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Bakgrund: Ett av mänsklighetens största hälsoproblem är övervikt och fetma. Ett högt BMI ökar risken för morbiditet och mortalitet, därför är en förändrad livsstil med bra matvanor och regelbunden motion det bästa alternativet för att gå ned i vikt. Viktreducerande kirurgi kan vara ett alternativ, som bör undersökas vidare. Syfte: Syftet med litteraturöversikten är att belysa hur hälsa och välmående påverkas hos personer som genomgått ett gastric bypass ingrepp. Metod: En litteraturöversikt utfördes för att studera valt problemområde. Femton vetenskapliga artiklar har använts. Kvalitetsgranskning av artiklarna har gjorts med hjälp av relevanta granskningsmallar och analysförfarandet utfördes av författarna tillsammans. Resultat: Livskvaliteten är lägre hos patienter som vill genomgå viktreducerande kirurgi än genomsnitts befolkning. Patienterna kände att de fick en andra chans i livet efter kirurgin, de uttryckte glädje, såg nya möjligheter och hade bättre välmående både psykiskt och fysiskt efter ingreppet. Det är vanligt med överskottshud, speciellt på magen som en följd av kraftig viktreducering. Patienterna kände frustration över nutritionen, då kosten inte var lika naturlig som tidigare. Det krävdes större måltidsplanering för att få ett tillräckligt näringsintag efter kirurgin. Diskussion: Majoriteten av deltagarnas livskvalitet höjdes och patienterna medverkade i fler sociala aktiviteter efter kirurgin. Patienterna skämdes dock över sin kropp efter kirurgin på grund av överskottshuden. Slutsats: Generellt ökade hälsan och välmående hos de personer som genomgått en viktminskningsoperation, de hade lättare att anpassa sig till samhället och kände sig inte längre överviktiga. / <p>Godkännande datum: 2016-10-31</p>

M.Phil. (Biokinetics) / Although coronary artery bypass graft (CABG) is well-established worldwide as a safe, effective operation for the treatment of coronary artery disease (CAD), it is an invasive procedure that often leaves patients feeling very anxious about the recovery process. The post-surgery phase should not only entail exercise intervention, but should also be paralleled with education and counselling to encourage patients to become responsible for the management of their own health and to achieve good functional capacity and quality of life (QoL). This prospective longitudinal study was aimed at achieving return to health and wellness in a group of CABG patients (n=18) with a mean age of 65 years. Four questionnaires were administered at the pre- and post-test, including Stone’s Heart Disease Risk Factor Questionnaire (1984), Paffenbarger Physical Activity Questionnaire (1978), Hawkes and Nowak Nutrition Knowledge Questionnaire (1998) and the Quality of Life Questionnaire. Morphological variables, biological and physiological fitness parameters, and health-related fitness were also assessed at the pre- and post-test. Prescribed exercise and lifestyle modifications were employed over twelve weeks, with emphasis on healthier nutrition and improved mental health. The level of significance was set at 5% (p ≤ 0.05) and 1% (p ≤ 0.0167). The findings in this study reflected significant improvements in heart disease risk, kilocalorie expenditure, nutrition knowledge, physical and mental QoL, waist circumference, body fat percentage, resting and recovery systolic blood pressure, aerobic endurance, flexibility, agility and dynamic balance, and lower-body strength. However, no significant changes were found in distance walked per day, body weight, body mass index, resting heart rate, resting diastolic blood pressure, blood cholesterol, maximum heart rate, maximum systolic and diastolic blood pressure, rating of perceived exertion, recovery heart rate, and recovery diastolic blood pressure. In addition, a deleterious change was found in blood glucose. Significant improvements were noted in the QoL and nutrition knowledge of this group of participants. The role limitations due to physical health reflected the most prominent improvement, indicating that the intervention positively influenced overall health, wellness, and activities of daily living. This study concluded that cardiac rehabilitation encompassing exercise intervention, nutrition guidelines, and psychosocial advice has been successful in improving the QoL of patients who have undergone CABG surgery.

Background: Obesity has exploaded in the last decades and an ongoing increase is to be seen. The disease is rated as a huge epidemia of times and has developed to an economic social problem. Today more people die from obesity and it´s complications than from nutritional diseases and malnutrition. Gastric Bypass has proved to enable a new life including an improved health and quality of life but has also been critized for being a quick solution not resulting in a long term perspective weight loss. Aim: The aim of this study was to describe people´s experiences from going through Gastric Bypass surgery. Method: The method used was a literature study based on qualitative research. The articles were analysed according to Fribergs five step model and resulted in three main themes and nine sub-themes. Results: The main themes were- The last way out, The battle against oneself and On a new adventure. In order to be able to support these people keeping their new life style and weight reduction the nurse must have insight in people´s experiences of having undergone a Gastric Bypass surgery. Conclusion: The result showed that Gastric Bypass can be a last alternative for hope about a better future and a chance to an improved health and quality of life. Though the surgery has to be combined with individually created coping strategies and a genuine, strong will to make a change in order to become a successful action in a long term perspective.

Submitted by Pedro Barros (pedro.silvabarros@ufpe.br) on 2018-10-10T20:25:01Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE Vladimir Curvêlo Tavares de Sá.pdf: 5027135 bytes, checksum: 3dbf54316fef3d2bcf072fc3495d79ca (MD5) / Approved for entry into archive by Alice Araujo (alice.caraujo@ufpe.br) on 2018-11-21T22:22:07Z (GMT) No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE Vladimir Curvêlo Tavares de Sá.pdf: 5027135 bytes, checksum: 3dbf54316fef3d2bcf072fc3495d79ca (MD5) / Made available in DSpace on 2018-11-21T22:22:07Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE Vladimir Curvêlo Tavares de Sá.pdf: 5027135 bytes, checksum: 3dbf54316fef3d2bcf072fc3495d79ca (MD5) Previous issue date: 2014-02-10 / Introdução: O diabetes mellitus tipo 2 (DM2) e a síndrome metabólica são pandemias sem controle clinico adequado. Cirurgias bariátricas proporcionam boa resolução do DM2 em obesos no curto prazo, entretanto, os efeitos da derivação gástrica em Y de Roux (DGYR) são desconhecidos em diabéticos sem obesidade ou no longo prazo na obesidade grau I. Objetivo: Avaliação da eficácia e segurança da DGYR no tratamento do DM2 sem controle clínico associada ao sobrepeso e à obesidade grau I. Metodologia: Foram analisadas prospectivamente duas populações distintas, submetidas à DGYR comparando-se variáveis clínicas e laboratoriais no pré e pós-operatório. No longo prazo foram avaliados os pacientes com obesidade grau I (grupo A) e, no curto prazo, os pacientes com sobrepeso (grupo B). O grupo A (n=18) teve seguimento médio de cinco anos e apresentou média de IMC de 33,4 Kg/m² e HbA₁c de 8,8% e tempo de diagnostico do DM2 há 9,4 anos. O grupo B (n=17) teve seguimento médio de 20 meses e apresentou média de IMC 27,7 Kg/m² e HbA₁c de 10,2% e tempo de diagnostico do DM2 há 10,4 anos. Resultados: Grupo A: 1- A remissão do DM2 foi de 39% (n=7). 2- O controle glicêmico sem drogas foi obtido em metade dos casos (n=9), e independente das medicações em 78% (n=14). 3- Redução de 22% do peso. Grupo B: 1- A remissão do DM2 foi de 29% (n=5). 2- O controle glicêmico sem drogas foi obtido 35% dos casos (n=6), e independente das medicações em 53% (n=9). 3- A síndrome metabólica foi reduzida de 62% a 54%, com diminuição pela metade do risco de eventos coronarianos. 4- Redução de 18% do peso. Em ambos os grupos não houve mortalidade, morbidade grave, desnutrição ou casos com IMC abaixo de 20 Kg/m². O menor tempo de doença proporcionou melhores resultados, porem não há interferência quanto ao grau de IMC ou uso de insulina. Conclusão: A DGYR é uma opção segura e eficaz no tratamento do DM2 associada a obesidade grau I no longo prazo e sobrepeso no curto prazo. / Introduction: Type 2 diabetes mellitus (T2DM) and the metabolic syndrome are pandemics without adequate clinical control. Bariatric surgery provides good resolution of T2DM in obesity in the short follow-up, however, the effects of Roux-en-Y gastric bypass (BGYR) are unknown in diabetics patients non-obese, or in the long follow-up in diabetics patients with obesity class I. Objective: This article aims to evaluate the efficacy and safety of BGYR in the treatment of T2DM without clinical control associated with overweight and obesity class I. Methodology: Two distinct populations were analyzed prospectively, submitted to the BGYR comparing clinical and laboratory variables in the pre and postoperative period. In the long follow-up, patients with grade I obesity (group A) and, in the short follow-up, overweight patients (group B) were evaluated. Group A (n = 18) had an average follow-up of five years and presented a mean BMI of 33.4 kg / m2 and HbA1c of 8.8% and a diagnosis time of T2DM for 9.4 years. Group B (n = 17) had a mean follow-up of 20 months and had a mean BMI of 27.7 kg / m2 and HbA1c of 10.2% and a diagnosis time of T2DM for 10.4 years. Results: Group A: 1- The remission of T2DM was 39% (n = 7). 2-Glycemic control without drugs was obtained in half of the cases (n = 9) and independent of the medications in 78% (n = 14). 3- Reduction of 22% of the weight. Group B: 1- The remission of T2DM was 29% (n = 5). 2- Glycemic control without drugs was obtained 35% of the cases (n = 6), and independent of the medications in 53% (n = 9). 3- Metabolic syndrome was reduced from 62% to 54%, with the reduction of half of the risk of coronary events. 4- Reduction of 18% of the weight. In both groups there was no mortality, severe morbidity, malnutrition or cases with BMI below 20 kg / m2. The shorter disease time provided better results, but there was no interference with the class of BMI or insulin use. Conclusion: BGYR is a safe and effective option for the treatment of T2DM associated with obesity class I in the long-term follow-up and with overweight in the short-term follow-up.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23071号 / 医博第4698号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 YOUSSEFIAN Shohab, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Erkrankungen der Herzkranzgefäße sind die häufigste Todesursache in den Industrieländern. Chirurgische und interventionelle Verfahren spielen eine wichtige Rolle in ihrer Behandlung. Die Anzahl perkutaner koronarer Interventionen (PCI) nimmt seit ihrer Einführung stetig zu. Bislang ist unklar, welchen Einfluss diese Entwicklung auf das Ergebnis einer späteren chirurgischen Revaskularisierung hat. Für die vorliegende Arbeit wurden 815 Patienten untersucht, die sich im Jahr 2008 am Herzzentrum Leipzig einer koronaren Bypassoperation unterzogen. Davon wiesen 181 Patienten präoperativ eine oder mehrere PCI auf. Die retrospektiv erhobenen Daten wurden mithilfe von χ²-Test, t-Test und Mann-Whitney-U-Test ausgewertet. Die gewonnenen Follow-up Daten wurden mittels logistischer Regressionsanalyse, Cox-Regressionsanalyse und dem Kaplan-Meier-Überlebensmodell ausgewertet. Es wurde untersucht, inwieweit präoperativ durchgeführte PCIs das Ergebnis der chirurgischen Revaskularisierung beeinflussten. Eine vorausgegangene PCI konnte nicht als negativer Prädiktor für die Krankenhausmortalität (OR 0,87; CI 0,24–3,13; p = 0,836) oder für das Auftreten von MACCE (OR 0,55; CI 0,26–1,19; p = 0,129) nachgewiesen werden. Das Risiko für MACCE im Follow-up erhöhte sich abhängig von der Anzahl der präoperativ stattgehabten PCIs (HR 1,07; CI 1,01–1,14; p = 0,017) und der Anzahl implantierter Stents (HR 1,14; CI 1,05–1,22; p = 0,001). Dies zeigte sich speziell bei der Verwendung von bare-metal stents (HR 1,18; CI 1,08–1,29; p ≤ 0,001). Die genannten Variablen konnten jedoch nicht als unabhängige Einflussgrößen bestätigt werden. Die Patienten der PCI-Gruppe litten im Langzeitverlauf signifikant häufiger an Dyspnoe (p = 0,023) und an pectanginösen Ruhebeschwerden (p = 0,009).

A 67-year-old male patient received a coronary artery bypass graft. Less than 2 months afterward, he presented with recurrent exacerbations of congestive heart failure. His response to a standard treatment regimen for heart failure was partly successful, but a few days after discharge he was readmitted for worsening dyspnea and edema. Doppler echocardiography suggested the hemodynamics of constrictive pericarditis. Magnetic resonance imaging showed thickened pericardium with exudates in the pericardial space. Cardiac catheterization confirmed the diagnosis, showing equalization of diastolic pressures of the left and right ventricles. The patient underwent subtotal pericardiectomy with resolution of the pericardial disease, but he died from respiratory insufficiency.

The severely obese patient has varying degrees of intrinsic reduction of expiratory flow rates and lung volumes. Thus, the severely obese patient is predisposed to postoperative atelectasis, ineffective clearing of respiratory secretions, and other pulmonary complications. This study evaluated the effect of bi-level positive airway pressure (Bi-PAP) on pulmonary function in obese patients following open gastric bypass surgery. Patients with a body mass index (BMI) of at least 40 kg/m2 who were undergoing elective gastric bypass were eligible to be randomized to receive either BiPAP during the first 24 h postoperatively or conventional postoperative care. Patients with significant cardiovascular and pulmonary diseases were excluded from the study. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), peak expiratory flow rate (PEFR), and percent hemoglobin oxygen saturation (SpO2) were measured preoperatively, and on postoperative days 1, 2, and 3. Twenty-seven patients were entered in the study, 14 received BiPAP and 13 received conventional postoperative care. There was no significant difference preoperatively between the study and control groups in regards to age, BMI, FVC, FEV1.0, PEFR or SpO2. Postoperatively, expiratory flow was decreased in both groups. However, the FVC and FEV1.0 were significantly higher on each of the three consecutive postoperative days in the patients who received BiPAP therapy. The SpO2 was significantly decreased in the control group over the same time period. Prophylactic BiPAP during the first 12--24 h postoperatively resulted in significantly higher measures of pulmonary function in severely obese patients who had undergone elective gastric bypass surgery. These improved measures of pulmonary function, however, did not translate into fewer hospital days or a lower complication rate in our study population of other wise healthy obese patients. Further study is necessary to determine if BiPAP therapy in the first 24 postoperative hours would be of benefit in severely obese patients with comorbid illnesses who have undergone elective gastric bypass.

Bakgrund: Övervikt och fetma har ökat dramatiskt under de senaste åren och idag ett problem både nationellt och globlt. Vid svår fetma och övervikt görs olika kiruriska ingrepp. gastric bypass är ett av de vanligaste ingreppen som görs i Sverige. Det sker förändringar i personens levnadsvanor efter ingreppet. Matintaget blir mindre och personen går ner i vikt. Samtidigt blir det förändringar i sociala relationer och den psykiska hälsan.  Syfte: Syftet med studien var att beskriva patientens upplevelser av hälsa efter en Gastric bypass operation. Metod: Metoden var en allmän litteratuöversikt enligt Friberg metod med en kvalitativ anstas. Nio artiklar valdes för studiens resultat. Resultat: I resultatet framkom tre huvudkategorier som beskrev patientens upplevelse av hälsa efter en Gastric bypass operation: betydelsen av ändrade levnadsvanor, känslors påverkan efter operation och sociala perspektivets inflytande efter operation. Slutsats: Stöd från närstående, familjer och sjuksköterskan har en stor betydelse i personers upplevelse av hälsa efter en Gastric bypass.