Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / INTRODUÃÃO: Recentemente, foi demonstrado que o H2S està envolvido em inÃmeras funÃÃes fisiolÃgicas e patolÃgicas, sendo produzido em muitos tecidos de mamÃferos. OBJETIVOS: Avaliar o papel do H2S na defesa da mucosa e no controle da motilidade gÃstrica em camundongos, bem como estudar a participaÃÃo dos canais de KATP, dos neurÃnios sensoriais sensÃveis à capsaicina e dos receptores TRPV1 neste efeito. MÃTODOS: Camundongos Swiss foram prÃ-tratados com L-cisteÃna (25, 50 ou 100 mg/kg, v.o), NaHS (75, 150 ou 300 Âmol/kg, v.o) ou LawessonÂs (3, 9, 27 ou 81 Âmol/kg, v.o). Trinta minutos depois, o etanol 50% (0,5ml/25g, v.o) foi administrado. Depois de 1 h, os animais foram sacrificados e os estÃmagos abertos para determinaÃÃo da Ãrea da lesÃo usando planimetria computadorizada. AlÃm disso, fragmentos de tecidos foram removidos para anÃlise microscÃpica e dosagem de glutationa e malondialdeÃdo. Para o estudo do esvaziamento gÃstrico, outro grupo experimental foi tratado, por gavagem, com as mesmas doses de L-cisteÃna, NaHS ou LawessonÂs, decorridos 30 min os animais receberam uma soluÃÃo glicosada (5%) contendo vermelho de fenol (0,75 mg/ml) em cada animal. ApÃs 10, 20 ou 30 min os animais foram sacrificados e o esvaziamento gÃstrico foi avaliado por tÃcnica de espectrofotometria. Em outro grupo experimental os animais foram prÃ-tratados com glibenclamida (3 e 10 mg/Kg, v.o.) ou capsazepina (10 mg/kg, i.p). ApÃs 1h, foram administrados a L-cisteÃna (50 mg/kg) ou os doadores de H2S (NaHS 150 Âmol/kg ou o reagente de LawessonÂs 27Âmol/kg, v.o). Trinta minutos depois, o etanol 50% foi administrado para avaliaÃÃo da lesÃo gÃstrica e soluÃÃo de vermelho de fenol foi administrada para avaliar o esvaziamento gÃstrico conforme descrito anteriormente. Para o estudo dos neurÃnios aferentes, foi realizado protocolo de ablaÃÃo dos com doses neurotÃxicas de capsaicina. ApÃs 8 dias, os animais receberam NaHS ou o LawessonÂs e o protocolo de lesÃo gÃstrica por etanol 50% foi determinado como descrito acima. TambÃm foi determinado a contratilidade espontÃnea do fundo gÃstrico incubado com doses crescentes de NaHS ou KCl (controle) utilizando um transdutor de forÃa isomÃtrico acoplado a um sistema de aquisiÃÃo de dados. RESULTADOS: A administraÃÃo de L-cisteÃna, NaHS ou Reagente de LawessonÂs preveniu, de forma dose dependente, a lesÃo por etanol no estÃmago. Essa proteÃÃo foi acompanhada do aumento de GSH e diminuiÃÃo dos nÃveis gÃstricos de MDA quando comparado com o grupo tratado apenas com etanol. Glibenclamida (10 mg/kg) e a capsazepina reverteram completamente esse efeito protetor dos doadores de H2S. Nos animais depletados de neurÃnios aferentes, tambÃm houve uma reversÃo do efeito protetor dos doadores de H2S e da L-cisteÃna. O NaHS, o LawessonÂs e a L-cisteÃna promoveram aceleraÃÃo do esvaziamento gÃstrico quando comparado com o controle, de maneira dose dependente. Este efeito procÃnÃtico foi abolido pela prÃ-administraÃÃo de glibenclamida e capsazepina O NaHS tambÃm foi capaz de induzir um aumento no tÃnus basal que iniciou-se com mÃximo efeito na concentraÃÃo de 300 ÂM em relaÃÃo à contraÃÃo controle de KCl. CONCLUSÃES: o H2S preveniu a lesÃo gÃstrica, o consumo de GSH e aumento da peroxidaÃÃo lipÃdica na mucosa gÃstrica, induzidos pela administraÃÃo de etanol em camundongos. O H2S tambÃm apresentou efeito procinÃtico, acelerando o esvaziamento gÃstrico de lÃquidos em camundongos. Podemos inferir que esses efeitos devem-se a ativaÃÃo dos canais de KATP, dos neurÃnios sensoriais sensÃveis à capsaicina e dos receptores TRPV1. / INTRODUCTION: Recently, the involvement of H2S has been demonstrated in several physiological and pathological conditions, being constitutively produced in mammalian tissues. AIM: To study the role of H2S on both the gastric mucosa defense and the control of gastric motility in mice, and additionally to evaluate the participation of KATP channels, capsaicin-sensitive afferent neurons and TRPV1 receptors in these effects. METHODS: Swiss mice were pre-treated with either L-cysteine (25, 50 or 100 mg/kg, p.o), NaHS (75, 150 or 300 Âmol/kg, p.o) or LawessonÂs reagent (3, 9, 27 or 81 Âmol/kg, p.o). The animals were then given ethanol 50% (0.5ml/25g, p.o.) 30 min later. After 1h of ethanol instillation, the mice were sacrificed and had the stomach collected to measure the injured area through planimetry software. Moreover some samples were obtained to histopathological analysis, glutathione (GSH), and malonyldialdehyde (MDA) dosages. In the study of gastric empty, the animals were administered L-cysteine, NaHS or LawessonÂs reagent, and 30 min later a phenol red solution (0.75 mg/ml) diluted in glucose (5%) was also given. The sacrifice was performed 10, 20 or 30 min after the latter to determine in a spectrophotometer the gastric empty. In another experimental setting, glibenclamide (3 or 10 mg/Kg, v.o.) or capsazepine (10 mg/kg, i.p) were injected 1h previously to the L-cysteine (50 mg/kg, p.o) or H2S donors (NaHS 150 Âmol/kg or LawessonÂs reagent 27Âmol/kg, p.o) instillation. In order to study the role of capsaicin-sensitive afferent neurons, high neurotoxic doses of capsaicin was instilled into the animals. On the 8th day post capsaicin injection, NaHS or LawessonÂs reagent was administered. The protocol for ethanol administration, sacrifice, and dosages were repeated for these conditions as described previously. Finally, the spontaneous contraction of isolated gastric fundus to KCl (control contraction) and growing doses of NaHS was determined in vitro through and isometric force transducer connected to an acquisition system. RESULTS: L-cysteine, NaHS and LawessonÂs reagent prevented, in a dose dependent manner, the ethanol-induced gastric injury. Besides, high and low levels of GSH and MDA were found respectively in comparison to the control group given only ethanol. Glibenclamide (10 mg/kg) and capsazepine completely reversed the protective effect of the H2S donors. The animals that undergone afferent neuronal ablation also developed gastric lesions despite the injection of L-cysteine and H2S donors. NaHS, LawessonÂs reagent and L-cysteine all accelerated gastric empty in comparison to the control group and in a dose-dependent manner. Such prokinetic effect was abolished in glibenclamide and capsazepine pre-treated mice. The NaHS was also able to induce an increase in gastric fundus basal tonus in vitro presenting a ceiling effect in the concentration of 300ÂM when compared with the standard KCl contraction. CONCLUSIONS: The H2S prevented the ethanol-induced gastric damage, GSH consumption, and lipid peroxidation processes in the stomach mucosa of mice. The H2S also revealed a prokinetic effect leading to a higher liquid gastric empty in mice. Such results seem to be dependent on KATP channels, sensory afferent neurons, and TRPV1 receptors activation.

Os objetivos deste trabalho foram, em indivíduos com câncer de coto gástrico: identificar o padrão de disseminação de linfonodos acometidos, quantificar a invasão tumoral da linha de anastomose, correlacionar a invasão da linha de anastomose com o comprometimento linfonodal e mesenterial, correlacionar o acometimento linfonodal com sobrevivência e correlacionar o acometimento da linha de anastomose com sobrevivência. Foi realizado estudo retrospectivo com revisão de prontuários, peças cirúrgicas e exames anátomo-patológicos de 113 pacientes. O câncer de coto gástrico não tem um padrão de disseminação linfonodal específico; 75% dos pacientes apresentaram invasão tumoral da linha de anastomose; em 66,7% dos casos ocorreu invasão da linha anastomótica e linfonodal concomitantes; menos de 10% dos casos exibiam invasão mesenterial; houve óbito em 86,5% dos casos com invasão linfonodal e 64,7% com invasão da linha de anastomose e em 100% com invasão mesenterial. / The objectives of this study are to identify the metastatic pattern of lymph node for gastric stump cancer; to quantify the invasion of anastomotic site by tumor; to relate the invasion of anastomotic site with metastasis lymph node or mesenterial lymph node and these parameters with the survival of patients with gastric stump cancer. One hundred and thirteen patients with gastric stump cancer were retrospectively analyzed along with their medical records, surgical pieces and histopathologic exam. The metastatic pattern of lymph node isnt specific to gastric stump cancer. 75% of patients had tumoral invasion in the anastomotic site. In 66.7% of the cases there was an invasion of the anastomotic site with metastatic lymph nodes. 9% of patients had mesenterial lymph node invasion by tumor. Fatal cases occurred in 86,5% of the patients with metastatic lymph node, 64,7% with invasion of the anastomotic site and 100% with mesenterial lymph node invasion.

No description available.

No description available.

The aims of the study were to obtain a method with which it would be possible to produce standardized wounds in the gastric mucosa, and to follow the regeneration of the acid producing parietal cells in those lesions during different experimental conditions. Quantitative methods applied to light and electron microscopy were used. Wounds were cauterized in the corpus mucosa in Sprague-Dawley rats and in addition, pyloroplasty, truncal vagotomy with pyloroplasty or ant- rectoiriy were performed. Other groups of rats with wounds were given long-term treatment with pentagastrin or cimetidine. Stimulation tests were carried out in two groups of wound operated rats. After different periods of time the animals were perfusion fixed and specimens from the wounds and normal mucosa beside the wounds were pre­pared for light and electron microscopy. By means of stereological techniques, different mucosal and cellular structures were then measur­ed. Parietal cells were found in 90 days old wounds. At this stage they were immature with large nuclei and few specialized cell organelles. In spite of this appearance they were able to respond morphologically to stimulation and to secrete acid. With further healing the morphology of the parietal cells became normal, but their volume fraction in the mucosa remained subnormal. The fraction of mucosa occupied by epithel­ial cells also stayed lower than normal. Pyloroplasty resulted in decreased cell and nuclear size of both normal and regenerating parietal cells. In the latter, there was also a de­crease in the mitochondrial volume density. If a truncal vagotomy was added to the pyloroplasty these changes disappeared and, in addition, an increase in parietal cell volume density was noticed in the normal mucosa. Antrectorny produced smaller parietal cells, and their maturation was delayed. Furthermore, mucosal thickness decreased. If pentagastrin was given to rats with wounds an increase in the number of parietal cells was noted, but maturation and morphology remained unaffected. Cimetidine treatment did not affect the parietal cell volume density in wounds or normal mucosa. However, a large increase in the secretory surface density was noticed when the effect of the last dose had ceas­ed. / <p>S. 1-45: sammanfattning, s. 47-121 utgörs av 5 uppsatser</p> / digitalisering@umu

Bakgrund: Fetma och övervikt är ett globalt växande problem och kan medföra välfärdssjukdomar, till exempel diabetes typ II. Gastric Bypass (GBP) är den mest utförda överviktsoperationen för behandling av fetma och övervikt. Det saknas forskning om patienters kostvanor efter GBP och det är kunskap som behövs för att sjuksköterskan ska kunna bidra med råd och motivation till dessa patienter efter deras GBP-operation. Syfte: Att beskriva GBP-patienters erfarenheter av sina kostvanor efter operation, samt beskriva vilka urvalsmetoder som använts i de valda studierna. Metod: En deskriptiv litteraturstudie med elva vetenskapliga studier. Huvudresultat: Många av patienterna beskrev att deras kostvanor hade förändrats efter GBP-operationen. Framförallt kolhydratrik mat hade exkluderats ur deras kost. Det enda som inte hade exkluderats ur kosten var vegetabilier. De beskrev även att de hade utvecklat låg tolerans mot främst kött- och mejeriprodukter. Antalet måltider under dagen hade ökat och storleken på portionerna hade blivit mindre, vilket beror på den minskade volymen i magsäcken. Slutsats: De allra flesta GBP-patienternas kostvanor hade förändrats. Energiintaget var som lägst under den första tiden efter operationen, men med tiden lärde patienterna sig hur och vad de kunde äta, vilket ledde till ett successivt ökat energiintag. Få patienter uppgav att de fått professionell hjälp angående kost och kostvanor. Sjuksköterskan ska kunna undervisa och bidra med svar på frågor om förändringar i kostvanor för att patienten ska kunna uppnå god hälsa efter GBP-operationen. / Background: Obesity and being overweight is a globally increasing problem and can cause other health related diseases, such as diabetes type II. Gastric bypass (GBP) is the most performed kind of bariatric surgery in treatment for obesity and overweight. There are not enough studies on, and knowledge about, patients’ postoperative food habits for the nurse to be able to provide with the help and aid the patients will need after the GBP-operation. Aim: To describe GBP-patients’ experiences of postoperative food habits and which methods of sampling that have been used in the studies on which we base our results. Method: A descriptive literature study including eleven scientific studies. Results: Many of the participating patients described that their food habits had changed after their GBP-operation. Foods that consisted mainly of carbohydrates were excluded and vegetables were the only type of food that had not been excluded. The GBP-patients described that they had developed a low tolerance mainly towards meat and milk based products. The daily number of meals had increased and the servings of food were smaller than before the surgery. This mainly depends on the decreased volume in the gastric pouch. Conclusion: Almost every participating GBP-patient’s food habit had changed. The daily energy intake was at its lowest during the first time after the operation, but the patients learned how and what to eat in the course of time which would gradually lead to an increased energy intake. Few GBP-patients described that they had undergone professional counseling regarding food and food habits. The nurse must be able to teach the patients about food habits and give adequate answers to questions regarding changes in food habits so that the patients may achieve good health after the GBP-operation.

Dentre os mecanismos de defesa da mucosa do estômago, o fluxo sangüíneo é citado como responsável por suprir a mucosa com oxigênio e nutrientes, necessários à manutenção da integridade da mesma. O delineamento de experimentos voltados à análise do fluxo sangüíneo na mucosa do estômago de eqüinos requer informações de caráter macroscópico e microscópico referentes à vascularização do órgão. O objetivo deste trabalho foi contribuir com a definição de parâmetros macroscópicos e microscópicos da vascularização sangüínea do estômago de eqüinos. Utilizaram-se 30 estômagos de eqüinos, 15 machos e 15 fêmeas, adultos, sem raça definida e destinados a abate. A divisão do estômago em quadrantes foi utilizada com o objetivo de facilitar a visualização dos diferentes arranjos arteriais encontrados. Avaliou-se o comportamento da artéria gástrica esquerda (AGE), após injeção de látex corado, e também no estado in natura. Foram observados aspectos quantitativos dos ramos das AGE, artéria gástrica direita (AGD), artérias gastroepiploicas esquerda (AGEE) e direita (AGED) e artérias gástricas curtas (AGC). Verificou-se a relação entre número de ramos das AGE e AGC com a área de superfície do estômago, mensurada com software de análise de imagens. Ao exame microscópico foram realizadas mensurações do percentual de vascularização do epitélio aglandular nas regiões das curvaturas maior e menor do estômago. Dentre todas as variáveis analisadas, destacou-se a baixa freqüência de ramificação da AGE para a região da curvatura menor do estômago. O ramo visceral da AGE contribuiu com vasos para a curvatura menor em 26,66% dos casos e o ramo parietal contribuiu com ramos para a mesma região em apenas 20% dos casos. Com base nos resultados obtidos, sugere-se o estudo de particularidades anatômicas da região da curvatura menor do estômago de eqüinos, em pesquisas futuras. / Among the gastric mucous defense mechanisms, the blood flow is cited as responsible for supplying the mucous with oxygen and nutrients, necessary for the maintenance of its integrity. The delineation of experiments related to blood flow analysis in gastric mucous requires macroscopic and microscopic information about stomach vascularization. The aim of this research is to contribute with definitions of macroscopic and microscopic parameters of the equine stomach blood vascularization. Thirty equine stomachs of mixed breed, male or female, all adults and destined to slaughter, were used. The stomach division in quadrants was used for easier visualization of the different artery arrangements found. The left gastric artery (LGA) behavior was evaluated after injection with colored latex and also in natura state. Quantitative aspects of the LGA branches, right gastric artery (RGA), left gastroepiploic artery (LGEA), right gastroepiploic artery (RGEA) and breves gastric arteries (BGA) were evaluated. The relation between the number of LGA and BGA branches and the stomach surface area measured with image analysis software, were taken. Measurements of the vascularization percent of the nonglandular epithelium were taken in major and minor curvatures of the stomach. Among all the analyzed variables, the low occurrence of LGA branch in the minor stomach curvature was emphasized. The LGA visceral branch contributed with vessels for the minor curvature at 26,66% of cases and the parietal branch contributed with branches for this same region at just 20% of cases. Based on theses results, is suggested more studies about anatomical particularities in minor curvature of the equine stomach, in subsequent researches.

Motivação: A introdução do medicamento antagonista H2, e a descoberta do papel do Helicobacter pylori, na patogênese da úlcera péptica, diminuiu a indicação cirúrgica da doença ulcerosa. Todavia, a incidência de perfuração na doença ulcerosa tem se mantido constante, e o tratamento cirúrgico é a conduta mais indicada. A mortalidade nesta circunstância continua expressiva. Objetivo: Este trabalho teve como objetivo analisar possíveis fatores de risco de mortalidade no tratamento da úlcera gastroduodenal perfurada tratada com cirurgia. Casuística e métodos: Foram estudados 311 pacientes (268 do sexo masculino e 43 do sexo feminino), sendo 242 portadores de úlcera duodenal e 69 de úlcera gástrica, no período de janeiro de 1997 a dezembro de 2000. Ocorreram 35 óbitos (11,25%). Analisaram-se os seguintes fatores: idade, sexo, tabagismo, etilismo, doença ulcerosa prévia, uso de antiinflamatório, pneumoperitônio, doenças concomitantes, choque na admissão, tempo de perfuração, peritonite, tipo de cirurgia e local de perfuração. Os fatores de risco de mortalidade nos dois tipos de úlcera foram comparados descritivamente utilizando-se o odds ratio, os percentuais de mortalidade, o teste de Zelen e análise de regressão logística univariada e multivariada. Destaca-se que a maioria do pacientes foi submetida ao tratamento cirúrgico não definitivo, sendo o critério utilizado para definir o tipo de cirurgia determinado por escolha aleatória da equipe cirúrgica. Resultados: Os fatores de risco associados à mortalidade na úlcera gastroduodenal perfurada identificados na análise univariada foram: idade (UG), pneumoperitônio, doenças concomitantes, local de perfuração, choque na admissão e tempo de perfuração. A presença do pneumoperitônio é um sinal radiológico importante no diagnóstico da úlcera gastroduodenal perfurada. Na sua ausência, ocorreu aumento de incidência de mortalidade. A incidência de mortalidade na úlcera gástrica perfurada foi maior no idoso. Na úlcera gástrica a incidência de mortalidade foi maior do que na úlcera duodenal. Entretanto, a análise multivariada mostrou que os fatores de risco independentes preditivos de mortalidade foram na úlcera duodenal: tempo de perfuração maior que 24 horas, doenças concomitantes e choque na admissão e na úlcera gástrica: idade, tempo de perfuração maior que 24 horas e choque na admissão. Conclusões: O risco aumentado de mortalidade na úlcera gastroduodenal perfurada pode ser previsto quando os pacientes apresentam idade avançada (UG), doenças concomitantes (UD), tempo de perfuração maior que 24 horas, e choque na admissão hospitalar / Motivation: The introduction of the H2 antagonist drug and the discovery that the Helicobacter pylori played a role in the pathogenesis of the peptic ulcer caused a decrease in the indication of surgical treatment for ulcer disease. However, the incidence of perforation in ulcer disease has remained constant, and surgical treatment is the most indicated treatment modality. In these cases, the rate of mortality is still significant. Objective: This paper aimed at analyzing the risk factors for mortality in the surgically treated perforated gastroduodenal ulcer. Cases and methods: 311 patients were studied (268 males and 43 females), seeing that 242 were duodenal ulcer carriers and 69 gastric ulcer, in the period from January 1997 to December 2000. Thirty-five patients died (11,25%). The following factors were analyzed: age, sex, smoking, chronic alcohol consumption, previous ulcer disease, use of anti-inflammatory medication, pneumoperitoneum, concomitant diseases, shock upon admittance, time lapsed since perforation, peritonitis, type of surgery and perforation site. The risk factors for mortality in the two types of ulcer were compared descriptively, using the odds ratio, percentage of mortality, the Zelen test and the univariate and multivariate logistic regression analysis. It is worth pointing out that most of the patients had undergone nondefinitive surgical treatment and the criterion used to decide the type of surgery was random selection by the surgical team. Results: The risk factors associated to mortality in the perforated gastroduodenal ulcer identified by the univariate analisys were: age (GU), pneumoperitoneum, concomitant diseases, perforation site, shock upon admittance, time lapsed since perforation, peritonitis and type of surgery. The presence of pneumoperitoneum is an important radiological sign for the diagnosis of the perforated peptic ulcer. When this diagnostic tool was not used, an increase in the incidence of mortality was observed. The incidence of mortality for perforated gastric ulcers was higher in elderly patients. The incidence of mortality was higher for gastric ulcers relative to duodenal ulcers. However, the multivariate analysis showed that independent predictive risk factors for mortality were the following, for the duodenal ulcer: time lapse of more than 24 hours since perforation, severe coexisting diseases and shock at the time of admittance; for gastric ulcer: age, time lapse of more than 24 hours, from moment perforation and shock at the time of admittance. Conclusion: The increased risk of mortality for perforated duodenal ulcer can be predicted when the patients are elderly (GU), when there are concomitant diseases (DU), the time lapsed from the moment of perforation exceeds 24 hours, and when the patients are in shock at the time of admittance

Com objetivo de analisar criticamente os tipos histológicos propostos na classificação da Sociedade Brasileira de Patologia para o adenocarcinoma gástrico, estudamos os tipos histológicos e o perfil imuno-histoquímico de mucinas em 272 adenocarcinomas gástricos operados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A casuística pode ser dividida em 237 tumores únicos, 4 tumores múltiplos e 31 tumores com mais de um tipo histológico. Foram avaliados idade, gênero, localização, aspecto, estadiamento tumoral, padrões de expressão de mucinas intestinais pelos marcadores MUC2 e CD10 e gástricas por MUC5AC e MUC6. A coexistência de focos de padrão pouco diferenciado e de padrão gástrico em adenocarcinoma gástrico com mais de um aspecto e em casos com mais de um tumor e a ausência de tal concomitância com o padrão intestinal favorece sua compreensão como padrões independentes. As variáveis histológicas \"favoráveis\" predominaram nos adenocarcinomas gástricos de padrão intestinal, seguido dos de padrão tubular gástrico. Estes representam o cerne para estudos futuros por compreender o tipo túbulo-papilífero cujos aspectos clínicos se assemelham aos intestinais, o tipo tubular com expressão de mucina incaracterística e o tipo microtubular pela primeira vez individualizado, com aspectos morfológicos menos favoráveis e expressão imuno-histoquímica própria da mucosa gástrica. Os adenocarcinomas mucinosos mostraram marcante dicotomia quer nos aspectos clínicomorfológicos, quer no padrão de expressão de mucinas. Os dados indicam a necessidade de compreendê-los como entidades díspares. O tipo histológico foi detectado em casos com apresentação precoce, mas representa a maior fração daqueles avançados Borrmann IV exibindo predomínio de mucinas gástricas. O mucinoso muconodular só foi detectado em estadios avançados e co-expressou mucinas de intestinais e gástricas. O padrão pouco diferenciado diferiu distinto dos demais tanto pelos dados clínico-morfológicos, como pela escassa expressão de mucinas. / Aiming at a critical assessment of the histological types proposed at the classification of Brazilian Society of Pathology for gastric adenocarcinoma, we studied herein the histological and immunohistochemical profile of mucins in 272 gastric adenocarcinoma surgical samples from Hospital das Clínicas University of São Paulo School of Medicine. The casuistic can be divided into 237 single tumors, 4 multiple tumors and 31 tumors with more than one histological type. We evaluated age, gender, tumor location and appearance, tumor staging, the expression patterns of intestinal mucins by the markers MUC2 and CD10 and for gastric tumor by MUC5AC and MUC6 markers. The coexistence of foci of poorly differentiated pattern and foci of gastric pattern in gastric adenocarcinoma with more than one pattern and in cases with more than one tumor and the absence of such concurrence with the intestinal pattern, lead to its understanding as independent patterns. Favorable histological variables prevailed in gastric adenocarcinomas of intestinal pattern, followed by the gastric tubular pattern. These represent the core for future studies to include: the tubulo-papilary type, whose clinical features resemble the intestinal types, the tubular type with uncharacteristic mucin expression and the microtubulat type, individualized for the first time in the present study, with less favorable morphological aspects and immunohistochemical expression of the gastric mucosa itself. Mucinous adenocarcinomas have shown a stricking dichotomy in both clinical and morphological aspects, as in the expression pattern of mucins. Data indicate the need to understand them as disparate entities. The mucocelular type (signet ring cells) was detected in cases found inearly tumor stages, but includes the highest fraction of advanced tumors, Borrmann IV with predominant expression of gastric mucins. Muconodular type was only detected in advanced stages and co-expressed intestinal and gastric mucins. The poorly differentiated cases were frankly distinct from the other types, by both clinical and morphological data, and by the scarcity of mucin expression.

Syftet med studien var att beskriva patientens upplevelser efter en gastric bypass operation. En empirisk studie med kvalitativ ansats genomfördes, där intervjuer skedde med sex personer som genomfört en gastric bypass operation. Data analyserades genom kvalitativ innehållsanalys. Under intervjuerna framkom att informanterna upplevde att operationen inte hade någon negativ inverkan på deras vardagliga liv. De upplevde en ökad livskvalitet och förbättrad hälsa som lett till ett mer fysiskt aktivt liv. Viktnedgången tillsammans med omgivningens positiva reaktioner på den nya kroppen hade stärkt deras självförtroende. Den största förändringen informanterna upplevde i det vardagliga livet var deras förändrade matvanor. De beskrev att maten var i fokus och att de planerade sin vardag efter måltiderna. De följder som framkom upplevdes inte som något stort problem, utan viktminskningen och de positiva hälsoupplevelserna dominerade. Informanterna kände sig välinformerade och hade realistiska förväntningar på operationen, samt var förberedda på de konsekvenser som kunde uppstå. Studien visar att den specialiserade vården på överviktskliniker kan bidra till att underlätta tiden efter operationen för patienten. Det framkom att informanterna upplevde en kunskapsbrist om gastric bypass operationer bland sjukvårdspersonal, inom primärvård och slutenvård. För att patienten ska känna trygghet och förtroende är det därför viktigt att öka kunskapen om överviktsoperationer bland hälso- och sjukvårdspersonal.