Swedish Healthcare is organised by relatively independent counties which are responsible for the ... more Swedish Healthcare is organised by relatively independent counties which are responsible for the appropriateness of delivered care. As a consequence, few formal guidelines are issued by national authorities or professional societies, which is the case for the treatment of pulmonary embolism (PE). The yearly incidence of PE in Swedish adults was 86/100,000 in 2011, corresponding to approximately 6000 cases with an overall mortality of 6.5%. Acute massive PE with circulatory shock carries mortality up to 50% but its true incidence in Sweden is not known. First-line treatment is intravenous thrombolysis but non-pharmacological alternatives for cases where thrombolysis has no effect or is contraindicated have recently undergone technical development. This includes catheter fragmentation, surgical embolectomy and extracorporeal circulatory support, which may be used as a bridge to further treatment in very unstable patients. This article summarises the treatment options for acute massive...
Aims To evaluate the long-term use of secondary prevention medications [statins, β-blockers, reni... more Aims To evaluate the long-term use of secondary prevention medications [statins, β-blockers, renin–angiotensin–aldosterone system (RAAS) inhibitors, and platelet inhibitors] after coronary artery bypass grafting (CABG) and the association between medication use and mortality. Methods and results All patients who underwent isolated CABG in Sweden from 2006 to 2015 and survived at least 6 months after discharge were included (n = 28 812). Individual patient data from SWEDEHEART and other mandatory nationwide registries were merged. Multivariable Cox regression models using time-updated data on dispensed prescriptions were used to assess associations between medication use and long-term mortality. Statins were dispensed to 93.9% of the patients 6 months after discharge and to 77.3% 8 years later. Corresponding figures for β-blockers were 91.0% and 76.4%, for RAAS inhibitors 72.9% and 65.9%, and for platelet inhibitors 93.0% and 79.8%. All medications were dispensed less often to patien...
OBJECTIVES Our goal was to compare short- and midterm outcomes after coronary artery bypass graft... more OBJECTIVES Our goal was to compare short- and midterm outcomes after coronary artery bypass grafting (CABG) using 2 different revascularization strategies. METHODS A total of 6895 patients were included who had CABG in Sweden from 2009 to 2015 using the left internal mammary artery to the left anterior descending artery and either a single sequential saphenous vein graft connecting the left and right coronary territories to the aorta (snake graft, n = 2122) or separate vein grafts to both territories (n = 4773). Data were obtained from the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and the Swedish Patient Registry. The groups were compared using adjusted logistic regression for short-term (30-day) and Cox regression and flexible parametric survival models for midterm outcomes. Primary outcome was a composite of all-cause mortality, myocardial infarction (MI), reangiography and new revasculariza...
Wound blood is highly activated and has poor haemostatic properties. Recent data suggest that ret... more Wound blood is highly activated and has poor haemostatic properties. Recent data suggest that retransfusion of unwashed wound blood may impair haemostasis. We hypothesized that cell saver processing of wound blood before retransfusion reduces the negative effects.
Background Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and a P2Y12 inhibitor... more Background Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and a P2Y12 inhibitor improves outcome in acute coronary syndrome (ACS). In the subset of ACS patients undergoing urgent cardiac surgery, ongoing or recently discontinued DAPT is associated with increased risk of bleeding. Postoperative DAPT in ACS patients after coronary artery bypass grafting (CABG) may improve graft patency and short-term survival. The aim of this project was to study ACS patients undergoing cardiac surgery and how DAPT with ASA and ticagrelor influences perioperative bleeding risks, how bleeding can be treated, and to investigate if survival after CABG is influenced by antiplatelet therapy. Methods In paper I, recovery of platelet function after discontinuation of ticagrelor was investigated using multiple-electrode aggregometry (MEA) in ACS patients awaiting CABG. The effect of platelet concentrate at different discontinuation times was also studied. Paper II was a prospective observati...
Background Low income and short education have been found to be independently associated with inf... more Background Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting ( CABG ), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long‐term survival in CABG patients with a low income and short education. Methods and Results Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population‐based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β‐blockers, and RAAS inhibitors), socioeconomic factors, patient character...
Heart & lung : the journal of critical care, Jan 4, 2015
Pulmonary artery dissection is rare and highly lethal and most reports in the literature are from... more Pulmonary artery dissection is rare and highly lethal and most reports in the literature are from autopsies. We describe a patient with undiagnosed primary pulmonary hypertension suffering from pulmonary artery dissection that subsequently underwent surgical repair and in addition review the current literature on this topic.
The naevoid basal cell carcinoma syndrome (NBCCS) is caused by mutations in the hedgehog receptor... more The naevoid basal cell carcinoma syndrome (NBCCS) is caused by mutations in the hedgehog receptor PTCH gene. It is characterized by developmental defects and a predisposition to the development of certain tumours, such as basal cell carcinoma, medulloblastoma and meningioma, and potentially fetal rhabdomyomas and embryonal rhabdomyosarcomas. This study aimed to analyse PTCH status in an NBCCS patient with fetal rhabdomyoma and to investigate whether deregulation of hedgehog signalling, as shown by altered expression of hedgehog pathway components and/or genetic imbalances, is a general finding in sporadic rhabdomyomas and rhabdomyosarcomas. The NBCCS patient had a novel PTCH germ-line mutation, 1370insT, and developed a fetal rhabdomyoma that harboured a 30 bp in-frame deletion in the second allele resulting in homozygous inactivation of PTCH. Sporadic rhabdomyomas and rhabdomyosarcomas showed overexpression of PTCH (43/43) and GLI1 (41/43) mRNA, as determined by in situ hybridization, indicating ongoing active hedgehog signalling. Immunohistochemical staining revealed a subgroup of fetal rhabdomyomas and embryonal rhabdomyosarcomas (12/34) lacking PTCH immunoreactivity. Four of nine informative fetal rhabdomyomas and embryonal rhabdomyosarcomas showed loss of heterozygosity (LOH) in the PTCH region with two of these (one fetal rhabdomyoma and one embryonal rhabdomyosarcoma) also showing LOH in the SUFU region. These findings suggest that haploinsufficiency for the two tumour suppressor genes PTCH and SUFU, which are both active in the same signalling pathway, may be important for tumour development. Based on our results we propose that the pathogenesis of rhabdomyoblastic tumours, particularly fetal rhabdomyomas and embryonal rhabdomyosarcomas, involves deregulation of the hedgehog signalling pathway.
Many patients in need of bypass surgery lack graft material and current synthetic alternatives ha... more Many patients in need of bypass surgery lack graft material and current synthetic alternatives have poor performance. A 4 mm vascular graft composed of bacterial cellulose (BC) was developed and tested in pilot study in a large animal model.
Swedish Healthcare is organised by relatively independent counties which are responsible for the ... more Swedish Healthcare is organised by relatively independent counties which are responsible for the appropriateness of delivered care. As a consequence, few formal guidelines are issued by national authorities or professional societies, which is the case for the treatment of pulmonary embolism (PE). The yearly incidence of PE in Swedish adults was 86/100,000 in 2011, corresponding to approximately 6000 cases with an overall mortality of 6.5%. Acute massive PE with circulatory shock carries mortality up to 50% but its true incidence in Sweden is not known. First-line treatment is intravenous thrombolysis but non-pharmacological alternatives for cases where thrombolysis has no effect or is contraindicated have recently undergone technical development. This includes catheter fragmentation, surgical embolectomy and extracorporeal circulatory support, which may be used as a bridge to further treatment in very unstable patients. This article summarises the treatment options for acute massive...
Aims To evaluate the long-term use of secondary prevention medications [statins, β-blockers, reni... more Aims To evaluate the long-term use of secondary prevention medications [statins, β-blockers, renin–angiotensin–aldosterone system (RAAS) inhibitors, and platelet inhibitors] after coronary artery bypass grafting (CABG) and the association between medication use and mortality. Methods and results All patients who underwent isolated CABG in Sweden from 2006 to 2015 and survived at least 6 months after discharge were included (n = 28 812). Individual patient data from SWEDEHEART and other mandatory nationwide registries were merged. Multivariable Cox regression models using time-updated data on dispensed prescriptions were used to assess associations between medication use and long-term mortality. Statins were dispensed to 93.9% of the patients 6 months after discharge and to 77.3% 8 years later. Corresponding figures for β-blockers were 91.0% and 76.4%, for RAAS inhibitors 72.9% and 65.9%, and for platelet inhibitors 93.0% and 79.8%. All medications were dispensed less often to patien...
OBJECTIVES Our goal was to compare short- and midterm outcomes after coronary artery bypass graft... more OBJECTIVES Our goal was to compare short- and midterm outcomes after coronary artery bypass grafting (CABG) using 2 different revascularization strategies. METHODS A total of 6895 patients were included who had CABG in Sweden from 2009 to 2015 using the left internal mammary artery to the left anterior descending artery and either a single sequential saphenous vein graft connecting the left and right coronary territories to the aorta (snake graft, n = 2122) or separate vein grafts to both territories (n = 4773). Data were obtained from the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and the Swedish Patient Registry. The groups were compared using adjusted logistic regression for short-term (30-day) and Cox regression and flexible parametric survival models for midterm outcomes. Primary outcome was a composite of all-cause mortality, myocardial infarction (MI), reangiography and new revasculariza...
Wound blood is highly activated and has poor haemostatic properties. Recent data suggest that ret... more Wound blood is highly activated and has poor haemostatic properties. Recent data suggest that retransfusion of unwashed wound blood may impair haemostasis. We hypothesized that cell saver processing of wound blood before retransfusion reduces the negative effects.
Background Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and a P2Y12 inhibitor... more Background Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and a P2Y12 inhibitor improves outcome in acute coronary syndrome (ACS). In the subset of ACS patients undergoing urgent cardiac surgery, ongoing or recently discontinued DAPT is associated with increased risk of bleeding. Postoperative DAPT in ACS patients after coronary artery bypass grafting (CABG) may improve graft patency and short-term survival. The aim of this project was to study ACS patients undergoing cardiac surgery and how DAPT with ASA and ticagrelor influences perioperative bleeding risks, how bleeding can be treated, and to investigate if survival after CABG is influenced by antiplatelet therapy. Methods In paper I, recovery of platelet function after discontinuation of ticagrelor was investigated using multiple-electrode aggregometry (MEA) in ACS patients awaiting CABG. The effect of platelet concentrate at different discontinuation times was also studied. Paper II was a prospective observati...
Background Low income and short education have been found to be independently associated with inf... more Background Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting ( CABG ), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long‐term survival in CABG patients with a low income and short education. Methods and Results Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population‐based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β‐blockers, and RAAS inhibitors), socioeconomic factors, patient character...
Heart & lung : the journal of critical care, Jan 4, 2015
Pulmonary artery dissection is rare and highly lethal and most reports in the literature are from... more Pulmonary artery dissection is rare and highly lethal and most reports in the literature are from autopsies. We describe a patient with undiagnosed primary pulmonary hypertension suffering from pulmonary artery dissection that subsequently underwent surgical repair and in addition review the current literature on this topic.
The naevoid basal cell carcinoma syndrome (NBCCS) is caused by mutations in the hedgehog receptor... more The naevoid basal cell carcinoma syndrome (NBCCS) is caused by mutations in the hedgehog receptor PTCH gene. It is characterized by developmental defects and a predisposition to the development of certain tumours, such as basal cell carcinoma, medulloblastoma and meningioma, and potentially fetal rhabdomyomas and embryonal rhabdomyosarcomas. This study aimed to analyse PTCH status in an NBCCS patient with fetal rhabdomyoma and to investigate whether deregulation of hedgehog signalling, as shown by altered expression of hedgehog pathway components and/or genetic imbalances, is a general finding in sporadic rhabdomyomas and rhabdomyosarcomas. The NBCCS patient had a novel PTCH germ-line mutation, 1370insT, and developed a fetal rhabdomyoma that harboured a 30 bp in-frame deletion in the second allele resulting in homozygous inactivation of PTCH. Sporadic rhabdomyomas and rhabdomyosarcomas showed overexpression of PTCH (43/43) and GLI1 (41/43) mRNA, as determined by in situ hybridization, indicating ongoing active hedgehog signalling. Immunohistochemical staining revealed a subgroup of fetal rhabdomyomas and embryonal rhabdomyosarcomas (12/34) lacking PTCH immunoreactivity. Four of nine informative fetal rhabdomyomas and embryonal rhabdomyosarcomas showed loss of heterozygosity (LOH) in the PTCH region with two of these (one fetal rhabdomyoma and one embryonal rhabdomyosarcoma) also showing LOH in the SUFU region. These findings suggest that haploinsufficiency for the two tumour suppressor genes PTCH and SUFU, which are both active in the same signalling pathway, may be important for tumour development. Based on our results we propose that the pathogenesis of rhabdomyoblastic tumours, particularly fetal rhabdomyomas and embryonal rhabdomyosarcomas, involves deregulation of the hedgehog signalling pathway.
Many patients in need of bypass surgery lack graft material and current synthetic alternatives ha... more Many patients in need of bypass surgery lack graft material and current synthetic alternatives have poor performance. A 4 mm vascular graft composed of bacterial cellulose (BC) was developed and tested in pilot study in a large animal model.
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