Ulf Erik Kongsgaard

• Kongsgaard, Ulf Erik; Menchini, Robin Johansen; Larsen, Stein Gunnar & Juul-Hansen, Knut Erling (2024). Skin conductance algesimeter is unreliable during sudden perioperative temperature increases. Scandinavian Journal of Pain. ISSN 1877-8860. 24(1). doi: 10.1515/sjpain-2023-0106. Full text in Research Archive Show summary

  Objectives Pain assessment in anesthetized and non-communicative patients remains a challenge. Clinical signs such as tachycardia, hypertension, sweat and tears, have a low specificity for pain and should therefore ideally be replaced by more specific monitoring techniques. Skin conductance variability has been demonstrated to establish a patients’ sensitivity to pain, but may be influenced by temperature changes that leads to profuse sweating. The aim of this pilot study was to test skin conductance changes during sudden temperature changes due to hyperthermic intraperitoneal chemotherapy (HIPEC) perfusation. Methods We investigated skin conductance algesimeter (SCA) in ten consecutive patients undergoing cytoreductive surgery and HIPEC. Results from the SCA was compared to other standard physiological variables at seven time points during the surgical procedure, in particular during the period with hyperthermic intraabdominal perfusion leading to an increase in the patients core temperature. Results Nine out of ten patients had an increase in the SCA measurements during the HIPEC phase correlating the increase in temperature. Conclusion SCA is unreliable to detect increased pain sensation during sudden perioperative temperature changes in adult patients. Keywords: pain; anaesthesia; intraoperative monitoring; skin conductance; body temperature changes

• Larsen, Camilla Kjellstad; Smiseth, Otto Armin; Duchenne, Jürgen; Galli, Elena; Aalen, John & Lederlin, Mathieu [Show all 13 contributors for this article] (2023). Cardiac Magnetic Resonance Identifies Responders to Cardiac Resynchronization Therapy with an Assessment of Septal Scar and Left Ventricular Dyssynchrony. Journal of Clinical Medicine. 12(22). doi: 10.3390/jcm12227182. Full text in Research Archive Show summary

  Background: The response to cardiac resynchronization therapy (CRT) depends on septal viability and correction of abnormal septal motion. This study investigates if cardiac magnetic resonance (CMR) as a single modality can identify CRT responders with combined imaging of pathological septal motion (septal flash) and septal scar. Methods: In a prospective, multicenter, observational study of 136 CRT recipients, septal scar was assessed using late gadolinium enhancement (LGE) (n = 127) and septal flash visually from cine CMR sequences. The primary endpoint was CRT response, defined as ≥15% reduction in LV end-systolic volume with echocardiography after 6 months. The secondary endpoint was heart transplantation or death of any cause assessed after 39 ± 13 months. Results: Septal scar and septal flash were independent predictors of CRT response in multivariable analysis (both p < 0.001), while QRS duration and morphology were not. The combined approach of septal scar and septal flash predicted CRT response with an area under the curve of 0.86 (95% confidence interval (CI): 0.78–0.94) and was a strong predictor of long-term survival without heart transplantation (hazard ratio 0.27, 95% CI: 0.10–0.79). The accuracy of the approach was similar in the subgroup with intermediate (130–150 ms) QRS duration. The combined approach was superior to septal scar and septal flash alone (p < 0.01). Conclusions: The combined assessment of septal scar and septal flash using CMR as a single-image modality identifies CRT responders with high accuracy and predicts long-term survival.

• Lindemann, Kristina Yvonne Kathe; Kleppe, Andreas; Eyjólfsdóttir, Brynhildur; Danbolt, Svana Heimisdottir; Wang, Yun Yong & Heli-Haugestøl, Anne Gjertine [Show all 12 contributors for this article] (2023). Prospective evaluation of an enhanced recovery after surgery (ERAS) pathway in a Norwegian cohort of patients with suspected or advanced ovarian cancer. International Journal of Gynecological Cancer. ISSN 1048-891X. 33(8), p. 1279–1286. doi: 10.1136/ijgc-2023-004355. Full text in Research Archive Show summary

  Objective This prospective cohort study evaluated the introduction of an enhanced recovery after surgery (ERAS) pathway in a tertiary gynecologic oncology referral center. Compliance and clinical outcomes were studied in two separate surgical cohorts. Methods Patients undergoing laparotomy for suspected or verified advanced ovarian cancer at Oslo University Hospital were prospectively included in a pre- and post-implementation cohort. A priori, patients were stratified into: cohort 1, patients planned for surgery of advanced disease; and cohort 2, patients undergoing surgery for suspicious pelvic tumor. Baseline characteristics, adherence to the pathway, and clinical outcomes were assessed. Results Of the 439 included patients, 235 (54%) underwent surgery for advanced ovarian cancer in cohort 1 and 204 (46%) in cohort 2. In cohort 1, 53% of the patients underwent surgery with an intermediate/high Aletti complexity score. Post-ERAS, median fasting times for solids (13.1 hours post-ERAS vs 16.0 hours pre-ERAS, p<0.001) and fluids (3.7 hours post-ERAS vs 11.0 hours pre-ERAS, p<0.001) were significantly reduced. Peri-operative fluid management varied less and was reduced from median 15.8 mL/kg/hour (IQR 10.8–22.5) to 11.5 mL/kg/hour (IQR 9.0–15.4) (p<0.001). In cohort 2 only there was a statistically significant reduction in length of stay (mean (SD) 4.3±1.5 post-ERAS vs 4.6±1.2 pre-ERAS, p=0.026). Despite stable readmission rates, there were significantly more serious complications reported in cohort 1 post-ERAS. Conclusions ERAS increased adherence to current standards in peri-operative management with significant reduction in fasting times for both solids and fluids, and peri-operative fluid administration. Length of stay was reduced in patients with suspicious pelvic tumor. Despite serious complications being common in patients with advanced disease undergoing debulking surgery, a causal relationship with the ERAS protocol could not be established. Implementing ERAS and continuous performance auditing are crucial to advancing peri-operative care of patients with ovarian cancer.

• Thaulow, Cecilie Hasselø; Helland, Arne; Kongsgaard, Ulf Erik & Høiseth, Gudrun (2023). Oxycodone, Morphine, and Fentanyl in Patients with Chronic Pain: Proposal of Dose-Specific Concentration Ranges. Therapeutic Drug Monitoring. ISSN 0163-4356. 45(6), p. 777–785. doi: 10.1097/FTD.0000000000001112. Full text in Research Archive Show summary

  Background: Interpreting opioid concentrations is challenging because of the lack of reference ranges. Therefore, the authors aimed to propose dose-specific concentration ranges in serum for oxycodone, morphine, and fentanyl in patients with chronic pain, based on concentration measurements from a large number of patients and supported by theoretical pharmacokinetic calculations and previously published concentrations. Methods: The opioid concentrations in patients undergoing therapeutic drug monitoring (TDM) for various indications (TDM group) and patients with cancer (cancer group) were investigated. Patients were divided based on the daily opioid doses, and the 10th and 90th percentiles of the concentrations in each dose interval were evaluated. In addition, the expected average serum concentrations were calculated for each dose interval based on published pharmacokinetic data, and a targeted literature search for previously reported dose-specific concentrations was performed. Results: The opioid concentrations in 1054 patient samples were included: 1004 in the TDM group and 50 in the cancer group. In total, 607 oxycodone, 246 morphine, and 248 fentanyl samples were evaluated. The authors proposed dose-specific concentration ranges based mainly on 10th–90th percentiles of the concentrations measured in patient samples, whereas the calculated average concentrations and previously published concentrations were used to adjust the ranges. In general, results from calculations and concentrations retrieved from previous literature were within the 10th–90th percentiles of concentrations from patient samples. However, the lowest calculated average concentrations of fentanyl and morphine were below the 10th percentiles of patient samples in all dose groups. Conclusions: The proposed dose-specific ranges may be useful for interpreting steady-state opioid serum concentrations in clinical and forensic settings.

• Lindemann, Kristina Yvonne Kathe; Danbolt, Svana Heimisdottir; Ramberg, Lene Kristine Marsby; Eyjólfsdóttir, Brynhildur; Wang, Yun & Heli-Haugestøl, Anne Gjertine [Show all 15 contributors for this article] (2023). Patient-reported nausea after implementation of an enhanced recovery after surgery protocol for gynae-oncology patients. International Journal of Gynecological Cancer. ISSN 1048-891X. 33(8), p. 1287–1294. doi: 10.1136/ijgc-2023-004356. Full text in Research Archive Show summary

  Objectives This study aimed to analyze the adherence to strategies to prevent post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) protocol for gynae-oncology patients. Patient-reported nausea before and after ERAS was also studied. Methods This prospective observational study included all patients undergoing laparotomy for a suspicious pelvic mass or confirmed advanced ovarian cancer before (pre-ERAS) and after the implementation of ERAS (post-ERAS) at Oslo University Hospital, Norway. Patients were a priori stratified according to the planned extent of surgery into two cohorts (Cohort 1: Surgery of advanced disease; Cohort 2: Surgery for a suspicious pelvic tumor). Clinical data including baseline characteristics and outcome data were prospectively collected. Results A total of 439 patients were included, 243 pre-ERAS and 196 post-ERAS. At baseline, 27% of the patients reported any grade of nausea. In the post-ERAS cohort, statistically significantly more patients received double post-operative nausea and vomiting prophylaxis (64% pre-ERAS vs 84% post-ERAS, p<0.0001). There was no difference in the need for rescue medication (82% pre-ERAS vs 79% post-ERAS; p=0.17) and no statistically significant difference between pre- and post-ERAS or between the surgical cohorts in patient-reported nausea of any grade on day 2. Patients who reported none/mild nausea on day 2 had significantly less peri-operative fluid administered during surgery than those who reported moderate or severe nausea (median 12.5 mL/kg/hour vs 16.5 mL/kg/hour, p=0.045) but, in multivariable analysis, fluid management did not remain significantly associated with nausea. Conclusion Implementation of an ERAS protocol increased the adherence to post-operative nausea and vomiting prevention guidelines. Nausea, both before and after laparotomy, remains an unmet clinical need of gynae-oncology patients also in an ERAS program. Patient-reported outcome measures warrant further investigation in the evaluation of ERAS.

• Eiding, Helge; Røise, Olav & Kongsgaard, Ulf (2022). Potentially Severe Incidents During Interhospital Transport of Critically Ill Patients, Frequently Occurring But Rarely Reported: A Prospective Study. Journal of patient safety. ISSN 1549-8417. 18(1), p. E315–E319. doi: 10.1097/PTS.0000000000000769. Full text in Research Archive Show summary

  Objectives The out-of-hospital environment can pose significant challenges to the quality and safety of interhospital transport of critically ill patients. Because we lack knowledge of the occurrence of incidents, their potential consequences, and whether they are actually reported, this study was initiated. Methods Two different services in Norway were asked to self-report incidents after every interhospital transport of critically ill patients. Sampling lasted for 12 and 8 months, respectively. An expert group evaluated each incident for severity and demand for reporting into the hospital’s electronic incident reporting system. One year later, the hospital’s reporting system was scrutinized to determine the number of incidents actually reported. Results A total of 455 transports of critically ill patients were performed, resulting in 294 unique incidents reported: medical (15%), technical (25%), missing equipment (17%), and personal failures and communication difficulties (42%). Only 3 (1%) of the 294 unique incidents were actually reported in the hospital’s electronic incident reporting system. The experts were inconsistent in which incidents should have been reported and to what degree checklists, standard operating procedures, simulation, and training could have prevented the incidents. Conclusions This study of interhospital transports of critically ill patients reveals a very high number of incidents. Despite this fact, these incidents are severely underreported in the hospital’s electronic incident reporting system. This suggests that learning is lost and errors with predominant probability are repeated. These results emphasize the existing challenges in regard to the quality and safety of interhospital transport of critically ill patients.

• Eiding, Helge; Kongsgaard, Ulf; Olasveengen, Theresa M. & Heyerdahl, Fridtjof (2021). Interhospital transport of critically ill patients: A prospective observational study of patient and transport characteristics. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. p. 1–8. doi: 10.1111/aas.14005. Full text in Research Archive
• Kongsgaard, Ulf & Høiseth, Gudrun (2019). Dynamic assessment of the pupillary reflex in patients on high-dose opioids. Scandinavian Journal of Pain. ISSN 1877-8860. 19(3), p. 465–471. doi: 10.1515/sjpain-2019-0032. Full text in Research Archive Show summary

  Background and aims Pupil size and reaction are influenced by opioids, an effect that is not considered to be affected by opioid tolerance. As clinicians have observed patients on high-dose opioids who exhibited seemingly normal pupil sizes, we wanted to dynamically assess the pupillary reflex in cancer patients on high-dose opioids. Methods We performed a dynamic assessment of the pupillary reflex in cancer patients on high-dose opioids and a control group of healthy volunteers using a portable, monocular, infrared pupillometer. We also performed a clinical examination and measured blood concentrations of opioids and their active metabolites. Results Sixty three patients who were on opioids for 2 months (median time) and on an oral morphine equivalent dose of 250 mg (median dose) were investigated. Most patients used more than one opioid. When correcting for age, pupil size in the group that had received no increase of opioid dose over the last 14 days was not significantly different from pupil size in the healthy volunteer group (p = 0.76), while the group that had increased the dose of opioids differed significantly from healthy volunteers (p = 0.006). We found no statistically significant correlation between total oral morphine equivalents and pupillary reactions or between blood opioid or opioid metabolite concentrations and baseline pupillary changes. Conclusion Pupillary changes do take place in patients on opioids. However, tolerance to these changes occurs when medication is not increased over time. Dynamic pupillometry can give additional information about the degree of tolerance to opioids. Implications These findings elucidate previous misconceptions regarding pupillary effects and tolerance to opioids.

• Eiding, Helge; Kongsgaard, Ulf & Næss, Anne-Cathrine Braarud (2019). Interhospital transport of critically ill patients - experiences and challenges, a qualitative study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 27:27, p. 1–9. doi: 10.1186/s13049-019-0604-8. Full text in Research Archive Show summary

  Background No consensus based national standard for interhospital transports of critically ill patients exists in Norway. The local hospitals are responsible for funding, organizing and performing these transports, resulting in potentially different level of care for the critically ill patients depending on local hospital resources and not the level of severity in the patient’s condition. The aim of this study was to examine how these transports are executed and to discover challenges during transports and potentials of improvement. Methods A qualitative study with 20 semi-structured interviews of doctors, nurses and ambulance personnel representing a wide range in experience and formal education, reflecting the different compositions of crews performing interhospital transports was conducted. A systematic text condensation of the interviews was performed to describe personal experiences and values. Results Few interviewees reported special adverse events when asked. Instead they chose to describe more general characteristics of the working environment, their own positive emotions or fears and the strengths and weaknesses of the organizational system. The prehospital working environment was described as different from the in-hospital environment. The personnel experienced being on their own during transports, lack of procedures and checklists and often no systematic education or demanded preparedness for participating. The resident doctors described pressure from elderly colleagues to participate in the transports. At the same time, all interviewees reported a self-interest in participating in these transports. Conclusions Safe interhospital transports of the critically ill patients are challenged by the characteristics of the out of hospital environment. The transports are described as potentially unsafe for both patients and personnel. Systematic education is warranted, highlighting the use of checklists and special educational programs in prehospital critical care medicine. The strong personal interest to participate in these transports may serve as a barrier against changing todays system. To ensure the right level of competence and safety for each unique patient, it is imperative to standardize the interhospital transports on a national level, built on consensus from experienced prehospital personnel. Trial registration The trial is approved and registered by the local representative for the Norwegian Data Protection Authority as trial 13–7751.

• Langerud, Anne Kathrine; Rustøen, Tone; Småstuen, Milada C; Kongsgaard, Ulf & Stubhaug, Audun (2018). Intensive care survivor-reported symptoms: a longitudinal study of survivors' symptoms. Nursing in Critical Care. ISSN 1362-1017. 23(1), p. 48–54. doi: 10.1111/nicc.12330. Full text in Research Archive
• Hausken, John; Haave, Ellen M; Haugaa, Håkon; Løberg, Else Marit & Kongsgaard, Ulf (2018). A patient with solid gynecologic cancer causing lactic acidosis, severe hypercalcemia, and hypoglycemia. Clinical Case Reports. doi: 10.1002/ccr3.1904. Full text in Research Archive Show summary

  Though rare in cervical cancer patients, paraneoplastic syndrome usually presents with several endocrine and hormonal symptoms. Knowledge of the pathophysiology that underlies these abnormalities is beneficial to diagnosis and treatment. An interdisciplinary approach and test analysis prior to initiating specific treatment is recommended, though prognosis appears poor in advanced cases. Endocrine paraneoplastic syndromes occur in patients with malignant disease and are caused by tumor production of hormones or peptides leading to metabolic derangements. These syndromes are typically detected after cancer diagnosis,1,2 and physician knowledge about these syndromes is important for patient care.3 Herein, we report an unusual case of paraneoplastic syndrome with three different simultaneously occurring metabolic disturbances in a 45‐year‐old female with a solid gynecologic tumor.

• Langerud, Anne Kathrine; Rustøen, Tone; Småstuen, Milada C; Kongsgaard, Ulf & Stubhaug, Audun (2018). Health-related quality of life in intensive care survivors: Associations with social support, comorbidity, and pain interference. PLOS ONE. 13:e0199656(6). doi: 10.1371/journal.pone.0199656. Full text in Research Archive Show summary

  Background: Experiences during a stay in the intensive care unit (ICU), including pain, delirium, physical deterioration, and the critical illness itself, may all influence survivors’ health-related quality of life (HRQOL). However, few studies have examined the influence of social support, comorbidity, and pain interference on ICU survivors’ HRQOL. Objectives: To investigate possible associations between social support, number of comorbidities, and pain interference on HRQOL in ICU survivors. Methods: ICU survivors responded to a survey 3 months (n = 118) and 1 year (n = 89) after ICU discharge. HRQOL was measured using the Short Form Health Survey-12 (v1), social support using the revised Social Provision Scale, pain interference using the Brief Pain Inventory– Short Form, and comorbidities using the Self-Administered Comorbidity Questionnaire. Results: Physical and mental HRQOL were reduced at both 3 months and 1 year in ICU survivors compared with the general population. This reduction was more pronounced at 3 months for physical HRQOL, while a small reduction in mental HRQOL was not clinically relevant. Social support was statistical significantly positively associated with mental HRQOL at 3 months, while number of comorbidities was statistical significantly associated with a reduction in physical HRQOL at 3 months and 1 year and mental HRQOL at 1 year. Lastly pain interference was significantly associated with a reduction in physical HRQOL at 3 months and 1 year. Conclusions: ICU survivors primarily report reduced physical HRQOL. Social support was positively associated with mental HRQOL, while number of comorbidities, and pain interference were all significantly associated with a reduction in HRQOL. Pain interference was associated with the largest reduction in HRQOL.

• Langerud, Anne Kathrine; Rustøen, Tone; Brunborg, Cathrine; Kongsgaard, Ulf & Stubhaug, Audun (2018). Prevalence, Location,and Characteristics of Chronic Pain in Intensive Care Survivors. Pain Management Nursing. ISSN 1524-9042. 19(4), p. 366–376. doi: 10.1016/j.pmn.2017.11.005. Full text in Research Archive
• Kongsgaard, Ulf; Holtan, Anders & Perner, Anders (2018). Changes in colloid solution sales in Nordic countries. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 62(4), p. 522–530. doi: 10.1111/aas.13057. Full text in Research Archive
• Kongsgaard, Ulf (2018). Letter to the Editor regarding “CT guided neurolytic blockade of the coeliac plexus in patients with advanced and intractably painful pancreatic cancer”. Scandinavian Journal of Pain. ISSN 1877-8860. 18(4), p. 1–1. doi: 10.1515/sjpain-2018-0110. Full text in Research Archive
• Fornebo, Ida; Simonsen, K.A.; Bukholm, Ida Rashida Khan & Kongsgaard, Ulf (2017). Claims for compensation after injuries related to airway management: a nationwide study covering 15 years. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 61(7), p. 781–789. doi: 10.1111/aas.12914. Full text in Research Archive
• Hetmann, Fredrik; Kongsgaard, Ulf; Sandvik, Leiv & Bredal, Inger Schou (2017). Post-thoracotomy pain syndrome and sensory disturbances following thoracotomy at 6-and 12-month follow-ups. Journal of Pain Research. 10, p. 663–668. doi: 10.2147/JPR.S126639. Full text in Research Archive Show summary

  Background: Persistent pain affects a large proportion of patients after thoracotomy and is associated with sensory disturbances. The objective of this prospective study was to investigate the time course of pain and sensory disturbances over a 12-month period. Methods: Patients scheduled for thoracotomy were recruited. Data were collected on the day before surgery, including baseline characteristics and the presence of any preoperative pain. At 6- and 12-month follow-ups, data on pain were collected using the Brief Pain Inventory-Short Form, and perceived sensory disturbances around the thoracotomy scar were recorded from a self-exploration test. Results: At 12 months after surgery, 97 patients had complete data including baseline and 6- and 12-month measurements. Almost half of the patients reported post-thoracotomy pain at the follow-ups. However, 20% of the patients not reporting post-thoracotomy pain at 6 months did report it at 12 months. Between 40% and 60% of patients experienced some kind of sensory disturbance at 6 months. A small decline in some kind of sensory disturbance was reported by 20%–50% of patients at 12 months. Conclusion: A proportion of patients experienced either resolved or delayed onset of pain. Sensory changes were strongly associated with post-thoracotomy pain syndrome, but were also present in a large proportion of patients without it.

• Kongsgaard, Ulf; Fischer, Kristine; Pedersen, Tor Erlend; Bukholm, Ida Rashida Khan & Warncke, Torhild (2016). Klager etter nerveblokade til Norsk pasientskadeerstatning 2001-14 [Complaints to the Norwegian System of Patient Injury Compensation 2001 - 14 following nerve blockade]. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(23-24), p. 1989–1993. doi: 10.4045/tidsskr.16.0368. Full text in Research Archive
• Kongsgaard, Ulf & Werner, Mads U (2016). Tachyphylaxis to local anaesthetics. What is the clinical evidence? A systematic review. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 60(1), p. 6–14. doi: 10.1111/aas.12631. Full text in Research Archive
• Drewes, Asbjørn Mohr; Munkholm, Pia; Simrén, Magnus; Breivik, Harald; Kongsgaard, Ulf & Hatlebakk, Jan Gunnar [Show all 9 contributors for this article] (2016). Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction-Recommendations of the Nordic Working Group. Scandinavian Journal of Pain. ISSN 1877-8860. 11, p. 111–122. doi: 10.1016/j.sjpain.2015.12.005. Full text in Research Archive Show summary

  Background and aims Opioid-induced bowel dysfunction (OIBD) is an increasing problem due to the common use of opioids for pain worldwide. It manifests with different symptoms, such as dry mouth, gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation and incomplete evacuation. Opioid-induced constipation (OIC) is one of its many symptoms and probably the most prevalent. The current review describes the pathophysiology, clinical implications and treatment of OIBD. Methods The Nordic Working Group was formed to provide input for Scandinavian specialists in multiple, relevant areas. Seven main topics with associated statements were defined. The working plan provided a structured format for systematic reviews and included instructions on how to evaluate the level of evidence according to the GRADE guidelines. The quality of evidence supporting the different statements was rated as high, moderate or low. At a second meeting, the group discussed and voted on each section with recommendations (weak and strong) for the statements. Results The literature review supported the fact that opioid receptors are expressed throughout the gastrointestinal tract. When blocked by exogenous opioids, there are changes in motility, secretion and absorption of fluids, and sphincter function that are reflected in clinical symptoms. The group supported a recent consensus statement for OIC, which takes into account the change in bowel habits for at least one week rather than focusing on the frequency of bowel movements. Many patients with pain receive opioid therapy and concomitant constipation is associated with increased morbidity and utilization of healthcare resources. Opioid treatment for acute postoperative pain will prolong the postoperative ileus and should also be considered in this context. There are no available tools to assess OIBD, but many rating scales have been developed to assess constipation, and a few specifically address OIC. A clinical treatment strategy for OIBD/OIC was proposed and presented in a flowchart. First-line treatment of OIC is conventional laxatives, lifestyle changes, tapering the opioid dosage and alternative analgesics. Whilst opioid rotation may also improve symptoms, these remain unalleviated in a substantial proportion of patients. Should conventional treatment fail, mechanism-based treatment with opioid antagonists should be considered, and they show advantages over laxatives. It should not be overlooked that many reasons for constipation other than OIBD exist, which should be taken into consideration in the individual patient. Conclusion and implications It is the belief of this Nordic Working Group that increased awareness of adverse effects and OIBD, particularly OIC, will lead to better pain treatment in patients on opioid therapy. Subsequently, optimised therapy will improve quality of life and, from a socio-economic perspective, may also reduce costs associated with hospitalisation, sick leave and early retirement in these patients.

• Rosseland, Leiv Arne; Narum, Jon; Stubhaug, Audun; Kongsgaard, Ulf; Sorteberg, Wilhelm & Sorteberg, Angelika Gabriel (2015). The effect of tracheotomy on drug consumption in patients with acute aneurysmal subarachnoid hemorrhage: An observational study. BMC Anesthesiology. 15(47). doi: 10.1186/s12871-015-0029-5. Full text in Research Archive Show summary

  Background Patients with aneurysmal subarachnoid hemorrhage (aSAH) are common in intensive care units (ICU). In patients with aSAH, sedation is used as a neuroprotective measure in order to secure adequate cerebral perfusion pressure (CPP). Compared with the use of an endotracheal tube, a tracheotomy has the advantage of securing the airway at a much lower level of distress, and aSAH patients can often be awakened more rapidly. Little is known about the impact of tracheotomy on the consumption of sedative/analgesic and vasoactive drugs and the maintenance of CPP within defined limits in aSAH patients. Methods We conducted an observational study of aSAH patients who underwent percutaneous tracheotomy. A prospective registry of patient data was supplemented with retrospective retrievals from medical records. Sedative, analgesic and vasoactive drug doses were registered for 3 days prior to and after percutaneous tracheotomy, respectively. Blood pressure, CPP, and the mode of mechanical ventilation were registered 24 h prior to and after tracheotomy. Results Between January 2001 and June 2009, 902 aSAH patients were admitted to our hospital; 74 (8%) were deeply comatose/dying upon arrival. The ruptured aneurysm was repaired in 828 patients (surgical repair 50%) and percutaneous tracheotomy was performed 182 times in 178 patients (59 men and 119 women). This subpopulation (178 of 828 patients) was significantly older (56 vs. 53 years) and presented with a more severe Hunt & Hess grade (p < 0.001). Percutaneous tracheotomy caused a marked decline in mean daily consumption of the analgesics/sedatives fentanyl, midazolam, and propofol, as well as the vasoactive drugs noradrenaline and dopamine. These declines were statistically and clinically significant. The mean CPP was 76 mmHg (SD 8.6) the day before and 79 mmHg (SD 9.6) 24 h after percutaneous tracheotomy. After percutaneous tracheotomy, mechanical ventilatory support could be reduced to a patient-controlled ventilatory support mode in a significant number of patients (p < 0.001). Conclusions Percutaneous tracheotomy in aSAH patients is a swift procedure with low risk that is associated with a significant decline in the consumption of sedative/analgesic and vasoactive drugs while clinical surveillance parameters remain stable or improve.

• Switlyk, Marta Daniela; Kongsgaard, Ulf; Skjeldal, Sigmund; Hald, John K; Hole, Knut Håkon & Knutstad, Kjetil [Show all 7 contributors for this article] (2015). Prognostic factors in patients with symptomatic spinal metastases and normal neurological function. Clinical Oncology. ISSN 0936-6555. 27(4), p. 213–221. doi: 10.1016/j.clon.2015.01.002. Full text in Research Archive
• Hetmann, Fredrik; Kongsgaard, Ulf; Sandvik, Leiv & Bredal, Inger Schou (2015). Prevalence and predictors of persistent post-surgical pain 12 months after thoracotomy. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 59(6), p. 740–748. doi: 10.1111/aas.12532. Full text in Research Archive Show summary

  Background: Persistent post-surgical pain is recognised as a major problem. Prevalence after different surgical procedures has been reported to range from 5% up to 85%. Limb amputation and thoracotomy have the highest reported prevalence. Prediction of persistent post-surgical pain has over the last decade caught atten- tion. Several factors have been investigated, but in-depth knowl- edge is still scarce. The purpose of this study was to investigate the prevalence of persistent post-surgical pain, and predictive fac- tors for persistent post-surgical pain 12 months after thoracotomy. Methods: A prospective longitudinal study was conducted. One- hundred and seventy patients were recruited before scheduled thoracotomy, and asked to answer a questionnaire. One-hundred and six patients completed the same questionnaire at 12-month follow-up. Regression analysis was performed to explore vari- ables assumed predictive of persistent post-surgical pain. Results: One-hundred and six patients (62%) filled out the questionnaire at both time points. Preoperative, 34% reported muscle-skeletal related chronic pain. At 12-month follow-up, 50% of the patients reported persistent post-surgical pain. Of the vari- ables explored in the logistic regression model, only preoperative pain ( P < 0.001) and dispositional optimism ( P = 0.04) were sta- tistically significant. In this study, preoperative pain was a pre- dominant predictor for persistent postoperative pain (OR 6.97, CI 2.40 – 20.21), while dispositional optimism (OR 0.36, CI 0.14 – 0.96) seem to have protective properties. Conclusion: Our results show that preoperative pain is a pre- dominant predictor of future pain. This implies that patients pre- senting with a chronic pain condition prior to surgery should be assessed thoroughly preoperatively and have an individually tailored analgesic regimen.

• Kongsgaard, Ulf; Eeg, Martin & Greisen, Hanna (2014). The use of Instanyl® in the treatment of breakthrough pain in cancer patients: A 3-month observational, prospective, cohort study. Supportive Care in Cancer. ISSN 0941-4355. 22(6), p. 1655–1662. doi: 10.1007/s00520-014-2128-0. Full text in Research Archive
• Wranicz, Piotr; Andersen, Hege Kilen; Nordbø, Arve & Kongsgaard, Ulf (2014). Factors influencing the quality of postoperative epidural analgesia: An observational multicenter study. Local and Regional Anesthesia. 7(1), p. 39–45. doi: 10.2147/LRA.S67153. Full text in Research Archive
• Hetmann, Fredrik; Bredal, Inger Schou; Sandvik, Leiv & Kongsgaard, Ulf (2013). Does chronic preoperative pain predict severe postoperative pain after thoracotomy. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 57(8), p. 1065–1072. Full text in Research Archive
• Rustøen, Tone; Geerling, Jenske I.; Pappa, Theodora; Rundström, Carina; Weisse, Isolde & Williams, Sian [Show all 9 contributors for this article] (2013). A European survey of oncology nurse breakthrough cancer pain practices. European Journal of Oncology Nursing. ISSN 1462-3889. 17(1), p. 95–100. doi: 10.1016/j.ejon.2012.05.005. Full text in Research Archive
• Reine, Pål Aarstrand; Vethe, Nils Tore; Kongsgaard, Ulf; Andersen, Anders Mikal; Line, Pål Dag & Ali, Mohamad [Show all 7 contributors for this article] (2013). Mycophenolate pharmacokinetics and inosine monophosphate dehydrogenase activity in liver transplant recipients with an emphasis on therapeutic drug monitoring. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 73(2), p. 117–124. doi: 10.3109/00365513.2012.745947. Full text in Research Archive
• Hetmann, Fredrik; Bredal, Inger Schou; Sandvik, Leiv & Kongsgaard, Ulf (2013). Does chronic pre-operative pain predict severe post-operative pain after thoracotomy? A prospective longitudinal study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 57(8), p. 1065–1072. doi: 10.1111/aas.12159. Full text in Research Archive
• Melnikov, Andrey; Bjørgo, Steinar & Kongsgaard, Ulf (2012). Thoracic paravertebral block versus transversus abdominis plane block in major gynecological surgery: a prospective, randomized, controlled, observer-blinded study. Local and Regional Anesthesia. 5, p. 55–61. doi: 10.2147/LRA.S35858. Full text in Research Archive Show summary

  Background and objectives: Patients undergoing abdominal surgery often receive an epidural infusion for postoperative analgesia. However, when epidural analgesia is contraindicated or unwanted, the administration of opioids is the usual means used to relieve pain. Various regional analgesia techniques used in conjunction with systemic analgesia have been reported to reduce the cumulative postoperative opioid consumption and opioid-induced side effects. The objective of this trial was to assess the effectiveness of transversus abdominis plane block and paravertebral block in women undergoing major gynecological surgery. Methods: We analyzed 58 patients scheduled for a midline vertical laparatomy due to gynecological cancer. They were all equipped with a patient-controlled postoperative analgesia pump that delivered ketobemidon. In addition, some patients were randomized to receive either a bilateral transversus abdominis plane block (n = 19) or a bilateral paravertebral block at the level of Th10 (n = 19). Both blocks were performed preoperatively as a single injection of bupivacaine. Results: Cumulative ketobemidon consumption, postoperative pain scores at rest and while coughing, and postoperative nausea and vomiting scores were assessed by a blinded observer at 2, 4, 6, 24, and 48 hours postoperatively. Both blocks were associated with significant reductions in opioid consumption and pain scores throughout the study period compared with the control patients. Postoperative nausea and vomiting scores were low in all groups, but during the early postoperative period more control group patients needed antiemetics. Conclusion: Both methods of inducing block can serve as effective analgesia adjuncts in women undergoing major gynecological surgery. Although thoracic paravertebral block appeared to be more effective than transversus abdomins block, the latter performed under ultrasound guidance seems to be a more controlled and safe alternative. Keywords: hysterectomy, transversus abdominis plane block, paravertebral block,postoperative pain.

• Axcrona, Karol; Vlatkovic, Ljiljana; Hovland, Jarl; Brennhovd, Bjørn; Kongsgaard, Ulf & Giercksky, Karl-Erik (2011). Robot-assisted laparoscopic prostatectomy in a 68-year-old patient with previous heart transplantation and pelvic irradiation. International Journal of Medical Robotics and Computer Assisted Surgery. ISSN 1478-5951. 6(1), p. 81–83. doi: 10.1007/s11701-011-0270-y. Full text in Research Archive
• ZAIKOVA, OLGA; Fosså, Sophie Dorothea; Kongsgaard, Ulf; Kvaløy, Stein Olav; Giercksky, Karl-Erik & Skjeldal, Sigmund (2010). Pain after Palliative Radiotherapy for Spine Metastases. Clinical Oncology. ISSN 0936-6555. 22(10), p. 828–836. doi: 10.1016/j.clon.2010.03.008. Full text in Research Archive
• Wranicz, Piotr; Herlofson, Bente Brokstad; Evensen, Jan Folkvard & Kongsgaard, Ulf (2010). Prevention and treatment of trismus in head and neck cancer: A case report and a systematic review of the literature. Scandinavian Journal of Pain. ISSN 1877-8860. 1(2), p. 84–88. doi: 10.1016/j.sjpain.2010.01.006. Full text in Research Archive
• Reine, Pål Aarstrand; Kongsgaard, Ulf; Andersen, A.; Thøgersen, A-K & Olsen, H. (2010). Infusions of albumin increase free fraction of naproxen in healthy volunteers: a randomized crossover study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 54(4), p. 430–434. doi: 10.1111/j.1399-6576.2009.02142.x. Full text in Research Archive
• Rud, A Kongsgaard; Bjørgo, S; Kristensen, GB & Kongsgaard, Ulf (2009). Hyperbaric oxygen therapy for late radiation tissue injury in gynaecological patients. Supportive Care in Cancer. ISSN 0941-4355. 17(12), p. 1517–1521. doi: 10.1007/s00520-009-0619-1. Full text in Research Archive
• Holtan, Anders & Kongsgaard, Ulf (2009). The Use of Pain Descriptors in Cancer Patients. Journal of Pain and Symptom Management. ISSN 0885-3924. 38(2), p. 208–215. doi: 10.1016/j.jpainsymman.2008.08.008. Full text in Research Archive
• Kongsgaard, Ulf & Werner, M.U. (2008). Clinical trials: acute and chronic pain. In Campbell, WI; Nickolas, MK; Breivik, Harald; Newton-John, Toby & Rice, Andrew (Ed.), Clinical Pain Management Series: Practice and Procedures (2.ed). Hodder Education. ISSN 9780340940068. p. 538–551. Full text in Research Archive
• Holtan, Anders; Kongsgaard, Ulf & Brosstad, Frank Roger (2008). Pelvic surgery in a child with hemophilia C: a rare disease, a real challenge, a simple solution. Transfusion Alternatives in Transfusion Medicine. ISSN 1295-9022. 10(1), p. 26–29. doi: 10.1111/J.1778-428x.2007.00079.x. Full text in Research Archive
• Ernst, Gernot & Kongsgaard, Ulf (2008). Bruk av cannabinoider i palliativ medisin. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 128(7), p. 822–825. Full text in Research Archive
• Torvik, Karin; Hølen, Jacob C; Kaasa, Stein; Kirkevold, Øyvind; Holtan, Anders & Kongsgaard, Ulf [Show all 7 contributors for this article] (2008). Pain in elderly hospitalized cancer patients with bone metastases in Norway. International Journal of Palliative Nursing. ISSN 1357-6321. 14(5), p. 238–45. Full text in Research Archive Show summary

  AIM: To examine differences in reported pain, pain management and satisfaction with pain management between middle-aged and elderly patients. The study also examined differences in global quality of life (QoL) and pain interference with patient function between middle-aged and elderly patients with bone metastases. METHOD: A one-day prevalence study was performed, targeting hospitalized cancer patients 18 years and over in Norwegian hospitals; 79 patients with bone metastases were included. RESULTS: In total, 89% of patients reported daily pain, and there was no significant difference between the two age groups (p=0.52). Elderly patients reported significantly higher scores for 'worst pain' (p=0.036) and 'pain severity intensity' (p=0.027), but received strong opioids for their cancer pain significantly less often than middle-aged patients (p=0.024). We found a significant linear association between increasing age and decreasing scores on Cleeland's pain management index (p=0.002). There were no statistically significant differences between age groups in satisfaction with pain management, pain interference with functioning or global QoL. CONCLUSION: These results indicate that more focus is needed on pain management in elderly cancer patients with bone metastases.

• Reine, PA; Kongsgaard, Ulf; Andersen, A; Thogersen, AK & Olsen, H (2008). Infusion of albumin attenuates changes in serum protein binding of drugs in surgical patients compared with volume replacement with HAES. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 52, p. 406–412. doi: 10.1111/j.1399-6576.2007.01555.x. Full text in Research Archive
• Holtan, Anders; Aass, N; Nordoy, T; Haugen, DF; Kaasa, S & Mohr, W [Show all 7 contributors for this article] (2007). Prevalence of pain in hospitalised cancer patients in Norway: a national survey. Palliative Medicine. ISSN 0269-2163. 21, p. 7–13. doi: 10.1177/0269216306073127. Full text in Research Archive
• Høiseth, Lars Øivind; Giercksky, Karl-Erik; Larsen, Stein Gunnar & Kongsgaard, Ulf (2006). Større kirurgiske inngrep hos Jehovas vitner. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 126(20), p. 2658–2661. Full text in Research Archive
• Svendsen, Kristina B; Andersen, Steen; Arnason, Sigurdur; Arnér, Staffan; Breivik, Harald & Heiskanen, Tarja [Show all 12 contributors for this article] (2005). Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms. European Journal of Pain. ISSN 1090-3801. 9(2), p. 195–206. doi: 10.1016/j.ejpain.2004.06.001. Full text in Research Archive
• Holtan, Anders; Kongsgaard, Ulf & Ohnstad, Hege Oma (2005). Smerter hos kreftpasienter innlagt i sykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 125(4), p. 416–418. Full text in Research Archive
• Kongsgaard, Ulf; Bell, Rae Francis & Breivik, Harald (2005). Smertelindring ved stoffmisbruk eller langvarig opioidbehandling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 125(20), p. 2808–2810. Full text in Research Archive
• Borchgrevik, Petter C; Klepstad, Pål; Kongsgaard, Ulf & Kaasa, Stein (2004). Bruk av opioider mot sterke kreftrelaterte smerter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 124(3), p. 337–338. Full text in Research Archive
• Kongsgaard, Ulf; Olsen, Harald; Børmer, Ole P. & Andersen, Anders (2004). Pharmaceutical-grade albumin: impaired drug-binding capacity in vitro. BMC Clinical Pharmacology. 4, p. 4–4. Full text in Research Archive
• Kongsgaard, Ulf; Bjørgo, Steinar & Hauser, Markus (2004). Nevrolytisk blokade hos kreftpasienter - fortsatt en nyttig<BR/>behandling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. p. 481-483 : ill.–481-483 : ill.. Full text in Research Archive
• Reine, Pål; Kongsgaard, Ulf & Smith-Erichsen, Nils (2004). Hemoglobin og transfusjonspraksis - en spørreundersøkelse balnt norske anestesiologer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 124(20), p. 2610–2612. Full text in Research Archive
• Knutsen, Anders holtan; Mitic, Zorica; Kongsgaard, Ulf & Nordbø, Arve (2003). Endringer i albuminforbruk ved norske sykehus etter Cochranrapporten (1998-2001). Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 123(9), p. 1181–1183. Full text in Research Archive
• Kongsgaard, Ulf; Solheim, Bjarte G. & Heier, Hans Erik (2003). Transfusjon av "gammelt" bankblod, - tid for nytenkning? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 123(3), p. 325–327. Full text in Research Archive
• Kongsgaard, Ulf & Werner, M.U. (2003). Clinical trials: Cancer pain, Clinical trials: cancer pain.. In: Clinical Pain Management. Practical applications & procedures. Breivik H, Campbell W, Eccleston C, eds. Edward Arnold. ISSN 9780340809952. p. 538–551. Full text in Research Archive
• Kongsgaard, Ulf (2000). Mechanical ventilation in critically ill cancer patients. Opinions on Topics in Supportive Care in Oncology. 34, p. 12–13. Full text in Research Archive Show summary

  The role of ICU facilities, including mechanical ventilation, is important for optimal supportive care. This treatment modality should not generally be restricted in critically ill cancer patients. However, decisions concerning the level of care in the ICU will necessarily involve medical as well as ethical considerations.

• Børmer, Ole P.; Amlie, L.M.; Paus, Elisabeth & Kongsgaard, Ulf (1999). Automated albumin method underestimates pharmaceutical-grade albumin in vivo. Clinical Chemistry. ISSN 0009-9147. 45(7), p. 1082–1084. Full text in Research Archive
• Sundfør, Kolbein; Lyng, Heidi; Kongsgaard, Ulf; Trope, Claes Gøran & Rofstad, Einar K. (1997). Polarographic Measurement of pO2 in Cervix Carcinoma. Gynecologic Oncology. ISSN 0090-8258. 64, p. 230–236. Full text in Research Archive
• Kongsgaard, Ulf; Wang, Meng Yu & Kvalheim, Gunnar (1996). Leucocyte depletion filter removes cancer cells in human blood. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 40, p. 118–120. Full text in Research Archive
• Svennevig, Jan Ludvig; Tølløfsrud, Stein; Kongsgaard, Ulf; Noddeland, Harald; Mohr, Brit & Øzer, M [Show all 7 contributors for this article] (1996). Complement activation during and after heart surgery is only marginally affected by the choice of fluid for volume replacement. Perfusion. ISSN 0267-6591. 11, p. 326–332. Full text in Research Archive Show summary

  Complement, complement activation, heart surgery

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• Werner, Mads U. & Kongsgaard, Ulf (2016). Smärtans patofysiologi hos cancerpatienter. Gyldendal Akademisk. ISBN 9788205488403. 11 p. Full text in Research Archive
• Rosland, Jan Henrik; Borchgrevink, Petter Chr.; Klepstad, Pål & Kongsgaard, Ulf (2016). Smertebehandling hos pasienter som har kreft. Universitetet I Oslo, Det medisinske fakultet, Institutt for klinisk medisin, Avdeling for farmakologi. ISBN 9788299233149. Full text in Research Archive
• Kongsgaard, Ulf (2003). Clinical trials: cancer pain.. In: Clinical Pain Management. Practical applications & procedures. Breivik H, Campbell W, Eccleston C, eds. Edward Arnold. ISBN 9780340809952. 13 p. Full text in Research Archive

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• Espinosa, Aurora; Aandahl, Astrid; Arsenovic, Mira; Jacobsen, Barbora; Kristoffersen, Gunn & Sundic, Tatjana [Show all 11 contributors for this article] (2025). Myter og fakta om plasmatransfusjon. 145(8). doi: 10.4045/tidsskr.25.0085. Full text in Research Archive
• Kvandal, Per; Kleven, Josef; Kongsgaard, Ulf; Fremmerlid, Margit Louise & Kristiansen, Thomas (2021). Cerebral Circulatory Ultrasound Assessment Of Patients Undergoing Robotic Surgery In A Trendelenburg Position - CURT. Full text in Research Archive
• Kongsgaard, Ulf & Switlyk, Marta Daniela (2016). Postoperative paraplegia following spinal cord infarction in a patient with a thoracic epidural catheter. Full text in Research Archive
• Kongsgaard, Ulf (2016). Measuring outcomes of pain management. Scandinavian Journal of Pain. ISSN 1877-8860. 13, p. 173–174. doi: 10.1016/j.sjpain.2016.09.003. Full text in Research Archive
• Førde, Reidun; Materstvedt, Lars Johan; Markestad, Trond; Kongsgaard, Ulf; Hofacker, Sebastian von & Brelin, Siri [Show all 8 contributors for this article] (2015). Lindrende sedering i livets sluttfase - reviderte retningslinjer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(3), p. 220–221. doi: 10.4045/tidsskr.14.1116. Full text in Research Archive Show summary

  Lindrende sedering til pasienter i livets sluttfase byr på mange medisinske, etiske og juridiske utfordringer. Som støtte til leger som yter denne behandlingen til pasienter som ikke kan hjelpes på annen måte, laget Legeforeningen retningslinjer i 2001. Disse er nå revidert og ble vedtatt av sentralstyret i juni 2014. Her presenteres arbeidet og noen viktige punkter i de nye retningslinjene.

• Kongsgaard, Ulf & Steen, Petter Andreas (2014). Lasarus-fenomenet :. 134(12/13), p. 1257–1259. doi: 10.4045/tidsskr.14.0052. Full text in Research Archive
• Werner, Mads U. & Kongsgaard, Ulf (2014). Defining persistent post-surgical pain: Is an update required? British Journal of Anaesthesia. ISSN 0007-0912. 113(1), p. 1–4. doi: 10.1093/bja/aeu012. Full text in Research Archive
• Kongsgaard, Ulf (2011). Frédéric Chopin and his suffering. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 131(7), p. 707–710. Full text in Research Archive Show summary

  BACKGROUND: In 2010 we celebrated the bicentennial of Chopin's birth. He left more than 230 fantastic compositions, often described as romantic, emotional and poetic. Chopin composed almost exclusively for piano solo and has been called the pianists' composer. From his teens he suffered from respiratory tract infections, gradually accompanied by haemoptysis, pronounced breathing problems, diarrhoea and loss of weight. He experienced part of his adult life as a period of great suffering. He was 39 years old when he died. The assumed cause of death was tuberculosis, but other possible differential diagnoses have been suggested in recent years. MATERIAL AND METHOD: In order to examine the different diagnostic alternatives, a non-systematic search of the literature was carried out in PubMed, Embase, Current Contents, Google and relevant reference books. RESULTS: The official cause of death was tuberculosis, but the autopsy report has never been found. Both cystic fibrosis and alpha-1-antitrypsin deficiency are possible differential diagnoses that can explain his symptoms. INTERPRETATION: In spite of a disabling disease, Chopin was musically creative right to the end of his life. His suffering must have influenced his musical expression, which is characterised by intimacy and sentimentality. It is unlikely that we will ever find the true cause of death.

• Høiseth, Lars Øivind & Kongsgaard, Ulf (2009). Jehovas vitner og blodløs behandling - medisinske utfordringer. In Ringnes, Hege Kristin & Sødal, Helje Kringlebotn (Ed.), Jehovas vitner: en flerfaglig studie. Universitetsforlaget. ISSN 9788215014531. p. 108–121. Full text in Research Archive
• Kongsgaard, Ulf & Werner, Mads U (2009). Evidence-Based Medicine Works Best When There is Evidence: Challenges in Palliative Medicine When Randomized Controlled Trials are not Possible. Journal of Pain & Palliative Care Pharmacotherapy. ISSN 1536-0288. 23(1), p. 48–50. doi: 10.1080/15360280902728237. Full text in Research Archive
• Kongsgaard, Ulf; Wyller, Torgeir Bruun & Breivik, Harald (2008). Eldre trenger bedre smertebehandling. 128(5), p. 590–591. Full text in Research Archive
• Holtan, Anders; Hestenes, Siv & Kongsgaard, Ulf (2004). Smerter hos kreftpasienter innlagt i sykehus - en nasjonal prevalensstudie. Full text in Research Archive
• Reine, Pål; Hestenes, Siv & Kongsgaard, Ulf (2004). Epidural abscess etter langvargi bruk av epidural kateter. Full text in Research Archive
• Hestenes, Siv; Helset, Elin & Kongsgaard, Ulf (2004). Livstruende hyponatremi som følge av alternativ behandling. Full text in Research Archive
• Holtan, Anders; Kongsgaard, Ulf & Brosstad, Frank Roger (2003). Bekkenkirurgi på et barn med hemofili C - sjelden tilstand - stor utfordring - enkel løsning. Full text in Research Archive
• Reine, Pål; Holtan, Anders; Bjørgo, Steinar & Kongsgaard, Ulf (2003). Dobbel-lumen tube & Univent - fordeler og ulemper. Full text in Research Archive
• Knutsen, Anders holtan & Kongsgaard, Ulf (2003). Smerter hos kreftpasienter innlagt i sykehus - en prevalensundersøkelse i Helse Sør. Full text in Research Archive
• Kongsgaard, Ulf (2003). Pain management of the drug abuser. Full text in Research Archive
• Kongsgaard, Ulf (2003). Neuropathic pain in cancer patients. Full text in Research Archive
• Karlsen, Harald; Pedersen, Terje Rolf; Kongsgaard, Ulf; Omdal, S. & Giercksky, Karl-Erik (2001). Establishing an isolated perfusion service for management og malignant disase at the Norwegian Radium Hospital. Full text in Research Archive
• Nordbø, Arve; Larsen, Stein; Kongsgaard, Ulf; Pettersen, Bjørn; Quist, Hanne & Kvalheim, Gunnar [Show all 7 contributors for this article] (2000). Preoperativ bruk av erythropoitin og jern kombinert med preoperativ autotransfusjon ved kirurgiske inngrep hos kreftpasienter. Full text in Research Archive
• Nordbø, Arve; Wranicz, Piotr; Lindheim, Dagne & Kongsgaard, Ulf (2000). Cardiovascular response to sevoflurane compared to propofol in elderly patients. Full text in Research Archive
• Nordbø, Arve; Larsen, Stein; Kongsgaard, Ulf; Pettersen, Bjørn; Quist, Hanne & Kvalheim, Gunnar [Show all 7 contributors for this article] (2000). Preoperative erythropoietin and intravenous iron in combination with intraoperative autotransfusion in cancer surgery. Full text in Research Archive
• Kongsgaard, Ulf; Erikstein, Bjørn & Kvinnsland, Stener (2000). Late sequelae of post-mastectomy radiotherapy. Full text in Research Archive Show summary

  Evaluation of symptoms after breat irradiation. 2113 patients were treated with either 4.3 GY x 10 (1496 pts) or 2.5 GY x 10 (617 pts) to the breast wall and /or regional lymph nodes. 450 of these patients were still alive at the end of 1996. From this group 361 patients were examined for late radiation side effects, 245 patients had received 4.3 GY x 10 and 119 had received 2.5 GY x 10. The patients were examined clinically by an oncologist and physiotherapist. Radiologic evaluation of the thorax was performed. Self-evaluation regarding pain experience and interference of pain in the patient's life was achieved using the Brief Pain Inventory (BPI). Arm-oedema, fractures of the ribs and impaired shoulder function were the three most objective factors predicting late radiation side effects. Pain interference in the patient's life evaluated by the BPI was characteristic in most patients. Despite a high sum on the BPI pain score, only 37 % were on pain medication (15 % on Paracetamol and 14 % on Paracetamol + Codeine). Only 1.5 % was taking opioids. Late sequelae after breast irradiation is associated with physical and psychological distress compromising quality of life. These problems are possibly underestimated.

• Kongsgaard, Ulf (2000). The "intractable" cancer patient. Full text in Research Archive Show summary

  In spite of increased knowledge in care of the cancer patient, there are still a few patients who experience intolerable suffering, especially in the last days of their life. In selected patients, aggressive and invasive treatments, such as neurolysis, implantable intrathecal or epidural catheters for infusion of analgesic medications, or neuroaugmentative procedures may reduce or eliminate the requirement for systemically administered analgesics. Like other interventions, however, they should never be instituted in isolation, but rather as a component of a therapeutic strategy implemented in a multidisciplinary setting. At the end of life, induced sedation in the management of refractory symptoms may be the only therapeutic option capable of providing adequate relief. This approach is described as sedation in the management of intolerable symptoms in the imminently dying. The medical and ethical issues surrounding this therapy are complex and have become a focus of palliative medicin. The provision of clinical care must proceed in parallel with an increased focus on, and resources for, the development of research initiatives.

• Kongsgaard, Ulf; Kaasa, Stein; Dale, Ola; Ottesen, Stig; Nordøy, Tone & Hessling, Sten Erik [Show all 9 contributors for this article] (2005). Lindring av smerter hos kreftpasienter. Folkehelseinstituttet. ISSN 9788281210745. Full text in Research Archive Show summary

  Denne rapporten er en bestilling fra tidligere Sosial-og helsedepartementet om å vurdere kunnskapsgrunnlaget om effekt av palliativ smertebehandling ved kreft, dvs. Effekt av ulike behandlingsmetoder for å lindre smerter hos pasienter med uhelbredelig (ikke-kurabel) kreftsykdom.

• Kongsgaard, Ulf; Kaasa, Stein; Dale, Ola; Ottersen, Stig; Nordøy, Tone & Hessling, Stein Erik [Show all 12 contributors for this article] (2005). Lindring av smerter hos kreftpasienter. Nasjonalt kunnskapssenter for helsetjenester. ISSN 9788281210745. Full text in Research Archive
• Høiby, Ernst Arne; Sandven, Per; Lassen, Jørgen; Kvaløy, Stein; Vorkinn, E. & Holte, H. [Show all 16 contributors for this article] (1997). Antimikrobielle midler: grunnlag for fornuftig bruk. Oslo universitetssykehus HF. ISSN 9788291929019. Full text in Research Archive

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