Bakgrund: Enligt World Health Organisation är bröstcancer den vanligaste cancerformen hos kvinnor världen över. År 2015 diagnostiserades drygt 7000 kvinnor i åldrarna 20-75 år med diagnosen bröstcancer i Sverige. Varav 90% hade gjort ett kirurgiskt ingrepp. Brösten har varit en symbol för att visa stolthet över sin kropp, sexualitet, moderskap och fruktbarhet genom alla tider. Livskvalitén hos kvinnor som hade gjort bröstkirurgi kunde påverkas både fysiskt och psykiskt. Syfte: Syftet med litteraturöversikten var att beskriva vad som påverkade kvinnors livskvalité efter kirurgi vid bröstcancer. Metod: En litteraturöversikt med en kvalitativ design Resultat: Resultatet visade att kvinnorna beskrev sin livskvalité som både positiv och negativ utifrån de tre tema som framkom i resultatet. Tema som framkom var Förändrad uppfattning av kroppen, Förändrat känsloliv och Förändrat vardagsliv. Slutsats: Denna litteraturöversikt har skapat en förståelse kring ämnet samt en mer ingående fördjupning. Bröstkirurgi kan ses som en lättnad över att fortfarande vara vid liv men även försvaga kvinnorna både fysiskt och psykiskt.

I samband med kirurgi kan patienterna drabbas av postoperativa komplikationer. Rökning är en av riskfaktorerna för detta. Flera landsting arbetar nu aktivt för att förmå patienterna att göra rökuppehåll i samband med kirurgi. I Sverige röker cirka 10-12 procent av den vuxna befolkningen. Andelen rökare har minskat de senaste åren, men varierar fortfarande beroende på socioekonomisk bakgrund och utbildningsnivå. Tobakens skadeverkningar är många och allvarliga både för samhälle och individen, till exempel att syreupptagningen försvåras, luftvägarna skadas och vävnadernas genomblödning minskar. Hälso- och sjukvårdskostnaderna kopplade till rökningens skadeverkningar beräknas till 2,2 miljarder årligen. Sjukvården kan hjälpa till med rökavvänjning genom information, stödprogram och läkemedelsbehandling. Här har sjuksköterskan en viktig roll att fylla när det gäller information, undervisning och motivation. Syftet var att belysa hur rökning påverkar postoperativa komplikationer i samband med kirurgi. Som metod valdes en forskningsöversikt. Efter sökningar i databaserna PubMed och Cinahl valdes 17 vetenskapliga artiklar ut. Sökorden var MESH-termerna smoking cessation, surgical procedure, wound healing, complications, nursing samt surgery. Vid sökning i Cinahl gjordes fritextsökningar med sökorden: smoking, abstinence, surgery och complications. Resultatet visade att rökuppehåll resulterade i färre postoperativa komplikationer. Detta gällde främst sårkomplikationer och i flertalet fall även lungkomplikationer. Hälften av studierna visade minskade hjärt-kärlkomplikationer. De flesta studierna kom även fram till att rökuppehållet måste inledas minst fyra veckor före operationen. Kortare uppehåll hade inget samband med postoperativa komplikationer. Slutsatsen var att ha rökuppehåll i samband med operation ger färre postoperativa komplikationer, främst när det gäller sårkomplikationer och i något mindre grad vid lungkomplikationer. För att genomföra rökuppehåll har sjuksköterskan en viktig roll med information och stöd. Arbetet kring rökuppehåll måste vara välplanerat och strukturerat, men kräver bara begränsade arbetsinsatser för att patienten ska få bättre förutsättningar att lyckas. Rökuppehållet måste enligt studierna vara minst fyra veckor före operation för att resultera i minskat antal komplikationer. Kortare uppehåll gav inga signifikanta förbättringar, men heller inte några försämringar. Rökuppehåll kan alltid rekommenderas.

Bakgrund: Bariatrisk kirurgi är en etablerad behandling för personer med fetma. År 2021 genomfördes cirka 4000 bariatriska ingrepp med syfte att förbättra patienters hälsa och reducera risken av för tidig död orsakat av fetmarelateraterade följdsjukdomar. Ingreppet medför inte bara generell postoperativ vård, utan ibland även intensivvård eller sekundära operationer efter komplikationer som kan uppstå postoperativt. Sjuksköterskan har en viktig roll genom hela vårdförloppet och erbjuder vård baserat på kunskap, men behöver också skapa förståelse för patienter som som genomgått bariatrisk kirurgi för ett individanpassat vårdande. Syfte: Syftet var att undersöka patienters erfarenheter efter bariatrisk kirurgi. Metod: En litteraturstudie baserad på 12 artiklar varav 11 med kvalitativ ansats och en med mixad metod. För sammanställning av resultatet genomfördes en integrerad analys. Resultat: Resultatet presenterades i nio kategorier som beskriver patienternas olika erfarenheter: relationer, hälsa, förändrad identitet och livsstil, anpassning till sin nya kropp, livskvalitet, självförtroende, relationen till mat, viktminskningsprocessen samt patienternas erfarenheter och förväntningar på vården. Många patienter upplevde bättre självförtroende, framgång i relationer och förbättrad hälsa efter kirurgin men resultatet visade även att kirurgin gett upphov till negativa känslor och hälsoeffekter. Relationen till mat hade en stor påverkan på hur patienterna erfor tiden efter genomgången bariatrisk kirurgi och det fanns ett behov av stöd i relationer och från hälso- och sjukvård. Slutsats: Patienters olika upplevelser och erfarenheter efter bariatrisk kirurgi tyder på ett behov av eftervård som är individuellt anpassad.

No description available.

Familial primary hyperparathyroidism (HPT) is a rare disorder that is treated surgically and mostly occurs in association with tumor-susceptibility syndromes, like multiple endocrine neoplasia and the hyperparathyroidism-jaw tumor syndrome. Familial hypercalciuric hypercalcemia (FHH) is another cause of hereditary hypercalcemia that generally is considered to require no treatment and is genetically and pathophysiologically distinct from HPT. Inactivating mutations in the calcium receptor gene cause FHH, whereas the down-regulated expression of the CaR in HPT never has been coupled to CaR gene mutations. Family screening revealed a hitherto unknown familial condition with characteristics of both FHH and HPT. The hypercalcemia was mapped to a point mutation in the intracellular domain of the CaR gene that was coupled to relative calcium resistance of the PTH release by transient expression in HEK 294 cells. Unusually radical excision of parathyroid glands was required to normalise the hypercalcemia. The mildly enlarged parathyroid glands displayed hyperplasia with nodular components. Frequent allelic loss on especially 12q was found and contrasts to findings in HPT. Allelic loss was also seen in loci typical for primary HPT like 1p, 6q and 15q, but not 11q13. Quantitative mRNA analysis showed that the glands had mild increase in a proliferation index (PCNA/GAPDH mRNA ratio) and mild reduction in genes important to parathyroid cell function, like CaR, PTH, VDR and LRP2. A previously unrecognized variant of hypercalcemia is explored that could be one explanation for persistent hypercalcemia after apparently typical routine operations for HPT. It also raises the issue of possibilities to treat FHH with parathyroidectomy provided it is radical enough.

<p>Background:Pancreas cancer is a most aggressive malignancy. More than 80% of patients diagnosed with pancreas cancer, exhibit such advanced disease, that curative surgery is impossible. Systemic chemotherapy prolongs survival to 5-9 months. High concentrations of chemotherapeutic agents in the abdominal cavity and in the lymphatics draining the area is achieved by intraperitoneal administration. Vasopressin decreases splanchnic blood flow, reducing the intraperitoneal uptake of drugs, thus raising the local and lymphatic dose intensity.</p><p>Aim: The aim of the study was to investigate the feasibility and tumour response of intraperitoneal 5-Fluorouracil (5-FU) treatment in non-resectable pancreas cancer, using vasopressin to improve the pharmacokinetic profile. Further, to study the effect of vasopressin on peritoneal blood flow, altered by intraperitoneal 5-FU or the presence of peritoneal carcinomatosis.</p><p>Methods: In the animal experiments, the 133Xe-clearance technique and as a comparison Laser doppler flow, were used to identify changes of peritoneal blood flow caused by vasopressin in unmanipulated animals and in animals with peritoneal carcinomatosis or animals given intraperitoneal 5-FU. In the clinical studies, 68 (39 women/29 men) patients, with a non-resectable ductal pancreas cancer and a Karnovsky Index ≥70 were included. Patients were treated with 750-1500 mg/m2 5-FU intraperitoneally through a Port-a-cath and Leucovorin 100 mg/m2 intravenously on two consecutive days every 21 days until progression. Seventeen patients, receiving 750 mg/m2 5-FU, were given concomitant vasopressin 0.1 IU/min during 180 minutes, alternatively day 1 or 2.</p><p>Results: In the animal experiments, vasopressin 0.07 IU/kg/min significantly reduced the 133Xe-clearance. Intraperitoneal 5-FU decreased the basal peritoneal blood flow and abrogated the vasopressin effect for 1-2 days. The presence of peritoneal carcinomatosis did not influence the basal peritoneal blood flow, nor the reduction of peritoneal blood flow caused by vasopressin. In the clinical studies, the treatment with intraperitoneal 5-FU was well tolerated, with no WHO Grade 3 or 4 toxicity with doses up to 1250 mg/m2. Thirty patients achieved at least stable disease at three months. The median survival time was 8.0 (range 0.8-54.1) months. There was a significant reduction of 5-FU Cmax on day 2, but no significant reduction of AUC, when vasopressin was given.</p><p>Conclusion: Peritoneal blood flow changes caused by vasopressin can be estimated with the 133Xe-clearance technique. Intraperitoneal 5-FU but not peritoneal carcinomatosis decreases the vasopressin induced 133Xe-clearance reduction, 1-2 days after administration. In patients with non-resectable pancreas cancer, intraperitoneal 5-FU up to 1250 mg/m2 for two days every third week can be given without WHO grade 3 and 4 toxicity. The treatment is well tolerated with few and minor side effects. Tumour responses were observed. Addition of vasopressin does not significantly enhance the pharmacokinetics of intraperitoneal 5-Flurorouracil, but adds toxicity.</p>

<p>Loosening of implants is a frequent complication in orthopaedic surgery. The aim of this thesis was to evaluate hydroxyapatite coating of pedicle screws with mechanical and histological methods and to correlate the results with the radiological findings.</p><p>Hydroxyapatite (HA) coating of pedicle screws was investigated in experimental studies in sheep. Nine sheep were operated on with destabilising laminectomies at L2-L3 and L4-L5 and stabilised with pedicle screw instrumentations, where HA coated and uncoated screws were used in a randomised fashion. After both 6 and 12 weeks of implantation, the HA coated screws demonstrated a higher bone-to-implant contact and a higher amount of bone in the area close to the screw. The pull-out resistance, stiffness and total energy to failure was higher for the HA coated screws after 12 weeks of implantation.</p><p>HA coating of pedicle screws was examined in two clinical studies. In the first series, the patients were stabilised with pedicle screw instrumentations, where HA coated screws were used in either the upper or lower instrumented level in a randomised fashion. After 10-22 months of implantation, the extraction torque was markedly higher for the HA coated screws. In the second series, instrumentations with uncoated, partly HA coated or fully HA coated screws were used. After 11-16 months implantation, the extraction torques were recorded. There were significant differences between all three groups, with the lowest extraction torques for the uncoated screws and the highest torques for the fully HA coated screws. The frequency of radiolucent zones surrounding the screws was higher for the uncoated screws than for the HA coated screws.</p><p>Radiographs from both experimental and clinical studies were examined. Screws demonstrating radiolucent zones were compared to screws without zones with respect to pull-out resistance, extraction torque, bone-to-implant contact and amount of bone surrounding the screws. All these variables demonstrated higher values for the screws without radiolucent zones. The frequency of radiolucent zones surrounding uncoated screws in the clinical study was 53%.</p><p>Conclusions: Radiolucent zones are good predictors of screw loosening. The frequency of radiolucent zones is higher than previously described. Hydroxyapatite coating improves the purchase of pedicle screws and reduces the frequency of screw loosening.</p>

<p>A large amount of non-protein nitrogen, in the form of urea and ammonium, is present in human breastmilk; however its physiological role in the infant is as yet not fully understood. It has been hypothesized that an insufficient enteric metabolism of urea could play a role in the sudden infant death syndrome (SIDS). This thesis was undertaken to study the enteric metabolism of non- protein nitrogen in healthy infants, in comparison with those who had succumbed to SIDS.</p><p>Aerobic and anaerobic faecal microflora, were studied in healthy infants from birth to 6 months of age. They were found to appear in faeces within 3 days of birth and were present throughout the first 6 months of life. The effect of nitrate, nitrite and nitric oxide on faecal urease activity was investigated and found to be inhibitory in action. The sigmoid faecal urease activity and sigmoid faecal urea content of SIDS infants were compared to those of control infants; significantly lower sigmoid faecal urease activity and greater sigmoid faecal urea content were found in the SIDS infants. The total number of SIDS cases occurring in Sweden during the period 1990 through 1996 was analysed regarding geographical and seasonal distribution, in relation to the nitrate concentration in drinking water and changes in the groundwater level. The northernmost parts of the country had its highest incidence when the rest of the country had its lowest incidence, and the occurrence of individual deaths was associated with the recharge of groundwater, which is known to increase its nitrate content. The effect of ingested ammonium on carbon dioxide production was determined in healthy infants using the doubly labelled water technique. No change in carbon dioxide production was observed.</p><p>An insufficient enteric metabolism of urea in infants and peak or greatly varying nitrate concentrations in drinking water are associated with the occurrence of SIDS. Ingested ammonium supplements in the given doses did not influence carbon dioxide production in healthy infants.</p>

<p>The primary aim of this thesis was to modify saphenous vein (SV) harvesting technique and evaluate its clinical importance. A new "no touch" (NT) technique of SV preparation was developed where the vein is harvested with a pedicle of surrounding tissue, which protects the vein from spasm therefore obviating the need for distension.</p><p>Firstly, a prospective randomised study in 156 patients who underwent coronary artery bypass grafting was done to compare this new "no touch" technique to two others, the conventional (C) and the intermediate (I) techniques. A morphological study of the endothelium showed an endothelial integrity of 97% in NT vessels while about half of endothelial surface of veins harvested by the other two techniques was devoid of endothelium. At angiographic follow up, the patency for NT was 95.4%, 88.9% for grafts in group C and 86.2% for grafts in group I. A statistically significant difference in patency rate was found between the NT group and group C (p=0.025) and the poorest result was observed in group I.</p><p>Secondly, the immunohistochemistry assessment using CD31-antibody confirmed a better-preserved endothelium for NT vessels. Putative NOS was identified by NADPH-diaphorase histochemistry and autoradiographic localization of [3H] L-nitroarginine (NOARG) binding. NADPH staining was almost continuous on the luminal aspect and was also present in the intact adventitia of NT vessels, which was markedly reduced in conventionally harvested veins. Autoradiographic analysis of specific NOARG binding showed greater binding in the no-touch vessels, confirming the histochemistry results. All three NOS isoforms were identified in the media of SV grafts. In NT, NOS I was abundant in adventitial nerves; NOS II was found in adventitial vasa vasorum and NOS III was associated with endothelial cells lining both the vessel lumen and microvessels within the adventitia.</p><p>In conclusion, this study demonstrated that the endothelial integrity and NOS activity are better maintained when using the no-touch technique for vein graft harvesting. The vasorelaxant and thromboresistent activities of NO may be responsible for the reduced venospasm and improved early patency rates observed. Furthermore, the mechanical properties provided by the cushion of surrounding tissue in grafts harvested by NT technique may contribute to the observed high patency rate.</p>

<p>Familial primary hyperparathyroidism (HPT) is a rare disorder that is treated surgically and mostly occurs in association with tumor-susceptibility syndromes, like multiple endocrine neoplasia and the hyperparathyroidism-jaw tumor syndrome. Familial hypercalciuric hypercalcemia (FHH) is another cause of hereditary hypercalcemia that generally is considered to require no treatment and is genetically and pathophysiologically distinct from HPT. Inactivating mutations in the calcium receptor gene cause FHH, whereas the down-regulated expression of the CaR in HPT never has been coupled to CaR gene mutations. </p><p>Family screening revealed a hitherto unknown familial condition with characteristics of both FHH and HPT. The hypercalcemia was mapped to a point mutation in the intracellular domain of the CaR gene that was coupled to relative calcium resistance of the PTH release by transient expression in HEK 294 cells. Unusually radical excision of parathyroid glands was required to normalise the hypercalcemia. The mildly enlarged parathyroid glands displayed hyperplasia with nodular components. Frequent allelic loss on especially 12q was found and contrasts to findings in HPT. Allelic loss was also seen in loci typical for primary HPT like 1p, 6q and 15q, but not 11q13. Quantitative mRNA analysis showed that the glands had mild increase in a proliferation index (PCNA/GAPDH mRNA ratio) and mild reduction in genes important to parathyroid cell function, like CaR, PTH, VDR and LRP2. </p><p>A previously unrecognized variant of hypercalcemia is explored that could be one explanation for persistent hypercalcemia after apparently typical routine operations for HPT. It also raises the issue of possibilities to treat FHH with parathyroidectomy provided it is radical enough.</p>