Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 167
Filter
Add more filters

Country/Region as subject
Publication year range
1.
Langenbecks Arch Surg ; 408(1): 341, 2023 Aug 29.
Article in English | MEDLINE | ID: mdl-37642708

ABSTRACT

PURPOSE: Small bowel obstruction (SBO) is a common surgical emergency. Previous studies have shown the value computed tomography (CT) scanning in both confirming this diagnosis and identifying indications for urgent surgical intervention, such as strangulated bowel or closed loop obstructions. However, most of the literature is based on retrospective expert review of previous imaging and little data regarding the real-time accuracy of CT reporting is available. Here, we investigated the real-world accuracy of CT reporting in patients admitted with SBO. METHODS: This was a multicentre prospective study including consecutive patients admitted with SBO. The primary outcomes were the sensitivity and specificity of CT scanning for bowel obstruction with ischaemia and closed loop obstruction. Data were retrieved from the original CT reports written by on-call radiologists and compared with operative findings. RESULTS: One hundred seventy-six patients were included, all of whom underwent CT scanning with intravenous contrast followed by operative management of SBO. Bowel obstruction with ischaemia was noted in 20 patients, with a sensitivity and specificity of CT scanning of 40.0% and 85.5%, respectively. Closed loop obstructions were noted in 26 patients, with a sensitivity and specificity of CT scanning of 23.1% and 98.0%, respectively. CONCLUSIONS: The real-world accuracy of CT scanning appears to be lower than previously reported in the literature. Strategies to address this could include the development of standardised reporting schemas and to increase the surgeon's own familiarity with relevant CT features in patients admitted with SBO.


Subject(s)
Intestinal Obstruction , Tomography, X-Ray Computed , Humans , Prospective Studies , Retrospective Studies , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/surgery , Hospitalization
2.
Am J Transplant ; 18(4): 952-963, 2018 04.
Article in English | MEDLINE | ID: mdl-28925583

ABSTRACT

Cancer remains one of the most serious long-term complications after liver transplantation (LT). Data for all adult LT patients between 1982 and 2013 were extracted from the Nordic Liver Transplant Registry. Through linkage with respective national cancer-registry data, we calculated standardized incidence ratios (SIRs) based on country, sex, calendar time, and age-specific incidence rates. Altogether 461 cancers were observed in 424 individuals of the 4246 LT patients during a mean 6.6-year follow-up. The overall SIR was 2.22 (95% confidence interval [CI], 2.02-2.43). SIRs were especially increased for colorectal cancer in recipients with primary sclerosing cholangitis (4.04) and for lung cancer in recipients with alcoholic liver disease (4.96). A decrease in the SIR for cancers occurring within 10 years post-LT was observed from the 1980s: 4.53 (95%CI, 2.47-7.60), the 1990s: 3.17 (95%CI, 2.70-3.71), to the 2000s: 1.76 (95%CI, 1.51-2.05). This was observed across age- and indication-groups. The sequential decrease for the SIR of non-Hodgkin lymphoma was 25.0-12.9-7.53, and for nonmelanoma skin cancer 80.0-29.7-10.4. Cancer risk after LT was found to be decreasing over time, especially for those cancers that are strongly associated with immunosuppression. Whether immunosuppression minimization contributed to this decrease merits further study.


Subject(s)
Colorectal Neoplasms/epidemiology , Liver Neoplasms/epidemiology , Liver Transplantation/adverse effects , Lung Neoplasms/epidemiology , Registries/statistics & numerical data , Adult , Cohort Studies , Colorectal Neoplasms/etiology , Colorectal Neoplasms/prevention & control , Female , Follow-Up Studies , Humans , Incidence , Liver Neoplasms/etiology , Liver Neoplasms/prevention & control , Lung Neoplasms/etiology , Lung Neoplasms/prevention & control , Male , Middle Aged , Prognosis , Risk Factors , Scandinavian and Nordic Countries/epidemiology
3.
Am J Transplant ; 18(5): 1270-1274, 2018 05.
Article in English | MEDLINE | ID: mdl-29575738

ABSTRACT

Uterus transplantation has proven to be a successful treatment for women with absolute uterine infertility, caused either by the absence of a uterus or the presence of a nonfunctioning uterus. We report the first birth of a healthy child following uterus transplantation in the United States, from a recipient of a uterus allograft procured from an altruistic living donor. Two major modifications from the previously reported live births characterized this uterus transplant. First, the transplanted uterus relied upon and sustained the pregnancy while having only the utero-ovarian vein as venous outflow. The implication is a significantly simplified living donor surgery that paves the way for minimally invasive laparoscopic or robot-assisted techniques for the donor hysterectomy. Second, the time from transplantation to embryo transfer was significantly shortened from prior protocols, allowing for an overall shorter exposure to immunosuppression by the recipient and lowering the risk for potential adverse effects from these medications.


Subject(s)
Infertility, Female/surgery , Live Birth , Living Donors/supply & distribution , Uterus/transplantation , Adult , Female , Humans , Hysterectomy , Pregnancy
4.
Am J Transplant ; 17(11): 2901-2910, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28432742

ABSTRACT

Uterus transplantation is a vascularized composite allograft transplantation. It allows women who do not have a uterus to become pregnant and deliver a baby. In this paper, we analyze the first five cases of living donor uterus transplantation performed in the United States. The first three recipients lost their uterus grafts at days 14, 12, and 6, respectively, after transplant. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for the graft losses. Two recipients, at 6 and 3 mo, respectively, after transplant, have functioning grafts with regular menstrual cycles. Ultimate success will be claimed only after a live birth. This paper is an in-depth analysis of evaluation, surgical technique, and follow-up of these five living donor uterus transplants. The lessons learned were instrumental in allowing us to evolve from failure to technical and functional success. We aim to share our conclusions and build on knowledge in the evolving field of uterus transplantation.


Subject(s)
Graft Rejection/epidemiology , Infertility, Female/therapy , Living Donors , Postoperative Complications , Uterus/transplantation , Adult , Aged , Female , Follow-Up Studies , Graft Survival , Humans , Middle Aged , Pregnancy , Pregnancy Outcome , Risk Factors , Young Adult
5.
Pediatr Transplant ; 21(5)2017 Aug.
Article in English | MEDLINE | ID: mdl-28039929

ABSTRACT

The rate of PTLD can be reduced by weaned IS guided by monitoring of EBV DNA. In this single-center retrospective case series study, we analyzed how reduction in IS influenced EBV DNA levels in whole blood and serum in 30 children during the first year after liver transplantation, and how these levels were related to symptoms putatively due to EBV. Primary and reactivated EBV infection was seen in 18 (60%) and eight patients (27%), respectively. Thirteen patients (42%) developed chronic high load the first year post-transplant. IS was successfully discontinued in six patients the first year post-transplant and in another two patients within 3 years. EBV DNA levels were reduced, but persisted long term in all the eight patients who had IS completely withdrawn. There was no case of PTLD. In summary, EBV DNAemia and chronic high load were very common after pediatric liver transplantation. Liver graft tolerance facilitates radical reduction in IS treatment, which may prevent PTLD, but EBV DNAemia may persist long term after discontinued IS.


Subject(s)
DNA, Viral/blood , Epstein-Barr Virus Infections/prevention & control , Herpesvirus 4, Human/isolation & purification , Immunosuppressive Agents/administration & dosage , Liver Transplantation , Postoperative Complications/prevention & control , Withholding Treatment , Adolescent , Biomarkers/blood , Child , Child, Preschool , Drug Administration Schedule , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/epidemiology , Epstein-Barr Virus Infections/etiology , Female , Follow-Up Studies , Graft Rejection/prevention & control , Herpesvirus 4, Human/genetics , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Infant , Lymphoproliferative Disorders/diagnosis , Lymphoproliferative Disorders/epidemiology , Lymphoproliferative Disorders/etiology , Lymphoproliferative Disorders/prevention & control , Male , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Treatment Outcome , Viral Load
6.
Pediatr Transplant ; 21(2)2017 Mar.
Article in English | MEDLINE | ID: mdl-27957786

ABSTRACT

Biliary atresia (BA) is the most common indication for LT in children. We investigated whether this diagnosis per se, compared to other chronic liver diseases (OCLD), had an influence on patient survival. Data from 421 Scandinavian children, 194 with BA and 227 with OCLD, listed for LT between 1990 and 2010 were analyzed. The intention-to-treat survival and influencing risk factors were studied. Patients with BA had higher risk of death after listing than patients with OCLD. The youngest (<1 year) and smallest (<10 kg) children with the highest bilirubin (>510 µmol/L), highest INR (>1.6), and highest PELD score (>20) listed during 1990s had the worst outcome. Given the same PELD score, patients with BA had higher risk of death than patients with OCLD. For adolescents, low weight/BMI was the only prognostic marker. Impaired intention-to-treat survival in patients with BA was mainly explained by more advanced liver disease in younger ages and higher proportion of young children in the BA group rather than diagnosis per se. PELD score predicted death, but seemed to underestimate the severity of liver disease in patients with BA. Poor nutritional status and severe cholestasis had negative impact on survival, supporting the "sickest children first" allocation policy and correction of malnutrition before surgery.


Subject(s)
Biliary Atresia/mortality , Biliary Atresia/surgery , Liver Failure/mortality , Liver Failure/surgery , Liver Transplantation , Adolescent , Body Mass Index , Child , Child, Preschool , Female , Graft Survival , Humans , Infant , Infant, Newborn , Intention to Treat Analysis , International Normalized Ratio , Male , Multivariate Analysis , Nutritional Status , Prognosis , Prospective Studies , Registries , Risk Factors , Scandinavian and Nordic Countries , Time-to-Treatment , Treatment Outcome
7.
Physiol Res ; 73(3): 485, 2024 07 17.
Article in English | MEDLINE | ID: mdl-39027963

ABSTRACT

On the basis of author's request the publisher of Physiological Research decided to change the license of the article to CC BY license.


Subject(s)
Thrombosis , Uterus , Humans , Female , Thrombosis/etiology , Thrombosis/prevention & control , Thrombosis/diagnosis , Uterus/transplantation , Adult
8.
Hum Reprod ; 28(1): 189-98, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23108346

ABSTRACT

STUDY QUESTION: Is it possible to perform allogeneic uterus transplantation (UTx) with a donation from a live donor in a non-human primate species and what immunosuppression is needed to prevent rejection? SUMMARY ANSWER: Allogeneic UTx in the baboon is a donor- and recipient-safe surgical procedure; immunosuppression with induction therapy and a triple protocol should be used. WHAT IS KNOWN ALREADY: UTx may become a treatment for absolute uterine factor infertility. Autologous UTx models have been developed in non-human primates with reports on long-term survival of the uterine grafts. STUDY DESIGN, SIZEAND DURATION: This experimental study included 18 female baboons as uterus donors and 18 female baboons as uterus recipients. The follow-up time was 5-8 weeks. PARTICIPANTS/MATERIALS, SETTING AND METHODS: Uterus retrieval was performed with extended hysterectomy including bilateral uterine and internal iliac arteries and ovarian veins. After UTx, with vascular anastomoses unilateral to the internal iliac artery and the external iliac vein, the uterus recipients received one of the following: no immunosuppression (n = 4); monotherapy (oral slow release tacrolimus) (n = 4) or induction therapy (antithymocyte globulin) followed by triple therapy (tacrolimus, mycophenolate, corticosteroids; n = 10). Surgical parameters, survival, immunosuppression and rejection patterns were evaluated. MAIN RESULTS AND THE ROLE OF CHANCE: The durations of uterus retrieval and recipient surgery were around 3 and 3.5 h, respectively. The total ischemic time was around 3 h. All the recipients and the donors survived the surgery. All the recipients presented rejection to some extent within the first weeks following UTx. In one recipient, the uterus was of normal appearance at the end of the study period. In spite of occasional high (>60 ng/ml) blood levels of tacrolimus, there was no evidence of nephrotoxicity. LIMITATIONS AND REASONS FOR CAUTION: This initial non-human primate allogeneic UTx study indicates that further research is needed to optimize immunosuppression protocols in order to avoid uterine rejection. WIDER IMPLICATIONS OF THE FINDINGS: The findings suggest that allogeneic UTx in primate species is feasible but continued work on this issue is needed. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the Swedish Research Council, ALF University of Gothenburg, Hjalmar Svensson Foundation and by Jane and Dan Olsson Research Foundation. The authors do not have any competing interest.


Subject(s)
Disease Models, Animal , Immunosuppression Therapy/methods , Induction Chemotherapy , Infertility, Female/surgery , Uterine Diseases/physiopathology , Uterus/transplantation , Adrenal Cortex Hormones/therapeutic use , Animals , Antilymphocyte Serum/therapeutic use , Drug Therapy, Combination , Feasibility Studies , Female , Graft Rejection/prevention & control , Graft Survival/drug effects , Infertility, Female/etiology , Living Donors , Maintenance Chemotherapy , Mycophenolic Acid/therapeutic use , Papio , Tacrolimus/therapeutic use , Transplantation, Homologous , Uterus/immunology
9.
Eur J Trauma Emerg Surg ; 49(2): 1121-1130, 2023 Apr.
Article in English | MEDLINE | ID: mdl-36357790

ABSTRACT

AIMS: The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, a more surgically aggressive strategy has traditionally been used, but to what extent patient outcomes differ from international reports is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark. METHODS: This was a prospective cohort study conducted at six acute hospitals in Denmark over a 4-month period. Patients aged ≥ 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30 day morbidity and mortality rates. RESULTS: 316 patients were included during the study period. The median age was 72 years and 56% were female. Diagnosis was made by computed tomography (CT) in 313 patients (99.1%), with the remaining three diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 119 (78.3%). Urgent surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The entire cohort had a 30 day mortality rate of 7.3% and a 30 day morbidity rate of 17.1%. CONCLUSIONS: The management of SBO in Denmark differs markedly to previous international reports, with an almost ubiquitous use of CT for diagnosis and a high proportion of patients undergoing urgent surgery. Despite higher rates of surgery, patient outcomes are broadly similar to reports of more conservative strategies, perhaps due to a reduction in delayed operations. TRIAL REGISTRATION: Trial registration number: NCT04750811. Trial registration date: 11/02/2021.


Subject(s)
Intestinal Obstruction , Humans , Female , Aged , Male , Prospective Studies , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Morbidity , Intestine, Small/diagnostic imaging , Intestine, Small/surgery , Denmark/epidemiology
10.
Am J Transplant ; 12(8): 2044-51, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22548829

ABSTRACT

Rapidly progressing mucosal breakdown limits the intestinal preservation time below 10 h. Recent studies indicate that intraluminal solutions containing polyethylene glycol (PEG) alleviate preservation injury of intestines stored in UW-Viaspan. We investigated whether a low-sodium PEG solution is beneficial for intestines stored in histidine-tryptophane-ketoglutarate (HTK) preservation solution. Rat intestines used as control tissue (group 1) were perfused with HTK, groups 2 and 3 received either a customized PEG-3350 (group 2) or an electrolyte solution (group 3) intraluminally before cold storage. Tissue injury, brush-border maltase activity, zonula occludens-1 (ZO-1) and claudin-3 expression in the tight junctions (TJ) were analyzed after 8, 14 and 20 h. We measured epithelial resistance and permeability (Ussing chamber) after 8 and 14 h. Group 2 had superior morphology while maltase activity was similar in all groups. TJ proteins rapidly decreased and decolocalized in groups 1 3; these negative events were delayed in group 2, where colocalization persisted for about 14 h. Intestines in group 2 had higher epithelial resistance and lower permeability than the other groups. These results suggest that a customized PEG solution intraluminally reduces the intestinal preservation injury by improving several major epithelial characteristics without negatively affecting the brush-border enzymes or promoting edema.


Subject(s)
Intestines/drug effects , Polyethylene Glycols/pharmacology , Tight Junctions/drug effects , Animals , Immunohistochemistry , Intestines/physiology , Male , Rats , Rats, Sprague-Dawley
11.
Mol Hum Reprod ; 18(2): 68-78, 2012 Feb.
Article in English | MEDLINE | ID: mdl-21900333

ABSTRACT

The aim of this review is to summarize the state-of the-art methods that are used in clinical organ transplantation today, as well as the major findings of recent experimental uterus transplantation (UTx) research regarding organ donation/retrieval, ischemic preservation, surgical techniques for anastomosis, immunosuppression and pregnancy. Absolute uterine factor infertility lacks treatment despite the major developments in infertility treatment and assisted reproduction. Concerning uterine factor infertile patients, genetic motherhood is only possible through gestational surrogacy. The latter can pose medical, ethical and legal concerns such as lack of control of life habits during surrogate pregnancy, economic motives for women to become surrogate mothers, medical/psychological pregnancy-related risks of the surrogate mother and uncertainties regarding the mother definition. Thus, surrogacy is non-approved in large parts of the world. Recent advances in the field of solid organ transplantation and experimental UTx provide a favourable and safe background in a scenario in which a human clinical UTx trial can take place. Protocols based on animal research over the last decade are described with a view to providing a scientifically guided approach to human UTx as an experimental procedure in the future.


Subject(s)
Infertility, Female/therapy , Tissue and Organ Harvesting/methods , Uterine Diseases/therapy , Uterus/transplantation , Female , Humans , Immunosuppression Therapy , Infertility, Female/surgery , Lymphocyte Depletion , Organ Preservation Solutions , Pregnancy , Reperfusion Injury/prevention & control , Surrogate Mothers/legislation & jurisprudence , Transplantation, Homologous , Uterine Diseases/surgery , Uterus/immunology
12.
Hum Reprod ; 27(6): 1640-8, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22454459

ABSTRACT

BACKGROUND: Uterus transplantation (UTx) may provide the first available treatment for women affected by uterine infertility. The present study aimed to further develop a surgical technique for autologous UTx in a non-human primate species and to assess long-term function. METHODS: Female baboons (n= 16) underwent autologous transplantation of the uterus with the Fallopian tubes and ovaries, performed with a previously published surgical technique (n= 6, Group 1) or using a modified technique (n= 10; Group 2). The uterine arteries were dissected to the proximal end of the anterior branch (Group 1) or the entire (Group 2) internal iliac artery, and the ovarian veins were dissected to the crossing over the ureter (Group 1) or further cranially to include greater lengths and patches of the cava/renal vein (Group 2). Back-table preparation created common venous and arterial ends with arterial anastomosis either end-to-side to the left external iliac artery (Group 1) or end-to-end to the left internal iliac artery (Group 2). RESULTS: Overall short-time survival of the animals was 88% (66% in Group 1 and 100% in Group 2). Of all the operated animals, 75% (66% in Group 1 and 80% in Group 2) resumed ovarian cyclicity. Regular menstruation after UTx was demonstrated only in Group 2 (60%). Menstruating animals (n= 6) were each exposed to timed mating for ≥5 menstrual cycles, but pregnancy did not occur. Adhesions and tubal blockage were seen in post-mortem analysis. CONCLUSIONS: The modified UTx model of Group 2 is a safe procedure and shows resumed long-term uterine function in a majority of the animals, although pregnancy could not be demonstrated.


Subject(s)
Papio , Uterus/transplantation , Animals , Arteries/surgery , Breeding , Fallopian Tubes/transplantation , Female , Follow-Up Studies , Iliac Artery/surgery , Menstruation , Ovary/blood supply , Ovary/transplantation , Pregnancy , Transplantation, Autologous/methods , Transplantation, Autologous/veterinary , Treatment Outcome , Uterus/blood supply , Veins/surgery
13.
Physiol Res ; 71(Suppl 1): S75-S87, 2022 Dec 27.
Article in English | MEDLINE | ID: mdl-36592443

ABSTRACT

Uterus transplantation (UTx) is a promising treatment option for women who wish to give birth but suffer from absolute uterine factor infertility. This paper presents an interim analysis of a trial focusing on the causes, prevention, diagnosis, and management of graft thrombosis. Our team analyzed 10 cases of UTx (recipients numbered 1 to 10). Early thrombosis developed in 2 of 10 (20 %) recipients, and thrombectomy and temporary viability preservation were achieved in both cases. However, re-thrombosis developed in both cases, and a graft hysterectomy was carried out. In recipient number 2, vascular changes might have contributed to graft thrombosis. The histopathological finding of the explant revealed subintimal excentric fibrosis with focal sclerotic changes. In recipient number 8, thrombosis was facilitated by external compression of the vascular pedicles by the hematoma as well as production of de novo donor-specific antibodies. Thrombosis led to graft loss in both cases despite an attempt at a thrombectomy. Therefore, the focus must be on prevention including a thorough evaluation of the donor candidate. In the postoperative course, perfusion is closely followed-up with an ultrasound, Doppler flow monitoring, and macroscopic evaluation of the cervix. In the event that findings are unclear, a relaparotomy should be promptly indicated. If thrombosis is revealed, a thrombectomy and an attempt to salvage the graft are indicated; however, the role of this strategy is questionable due to the low chance of long-term success. The indication of upfront graft removal and early re-transplantation in the treatment of uterine graft remains debatable.


Subject(s)
Thrombosis , Transplants , Humans , Female , Uterus/transplantation , Thrombosis/etiology , Thrombosis/prevention & control , Tissue Donors , Fibrosis
14.
Hum Reprod ; 26(12): 3303-11, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21954279

ABSTRACT

BACKGROUND: Several sites have been used for ovarian cortex transplantation (OCT) in humans. The present study was designed to evaluate different intra-abdominal transplantation sites in the baboon to gain further knowledge about alternative transplantation sites in a human setting. METHODS: Autologous fresh OCTs were performed in 12 baboons (Papio anubis). Four different sites were tested: the free portion of the omentum (OMF), the portion of the omentum adjacent to the spleen (OMS), the pouch of Douglas (D) and the pelvic wall on the psoas muscle (PW). Cortex survival, follicle density, cyclicity and hormonal levels were compared between the different sites, 3 and 6 months after transplantation. RESULTS: Macroscopically, antral follicles were only found in the OMS and OMF locations, which also showed a higher proportion of follicle-containing cortex at light microscopy (OMF 71.4%, OMS 83.3% versus PW 58.8% and D 40%, P< 0.05). Higher densities of primordial [OMF: 3.54 (0-13.18) follicles/grid, OMS: 3.85 (0-8.53), PW: 0 (0-13.25), D 0 (0-1.33), P< 0.05] and primary follicles [OMF: 3.54 (0-18.52), OMS: 3.85 (0-1), PW: 0 (0-4.58), D 0 (0-0.25), P< 0.05] was also found in the omental locations. CONCLUSIONS: Omental locations provide a better site, in terms of follicle survival, for intra-abdominal OCT in the baboon compared with the pelvic wall and the D.


Subject(s)
Organ Transplantation/methods , Ovary/transplantation , Animals , Douglas' Pouch , Estradiol/blood , Female , Fertility Preservation/methods , Menstrual Cycle/physiology , Omentum , Papio anubis , Progesterone/blood , Psoas Muscles , Transplantation, Heterotopic
15.
Resuscitation ; 162: 11-19, 2021 05.
Article in English | MEDLINE | ID: mdl-33549688

ABSTRACT

AIM: Drowning is a global health problem and deeper knowledge about the extent and causes is of utmost importance for implementing preventative actions. The aim of this study was to describe the incidence and characteristics of drowning in Sweden over time, including both non-fatal and fatal cases. METHODS: All cases identified as drowning (ICD-10 coding) at a national level in Sweden between 2003-2017 were collected. Three sources of data from the Swedish National Board of Health and Welfare were extracted via the Cause of Death Register and the National Patient Register. RESULTS: Over 15 years, a total of 6609 cases occurred, resulting in an annual incidence of 4.66 per 100 000. The median age was 49 years (IQR 23-67) and 67% were males. Non-fatal drownings represented 51% (n = 3363), with an overall non-fatal to fatal ratio of 1:1, this being 8:1 for children (0-17 years of age). Non-fatal cases were more often female (36% vs. 30%; p < 0.001), younger 30 (IQR 10-56) vs. 60 (IQR: 45-72) (p < 0.001) and of unintentional nature (81% vs. 55%; p < 0.001). The overall incidence decreased over time from 5.6 to 4.1 per 100 000 (p < 0.001). The highest rate of 30-day survival was found in females 0-17 years (94%, 95% CI 91.1-95.5) and the lowest in males >66 years (28.7%, 95% CI 26.2-31.2). Although the incidence in children 0-4 years increased from 7.4 to 8.1 per 100 000 (p < 0.001), they demonstrated the highest non-fatal to fatal ratio (13:1). CONCLUSION: Drowning is declining but remains a consistent and underestimated public-health problem. Non-fatal drowning cases represent about half of the burden and characteristics differ from fatal drowning cases, being younger, more often female and of unintentional nature.


Subject(s)
Drowning , Child , Drowning/epidemiology , Female , Humans , Incidence , Infant , Male , Middle Aged , Retrospective Studies , Risk Factors , Sweden/epidemiology
16.
Resuscitation ; 156: 196-201, 2020 11.
Article in English | MEDLINE | ID: mdl-32976963

ABSTRACT

BACKGROUND: Submersion time is a strong predictor for death in drowning, already 10 min after submersion, survival is poor. Traditional search efforts are time-consuming and demand a large number of rescuers and resources. We aim to investigate the feasibility and effectiveness of using drones combined with an online machine learning (ML) model for automated recognition of simulated drowning victims. METHODS: This feasibility study used photos taken by a drone hovering at 40 m altitude over an estimated 3000 m2 surf area with individuals simulating drowning. Photos from 2 ocean beaches in the south of Sweden were used to (a) train an online ML model (b) test the model for recognition of a drowning victim. RESULTS: The model was tested for recognition on n = 100 photos with one victim and n = 100 photos with no victims. In drone photos containing one victim (n = 100) the ML model sensitivity for drowning victim recognition was 91% (95%CI 84.9%-96.2%) with a median probability score that the finding was human of 66% (IQR 52-71). In photos with no victim (n = 100) the ML model specificity was 90% (95%CI: 83.9%-95.6%). False positives were present in 17.5% of all n = 200 photos but could all be ruled out manually as false objects. CONCLUSIONS: The use of a drone and a ML model was feasible and showed satisfying effectiveness in identifying a submerged static human simulating drowning in open water and favorable environmental conditions. The ML algorithm and methodology should be further optimized, again tested and validated in a real-life clinical study.


Subject(s)
Drowning , Near Drowning , Drowning/diagnosis , Feasibility Studies , Humans , Machine Learning , Sweden , Water
17.
Transplant Proc ; 41(2): 732-5, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19328968

ABSTRACT

Scandiatransplant is the Nordic organ exchange organization having existed for almost 40 years. With close collaboration between transplant centers in the Nordic countries, it has been valuable to ensure the optimal usage of available organs. The heart is the most often exchanged organ within the collaboration. It has been decided to create a priority for hyperimmunized kidney patients for compulsory exchange of organs from deceased donors. The age of the deceased organ donors has changed from younger to older donors. The evaluation of deceased kidney transplantations and deceased liver transplantations from 1995 to 2007 is shown for 4 countries. Iceland by itself is performing living donor kidney transplantations with great intensity. Scandiatransplant will make efforts to present more data than just transplantation to yield a more complete picture of organ transplantation.


Subject(s)
Organ Transplantation/statistics & numerical data , Age Distribution , Brain Death , Cadaver , Cause of Death , Databases, Factual , Denmark , Finland , Forecasting , Heart Transplantation/statistics & numerical data , Humans , Kidney Transplantation/statistics & numerical data , Liver Transplantation/statistics & numerical data , Lung Transplantation/statistics & numerical data , Norway , Resource Allocation/statistics & numerical data , Scandinavian and Nordic Countries , Tissue Donors/statistics & numerical data
18.
Transplant Proc ; 41(2): 764-5, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19328974

ABSTRACT

BACKGROUND: A kidney with a single artery is preferred for donation. We wondered how often the donor is left with double or triple arteries, and whether this has any implications for long-term kidney function. METHODS: The consecutive living donors from 1984 to 1988 were reevaluated for kidney function and outcome. RESULTS: In total, 154 donor nephrectomies were performed with an open anterior technique. Ninety-eight patients were left with a single artery to the remnant kidney and 56 (36%) with more than one. Six individuals were left with 3 arteries. The mean age at donation was 48 +/- 12 years and mean age at reevaluation was 68 +/- SD 12 years. In the group with a remnant single artery, the mean preoperative serum creatinine level was 87 +/- 11 micromol/L, at 6 months it was 127 +/- 20 micromol/L, and in 2007 it was 90 +/- SD 23 micromol/L. The estimated glomerular filtration rate (GFR) was 67 +/- 18 mL/min. Thirty-three percent of donors (19/58) had developed hypertension. Among the group with multiple remnant arteries, the mean preoperative serum creatinine level was 87 +/- SD 11 micromol/L, at 6 months it was 131 +/- 21 micromol/L, and in 2007 it was 100 +/- 45 micromol/L. Estimated GFR was 64 +/- 16) mL/min. Twenty-eight percent of the donors (10/36) had developed hypertension. CONCLUSIONS: One third of kidney donors were left with double or triple arteries to the remnant kidney. The 20-year follow-up showed no significant difference in the renal function between the 2 groups.


Subject(s)
Kidney/physiology , Living Donors , Nephrectomy , Renal Artery/physiology , Renal Circulation/physiology , Adult , Age Factors , Blood Pressure , Creatinine/blood , Follow-Up Studies , Glomerular Filtration Rate , Humans , Hypertension/epidemiology , Kidney Function Tests , Middle Aged , Postoperative Complications/epidemiology , Renal Artery/abnormalities , Tissue and Organ Harvesting
19.
Transplant Proc ; 39(2): 385-6, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17362737

ABSTRACT

There has been a need to assess the "sickness degree" in patients with acute and chronic hepatic failure. The Model for End-Stage Liver Disease (MELD) score was developed as a tool for a more objective estimate of the "degree" of sickness in patients with chronic liver disease. In this study, the MELD score was retrospectively calculated and compared in adult patients accepted for orthotopic liver transplantation (OLT) in our institution in 1999 and 2004. We analyzed the gender, age, and MELD score associated with different indications for OLT during this period.


Subject(s)
Liver Failure/surgery , Liver Transplantation/statistics & numerical data , Patient Selection , Female , Humans , Liver Cirrhosis/surgery , Liver Neoplasms/surgery , Male , Prognosis , Reoperation/statistics & numerical data , Retrospective Studies , Sweden
20.
Eur J Surg Oncol ; 32(3): 292-6, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16434163

ABSTRACT

AIM: To compare the outcome after extended right liver lobe resection (ERL) for patients with liver metastases from colorectal cancer with preceding portal vein embolisation (PVE) with a non-PVE-group. METHODS: Nineteen patients underwent ERL (resection of segment 4-8) for colorectal liver metastases after PVE. They were compared with 21 patients that underwent an ERL without embolisation. A comparison was made with 84 patients undergoing right lobe liver resection during the same time period. Survival, post-operative morbidity and mortality were recorded and the volume of the future remnant liver (FRL) was measured with CT. RESULTS: There were major complications in 1/19 patients in the PVE-group and in 6/21 in the non-PVE-group (p=0.04). No post-operative deaths were observed in the PVE-group, compared to three deaths in the non-PVE-group (p=0.09). The median survival in the PVE-group was 32 months, which did not differ from the non-PVE-group. In 21% of the patients that underwent PVE, progression occurred during the time between embolisation and surgery. There was no difference in survival for patients that underwent PVE followed by ERL, compared to patients that underwent standard right lobe liver resection. CONCLUSION: The survival of patients after ERL is comparable with patients that undergo standard right lobe resection and have less liver tumour.


Subject(s)
Colorectal Neoplasms/pathology , Embolization, Therapeutic/methods , Hepatectomy/methods , Liver Neoplasms/therapy , Portal Vein , Female , Follow-Up Studies , Humans , Liver Neoplasms/mortality , Liver Neoplasms/secondary , Male , Middle Aged , Preoperative Care , Retrospective Studies , Survival Rate , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL