F Hjern

Karolinska Institutet, Solna, Stockholm, Sweden

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Publications (19)67.78 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: The standard of care for acute uncomplicated diverticulitis today is antibiotic treatment, although there are no controlled studies supporting this management. The aim was to investigate the need for antibiotic treatment in acute uncomplicated diverticulitis, with the endpoint of recovery without complications after 12 months of follow-up. This multicentre randomized trial involving ten surgical departments in Sweden and one in Iceland recruited 623 patients with computed tomography-verified acute uncomplicated left-sided diverticulitis. Patients were randomized to treatment with (314 patients) or without (309 patients) antibiotics. Age, sex, body mass index, co-morbidities, body temperature, white blood cell count and C-reactive protein level on admission were similar in the two groups. Complications such as perforation or abscess formation were found in six patients (1·9 per cent) who received no antibiotics and in three (1·0 per cent) who were treated with antibiotics (P = 0·302). The median hospital stay was 3 days in both groups. Recurrent diverticulitis necessitating readmission to hospital at the 1-year follow-up was similar in the two groups (16 per cent, P = 0·881). Antibiotic treatment for acute uncomplicated diverticulitis neither accelerates recovery nor prevents complications or recurrence. It should be reserved for the treatment of complicated diverticulitis.
    British Journal of Surgery 04/2012; 99(4):532-9. · 4.84 Impact Factor
  • Fredrik Hjern, Alicja Wolk, Niclas Håkansson
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    ABSTRACT: Lifestyle factors other than dietary fiber intake and risk for colonic diverticular disease have only been examined in few studies. The objective of this study was to investigate the association between obesity and physical inactivity and diverticular disease in a population-based cohort of women. This was a prospective population-based cohort study. In all, 36,592 women, born 1914-1948, in the Swedish Mammography Cohort were followed 1997-2009. Body mass index (BMI; kg/m(2)), physical activity, diet, smoking, and other lifestyle factors were collected at baseline through questionnaires. Cases of diverticular disease were identified from the Swedish Patient and Death Registers. Relative risks (RRs) of diverticular disease requiring hospitalization (or being the cause of death) according to BMI and physical activity were estimated using Cox proportional hazards models. The multivariable models were adjusted for age; intake of dietary fiber; diabetes; hypertension; use of acetylsalicylate acid, non-steroid anti-inflammatory drug, or steroid medication; alcohol consumption; smoking; and educational level. During 12 years, 626 cases of incident diverticular disease requiring hospitalization were found. Two women were registered in the National Death Register only. In multivariable analysis, women with BMI 25-29.99 had 29% increased risk (RR=1.29; 95% confidence interval (CI): 1.08, 1.54) and obese women (BMI≥30) had 33% (1.33; 95% CI: 1.03-1.72) increased risk of diverticular disease compared to women with BMI 20-24.99. Exercise ≤30 min/day increased the risk for disease with 42% (1.42; 95% CI: 1.18-1.69) compared with exercise >30 min/day in multivariable analysis. Ninety-eight subjects were hospitalized due to complications; perforation or abscess. Women with BMI≥30 had a twofold (RR=2.00; 95% CI: 1.08-3.73; P=0.028) increased risk for complicated disease. Overweight, obesity, and physical inactivity among women increase diverticular disease requiring hospitalization.
    The American Journal of Gastroenterology 02/2012; 107(2):296-302. · 7.55 Impact Factor
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    ABSTRACT: Perioperative fluid therapy can influence postoperative hospital stay and complications after elective colorectal surgery. This trial was designed to examine whether an extremely restricted perioperative fluid protocol would reduce hospital stay beyond the existing fast-track hospital time of 7 days after surgery. Patients were randomized to restricted or standard perioperative intravenous fluid regimens in a single-centre trial. Randomization was stratified for colonic, rectal, open and laparoscopic surgery. Patients were all treated within a fast-track protocol (careful preoperative preparation, optimal analgesia, early oral nutrition and early mobilization). The primary endpoint was length of postoperative hospital stay. The secondary endpoint was complications within 30 days. Seventy-nine patients were randomized to restricted and 82 to standard fluid therapy. Patients in the restricted group received a median of 3050 ml fluid on the day of surgery compared with 5775 ml in the standard group (P < 0·001). There was no difference between groups in primary hospital stay (median 6·0 days in both groups; P = 0·194) or stay including readmission (median 6·0 days in both groups; P = 0·158). The proportion of patients with complications was significantly lower in the restricted group (31 of 79 versus 47 of 82; P = 0·027). Vasopressors were more often required in the restricted group (97 versus 80 per cent; P < 0·001). Restricted perioperative intravenous fluid administration does not reduce length of stay in a fast-track protocol.
    British Journal of Surgery 09/2011; 99(2):186-91. · 4.84 Impact Factor
  • F Hjern, A Wolk, N Håkansson
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    ABSTRACT: The relationship between smoking and the risk of diverticular disease is unclear. An observational cohort study was undertaken to investigate the association between smoking and diverticular disease. Women in the Swedish Mammography Cohort born between 1914 and 1948 were followed from 1997 to 2008. Information on smoking and other lifestyle factors was collected through questionnaires. Patients with symptomatic diverticular disease were identified from Swedish national registers. Relative risks (RRs) of symptomatic diverticular disease (resulting in hospital admission or death) according to smoking status were estimated using Cox proportional hazards models. Of 35 809 women included in the study, 561 (1·6 per cent) had symptomatic diverticular disease. In multivariable analysis, current smokers had an increased risk of symptomatic diverticular disease compared with non-smokers after adjustment for age, intake of dietary fibre, diabetes, hypertension, use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs or steroid medication, alcohol consumption, body mass index, physical activity and level of education (RR 1·23, 95 per cent confidence interval 0·99 to 1·52). Past smokers also had an increased risk (RR 1·26, 1·02 to 1·56). Smokers had a higher risk of developing a diverticular perforation/abscess than non-smokers (RR 1·89, 1·15 to 3·10). Smoking is associated with symptomatic diverticular disease.
    British Journal of Surgery 04/2011; 98(7):997-1002. · 4.84 Impact Factor
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    ABSTRACT: Recently, several genome-wide association studies (GWAS) have independently found numerous loci at which common single-nucleotide polymorphisms (SNPs) modestly influence the risk of developing colorectal cancer. The aim of this study was to test 11 loci, reported to be associated with an increased or decreased risk of colorectal cancer: 8q23.3 (rs16892766), 8q24.21 (rs6983267), 9p24 (rs719725), 10p14 (rs10795668), 11q23.1 (rs3802842), 14q22.2 (rs4444235), 15q13.3 (rs4779584), 16q22.1 (rs9929218), 18q21.1 (rs4939827), 19q13.1 (rs10411210) and 20p12.3 (rs961253), in a Swedish-based cohort. The cohort was composed of 1786 cases and 1749 controls that were genotyped and analysed statistically. Genotype-phenotype analysis, for all 11 SNPs and sex, age of onset, family history of CRC and tumour location, was performed. Of eleven loci, 5 showed statistically significant odds ratios similar to previously published findings: 8q23.3, 8q24.21, 10p14, 15q13.3 and 18q21.1. The remaining loci 11q23.1, 16q22.1, 19q13.1 and 20p12.3 showed weak trends but somehow similar to what was previously published. The loci 9p24 and 14q22.2 could not be confirmed. We show a higher number of risk alleles in affected individuals compared to controls. Four statistically significant genotype-phenotype associations were found; the G allele of rs6983267 was associated to older age, the G allele of rs1075668 was associated with a younger age and sporadic cases, and the T allele of rs10411210 was associated with younger age. Our study, using a Swedish population, supports most genetic variants published in GWAS. More studies are needed to validate the genotype-phenotype correlations.
    British Journal of Cancer 08/2010; 103(4):575-80. · 5.08 Impact Factor
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    ABSTRACT: The genetic susceptibility to colorectal cancer (CRC) has been estimated to be around 35% and yet high-penetrance germline mutations found so far explain less than 5% of all cases. Much of the remaining variations could be due to the co-inheritance of multiple low penetrant variants. The identification of all the susceptibility alleles could have public health relevance in the near future. To test the hypothesis that what are considered polymorphisms in human CRC genes could constitute low-risk alleles, we selected eight common SNPs for a pilot association study in 1785 cases and 1722 controls. One SNP, rs3219489:G>C (MUTYH Q324H) seemed to confer an increased risk of rectal cancer in homozygous status (OR=1.52; CI=1.06-2.17). When the analysis was restricted to our 'super-controls', healthy individuals with no family history for cancer, also rs1799977:A>G (MLH1 I219V) was associated with an increased risk in both colon and rectum patients with an odds ratio of 1.28 (CI=1.02-1.60) and 1.34 (CI=1.05-1.72), respectively (under the dominant model); while 2 SNPs, rs1800932:A>G (MSH6 P92P) and rs459552:T>A (APC D1822V) seemed to confer a protective effect. The latter, in particular showed an odds ratio of 0.76 (CI=0.60-0.97) among colon patients and 0.73 (CI=0.56-0.95) among rectal patients. In conclusion, our study suggests that common variants in human CRC genes could constitute low-risk alleles.
    European journal of cancer (Oxford, England: 1990) 02/2010; 46(6):1041-8. · 4.12 Impact Factor
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    ABSTRACT: : Diverticulitis is a risk factor for fistula formation but little is known about the influence of hysterectomy in this association. A population-based nationwide matched cohort study was performed to determine the risk of fistula formation in hysterectomized women with, and without, diverticulitis. : Women who had a hysterectomy between 1973 and 2003, and a matched control cohort, were identified from the Swedish Inpatient Register. Incidence of diverticulitis and fistula surgery was determined by cross-linkage to the Register, and risk was estimated using a Cox regression model. : In a cohort of 168 563 hysterectomized and 614 682 non-hysterectomized women (mean follow-up 11.0 and 11.5 years respectively), there were 14 051 cases of diverticulitis and 851 fistulas. Compared with women who had neither hysterectomy nor diverticulitis, the risk of fistula surgery increased fourfold in hysterectomized women without diverticulitis (hazard ratio (HR) 4.0 (95 per cent confidence interval (c.i.) 3.5 to 4.7)), sevenfold in non-hysterectomized women with diverticulitis (HR 7.6 (4.8 to 12.1)) and 25-fold in hysterectomized women with diverticulitis (HR 25.2 (15.5 to 41.2)). : Diverticulitis, and to a lesser extent hysterectomy, is strongly associated with the risk of fistula formation. Hysterectomized women with diverticulitis have the highest risk of developing surgically managed fistula.
    British Journal of Surgery 02/2010; 97(2):251-7. · 4.84 Impact Factor
  • Journal de Chirurgie. 08/2008; 145(4):403.
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    ABSTRACT: There is controversy over whether patients presenting with a primary attack of acute diverticulitis at a younger age are more prone to complications and recurrence than older patients. A review, including postal questionnaires, was undertaken of 234 patients who had a primary episode of acute diverticulitis. The diagnosis was confirmed by computed tomography (CT) and/or pathology report. The mean length of follow-up was 30 (range 16-45) months. In 58 patients aged 50 years or less no differences in fever or white blood cell count were found in comparison with findings in 176 patients aged above 50 years. The rate of severe diverticulitis observed with CT was lower in the younger patients (2 versus 11.9 per cent; P = 0.025). Surgical management during the first admission was undertaken less commonly in younger patients (2 versus 6.8 per cent; P = 0.271). Rates of subsequent events (recurrent diverticulitis and/or further surgery) during follow-up were higher in younger patients (25 versus 19.5 per cent), but this was not significant (P = 0.423). A type II error cannot be excluded. First episodes of acute diverticulitis were not more aggressive in patients aged 50 years or less. Recurrence rates were slightly higher than in older patients.
    British Journal of Surgery 07/2008; 95(6):758-64. · 4.84 Impact Factor
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    ABSTRACT: To assess whether computed tomography colonography (CTC) is a viable alternative to colonoscopy or double contrast barium enema in the follow-up of patients after diverticulitis. Fifty patients underwent CTC followed immediately by colonoscopy. Results were blinded to the examiners. Findings of diverticular disease and patient acceptance were evaluated. Bowel preparation and distension were good in the majority of CTC and colonoscopy examinations. Diverticular disease was found in 96% of patients at CTC and in 90% at colonoscopy. The rate of agreement between CTC and colonoscopy for diverticular findings in the sigmoid colon was good (kappa=0.64). No complications were seen. Patients found colonoscopy more uncomfortable (p<0.03), more painful (p<0.001), and more difficult (p<0.01) than CTC. Of the patients favouring one examination, 74% preferred CTC. CTC appears to have a better diagnostic potential for imaging of diverticular disease-specific findings, when compared with colonoscopy. Also, CTC was less uncomfortable and was preferred by a majority of patients. CTC seems to be a reasonable alternative in follow-up of patients with symptomatic diverticular disease.
    Clinical Radiology 08/2007; 62(7):645-50. · 1.82 Impact Factor
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    ABSTRACT: Recently a common variant of the TGFBR1 gene, TGFBR1*6A, has been proposed to act as a low-penetrance tumor susceptibility allele for colorectal cancer, but data from published studies with individually low statistical power are conflicting. To further evaluate the relationship between TGFBR1*6A and colorectal cancer risk, we have conducted a large case-control study and a meta-analysis of previously published studies. A total of 1,042 colorectal cancer cases and 856 population controls were genotyped for the TGFBR1*6A polymorphism. Previously published case-control studies of the relationship between TGFBR1*6A and colorectal cancer were identified, and a meta-analysis was conducted. We found no evidence that homozygosity, heterozygosity or carrier status for the TGFBR1*6A allele confers an increased risk of colorectal cancer; respective odds ratios (OR) were 1.05 [95% confidence interval (95% CI), 0.83-1.32], 0.82 (95% CI, 0.34-1.99), and 0.92 (95% CI, 0.74-1.15), respectively. A meta-analysis of our case-control study and seven other studies that provided data on 2,627 colorectal cancer cases and 3,387 controls also yielded no evidence that possession of the TGFBR1*6A allele is associated with an elevated risk of colorectal cancer; pooled estimate of the OR were 1.20 (95% CI, 0.64-2.24) for homozygosity, 1.11 (95% CI, 0.96-1.29) for heterozygosity, and 1.13 (95% CI, 0.98-1.30) for carriers of TGFBR1*6A. Current data provide limited support for the hypothesis that sequence variation in TGFBR1 defined by the TGFBR1*6A allele confers an elevated risk of colorectal cancer.
    Clinical Cancer Research 07/2007; 13(12):3748-52. · 7.84 Impact Factor
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    ABSTRACT: Fistulae to the female genital tract are an infrequent but severe complication of diverticular disease. The purpose of this study was to evaluate treatment and outcome in patients with diverticular colo-genital fistulae. Sixty women treated for diverticular fistulae (DF) to the female genital tract during 1992-2004 were identified. Clinic and operative charts were reviewed. Mean age was 70 years and mean follow-up time after surgery was 1 year. Most common presenting symptoms were vaginal discharge of faeces or gas (95% of patients) and abdominal pain (43%). About 75% of patients had undergone a hysterectomy. Forty-six patients underwent at least one radiological contrast study and the fistula was demonstrated in 35 (76%) patients. Fifty-seven patients had surgery, and findings included colo-vaginal fistulae (n = 47), colo-uterine fistulae (n = 2) and multiple fistulae involving vagina and other organs (n = 8). A sigmoid resection and primary anastomosis was performed in 51 and a Hartmann procedure with colostomy in six patients. Sixteen (28%) patients experienced morbidity after surgery, including anastomotic dehiscence (n = 4) and ureteric injury (n = 3). There was no mortality. Diverticular fistulae to the female genital tract usually occur in elderly patients with a prior hysterectomy. Radiological contrast studies demonstrate the fistulous tract in most cases. Sigmoid resection and primary anastomosis results in a satisfactory outcome in the majority of patients.
    Colorectal Disease 07/2007; 9(5):438-42. · 2.08 Impact Factor
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    ABSTRACT: Most patients admitted for acute colonic diverticulitis (AD) are managed conservatively and receive antibiotics, although it is uncertain whether all patients with AD benefit from this treatment. The aim of this study was to evaluate the influence of antibiotic treatment on outcome in the conservative management of patients with mild AD. A retrospective audit of 311 patients (64% F, mean age 60 years) hospitalized for AD was carried out. All patients were initially treated conservatively with observation and restriction of oral intake. Patients receiving antibiotics (n=118) were compared with patients treated with observation and restriction of oral intake only (n=193). Mean follow-up time (FU) was 30 months. Inflammation in patients treated with antibiotics was more pronounced (laboratory parameters (C-reactive protein, white blood cell count) were higher (p<0.01), fever was more common (p<0.01) and CT grading of inflammation was classified as severe in a higher proportion (p<0.01)) compared with patients treated without antibiotics. When initially treated with antibiotics, 3 patients (3%) failed to respond to treatment and had to undergo surgery. There were 7 (4%) failures in patients initially treated without antibiotics, and antibiotics were then added. During FU, 29% of patients treated with antibiotics had further events (recurrent AD and/or subsequent surgery) compared with 28% (NS) among those treated without antibiotics. In a multivariate analysis, the risk of a further event was not influenced by antibiotic treatment (OR 1.03, CI 95% 0.61-1.74). Our results indicate that antibiotics are not mandatory in mild AD. Treatment without antibiotics appears to be safe and seems not to change the rate of further events. These results warrant further randomized prospective studies.
    Scandinavian Journal of Gastroenterology 01/2007; 42(1):41-7. · 2.16 Impact Factor
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    ABSTRACT: Fragestellung:Ziel dieser Studie war es, die Prävalenz von Genitalprolaps-Operationen und Harninkontinenz bei Patientinnen, die wegen eines Rektumprolaps operiert worden waren, im Vergleich zu einer entsprechenden Kontrollgruppe ohne Rektumprolaps zu untersuchen. Patienten und Methodik:52 Patientinnen mit Rektumprolaps-Operationen in der Vorgeschichte sowie 200 willkürlich ausgewählte, alters- und geschlechtsangepasste Kontrollpersonen ohne Rektumprolaps erhielten einen ausführlichen Gesundheitsfragebogen. Ergebnisse:Die Rücklaufquote betrug in der Patientinnengruppe 48 von 52 (92%) und in der Kontrollgruppe 165 von 200 (82%). Ein Rektumprolaps war mit einem gesteigerten Operationsrisiko wegen eines Uterusprolaps (Odds-Ratio = 3,1; 95%-Konfidenzintervall = 1,4–6,9) und eines Vaginalprolaps (Odds-Ratio = 3,2; 95%-Konfidenzintervall = 1,3–7,8) assoziiert. Das mittlere Alter bei einer Hysterektomie wegen Uterusprolaps betrug 54,7 Jahre in der Patientinnengruppe, verglichen mit 62,6 Jahren in der Kontrollgruppe (p < 0,01). Das mittlere Alter bei Vaginalprolaps-Operation betrug 60,2 Jahre in der Patientinnengruppe, verglichen mit 66,6 Jahren in der Kontrollgruppe (p < 0,05). Es fanden sich keine signifikanten Unterschiede zwischen den Gruppen bezüglich einer höheren Prävalenz oder des Alters beim ersten Auftreten einer Harninkontinenz. Schlussfolgerung:Die Ergebnisse zeigen einen starken Zusammenhang zwischen einer rektalen und genitalen Prolapsoperation. Dies legt nahe, dass der Diagnose eines Rektumprolaps, der operiert werden soll, eine multidisziplinäre Beckenboden-Untersuchung folgen muss. Purpose:This study aimed to investigate the prevalence of genital prolapse surgery and urinary incontinence in female patients operated on for rectal prolapse compared with a matched control group without rectal prolapse. Methods:Fifty-two patients with a history of abdominal rectal prolapse surgery and 200 randomly selected age- and gender-matched control subjects without rectal prolapse received an extensive health care history survey. Results:Response rate in the patient group was 48 of 52 (92 percent) and 165 of 200 (82 percent) in the control group. Rectal prolapse was associated with an increased risk of surgery for uterine prolapse (odds ratio = 3.1; 95 percent confidence interval = 1.4–6.9) and vaginal wall prolapse (odds ratio = 3.2; 95 percent confidence interval = 1.3–7.8). Mean age at hysterectomy because of uterine prolapse was 54.7 years in the patient group compared with 62.6 years in the control group (p < 0.01). Mean age at vaginal wall prolapse surgery was 60.2 years in the patient group compared with 66.6 years in the control group (p < 0.05). There were no significant differences between the cohorts regarding prevalence or age at debut of urinary incontinence. Conclusion:Our results indicate a strong association between rectal and genital prolapse surgery suggesting that diagnosis of rectal prolapse necessitating surgical intervention should prompt a multidisciplinary pelvic floor assessment.
    coloproctology 09/2006; 28(5):255-263.
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    ABSTRACT: Diverticular disease of the colon is more common in the Western world, compared with non-Western countries. To investigate the risk of diverticular disease in immigrants of diverse ethnicity and in different phases of acculturation. Socio-demographic indicators and the risk of diverticular disease were investigated. The study population was a prospectively followed national cohort of 4 million residents born between 1925 and 1965. Risk ratios (RRs) of hospital admissions and deaths because of diverticular disease and acute diverticulitis from 1991 through 2000 were calculated. The risk of hospital admission because of diverticular disease, after adjustment for age, sex and socio-economic indicators, was lower in non-Western immigrants (RRs = 0.5-0.7) compared with natives and the risk increased with time after the settlement. Women of all origins had a higher risk compared with men (RR = 1.5). This sex-difference increased with age (P < 0.001). Socio-economic status, residency or housing situation were not risk factors. This population-based study found that immigrants from non-Westernized countries had lower relative risks for hospitalization because of diverticular disease than natives, but the risk increased during a relatively short period of time after settlement. Diverticular disease of the colon appears to be an acquired disorder and acculturation to a Western lifestyle has an impact on the risk.
    Alimentary Pharmacology & Therapeutics 03/2006; 23(6):797-805. · 4.55 Impact Factor
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    ABSTRACT: The cell cycle checkpoint kinase 2 (CHEK2) 1100delC variant has recently been identified at high frequency in families with both breast and colorectal cancer, suggesting the possible role of this variant in colorectal cancer predisposition. To evaluate the role of CHEK2 ll00delC among Swedish colorectal cancer patients, the variant frequency was determined in 174 selected familial cases, 644 unselected cases and 760 controls, as well as in l8 families used in the genome-wide linkage analysis, where weak linkage was seen for the region harboring the CHEK2 gene. CHEK2 l100delC was found in 1.15% of familial and in 0.93% of unselected cases, compared to 0.66% of controls, showing no significant difference between groups. One out of 45 familial cases with a family history of breast cancer was shown to be a carrier. The variant was not identified in the 18 families included in the linkage analysis. The CHEK2 1100delC was not significantly increased in Swedish colorectal cancer patients, however, in order to determine the role of the variant in colorectal cancer families with the history of breast cancer a larger sample size is needed.
    Anticancer research 01/2006; 26(6C):4885-8. · 1.71 Impact Factor
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    ABSTRACT: This study aimed to investigate the prevalence of genital prolapse surgery and urinary incontinence in female patients operated on for rectal prolapse compared with a matched control group without rectal prolapse. Fifty-two patients with a history of abdominal rectal prolapse surgery and 200 randomly selected age-matched and gender-matched control subjects without rectal prolapse received an extensive health care history survey. Response rate in the patient group was 48 of 52 (92 percent) and 165 of 200 (82 percent) in the control group. Rectal prolapse was associated with an increased risk of surgery for uterine prolapse (odds ratio = 3.1; 95 percent confidence interval = 1.4-6.9) and vaginal wall prolapse (odds ratio = 3.2; 95 percent confidence interval = 1.3-7.8). Mean age at hysterectomy because of uterine prolapse was 54.7 years in the patient group compared with 62.6 years in the control group (P < 0.01). Mean age at vaginal wall prolapse surgery was 60.2 years in the patient group compared with 66.6 years in the control group (P < 0.05). There were no significant differences between the cohorts regarding prevalence or age at debut of urinary incontinence. Our results indicate a strong association between rectal and genital prolapse surgery suggesting that diagnosis of rectal prolapse necessitating surgical intervention should prompt a multidisciplinary pelvic floor assessment.
    Diseases of the Colon & Rectum 01/2006; 49(1):28-35. · 3.34 Impact Factor
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    ABSTRACT: This study was designed to evaluate rectocele repair using collagen mesh. 32 female patients underwent surgical repair using collagen mesh. Outcome was assessed in 29 patients and preoperative assessment included standardized questionnaire, clinical examination, and defecography. At the six-month follow-up, patients answered a standardized questionnaire and underwent clinical examination. At the 12-month follow-up, patients answered a standardized questionnaire, underwent clinical examination, and defecography. Preoperatively, 26 patients had a Stage II and 3 patients had a Stage III rectocele. At the 6-month follow-up, five patients had rectocele > or = Stage II (P < 0.001) and at the 12-month follow-up, seven patients had rectocele > or = Stage II (P < 0.001) at clinical examination. At the preoperative defecography, all patients presented a rectocele. At the 12-month defecography, 14 patients had no rectocele (P < 0.001) and 15 had a rectocele. At the six-month follow-up, there was a significant decrease in rectal emptying difficulties, need of digital support of the posterior vaginal wall at defecation, and defecation frequency. At the 12-month follow-up, symptom improvement remained, but was less pronounced. Rectocele repair using collagen mesh improved anatomic support, but there is a substantial risk for recurrence with unsatisfactory anatomic and functional outcome one year after surgery. Rectocele repair using mesh was not associated with an increased risk of dyspareunia. Rectocele repair using biomaterial mesh reinforcement needs further evaluation before adopted into clinical practice.
    Diseases of the Colon & Rectum 06/2005; 48(6):1233-41; discussion 1241-2; author reply 1242. · 3.34 Impact Factor
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    Fredrik Hjern
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    ABSTRACT: ABSTRACT Objective: The aims of this thesis were to evaluate the influence of ethnicity and other socio- demographic factors on the rate of diverticular disease (DD) (Paper I), to compare findings specific for DD and ,acceptance of CT Colonography (CTC) and conventional Colonoscopy (CC) in patients examined after diverticulitis (AD) (Paper II), to evaluate the value of antibiotics inconservative,treatment of patients ,with mild AD (Paper III) and to study ,patients with diverticular fistulas to the female genital tract (Paper IV). Methods: In paper I, Swedish national registers with information about health and socio- demographic,indicators were used to study ethnicity and other socio-demographic factors and

Publication Stats

226 Citations
67.78 Total Impact Points

Institutions

  • 2006–2012
    • Karolinska Institutet
      • • Institutionen för kliniska vetenskaper, Danderyds sjukhus
      • • Department of Surgery
      Solna, Stockholm, Sweden
  • 2006–2011
    • Danderyds Sjukhus AB
      Tukholma, Stockholm, Sweden