Background and aims: Laparoscopic technique was quickly adopted in general surgery because of less pain, quicker recovery and shorter hospital stay. In the 1990´s several reports on port site metastases restrained the enthusiasm to use laparoscopic surgery in malignant diseases. The numerous reports on port site metastases initiated a debate whether laparoscopic surgery would increase the risk of tumour spread and growth. Personal experience of two patients who devloped port site metastases from an incidental gall bladder cancer (GBC) after laparoscopic cholecystectomy (LC), encouraged us to study the incidence of wound metastases from GBC after laparoscopic and open cholecystectomy (OC). Experimentally we examined whether pneumoperitoneum would increase the risk of tumour development. Several studies had demonstrated that minimally invasive procedures exert a less negative influence on the immune system and may have beneficial effects for cancer patients. We wanted to compare the long term survival after OC and LC and if the occurence of port site metastases had any impact on survival. Material and methods: A questionnaire was sent out to all major hospitals in Sweden requesting information obout the number of port site metastases encountered 1991-94. Data on all pateints with verfied GBC were obtained from the Swedish Oncological Centres. Data on all patients with GBC registered with surgical codes for cholecystectomy were collected from the National Board of Health and Welfare (EpC). The patient files were scrutinized and long term survival data was achieved (EpC). In the first experiment on Wistar Fu rats, adenocarcinoma cells were injected intraperitoneally in animals insufflated with air, CO2 and not insufflated controls. In the following studies, rats were similarly insufflated with air,CO2 and compared to not insufflated controls. Laser Doppler blood flow in the abdominal wall was concomitantly measured. To study the effect of reduced blood flow, one rectus muscle was clamped and the other not and laser Doppler Blood flow was measured in both rectus muscles. Adenocarcinoma cells were injected into the rectus muscles in all animals at the induction of pneumoperitoneum/clamping. Results: 14 of 55 patients developed wound metastases from GBC after LC and 12 of 187 after OC. Gallbladder perforation was overrepresented in patients with wound metastases. Improved survival was noted after LC in patients with T3 tumours. Experimentally, air and CO2 equally increased intraperitoneal tumour development, Insufflation with air,CO2 and clamping decreased blood flow in the abdominal wall and increased tumour growth at the same site. Conclusion: Despite a high rate of wound metastases, LC does not seem to worsen the prognosis of GBC and may even have a positive effect on survival. Perforation of the malignant gallbladder seems to be associated with an increased risk of metastatic formation. In the experimental setting, pneumoperitoneum seems to increase tumour development. Other features of laparoscopic surgery such as decreased blood flow in the abdominal wall may contribute to increased risk of tumour progress.

Polyethylene wear and micromotion of the implant play an important role in multifactorial etiology of osteolysis leading to aseptic loosening of the acetabular components. Despite excellent results in primary total hip arthoplasty in a 10-15 year perspective there are still unsolved problems. The weakest link is the longevity of the actabular component. Young and active patients have a clearly worse outcome than older patients. Consequences of polyehtylene wear and ways to reduce wear have therefore been in focus during recent years. Radiostereometry (RSA) is the golden standard in measuring in vivo micromotions. In 4 clinical studies including 332 patients we used therefore RSA to record the efficacy of fixation of cemented and uncemented cups. The amount of wear of old and newly designed polyethylenes (PE) was related to cup stability and radiological and clinical measures of outcome. This study showed that cementless cups inserted with pressfit technique do not need additional augmentation. Screws and pegs increase the risk for radiolucencies and osteolystic lesions but are helpful tools in cases where primary stability is jeopardized. In the second decade clinically silent osteolysis is common for the porous coated Harris Galante cup with unsealed screw holes. The locking mechanism of the PE liner in this cup is unsatisfactory and an increase of liner dissociations is expected. EtO sterilized PE displayed high in vivo wear and we do not recommend its continued use but close monitoring of patients with earlier inserted EtO sterilized implants. The substantially reduced wear in cemented highly cross-linked PE cups without any negative in vivo tradeoffs might have a substantial impact on choice of material and operating technique in the near future. However, we still recommend its restrained use in controlled series until longer follow-up data is available. Nevertheless, the short term in vivo results of modern highly cross-linked PE look promising and ight improve the outcome of cemented and uncemented hip arthroplasties by reducing complication and revisions.

One main hurdle to xenotransplantation, i.e. transplantation between different species, is the immunological barrier that the organ meets in the recipient. The aim of this thesis was to characterise xenogeneic rejection mechanisms by using the concordant mouse-to-rat heart transplantation model. Graft-infiltrating immune cells could be isolated from both rejecting and non-rejecting grafts using ex vivo propagation, a technique based on incubation of graft biopsies in culture medium for 48 hours. The numbers of recovered T lymphocytes were considerably higher in grafts undergoing cell-mediated rejection than in grafts undergoing acute vascular rejection (AVR) or in non-rejecting transplants. Thus, ex vivo propagation should be a valuable tool for further studies of cell-mediated rejection. Cytokine patterns in the grafts, as measured by a quantitative real-time RT-PCR method, showed that AVR and cell-mediated rejection are associated with an increase of both pro-inflammatory cytokines (IL-1β and TNF-α) and more specific cytokines (IL-2, IL-10, IL-12p40 and IFN-γ). These data differed considerably from the patterns seen in the spleens of the recipients. Cell-mediated xenograft rejection was also found to be associated with a local accumulation of hyaluronan. Oral administration of xenogeneic cells stimulated a production of antibodies that could induce hyperacute rejection of cardiac xenografts when passively transferred to graft recipients. This is in contrast to several models for autoimmune diseases and allogeneic transplantation where oral administration of antigens is an effective way to induce unresponsiveness. Hence, future attempts to induce oral tolerance in xenotransplantation should be done with caution.

Spatial haptics is a fascinating technology with which users can explore and modify3D computer graphics objects with the sense of touch, but its application potentialis often misunderstood. For a large group of application designers it is still unknown,and those who are aware of it often have either too high expectations of what is technicallyachievable or believe it is too complicated to consider at all. In addition, spatialhaptics is in its current form ill-suited to interaction design. This is partly because theproperties and use qualities cannot be experienced in an application prototype until asystem is fully implemented, which takes too much effort to be practical in most designsettings. In order to find a good match between a solution and a framing of aproblem, the designer needs to be able to mould/shape/form the technology into a solution,but also to re-frame the problem and question initial conceptual designs as shelearns more about what the technology affords. Both of these activities require a goodunderstanding of the design opportunities of this technology. In this thesis I present a new way of working with spatial haptic interaction design.Studying the serially linked mechanism from a well-known haptic device, and a forcereflectingcarving algorithm in particular, I show how to turn these technologies froman esoteric engineering form into a form ready for interaction design. The work isgrounded in a real application: an oral surgery simulator named Kobra that has beendeveloped over the course of seven years within our research group. Its design hasgone through an evolutionary process with iterative design and hundreds of encounterswith the audience; surgeon-teachers as users and potential customers. Some ideas, e.g.gestalting authentic patient cases, have as a result received increased attention by thedesign team, while other ideas, e.g. automatic assessment, have faded away. Simulation is an idea that leads to ideals of realism; that e.g. simulated instrumentsshould behave as in reality, e.g. a simulated dental instrument for prying teeth is expectedto behave according to the laws of physics and give force and torque feedback.If it does not, it is a bad simulation. In the present work it is shown how some of therealism ideal is unnecessary for creating meaningful learning applications and can actuallyeven be counter-productive, since it may limit the exploration of creative designsolutions. This result is a shift in perspective from working towards constantly improvingtechnological components, to finding and making use of the qualities of modern,but not necessarily absolute cutting-edge, haptic technology. To be able to work creatively with a haptic system as a design resource we needto learn its material qualities and how - through changing essential properties - meaningfulexperiential qualities can be modulated and tuned. This requires novel tools andworkflows that enable designers to explore the creative design space, create interactionsketches and tune the design to cater for the user experience. In essence, this thesisshows how one instance of spatial haptics can be turned from an esoteric technologyinto a design material, and how that can be used, and formed, with novel tools throughthe interaction design of a purposeful product in the domain of dental education. / 3D-haptik är en fascinerande teknologi med vilken användare kan utforska ochmodifiera tredimensionella datorgrafik-objekt med känseln, men dess användningspotentialär ofta missförstådd. För flertalet applikationsutvecklare är tekniken fortfarandetill stor del okänd, och de som känner till den har antingen alltför höga förväntingarav vad som är tekniskt möjligt, eller uppfattar 3D-haptik som alltför komplicerat föratt vara ett gångbart alternativ. Dessutom är 3D-haptik i sin nuvarande form tämligenomoget för interaktionsdesign. Detta beror till stor del på att en applikationsprototypsegenskaper och användarkvaliteter inte kan upplevas innan ett system är implementerati sin helhet, vilket kräver alltför stora utvecklingsresurser för att vara praktisktförsvarbart i de flesta designsituationer. För att uppnå en bra matchning mellan ett användarbehovi en viss situation och en potentiell lösning behöver en designer kunna åena sidan formge och finjustera tekniken, och å andra sidan vara öppen för att ifrågasättaoch ändra problemformulering och konceptdesign när hen lär sig mer om vilkamöjligheter tekniken erbjuder. Båda dessa aktiviteter kräver en god förståelse för vilkadesignmöjligheter som en viss teknik, eller material, erbjuder. I den här avhandlingen presenterar jag ett nytt sätt att arbeta med interaktionsdesignför 3D-haptik. Genom att studera i synnerhet den seriellt länkade mekanismen somåterfinns i en vanligt förekommande typ av 3D-haptikenhet, och en kraftåterkopplandeskärande/borrande algoritm visar jag hur man kan omvandla dessa teknologier från attvara en svårtillgänglig ingengörskonst till en form som är mer redo för interaktionsdesign.Denna förberedelse resulterar i ett slags designmaterial, samt de verktyg ochprocesser som har visat sig nödvändiga för att effektivt kunna arbeta med materialet.Forskningen är grundad i en verklig tillämpning: en simulator för käkkirurgi vidnamn Kobra, som har utvecklas under sju år inom vår forskargrupp. Kobras utformninghar genomgått en evolutionär utvecklingsprocess med iterativ design och hundratalsmöten med målgruppen; lärarpraktiserande käkkirurger och studenter som användareoch potentiella kunder. Därvid har några designidéer, t.ex. gestaltning av patientfall, avdesignteamet fått utökad uppmärksamhet medan andra idéer, t.ex. automatisk gradering,har tonats ned. Simulering är i sig självt en idé som ofta leder till ett ideal av realism; till exempelatt simulerade instrument ska uppföra sig som i verkligheten, det vill säga ett simulerattandläkarinstrument för att hävla (bända) tänder förväntas följa fysikens lagar och geåterkoppling i form av av både kraft och vridmoment. Om detta inte uppfylls betraktassimuleringen som undermålig. I det aktuella arbetet visas hur delar av realism-idealetinte är nödvändigt för att skapa meningsfulla lärandeapplikationer, och att det till ochmed kan vara kontraproduktivt eftersom det begränsar utforskande av kreativa designlösningar.Ifrågasättandet av realsimidealet resulterar i ett perspektivskifte vad gällersimulatorutveckling generellt, från att ensidigt fokusera på vidareutveckling av enskildatekniska komponenter, till att identifiera och dra nytta av kvaliteterna som redanerbjuds i modern haptisk teknik. För att kunna arbeta kreativt med ett haptiksystem som en designresurs behöver vilära känna dess materialkvaliteter och hur, genom att ändra grundläggande parametrar,meningsfulla upplevelsekvaliteter kan moduleras och finjusteras. Detta kräver i sin turnyskapande av verktyg och arbetsflöden som möjliggör utforskande av det kreativadesignrummet, skapande av interaktionssketcher och finjustering av gestaltningen föratt tillgodose användarupplevelsen. I grund och botten visar denna avhandling hur en specifik 3D-haptik-teknologi kanomvandlas från att vara en svårtillgänglig teknologi till att vara ett designmaterial, ochhur det kan användas, och formas, med nyskapande verktyg genom interaktionsdesignav en nyttoprodukt inom tandläkarutbildning / <p>QC 20160309</p>

Syfte: Studiens syfte var att undersöka hur refraktiv kirurgi ser ut i Sverige idag, vilka komplikationer som finns och vilka metoder som används genom att göra en kort redovisning av de vanligaste teknikerna FS-lasik, LASEK, TransPRK och RLE som finns inom refraktiv kirurgi och med hjälp av en enkät ta reda på de olika komplikationerna mellan olika åldersgrupper.  Metod: En enkätstudie inom refraktiv kirurgi i Sverige genomfördes. Enkäten var webbaserad och skapad i Google Docs (http://docs.google.com). Enkäten innehöll totalt 11 frågor som handlade om patientens tidiga refraktion, operationsmetod och ögonhälsa efter operationen. Enkäten spreds via sociala medier som Facebook, Instagram, Twitter, olika forumsiter, samt mail. En del av enkäten var även fördelad på två olika ögonkliniker i Lund. Resultat: Resultaten av enkäten visar att det finns inte någon skillnad i komplikationsgraden mellan de olika åldersgrupperna och komplikationerna efter kirurgin beror på typen av metod och patientens synfel och brytningsfel.  Slutsats: Vid de olika metoderna förekommer olika komplikationer och ju mer närsynt patienten är desto större är risken för komplikationer i samband med operationen. / Refractive surgery is an effective method for correcting visual refractive errors. The method has evolved quickly over the past decade. The aim of this study was to examine what refractive surgery is in Sweden today. What complications exist and which methods are used, are described by making a presentation of the refractive surgery techniques FS-LASIK, LASEK, TransPRK and RLE. This was done by a survey to find out the various complications between different age groups. A web-based survey was disseminated trough social media like Facebook, different forum sites and e-mail. The survey was also submitted to various eye clinics. The respondents were asked questions about their age, gender, the surgical method used and the complications after surgery. The results of the survey showed that there is no difference in the complication rate between the different age groups. Complications only depend on the type of method used and the patient’s refractive errors.

No description available.

Bakgrund: Enhanced Recovery After Surgery (ERAS) är ett vårdprogram skapat för att förbättra återhämtning och minska kroppens stresspåslag efter kirurgi. Det första ERAS- programmet utvecklades år 2012 för kolorektalkirurgi.  Kolorektalcancer drabbar ca 6 400 personer/år i Sverige, och ca 2 600 personer dör årligen. Detta gör det till en av de vanligaste cancerformerna, och den behandlas med kirurgi. Fler och fler sjukhus vårdar patienter, med denna typ av cancer, enligt vårdprogrammet ERAS. Det har visat sig att det har gett patienter en kortare vårdtid, färre komplikationer och i och med detta blir kostnaderna inte lika höga. Syfte: Syftet är att beskriva patienters upplevelse av att vårdas enligt ERAS vid kolorektalkirurgi. Metod: En litteraturöversikt baserat på 10 empiriska studier. Databaserna PubMed och CINAHL användes vid datainsamlingen. Virginia Hendersons omvårdnadsteori utgjorde litteraturöversiktens teoretiska referensram. Resultat: Fem teman identifierades som beskrev patienternas upplevelse av ERAS vid kolorektalkirurgi. Dessa teman var: information, vårdpersonalens bemötande, delaktighet i sin egen vård, nutrition och vårdmiljö. Resultatet visar att mer information behövs och att både informationen och vården måste vara individanpassad. Slutsats: Patienterna upplever inte att ERAS individanpassar informationen vilket gör den svårförstådd och ger en känsla av att inte ha kontroll. Programmet skulle behöva göra individanpassningar för att passa alla typer av patienter och för att kunna ge patienterna möjlighet till att vara delaktiga i sin vård. Genom att vårdpersonal får en ökad förståelse för patienternas upplevelser kan vårdprogrammet förbättras.

<p>Prostasomes are submicron-sized, membrane-bound organelles produced by the epithelial cells of the prostate and normally found in the secretion in the gland ducts. Their physiological role is in the promotion of sperm-function in human reproduction. This thesis contains four papers dealing with the production of prostasomes and some possible applications in clinical urology of the prostasome. </p><p>Paper I and II provided an ultrastructural description of the synthesis, storage and secretion of prostasomes in benign as well as in malignant tissue. Most notable were the extracellular appearances of prostasomes in metastatic lesions whereby the prostasomes become exposed to the immune system of the patient. This supported findings in earlier studies in which patients with advanced prostate cancer had elevated levels of anti-prostasome antibodies. The results of paper III reinforced the view of the prostate-unique origin of the prostasome. In particular, there were no indications in SDS-PAGE patterns or flow-cytometric studies of material from seminal vesicle secretion that it contained components that could be associated with a production of prostasomes. </p><p>Some possible clinical functions of the prostasomes were investigated in paper IV. Exposure of prostasomes to the immune system through mechanical and thermal trauma to the prostate did not induce an evident formation of anti-prostasome autoantibodies. Furthermore, the serum levels of anti-prostasome antibodies registered by assays with preparations of prostasomes from seminal plasma as antigen did not correlate with existing prostate cancer. Seminal prostasomes seemed not to function as substitute markers for prostate cancer in the test kit used. A possible explanation could be underestimated differences in antigen properties between seminal or prostate gland-derived prostasomes and prostasomes from tumor tissue.</p>

Prostasomes are submicron-sized, membrane-bound organelles produced by the epithelial cells of the prostate and normally found in the secretion in the gland ducts. Their physiological role is in the promotion of sperm-function in human reproduction. This thesis contains four papers dealing with the production of prostasomes and some possible applications in clinical urology of the prostasome. Paper I and II provided an ultrastructural description of the synthesis, storage and secretion of prostasomes in benign as well as in malignant tissue. Most notable were the extracellular appearances of prostasomes in metastatic lesions whereby the prostasomes become exposed to the immune system of the patient. This supported findings in earlier studies in which patients with advanced prostate cancer had elevated levels of anti-prostasome antibodies. The results of paper III reinforced the view of the prostate-unique origin of the prostasome. In particular, there were no indications in SDS-PAGE patterns or flow-cytometric studies of material from seminal vesicle secretion that it contained components that could be associated with a production of prostasomes. Some possible clinical functions of the prostasomes were investigated in paper IV. Exposure of prostasomes to the immune system through mechanical and thermal trauma to the prostate did not induce an evident formation of anti-prostasome autoantibodies. Furthermore, the serum levels of anti-prostasome antibodies registered by assays with preparations of prostasomes from seminal plasma as antigen did not correlate with existing prostate cancer. Seminal prostasomes seemed not to function as substitute markers for prostate cancer in the test kit used. A possible explanation could be underestimated differences in antigen properties between seminal or prostate gland-derived prostasomes and prostasomes from tumor tissue.

Syfte: Syftet med denna litteraturstudie var att sammanställa och beskriva faktorer som är av betydelse för långsiktigt viktminskningsresultat, mer än tre år efter gastric bypass. Metod: För att besvara studiens syfte gjordes en litteraturstudie med deskriptiv design. Studien har baserats på fjorton vetenskapliga artiklar som har sökts fram via Medline samt genom manuell sökning. Resultat: Studien visade att faktorer som var av betydelse för långsiktigt viktminskningsresultat var kost, fysisk aktivitet, beteende, uppföljning, preoperativ viktnedgång samt medicinska faktorer såsom utvidgning av magsäck och gastrojejunal stomi. God kostkvalitet och utövande av fysisk aktivitet visade sig ha ett signifikant samband med långsiktig viktminskning. Beteenden såsom kontroll över matbegär och ätvanor var av stor betydelse. Hetsätning visade sig påverka viktresultatet negativt. Patienter som gick på uppföljning visade större viktminskning på lång sikt liksom patienter som lyckades minska i vikt före operationen. Slutsats: Långsiktigt viktresultat efter gastric bypass kan förbättras genom rätt kost, fysisk aktivitet, långsiktig uppföljning samt genom att tidigt upptäcka ohälsosamma ätbeteenden. Mer forskning krävs angående faktorer som påverkar viktresultatet på lång sikt och vad sjukvården kan göra för att påverka dessa.