PhD-students - surgery

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A -F

Zeeshan Ateeb
 

Zeeshan Ateeb
zeeshan.ateeb@ki.se

Supervisors
Marco Del Chiaro, Stephan Haas, Urban Arnelo, Matthias Löhr

Title of the project
Improvement of the diagnosis and management of cystic tumors of the pancreas

My Blohm
 

My Blohm
my.blohm@ki.se

Handledare
Gabriel Sandblom, Lars Enochsson, Johanna Österberg, Mats Hedberg

Projekttitel
Treatment of cholelithiasis and acute cholecystitis

Melroy Desouza
 

Melroy Alistair D'souza, specialistläkare
melroy.dsouza@karolinska.se

Supervisors 
Bengt Isaksson, Mikael Björnstedt, Greg Nowak

Title of the project
Hepatic ischaemia-reperfusion injury

Summary
Improved understanding of liver anatomy, advances in peri-operative care and better surgical techniques have resulted in a remarkable increase in the number and complexity of liver resections being performed. A number of techniques have been used to reduce intra-operative blood loss during hepatectomy, involving interruption of the blood supply to the liver for eg. the Pringle maneuver. These and other intra-operative manouvers during liver resection and transplantation can cause hepatic ischemia and subsequent reperfusion injury to the liver so called IR injury. This impacts directly on liver viability with consequences ranging from mild organ dysfunction to liver failure. Studying the effects of ischemia-reperfusion injury on liver metabolism can be useful to:

Understand the effect of various operative manouvers on the hepatic metbolism.
Correlate metabolic alterations with clinical outcome after hepatic surgery
To establish safety of various clamping manouvers during liver surgery
Modify intra and post-operative strategies to reduce IR injury in the liver.

The studies will aim to define the metabolic and cellular changes that accompany hepatic IR injury. This will be achieved by employing techniques like microdialysis to measure and monitor levels of various metabolites in the liver during and after ischemic periods induced by various manouvers. In addition the changes occurring at a cellular level in terms of ultrastructural changes, gene expression and enzyme system activation will also be studied.


 

Peter Elbe
peter.elbe@ki.se

Supervisors
Mats Lindblad, Lars Lundell, Anders Thorell

Title of the project
Metaplastiska och dysplastiska förändringar I esophagus: Hur kan vi förebygga återkomst efter endoskopisk ablationsbehandling?

Jessica Ericson
 

Jessica Ericson
jessica.ericson@ki.se

Supervisors
Ioannis Rouvelas, Magnus Nilsson, Mats Lindblad

Title of the project
Pre- och postoperativa effekter för patienter med esofaguscaner avseende dysfagiutveckling, nutrition och fysisk återhämtning/Pre- and postoperative effects for patients suffering from oesophageal cancer regarding dysphagia, nutrition and physical rehabilitation.

G - I


 

Poya Ghorbani
poya.ghorbani@ki.se

Supervisors
Lovisa Strömmer, Kjetil Gorseth Ringdahl, Anders Ekbom

Title of the project
Quality of care in two Scandinavian trauma centers - outcome and process indicators

Stefan Gilg

Stefan Gilg, ST-läkare
stefan.gilg@ki.se

Supervisors 
Bengt Isaksson, Greg Nowak, Cecilia Strömberg, Mikael Björnstedt

Title of the project
New markers of liver injury and intravenous hepatic microdialysis for monitoring liver function

Summary
Today liver resection is the accepted gold standard for treatment of liver tumors. Over the last decades progress in liver surgery has improved the outcome for all types of liver resections and has extended the limits of resectability. Simultaneously, mortality after hepatic resection has steadily decreased and its incidence ranges today between 2% and 5%. However, postoperative liver failure (PLF) remains the most frequent life-threatening complication after liver surgery with a reported incidence up to 9%. PLF causes prolonged stay in intensivecare units, prolonged hospitalisation and up to 4 times higher overall treatment costs. The major risk factors for postoperative liver failure are comorbid conditions, a pre-existent liver disease and a small remnant liver volume after surgery. However, until today the mechanisms leading to liver failure after partial hepatectomy remain incompletely understood. So, further elucidation of the mechanisms contributing to liver injury and consecutive liver failure after liver resection are crucial and would be highly beneficial.

Aims of the project
The aim of the research plan is:

  • to investigate the incidence of post-operative liver failure and to identify predictive factors related to it
  • to identify new markers of liver function with predictive value to liver failure
  • to evaluate intravenous hepatic microdialysis as an alternative to intraparenchymal hepatic microdialysis in experimental and clinical settings

 

Truls Gråberg
truls.graberg@ki.se

Supervisors
Lovisa Strömmer, Ann-Charlott Wikström, Ewa Ehrenborg

Title of the project
Intracellulär metabolism och inflammation I samband med kirurgisk stress

Erik Haraldsson
 

Erik Haraldsson, forskarstuderande, överläkare kirurgkliniken, Skövde
erik.haraldsson@ki.se

Supervisors 
Urban Arnelo, Matthias Löhr, Kjell-Arne Ung

Title of the project
The Papilla of Vater, Issues relevant to transpapillary cannulation and clinical management.

Summary

This clinical research project will address several aspects pertaining to the papilla of Vater, with its central role in the endoscopic treatment of pancreatobiliary disorders.

In the literature there is no previous attempt to make a validated classification of the appearance of the papilla of Vater. This we believe is a weakness when comparing studies concerning ERCP and cannulation. In the first part of this research project we will make a classification of different papillae based on how they look thru the duodenoscope. At the same time measuring cannulation, with a structured protocol to see if there is a correlation between cannulation difficulties and certain kinds of papillae.

To validate our classification we will test it on experienced ERCP operators in different centres in Scandinavia. The classification can then be used as an important tool in further research into the field of ERCP and cannulation.

Next we will dig further into the problem of cannulation. There are previous studies indicating that fat ingestion before ERCP may shorten the time to successful cannulation. The third part of this research project will be a prospective randomized multicentre trial to investigate the potential benefits of fat ingestion prior to ERCP.

The last 2 parts will evaluate new endoscopic treatment options of diseases in the papilla of Vater. Endoscopic papillectomy is a new technique that still is under constant development. This has been evaluated internationally previously but not in Scandinavia. The fourth part of this research project will retrospectively and prospectively evaluate the outcome after endoscopic papillectomy at Karolinska Huddinge both clinically and histopathologically.

The last part of this project will evaluate the use of ERCP to examine the papilla of Vater in patients with cryptogenic recurrent acute pancreatic and chronic pancreatitis of unknown origin. Recurrent acute pancreatitis is a troublesome condition especially when the underlying explanation is not discovered. The aim of this last part is to examine patients, with no obvious explanation for recurrent pancreatitis in crossectional imaging or laboratory parameters, endoscopically to see if there is pathology in the papilla of Vater and endoscopically treat the pathologies.

endoskopiskt, för att värdera om det finns patologi i papilla Vateri som kan behandlas endoskopiskt.

 

Katarina Hellberg
katarina.hellberg@ki.se

Supervisors
Ulf Gunnarsson, Bengt Glimelius, Jonas Lundkvist

Title of the project
Kostnadsanalys och resursförbrukning vid behandling av kolorektal cancer.

J - L

Gona Jaafar

Gona Jaafar, ST-läkare
gona.jaafar@karolinska.se

Supervisors 
Gabriel Sandblom, Folke Hammarqvist, Omid Sadr-Azodi

Title of the project
Management of gallbladder perforation and cholecystitis

Summary
The project study use of prophylactic antibiotic in acute cholecystectomy and the benefit of it. The result adjusted for cofounders. Although study short and long term effect of gallbladder perforation. The projects are register based and randomized controlled study.

Jeanna Joneberg

Jeanna Joneberg
jeanna.joneberg@ki.se

Supervisors
Cecilia Strömberg, Bengt Isaksson, Anders Jansson, Eduard Jonas

Title of the project
Studies on bile leakage after hepatic resection

 

Magnus Konradsson
magnus.konradsson@ki.se

Handledare
Magnus Nilsson, Mats Lindblad, Anders Ekbom, Pernilla Lagergren

Projekttitel
Gastric outlet obstruction after esophagectomy: Epidemiology , diagnosis  and treatment

Maximilian Kordes

Maximilian Kordes
maximilian.kordes@ki.se

Handledare
Matthias Löhr, Samir El-Andaloussi, Maria Gustafsson Liljefors, Rainer Heuchel

Projekttitel
Functional and structural features of extracellular vesicles in  pancreatic adnenocarcinoma and implications for cell-cell interaction

Chih-Han Kung

Chih-Han Kung
chih-han.kung@ki.se

Supervisors 
Jon Tsai, Mats Lindblad, Magnus Nilsson

Title of the project
Outcome of gastric cancer surgery in Sweden

 

Xuan Li
xuan.li@ki.se

Supervisors 
Rainer Heuchel, Matthias Löhr, Philipp Jungebluth, Caroline Verbeke

Title of the project
The role of the pro-fibrotic transforming growth factor-β (TGF-β) and its major negative regulator Smad7 during chronic pancreatitis

Jeanne Lubbe

Jeanne Lubbe
jeanne.lubbe@ki.se

Supervisors
Lars Enochsson, Eduard Jonas, Urban Arnelo, Sam Moore

Title of the project
Aspects on advanced procedure during endoscopic retrograd cholangiopancreatography for complex hepatobiliary disorders

 

Per Lundquist
per.lundquist@ki.se

Supervisors 
Greger Lindberg, Svante Sjöstedt

Title of the project
 

M - O

Anonym kvinna

Mahboubeh Mehrabi, specialist i kirurgi
mahboubeh.mehrabi@karolinska.se

Supervisors 
Folke Hammarqvist, Olav Rooyacker, Ralf Segersvärd, Åke Andrén-Sandberg

Title of the project
Development of new treatment concept in patient with mild pancreatitis with focus on prediction and nutrition.

Summary

Pancreatitis, inflammation of the pancreas, is a common diagnosis with an incidens of around 30/100.000 inhabitants and year. The clinical symptoms vary from a mild to a more uncommon severe form associated with multiple organ failure and increased mortality. Pancreatitis is associated with a catabolic condition with inflammation, enhanced stressresponse and the patients are often treated with fasting. This leads to a negative energy balance with possibly negative consequences regarding muscle strength, immune competence and prolonged convaelscent period. Even though patients with pancreatitis today are treated with fasting there is a common consensus that early oral intake does not impair the clinical course.

In the present research project early prognostic markers of the development in pancreatitis will be evaluated. Hereby the risk for a patient to develop a more severe form of pancreatitis will be identified. Patients without risk of developing a severe form of pancreatitis will be studied in a new concept including nutrition where the patients themselves determine when and how much to eat. In the study the energy-balance over time, the relations between patients characteristics, inflammatory response, thermal losses and substrate oxidation will be determined.

If patients with a milder form of pancreatitis can be treated with early oral nutrition it is possible that energylosses and catabolism can be reduced with positive effects on the clinical course and during the convalescence period.

The research project will furthermore assess the possibilities to safely treat patients with milder forms of pancreatitis in a non-invasive way, without infusions and injections in a first step to treat the mild form in an outward form. Patients with a milder form of pancreatitis will be identified according to the HAPS-score (Harmless acute pancreatitis score)and treated in with a non-invasive regimen. Patientexperience parameters will be monitored. It is plausible that this new concept will lead to shorter hospital stay and improved recovery.

Linnéa Malgerud

Linnéa Malgerud
linnea.malgerud@ki.se

Supervisors 
Matthias Löhr, Rainer Heuchel, Henrik Grönberg, Marco del Chiaro

Title of the project
Personalised pancreatic cancer: Individualized, evidence based treatment 

Ann Morgell

Ann Morgell
ann.morgell@sll.se

Handledare
Marco del Chiaro, Matthias Löhr, Markus Maeurer, Urban Arnelo

Projekttitel
Preemptive pancreatic surgery

Klara Nilsson

Klara Nilsson
klara.nilsson@ki.se

Handledare
Magnus Nilsson, Fredrik Klevebro, Mats Lindblad

Projekttitel
Aspects of the timing of surgical resection after neoadjuvant chemoradiotherapy in treatment of esophageal cancer

 

Jessica Norberg
jessica.norberg@ki.se

Supervisors 
Matthias Löhr, Rainer Heuchel, Arne Östman

Title of the project
The Reactive stroma in Pancreatic Diseases

 

Bengt Novik
bengt.novik@ki.se

Supervisors 
Lars Enochsson, Jan Dalenbäck

Title of the project
 

Ninos Oussi

Ninos Oussi
ninos.oussi@ki.se

Supervisors 
Lars Enochsson, Lars Henningsohn, Markus Castegren, Ann Kjellin

Title of the project
Is it all about the money? The effects of low and high cost simulator training scenarios in surgical training.

P - R

Saga Persson

Saga Persson
saga.persson@ki.se

Supervisors 
Jon Tsai, Mats Lindblad, Magnus Nilsson

Title of the project
Application of esophageal stents in benign and malignant conditions


 

Agnieszka Popowicz
agnieszka.popowicz@ki.se

Supervisors
Gabriel Sandblom, Folke Hammarqvist, Lars Lundell, Amir Babiker

Title of the project
Percutaneus drainage or surgery in patients with acute cholecystitis.

Elena Rangelova

Elena Rangelova, ST-läkare
elena.rangelova@karolinska.se

Supervisorse 
Ralf Segersvärd, Med Dr, Åke Andrén-Sandberg

Title of the project
Prevalence and mechanisms of malabsorption in patients with pancreatic cancer.

Summary

Pancreatic cancer is a disease with dismal prognosis despite improved surgical care and new adjuvant oncological treatments. Most patients experience a significant weight loss which reduces the patients ability to tolerate therapy and affect both short and long term prognosis in a negative way. An increase in food intake, orally or parenterally, together with the replacement of pancreatic enzymes cannot influence this weight loss. The underlying mechanisms are not fully understood but often an elevated inflammatory response, induced by the tumor, is observed which affects the metabolism in a catabolic direction. Malabsorption of the small intestine can be a significant component of such involuntary weight loss and may be an indirect indicator to a pro-inflammatory disorder of the bowel which in turn, upregulates the systemic immune response and thus the patient's prognosis negative. There are few studies which suggest that pancreatic cancer patients have a primary malabsorption in the small intestine, not seen in eg benign chronic pancreatitis. On the other hand it has been observed that patients who suffer from disorders of the gut immune response often has a faulty intestinal absorption and permeability. Whether removal of the tumor improves malabsorption and gut immunity as a sign of a tumor induced disturbance is not studied. More knowledge about the existence, significance and underlying mechanisms behind malabsorption in pancreatic cancer patients is needed to develop new treatment strategies (eg immunonutrition) in hope of improving the prognosis for these very ill patients with pancreatic cancer.

  1. To investigate the prevalence of and underlying mechanisms of malabsorption and cachexia and sarcopenia with focus on intestinal immunity in patients with pancreatic cancer the following will be done:
  2. To assess the prevalence of malnutrition/sarcopenia and outcome in patients undergoing pancreatic resections with and without pancreatic ductal adenocarcinoma and its association with tumor diagnosis and stage, presence of systemic inflammatory response, body mass index and age.
  3. To assess the prevalence of intestinal malabsorption / permeability and its association with tumor stage, presence of systemic inflammatory response, severity of malnutrition, sarcopenia, body mass index and age, in patients with pancreatic ductal adenocarcinoma.
  4. To investigate if intestinal malabsorption / permeability is associated with the pancreatic tumor itself, i.e. do they change after surgical removal of the tumor (but not after eg palliative surgical bypass).
  5. Investigate through immunohistochemistry and expressionanalysis changes in the local immunity of the small bowel, predominantly cell-mediated immunity and expression of inflammatory mediators such as IL6 and IL8.

 

Dan Razavi
dan.razavi@ki.se

Supervisors
 

Title of the project
 


Marcus Reuterwall Hansson

Marcus Reuterwall Hansson
marcus.reuterwall.hansson@ki.se

Supervisors
Urban Arnelo, Matthias Löhr, Marco Del Chiaro, Annika Bergquist

Title of the project
Endoscopic Diagnosis, Staging and Surveillance of Neoplasms in the Bile Ducts, Liver and Pancreas


 

Hanna Ribbing Wilén
hanna.ribbing.wilen@ki.se

Supervisors
Per-Olof Nyström, Leif Törkvist, Johannes Blom, Mauro Dámato

Title of the project
Kirurgi vid inflammatorisk tarmsjukdom: Crohns sjukdom, klinik, utfall, komplikationer och genetiska aspekter

S - U

Johanna Samola Winnberg

Johanna Samola Winnberg
johanna.samola.winnberg@ki.se

Handledare
Mats Lindblad,  Annika Lindblom, Magnus Nilsson, Krister Sjödal

Projekttitel
Hereditary ventricular cancer

Srinivas Sanjeevi

Srinivas Sanjeevi
srinivas.sanjeevi@ki.se

Supervisors
Christoph Ansorge, Marco del Chiaro, Eduard Jonas

Title of the project
Advances in the surgical management of pancreatic cancer


 

Richard Shore
richard.shore@ki.se

Supervisors
 

Title of the project
 


Sebastian Sjöqvist

Sebastian Sjöqvist
sebastian.sjoqvist@ki.se

Supervisors
Matthias Löhr, Magnus Nilsson

Title of the project
Regenerative medicine approaches to reduce the risk of strictures after endoscopic interventions of the esophagus


Harald Söderbäck

Harald Söderbäck
harald.soderback@ki.se

Supervisors
Gabriel Sandblom, Ulf Gunnarsson, Per Hellman

Title of the project
Bukväggsförslutning vid högriskkirurgi


Berit Sunde

Berit Sunde
berit.sunde@ki.se

Supervisors
Magnus Nilsson, Mats Lindblad, Pernilla Lagergren, Jon Tsai

Title of the project
Studies on health related quality of life with a special reference to swallowing function in patients treated for carcinoma of the esophagus and gastro-esophageal junction


John Thörling

John Thörling
john.thorling@ki.se

Supervisors
Folke Hammarqvist, Olle Ljungqvist, Olof Sköldenberg

Projekttitel
Aspects of glucose metabolism in acute surgical and orthopedic patients

V - Ö


 

Linn Westin
linn.westin@ki.se

Supervisors
Ursula Dahlstrand, Ulf Gunnarsson, Gabriel Sandblom

Projekttitel
Inguinal hernia - optimizing surgical treatment.

Surgery