Universitetssjukhuset, Sweden


Universitetssjukhuset, Sweden
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Kylhammar D.,Universitetssjukhuset | Radegran G.,Skanes universitetssjukhus | Radegran G.,Lund University
Lakartidningen | Year: 2017

In 2015 the European Society of Cardiology and European Respiratory Society published new guidelines on the diagnosis and treatment of pulmonary hypertension (PH). PH due to lung diseases and/ or hypoxia was classified as a separate entity. PH is common in lung diseases, but seldom severe. Nevertheless, the presence of PH in a patient with lung disease is associated with worse outcome. If there is clinical suspicion of PH in a patient with lung disease, echocardiography is recommended, and if there are signs of severe PH and/or severe right ventricular dysfunction the patient should be referred to a PH expert centre. Patients may have lung disease and e.g. pulmonary arterial hypertension or chronic thromboembolic PH simultaneously, and targeted treatments are available in such cases. PH-targeted drugs should, however, not be used to treat PH due to lung diseases, since there are no robust data speaking for their benefit and a risk of impaired arterial oxygenation due to inhibition of hypoxic pulmonary vasoconstriction. Instead, the underlying lung disease should be optimally treated, including long-term oxygen therapy in case of chronic hypoxemia. © 2017, Swedish Medical Association. All rights reserved.

Kreutz C.,Albert Ludwigs University of Freiburg | Raue A.,Albert Ludwigs University of Freiburg | Raue A.,Helmholtz Center Munich | Timmer J.,Albert Ludwigs University of Freiburg | Timmer J.,Universitetssjukhuset
BMC Systems Biology | Year: 2012

Background: Predicting a system's behavior based on a mathematical model is a primary task in Systems Biology. If the model parameters are estimated from experimental data, the parameter uncertainty has to be translated into confidence intervals for model predictions. For dynamic models of biochemical networks, the nonlinearity in combination with the large number of parameters hampers the calculation of prediction confidence intervals and renders classical approaches as hardly feasible.Results: In this article reliable confidence intervals are calculated based on the prediction profile likelihood. Such prediction confidence intervals of the dynamic states can be utilized for a data-based observability analysis. The method is also applicable if there are non-identifiable parameters yielding to some insufficiently specified model predictions that can be interpreted as non-observability. Moreover, a validation profile likelihood is introduced that should be applied when noisy validation experiments are to be interpreted.Conclusions: The presented methodology allows the propagation of uncertainty from experimental to model predictions. Although presented in the context of ordinary differential equations, the concept is general and also applicable to other types of models. Matlab code which can be used as a template to implement the method is provided at http://www.fdmold.uni-freiburg.de/∼ckreutz/PPL. © 2012 Kreutz et al.; licensee BioMed Central Ltd.

Childhood stroke is an uncommon but serious condition with mortality of 8-20 % and residual impairments in 50-85 % of survivors. It is important to »think stroke« when a child or teenager presents acutely with new neurological deficit, seizures or lowered consciousness. Early consultation with an experienced radiologist, neurosurgeon and neurointerventionist is important in a childhood stroke case. The aetiology of stroke in children is very different from the adults' and dominated by heart diseases, acute infections, vasculitis, coagulopathies, chronic diseases and several syndromes. A broad investigation of risk factors should therefore be made. Current treatment is not yet evidence-based but consensus recommendations are available. A review of aetiologies, investigations and recommended treatments so far is presented. New Swedish guidelines are presented. With an earlier diagnosis a more active approach is possible and recommended.

Helmrot K.,Örebro University | Ziegler B.,Universitetssjukhuset
Lakartidningen | Year: 2016

For unknown reasons, the number of visits to Swedish A&E Departments is on the increase. This study was designed to research whether patients had been in contact with the health service prior to their visit to the Örebro University Hospital A&E Department and if so, which part of the healthcare system. Our study revealed that 80% of patients had been in contact with the healthcare service prior to their visit, that referrals by telephone constituted a large proportion of visits and that the level of medical seriousness differed between the various methods of referral. © 2016, Swedish Medical Association. All rights reserved.

Peebo B.B.,Moorfields Eye Hospital Dubai | Mirabelli P.,Universitetssjukhuset
Lakartidningen | Year: 2016

Uveitides are inflammatory diseases of the choroidea, iris and ciliary body accounting for 10-20% of blindness worldwide. Standardisation of Uveitis Nomenclature (SUN) classification distinguishes between anterior uveitis (iritis), intermediate, and posterior uveitis (choroiditis), based on the origin of inflammation – each one with different symptoms, causes and treatment. Onset may be acute or chronic. Possible sightthreatening complications are glaucoma, cataract, and macular edema. Diagnostics and treatment are challenging, because of the variability of signs and causes, thus requiring an interdisciplinary approach. Etiology is autoimmune, infective, or idiopathic (in 40%). Uveitis can be a sign of serious systemic diseases that require diagnosis and treatment (rheumatic, neurologic, or other autoimmune/infective disorder). Rare but serious masquerade syndromes may mimic uveitis. Treatment is based on steroids (by topical, local or systemic routes), and immunomodulatory therapy if an infective cause has been excluded. © 2016, Swedish Medical Association. All rights reserved.

Andren-Sandberg A.,Universitetssjukhuset
Lakartidningen | Year: 2016

Exocrine pancreatic insufficiency may result in urgency and foul smelling steatorrhea that is difficult to flush. The simplest way of diagnosis is by observing the response to therapy with high dose pancreatic enzymes. Here we describe two different cases of exocrine insufficiency in elderly patients who earlier had some form of pancreatic surgery. These cases illustrate the varying presentations of exocrine pancreatic insufficiency and how proper history taking can help to cure this debilitating condition. © 2016, (Publisher). All rights reserved.

Ibrahim A.,Universitetssjukhuset | Emilsson K.,Universitetssjukhuset
Lakartidningen | Year: 2015

An echocardiographic examination of a middle-aged woman at Örebro University Hospital, showed an unusual finding. The patient had a quadricuspid aortic valve. The reviewed literature, consisting of older and more recent studies based on cases found substantially through echocardiographic examinations, indicate an estimated prevalence of 0.013% to 0.043%. The quadricuspid aortic valve is believed to develop during the separation of the truncus arteriosus into the aortic artery and the pulmonary artery following the 4th week of gestation. The two most common types of this rare abnormality consist of either four equally sized cusps or one smaller cusp in addition to three equally sized cusps. There are also cases of associated congenital cardiac malformations, where the most recurrent ones seem to be anomalies of the coronary arteries. A quadricuspid aortic valve is not only a rare phenomenon; rather it is an abnormal valve with risk of malfunction. The most commonly associated valve malfunction is aortic regurgitation, which is encountered more frequently in older patients. This may indicate that the quadricuspid aortic valve is more prone to degeneration compared to the normal tricuspid aortic valve, which may highlight the necessity of following up such a finding. © 2015, Swedish Medical Association. All rights reserved.

Gustavsson A.,I3 Innovus | Bjorkman J.,Grunenthal | Ljungcrantz C.,I3 Innovus | Rhodin A.,Grunenthal | And 3 more authors.
Pain | Year: 2012

Slow-release strong opioids (SRSO) are indicated in patients with severe chronic pain. Side effects, lack of efficacy and risk of dependency limit their use in clinical practice. The aim of this study was to explore prescription patterns of SRSO in Swedish real-world data on patients with a diagnosis related to chronic pain (DRCP). Patient-level data were extracted from the national prescriptions register and a regional register with diagnosis codes. The prescription sequences, switches, co-medications, and strengths over time were analyzed for cancer and noncancer patients. Of 840,000 patients with a DRCP, 16,257 initiated treatment with an SRSO in 2007 to 2008. They were 71 years old on average; 60% were female and 34% had cancer. The most common first prescription was oxycodone (54%) followed by fentanyl (19%), buprenorphine (14%), and morphine (13%). 63% refilled their prescription within 6 months, and 12% switched to another SRSO, most commonly fentanyl. After 3 years, 51% of cancer and 27% of noncancer patients still being in contact with health care remained on any SRSO. Of noncancer patients, 35% had a psychiatric co-medication (SSRI or benzodiazepine). In conclusion, fewer patients remain on SRSO in the long-term in clinical practice than reported in previous clinical trials. Oxycodone is the most common first SRSO prescription and one-third of patients get a prescription indicating psychiatric comorbidity. Our interpretation of these findings are that there is need for better treatment options for these patients, and that more effort is needed to improve treatment guidelines and to ascertain that these guidelines are followed. © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Liden M.,Örebro University | Liden M.,Universitetssjukhuset | Andersson T.,Örebro University | Geijer H.,Örebro University
European Radiology | Year: 2011

Objectives: The objectives of this study were to quantify the impact of image post-processing parameters on the apparent renal stone size, and to quantify the intra- and inter-reader variability in renal stone size estimation. Methods: Fifty CT datasets including a renal or ureteral stone were included retrospectively during a prospective inclusion period. Each of the CT datasets was post-processed in different ways regarding slice thickness, slice increment and window setting. In the first part of the study a single reader repeated size estimations for the renal stones using different post-processing parameters. In the intra-reader variability experiment one reader reported size estimations for the same images with a one-week interval. The inter-reader variability data were obtained from 11 readers reporting size estimations for the same renal stones. Results: The apparent stone size differed according to image post-processing parameters with the largest mean differences seen with regard to the window settings experiment (1.5 mm, p<0.001) and slice thickness (0.8 mm, p<0.001). Changes in parameters introduced a bias and a pseudo-random variability. The inter-reader variability was considerably larger than the intra-reader variability. Conclusion: Our results indicate a need for the standardisation of making measurements on CT images. © 2011 European Society of Radiology.

Samsioe G.,Universitetssjukhuset | Hruska J.,Novo Nordisk AS
Climacteric | Year: 2010

ObjectiveTo evaluate the influence of two ultra-low doses of oral continuous combined hormone therapy and placebo on metabolic parameters, and to assess safety endpoints and overall tolerability in healthy postmenopausal women. DesignIn a subpopulation of the Clinical study on Hormone dose Optimisation In Climacteric symptoms Evaluation (CHOICE) trial, lipids and parameters of glucose metabolism and hemostasis were analyzed in Nordic women (n158) at baseline and after 12 and 24 weeks of treatment with 0.5mg 17β-estradiol (E2)0.25mg norethisterone acetate (NETA), 0.5mg E20.1mg NETA or placebo. Adverse events occurring from the first trial-related activity, whether related or not related to the study medication, were recorded for the entire population (n575) of the trial. The seriousness, relationship to treatment and the reason for withdrawal were reported. ResultsBoth ultra-low-dose combinations were neutral to changes in lipid and lipoprotein, hemostasis parameters and carbohydrate metabolism during the trial. The incidence of serious adverse events was only 1 in respective treatment groups. Adverse events were the reason for withdrawal in only 2 and 6 of women in the 0.5mg E20.25mg and 0.1mg NETA groups, and in 8 in the placebo group. No weight gain or change in blood pressure was reported during the trial in any of the study groups. ConclusionThe treatments had neutral effects on metabolic parameters in the study population. Excellent tolerability of both ultra-low doses resulted in high completion rates. © 2010 International Menopause Society.

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