The present project investigated the effect of glucose, high dose insulin and normoglycemia (GIN) therapy in patients undergoing coronary revascularization surgery. A reduction in myocardial injury as measured by cardiac troponin I was the primary end point. Cardiac function based on hemodynamics and vasoactive drug requirements as well as clinical outcome were evaluated. Hormones and metabolites and cardiac metabolism were investigated concurrently as potential mechanisms of GIN therapy. The major findings of the present study are that GIN therapy reduced post-operative myocardial injury and myocardial dysfunction leading to a decrease in major complications following coronary artery bypass grafting surgery. The mechanism of the overall improvement in cardiac function and decreased morbidity following CABG with GIN therapy is likely to be multi-factorial, but from the present results, is influenced by improved myocardial metabolism. GIN therapy is thus an effective diet for the ischemic heart.

Pulmonary dysfunction following cardiopulmonary bypass surgery is a widely explored complication and a multitude of factors have been implicated, including but not limited to: operative trauma; the cardiopulmonary bypass circuit; cardioplegia; the type of donor grafts utilised; anaesthesia and fluid administered. There is a paucity of information regarding the effect of cardioplegia on the lungs. No studies have previously investigated whether allowing cold-blood cardioplegic solution to enter the lung parenchyma, during the period of cardioplegia delivery, has an effect on the clinical outcome of lung function following cardiopulmonary bypass surgery. For this reason an original study was done to determine the effect of preventing cardioplegia from entering the lungs, by evacuating overflow of cardioplegia not drained via the atriocaval cannula, by using a pulmonary artery vent. A total of 403 patients admitted to undergo full cardiopulmonary bypass were screened and 142 patients who fitted the criteria for inclusion and provided informed consent took part in this prospective double blind randomised clinical trial. The control group underwent routine cardiopulmonary bypass grafting. The study group had the intervention of a pulmonary artery vent sutured in position at the time the heart was cannulated for bypass. During cardioplegia delivery the cardioplegia was removed via the atriocaval cannula in the control group (A) and via the atriocaval cannula and the pulmonary artery vent in the study group (B). Aside from this difference, the two groups were managed identically intra- and post-operatively. Outcomes which were compared included eight time measures of arterial blood gases; electrolytes and shunt fraction; bedside lung spirometry measures over five time periods; radiographic measures of atelectasis and effusion over three time points; as well as physiotherapy and hospitalisation requirements. Numerous other potentially extraneous variables were measured and compared in order to monitor homogeneity of the study samples. The consistency of the results within each group throughout the study provides strong evidence that the measurements taken were accurate. The use of standardised equipment and vigilant adherence to the protocol ensured no extraneous deviation. The internal validity of this study was therefore good and accurate. The findings of the study however brought into question a previously accepted belief that the pulmonary artery vent prevents the overflow of cardioplegia, not drained from the right atrium, from entering the lungs. There was no literature or previous studies to confirm or dispute this accepted ‘observation’ by cardiac surgeons that the cardioplegia does enter the lung parenchyma. To therefore validate the findings of the study a further four original studies were designed and initiated. The objective of these studies was to establish the efficacy of the pulmonary artery vent and to determine whether cardioplegia indeed circulates through the lung parenchyma or merely accumulates and ‘pools’. Technetium (Tc-99m), a radio labelled isotope was added to the cold blood cardioplegia solution prior to delivery in order to determine this. In the four sub-studies it was confirmed that the pulmonary artery vent is 90-100% effective in retrieving any cardioplegic solution not drained by the atriocaval cannulae, thus confirming the effectiveness of the pulmonary artery vent in preventing cold blood cardioplegic solution from entering the lungs. The findings of the main study confirmed that respiratory impairment after uncomplicated cardiopulmonary bypass, even in low risk patients, is relatively common, as within each group there was a significant change in outcome measures over time. Inter-group comparisons however showed these changes were not significant, with both groups deteriorating by the same degree post-operatively, therefore establishing that these changes were independent of the intervention of the pulmonary artery vent. In the control group, the cold blood cardioplegia solution that did not drain from the atriocaval cannula entered the lungs and circulated the lung parenchyma during cardiopulmonary bypass. The study group made certain that none, or very little, of the cold blood cardioplegia solution entered the lungs. The main findings of this study are therefore that pulmonary function and gas exchange, although markedly reduced following cardiac surgery, are not affected by placement and suctioning via a pulmonary artery vent during the time of cardioplegia delivery intraoperatively. Furthermore, these studies strongly suggest that cold blood cardioplegia solution is innocuous to the lungs / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2006.

With the decreasing length of hospitalization for the Coronary Artery Bypass Graft (CABG) patient population, it is becoming increasingly difficult to provide patients with necessary education. The purpose of this study was to examine patients' perceptions of the importance of patient teaching information, and how realistic they perceive it is to learn the information following CABG surgery. Patients' learning and understanding are increased when the information is perceived as important.The findings of this study indicated that CABG patients rated the areas of medication, diet and activity information as the most important to learn during the early recovery period. The patients indicated that it was less realistic to learn in the areas of anatomy and physiology, risk factors, medications, diet, activity, post surgical care, psychological factors, and other pertinent information during the early recovery period. The information gained from this study could be used to enhance educational content for patients who have undertaken CABG surgeries. / School of Nursing

Fetma ökar världen över och likaså gör antalet gastric bypass- operationer. Syftet med en gastric bypass- operation är att åstadkomma en viktminskning genom en förminskning av magsäcken, vilket resulterar i minskad hungerkänsla och reducerat matintag. Ett centralt mål inom överviktskirurgi är en ökad livskvalité. Det är därför betydelsefullt att se behandlingen som en helhet och att inte iaktta viktminskning som den enda betydande faktorn. Syftet i denna studie var att beskriva hur personer som genomgår en gastric bypass-operation hanterar situationen före och efter operationen. Studien är induktiv och utgår ifrån en kvalitativ ansats och baseras på en manifest analys utifrån textens innehåll ur sex bloggar skrivna av personer som genomgått en gastric bypass-operation. Analysen gjordes utifrån Fribergs femstegsmodell. Tre huvudkategorier och sex underkategorier framkom. Huvudkategorierna består av: (1)Mental förberedelse, (2) Ansvarstagande och (3) Att släppa på kontrollen och ta emot hjälp. Mental förberedelse beskriver hur deltagarna söker och använder information om operationen och om en inre dialog som personerna förde med sig själva. Vidare skildrar Att släppa på kontrollen och ta emot hjälp hur personerna nyttjade personer i sin omgivning för en stödjande funktion. Här beskrivs också att personerna fick en insikt om att de hade få möjligheter att påverka situationen och därför var tvungna att acceptera den som den var. Ansvarstagande skildrar vad inspiration och motivation hade för positiv inverkan hos individerna till att nå sina mål samt hur de gick tillväga för att kontrollera och planera vardagen utifrån sina nya förutsättningar. / Obesity in the world is increasing and likewise the amount of gastric bypass surgery. The purpose of the surgery is to accomplish a weightloss by reducing the size of the stomach, which results in reduced hunger and intake of food. A central goal of obesity surgery is an increased quality of life. Therefore, it is important to see the treatment as a whole and not observe the weightloss as the only significant factor. The aim of this study was to describe the strategies of actions that have been used by patients who have experienced a gastric bypass- operation. The structure of this study is inductive and is in line with a qualitative methodology and based upon a manifested analysis of the content of six different blogs written by six individuals who have experienced a gastric bypass- operation. The analysis has been done based upon Friberg’s five step model. During the analytical process, nine categories emerged of which three main- categories are divided in (1) Mental preparation, Responsibility and (3) To let go of control and receive help. Mental preparation concerns the operation and the furthermore the use of this information as well as the process of the patient’s internal dialogue. To let go of control and accept help includes how the patients utilized internal dialogue. To let go of control and accept help includes how the patients utilized people in their surroundings to create a supporting network during the process of the operation. Furthermore, this part describes the emerging of an understanding of the fact that they were very limited in affecting the process in question and consequently had to accept the situation as it was. Responsibility describes how inspiration and motivation influenced the individuals positively to reach their personal goals and furthermore how they managed to outline and organize their everyday life in accordance with the new conditions that had appeared as a result of the process surrounding a gastric bypass- operation.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 4 uppsatser.

Τα επίπεδα της γκρελίνης και του PYY μετά από χειρουργείο χολοπαγκρεατικής εκτροπής και Roux-en-Y γαστρικού bypass και μετά από χειρουργείο κολεκτομής: προοπτική συγκριτική μελέτη Οι ορμόνες του γαστρεντερικού γκρελίνη και PYY έχει αποδειχθεί ότι παίζουν κάποιο ρόλο στη ρύθμιση του μεταβολισμού και της όρεξης. Μελετάμε την επίδραση του χειρουργείου της χολοπαγκρεατικής εκτροπής και RYGBP (BPD-RYGBP) στα κυκλοφορούντα επίπεδα της γκρελίνης και του PYY άμεσα μετεγχειρητικά και τα συγκρίνουμε με την αντίστοιχη επίδραση μιας άλλης χειρουργικής επέμβασης της ίδιας βαρύτητας, την κολεκτομή. Μέθοδος. Μελετάμε τα επίπεδα νηστείας της γκρελίνης και του PYY σε 20 παχύσαρκους ασθενείς (super-obese) που υποβλήθηκαν σε BPDRYGBP και σε 13 ασθενείς που υποβλήθηκαν σε κολεκτομή για καρκίνο παχέος εντέρου. Οι μετρήσεις έγιναν προεγχειρητικά, και τις μετεγχειρητικές ημέρες 1,3,7,30 και 90 και στις δύο ομάδες, καθώς και στον 1 χρόνο στην ομάδα των παχυσάρκων. Αποτελέσματα. Προεγχειρητικά, τα επίπεδα και της γκρελίνης και του PYY ήταν χαμηλότερα στην ομάδα των παχυσάρκων. Μια προσωρινή μείωση των τιμών της γκρελίνης παρατηρήθηκε και στις δύο ομάδες άμεσα μετεγχειρητικά με σταδιακή επάνοδο στα προεγχειρητικά επίπεδα έως τον 3ο μήνα. Επιπλέον τα επίπεδα της γκρελίνης αυξήθηκαν 40%, σε σύγκριση με τα προεγχειρητικά, στην ομάδα των παχυσάρκων στον 1ο χρόνο παρακολούθησης. Τα επίπεδα του PYY στην ομάδα των κολεκτομών μειώθηκαν τις πρώτες 3 μετεγχειρητικές ημέρες και έπειτα επέστρεψαν στα προεγχειρητικά. Σε αντίθεση, τα επίπεδα του PYY στην ομάδα των παχυσάρκων δεν άλλαξαν άμεσα μετεγχειρητικά αλλά αυξήθηκαν σε επίπεδα 50% υψηλότερα στον 3ο μήνα και 170% υψηλότερα στον 1ο χρόνο, σε σύγκριση με τα προεγχειρητικά. Συμπεράσματα. Η μεγάλη μετεγχειρητική αύξηση των επιπέδων της ανορεξιογόνου ορμόνης PYY μετά από BPD-RYGBP μπορεί να παίζει ρόλο στην μειωμένη όρεξη που παρατηρείται μετά από αυτό τον τύπο βαριατρικής επέμβασης. Οι αλλαγές της γκρελίνης μετεγχειρητικά κάνουν τη συμμετοχή της ορμόνης αυτής στη μείωση της όρεξης λιγότερο πιθανή. / Ghrelin and Peptide YY levels anfter a variant of biliopancreatic diversion with Roux-en-Y gastric bypass versus after colectomy: A prospective comparative study Background. The gastrointestinal peptide hormones ghrelin and PYY, have been shown to play a role in the regulation of metabolism and apetite. We investigate the effect of the biliopancreatic diversion with Roux-en-Y gastric bypass (BPD-RYGBP) procedure on the circulating levels of ghrelin and PYY during the first 3 months postoperatively as compared to the effects of colectomy, an abdominal operation of similar severity. Methods. We determined the fasting plasma levels of ghrelin and PYY in 20 morbidly super obese patients that underwent BPD-RYGBP and in 13 subjects that underwent a colectomy because of large bowel cancer. Fasting plasma ghrelin and PYY levels were measured preoperatively and during the postoperative period on days 1,3,7,30 and 90 in all patients of both groups and at the 1 year for the patients who had attained 1-year follow up. Results. Preoperatively, both plasma ghrelin and PYY levels were lower in the BPD-RYGBP group of patients. A temporary decrease in plasma ghrelin levels was observed in both groups of patients during the immediate postoperative period with a gradual return to preoperative levels by the third month. In addition, ghrelin concentrations increased at one year to levels 40% higher than those in baseline, in ten of the BPD-RYGBP patients who had completed the one-year follow up (p=0.004). Plasma PYY levels in the colectomy group decreased the first three postoperative days and then returned to baseline. In contrast, PYY levels in the BPD-RYGBP group did not change during the early postopera¬tive period but increased to levels 50% higher at 3 months (p<0.001) and 170% higher at one year (p<0.001) than the baseline. Conclusions. The great postoperative increase of the levels of the anorexigenic peptide PYY following BPD-RYGBP may contribute to the reduced appetite observed after this type of bariatric surgery. The changes in ghrelin levels postoperatively make its contribution to the appetite suppression less likely.

Introduktion: Övervikt är ett stort stigande folkhälsoproblem och har tredubblats globalt sedan 1975. Med svår fetma uppnås sällan viktnedgångsmål utan viktreducerande kirurgi. Gastric bypass är den vanligaste kirurgimetoden och kräver stor livsstilsförändring med individuell ansträngning. Syfte: Var att belysa patienters upplevelser efter en gastric bypass operation. Metod: Litteraturstudien gjordes med utgångspunkt i Polit och Becks (2016) 9 steg. Databassökningen gjordes i CINAHL och PubMed och resulterade tillsammans med frisökning i 11 vetenskapliga artiklar efter kvalitetsgranskning enligt Polit och Becks (2016) granskningsmallar för kvalitativ samt kvantitativ metod. Nio kvalitativa och två kvantitativa artiklar valdes till resultatet. Artiklarna lästes enskilt och sedan tillsammans och gemensam diskussion fördes för att identifiera likheter och skillnader i fynden som utgick från litteraturstudiens syfte. Resultat: I resultatet framkom tre kategorier; den förändrade kroppen, att hantera en förändrad kosthållning och behov av stöd och uppföljning. Patienternas upplevelser var individuella men en gemensam upplevelse var att en stor livsstilsförändring krävdes för att upprätthålla både vikt och välmående efter operationen. Slutsats: Litteraturstudiens resultat betonade förekomsten av både fysisk, psykisk och psykosocial förändring efter en gastric bypass operation. Generellt förändrade operationen patienternas liv och gav patienterna möjlighet till en framtid.

Introdução: Apesar de não ser puramente disabsortiva, o Bypass Gástrico em Y de Roux pode provocar alteração da absorção de muitas vitaminas e minerais. Considerando ainda o fato de existirem poucos estudos que relatem o estado geral destes indivíduos, sobretudo com relação aos parâmetros nutricionais em longo prazo, observou-se à necessidade do desenvolvimento de um estudo que verifique a prevalência das carências nutricionais e a efetividade da técnica empregada, bem como o estado geral destes pacientes e suas inter-relações com outros fatores, para especialmente direcionar com maior efetividade as condutas a serem empregadas no pós-operatório pela equipe multidisciplinar. Métodos: 8 homens e 67 mulheres de uma amostra inicial de 130 pacientes compareceram a entrevista. Estes pacientes foram operados pela técnica de Bypass Gástrico em Y de Roux, possuíam entre 18-65 anos e tinham mais que 5 anos de pós-operatório. Foram coletados os seguintes dados: IMC pré e pós-operatório, perda do excesso de peso, queixa de sintomas gastrointestinais, além de dados referente a deficiências nutricionais através da análise de sangue pelos métodos padrões. Resultados: O IMC inicial foi de 56,5 +/- 10 Kg/m2. Após 2 anos, o IMC médio havia caído para 29,4 +/-6 e após 87 meses após a cirurgia, este era de 34,3 +/-10 Kg/m². Uma associação inversa entre perda do excesso de peso (PEP) e tempo de pósoperatório foi observada (P= 0,27; p=0,0183). Após 2 anos apenas 1,33 % (n=1) não atingiu a PEP esperada de 50% do excesso de peso e no momento da entrevista, 30,6% (n=23) não haviam conseguido mantê-la. As deficiências mais comumente verificadas foram as deficiências de vitamina B12 (61,82%) e D (60,53%). Baixos níveis de hemoglobina também foram verificados (50,82%). Vômitos e Síndrome de Dumping foram às queixas gastrointestinais mais observadas 66,19% e 56,76%. Verificou-se correlações significantes entre baixos níveis de hemoglobina e o sexo feminino (p=0,011), % de PEP e ocorrência de vômito com deficiência de vitamina B12 (p=0,028) e (p=0,022). Conclusão: O BGYR é eficiente na promoção e manutenção de perda de peso em longo prazo. Especial atenção deve ser dada aos grupos de maior risco para desenvolvimento de deficiências nutricionais, mulheres em idade fértil, perda de peso excessiva e naqueles que apresentam vômitos freqüentes. / Background: The goal of this study is determining both the efficacy of the surgery and the prevalence of nutritional deficiencies in the long term after the Roux-en Y Gastric Bypass and search for relations of theses deficiencies with other factors. Methods: 8 men and 67 women consecutives patients, who had 5 years or more after the surgery were assessed during regular visits. Pre and Post-operative BMI, excess weight loss and gastrointestinal symptoms were registered. Nutritional deficiencies were accessed by standard laboratory assays. Result: The initial BMI was 56,5 +/- 10 Kg/m2. After 2 years, the mean BMI had dropped to 29,4 +/-6 and by and average of 87 months it was 34,3 +/-10 Kg/m². A inverse association beetwen Excess Weight Loss (EWL) and time of postoperative was verified (P= 0,27; p=0,0183). After 2 years only 1,33 % (n=1) had not achieve a EWL of at least 50%. At the end, 30,6% (n=23) could not maintain this EWL. The more commom nutricional deficiencies are vitamin B12 (61,82%) and D (60,53%). Low levels of hemoglobin (50,82%) was also verified. Vomiting and dumping syndrome was reffered in 66,19% and 56,76%. Significant correlation and with clinical signify was observed between low hemoglobin levels and femine sex (p=0,011), % of weight loss and the B12 deficiency (p=0,028) and vomiting and deficiency of B12 (p=0,022). Conclusion: The RYGB is efficient to promotes and maintain the weight. Special attention should be given to patients with massive weight loss, frequent vomiting and women in reprodutive age.

Bakgrund: Fetma är ett hot mot folkhälsan och har ökat snabbt de senaste årtiondena. I Sverige utförs många operationer mot fetma vilket kan minska sjukdomsföljder samt ge en förbättrad livskvalitet. Det finns olika typer av överviktskirurgi där gastric bypassoperationen är den vanligaste. Hälsa är sammankopplat med självuppfattning vilket är av betydelse för de personer som väljer att genomgå en operation. Egenvård används för att bibehålla hälsa i det dagliga livet. Syfte: Syftet med denna studie var att beskriva personers erfarenheter av dagligt liv efter en gastric bypassoperation. Metod: Den metod som användes var narrativ analys av sex bloggar skrivna av kvinnor. Resultat: Ur analysen av datamaterialet framträdde tre kategorier; anpassa till en ny vardag, svårigheter att leva ett normalt liv och medaktör i den fortsatta planeringen med sju underkategorier. Slutsats: Studiens resultat har genererat information som med fördel kan användas för att förstå hur personer som genomgått en gastric bypassoperation erfar det dagliga livet. Denna kunskap kan hjälpa sjuksköterskor till att få en djupare förståelse för dessa personer, kunna tillämpa patientcentrerad vård och därmed bedriva en god omvårdnad. / Background: Obesity is a threat against public health and has grown rapidly the last decades. Many surgeries against obesity are done in Sweden which may reduce disease outcomes as well as providing an improved quality of life. There are different types of obesity surgery where gastric bypass is the most common. Health is connected to self-perception which is important for those who choose to undergo surgery. Self-treatment are used to maintain health in daily life. Objective: The aim of this study was to describe people´s experiences of everyday life after a gastric bypass surgery. Method: The method used was a narrative analysis of six blogs written by women. Result: Three categories emerged from the analysis; adjust to a new daily life, difficulties to live a normal life and co-actors in the continued planning with seven subcategories. Conclusion: The study’s results have generated information that can be advantageously used to understand how people who have undergone a gastric bypass surgery experiencing daily life. This knowledge can help nurses to get a deeper understanding of these people, be able to apply patient-centered care and therefore operate good care.

M.Cur. / The emotional state of health of pre-operative patients about to have coronary artery bypass graft (CABG) is a decisive factor in the outcome of the procedure. Nel (1989) carried out quantitative research to determine the effect of a pre-operative education programme on CABG patients. This education programme is based on the fact that a person's emotional disposition is a critical variable in his successful recovery from coronary disease. However, the researcher is of the opinion that although Nel's study made a positive contribution regarding this phenomenon, a quantitative research design does not reflect the real experience of the patients that follow a pre-operative education programme. In the researcher's view, a qualitative research design is more appropriate. The aim of the present qualitative, exploring, descriptive, contextual research is to explore and describe the experience of CABG patients exposed to a pre-operative education programme and to lay down guidelines for nursing staff in practice The research was conducted in three phases. One private hospital in Pretoria was use for the research.