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Östersund, Sweden

Stenfors N.,Ostersund Hospital | Stenfors N.,Umea University
Respiratory Medicine

Introduction: Respiratory symptoms in relationship to exercise, bronchial hyperresponsiveness (BHR), and exercise-induced asthma (EIA) are very common in elite winter athletes. Symptom-based screening for BHR would facilitate selection of athletes with possible EIA. Objectives: The aim of the present study was to evaluate the diagnostic accuracy of self-reported symptoms as predictors of BHR in an unselected population of adult elite cross-country skiers. Methods: Forty-six Swedish adult skiers competing at national or international level were included. They had a mean (SD) training volume in the past 12 months of 593 (122) hours. Twenty-four subjects had previous physician-diagnosed asthma. The European Community Respiratory Health Survey questionnaire was used to evaluate the presence of respiratory symptoms. BHR was defined as bronchoconstriction to either eucapnic voluntary hyperventilation, dry powder mannitol or methacholine provocation. Results: The "classical" EIA symptom of shortness of breath post-exercise was reported by 17% of all skiers. Eight subjects (17%) had BHR. None of the self-reported respiratory symptoms had high positive predictive values. However, symptoms caused by grass or pollen had high negative predictive values. Discussion: EIA in elite winter athletes cannot accurately be based only on self-reported symptoms but requires verification with objective testing of BHR. Bronchoprovocation of elite winter athletes reporting respiratory symptoms in rest or because of exercise will probably reveal a high proportion of athletes without BHR. Clinical trial: EUDRA-CT number 2006-005822-21. © 2010 Elsevier Ltd. All rights reserved. Source

Rosemar A.,Sahlgrenska University Hospital | Angeras U.,Sahlgrenska University Hospital | Rosengren A.,Sahlgrenska University Hospital | Nordin P.,Ostersund Hospital | Nordin P.,Umea University
Annals of Surgery

Objective: To analyze the effect of underweight, overweight, and obesity in relation to clinical characteristics, the risk of postoperative complications, 30-day mortality, and reoperations for recurrence after groin hernia surgery. Summary of background data: Groin hernia surgery is one of the most frequent operations performed in general surgery. Several studies have demonstrated a protective effect of overweight and obesity on the risk of developing primary groin hernia. However, obesity has also been suggested to increase the risk for recurrence of groin hernia. Methods: Through the Swedish Hernia Register, 49,094 primary groin hernia operations were identified between January 1, 2003 and December 31, 2007. Patients were divided into 4 body mass index (BMI) groups: BMI 1, <20 kg/m; BMI 2, 20 to 25 kg/m; BMI 3, 25-30 kg/m; and BMI 4, >30 kg/m. Results: Of the 49,094 patients, 3.5% had a BMI <20 kg/m and 5.2% were obese. Altogether, women constituted only 7.7% of the studied group, but among patients with BMI <20 kg/m that had surgical procedures for femoral hernia, 81.4% were women. The relation between BMI and postoperative complications was U-shaped and after adjustment for age, gender, and emergency procedure, patients with BMI <20 and >25 had a significant increased risk when compared with patients with BMI from 20 to 25. Reoperation for recurrence of groin hernia has an increased hazard ratio of 1.20 (95% confidence interval, 1.00-1.40) in overweight, which was particularly evident after open suture and preperitoneal mesh techniques. Conclusions: In this large and unselected population of patients with a first surgical procedure for groin hernia a relative dominance of female and femoral hernias presented as an emergency condition was observed in the low BMI group. The prevalence of obesity was markedly low. Both lean and obese patients had an increased risk for postoperative complications. Copyright © 2010 by Lippincott Williams & Wilkins. Source

De Flon P.,Ostersund Hospital | Kumlien E.,Uppsala University | Reuterwall C.,Research and Development Unit | Reuterwall C.,Umea University | Mattsson P.,Uppsala University
European Journal of Neurology

Background: Epilepsy surgery is a treatment that can cure patients with intractable epilepsy. This study investigates whether referrals for epilepsy surgery evaluation are underutilized. Methods: Patients with epilepsy aged 18-60 years were identified in a computerized registry held by public health care providers in a Swedish county using ICD codes. Clinical data and data on referral status for epilepsy surgery were obtained from the patients' medical records. Potential candidates for epilepsy surgery evaluation were identified using pre-specified criteria. Obstacles for referral were analysed by comparing clinical data in patients who were considered for referral and those who were not. Appropriateness of non-referral was evaluated against recommendations from the Swedish Council on Technology in Health Care (SBU). Results: Of 378 patients with epilepsy in the registry, 251 agreed to participate. Of 251, 40 were already referred patients and 48 patients were identified as potential candidates for epilepsy surgery evaluation by study criteria. Referral had been considered but not performed in 15 of the potential candidates. Potential candidates not considered for referral were less likely to have seen a neurologist, to have had an EEG, CT and MRI, and more likely to have cognitive disturbances. Following the recommendations by the SBU, 28 of 48 potential candidates were identified as inappropriately not referred patients. Conclusion: The number of missed referrals for epilepsy surgery evaluation was estimated to be 60 per 100 000 inhabitants. Several important obstacles were found for not referring patients for epilepsy surgery evaluation. © 2009 EFNS. Source

Van Der Linden W.,Ostersund Hospital | Warg A.,Ostersund Hospital | Nordin P.,Ostersund Hospital | Nordin P.,Umea University
Archives of Surgery

Objectives: To examine the relationship between operating time and reoperation for recurrence and other complications in groin hernia repairs. Design: Observational population-based register study. Setting: Data from the nationwide Swedish Hernia Register, which prospectively collects data from almost all groin hernia repairs performed in Sweden. Patients: There were 123 917 primary groin hernia repairs recorded in the Swedish Hernia Register from January 1, 1998, through December 31, 2007. Main Outcome Measures: Relative risk of reoperation for recurrence and odds ratios for postoperative complications in 4 operating time groups.Results: The relative risk of reoperation for recurrence of all patients operated on in less than 36 minutes was 26% higher than that of all patients with an operating time of more than 66 minutes (1.26; 95% CI, 1.11-1.43). Because the Lichtenstein procedure is the standard procedure in Sweden today, its results were also analyzed separately. In this homogeneous group, the difference was even more striking with an increased relative risk of 45% (1.45; 95% CI, 1.21-1.75). The odds ratio for infection and other postoperative complications increased with increasing operating time. Conclusion: A significant decrease in reoperation for recurrence with increasing operating time exhorts the hernia surgeon to avoid speed and to maintain thoroughness throughout the procedure. ©2011 American Medical Association. All rights reserved. Source

Sevonius D.,Skane University Hospital | Gunnarsson U.,Karolinska Institutet | Nordin P.,Ostersund Hospital | Nilsson E.,Umea University | Sandblom G.,Karolinska Institutet
British Journal of Surgery

Background: The reoperation rate after recurrent groin hernia surgery is more than twice that recorded for primary groin hernia procedures. The aim was to define the outcome from routine redo hernia surgery by analysing a large population-based cohort from a national hernia register. Methods: All recurrent groin hernia operations registered in the Swedish Hernia Register from 1992 to 2008 were analysed using multivariable analysis with stratification for preceding repair. Results: Altogether 174 527 hernia operations were recorded in the Swedish Hernia Register between 1992 and 2008, including 19 582 reoperations. The preceding repair was included in the register for 5565 of these recurrent repairs. With laparoscopic repair as reference standard, the hazard ratio for recurrence was 2·55 (95 per cent confidence interval 1·66 to 3·93) after sutured repair, 1·53 (1·20 to 1·95) after Lichtenstein repair, 2·31 (1·76 to 3·03) after plug repair, 1·36 (0·95 to 1·94) after open preperitoneal mesh and 3·08 (2·22 to 4·29) after other repairs. Laparoscopic and open preperitoneal repair were associated with a lower risk of reoperation following a preceding open repair (P < 0·001), but no technique differed significantly from the others following a preceding preperitoneal repair. Conclusion: The laparoscopic and the open preperitoneal mesh methods of repair for recurrent groin hernias were associated with the lowest risk of reoperation. Although the method of repair in previous surgery must be considered, these techniques are the preferred methods for recurrent groin hernia surgery. © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Source

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