study covering a 3-yr period. The results show that primary concurrent cancer is higher among patients with MPN compared to the general population. When pooled together, the Swedish and the Norwegian cohort showed increased prevalence of all types of cancer in general compared with the general population, standard prevalence ratio (SPR) of 1.20 (95% CI 1.07-1.34). Significantly high SPRs were reached for skin malignant melanoma [1.89 (95% CI 1.33-2.62)], prostate cancer [1.39 (95% CI 1.11-1.71)], and hematologic cancer [1.49 (95% CI 1.00-2.12)]. In the polycythemia vera group, the risk of having prior malignant melanoma of the skin was significant, with an SPR of 2.20 (95% CI 1.17-3.77). For patients with essential thrombocythemia and primary myelofibrosis, no significant risks were found. Coexisting cancers have a high impact on the treatment strategies of MPN, as it narrows down the treatment options. Chronic inflammation, as a common denominator of MPN with other cancers, can catalyze each other's existence and progression. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Ahlden M.,Sahlgrenska University Hospital | Sernert N.,NU Hospital Group | Karlsson J.,Sahlgrenska University Hospital | Kartus J.,NU Hospital Group
American Journal of Sports Medicine | Year: 2013

Background: The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using either the double-bundle or single-bundle technique with hamstring tendon autografts in an unselected group of patients. Hypothesis: Double-bundle ACL reconstruction will render a better outcome on the pivot-shift test. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A randomized series of 103 patients (33 women, 70 men; median age, 27 years; range, 18-52 years) with a unilateral ACL rupture underwent anatomic ACL reconstruction. The double-bundle technique was used in 53 patients, and the single-bundle technique was used in 50 patients. The ACL footprint was visualized, and the femoral tunnel was drilled through the anteromedial portal; interference screw fixation was used at both ends. The patients were examined preoperatively and at a median of 26 months (range, 22-42 months) after the reconstruction by a blinded observer. The primary variable was the pivot-shift test. Results: At 2-year follow-up, 98 patients (93%) were examined. Clinical assessments at follow-up revealed no significant differences between the double-bundle and single-bundle groups in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, manual Lachman test, range of motion, Lysholm knee scoring scale, Tegner activity scale, Knee Injury and Osteoarthritis and Outcome Score (KOOS), 1-legged hop test, and square hop test. A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessments. Conclusion: In this prospective randomized study, the primary variable, the pivot-shift test, and other subjective and objective outcome variables revealed no significant differences between the double-bundle and single-bundle techniques at 2 years after ACL reconstruction in an unselected group of patients. © 2013 The Author(s).

Prytz M.,NU Hospital Group | Prytz M.,Gothenburg University | Angenete E.,Sahlgrenska University Hospital | Angenete E.,Gothenburg University | And 3 more authors.
International Journal of Colorectal Disease | Year: 2014

Purpose: Local recurrences are more common after abdominoperineal excision (APE) than after anterior resection of rectal cancer. Extralevator APE was introduced to address this problem. This prospective registry-based population study aims to investigate the efficacy of extralevator APE (ELAPE) in improving short-term oncological outcome. Methods: All Swedish patients operated with any kind of abdominoperineal excision and registered in the Swedish Rectal Cancer Registry 2007-2009 were included (n=1,397) and analyzed with emphasis on the perineal part of the operation. Short-term perioperative and oncological results were collected from the registry. Results: Extralevator APE did not result in fewer intraoperative perforations or involved circumferential resection margins as compared to standard APE for the entire group. Intraoperative perforations were significantly fewer for patients with low tumours (≤4 cm) (ELAPE: n=28/386 versus APE: n=9/58) (p=0.043) and for early (T0-T2) T-stages (ELAPE: n=3/172 versus APE: n=6/75) (p=0.025). There were significantly more post-operative wound infections for ELAPE than for APE (n=106 (20.4 %) versus n=25 (12.0 %), p=0.011). Conclusions: The short-term results indicate that selective use of extralevator APE can be warranted, for example, for subgroups with low tumours. In conclusion, selective use of the extralevator APE is advocated as not all patients seem to benefit from the technique, and there are significantly more short-term complications after extralevator APE. © 2014 The Author(s).

Kvist J.,Linköping University | Kartus J.,NU Hospital Group | Karlsson J.,Sahlgrenska University Hospital | Forssblad M.,Karolinska Institutet
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2014

Purpose The purpose of the study was to analyze the baseline variables and clinical outcomes for almost 24,000 patients entered into the Swedish National ACL Register between January 2005 and December 2012. Methods The register consists of 2 parts: 1 section in which surgeons report baseline and surgical data and 1 section in which patients report the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D score before and 1, 2, and 5 years after surgery. Results By December 2012, 23,744 patients had been entered into the surgeons' part of the register. The female-male ratio in the register is 42:58. The mean age at primary anterior cruciate ligament (ACL) reconstruction was 26 years (SD, 11 years) and 28 years (SD, 9 years) for the female and male patients, respectively. The ACL injury occurred during soccer in 36% of the female patients and 49% of the male patients. In 2012, 95% of the primary ACL reconstructions were performed using hamstring tendon autografts. For patients who had a minimum of 5 years' follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to 5 years, patients who had undergone revision had a significantly (P <.001) poorer outcome than those who had undergone primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions. On all follow-up occasions, smokers obtained significantly poorer scores than nonsmokers in terms of both the KOOS (P <.008) and the EQ-5D (P <.024). Conclusions Soccer is the most common cause of injury in both female and male patients, and patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions, as well as bilateral reconstructions. Furthermore, smokers fare less well than nonsmokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a 5-year period is approximately 7%. For patients aged younger than 19 years, the cumulative risk is significantly higher. Level of Evidence Level II, retrospective prognostic study. © 2014 by the Arthroscopy Association of North America.

Gerdner A.,Health Science University | Kestenberg J.,NU Hospital Group | Edvinsson M.,NU Hospital Group
Nordic Journal of Psychiatry | Year: 2015

Objective: The study explores agreement on diagnoses and diagnostic criteria for substance use disorders between two structured assessment interviews, the Structured Clinical Interview for the DSM-IV (SCID) and the Alkohol/Drog Diagnos InStrument (ADDIS). Both interviews are compared with a golden standard (GS), based on a LEAD model (Longitudinal, Expert, All Data).Method: Patients were interviewed concerning substance use problems by trained interviewers using SCID and ADDIS separately and blind to each other's results. SCID and ADDIS interviews were compared with each other, and both were compared with a GS.Results: Satisfactory agreement exists between SCID and ADDIS on criteria as well as final diagnostic suggestions, although ADDIS tended to propose dependence diagnoses somewhat more often than SCID. Agreement between SCID and GS is moderate. Sensitivity of SCID is satisfactory, as is specificity for lifetime diagnoses, while specificity for current diagnoses is perfect. ADDIS demonstrates substantial to perfect agreement with GS on dependence diagnoses and moderate agreement on abuse diagnoses (both lifetime and current), as well as showing excellent to perfect overall sensitivity and specificity. Both instruments are in almost perfect agreement with the GS on severity ratings.Conclusion: Both ADDIS and SCID can be used to ensure good standards in the diagnostic assessment of substance use disorders (both alcohol and drugs), with and without psychiatric comorbidity. Significant outcomes. Both SCID and ADDIS are in good agreement with the GS based on a LEAD model concerning substance use disorders. © 2014 Informa Healthcare.

Mansson O.,NU Hospital Group | Mansson O.,Gothenburg University | Sernert N.,Gothenburg University | Sernert N.,NU Hospital Group | And 3 more authors.
American Journal of Sports Medicine | Year: 2015

Background: The risk of further intra-articular damage associated with nonoperative or delayed anterior cruciate ligament (ACL) reconstruction must be considered against the risk of growth disturbance with early reconstruction and transphyseal drilling. Long-term follow-ups after the surgical treatment of ACL injuries in adolescents are rare. Purpose: To evaluate results 10 to 20 years after ACL reconstruction in terms of the radiographic presence of osteoarthritis, clinical assessments, and health-related quality of life in patients who were adolescents at the time of surgery. Study Design: Case series; Level of evidence, 4. Methods: Thirty-two adolescents (mean age, 15.2 years [range, 12-16 years]; 11 boys, 21 girls), with a symptomatic unilateral ACL rupture, underwent reconstruction using bone-patellar tendon-bone (n = 10) or hamstring tendon (n = 22) autografts at an almost skeletally mature age according to Tanner stage 4. Twenty-nine patients (91%) underwent clinical, radiographic, and health-related quality of life assessments after 10 to 20 years (mean, 175 months). Results: The mean time between the injury and index surgery was 11.6 months. The reconstructed knee had significantly more osteoarthritic changes compared with the noninvolved contralateral knee (P = .001). Preoperatively, the median Tegner activity level was 4 (range, 2-8), and the median Lysholm knee score was 75 (range, 50-90) points. At follow-up, the respective median values were 4 (range, 1-7) and 84 (range, 34-100) points (P = not significant [preoperatively vs follow-up]). The median finding for the single-legged hop test was 84% (range, 0%-105%) preoperatively and 93% (range, 53%-126%) at follow-up (P = .01). At follow-up, muscle strength measurements displayed more than 90% of the noninvolved leg in both extension and flexion. The manual Lachman test result was significantly improved at follow-up compared with preoperatively (P<.001). The 36-item Short Form Health Survey (SF-36) revealed scores comparable with those of healthy controls. The mean EuroQol (EQ-5D) score was 0.86 6 0.12. The Knee injury and Osteoarthritis Outcome Score (KOOS) values were lower in all dimensions compared with age-matched healthy controls. Conclusion: In the long term, patients who were adolescents at the time of ACL reconstruction revealed significantly more radiographically visible osteoarthritic changes in their operated knee than in their noninvolved contralateral knee. Clinical outcomes and health-related quality of life are comparable with those of healthy controls. © 2014 The Author(s).

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