bluuebunny/crossref_metadata_2025_split huggingface dataset:
72229 - Ultralow dose of superparamagnetic iron oxide nanoparticles in combination with Magseed for sentinel node detection in nonpalpable breast cancer
Authors: Båtelsson Sarah , AbuOddos Nizar , Mirzaei Nushin , Andersson Yvette , Bagge Roger Olofsson , Wärnberg Fredrik , Eriksson Staffan 
Published: August 2024

Abstract

Introduction
A nonpalpable breast cancer can be localized using a magnetic seed (Magseed). Sentinel lymph node (SLN) detection with superparamagnetic iron oxide (SPIO) nanoparticles is comparable to Technetium (Tc99) +/- blue dye (BD). The study aim was to evaluate the feasibility of the combined use of a Magseed and an ultra-low, intradermal SPIO dose.

Method
Women from the Magsnow 2.0 study with non-palpable breast cancer planned for SLN-biopsy and breast tumour localisation with Magseed were selectively included for this subgroup analysis. The patients received 0.1 mL SPIO up until 30 days prior surgery, as well as Tc99 +/- BD according to routine. SPIO was injected by the surgeons in Gothenburg and by radiologists in Västerås. The SPIO was usually injected more than 2 cm away from the Magseed. Analyses of surgical margins, reoperations and SLN detection were made. Surgeons was asked about their experience with the combination on a scale from 1-10.

Result
In total, 20 women were included. SLN detection was 95% (19/20) with SPIO and 100% with Tc99 +/- BD. The median number of SLNs was three and metastases were found in five patients (25%). Mean minimum surgical margin was 6.5 mm (range 0.36-16 mm) and no reoperations were needed. The feasibility of indication with Magseed in combination with SPIO according to the operating surgeons was high, eight surgeons rated a mean value of 7,8 (1-10).

Discussion
In women with nonpalpable breast cancer undergoing breast conserving surgery, the combination of Magseed and SPIO seems to be feasible even though an ultralow dosage were used.
71670 - Survival and oncological outcomes in colorectal cancer patients undergoing urological resections: A National Study Cohort
Authors: Assi Hanin , Valdimarsson Valentinus , Angenete Eva , Buchwald Pamela , Lydrup Marie-Louise 
Published: August 2024

Abstract

Introduction
Colorectal cancer (CRC) growing into urinary organs may require en-bloc resections such as total cystectomy (TC), partial cystectomy (PC), or ureter resection (UR). This study aimed to investigate survival and oncological outcomes after CRC in patients operated with addition of urological resections.

Method
Patients undergoing CRC resection in Sweden from 2007 until 2018 were collected via the Swedish Colorectal Cancer Registry. The free text variable “resection other organ” was used to identify CRC undergoing urological resections and subdivided to TC, PC and UR.

Result
A total of 57 907 patients underwent primary CRC surgical resection, of these 1093 patients underwent urological resection (Figure 1). TC, PC and UR were performed in 589, 345 and 159 patients respectively. The vast majority of patients undergoing urinary bladder resection were male, especially regarding rectal cancer patients subjected to TC (205 (92%) male patients).
R0 resection was obtained in 86%, 86% and 84% in TC, PC and UR respectively. 30-day mortality did not differ between groups. 5-years OS rates were 61%, 58%, and 53% in TC, PC and UR (p=0.205). For subgroup analysis patients were divided into four equal groups based on surgical period 2007-2009, 2009-2012, 2012-2016 and 2016-2018. Multivariable analyses adjusted for age, ASA classification, cTNM, pTN, surgical period and type (elective/emergency) revealed higher local recurrence rate in the UR group (p=0.016) while 5-year OS and distant metastases rates did not differ between groups.

Discussion
PC may represent an option to TC in selected patients with CRC overgrowth, while maintaining favourable survival and oncological outcomes.
71698 - A multicenter randomized trial: Collagen implant vs myocutaneous flap for reconstruction after extralevator abdominoperineal excision of the rectum
Authors: Rutegård Martin , Rutegård Jörgen , Haapamäki Markku M 
Published: August 2024

Abstract

Introduction
The procedures to address the defect in the lesser pelvis following an ‘extralevator’ abdominoperineal excision (ELAPE) for rectal cancer have been explored only sparsely. The objective was to determine whether a porcine-collagen implant or a gluteus maximus myocutaneous flap for reconstruction is superior.

Method
This study was a multicenter, randomized clinical trial (the NEAPE study). Eligible participants were rectal cancer patients undergoing ELAPE, where the remaining muscles could not be closed in the midline, necessitating adjuncts for closure. Randomization was computer-generated, concealed, and stratified by hospital and preoperative radiotherapy regimen. The experimental arm consisted of a porcine-collagen implant, whilst the control arm comprised a gluteal maximus myocutaneous flap. The primary outcome was physical performance six months after surgery, measured using the timed-stands test (TST). Secondary outcomes included perineal wound healing and sitting ability.

Result
In total, 83 patients (57 men and 26 women) from 8 hospitals were included. The mean age was 68 years (range: 41–93). Some 78 patients had preoperative radiotherapy, 40 had preoperative chemotherapy and 38 had a preoperative combination of both.
The proportion of patients within reference values of TST matched for age and sex was 28.6 per cent for the collagen implant group and 39.4 per cent for the myocutaneous flap group (missing excluded), p=0.44. Results of primary and two secondary outcomes are shown in Table 1.

Discussion
The NEAPE study was unable to show superiority for any of the two reconstructive techniques, which seem equally effective regarding postoperative physical function, wound complications and ability to sit.
71722 - Favourable 5-year survival in patients with isolated colorectal cancer lung metastases treated surgically with curative intent – a retrospective study
Authors: Dahlberg Sofia , Jörgren Fredrik , Buchwald Pamela , Vidarsdottir Halla 
Published: August 2024

Abstract

Introduction
The benefit of surgical resection for colorectal cancer (CRC) lung metastases is unclear. The aim was to investigate the incidence, treatment strategy and overall survival (OS) in CRC patients with isolated lung metastases.

Method
CRC patients with isolated lung metastases following curative resection were retrospectively analysed using data from the Swedish Colorectal Cancer Registry and medical charts. Patients treated within Region Skåne during 2010 – 2016 were eligible. Exclusion criteria were previous or concurrent metastases at other organ sites. Patients were divided into synchronous/metachronous lung metastases and curative/palliative treatment intent. The primary endpoint was OS. Multivariable Cox-regression and Kaplan-Meier survival analysis were performed.

Result
Of 8457 patients, 93 (1.1%) had isolated lung metastases (53 synchronous/40 metachronous). In all, 53 patients were treated with curative intent where most (51/53, 96%) were managed surgically. Forty patients were considered palliative and received either chemotherapy or best supportive care. Five-year OS was 42% (39/93), median 49 months (IQR [22 – 60]) for the entire cohort, and 68% (36/53), median 60 months (IQR [53 – 60]) and 7.5% (3/40), median 22 months (IQR [12 – 33]) for curative and palliative patients, respectively. In multivariable analysis, younger age (hazard ratio (HR) 1.04, confidence interval (CI): 1.01 – 1.07), the number of lung metastases (HR 1.64, CI: 1.08 – 2.47) and unilateral distribution (HR 0.41, CI: 0.20 – 0.84) were associated with better survival.

Discussion
Isolated CRC lung metastases are rare. Patients treated with curative intent undergoing surgical resection had a favourable prognosis, especially if the lung metastases were solitary and distributed unilaterally.
71757 - Identification of diverticular disease in Swedish healthcare registers: A validation study
Authors: Mahmood Wael Mahmood , Schmidt Peter Thelin , Olén Ola , Hellsing Christin , Hjern Fredrik , Abraham-Nordling Mirna 
Published: August 2024

Abstract

Introduction
The Swedish National Patient Register (SNPR) is frequently used in studies of colonic diverticular disease (DD). Despite this, the validity of the coding for this specific disease in the register has not been studied.

Method
From SNPR, 650 admissions were randomly identified encoded with ICD 10, K572-K579. From the years 2002 and 2010, 323 and 327 patients respectively were included in the validation study. Patients were excluded prior to, or up to 2 years after a diagnosis with IBD, Celiac disease, IBS, all forms of colorectal cancer (primary and secondary), and anal cancer. Medical records were collected and data on clinical findings with assessments, X-ray examinations, endoscopies and laboratory results were reviewed. The basis of coding was compared with internationally accepted definitions for colonic diverticular disease. Positive predictive values (PPV) were calculated.

Result
The overall PPV for all diagnoses and both years was 95%. The PPV for the year 2010 was slightly higher (98%) then the year 2002 (91%), which may be due to the increasing use of computed tomography (CT).

Discussion
The validity of DD in SNPR is high, making the SNPR a good source for population-based studies on DD.
71319 - Follow up study after implementation of the VERAS concept
Authors: Ottosson Frida , Leo Jonas , Block Tomas , Kristiansson Anna-Lotta 
Published: August 2024

Abstract

Introduction
Emergency laparotomy (EL) is a common surgical procedure with a 30-day mortality rate in Sweden of approximately 10% over the past five years. Most of these patients are over 65 years and have a higher risk of complications and mortality. Very important ERAS (VERAS) has been introduced to intensify care for high-risk patients undergoing EL. With this concept we are hoping to improve outcomes and reduce complications.

Method
This retrospective cohort study evaluate the outcomes for patients undergoing EL after the introduction of the VERAS concept. All patients undergoing EL between 2019 and 2023 were identified, inclusion criteria for classification as VERAS patients required postoperative values indicating a high relative risk of complications or mortality. The value was derived by multiplying NSQIP morbidity and mortality with a Surgical Apgar Score (SAS) postoperatively. Data were collected through chart review for various outcomes.

Result
A total of 108 patients were included, 63.8% were women and 36% were men. The mean age was 75 years. The median ASA class was 3. 56% of patients underwent EL due to ileus/volvulus. 10 patients died within 30 days postoperatively after acute laparotomy. Of these, 60% were over 80 years old. Among those with a postoperative mortality risk of over 40%, it was observed that out of 17 patients, only 6 (35%) had died within 30 and 90 days.

Discussion
The VERAS concept for EL has clearly shown a reduced risk of mortality. Improvements in postoperative follow-up guidelines should be made.
72001 - Incidence, epidemiology, and management of severe biliary pancreatitis
Authors: Hansson Moa , Högberg Dominika , Katsarelias Dimitrios 
Published: August 2024

Abstract

Introduction
According to Swedish guidelines, more than 4700 individuals are affected by acute pancreatitis yearly, with approximately 6000 admissions. Previous studies show that 7,5-10% of all pancreatitis are severe, defined as persistent organ insufficiency for more than 48 h. Approximately 40% of all cases are caused by gallstones.
The aim of the present study was to investigate the incidence of severe acute biliary pancreatitis (ABP), associated risk factors, impact of minimally invasive treatments on patients outcomes in our institution.

Method
All patients admitted to Sahlgrenska university hospital with ABP between 2018-2022 were included. Data was collected from patient records. Risk factors for severe disease like ASA-classification, age (&gt;65), and gender were analyzed. Hospital stay, additional interventions after discharge and minimally invasive treatment as EUS, ERCP and PTBD were recorded.

Result
Of 242 patients, 24 (9,9%) presented with severe pancreatitis. In a multivariate logistic regression model ASA-classification (OR: 3.21, 95% CI: 1.18-8.68), age (OR: 1.05, 95% CI: 0.39-2.87) and female gender (OR: 2.18, 95% CI: 0.85-5.55) were independently associated with severe pancreatitis.
23 patients were treated using some minimally invasive procedure of whom 43% with EUS, 43% underwent ERCP, and 13% had PTBD. The median time of hospital stay was 46.5 days (4–267) and 16 patients returned for additional intervention after discharge.

Discussion
Severe pancreatitis in our institution is 10% of all ABPs, with high morbidity, leading to prolonged hospital stay and demands great amounts of recourses and interventional methods that require expertise.
72014 - Malignant Large Bowel Obstruction Turned Out To Be Deadly Fungal Infection – A Case Report
Authors: Kaidi Donia , Rosemar Anders , Becker Marie , Lindström Johan , Hammarström Helena , Swartling Torbjörn , Asplund Dan 
Published: August 2024

Abstract

Introduction
This case report highlights the diagnostic and therapeutic challenges of a rare gastrointestinal fungal infection in an immunocompetent patient.

Method
A healthy 49-year-old man presented at the emergency department with abdominal pain and weight loss. The lower abdomen was tender, CRP 79, and CT was inconclusive, suggesting IBD or cancer. A colonoscopy was scheduled but never completed because of insufficient bowel preparation. The clinical condition worsened with increasing pain and peritonitis. MRI revealed obstructive lesions in the ascending and descending colon, which were verified during subacute surgery and a subtotal colectomy with anastomosis was performed. A few days later, the patient was reoperated on suspicion of anastomotic dehiscence, but no leakage was found. After an initial seeming recovery, the clinical condition deteriorated. CT and MRI now indicated peritoneal, liver, and lymph node metastases. Sigmoidoscopy showed fibrotic lesions, with pathology reporting only inflammation. Five weeks post-admission, the patient underwent surgery again. Large parts of the small bowel exhibited fibrotic, ulcerative, necrotic and stricturing lesions, which were resected. Multiple stomas were constructed, and VAC was applied.

Result
Pathology revealed fungal hyphae in colonic tissue. Empirical antimycotic treatment was initiated, including liposomal amphotericin B, with adjustments as Basidiobolus spp. mold was reported on day 45.
Despite efforts to optimize treatment, the patient succumbed shortly after a seventh surgery on day 51.

Discussion
The patient likely acquired the infection in a tropical/subtropical region, where the fungus is ubiquitous.
To the best of our knowledge, this is the first reported case of Basidiobolomycosis in Sweden.
71273 - Female and male general surgeons differ in personality traits - a Swedish cross-sectional study
Authors: Blohm My , McGrath Aleksandra , Mukka Sebastian , Jolbäck Per 
Published: August 2024

Abstract

Introduction
Evidence suggests that female surgeons achieve comparable or even more favourable outcomes than male surgeons. It is currently unclear what factors contribute to these potential differences. Possible explanations might be differences in personality traits, communication style, attitude, and risk-taking behaviour. This study aimed to examine disparities in personality traits between male and female general surgeons in Sweden.

Method
The research was conducted as a cross-sectional study of personality traits. Between August 29, 2022, and December 15, 2023, Swedish specialists in general surgery were invited to participate in an online survey. The survey, assessed with the Big Five Inventory, collected information on self-reported surgeon gender, years in practice, employment data, and differences in personality traits.

Result
The analysis encompassed responses from 223 Swedish general surgeons: 121 (54%) males and 102 (46%) females. In contrast to female surgeons, male surgeons were older and had longer surgical experience. A higher proportion of male surgeons were employed in rural hospitals. Higher mean scores were observed in all personality traits among female surgeons. The adjusted analysis showed significantly higher scores for conscientiousness (p&lt;0.001), extraversion (p&lt;0.001), agreeableness (p=0.006), and neuroticism (p&lt;0.001); however, no such change was observed for openness.

Discussion
This cross-sectional study demonstrates that Swedish female and male surgeons differ in personality traits. The implications of these results could lead to a deeper understanding of the variations in surgical outcomes based on the gender of the surgeon.
72297 - Cholecystectomy through minilaparotomy
Authors: Brokstorp Malin , Redéen Stefan , Österberg Johanna , Sandblom Gabriel 
Published: August 2024

Abstract

Introduction
The gold standard for managing gallstone disease is nowadays laparoscopic cholecystectomy. Nevertheless, few studies have evaluated the long-term outcomes of cholecystectomy by mini-laparotomy. The aim of this study was to evaluate complications following cholecystectomy through mini-laparotomy.

Method
The study population consisted of patients undergoing cholecystectomy by mini-laparotomy 2007-2012 in Motala registered in GallRiks. Patients with registered complications were matched with a control group in a 1:2 ratio based on gender and age. Data were retrieved from GallRiks and a retrospective patient report review assembling variables related to complications, patient satisfaction and health status. A chi-2 test analyzed risk factors and co-morbidities; other results were presented descriptively.

Result
During the study period, 599 patients underwent cholecystectomy. Thirty-three patients (5.5%) were registered in GallRiks as suffering a complication, including 29 (4.8%) surgical complications. Registered complications were infection (n=12), bleeding (n=8), liver lesion (n=2), bile duct injury (n=2), leakage from cystic duct (n=2), bile duct stones (n=1), ileus (n=1) and gastritis (n=1). Risk factors such as smoking, transection of rectus muscle or incision size showed no significant correlation to complication incidence. The co-morbidities diabetes, pulmonary disease and coronary heart disease had no significant impact on outcomes regarding complications.

Discussion
The results of this study may suggest that mini-laparotomy could be a safe option for cholecystectomy when the first-hand method, laparoscopy, is unavailable or inappropriate.
72316 - Trends and Prevalence of Umbilical Hernia Repairs in Sweden; A Nationwide Population-based Register-study
Authors: Bergström Mathias , Widhe Björn , Bringman Sven , Melkemichel Maria 
Published: August 2024

Abstract

Introduction
Umbilical hernia repairs (UHRs) are widely performed worldwide, yet knowledge about their repairs remains underexplored. Guidelines suggest that UHR larger than 1 cm should preferably be repaired using mesh. The aim was to assess trends and prevalence over time for the use of suture versus mesh following UHR in Sweden.

Method
This observational population-based register study included prospectively collected data from the nationwide Swedish Perioperative Register (SPOR). Patients &gt; 18 years old with a UHR between 2017-2022 in SPOR were eligible. Surgical units were categorized into six healthcare regions. Primary outcome was change in method of repair over time. Secondary outcome was regional variations in method of repairs.

Result
Out of 10,356 elective primary UHRs; mesh was used in 47.9%, whereas 14.1% of these were repaired laparoscopically. Women were less frequently repaired with mesh (38.8%) compared to men (52.1%). Suture repairs had a lower median age (49 years) and BMI (27.2 kg/m2) compared to mesh repairs (55 years, BMI 29.7 kg/m2). Lower ASA class (1-2) were predominant in suture repairs (53.8%), while higher ASA class (3-4) were predominant in mesh repairs (59.1%). Mesh repairs increased marginally, 46.1% to 49.3% during the study period (p &lt; 0.001). Only the South healthcare region had a significant increase from 25.9% to 56.4% for mesh repairs (p &lt; 0.001).

Discussion
Mesh repairs, despite guidelines, have still not significantly influenced UHR practices in Sweden. Mesh was more commonly used for men, obese patients, those of older age and with a greater co-morbidity.
71918 - The Swedish Breast Implant Registry (BRIMP) - experience with 50.000 Implants
Authors: Halle Martin , Stark Birgit 
Published: August 2024

Abstract

Introduction
The safety of breast implants has been questioned lately regarding the PIP scandal, BIA-ALCL and Breast implant illness (BII). Primary endpoints of BRIMP are to detect adverse events. Secondary endpoints may help in decision makings to choose defined implants in specific circumstances.

Method
Between 2014 and 2021 breast implants were registerd in BRIMP for both primary and secondary surgeries. Complications were studied at 60 days, one and six years postop. The incidence of long-term consequences such as brand related capsular contraction, rupture or deflation and rotation was studied. Explant surgery was reported with type of capsular surgery performed.

Result
In total 50.000 implants were registered for primary operations (71,9%) and reoperations (28,1%). The vast majority of primary operations were performed for benign conditions (91,8%). Peroperative antibiotic coverage was standard, where 23% of patients received intraoperative antibiotic irrigation in addition. Implants were predominantly placed in a dual plane position via inframammary incisions. Implant size below 400 cc was used in the vast majority of the cases and only 3,6% of the patients had implants above 600 cc. The risk for reoperation in aesthetic surgery within 60 days was less than 0.1%, with no difference between the brands. The risk for reoperation in aesthetic surgery for capsular contracture within 7 years was less than 2%. A linear increase was seen for permanent explantations together with increasing rates of total casulectomy performed.

Discussion
BRIMP helps to improve patient safety and is an important tool for providing objective information for patients, professional, health care and media.