Thomas Fork | Lund University (original) (raw)

Papers by Thomas Fork

Research paper thumbnail of Additional file 5 of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

Research paper thumbnail of Additional file 6 of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

Research paper thumbnail of Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule

BMC Medical Imaging, Feb 15, 2012

Background: Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visu... more Background: Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual examination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have largely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of small bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to exclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients in whom a test capsule did not present itself in due time. Methods: Seventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test capsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and imaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded. Results: Lesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in four, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss, haematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did not unveil any such lesion. VCE's were performed in only 20 patients, mainly younger than 50 years of age, although no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic intervention was performed indicating that the referring physician was content with the diagnostic information from MRE or CTE. Conclusion: The diagnostic value of MRE and CTE is sufficient for clinical management of most patients with suspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.

Research paper thumbnail of Additional file 3 of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

Research paper thumbnail of A novel food-based foam as oral contrast agent with negative Hounsfield units for demarcation of small bowel loops on abdominal CT: tolerability and bowel distension in 25 volunteers

Acta Radiologica, Nov 28, 2020

Background: Diseases of the bowel are not always displayed on conventional abdominal computed tom... more Background: Diseases of the bowel are not always displayed on conventional abdominal computed tomography (CT). The studied oral contrast agent aims to improve this. Purpose: To investigate whether the use of a novel oral contrast for abdominal CT enables the same diagnostic advantages as seen in magnetic resonance imaging (MRI). Material and Methods: Twenty-five consented volunteers drank up to 1400 mL of a stable, drinkable foam. Comments on acceptance and side effects were noted immediately and 24 h later. Foam palatability was documented through interviews, and distribution in the small bowel by Hounsfield units from the CT software. The CT results were compared with age-and sex-matched controls, pretreated according to routine. A non-enhanced abdominal CT protocol of lowest possible radiation dose was used. External referees evaluated all data obtained. Results: Foam was considered odd to swallow, and fullness was reported by all volunteers after 950 mL. Five had difficulties in drinking the last 320 mL and two abstained from it. All adverse symptoms were mild. The distribution in the small bowel was on par with standard agents. Foam density revealed stability with intraluminal values of around-550 HU from stomach to terminal ileum, satisfying the requirement of a great bowel lumen-to-wall contrast. External reviewers re-evaluated all our data, and one predicted the foam to offer a potential for improved diagnostics. Conclusion: A CT true-negative bowel filling agent was formulated, with high acceptance, few side effects, and a potential to mimic T1-weighted MRI images.

Research paper thumbnail of Diverticulosis in Total Colonic Aganglionosis

Acta radiologica: diagnosis, Jul 1, 1985

Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum ar... more Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction.

Research paper thumbnail of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

European Radiology Experimental, Apr 5, 2022

Background: A negative oral contrast agent (OCA) has been long sought for, to better delineate th... more Background: A negative oral contrast agent (OCA) has been long sought for, to better delineate the bowel and visualise surrounding structures. Lumentin® 44 (L44) is a new OCA formulated to fill the entire small bowel. The aim of this study was to compare L44 with positive and neutral conventional OCA in abdominal computed tomography (CT). Methods: Forty-five oncologic patients were randomised to receive either L44 or one of the two comparators (MoviPrep® or diluted Omnipaque®). Abdominal CT examinations with intravenous contrast agent were acquired according to standard protocols. The studies were read independently by two senior radiologists. Results: The mean intraluminal Hounsfield units (HU)-values of regions-of-interest (ROIs) for each subsegment of small bowel and treatment group were-404.0 HU for L44, 166.1 HU for Omnipaque®, and 16.7 HU for MoviPrep® (L44 versus Omnipaque, p < 0.001: L44 versus MoviPrep p < 0.001; Omnipaque versus MoviPrep, p = 0.003). Adverse events, only mild, using L44 were numerically fewer than for using conventional oral contrast agents. Visualisation of abdominal structures beyond the small bowel was similar to the comparators. Conclusions: L44 is a negative OCA with luminal radiodensity at approximately-400 HU creating a unique small bowel appearance on CT scans. The high bowel wall-to-lumen contrast may enable improved visualisation in a range of pathologic conditions. L44 showed a good safety profile and was well accepted by patients studied. Trial registration: EudraCT (2017-002368-42) and in ClinicalTrials.gov (NCT03326518).

Research paper thumbnail of Neue Lösung für ein altes Problem

Research paper thumbnail of Diverting Colostomy Increases Anastomotic Leakage in the Rat Colon

European Surgical Research, 2000

In the present study, we examined the effect of a diverting colostomy on the intestinal healing o... more In the present study, we examined the effect of a diverting colostomy on the intestinal healing of colonic anastomosis in the rat. For this purpose, we created a colonic stenosis 2 days prior to the formation of a distal one-layer end-to-end anastomosis with or without a proximal double-barreled deviation colostomy in the rats. Radiological examination of anastomotic leakage was performed daily for 4 days and on day 7 after the operation. We found that anastomotic leakage was markedly increased in rats with a diverting colostomy compared to control animals; i.e. the leakage index (percentage of days with leakage during the experimental period) in colostomy rats was 29%, whereas in animals with no colostomy, the leakage index was only 7%. Interestingly, it was observed that anastomosis formation was associated with a higher mortality rate in rats with colostomy diversion (36%) compared to control animals (7%). However, there was no difference in suture holding capacity on day 7. More...

Research paper thumbnail of Diverticulosis in Total Colonic Aganglionosis

Acta Radiologica, 1985

Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum ar... more Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction.

Research paper thumbnail of Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule

BMC Medical Imaging, 2012

Research paper thumbnail of Natural history and outcome in 32 Swedish patients with small duct primary sclerosing cholangitis (PSC)

Journal of Hepatology, 2002

Background/Aims: This study aims at describing the natural history and outcome of small duct prim... more Background/Aims: This study aims at describing the natural history and outcome of small duct primary sclerosing cholangitis (PSC). Methods: Thirty-two patients with small duct PSC were studied. The average time taken for diagnosis was 69 (1-168) months. The median follow-up time was 63 (1-194) months. Results: All patients including one who underwent liver transplantation because of end-stage liver disease and hepatocellular carcinoma were alive at follow-up. None developed cholangiocarcinoma. In 27 patients repeated cholangiographic examinations were done after a median time of 72 (12-192) months from first ERCP. Four developed features of large duct PSC. Conclusions: Small duct PSC rarely progresses to large bile duct PSC and it seems to have a benign course in most patients and no development of cholangiocarcinoma was found.

Research paper thumbnail of Current Sedation and Monitoring Practice for Colonoscopy: An International Observational Study (EPAGE)

Endoscopy, 2006

Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowled... more Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally. This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. 6004 patients were included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood pressure monitoring in 34 %, and electrocardiography in 24 %. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0 % to 100 % between centers. Oxygen desaturation (&lt;/= 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation. Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring.

Research paper thumbnail of Alpha1-antitrypsin deficiency (PiZ) may be a risk factor for duodenal ulcer in patients with Helicobacter pylori infection

BACKGROUND: Most individuals with Helicobacter pylori infection in Western countries have no evid... more BACKGROUND: Most individuals with Helicobacter pylori infection in Western countries have no evidence of peptic ulcer disease (PUD). We therefore assessed the PiZ deficiency variant of the major plasma protease inhibitor alpha1-antitrypsin (alpha1AT) as a risk factor for PUD in H. pylori-infected individuals. METHODS: The cohort comprised 100 patients with endoscopically or surgically proven PUD (30 patients with duodenal ulcer (DU) and 70 patients with gastric ulcer (GU)) and 162 age- and sex-matched controls with PUD-negative endoscopic findings and no history of PUD. Plasma samples were screened for alpha1AT deficiency (PiZ) with an enzyme-linked immunosorbent assay (ELISA) and phenotyped by isoelectric focusing. H. pylori infection was evaluated with an IgG ELISA technique. RESULTS: Among the 262 patients 17 (6.5%) were positive for the PiZ alpha1AT deficiency, a frequency of the same magnitude as in the Swedish general population (4.7%). Of the PiZ carriers 76% (13 of 17) had H...

Research paper thumbnail of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

European Radiology Experimental, 2022

A negative oral contrast agent (OCA) has been long sought for, to better delineate the bowel and ... more A negative oral contrast agent (OCA) has been long sought for, to better delineate the bowel and visualise surrounding structures. Lumentin® 44 (L44) is a new OCA formulated to fill the entire small bowel. The aim of this study was to compare L44 with positive and neutral conventional OCA in abdominal computed tomography (CT). Forty-five oncologic patients were randomised to receive either L44 or one of the two comparators (MoviPrep® or diluted Omnipaque®). Abdominal CT examinations with intravenous contrast agent were acquired according to standard protocols. The studies were read independently by two senior radiologists. The mean intraluminal Hounsfield units (HU)-values of regions-of-interest (ROIs) for each subsegment of small bowel and treatment group were -404.0 HU for L44, 166.1 HU for Omnipaque®, and 16.7 HU for MoviPrep® (L44 versus Omnipaque, p < 0.001: L44 versus MoviPrep p < 0.001; Omnipaque versus MoviPrep, p = 0.003). Adverse events, only mild, using L44 were num...

Research paper thumbnail of Enteroskopikapseln- sväljbart engångsinstrument för videoundersökning av tunntarmen

Läkartidningen, 2002

Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wirele... more Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wireless capsule-enteroscopy (WCE) has already contributed significantly to the understanding of patients with obscure intestinal symptoms. Series of occult bleeders show that WCE detects lesions in 60%, whereas enterography only in 15%, and push-enteroscopy in 25%. Lesions detected are angiodysplasia in 55%, ulcerations in 14%, aphtoid lesions and erosions in 11%, tumours in 8%. Active bleeding was seen in 43%. In patients with Crohn’s disease further information on extent of disease and type of lesions is gained, mainly seen as erosions in 64%. WCE in hereditary polyposis disclosed more and bigger lesions, and in celiac enteropathy villous atrophy and scalloping of the mucous membrane is readily identified. Software to locate the capsule in the gastrointestinal tract is recently launched together with a graphic display of capsule track and transit times. Soon displays for motility and pressu...

Research paper thumbnail of National guidelines for diagnosis and treatment of esophageal and colorectal cancers

Penelitian dan pengembangan ini bertujuan untuk: (1) menghasilkan instrumen tes terstandar untuk ... more Penelitian dan pengembangan ini bertujuan untuk: (1) menghasilkan instrumen tes terstandar untuk mata pelajaran Menganalisis Rangkaian Listrik yang tersimpan dalam bank soal elektronik; (2) menghasilkan perangkat lunak sistem penilaian berbasis CAT (SPBCAT) yang mampu melaksanakan tes secara adaptif; dan (3) SPBCAT yang mampu melakukan proses pengujian dengan unjuk kerja yang layak. Penelitian dan pengembangan ini dilaksanakan dalam empat tahap, yaitu: (1) definisi; (2) desain; (3) pengembangan; dan (4) pengujian. Kesimpulan dari hasil penelitian ini adalah: (1) instrumen tes terstandar yang berhasil dikembangkan berbentuk 105 butir pilihan ganda, tersusun dalam empat KD, dengan reliabilitas empiris, masing-masing 0,9086, 0,9067, 0,9087, dan 0,9086, dan tersimpan dalam bank soal elektronik; (2) SPBCAT mampu melaksanakan tes secara adaptif, dan menampilkan hasil tes dengan tepat; (3) perangkat lunak SPBCAT telah mampu menampilkan unjuk kerjanya secara layak dalam menguji 28 peserta tes secara serempak, dan mendapat penilaian sangat baik oleh pengguna.

Research paper thumbnail of Diagnostik ved mistanke of kolorektal cancer

Research paper thumbnail of Flat colorectal tumours in a south Swedish population: A prospective chromoendoscopic and histopathological study

Research paper thumbnail of Enteroskopikapseln- sväljbart engångsinstrument för videoundersökning av tunntarmen

Lakartidningen, 2002

Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wirele... more Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wireless capsule-enteroscopy (WCE) has already contributed significantly to the understanding of patients with obscure intestinal symptoms. Series of occult bleeders show that WCE detects lesions in 60%, whereas enterography only in 15%, and push-enteroscopy in 25%. Lesions detected are angiodysplasia in 55%, ulcerations in 14%, aphtoid lesions and erosions in 11%, tumours in 8%. Active bleeding was seen in 43%. In patients with Crohn’s disease further information on extent of disease and type of lesions is gained, mainly seen as erosions in 64%. WCE in hereditary polyposis disclosed more and bigger lesions, and in celiac enteropathy villous atrophy and scalloping of the mucous membrane is readily identified. Software to locate the capsule in the gastrointestinal tract is recently launched together with a graphic display of capsule track and transit times. Soon displays for motility and pressure will follow. Capsule adaptation for screening for Barrett’s esophagus and colon cancer might come true. (Less)

Research paper thumbnail of Additional file 5 of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

Research paper thumbnail of Additional file 6 of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

Research paper thumbnail of Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule

BMC Medical Imaging, Feb 15, 2012

Background: Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visu... more Background: Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual examination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have largely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of small bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to exclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients in whom a test capsule did not present itself in due time. Methods: Seventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test capsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and imaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded. Results: Lesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in four, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss, haematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did not unveil any such lesion. VCE's were performed in only 20 patients, mainly younger than 50 years of age, although no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic intervention was performed indicating that the referring physician was content with the diagnostic information from MRE or CTE. Conclusion: The diagnostic value of MRE and CTE is sufficient for clinical management of most patients with suspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.

Research paper thumbnail of Additional file 3 of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

Research paper thumbnail of A novel food-based foam as oral contrast agent with negative Hounsfield units for demarcation of small bowel loops on abdominal CT: tolerability and bowel distension in 25 volunteers

Acta Radiologica, Nov 28, 2020

Background: Diseases of the bowel are not always displayed on conventional abdominal computed tom... more Background: Diseases of the bowel are not always displayed on conventional abdominal computed tomography (CT). The studied oral contrast agent aims to improve this. Purpose: To investigate whether the use of a novel oral contrast for abdominal CT enables the same diagnostic advantages as seen in magnetic resonance imaging (MRI). Material and Methods: Twenty-five consented volunteers drank up to 1400 mL of a stable, drinkable foam. Comments on acceptance and side effects were noted immediately and 24 h later. Foam palatability was documented through interviews, and distribution in the small bowel by Hounsfield units from the CT software. The CT results were compared with age-and sex-matched controls, pretreated according to routine. A non-enhanced abdominal CT protocol of lowest possible radiation dose was used. External referees evaluated all data obtained. Results: Foam was considered odd to swallow, and fullness was reported by all volunteers after 950 mL. Five had difficulties in drinking the last 320 mL and two abstained from it. All adverse symptoms were mild. The distribution in the small bowel was on par with standard agents. Foam density revealed stability with intraluminal values of around-550 HU from stomach to terminal ileum, satisfying the requirement of a great bowel lumen-to-wall contrast. External reviewers re-evaluated all our data, and one predicted the foam to offer a potential for improved diagnostics. Conclusion: A CT true-negative bowel filling agent was formulated, with high acceptance, few side effects, and a potential to mimic T1-weighted MRI images.

Research paper thumbnail of Diverticulosis in Total Colonic Aganglionosis

Acta radiologica: diagnosis, Jul 1, 1985

Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum ar... more Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction.

Research paper thumbnail of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

European Radiology Experimental, Apr 5, 2022

Background: A negative oral contrast agent (OCA) has been long sought for, to better delineate th... more Background: A negative oral contrast agent (OCA) has been long sought for, to better delineate the bowel and visualise surrounding structures. Lumentin® 44 (L44) is a new OCA formulated to fill the entire small bowel. The aim of this study was to compare L44 with positive and neutral conventional OCA in abdominal computed tomography (CT). Methods: Forty-five oncologic patients were randomised to receive either L44 or one of the two comparators (MoviPrep® or diluted Omnipaque®). Abdominal CT examinations with intravenous contrast agent were acquired according to standard protocols. The studies were read independently by two senior radiologists. Results: The mean intraluminal Hounsfield units (HU)-values of regions-of-interest (ROIs) for each subsegment of small bowel and treatment group were-404.0 HU for L44, 166.1 HU for Omnipaque®, and 16.7 HU for MoviPrep® (L44 versus Omnipaque, p < 0.001: L44 versus MoviPrep p < 0.001; Omnipaque versus MoviPrep, p = 0.003). Adverse events, only mild, using L44 were numerically fewer than for using conventional oral contrast agents. Visualisation of abdominal structures beyond the small bowel was similar to the comparators. Conclusions: L44 is a negative OCA with luminal radiodensity at approximately-400 HU creating a unique small bowel appearance on CT scans. The high bowel wall-to-lumen contrast may enable improved visualisation in a range of pathologic conditions. L44 showed a good safety profile and was well accepted by patients studied. Trial registration: EudraCT (2017-002368-42) and in ClinicalTrials.gov (NCT03326518).

Research paper thumbnail of Neue Lösung für ein altes Problem

Research paper thumbnail of Diverting Colostomy Increases Anastomotic Leakage in the Rat Colon

European Surgical Research, 2000

In the present study, we examined the effect of a diverting colostomy on the intestinal healing o... more In the present study, we examined the effect of a diverting colostomy on the intestinal healing of colonic anastomosis in the rat. For this purpose, we created a colonic stenosis 2 days prior to the formation of a distal one-layer end-to-end anastomosis with or without a proximal double-barreled deviation colostomy in the rats. Radiological examination of anastomotic leakage was performed daily for 4 days and on day 7 after the operation. We found that anastomotic leakage was markedly increased in rats with a diverting colostomy compared to control animals; i.e. the leakage index (percentage of days with leakage during the experimental period) in colostomy rats was 29%, whereas in animals with no colostomy, the leakage index was only 7%. Interestingly, it was observed that anastomosis formation was associated with a higher mortality rate in rats with colostomy diversion (36%) compared to control animals (7%). However, there was no difference in suture holding capacity on day 7. More...

Research paper thumbnail of Diverticulosis in Total Colonic Aganglionosis

Acta Radiologica, 1985

Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum ar... more Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction.

Research paper thumbnail of Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule

BMC Medical Imaging, 2012

Research paper thumbnail of Natural history and outcome in 32 Swedish patients with small duct primary sclerosing cholangitis (PSC)

Journal of Hepatology, 2002

Background/Aims: This study aims at describing the natural history and outcome of small duct prim... more Background/Aims: This study aims at describing the natural history and outcome of small duct primary sclerosing cholangitis (PSC). Methods: Thirty-two patients with small duct PSC were studied. The average time taken for diagnosis was 69 (1-168) months. The median follow-up time was 63 (1-194) months. Results: All patients including one who underwent liver transplantation because of end-stage liver disease and hepatocellular carcinoma were alive at follow-up. None developed cholangiocarcinoma. In 27 patients repeated cholangiographic examinations were done after a median time of 72 (12-192) months from first ERCP. Four developed features of large duct PSC. Conclusions: Small duct PSC rarely progresses to large bile duct PSC and it seems to have a benign course in most patients and no development of cholangiocarcinoma was found.

Research paper thumbnail of Current Sedation and Monitoring Practice for Colonoscopy: An International Observational Study (EPAGE)

Endoscopy, 2006

Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowled... more Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally. This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. 6004 patients were included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood pressure monitoring in 34 %, and electrocardiography in 24 %. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0 % to 100 % between centers. Oxygen desaturation (&lt;/= 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation. Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring.

Research paper thumbnail of Alpha1-antitrypsin deficiency (PiZ) may be a risk factor for duodenal ulcer in patients with Helicobacter pylori infection

BACKGROUND: Most individuals with Helicobacter pylori infection in Western countries have no evid... more BACKGROUND: Most individuals with Helicobacter pylori infection in Western countries have no evidence of peptic ulcer disease (PUD). We therefore assessed the PiZ deficiency variant of the major plasma protease inhibitor alpha1-antitrypsin (alpha1AT) as a risk factor for PUD in H. pylori-infected individuals. METHODS: The cohort comprised 100 patients with endoscopically or surgically proven PUD (30 patients with duodenal ulcer (DU) and 70 patients with gastric ulcer (GU)) and 162 age- and sex-matched controls with PUD-negative endoscopic findings and no history of PUD. Plasma samples were screened for alpha1AT deficiency (PiZ) with an enzyme-linked immunosorbent assay (ELISA) and phenotyped by isoelectric focusing. H. pylori infection was evaluated with an IgG ELISA technique. RESULTS: Among the 262 patients 17 (6.5%) were positive for the PiZ alpha1AT deficiency, a frequency of the same magnitude as in the Swedish general population (4.7%). Of the PiZ carriers 76% (13 of 17) had H...

Research paper thumbnail of A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial

European Radiology Experimental, 2022

A negative oral contrast agent (OCA) has been long sought for, to better delineate the bowel and ... more A negative oral contrast agent (OCA) has been long sought for, to better delineate the bowel and visualise surrounding structures. Lumentin® 44 (L44) is a new OCA formulated to fill the entire small bowel. The aim of this study was to compare L44 with positive and neutral conventional OCA in abdominal computed tomography (CT). Forty-five oncologic patients were randomised to receive either L44 or one of the two comparators (MoviPrep® or diluted Omnipaque®). Abdominal CT examinations with intravenous contrast agent were acquired according to standard protocols. The studies were read independently by two senior radiologists. The mean intraluminal Hounsfield units (HU)-values of regions-of-interest (ROIs) for each subsegment of small bowel and treatment group were -404.0 HU for L44, 166.1 HU for Omnipaque®, and 16.7 HU for MoviPrep® (L44 versus Omnipaque, p < 0.001: L44 versus MoviPrep p < 0.001; Omnipaque versus MoviPrep, p = 0.003). Adverse events, only mild, using L44 were num...

Research paper thumbnail of Enteroskopikapseln- sväljbart engångsinstrument för videoundersökning av tunntarmen

Läkartidningen, 2002

Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wirele... more Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wireless capsule-enteroscopy (WCE) has already contributed significantly to the understanding of patients with obscure intestinal symptoms. Series of occult bleeders show that WCE detects lesions in 60%, whereas enterography only in 15%, and push-enteroscopy in 25%. Lesions detected are angiodysplasia in 55%, ulcerations in 14%, aphtoid lesions and erosions in 11%, tumours in 8%. Active bleeding was seen in 43%. In patients with Crohn’s disease further information on extent of disease and type of lesions is gained, mainly seen as erosions in 64%. WCE in hereditary polyposis disclosed more and bigger lesions, and in celiac enteropathy villous atrophy and scalloping of the mucous membrane is readily identified. Software to locate the capsule in the gastrointestinal tract is recently launched together with a graphic display of capsule track and transit times. Soon displays for motility and pressu...

Research paper thumbnail of National guidelines for diagnosis and treatment of esophageal and colorectal cancers

Penelitian dan pengembangan ini bertujuan untuk: (1) menghasilkan instrumen tes terstandar untuk ... more Penelitian dan pengembangan ini bertujuan untuk: (1) menghasilkan instrumen tes terstandar untuk mata pelajaran Menganalisis Rangkaian Listrik yang tersimpan dalam bank soal elektronik; (2) menghasilkan perangkat lunak sistem penilaian berbasis CAT (SPBCAT) yang mampu melaksanakan tes secara adaptif; dan (3) SPBCAT yang mampu melakukan proses pengujian dengan unjuk kerja yang layak. Penelitian dan pengembangan ini dilaksanakan dalam empat tahap, yaitu: (1) definisi; (2) desain; (3) pengembangan; dan (4) pengujian. Kesimpulan dari hasil penelitian ini adalah: (1) instrumen tes terstandar yang berhasil dikembangkan berbentuk 105 butir pilihan ganda, tersusun dalam empat KD, dengan reliabilitas empiris, masing-masing 0,9086, 0,9067, 0,9087, dan 0,9086, dan tersimpan dalam bank soal elektronik; (2) SPBCAT mampu melaksanakan tes secara adaptif, dan menampilkan hasil tes dengan tepat; (3) perangkat lunak SPBCAT telah mampu menampilkan unjuk kerjanya secara layak dalam menguji 28 peserta tes secara serempak, dan mendapat penilaian sangat baik oleh pengguna.

Research paper thumbnail of Diagnostik ved mistanke of kolorektal cancer

Research paper thumbnail of Flat colorectal tumours in a south Swedish population: A prospective chromoendoscopic and histopathological study

Research paper thumbnail of Enteroskopikapseln- sväljbart engångsinstrument för videoundersökning av tunntarmen

Lakartidningen, 2002

Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wirele... more Since 1,5 years wireless enteroscopy with the GivenM2A-capsule has been tested clinically. Wireless capsule-enteroscopy (WCE) has already contributed significantly to the understanding of patients with obscure intestinal symptoms. Series of occult bleeders show that WCE detects lesions in 60%, whereas enterography only in 15%, and push-enteroscopy in 25%. Lesions detected are angiodysplasia in 55%, ulcerations in 14%, aphtoid lesions and erosions in 11%, tumours in 8%. Active bleeding was seen in 43%. In patients with Crohn’s disease further information on extent of disease and type of lesions is gained, mainly seen as erosions in 64%. WCE in hereditary polyposis disclosed more and bigger lesions, and in celiac enteropathy villous atrophy and scalloping of the mucous membrane is readily identified. Software to locate the capsule in the gastrointestinal tract is recently launched together with a graphic display of capsule track and transit times. Soon displays for motility and pressure will follow. Capsule adaptation for screening for Barrett’s esophagus and colon cancer might come true. (Less)