Highly Spec. International/Regional Medical Services

Medical Services sorted under Departments

Allogeneic Stem Cell Transplantation
Karolinska University Hospital, Huddinge, has the only department specializing in allogeneic stem cell transplantation (SCT) in the Nordic region. We have provided services to both children and adults since 1975. Over the years we have carried out more than 1,200 SCTs. A total of 53 percent of Sweden's pediatric transplantations have been carried out at Karolinska, Huddinge, with very high survival rates in an international comparison.
Center for Allogeneic Stem Cell Transplantation (CAST)
Department Director: Britt-Marie Svahn

Alcohol Ablation for Hypertrophic Obstructive Cardiomyopathy
Since 1998 the Department of Cardiology has been the only center in Sweden to carry out alcohol ablation of hypertrophic obstructive cardiomyopathy, with excellent results for reduction of outflow gradient, quality of life, and work capacity.
Department of Cardiology
Department Director: Cecilia Linde

Respiratory Unit
The Respiratory Unit is located in the Neonatology Section of Karolinska University Hospital, Solna, with highly skilled specialists such as a respiratory physiologist, specialized nurses, and a professor of pediatric neonatology.
We provide both inpatient and outpatient services with work-up and assessment relating to treatment and follow-up planning in cooperation with the referral source:

* Work-up including neonatal spirometry for children with bronchopulmonary dysplasia, as well as other pulmonary or respiratory diseases such as diaphragmatic paresis, meconium aspiration, facial deformities (cleft palate, Treacher Collins, Pierre Robin), Down's syndrome, and achondroplasia
* Cardiorespiratory monitoring of children with apnea or bradycardia
* Sleep polygraphy of children with suspected disorders involving central respiratory control such as Prader-Willi Syndrome, CCHS, children with achondroplasia, and Arnold-Chiari malformation, where a more thorough analysis of chemoreceptor function as well as disruption of the normal breathing pattern are necessary

We collaborate extensively with other departments and healthcare facilities including the Respiratory Care Unit at Danderyd Hospital (mainly respiratory support for pediatric patients with muscular diseases), Department of Pediatric Neurology, Department of Plastic Surgery, Pediatric Endocrinology Clinic, and the Pediatric Pulmonary Section.
Neonatology Section, Solna
Director: Eva Berggren Broström
Contact: Hugo Lagercrantz, Professor, and Miriam Katz-Salamon, Associate Professor.

Advanced Thyroid Cancer
Karolinska University Hospital, Solna, has the biggest thyroid surgery unit in Sweden. We operate about 100 cases of thyroid cancer annually, 15 to 20 percent of which may be considered advanced. The hospital’s state-of-the-art cytology services allow outstanding preoperative diagnostics and collaboration with ENT surgeons and vascular surgeons enable us to successfully treat highly advanced cancer. In addition, our radiographic technology ensures optimal preparations, including lymphatic mapping, MRI for assessment of local spread, and PET/CT to diagnosis metastases. We have equipment for nerve stimulation and intraoperative monitoring and collaborate closely with Phoniatrics and Speech Therapy for both preoperative and postoperative voice problems.
Tissue bank: association with an extensive tissue bank for R&D and education. The unit is affiliated with the national quality assessment register for thyroid and parathyroid surgery.
Department of Surgery
Department Director: Martin Bäckdahl
Section Manager: Jan Zedenius

Pediatric Dialysis (Hemodialysis)
The Department of Renal Medicine has lengthy and extensive experience of initiating and providing hemodialysis in children, including infants. The care chain also involves the Department of Transplantation Surgery to establish dialysis access (hemodialysis catheter), the Department of Pediatrics at Karolinska, and in many cases, planning for renal transplantation.
Department of Renal Medicine
Department Director: Carl-Gustaf Elinder
Section Manager: Mats Efvergren, assistant senior physician, dialysis ward M87/89 Huddinge
Contact, optimized care chain: Peter Barany, senior physician

Pediatric Dialysis (Peritoneal Dialysis)
The Department of Renal Medicine has lengthy and extensive experience in initiating and providing PD to children, including infants, with acute and chronic renal failure. Relatives can be trained to administer dialysis to their children. Continuous support and monitoring throughout the treatment period is necessary. The care chain also involves the Department of Pediatrics at Karolinska and the Department of Transplantation Surgery to establish dialysis access (dialysis catheter), and in many cases, planning for renal transplantation.
Department of Renal Medicine
Department Director: Carl-Gustaf Elinder
Medical Director: Peter Bárány
Contact, optimized care chain: Peter Barany, senior physician

Pediatric Hematology/HIV
The Hematology/HIV Section at Pediatrics 1, Karolinska, Huddinge, works up and treats complicated non-malignant and immune-mediated hematological diseases, severe primary immunodeficiencies, and HIV in a highly specialized interprofessional team. In addition, the section carries out high-dose chemotherapy for malignant diseases and autologous stem cell transplantation. We are also the most experienced section in Sweden in providing expert care for bone marrow failure while minimizing side effects, integrated with high expertise in stem cell transplants (SCT) and from an international perspective, an exceedingly low mortality rate. We work up and assess all indications for SCT, collaborate with the Center for Allogeneic Stem Cell Transplantation (CAST) and provide post-SCT follow-up care and long-term monitoring. Karolinska, Huddinge, carries out more than half of Sweden's pediatric SCTs and the quality-controlled results rank at the top internationally. The treatment team is available to respond to patient inquiries and the care chain can access specialists for telephone consultations round the clock.
About 70 percent of Sweden's children and adolescents with HIV receive all or part of their treatment at this section; children from other counties receive this treatment as part of the optimized care chain, with an attending physician available at home. The HIV team also provides nationwide courses and support services for HIV-infected children and adolescents under the auspices of the Swedish National Board of Health and Welfare.
Department of Pediatrics
Department Director: Ann-Britt Bohlin
Contact, optimized care chain: Jacek Winiarski, Professor, Section Manager

Pediatric Nephrology
The Pediatric Nephrology Section at Karolinska University Hospital is the largest center in Sweden for children with renal disease. We currently follow more than two thirds of children in Sweden with severe renal disease, or about 400 children with various kidney diseases and 90 children who have undergone renal transplantation. A professor of pediatric nephrology, three senior physicians, and four clinical specialists, in cooperation with pathologists, radiologists, adult nephrology specialists, urologists, transplantation surgeons, anesthesiologists, dietitians, urotherapists, and specialized nurses comprise the complete care chain from acute diagnosis of renal disease in children and adolescents to treatment, including hemodialysis and peritoneal dialysis, transplantation, and long-term follow-up. A new patient group cared for in cooperation with neonatologists is neonates with immediate need for dialysis. Round-the-clock staffing is provided in pediatric nephrology, offering rapid access and feedback for referring doctors and inquiries.
Nephrology Section
Director: Ann-Britt Bohlin
Contact, optimized care chain: Gianni Celsi, Associate Professor, Section Manager

Pediatric Spine Surgery
The Department of Orthopedics in cooperation with Astrid Lindgren Children’s Hospital carries out all types of spine surgery procedures in children, including those for severe deformities and neuromuscular scolioses. These complicated procedures are currently carried out at only a few hospitals in Sweden and require a quality-assured care chain. Our services are based on extensive experience and we consider ourselves to be a national medical center in this field.
Department of Orthopedics
Department Director: Lennart Adamsson
 
Treatment Using Donated Eggs and Sperm
Since 2003 we have provided services for lesbian couples, women without functional eggs, and men without functional sperm. Such treatment may only be carried out at university medical centers and requires access to donors for needy recipients. The Fertility Unit is the largest in this field in Sweden and has established an efficient organization for its operations. Referrals come from both Sweden and abroad, with about 80 egg and 100 sperm donation procedures carried out annually.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström
Contact: Margareta Fridström

Treatment with Intraperitoneally Implanted Insulin Pump
Basic work-up is done in the day care setting and the implantation procedure is carried out at the Department of Transplantation Surgery. Cleaning and function testing of the pump should be done on an outpatient basis every nine to twelve months at a minimum. The department has several specially trained doctors who also serve as nationwide telephone consultants.
Department of Endocrinology, Metabolism, and Diabetes
Department Director: Bo Angelin
Section Manager: Erik Moberg
Contact, optimized care chain: Per Oskarsson, Mikael Rydén

Adrenal Surgery
For many decades Karolinska University Hospital, Solna, has had a dedicated interest in adrenal diseases and their treatment. Work-up includes scintigraphy, adrenal vein catheterization, and hormonal studies. The surgical unit carries out the most adrenal procedures within the Nordic region on an annual basis and performs about 40 laparoscopic adrenalectomies annually, as well as four to eight open adrenal surgeries. Collaborative efforts involving endocrine surgery, endocrinology, radiology, and highly specialized cytology and pathology services ensure optimal treatment for these patients.
Tissue bank: association with an extensive tissue bank for R&D and education.
Department of Surgery
Department Director: Martin Bäckdahl
Section Manager: Jan Zedenius
Contact, optimized care chain: Jan Zedenius

Adrenal Tumors
Work-up of patients with adrenal tumors is a collaborative effort involving endocrinology, endocrine surgery, radiology, cytology, and pathology, and includes scintigraphy, adrenal vein catheterization, and hormonal studies. The surgical unit conducts the majority of adrenal procedures in the Nordic region on an annual basis with about 40 laparoscopic adrenalectomies and four to eight open adrenal surgeries annually. Joint rounds are held.
Department of Endocrinology, Metabolism, and Diabetes
Department Director: Bo Angelin
Section Manager: Hans Wahrenberg
Contact, optimized care chain: Hans Wahrenberg, Jan Zedenius

Botox Treatment
Focal dystonia is a condition involving involuntary contractions in isolated muscle groups during voluntary movement. When this condition afflicts the jaw muscles, eating and speaking become difficult. When the laryngeal muscles are afflicted, a condition known as spasmodic dysphonia arises, which is associated with severe spastic speech that may create a significant medical, psychological, and social disability.
Patients receive botulinum toxin injections into the affected muscles and return for regular treatment about two to four times per year.
Ear, Nose, and Throat Department and Cochlear Section
Department Director: Pär Stjärne
Contact: Per-Åke Lindestad
 
Burn Treatment
The Burn Unit has three intensive care beds and two inpatient beds at its disposal for advanced burn care and can offer these services in cooperation with the Department of Anesthesiology and Intensive Care. Resources are also available for both hyperbaric treatment and ECMO for severely ill patients. This ward—the largest of its kind in Sweden—works in close collaboration with the Astrid Lindgren Children's Hospital to treat burn injuries, including those requiring intensive care. The ward also has its own operating room. All care centers around the patient.
Department of Reconstructive Plastic Surgery
Department Director: Marie Wickman
Section Manager: Viveca Björnhagen
Contact, optimized care chain: Viveca Björnhagen

Cochlear Implants
The cochlear implant (CI) is an electronic device that makes hearing possible for children who are born deaf and enables adults who have become deaf to hear again. The implant consists of a surgically implanted component and an external component that resembles an ordinary hearing aid.
Ear, Nose, and Throat Department and Cochlear Section
Department Director: Pär Stjärne
Contact: Eva Karltorp

Cystic Fibrosis
Cystic fibrosis is a congenital hereditary chronic progressive disease that requires a multidisciplinary approach. There is no cure for this disease at this time. Thanks to intensive symptomatic treatment, survival has increased from six to eight years during the 1960s to today's average life expectancy of about 50 years. Internationally, Sweden is on the cutting edge and one reason for this is centralized or shared care.
Care is provided according to the standards established by Kerem E, Conway S, Elborn S, Heijerman H in Consensus Committee Standards of care for patients with cystic fibrosis: a European consensus. J Cyst Fibros. 2005 Mar;4(1):7–26. Review.
Stockholm's CF Center meets the requirements of this document, including 24-hour access via pager.
CF Center
Department Director: Gunilla Hedlin
Contact: Lena Hjälte

Dialysis Care
The Department of Renal Medicine provides more than 50,000 hemodialysis treatments annually at five different dialysis centers: M87/89 Huddinge, SöS-dialysen, Kungsholmen, A14 Solna, and Kronan in Sundbyberg. We can provide everything from simple routine dialysis to highly specialized hemodialysis for severely ill patients on these wards. When necessary we can also provide hemodialysis on other wards (such as the Burn Unit) in Huddinge or Solna. When ordering “guest dialyses” for outpatient hemodialysis patients, we have to check that space is available at the requested time before the patient presents for treatment.
Department of Renal Medicine
Department Director: Carl-Gustaf Elinder
Program Medical Director: Alberto Gutierrez
 
Enhanced External Counter Pulsation (EECP)
For refractory angina pectoris where further revascularization procedures such as CABG or PCI are not possible, a new treatment is available that is administered 35 times over the course of seven weeks. EECP can be compared with an external intra-aortic balloon pump. The treatment provides symptomatic relief as a result of improved coronary circulation.
Department of Cardiology
Department Director: Cecilia Linde
Contact, optimized care chain: Inger Hagerman

Extra Corporeal Membrane Oxygenation (ECMO)
ECMO involves oxygenation outside the body through a membrane.
We treat patients with transient cardiac and/or pulmonary failure in which all conceivable intensive care measures are inadequate to save the patient's life. Reasons for cardiac and pulmonary failure include severe pneumonia, blood poisoning, or in the neonate, meconium aspiration or diaphragmatic hernia.
The purpose of ECMO is to allow the lungs and/or heart to rest, which permits healing to occur. Treatment time varies from a few days up to several months.
ECMO Center
Contact: Kenneth Palmér, Section Manager, ECMO Center

Esophageal Surgery
The Upper Abdominal Surgery Section at Karolinska University Hospital, Huddinge, carries out advanced, high-quality, and extensive esophageal surgical procedures. Volumes have increased steadily in recent years and we currently carry out about 50 esophageal resections annually. Services include surgical resection of cancer with extensive lymph node dissection, vagus-preserving resection surgery for benign conditions with retained physiological function, highly specialized antireflux surgery such as refundoplication, myotomy, stenting, and other endoluminal interventions including endoscopic mucosal resection. We carry out extensive clinical research across a broad range in association with our clinical services. Patients are treated with a multidisciplinary approach, in close collaboration with specialists such as oncologists, gastroenterologists, radiologists, and dietitians. During the coming year we will work more closely with clinical physiologists and cardiologists to achieve improved preoperative optimization.
Gastro Center Surgery
Director: Jörgen Larsson
Contact, optimized care chain: Magnus Nilsson
 
Fetal Shunts
The Center for Fetal Medicine (CFM) at Karolinska is the only department in Sweden with facilities for placement of shunts for fetal hydrothorax and congenital defects of the urinary bladder. We carry out about five such procedures annually.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström

Familial Adenomatous Polyposis (FAP)
The Gastro Center Medicine in Solna has a national register for patients with hereditary polyposis syndromes, especially familial adenomatous polyposis (FAP). A nurse and a doctor are responsible for both the register and the clinical care of these patients. The register includes 218 families. Of the approximately 330 persons currently living with FAP in Sweden, 90 are monitored at the Gastro Center Medicine, as well as about 60 additional individuals with other polyposis syndromes, or who are at risk of developing FAP. Lifelong endoscopic monitoring and prophylactic colorectal and upper abdominal surgery are necessary to prevent gastrointestinal cancer. In 2006 the center carried out about 150 endoscopies on these individuals. Work-up, follow-up, and treatment are provided in close collaboration with the departments of radiology (endoscopic ultrasound) and both lower and upper abdominal surgery in Solna and Huddinge.
Nowadays molecular genetic diagnosis has become routine, primarily at the clinical genetic units at Karolinska University and Sahlgrenska University Hospitals. Of the 186 families that could be tested, 132 (71%) have undergone molecular genetic testing as of the end of 2006.
Gastro Center Medicine
Department Director: Rolf Hultcrantz
Section Coordinator: Jan Björk
Contact, optimized care chain: Jan Björk

Fetal Transfusions
The Center for Fetal Medicine runs Sweden's leading program for fetal transfusions. We estimate that about 20 patients are treated with fetal transfusions per year. About ten to twelve of these patients receive their care at CFM Karolinska. CFM has Sweden's only fetal transfusion team that provides services 365 days a year. Strong arguments for concentrating these services to just one medical center in the country include assuring availability of well-trained and skilled personnel. The Center is involved in intensive research and development along with the Department of Transfusion Medicine, Karolinska. In 2007 we will initiate a national program and quality assessment register.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström
Contact: Magnus Westgren

Gastrointestinal Motility Disorders
Karolinska University Hospital has a lengthy tradition and interest in motility disorders of the gastrointestinal tract that has served as the basis of extensive development of methods to map these conditions. Gastro Center Medicine offers advanced diagnostics and counseling for treatment of all types of motility disorders in the gastrointestinal tract. We also offer support for patient follow-up in select diagnosis groups. These groups include esophageal spasm, achalasia, gastroparesis, intestinal dysmotility, intestinal pseudo-obstruction, and therapy-resistant constipation. We also participate in a European collaboration involving the most seriously ill patients, which provides the opportunity to discuss cases with leading European centers. We care for patients with esophageal motility disorders along with surgeons who have a special interest in such diseases. We treat patients with motility disorders of the stomach, including problems related to emptying, with a special focus on metabolic and neurological diseases.
Patients undergo a specialized work-up including scintigraphy, manometry, and hormone analyses. Treatment focuses on regulating motility and alleviating symptoms, including internal nerve stimulation through pacemaker treatment in the gastrointestinal tract. Patients with intestinal motility disorders, particularly for recalcitrant chronic pain such as intestinal pseudo-obstruction, are worked up with manometry, transit studies, and morphological examinations of full-thickness biopsies from the small intestine. Treatment focuses on regulating motility and symptomatic relief. We work up patients with therapy-resistant constipation using transit studies, anorectal physiology, neurophysiology, and defecography. Treatment includes biofeedback, surgery, and motility-regulating therapy.
Gastro Center Medicine
Department Director: Rolf Hultcrantz
Section Manager: Per Hellström, Greger Lindberg
Contact, optimized care chain: Per Hellström, Greger Lindberg
 
Grown-up Congenital Heart Disease (GUCH)
The Department of Thoracic Surgery offers well-established, evidence-based surgical correction and care of congenital heart defects in adults.
Department of Thoracic Surgery
Department Director: Ulf Kjellman
Contact, optimized care chain: Torbjörn Ivert

Gynecological Surgery for Hemophilia
Gynecological surgery on women with severe types of bleeding disorders is carried out in departments where experienced professionals work closely with coagulation specialists. Here at Karolinska University Hospital we collaborate with the Coagulation Center to perform the relatively few but sometimes unexpectedly complicated surgical procedures.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström
Contact, optimized care chain: Måns Edlund

Hepatocellular Cancer
The majority of patients with hepatocellular cancer have underlying cirrhosis of the liver and therefore a multidisciplinary approach is needed, including both hepatologists and surgeons. Diagnosis places high demands on radiographic techniques and specialist skills, as well as pathologists specializing in hepatology and oncology. Therapeutically, many patients must also be assessed from a transplantation surgery perspective. The complexity of these studies requires cooperation, logistics, and speed. A few years ago the Upper Abdominal Surgery Section at Gastro Center Surgery appointed a coordinator to keep track of work-ups of focal changes in the liver. Since January 1, 2007, the hepatology unit has had a hepatic tumor physician coordinator to keep track of the hepatology portion of the work-up and collaborate with the radiologist and pathologist, as well as the Upper Abdominal Surgery Section and the Department of Transplantation Surgery. The purpose is to achieve a cohesive care chain with short waiting times and decisions at the joint therapeutic conference, which includes representatives from all specialties.
The entire spectrum of therapeutic measures is available: liver resection, radio frequency ablation, liver transplantation, chemoembolization, and targeted radiation therapy.
Gastro Center Medicine
Department Director: Rolf Hultcrantz
Section Coordinator: Per Stål, senior physician
Contact, optimized care chain: Per Stål, Antti Oksanen

Immunoabsorption (IA)
In certain rare acute (anti-GBM nephritis, certain acute forms of vasculitis) and chronic renal diseases (nephrosis that is difficult to treat because of FSGS) treatment with immunoabsorption may be a viable option. In this treatment, the patient's blood plasma is pumped over several hours through a specially treated filter (Protein A-column) that captures certain antibodies. The treatment requires a special access to the bloodstream. IA has also been given—with extremely good results—before and shortly after renal transplantation in patients with antibodies targeting the transplanted organ. Thanks to IA over the past few years (2004–) it has been possible to carry out about twenty renal transplantations with excellent results in patients who previously—because of antibodies—could not undergo transplantation. The treatment is carried out in close collaboration with the Department of Transplantation Surgery.
Department of Reconstructive Plastic Surgery
Department Director: Carl-Gustaf Elinder
Section Manager: Mats Efvergren, assistant senior physician, dialysis ward M87/89, Huddinge
Contact, optimized care chain at renal transplantation: Professor Gunnar Tydén, Department of Transplantation Surgery

Inflammatory Bowel Disease (IBD)
Gastro Center Medicine, Karolinska University Hospital, has well-organized services for treating patients with IBD (Crohn’s disease, ulcerative colitis). The Center coordinates clinic services with surgeons for patients with fistulating Crohn's disease. The Center also collaborates with pediatric gastroenterologists and essentially all children with IBD cared for by pediatric services at Karolinska University Hospital are transferred to Gastro Center Medicine when they reach adulthood. Services include specialized endoscopic work-up and follow-up, as well as advanced non-surgical treatment with biologics (TNF blockers). This treatment is now provided almost exclusively on an outpatient basis. Immunosuppressive treatment is initiated and followed up in accordance with strict guidelines in close collaboration between doctors and nurses, and courses are regularly held at the IBD school for interested IBD patients. Communication between gastroenterologists and surgeons at the two sites takes place through modalities such as weekly telemedicine conferences.
In all, the entire Gastro Center Medicine cares for about 4,000 patients with these diagnoses, making this facility by far the largest in Sweden.
Gastro Center Medicine
Department Director: Rolf Hultcrantz
Section Coordinator: Jan Björk
Contact, optimized care chain: Jan Björk

IVF Treatment for HIV-Infected Men
The program, which began in 2000 as a pilot HIV project to reduce transmission, is a collaborative effort with Infectious Disease Clinic 2, Huddinge, FE. After thorough work-up, men with a stable HIV status who wish to have children may undergo IVF treatment with their partners. About 20 to 25 couples have been treated to date. The Fertility Unit is the only one of its kind in Sweden to provide this service.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström
Contact: Margareta Fridström

Surgical Treatment of Severe Heart Failure
The Department of Thoracic Surgery offers surgical treatment of severe heart failure using mechanical heart pumps and heart transplantation in close collaboration with the Department of Transplantation Surgery in Huddinge.
Department of Thoracic Surgery
Department Director: Ulf Kjellman
Contact, optimized care chain: Ulf Kjellman

Surgical Treatment of Chronic Pulmonary Embolism
Department of Thoracic Surgery offers surgical treatment of chronic pulmonary embolism using pulmonary thromboendarterectomy.
Department of Thoracic Surgery
Department Director: Ulf Kjellman
Contact, optimized care chain: Ulf Lockowandt

Colorectal Polyps
For several decades Karolinska University Hospital, Solna, has been particularly interested in endoscopic treatment and follow-up of sporadic colorectal polyps and patients with hereditary colorectal cancer syndrome, the latter in close collaboration with Clinical Genetics. We do various types of endoscopic examinations for work-up and monitoring. Treatment is also endoscopic in nature, which thanks to rapid technological advances and a high level of endoscopic expertise has largely replaced traditional surgery. From a national perspective, our department is on the cutting edge with respect to implementation of new technology. We follow the national guidelines adopted for monitoring colorectal polyps and cancer syndrome. Collaboration with pathologists, radiologists (endoscopic ultrasound), and surgeons, when appropriate, ensures optimal treatment of these patients.
Gastro Center Medicine
Department Director: Rolf Hultcrantz
Section Coordinator: Urban Sjökvist
Contact, optimized care chain: Urban Sjökvist

Laser Coagulation of Placental Vessels in Twin-to-Twin Transfusion
The Center for Fetal Medicine runs Sweden's only facility for laser coagulation of placental vessels to treat twin-to-twin transfusion syndrome. In all, we treat about twenty Swedish and Norwegian patients annually. There is a hidden need for this service, with patients in southern Sweden referred to Hamburg, Germany, for treatment. We estimate there to be about 40 potential candidates for treatment in Sweden each year. Survival rate at Karolinska is about the same as in Hamburg.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström
Contact: Magnus Westgren

Hepatic Surgery
Karolinska University Hospital, Huddinge, carries out one of the most extensive hepatic surgery programs in the Nordic region with over 200 hepatic procedures (including transplantations) annually. Services are based on multidisciplinary telemedicine decision-making conferences and encompass everything from local ablation to laparoscopic hepatic surgery, to more advanced resection surgery and transplantation. Services are integrated with liver transplantation services at Karolinska University Hospital, Huddinge.
Gastro Center Surgery
Director: Jörgen Larsson
Contact, optimized care chain: Bengt Isaksson

Liver Transplantation
Liver transplants have been carried out at Karolinska University Hospital, Huddinge, since 1984. Operations involve a large team at the hospital that provides 24-hour service daily, throughout the year, and assess patients with hepatic disease for optimal treatment including liver transplantation, with excellent transplantation results in both children and adults. All indications for liver transplantation are dealt with before and after transplantation. Special expertise is also available for transplantations in cases of hemophilia, HIV, familial amyloid polyneuropathy, and advanced hepatocellular cancer.
Department of Transplantation Surgery
Department Director: Annika Tibell
Contact, optimized care chain: Bo-Göran Ericzon, Professor

Liver Disease in Children
At the Gastroenterology, Hepatology, and Nutrition Section in Pediatrics 1 at Karolinska University Hospital, Huddinge, we work up and treat children and adolescents with severe liver disease, such as acute fulminant hepatic failure (AFL), cholestasis in infants, progressive chronic liver disease (including chronic infections), hepatic metabolic diseases (a group of diseases known as inborn errors metabolism that specifically afflict the liver), and circulatory disorders of the large vessels of the liver. In all, we treat about one hundred different diagnoses. Fewer than 10 percent of the patients are candidates for liver transplantation; work-up and assessment in these cases are carried out in close collaboration with the Departments of Transplantation Surgery and Anesthesiology. Many children are treated in cooperation with their local clinics under the optimized care chain format, while others need to be treated at our Pediatric Hepatology Center, especially during the acute phase when access to pediatric intensive care and neurosurgery is required. Early contact for assessment of transport requirements in these cases (AFL) can save lives.
For conditions that require surgical procedures, such as biliary atresia or portal vein thrombosis, we collaborate with pediatric surgeons. The section has a hepatologist on-call around the clock for questions and consultation, and during working hours a coordinator and specialist nurses are available to assist patients and local clinics.
Pediatric Gastroenterology
Department Director: Ann-Britt Bohlin
Contact, optimized care chain: Antal Nemeth, Associate Professor, Section Manager

Locally Advanced Colorectal Cancer
Locally advanced colorectal cancer is a subspecialty at the Colorectal Surgery Section in the Department of Surgery, Karolinska University Hospital, Solna.
Some patients with colorectal cancer have large tumors that grow into or up against adjacent organs. Such patients require a multidisciplinary, multimodal approach within the framework of a well-defined care chain. This care chain includes a meticulous preoperative work-up with CT scan and MRI and sometimes CT/PET, preoperative radiation therapy and/or chemotherapy, extensive surgery where multiple organs are often removed, as well as postoperative chemotherapy in most cases.
We receive referrals at Karolinska, Solna, for about 50 patients with locally advanced colorectal cancer annually from the Stockholm region and other parts of Sweden. We discuss each patient at a regular weekly multidisciplinary conference and a nurse coordinator, surgeon, and oncologist cooperate in patient care. Surgeons who refer patients to the Department of Surgery, Karolinska University Hospital, Solna, are provided the opportunity to participate in the surgery and postoperative care, and the patient is transferred to the local hospital in consultation with the attending physician at that hospital.
We have gradually expanded our services over the past decade and our unit now has extensive experience with this patient group, with good results even in an international comparison.
Department of Surgery
Department Director: Martin Bäckdahl
Contact, optimized care chain: Torbjörn Holm

Neuroendocrine Gastrointestinal Tumors
Karolinska University Hospital, Solna, has established services for the care of patients with NET of the gastrointestinal tract. The endocrinologist, endocrine surgeon, and specially trained oncologist see patients in a joint clinic. We also collaborate with the corresponding unit at Karolinska University Hospital, Huddinge, particularly with respect to patients with liver involvement who are scheduled for surgery at Karolinska, Huddinge. Joint rounds are held. Services include specialized work-up consisting of scintigraphy and hormone analyses, as well as regulation of medical treatment including blocking agents. In all, we monitor >350 patients with this diagnosis at Karolinska University Hospital.
Department of Endocrinology, Metabolism, and Diabetes
Department Director: Bo Angelin
Section Manager: Hans Wahrenberg
Contact, optimized care chain: Jan Zedenius and Hans Wahrenberg

Neuroendocrine Gastrointestinal Tumors
Karolinska University Hospital, Solna, has established services for the care of patients with NET of the gastrointestinal tract. The endocrinologist, endocrine surgeon, and specially trained oncologist see patients in a joint clinic. We also collaborate with the corresponding unit at Karolinska University Hospital, Huddinge, particularly with respect to patients with liver involvement who are scheduled for surgery at Karolinska, Huddinge. Services include specialized work-up consisting of scintigraphy and hormone analyses, as well as regulation of medical treatment including blocking agents. In all, we monitor more than 350 patients with this diagnosis at Karolinska University Hospital.
Endocrine pancreatic tumors are treated in conjunction with the endocrine surgeons at Solna and the upper abdominal surgeons at Huddinge. We are one of the few hospitals in Sweden to carry out enucleations and laparoscopic distal pancreatic resections for endocrinologically active pancreas tumors.
Department of Surgery
Department Director: Martin Bäckdahl
Section Manager: Jan Zedenius
Contact, optimized care chain: Jan Zedenius

Nephrolithiasis Unit
The Nephrolithiasis Unit at Karolinska University Hospital, Huddinge, offers minimally invasive treatment to remove stones. Access to two modern lithotripsy units, combined with extensive collective experience of this treatment modality, has created unique conditions for a treatment concept, which for most kidney stone patients is non-invasive. For patients with staghorn calculi caused by infection, we apply a combination approach using ESWL technology and chemolysis and in this way make it possible to remove stones from many patients for whom the use of other methods is out of the question. In this context, we can assert that probably no other facility in the world has a stone treatment center that employs such an advanced non-invasive or low-invasive approach as Huddinge. Assessment of risk factors for allowing medical treatment and counseling for patients with recurring nephrolithiasis are other areas in which the facility has well developed methods and high expertise.
Department of Urology
Department Director: Ingrid Ehrén

Kidney Transplantation Across Blood Groups and with Positive Immunological Cross-Testing
The Department of Transplantation Surgery runs a unique project in cooperation with the Departments of Transfusion Medicine and Renal Medicine in which renal transplantations that were previously not possible due to incompatible blood groups and immunological cross-testing are carried out following a special pretreatment and an entirely new protocol. The results are excellent and the number of possible living donor transplants can therefore be increased by 30 to 40 percent.
Department of Transplantation Surgery
Department Director: Annika Tibell
Contact, optimized care chain: Professor Gunnar Tydén

Neonates Who Need Surgery
The Neonatology Section at Karolinska University Hospital, Solna, is the biggest center in Sweden for newborn premature and term infants who need intensive care in conjunction with surgical procedures. Access to a highly specialized pediatric surgical team and the availability of ECMO treatment on site create the basis for an efficient care chain. The section is staffed with neonatologists around the clock and the recently expanded number of beds even allows for care of patients from outside the county.
Neonatology Section, Solna
Director: Eva Berggren Broström
Contact: Section Manager Baldvin Jonsson

Neonates with Renal Insufficiency
For the past two years the Neonatology Section at Karolinska University Hospital, Huddinge, has treated a new patient group of neonates with renal insufficiency and immediate need for dialysis. Work-up and assessment for transplantations take place in close collaboration with pediatric nephrologists who are available around the clock. The section has a back-up on-call staff including a neonatologist.
Neonatology Section in Huddinge
Director: Eva Berggren Broström
Contact: Section Manager Mikael Norman

Surgery Involving Soft Tissue Tumors of the Abdomen and Retroperitoneum
Treatment and surgery of soft tissue tumors in the abdominal cavity and retroperitoneal space has been a subspecialty in the Department of Surgery, Solna, since 1977 and in 2006 a specialist position was created. All mesenchymal tumors are considered to be soft tissue sarcomas, including GIST, which is the most common morphological diagnosis. We do surgery on about 50 patients annually, from both Stockholm county and other county councils. The surgeries are preceded by extensive work-up by a multidisciplinary team consisting of specialists in soft tissue sarcoma in each specialty (oncologist, pathologist, cytologist, and radiologist, as well as close collaboration with orthopedists with a subspecialty in oncology). Each week we hold a new patient clinic and a joint sarcoma conference to discuss each patient.
Surgery is often extensive and frequently takes place in close collaboration with other surgical specialties within the hospital.
We are also active members of the Scandinavian Sarcoma Group (SSG) in which a dedicated group was created for soft tissue sarcoma in the abdominal cavity and retroperitoneum in 2005. The organization has also formulated a care program for these patients, to which we subscribe.
We register patients with soft tissue sarcoma in the SSG Scandinavian sarcoma register, which is also accredited by the Swedish National Board of Health and Welfare and can be accessed from that organization's website.
Department of Surgery
Department Director: Martin Bäckdahl
Section Manager: Jan Åhlen
Contact, optimized care chain: Jan Åhlen
Link to quality register and results report Index and care program:
http://www.ocsyd.lu.se/
http://www.socialstyrelsen.se/
Link to other information: Treatment protocol, SSG organization, www.ssg-org.org

Osteogenesis Imperfecta
The Department of Pediatric Neurology at Karolinska is a national medical center for this field. OI is a hereditary collagen (connective tissue) disease classified under “Rare Diseases” by the Swedish National Board of Health and Welfare. The clinical picture varies from severe forms in which the child is born with multiple fractures and curved (bent) extremities (fatal forms occur) to extremely mild forms with few or no fractures, but often with a tendency for short stature. Other manifestations include dental problems, unstable joints, tendency to bruise easily, severely impaired hearing or deafness, and an increased risk for valvular heart disease. Untreated, individuals with severe forms of the disease reach an adult height of about one meter, have severe kyphoscoliosis, extreme malpositioning of the extremities, and are therefore severely disabled and restricted as to movement, being incapable of locomotion except through use of a motorized wheelchair; in other words, this severely debilitating condition requires major habilitative interventions. Every year about five children are born in Sweden with a form of the disease that is so severe that diagnosis can already be made at birth.
The OI team was formed in 1991–1992 as a collaborative effort involving the Department of Pediatrics, Karolinska Hospital, the Department of Pediatric Surgery, St. Göran's Hospital (now both part of Astrid Lindgren Children’s Hospital), and the Department of Pediatric Orthopedics, Uppsala University Children's Hospital, as well as dental specialists from the Eastman Institute. The broad multidisciplinary team consists of a pediatric neurologist, pediatric orthopedist, geneticist, pediatric radiologist, orthopedic technician, physical therapist, occupational therapist, pediatric nurse, pediatric nurse's aide, and pediatric dentist. The team meets 6 times each term and evaluates the children at Astrid Lindgren Children’s Hospital, usually on an outpatient basis. An individual care plan is formulated for each child in which care and treatment recommendations are reported orally and in writing to the home team. Upon request and when necessary, team members can gather on short notice. Many orthopedic procedures are carried out at Astrid Lindgren Children’s Hospital or Uppsala University Children's Hospital, since these surgeries should be undertaken by orthopedists who are familiar with both the procedures and the diagnosis.
Since 1991 the OI team has treated about 70 children with OI who have vertebral compression fractures (collapsed vertebrae) with intravenous infusion of pamidronate (a bisphosphonate), which decreases skeletal metabolism and increases mineralization of the skeleton. Follow-up has shown increased bone density, less skeletal pain, and often improved mobility and growth in the vertebrae.
The OI team has unique nationwide experience with children and adolescents suffering from OI. One thesis has been presented and several research projects are underway.
Department of Pediatric Neurology

Pancreas Surgery
Karolinska University Hospital in Huddinge runs one of the most extensive pancreatic surgery services in the Nordic region, with over 300 pancreatic resections over the past five years and a steady increase in annual volume. In addition, we carry out cutting-edge endoluminal surgery with transgastric drainage of pseudocysts, intraductal ultrasound, pancreatoscopy, and stenting. Autologous islet cell transplantation after resection surgery has become an established treatment method for us. Point-of-care clinical and tissue-based research and development are central elements in our care of patients with pancreatic problems. For example, today we can offer postoperative anti-tumoral cell therapy for pancreatic cancer. As a whole we provide services with a multidisciplinary, multiprofessional approach and a focus on the patient.
Gastro Center Surgery
Director/Professor: Jörgen Larsson
Contact, optimized care chain: Ralf Segersvärd

Parathyroid Surgery
The unit is the biggest in Sweden for surgical treatment of various conditions affecting the parathyroid glands. We have a special interest in hereditary disease and problems of secondary and tertiary hyperparathyroidism (renal hyperparathyroidism). Modern technological advances have optimized preoperative localization through the use of sestamibi scintigraphy, ultrasound, and when needed, PET/CT. In addition, we also have an effective intraoperative PTH monitoring system. Through close collaboration with the Department of Renal Medicine, our patients receive optimal care with respect to renal function and the need for dialysis.
Tissue bank: association with an extensive tissue bank for R&D. The unit is affiliated with the national quality assessment register for thyroid and parathyroid surgery.
Department of Surgery
Department Director: Martin Bäckdahl
Section Manager: Jan Zedenius
Contact, optimized care chain: Jan Zedenius

Pediatric Renal Transplantation
Karolinska University Hospital, Huddinge, participates in a collaborative effort with the Departments of Transplantation Surgery and Pediatrics in a pediatric renal transplantation program where children from the neonatal period and up are admitted for work-up, dialysis, and possible transplantation. About 75 percent of Sweden's pediatric renal transplantations are carried out at Karolinska, Huddinge. The department also coordinates the Nordic pediatric transplantation registry for the Nordic Pediatric Renal Transplant Study Group (NPRTSG).
Department of Transplantation Surgery
Department Director: Annika Tibell
Contact, optimized care chain: Professor Gunnar Tydén
Link to quality assessment register/results report:
http://www.scandiatransplant.org/ (see slide show for the Nordic Pediatric Renal Transplant Study Group)

Plexus Injuries
The Department of Pediatric Neurology at Karolinska is a national medical center for this field.
In Sweden about 250 children are born each year with obstetrics-related plexus brachialis injuries and about 25 percent of them suffer from varying degrees of residual damage. Since 1986 Astrid Lindgren Children’s Hospital and Karolinska Hospital have had a plexus team consisting of a pediatric neurologist, hand surgeon, occupational therapist, and physical therapist. The team holds a regular clinic once a week for children from all over Sweden with plexus injuries and to date we have seen over 700 children with this injury. The clinic is a collaborative effort involving the Department of Hand Surgery at Södersjukhuset (Stockholm South General Hospital) and the Pediatric Neurology Clinic at Astrid Lindgren Children’s Hospital. It was established in order to provide a common basis for assessment and follow-up of children with plexus injury, whether or not they had surgery with nerve reconstruction.
Only five to ten children annually suffer such severe injury that they require nerve reconstruction surgery and it is therefore important for the operation to be carried out at a single facility so that the surgeon can gain experience and so that patients who had surgery can be evaluated and compared with those who did not. To date, two hand surgeons have carried out more than 170 nerve reconstructions. Hand surgeons also carry out secondary surgery, especially of the shoulder, and this has now become more common than nerve reconstruction with more than 220 procedures since 1997. We provide assessments and counseling relating to physical and occupational therapy. Once or twice a year, we arrange “theme days” for parents of children with plexus injury and/or for teenagers with plexus injury. In addition, we arrange annual arrange theme days for our staff.
In summary, our obstetrics plexus injury team possesses a wealth of experience and knowledge. Two dissertations have been presented and several research projects are underway. No other facility in Sweden can offer equivalent multidisciplinary experience and expertise.
Department of Pediatric Neurology

Preimplantation Genetic Diagnosis (PGD)
Since 1996 the Fertility Unit has carried out PGD for couples who are at significant risk of transferring severe genetic diseases and/or early death to their children. The service is provided in collaboration between specialists at the Fertility Unit and the Clinical Genetics Laboratory in Solna. In Sweden such services are available in Stockholm and Göteborg. Stockholm’s operation is larger in both number of patients and worked up diagnoses. Referrals come from all over Sweden and abroad, particularly from Norway. We achieve results that are comparable to those in the rest of the world. The need for these services is increasing. We provide these services about 60 to 80 times per year at this time.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström
Contact: Margareta Fridström

Primary Immune Deficiency
The Immune Deficiency Unit at Karolinska University Hospital, Huddinge, is the largest in Sweden and is uniquely qualified to diagnose, treat, and monitor adult patients with primary immune deficiency. Immune deficiencies represent a heterogeneous group of diagnoses, each of which is relatively uncommon. The majority of patients have some form of antibody deficiency, but even diagnoses such as WHIM syndrome, complement, t-cell, and granulocyte defects occur. About 900 patients are currently treated at the unit.
Immune Deficiency Unit
Department Director: Joachim Lundahl
Contact, optimized care chain: Susanne Hansen

Prophylactic Mastectomy and Primary Reconstruction for Hereditary Breast Cancer
The department has carried out prophylactic mastectomy and primary reconstruction on about 140 patients, thereby making it the largest of its kind in Scandinavia. All of our patients are enrolled in a follow-up program for our quality-assured services. We discuss all patients preoperatively in special multidisciplinary team conferences, including a psychologist associated with the team. A special contact nurse can be reached during office hours and an attending doctor is always appointed.
Department of Reconstructive Plastic Surgery
Department Director: Marie Wickman
Section Manager: Jakob Lagergren
Contact, optimized care chain: Marie Wickman

Reconstructive Surgery for Aural Atresia
Congenital aural atresia is a rare birth defect that afflicts about twenty children annually in Sweden. One out of every ten cases is bilateral. The atresia is usually linked to a malformation of the external ear. Atresia is associated with impaired hearing to a level that precludes communication for the involved ear. Reconstructive surgery is based on close collaboration between plastic surgeon and ENT surgeon. Auditory canal reconstruction is combined with rebuilding the tympanic membrane and ossicular chain.
Ear, Nose, and Throat Department and Cochlear Section
Department Director: Pär Stjärne
Contact: Henrik Harder

Secondary Breast Reconstruction
We use all known established methods for secondary breast reconstruction, from implant insertion to various flap reconstructions as well as microsurgical reconstruction. We continuously develop and refine our methods and include all patients in follow-up. A contact nurse is available.
Department of Reconstructive Plastic Surgery
Department Director: Marie Wickman
Section Manager: Jakob Lagergren
Contact, optimized care chain: Jakob Lagergren

Sexual Medicine
The Center for Andrology and Sexual Medicine carries out complete fertility work-ups of men, work-up of Klinefelter's syndrome, and work-up and treatment of sexual dysfunction, as well as work-up in cooperation with several specialties prior to possible sex change surgery.
Department of Endocrinology, Metabolism, and Diabetes
Department Director: Bo Angelin
Section Manager: Stefan Arver
Contact, optimized care chain: Stefan Arver

Vocal Cord Laryngoplasty for Voice Pitch Correction
The Ear, Nose, and Throat Department and Cochlear Section at Karolinska University Hospital, Huddinge, is currently the only department in Sweden that carries out vocal cord laryngoplasty to raise voice pitch in patients undergoing male-to-female sex change surgery. Voice assessment and treatment are carried out in conjunction with a speech therapist at Karolinska University Hospital or a speech therapist from the home county council.
Department of Speech and Language Therapy
Department Director: Pär Stjärne
Contact: Stellan Hertegård
Other information: Stellan Hertegård, senior physician; Maria Södersten, Department of Speech and Language Therapy

Thoracoabdominal Aneurysm
The Department of Thoracic Surgery offers treatment of thoracoabdominal aneurysm with cutting-edge surgical therapy and postoperative care.
Department of Thoracic Surgery
Department Director: Ulf Kjellman
Contact, optimized care chain: Anders Winnerkvist

Tracheobronchial Stenting
The tracheobronchial stent has an essential role in the care of airway obstruction, or impending obstruction. The most common indication for stenting is to provide palliative treatment of cancer that threatens the major airways (trachea and bronchi), but there are other indications such as sealing off a barrier injury (trauma or fistula), benign tracheal stenosis, and to treat compression for other reasons, such as major vascular changes in the thorax. Rigid bronchoscopy and video monitoring have improved patient safety and treatment reliability during both insertion and replacement of stents.
Ear, Nose, and Throat Department and Cochlear Section
Department Director: Pär Stjärne
Contact: Jan-Erik Juto

Trachelectomy
Surgical treatment of women with cervical cancer, even in early stages, usually entails removal of the uterus. Since cervical cancer often afflicts young women of childbearing age, an advanced technique was developed to preserve the uterus when removing the tumor, thereby maintaining fertility: trachelectomy. Only about ten such surgeries are carried out annually nationwide. The majority of cases come to our department and we have achieved success with surgical methods, including the birth of several children to women who have had this surgery.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström
Contact: Måns Edlund

Transsexual Surgery, Male-to-Female
This department is a national medical center that carries out sex change operations, mainly from male to female, and recent years have seen a sharp rise the number of cases. Patients receive multidisciplinary care and a contact nurse is available. Follow-up studies are underway.
Department of Reconstructive Plastic Surgery
Department Director: Marie Wickman
Section Manager: Johan Rinder
Contact, optimized care chain: Johan Rinder

Pressure Ulcers
Pressure ulcer services are provided in cooperation with the Spinal Cord Injury Center, where patients receive outpatient care and Rehab Station Stockholm, where patients receive care during the mobilization and rehabilitation phase. A detailed care program with a structured care chain is available. Patients are treated postoperatively in special pressure-relieving beds and the postoperative rehabilitation phase has made it possible to reduce length of stay.
Department of Reconstructive Plastic Surgery
Department Director: Marie Wickman
Section Manager: Johan Rinder
Contact, optimized care chain: Jakob Lagergren

Self-Dialysis Training (hemodialysis and peritoneal dialysis)
The Department of Renal Medicine has extensive knowledge and experiences in informing and educating patients with chronic renal failure to take responsibility for their own dialysis treatment with peritoneal dialysis or home or self-hemodialysis. The department’s specially trained nurses teach the patients and training includes how to take care of the dialysis equipment. For self-hemodialysis in particular the patient must be well-trained and well-informed. Training is mainly provided at the department's Dialysis Unit on Kungsholmen.
Department of Renal Medicine
Department Director: Carl-Gustaf Elinder
Medical Director, self-dialysis: Erland Löfberg
Medical Director, peritoneal dialysis: Olof Heimbürger
Contact, optimized care chain: Kerstin E Karlsson, senior secretary
Section Leader, home dialysis: Britt-Louise Allenius, Kungsholm Dialysis

Work-up of Pituitary Tumors
Patients with pituitary tumors are worked up through a cooperative effort involving radiologists, neurologists, neurosurgeons, and ENT surgeons. Treatment is optimized through decisions made during joint rounds. The Department is usually responsible for preoperative and postoperative care, as well as initial outpatient follow-up.
Department of Endocrinology, Metabolism, and Diabetes
Department Director: Bo Angelin
Section Manager: Charlotte Höybye
Contact, optimized care chain: Charlotte Höybye

Urology, Robotic Surgery
Karolinska University Hospital's Department of Urology has a Center of Excellence for robotic surgery, which involves robot-assisted laparoscopic surgical techniques. We have two surgical robots that are mainly used for prostatectomies done on the indication of prostate cancer. This technology makes it possible to more precisely carry out dissection of the nerves responsible for potency and the area near the end muscle to preserve continence, which provides significant advantages with respect to postoperative urinary continence and erectile function. In addition, this laparoscopic technique usually allows the patient to be discharged on the day after surgery. We recently did surgery on our 1000th patient and our center is the biggest in Europe.
Department of Urology
Department Director: Ingrid Ehrén

Pre-Liver Transplantation Work-up
Since 1984 Gastro Center Medicine, Huddinge, has been working up patients with terminal cirrhosis of the liver, acute hepatic failure, metabolic liver disease, and liver tumors where it is anticipated that the need for liver transplantation will ultimately arise. We carry out the work-up in close collaboration with the Departments of Transplantation and Anesthesiology at Karolinska, Huddinge, and try to find the optimal time for transplantations in the course of disease and rule out contraindicated risk factors prior to transplantation. Other departments (Department of Radiology, Addiction Center, Infectious Disease, Social Work, Physical Therapy, etc.) form a network relating to patient work-up. In recent years work-up time has been reduced to 4 days for inpatients, while 10 days are required in the outpatient and day care setting. Decisions on transplantations are taken at a joint multidisciplinary therapy conference where the patient and relatives receive immediate notification and appropriate patients can immediately be placed on the transplantation waiting list.
In the case of certain metabolic liver diseases, such as familial amyloidosis with polyneuropathy, work-up can be more limited since a significant portion is already done at the regional hospital in the home county council (usually Norrland University Hospital). About one hundred patients are worked up annually. A quality assessment register has been established.
Gastro Center Medicine
Department Director: Rolf Hultcrantz
Section Coordinator, senior physician: Per Stål
Contact, optimized care chain: Per Stål, Staffan Wahlin
Other information: Per Stål, Antti Oksanen, Staffan Wahlin, Annika Bergquist

Vulva Surgery
Vulva surgery is carried out due to cancer and vaginal surgery for indications such as correction of birth defects and aplasia. By centralizing these less common patient categories, we can take best advantage of the experience gained and when necessary, we can work with crucial affiliated specialties such as oncology and plastic surgery.
Department of Obstetrics and Gynecology
Department Director: Lennart Nordström
Contact, optimized care chain: Måns Edlund

External Ear Reconstruction
The Department is responsible for a growing service in external ear reconstruction in cooperation with both national and international centers. We treat both children and adults. Care programs involving ENTs from both Stockholm and Uppsala are available for complicated cases. All patients are followed up in a well-organized program.
Department of Reconstructive Plastic Surgery
Department Director: Marie Wickman
Section Manager: Erik Neovius
Contact, optimized care chain: Åsa Edsander-Nord

Hereditary Metabolic Diseases (e.g., Gaucher's disease, Fabry's disease, bone metabolism diseases, familial hyperlipidemia)
Work-up of rare hereditary metabolic disorders, such as work-up of families for severe familial hyperlipidemia, is carried out in conjunction with the Department of Endocrinology, the Center for congenital metabolic disorders, the chemistry lab, pathology, and sometimes involves specialists in nephrology, neurology, and cardiology. LDL apheresis treatment is provided in cooperation with the Department of Transfusion Medicine. Joint rounds are held.
All work-ups are individualized and usually entail biochemical analysis, sometimes muscle, bone, liver, or skin biopsy, and in mitochondrial disease, a special work-up is carried out at the Center for congenital metabolic disorders. A specialized nurse investigates first-degree relatives. A separate clinic usually initiates special (expensive) treatments such as enzyme substitution, which generally begins in the day care setting. There is a dedicated family register for familial hyperlipidemia.
Department of Endocrinology, Metabolism, and Diabetes
Department Director: Bo Angelin
Section Manager: Mats Eriksson, Mats Palmér
Contact, optimized care chain: Mats Eriksson, Ingrid Dahlman, Maria Sääf