Sahlgren University Hospital

Gothenburg, Sweden

Sahlgren University Hospital

Gothenburg, Sweden
Time filter
Source Type

Ratasvuori M.,South Karelian Central Hospital | Ratasvuori M.,University of Tampere | Wedin R.,Karolinska University Hospital | Keller J.,Aarhus University Hospital | And 7 more authors.
Surgical Oncology | Year: 2013

The number of cancer patients living with metastatic disease is growing. The increased survival has led to an increase in the number of cancer-induced complications, such as pathologic fractures due to bone metastases. Surgery is most commonly needed for mechanical complications, such as fractures and intractable pain. We determined survival, disease free interval and complications in surgically treated bone metastasis. Data were collected from the Scandinavian Skeletal Metastasis Registry for patients with extremity skeletal metastases surgically treated at eight major Scandinavian referral centres between 1999 and 2009 covering a total of 1195 skeletal metastases in 1107 patients. Primary breast, prostate, renal, lung, and myeloma tumors make up 78% of the tumors. Number of complications is tolerable and is affected by methods of surgery as well as preoperative radiation therapy. Overall 1-year patient survival was 36%; however, mean survival was influenced by the primary tumor type and the presence of additional visceral metastases. Patients with impending fracture had more systemic complications than those with complete fracture. Although surgery is usually only a palliative treatment, patients can survive for years after surgery. We developed a simple, useful and reliable scoring system to predict survival among these patients. This scoring system gives good aid in predicting the prognosis when selecting the surgical method. While it is important to avoid unnecessary operations, operating when necessary can provide benefit. © 2013 Elsevier Ltd. All rights reserved.

El-Aidy S.,Wageningen University | El-Aidy S.,Italian National Cancer Institute | Hooiveld G.,Wageningen University | Tremaroli V.,Sahlgren University Hospital | And 3 more authors.
Gut Microbes | Year: 2013

The intimate interplay between the gut microbiota and the host may contribute to health and disease in the host. experiments using conventionalized and conventionally raised animal models have illustrated the role of the intestinal microbiota in shaping and maintaining the host immune system. however, it is still unclear whether colonization at birth or at adulthood induces different host responses. here, we perform comparative transcriptome analyses to elucidate the impact of the gut microbiota on the development and maintenance of the immune system in adult conventionalized (after 16 and 30 d of colonization) and conventionally raised mice, which were obtained in two independent laboratories. Transcriptional profiles of jejunum, ileum and colon were compared between germfree, conventionally raised mice and conventionalized mice. Germfree mice from the two different facilities clustered together, establishing the validity of the comparative analysis. Nevertheless, signifcant spatial differences were detected along the gut; the jejunum and colon exhibited a transient response (conventionalized mice) that eventually returned to a homeostatic level (conventionally raised). In contrast, the ileal response to microbiota was similar in conventionalized and conventionally raised mice. Overall, this comparative analysis supports the hypothesis that co-development of the gut microbiota and its host initiates at early stage of development and indicates that despite the achieved homeostasis, immune development is substantially different in mice conventionalized in adulthood. These findings imply that colonization during development is required to meet the window of opportunity where the gut microbiota can imprint the host's mucosal immune-homeostasis in a way that cannot be achieved at later stages in life. © 2013 Landes Bioscience.

Gil-Nagel A.,Hospital Ruber International | Elger C.,University of Bonn | Ben-Menachem E.,Sahlgren University Hospital | Halasz P.,Experimental Medical Research Institute | And 8 more authors.
Epilepsia | Year: 2013

Purpose: To evaluate the efficacy and safety profile of eslicarbazepine acetate (ESL) added to stable antiepileptic therapy in adults with partial-onset seizures. Methods: Data from 1,049 patients enrolled from 125 centers, in 23 countries, in three phase III double-blind, randomized, placebo-controlled studies were pooled and analyzed. Following a 2-week titration period, ESL was administered at 400 mg, 800 mg, and 1,200 mg once-daily doses for 12 weeks. Key Findings: Seizure frequency was significantly reduced with ESL 800 mg (p < 0.0001) and 1,200 mg (p < 0.0001) compared to placebo. Median relative reduction in seizure frequency was, respectively, 35% and 39% (placebo 15%) and responder rate was 36% and 44% (placebo 22%). ESL was more efficacious than placebo regardless of gender, geographic region, epilepsy duration, age at time of diagnosis, seizure type, and number and type of concomitant antiepileptic drugs (AEDs). Incidence of adverse events (AEs) and AEs leading to discontinuation were dose dependent. AEs occurred mainly during the first weeks of treatment, with no difference between groups after 6 weeks. Most common AEs (>10% patients) were dizziness, somnolence, and headache. The incidence of AEs in ESL groups compared to placebo was generally consistent among different subpopulations. Significance: Once-daily ESL 800 mg and 1,200 mg showed consistent results across all efficacy and safety end points. Results were independent of study population characteristics and type and number of concomitant AEDs. © 2012 International League Against Epilepsy.

Lagali N.,Linköping University | Stenevi U.,Sahlgren University Hospital | Claesson M.,Sahlgren University Hospital | Fagerholm P.,Linköping University | And 3 more authors.
Investigative Ophthalmology and Visual Science | Year: 2010

PURPOSE. To elucidate the pattern of donor and recipient endothelial cell populations in transplanted human corneas and determine the degree to which donor endothelial cells survive in the graft. METHODS. Thirty-six corneal grafts were collected from recipients of opposite sex to the donor, at the time of retransplantation for various indications. Cells from the endothelial side of the grafts were harvested, preserving their relative location on the endothelium. Fluorescence in situ hybridization of the sex chromosomes enabled each cell to be identified as donor-or recipient-derived. Images of the graft endothelium were assembled, to depict the pattern of cell population of the graft, and the proportion of donor cells present was estimated. RESULTS. Endothelial cells of donor origin were found in 26 of 36 grafts (72.2%)-in one case, up to 26 years after transplantation. The proportion of donor endothelium ranged from 2% to 99%; however, there was no significant correlation of this proportion with postoperative time (P =0.19). The mean annual rate of donor cell loss correlated negatively with the time to graft failure by endothelial decompensation (P =0.002). Endothelial images indicated a highly variable pattern of recipient cell repopulation of the graft. A tendency toward donor cell retention in transparent, successful grafts was noted; however, this feature alone was not a reliable indicator of long-term graft transparency. CONCLUSIONS. Two-dimensional imaging of the corneal graft endothelium revealed a variable pattern and extent of donor and recipient cell population, indicating the highly dynamic nature of the corneal endothelium after transplantation. © Association for Research in Vision and Ophthalmology.

le Roux C.W.,Imperial College London | Bueter M.,Imperial College London | Bueter M.,University of Zürich | Theis N.,University of Zürich | And 8 more authors.
American Journal of Physiology - Regulatory Integrative and Comparative Physiology | Year: 2011

Rouxen-Y gastric bypass is the most effective therapy for morbid obesity. This study investigated how gastric bypass affects intake of and preference for high-fat food in an experimental (rat) study and within a trial setting (human). Proportion of dietary fat in gastric bypass patients was significantly lower 6 yr after surgery compared with patients after vertical-banded gastroplasty (P < 0.046). Gastric bypass reduced total fat and caloric intake (P < 0.001) and increased standard low-fat chow consumption compared with sham controls (P < 0.001) in rats. Compared with sham-operated rats, gastric bypass rats displayed much lower preferences for Intralipid concentrations > 0.5% in an ascending concentration series (0.005%, 0.01%, 0.05%, 0.1%, 0.5%, 1%, 5%) of two-bottle preference tests (P = 0.005). This effect was demonstrated 10 and 200 days after surgery. However, there was no difference in appetitive or consummatory behavior in the brief access test between the two groups (P < 0.71) using similar Intralipid concentrations (0.005% through 5%). Levels of glucagon-like peptide-1 (GLP-1) were increased after gastric bypass as expected. An oral gavage of 1 ml corn oil after saccharin ingestion in gastric bypass rats induced a conditioned taste aversion. These findings suggest that changes in fat preference may contribute to long-term maintained weight loss after gastric bypass. Postingestive effects of high-fat nutrients resulting in conditioned taste aversion may partially explain this observation; the role of GLP-1 in mediating postprandial responses after gastric bypass requires further investigation. © 2011 the American Physiological Society.

Hufnagel A.,University of Duisburg - Essen | Ben-Menachem E.,Sahlgren University Hospital | Gabbai A.A.,Federal University of São Paulo | Falcao A.,University of Coimbra | And 3 more authors.
Epilepsy Research | Year: 2013

Objective: To evaluate the long-term safety, tolerability and efficacy of once-daily eslicarbazepine acetate (ESL) as adjunctive therapy in adults with partial-onset seizures. Methods: One-year open-label extension (OLE) study with ESL in patients who completed a randomised, double-blind placebo-controlled trial (study BIA-2093-302; Epilepsy Res. 89 (2010) 278-285). Starting dose was 800. mg once-daily, for 4 weeks; thereafter, dose could be individualised within the 400-1200. mg range. Doses of concomitant antiepileptic drugs were to be kept stable. Results: Overall, 325 patients were enrolled (intent-to-treat population); 223 (68.6%) patients completed 1-year of treatment. ESL median dose was 800. mg once-daily. Compared to the baseline period of the double-blind study completed prior to this OLE study, median seizure frequency decreased by 32% in weeks 1-4, and between 37% and 39% thereafter. The responder rate (seizure reduction ≥50%) was 37% during weeks 1-4 and thereafter ranged between 38% and 42% per 12-week interval. Proportion of seizure-free patients per 12-week interval ranged between 5% and 11%. Improvements from baseline in several Quality of Life in Epilepsy Inventory-31 (QOLIE-31) and Montgomery Asberg Depression Rating Scale (MADRS) scores were observed. Adverse events (AEs) were reported by 83% of patients. AEs occurring in ≥10% of patients were dizziness, headache and somnolence. AEs were usually of mild to moderate intensity. Conclusion: In this study, ESL demonstrated a sustained therapeutic effect and was well tolerated during 1-year add-on treatment of adults with partial-onset seizures. Additionally, significant improvements in quality of life domains and depressive symptoms were observed under long-term treatment with once-daily ESL. © 2012 Elsevier B.V.

Ben-Menachem E.,Sahlgren University Hospital | Gabbai A.A.,Paulista University | Hufnagel A.,University of Duisburg - Essen | Maia J.,BIAL Portela and Co | And 3 more authors.
Epilepsy Research | Year: 2010

Objective: To investigate the efficacy and safety of once-daily eslicarbazepine acetate (ESL) when used as add-on treatment in adults with ≥4 partial-onset seizures per 4-week despite treatment with 1 to 3 antiepileptic drugs (AEDs). Methods: This double-blind, parallel-group, multicenter study consisted of an 8-week observational baseline period, after which patients were randomized to placebo (n=100) or once-daily ESL 400. mg (n=96), 800. mg (n=101), or 1200. mg (n=98). Patients then entered a 14-week double-blind treatment phase. All patients started on their full maintenance dose except for those in the ESL 1200. mg group who received once-daily ESL 800. mg for 2 weeks before reaching their full maintenance dose. Results: Seizure frequency per 4-week (primary endpoint) over the 14-week double-blind treatment period was significantly lower than placebo in the ESL 800. mg and 1200. mg (p<0.001) groups. Responder rate (≥50% reduction in seizure frequency) was 13.0% (placebo), 16.7% (400. mg), 40.0% (800. mg, p<0.001), and 37.1% (1200. mg, p<0.001). Median relative reduction in seizure frequency was 0.8% (placebo), 18.7% (400. mg), 32.6% (800. mg, p<0.001), and 32.8% (1200. mg). Discontinuation rates due to adverse events (AEs) were 3.0% (placebo), 12.5% (400. mg), 18.8% (800. mg), and 26.5% (1200. mg). The most common (>5%) AEs in any group were dizziness, somnolence, headache, nausea, diplopia, abnormal coordination, vomiting, blurred vision, and fatigue. The majority of AEs were of mild or moderate severity. Conclusions: Treatment with once-daily eslicarbazepine acetate 800. mg and 1200. mg was more effective than placebo and generally well tolerated in patients with partial-onset seizures refractory to treatment with 1 to 3 concomitant AEDs. © 2010 Elsevier B.V.

Arzimanoglou A.,French Institute of Health and Medical Research | Ben-Menachem E.,Sahlgren University Hospital | Cramer J.,Yale University | Glauser T.,Cincinnati Childrens Hospital | And 2 more authors.
Epileptic Disorders | Year: 2010

The early years of antiepileptic drug development were characterised by observation and serendipity, rather than a rational, targeted approach to drug development. Control of seizures was seen as the primary aim of therapy, with much less focus on safety and tolerability. However, experience with thalidomide in the 1960s brought safety to the fore, resulting in an era of much tighter regulatory control that still persists today. A direct consequence of this was an increased emphasis on the importance of evidence from randomised controlled trials. Despite the continuing reliance on randomised controlled trials for regulatory approval and the formulation of evidence-based guidelines, the modern era has seen an increasing acknowledgment of their limitations and the need for complementary sources of 'real-world' evidence. Such sources include registries and studies that are designed to provide a much broader assessment of a drug's overall effectiveness; for example, by incorporating patient-reported outcomes to assess the effects of treatment on quality of life or functional status. Such changes reflect a more patient-centric approach to treatment, since it is now recognised that epilepsy can only be effectively managed if patients' individual real-life needs are addressed, since a key to successful treatment is long-term compliance. Alongside these changes in approach, the modern era has witnessed important advances in antiepileptic drugs themselves, either through development of novel molecules, or targeted, structural improvements of older agents.

Dabrowska-Kloda K.,County Hospital of Varmland | Kloda T.,Stockholm UniversityStockholm | Boudiaf S.,County Hospital of Varmland | Jakobsson G.,Sahlgren University Hospital | Stenevi U.,Sahlgren University Hospital
Journal of Cataract and Refractive Surgery | Year: 2015

Purpose To identify risk factors for late in-the-bag intraocular lens (IOL) dislocation and estimate the incidence of this condition over a 21-year period. Setting Department of Ophthalmology, County Hospital of Värmland, Karlstad, Sweden. Design Retrospective cohort study and nested case-control study. Methods The medical records of eyes operated on for late in-the-bag IOL dislocation between 1992 and 2012 were reviewed. The annual incidence and cumulative risk were calculated. Results Of 140 eyes whose records were reviewed, 123 qualified for comparison (24 variables) with an equal number in a control group. The annual incidence varied between 0.00% and 0.08%. An increasing trend was found (P <.001). The cumulative risk 5, 10, 15, and 20 years after cataract extraction was 0.09%, 0.55%, 1.00%, and 1.00%, respectively, and was significantly higher (P < .001) in eyes that had cataract surgery between 2002 and 2012 than in those operated on between 1992 and 2001 (0.89% versus 0.39% at 10 years postoperatively) (P <.001). Calendar time (date) of dislocation was positively correlated with the duration of preceding pseudophakia (P = .005). Phacoemulsification time was longer in eyes with dislocation than in control eyes (P <.001). Other identified risk factors were pseudoexfoliation, zonular dehiscence, pseudophacodonesis, and increased axial length. Conclusions The increasing number of late in-the-bag IOL dislocations cannot be explained by the growing pseudophakic population only. The increase in the incidence was due primarily to the longer duration of pseudophakia in the population and to a greater dislocation risk with recent cataract surgery. The increase in life expectancy played a minor role. Long phacoemulsification time was a risk factor for dislocation. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2015 ASCRS and ESCRS.

Frennered K.,Sahlgren University Hospital | Hagg O.,Sahlgren University Hospital | Wessberg P.,Sahlgren University Hospital
Spine | Year: 2010

Study Design. Validation study. Objective. A system for patient self-recording on a computer touch-screen was developed. The validity of this method compared with the use of regular paper-andpen questionnaires was studied. Summary of Background Data. Systematic evaluation of health problems often involves the use of self-reporting questionnaires in order to collect data on different variables. Recording of such data for subsequent analysis requires several steps including filling out of paper forms and secretarial work. Missing values and misrecordings are frequent problems. Methods. Seventy-nine patients with back problems visiting our outpatient clinic for surgical evaluation were invited to take part in the study by answering a mailed questionnaire concerning background data, pain, function, quality of life, and depressive symptoms approximately 3 weeks before their visit. At the day of the visit they were asked to again answer the same questions with a replicate response option format displayed on a computer touch-screen. Results. The agreement concerning background history questions, measured by kappa values was generally good (0.71-1.0). For visual analogue scale recordings (0-100) of back and leg pain, the mean of the differences were 1.1 and 2.1, respectively, and the correlations (Pearson) 0.72 and 0.87. The Euro-Qol 5 Dimension Score, the General Function Score, the Zung Depression Scale and the physical dimensions of the Short Form-36 showed a high degree of agreement between paper and screen recordings with difference means close to 0 and reliabilities comparing well to published methodologic errors for paper form versions. There were, however, differences concerning the mental components of the SF-36 with somewhat higher ratings on screen recordings. Missing values were 0% for screen recordings and for paper forms, 2.3% on individual questions and 12% on composite scores. Conclusion. Computerized touch-screen questionnaires virtually eliminates missing values and show good validity and reliability compared to paper forms. The SF-36 tended to produce slightly higher values on touchscreen recordings in questions concerning mental health. © 2010, Lippincott Williams & Wilkins.

Loading Sahlgren University Hospital collaborators
Loading Sahlgren University Hospital collaborators