Stockholm, Sweden


Stockholm, Sweden
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De Bruyne B.,Cardiovascular Center Aalst | Pijls N.H.J.,Catharina Hospital | Pijls N.H.J.,TU Eindhoven | Kalesan B.,University of Bern | And 20 more authors.
New England Journal of Medicine | Year: 2012

Background: The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone. Methods: In patients with stable coronary artery disease for whom PCI was being considered, we assessed all stenoses by measuring FFR. Patients in whom at least one stenosis was functionally significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus the best available medical therapy (PCI group) or the best available medical therapy alone (medical-therapy group). Patients in whom all stenoses had an FFR of more than 0.80 were entered into a registry and received the best available medical therapy. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. Results: Recruitment was halted prematurely after enrollment of 1220 patients (888 who underwent randomization and 332 enrolled in the registry) because of a significant between-group difference in the percentage of patients who had a primary endpoint event: 4.3% in the PCI group and 12.7% in the medical-therapy group (hazard ratio with PCI, 0.32; 95% confidence interval [CI], 0.19 to 0.53; P<0.001). The difference was driven by a lower rate of urgent revascularization in the PCI group than in the medical-therapy group (1.6% vs. 11.1%; hazard ratio, 0.13; 95% CI, 0.06 to 0.30; P<0.001); in particular, in the PCI group, fewer urgent revascularizations were triggered by a myocardial infarction or evidence of ischemia on electrocardiography (hazard ratio, 0.13; 95% CI, 0.04 to 0.43; P<0.001). Among patients in the registry, 3.0% had a primary end-point event. Conclusions: In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best available medical therapy alone, decreased the need for urgent revascularization. In patients without ischemia, the outcome appeared to be favorable with the best available medical therapy alone. (Funded by St. Jude Medical; number, NCT01132495.) Copyright © 2012 Massachusetts Medical Society.

Bjorklund U.,Sodersjukhuset | Marsk A.,Lakarhuset Odenplan | Levin C.,Sodersjukhuset | Ohman S.G.,University of Stockholm | Ohman S.G.,Karolinska Institutet
Patient Education and Counseling | Year: 2012

Objective: To evaluate the effects of an information film on making an informed choice regarding Down syndrome screening, and women's knowledge and experiences of information. Methods: Randomized controlled trial including 184 women in the intervention group and 206 controls recruited from maternity units in Stockholm, Sweden. The intervention was an information film presented as a complement to written and verbal information. Data were collected via a questionnaire in gestational week 27. Three different measures were combined to measure informed choice: attitudes towards Down syndrome screening, knowledge about Down syndrome and Down syndrome screening, and uptake of CUB (combined ultrasound and biochemical screening). Results: In the intervention group 71.5% made an informed choice versus 62.4% in the control group. Women in the intervention group had significantly increased knowledge, and to a greater extent than the control group, experienced the information as being sufficient, comprehensible, and correct. Conclusions: An information film tended to increase the number of women who made an informed choice about Down syndrome screening. Participants were more satisfied with the information received. Practice implications: Access to correct, nondirective, and sufficient information is essential when making a choice about prenatal diagnostics. It is essential with equivalent information to all women. © 2011 Elsevier Ireland Ltd.

Barenius B.,Karolinska Institutet | Ponzer S.,Karolinska Institutet | Shalabi A.,Akademiska Sjukhuset | Bujak R.,Sodersjukhuset | And 2 more authors.
American Journal of Sports Medicine | Year: 2014

Background: The reported prevalence of radiological osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction varies from 10% to 90%. Purpose/Hypothesis: To report the prevalence of OA after ACL reconstruction and to compare the OA prevalence between quadrupled semitendinosus tendon (ST) and bone-patellar tendon-bone (BPTB) grafts. The hypothesis was that there would be no difference in OA prevalence between the graft types. The secondary aim was to study whether patient characteristics and additional injuries were associated with long-term outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Radiological examination results, Tegner activity levels, and Knee injury and Osteoarthritis Outcome Score (KOOS) values were determined in 135 (82%) of 164 patients at a mean of 14 years after ACL reconstruction randomized to an ST or a BPTB graft. Osteoarthritis was defined according to a consensus by at least 2 of 3 radiologists of Kellgren-Lawrence grade >2. Using regression analysis, graft type, sex, age, overweight, time between injury and reconstruction, additional meniscus injury, and a number of other variables were assessed as risk factors for OA 14 years after ACL reconstruction. Results: Osteoarthritis of the medial compartment was most frequent, with 57% of OA cases in the ACL-reconstructed knee and 18% of OA cases in the contralateral knee (P < .001). There was no difference between the graft types: 49% of OA of the medial compartment for BPTB grafts and 65% for ST grafts (P = .073). The KOOS results were lower for patients with OA in all subscales, indicating that OA was symptomatic. No difference in the KOOS between the graft types was found. Meniscus resection was a strong risk factor for OA of the medial compartment (odds ratio, 3.6; 95% CI, 1.4-9.3) in the muttivariable logistic regression analysis. Conclusion: A 3-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee. No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found. An initial meniscus resection was a strong risk factor for OA; the time between injury and reconstruction was not. © 2014 The Author(s).

Hamsten C.,Karolinska University Hospital | Hamsten C.,Karolinska Institutet | Starkhammar M.,Sodersjukhuset | Tran T.A.T.,Karolinska University Hospital | And 7 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2013

Patients with IgE antibodies against the carbohydrate epitope galactose-α-1,3-galactose (α-Gal) have reported severe allergic reactions after consumption of red meat. Investigations have revealed associations between IgE to α-Gal and tick bites. We provide the first direct evidence that α-Gal is present within ticks thus potentially explaining the relationship between tick exposure and sensitization to α-Gal, with development of red meat allergy as a secondary phenomena. Serum from Swedish patients with delayed severe reactions to red meat was included in the study. A dose-dependent inhibition of IgE responses to α-Gal by the tick Ixodes ricinus is demonstrated. Furthermore, using cryostat-cut sections of I. ricinus, we show that both a monoclonal and a polyclonal antibody against α-Gal stains the gastrointestinal tract of the tick. The same pattern is seen when staining with patient sera IgE positive to α-Gal. These results confirm that the α-Gal epitope is present in I. ricinus and imply host exposure to α-Gal during a tick bite. This provides further evidence that tick bites are associated with IgE responses to α-Gal and red meat allergy. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Rosfors S.,Sodersjukhuset | Rosfors S.,Karolinska Institutet | Blomgren L.,Karolinska University Hospital | Blomgren L.,Karolinska Institutet
Journal of Vascular Surgery | Year: 2013

Objective: Post-thrombotic venous claudication is a serious condition that may be treated with iliac vein stenting or open surgery, and there is a need for hemodynamic tests in the preoperative evaluation. The purpose of this study was to describe the results of venous occlusion plethysmography in patients with venous claudication and to analyze the outflow curve to find variables that best describe the functional abnormality in this patient group. Methods: Twenty-nine patients with previous deep venous thrombosis and with clinical evidence of venous claudication were retrospectively identified. The results of venous occlusion plethysmography in these patients were compared with results obtained in a group of 63 healthy control subjects of similar age and sex. Computerized strain-gauge plethysmography was used in a capacitance mode where the occlusion time is determined by an electronic detector allowing the maximal venous volume to be achieved in all limbs. Outflow volumes (OV1, OV4) and outflow fractions (OF1, OF4) were calculated at 1 and 4 seconds after cuff release. Outflow fraction is OV divided by maximal venous volume. Results: Both outflow volumes and outflow fractions were significantly reduced in patients compared with healthy control subjects. Outflow fractions were more sensitive than outflow volumes in identifying patients with venous claudication. The most discriminating variable was OF4 that was reduced below the normal lower limit in 69% of the patients, most severely reduced in patients with severe claudication. Conclusions: Patients with venous claudication attributable to remaining post-thrombotic iliofemoral obstructive disease are characterized by a functional disturbance shown with venous occlusion plethysmography as a reduced venous outflow during the initial 4 seconds following cuff release in relation to their true maximal venous volume. Our results suggest that venous occlusion plethysmography can be a valuable tool in the preoperative workup for selection of patients with iliofemoral vein obstruction that may benefit from venous intervention. Copyright © 2013 by the Society for Vascular Surgery.

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.

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.

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.

Inngul C.,Sodersjukhuset | Blomfeldt R.,Sodersjukhuset | Ponzer S.,Sodersjukhuset | Enocson A.,Sodersjukhuset
Bone and Joint Journal | Year: 2015

The aim of this randomised controlled study was to compare functional and radiological outcomes between modern cemented and uncemented hydroxyapatite coated stems after one year in patients treated surgically for a fracture of the femoral neck. A total of 141 patients aged > 65 years were included. Patients were randomised to be treated with a cemented Exeter stem or an uncemented Bimetric stem. The patients were reviewed at four and 12 months. The cemented group performed better than the uncemented group for the Harris hip score (78 vs 70.7, p = 0.004) at four months and for the Short Musculoskeletal Function Assesment Questionnaire dysfunction score at four (29.8 vs 39.2, p = 0.007) and 12 months (22.3 vs 34.9, p = 0.001). The mean EQ-5D index score was better in the cemented group at four (0.68 vs 0.53, p = 0.001) and 12 months (0.75 vs 0.58, p = < 0.001) follow-up. There were nine intra-operative fractures in the uncemented group and none in the cemented group. In conclusion, our data do not support the use of an uncemented hydroxyapatite coated stem for the treatment of displaced fractures of the femoral neck in the elderly. © 2015 The British Editorial Society of Bone & Joint Surgery.

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