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Östermalm, Sweden

Wegnelius G.,Sodersjukhuset | Hammarstrom M.,Karolinska Institutet
Acta Obstetricia et Gynecologica Scandinavica | Year: 2011

Objective. To study long-term effects with respect to anal incontinence, pain, attitude to and mode of second delivery following complete rupture of the anal sphincter. Design. Case-control study. Settings. Södersjukhuset, a university hospital in Stockholm. Population. A case group of 136 primiparas who had experienced a complete rupture of the anal sphincter. Two matched control groups of primiparas, one of whom had cesarean section and the other a normal vaginal delivery. Methods. The case women were examined and asked for symptoms of anal incontinence 3-6 months after delivery; 3-8 years later they and two matched control groups answered a postal questionnaire. Response rate was 89%. Main outcome measures. Symptoms of pelvic floor dysfunction and, as secondary end-point, the attitude to and mode of second delivery. Results. Anal incontinence after delivery was reported by 31% in the case group, and at long-term follow-up by 54% in the case group, 21% in the cesarean section and 23% in the normal delivery group (p < 0.0001). A wish to postpone or abandon further childbirth was significantly more common in the case women (33 and 18%) than in the other groups, but about 60% delivered again in all groups. In the case group, the next delivery was by cesarean section in 49%. Conclusion. At long-term follow-up after a complete rupture of the anal sphincter, anal incontinence was common and many women wished to postpone or avoid further delivery. © 2010 The Authorsa Acta Obstetricia et Gynecologica Scandinavica© 2010 Nordic Federation of Societies of Obstetrics and Gynecology.


Dahlin M.,Karolinska Institutet | Nilsson C.,Sundsvalls Sjukhus Sundsvalls Hospital | Stotzer E.,Sodersjukhuset | Runeson B.,Karolinska Institutet
BMC Medical Education | Year: 2011

Background: Stress and distress among medical students are thoroughly studied and presumed to be particularly high, but comparative studies including other student groups are rare. Methods. A web-based survey was distributed to 500 medical students and 500 business students. We compared levels of study stress (HESI), burnout (OLBI), alcohol habits (AUDIT) and depression (MDI), and analysed their relationship with self-assessed mental health problems by logistic regression, with respect to gender. Results: Medical students' response rate was 81.6% and that of business students 69.4%. Business students scored higher on several study stress factors and on disengagement. Depression (OR 0.61, CI950.37;0.98) and harmful alcohol use (OR 0.55, CI 950.37; 0.75) were both less common among medical students. However, harmful alcohol use was highly prevalent among male students in both groups (medical students 28.0%, business students 35.4%), and among female business students (25.0%). Mental health problems in need of treatment were equally common in both groups; 22.1% and 19.3%, respectively, and was associated with female sex (OR 2.01, CI951.32;3.04), exhaustion (OR 2.56, CI 951.60;4.10), lower commitment to studies (OR 1.95, CI 951.09;3.51) and financial concerns (OR 1.81 CI951.18;2. 80). Conclusions: Medical students may not be more stressed than other high achieving student populations. The more cohesive structure of medical school and a higher awareness of a healthy lifestyle may be beneficial factors. © 2011 Dahlin et al; licensee BioMed Central Ltd.


A case is presented, where preoperative malnutrition was the most likely explanation to elevated lactate levels during and after surgery. Poor circulation, a common cause of elevated lactate during surgery, was excluded. The elevated lactate levels were normalized after intravenous administration of thiamine. Thiamine is an essential cofactor in carbohydrate metabolism for energy production. Thiamine deficiency is common among ICU patients. Clinical suspicion of malnutrition should lead to early parenteral administration of thiamine without specific laboratory confirmation of thiamine deficiency. © 2015 Swedish Medical Association. All rights reserved.


Landerholm A.H.,Karolinska Institutet | Ekblom A.G.,Sodersjukhuset | Hansson P.T.,Karolinska Institutet
European Journal of Pain | Year: 2010

Why traumatic injuries to the peripheral nervous system infrequently result in neuropathic pain is still unknown. The aim of this study was to examine the somatosensory system in patients with traumatic peripheral nerve injury with and without pain to try to unravel possible links to mechanisms underlying development and maintenance of pain. Eighteen patients with spontaneous ongoing pain and 16 patients without pain after unilateral partial peripheral traumatic nerve injury were studied. In the area of partial denervation and in the corresponding contralateral area perception thresholds to warmth, cold, light touch, pressure pain, cold- and heat pain were assessed as were pain intensities at suprathreshold heat pain stimulation. Comparing sides patients with pain reported allodynia to cold (p = 0.03) and pressure (p = 0.016) in conjunction with an increase in the perception threshold to non-painful warmth (p = 0.024) on the injured side. Pain-free patients reported hypoesthesia to light touch (p = 0.002), cold (p = 0.039) and warmth (p = 0.001) on the injured side. There were no side differences in stimulus-response functions using painful heat stimuli in any of the groups. In addition, no significant difference could be demonstrated in any sensory modality comparing side-to-side differences between the two groups. In conclusion, increased pain sensitivity to cold and pressure was found on the injured side in pain patients, pointing to hyperexcitability in the pain system, a finding not verified by a more challenging analysis of side-to-side differences between patients with and without pain. © 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.


Brostrom E.B.,Karolinska Institutet | Thunqvist P.,Karolinska Institutet | Adenfelt G.,Sachs Childrens Hospital and Specialist Care | Borling E.,Sodersjukhuset | Katz-Salamon M.,Karolinska Institutet
Respiratory Medicine | Year: 2010

Background: Bronchopulmonary dysplasia (BPD) is a common cause of respiratory insufficiency in children born very premature. Objectives: The purpose of this study was to examine the impact of the severity of BPD on pulmonary morbidity at school age, as measured by conventional spirometry and impulse oscillometry. We also studied the association between changes in lung function and structural changes in the lungs of children with BPD via High-Resolution Computed Tomography (HRCT). Finally we studied the prevalence of atopy associated with BPD. Methods: We studied 60 very low birth weight (VLBW) children, 28 with respiratory distress syndrome (RDS) who did not develop BPD ("preterm non-BPD") and 32 with RDS who developed BPD. The severity of BPD was graded as mild, moderate or severe. Follow-up at age 6-8 years consisted of spirometry, oscillometry, thoracic HRCT, allergy skin-prick test, blood samples and a questionnaire. Results: All children with BPD showed some evidence of impaired lung function (more negative reactance, FEV1 < 80% predicted, greater reversibility), although less than half of these children were symptomatic. The majority of children with BPD (19/26) showed abnormalities on HRCT. There was no evidence that atopy was associated with BPD. Conclusions: Children with mild BPD exhibited similar impairments in respiratory mechanics and lung structure to those diagnosed with moderate BPD. The widespread involvement of the peripheral airways suggests that all children diagnosed with BPD are potentially at risk of developing chronic obstructive pulmonary disease later in life. © 2009 Elsevier Ltd. All rights reserved.

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