Mette Siemsen - Academia.edu (original) (raw)
Papers by Mette Siemsen
Acta Oncologica, 2021
Background Decisions regarding tumor staging, operability, resectability, and treatment strategy ... more Background Decisions regarding tumor staging, operability, resectability, and treatment strategy in patients with esophageal cancer are made at multidisciplinary team (MDT) conferences. We aimed to assess interobserver agreement from four national MDT conferences and whether this would have a clinical impact. Methods A total of 20 patients with esophageal cancer were included across all four upper gastrointestinal (GI) cancer centers. Fully anonymized patient data were distributed among the MDT conferences which decided on TNM category, resectability, operability, curability, and treatment strategy blinded to each other’s decisions. The interobserver agreement was expressed as both the raw observer agreement and with Krippendorff’s α values. Finally, a case-by-case evaluation was performed to determine if disagreement would have had a clinical impact. Results A total of 80 MDT evaluations were available for analysis. A moderate to near-perfect observer agreement of 79.2%, 55.8%, and...
Acta Cytologica, 2002
Scan the quick response (QR) code to the left with your mobile device to watch this article's vid... more Scan the quick response (QR) code to the left with your mobile device to watch this article's video abstract and others. Don't have a QR code reader? Get one by searching 'QR Scanner' in your mobile device's app store.
endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal... more endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2015;48:1–15. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society
Ugeskrift for læger, May 7, 2012
Bronchogenic cysts are congenital and are caused by an abnormal budding of the endotracheobronchi... more Bronchogenic cysts are congenital and are caused by an abnormal budding of the endotracheobronchial tree in the first trimester. They are typically located in the thoracic cavity and are often diagnosed in early childhood due to persistent respiratory symptoms such as stridor, cough and dyspnoea. In adults bronchogenic cysts are seldom. Secondary infection is rare. We present two patients with infected bronchogenic cysts. The patients were both treated at the Department of Cardiothoracic Surgery, Rigshospitalet, within a period of six months.
Ugeskrift for læger, Jan 31, 2005
Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer
Ugeskrift for laeger, 2012
Bronchogenic cysts are congenital and are caused by an abnormal budding of the endotracheobronchi... more Bronchogenic cysts are congenital and are caused by an abnormal budding of the endotracheobronchial tree in the first trimester. They are typically located in the thoracic cavity and are often diagnosed in early childhood due to persistent respiratory symptoms such as stridor, cough and dyspnoea. In adults bronchogenic cysts are seldom. Secondary infection is rare. We present two patients with infected bronchogenic cysts. The patients were both treated at the Department of Cardiothoracic Surgery, Rigshospitalet, within a period of six months.
Ugeskrift for laeger, 2010
INTRODUCTION Endobronchial ultrasound (EBUS) is a minimally invasive diagnostic modality, by whic... more INTRODUCTION Endobronchial ultrasound (EBUS) is a minimally invasive diagnostic modality, by which it is possible to visualize and do biopsy of structures adjacent to the trachea and the central bronchial system. EBUS is mostly used for staging of lung cancer patients, but EBUS is now used worldwide as a diagnostic tool in patients with mediastinal tumours or adenopathy. MATERIAL AND METHODS In this paper, we report of the result of the first 100 EBUS patients referred for further investigation of mediastinal adenopathy or tumour found via CT. All 100 patients underwent EBUS in general anaesthesia, and 95 patients had transbronchial needle aspiration biopsy performed (TBNA). RESULTS A total of 46 patients were known to have or have had cancer; in 20 of these patients we found cancer in the mediastinum by EBUS-TBNA, 24 patients had lymph node aspirates without cancer and in two patients the aspirate was inconclusive. The remaining 49 patients all had a record of non-malignant medical...
Ugeskrift for laeger, 2014
Introduction of bronchoscopic lung volume reduction as a treatment for severe emphysema has been ... more Introduction of bronchoscopic lung volume reduction as a treatment for severe emphysema has been defined as an area of development by The Danish Health and Medicines Authority. We here present the rationale for treatment, in- and exclusion criteria, and ultimately the organization for assessment, treatment and follow-up in Denmark. The treatment aim is to lower dyspnoea. There is a national protocol for patient selection according to in- and exclusion criteria. Different commercial devices are available, but endobronchial valves have been the devices mostly applied. A national database has been established to evaluate cost-effectiveness.
Interventional Pulmonology
Interventional pulmonology
Minimally Invasive Surgery
Aim. To compare the peri- and postoperative data between a hybrid minimally invasive esophagectom... more Aim. To compare the peri- and postoperative data between a hybrid minimally invasive esophagectomy (HMIE) and the conventional Ivor Lewis esophagectomy. Methods. Retrospective comparison of perioperative characteristics, postoperative complications, and survival between HMIE and Ivor Lewis esophagectomy. Results. 216 patients were included, with 160 procedures performed with the conventional and 56 with the HMIE approach. Lower perioperative blood loss was found in the HMIE group (600 ml versus 200 ml, p<0.001). Also, a higher median number of lymph nodes were harvested in the HMIE group (median 28) than in the conventional group (median 23) (p=0.002). The median length of stay was longer in the conventional group compared to the HMIE group (11.5 days versus 10.0 days, p=0.03). Patients in the HMIE group experienced fewer grade 2 or higher complications than the conventional group (39% versus 57%, p=0.03). The rate of all pulmonary (51% versus 43%, p=0.32) and severe pulmonary co...
BMC Palliative Care
Background: Incurable oesophageal cancer patients are often affected by existential distress and ... more Background: Incurable oesophageal cancer patients are often affected by existential distress and deterioration of quality of life. Knowledge about the life situation of this patient group is important to provide relevant palliative care and support. The purpose of this study is to illuminate the ways in which incurable oesophageal cancer disrupts the patients' lives and how the patients experience and adapt to life with the disease. Methods: Seventeen patients receiving palliative care for oesophageal cancer were interviewed 1-23 months after diagnosis. The epistemological approach was inspired by phenomenology and hermeneutics, and the method of data collection, analysis and interpretation consisted of individual qualitative interviews and meaning condensation, inspired by Kvale and Brinkmann. Results: The study reveals how patients with incurable oesophageal cancer experience metaphorically to end up at a "table in the corner". The patients experience loss of dignity, identity and community. The study illuminated how illness and symptoms impact and control daily life and social relations, described under these subheadings: "sense of isolation"; "being in a zombie-like state"; "one day at a time"; and "at sea". Patients feel alone with the threat to their lives and everyday existence; they feel isolated due to the inhibiting symptoms of their illness, anxiety, worry and daily losses and challenges. Conclusions: The patients' lives are turned upside down, and they experience loss of health, function and familiar, daily habits. The prominent issues for the patients are loneliness and lack of continuity. As far as their normal everyday lives, social networks and the health system are concerned, patients feel they have been banished to a "table in the corner". These patients have a particular need for healthcare professionals who are dedicated to identifying what can be done to support the patients in their everyday lives, preserve dignity and provide additional palliative care.
The British Journal of Radiology
Journal of clinical nursing, Jan 4, 2018
To provide in-depth insight into patients' lived experiences of participating in an education... more To provide in-depth insight into patients' lived experiences of participating in an education and counseling nutritional intervention after curative surgery for esophageal cancer. Surgery for esophageal cancer carries a risk of malnutrition. The consequences of nutritional problems may lead to increased morbidity and mortality postoperatively and have consequences for convalescence, rehabilitation and quality of life. Qualitative study based on a phenomenological approach. The theoretical framework was grounded in the philosophy of Merleau-Ponty. Qualitative interviews were conducted with 10 patients who participated in an education and counseling nutritional intervention after surgery for esophageal squamous-cell carcinoma. Data were analyzed according to the principles of Kvale and Brinkmann and their three levels of interpretation were applied. The essence of experiencing the education and counseling nutritional intervention can be divided into three themes: embodied disorien...
Journal of the American College of Surgeons, Jan 29, 2017
Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasop... more Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasopressors and the surgical technique, could affect splanchnic microcirculation, in which the surgical target organ is of particular interest. This study used laser speckle contrast imaging (LSCI) to monitor gastric microcirculation during esophagectomy. Forty-five patients undergoing open esophagectomy were randomized to primary activation (EA; 25 patients) or no intraoperative activation (LA; 20 patients) of TEA. Phenylephrine managed intraoperative hypotension and gastric microcirculation was assessed at antrum and corpus area by LSCI. Antrum microcirculation (mean ± SD) was lower in the EA group at baseline (1,150 ± 189 laser speckle perfusion units [LSPU] vs LA group: 1,265 ± 163 LSPU; p = 0.036). In both groups, antrum microcirculation tended to decrease in response to anesthesia, TEA, and surgical procedure (LA: 1,265 ± 163 to 1,097 ± 184 LSPU, p = 0.021; EA: 1,150 ± 189 to 1,064 ± 1...
Scandinavian Journal of Gastroenterology, 2016
Reduced microvascular blood flow is related to anastomotic insufficiency following esophagectomy,... more Reduced microvascular blood flow is related to anastomotic insufficiency following esophagectomy, emphasizing a need for intraoperative monitoring of the microcirculation. This study evaluated if laser speckle contrast imaging (LSCI) was able to detect intraoperative changes in gastric microcirculation. Gastric microcirculation was assessed prior to and after reconstruction of gastric continuity in 25 consecutive patients operated for adenocarcinoma with open Ivor-Lewis esophagectomy while hemodynamic variables were recorded. During upper laparotomy, microcirculation at the corpus decreased by 25% from baseline to mobilization of the stomach (p = .008) and decreased further (to a total decrease of 40%) following gastric pull to the thorax (p = .013). On the other hand, microcirculation at the antrum did not change significantly after gastric mobilization (p = .091). The decrease in corpus microcirculation took place unrelated to central cardiovascular variables. Using LSCI technique, we identified a reduced microcirculation at the corpus area during open Ivor-Lewis esophagectomy. LSCI provides an option for real-time assessment of gastric microcirculation and could form basis for intraoperative stabilization of the microcirculation.
Acta Cytologica, 2002
A 26-year-old woman complained of upper abdominal pain. Computed tomography (CT) showed acute pan... more A 26-year-old woman complained of upper abdominal pain. Computed tomography (CT) showed acute pancreatitis, a left adrenal tumor and solitary right pulmonary metastasis. She underwent left adrenalectomy; the adrenal tumor was diagnosed as adrenocortical carcinoma (ACC). When preparing to resect the pulmonary metastasis, she suffered a second acute pancreatic attack. Magnetic resonance cholangiopancreatography (MRCP) showed that the proximal main pancreatic duct (MPD) was dilated, and the distal MPD was diminished; however, no pancreatic tumor was observed on CT or MRCP. Endoscopic ultrasonography revealed a solitary pancreatic mass, which was diagnosed as pancreatic metastasis from ACC by endoscopic ultrasonography-guided fine-needle aspiration.
Ugeskrift For Laeger, Jul 14, 2014
Acta Oncologica, 2021
Background Decisions regarding tumor staging, operability, resectability, and treatment strategy ... more Background Decisions regarding tumor staging, operability, resectability, and treatment strategy in patients with esophageal cancer are made at multidisciplinary team (MDT) conferences. We aimed to assess interobserver agreement from four national MDT conferences and whether this would have a clinical impact. Methods A total of 20 patients with esophageal cancer were included across all four upper gastrointestinal (GI) cancer centers. Fully anonymized patient data were distributed among the MDT conferences which decided on TNM category, resectability, operability, curability, and treatment strategy blinded to each other’s decisions. The interobserver agreement was expressed as both the raw observer agreement and with Krippendorff’s α values. Finally, a case-by-case evaluation was performed to determine if disagreement would have had a clinical impact. Results A total of 80 MDT evaluations were available for analysis. A moderate to near-perfect observer agreement of 79.2%, 55.8%, and...
Acta Cytologica, 2002
Scan the quick response (QR) code to the left with your mobile device to watch this article's vid... more Scan the quick response (QR) code to the left with your mobile device to watch this article's video abstract and others. Don't have a QR code reader? Get one by searching 'QR Scanner' in your mobile device's app store.
endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal... more endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2015;48:1–15. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society
Ugeskrift for læger, May 7, 2012
Bronchogenic cysts are congenital and are caused by an abnormal budding of the endotracheobronchi... more Bronchogenic cysts are congenital and are caused by an abnormal budding of the endotracheobronchial tree in the first trimester. They are typically located in the thoracic cavity and are often diagnosed in early childhood due to persistent respiratory symptoms such as stridor, cough and dyspnoea. In adults bronchogenic cysts are seldom. Secondary infection is rare. We present two patients with infected bronchogenic cysts. The patients were both treated at the Department of Cardiothoracic Surgery, Rigshospitalet, within a period of six months.
Ugeskrift for læger, Jan 31, 2005
Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer
Ugeskrift for laeger, 2012
Bronchogenic cysts are congenital and are caused by an abnormal budding of the endotracheobronchi... more Bronchogenic cysts are congenital and are caused by an abnormal budding of the endotracheobronchial tree in the first trimester. They are typically located in the thoracic cavity and are often diagnosed in early childhood due to persistent respiratory symptoms such as stridor, cough and dyspnoea. In adults bronchogenic cysts are seldom. Secondary infection is rare. We present two patients with infected bronchogenic cysts. The patients were both treated at the Department of Cardiothoracic Surgery, Rigshospitalet, within a period of six months.
Ugeskrift for laeger, 2010
INTRODUCTION Endobronchial ultrasound (EBUS) is a minimally invasive diagnostic modality, by whic... more INTRODUCTION Endobronchial ultrasound (EBUS) is a minimally invasive diagnostic modality, by which it is possible to visualize and do biopsy of structures adjacent to the trachea and the central bronchial system. EBUS is mostly used for staging of lung cancer patients, but EBUS is now used worldwide as a diagnostic tool in patients with mediastinal tumours or adenopathy. MATERIAL AND METHODS In this paper, we report of the result of the first 100 EBUS patients referred for further investigation of mediastinal adenopathy or tumour found via CT. All 100 patients underwent EBUS in general anaesthesia, and 95 patients had transbronchial needle aspiration biopsy performed (TBNA). RESULTS A total of 46 patients were known to have or have had cancer; in 20 of these patients we found cancer in the mediastinum by EBUS-TBNA, 24 patients had lymph node aspirates without cancer and in two patients the aspirate was inconclusive. The remaining 49 patients all had a record of non-malignant medical...
Ugeskrift for laeger, 2014
Introduction of bronchoscopic lung volume reduction as a treatment for severe emphysema has been ... more Introduction of bronchoscopic lung volume reduction as a treatment for severe emphysema has been defined as an area of development by The Danish Health and Medicines Authority. We here present the rationale for treatment, in- and exclusion criteria, and ultimately the organization for assessment, treatment and follow-up in Denmark. The treatment aim is to lower dyspnoea. There is a national protocol for patient selection according to in- and exclusion criteria. Different commercial devices are available, but endobronchial valves have been the devices mostly applied. A national database has been established to evaluate cost-effectiveness.
Interventional Pulmonology
Interventional pulmonology
Minimally Invasive Surgery
Aim. To compare the peri- and postoperative data between a hybrid minimally invasive esophagectom... more Aim. To compare the peri- and postoperative data between a hybrid minimally invasive esophagectomy (HMIE) and the conventional Ivor Lewis esophagectomy. Methods. Retrospective comparison of perioperative characteristics, postoperative complications, and survival between HMIE and Ivor Lewis esophagectomy. Results. 216 patients were included, with 160 procedures performed with the conventional and 56 with the HMIE approach. Lower perioperative blood loss was found in the HMIE group (600 ml versus 200 ml, p<0.001). Also, a higher median number of lymph nodes were harvested in the HMIE group (median 28) than in the conventional group (median 23) (p=0.002). The median length of stay was longer in the conventional group compared to the HMIE group (11.5 days versus 10.0 days, p=0.03). Patients in the HMIE group experienced fewer grade 2 or higher complications than the conventional group (39% versus 57%, p=0.03). The rate of all pulmonary (51% versus 43%, p=0.32) and severe pulmonary co...
BMC Palliative Care
Background: Incurable oesophageal cancer patients are often affected by existential distress and ... more Background: Incurable oesophageal cancer patients are often affected by existential distress and deterioration of quality of life. Knowledge about the life situation of this patient group is important to provide relevant palliative care and support. The purpose of this study is to illuminate the ways in which incurable oesophageal cancer disrupts the patients' lives and how the patients experience and adapt to life with the disease. Methods: Seventeen patients receiving palliative care for oesophageal cancer were interviewed 1-23 months after diagnosis. The epistemological approach was inspired by phenomenology and hermeneutics, and the method of data collection, analysis and interpretation consisted of individual qualitative interviews and meaning condensation, inspired by Kvale and Brinkmann. Results: The study reveals how patients with incurable oesophageal cancer experience metaphorically to end up at a "table in the corner". The patients experience loss of dignity, identity and community. The study illuminated how illness and symptoms impact and control daily life and social relations, described under these subheadings: "sense of isolation"; "being in a zombie-like state"; "one day at a time"; and "at sea". Patients feel alone with the threat to their lives and everyday existence; they feel isolated due to the inhibiting symptoms of their illness, anxiety, worry and daily losses and challenges. Conclusions: The patients' lives are turned upside down, and they experience loss of health, function and familiar, daily habits. The prominent issues for the patients are loneliness and lack of continuity. As far as their normal everyday lives, social networks and the health system are concerned, patients feel they have been banished to a "table in the corner". These patients have a particular need for healthcare professionals who are dedicated to identifying what can be done to support the patients in their everyday lives, preserve dignity and provide additional palliative care.
The British Journal of Radiology
Journal of clinical nursing, Jan 4, 2018
To provide in-depth insight into patients' lived experiences of participating in an education... more To provide in-depth insight into patients' lived experiences of participating in an education and counseling nutritional intervention after curative surgery for esophageal cancer. Surgery for esophageal cancer carries a risk of malnutrition. The consequences of nutritional problems may lead to increased morbidity and mortality postoperatively and have consequences for convalescence, rehabilitation and quality of life. Qualitative study based on a phenomenological approach. The theoretical framework was grounded in the philosophy of Merleau-Ponty. Qualitative interviews were conducted with 10 patients who participated in an education and counseling nutritional intervention after surgery for esophageal squamous-cell carcinoma. Data were analyzed according to the principles of Kvale and Brinkmann and their three levels of interpretation were applied. The essence of experiencing the education and counseling nutritional intervention can be divided into three themes: embodied disorien...
Journal of the American College of Surgeons, Jan 29, 2017
Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasop... more Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasopressors and the surgical technique, could affect splanchnic microcirculation, in which the surgical target organ is of particular interest. This study used laser speckle contrast imaging (LSCI) to monitor gastric microcirculation during esophagectomy. Forty-five patients undergoing open esophagectomy were randomized to primary activation (EA; 25 patients) or no intraoperative activation (LA; 20 patients) of TEA. Phenylephrine managed intraoperative hypotension and gastric microcirculation was assessed at antrum and corpus area by LSCI. Antrum microcirculation (mean ± SD) was lower in the EA group at baseline (1,150 ± 189 laser speckle perfusion units [LSPU] vs LA group: 1,265 ± 163 LSPU; p = 0.036). In both groups, antrum microcirculation tended to decrease in response to anesthesia, TEA, and surgical procedure (LA: 1,265 ± 163 to 1,097 ± 184 LSPU, p = 0.021; EA: 1,150 ± 189 to 1,064 ± 1...
Scandinavian Journal of Gastroenterology, 2016
Reduced microvascular blood flow is related to anastomotic insufficiency following esophagectomy,... more Reduced microvascular blood flow is related to anastomotic insufficiency following esophagectomy, emphasizing a need for intraoperative monitoring of the microcirculation. This study evaluated if laser speckle contrast imaging (LSCI) was able to detect intraoperative changes in gastric microcirculation. Gastric microcirculation was assessed prior to and after reconstruction of gastric continuity in 25 consecutive patients operated for adenocarcinoma with open Ivor-Lewis esophagectomy while hemodynamic variables were recorded. During upper laparotomy, microcirculation at the corpus decreased by 25% from baseline to mobilization of the stomach (p = .008) and decreased further (to a total decrease of 40%) following gastric pull to the thorax (p = .013). On the other hand, microcirculation at the antrum did not change significantly after gastric mobilization (p = .091). The decrease in corpus microcirculation took place unrelated to central cardiovascular variables. Using LSCI technique, we identified a reduced microcirculation at the corpus area during open Ivor-Lewis esophagectomy. LSCI provides an option for real-time assessment of gastric microcirculation and could form basis for intraoperative stabilization of the microcirculation.
Acta Cytologica, 2002
A 26-year-old woman complained of upper abdominal pain. Computed tomography (CT) showed acute pan... more A 26-year-old woman complained of upper abdominal pain. Computed tomography (CT) showed acute pancreatitis, a left adrenal tumor and solitary right pulmonary metastasis. She underwent left adrenalectomy; the adrenal tumor was diagnosed as adrenocortical carcinoma (ACC). When preparing to resect the pulmonary metastasis, she suffered a second acute pancreatic attack. Magnetic resonance cholangiopancreatography (MRCP) showed that the proximal main pancreatic duct (MPD) was dilated, and the distal MPD was diminished; however, no pancreatic tumor was observed on CT or MRCP. Endoscopic ultrasonography revealed a solitary pancreatic mass, which was diagnosed as pancreatic metastasis from ACC by endoscopic ultrasonography-guided fine-needle aspiration.
Ugeskrift For Laeger, Jul 14, 2014