37 research outputs found
Wuthering heights: Outcomes from pancreatic surgery and trends in treatment of pancreatic ductal adenocarcinoma in Norway in a post-centralization era
No full textAim: The main aim of this thesis was to explore the contemporary outcomes of pancreatic surgery and treatment of pancreatic ductal adenocarcinoma in Norway seen in light of the centralization process and the volume-outcome relationship.
Methods: We analysed three complete national patient cohorts using prospectively gathered data from national medical quality registries. The inclusion criteria were either having a pancreatoduodenectomy (Paper I and II) or being diagnosed with pancreatic ductal adenocarcinoma (Paper III). The main studied outcomes were short-term morbidity and mortality, and for paper III provision of tumour-directed treatment and survival.
Results: In paper I we found that the national in-hospital mortality and 90-day mortality after pancreatoduodenectomy were 2% and 4%, respectively, and 14% of patients had a relaparotomy within 30 days. High age, male gender and relaparotomy were independent predictors of 90-day mortality, whereas Regional Health Authority where treated was not. In paper II we showed that patients who had a pancreatoduodenectomy at the medium/low-volume units had similar short-term outcomes to patients treated at the sole high-volume unit (>40 PDs a year). For patients diagnosed with pancreatic ductal adenocarcinoma between 2004-2018 (paper III), resection rates (p<0.001) and use of perioperative chemotherapy (p<0.001) increased over time, and survival after resection improved with a HR (95% CI) for death of 0.65 (0.57-0.76) between late and early study period. For non-resected patients, provision of palliative chemotherapy increased over time (p<0.001). Still, four in ten patients did not receive any tumour-directed treatment.
Conclusions: The postoperative outcomes after pancreatoduodenectomy in Norway are beneficial and the current level of centralization of surgery seems just. Although more patients with pancreatic ductal adenocarcinoma currently reach resection and the survival prospects for this subgroup are slightly improving, no sizeable improvement was seen for this patient group when viewed as a whole
Korttidsresultater og reseksjonsmarginer for leverreseksjoner ved UNN etter implementering av laparoskopisk teknikk.
No full textBakgrunn: Leverreseksjoner utføres på bred indikasjon, og er en etablert behandlingsform for både maligne og benigne tilstander. Prosedyren har tradisjonelt sett vært utført med åpen teknikk, men i de senere år har også laparoskopi fått sin plass i behandlingen. Formålet med denne oppgaven er å beskrive utvikling i bruk av lapasoskopi, indikasjoner, komplikasjoner og reseksjonsmarginer for leverreseksjoner utført ved UNN Tromsø i perioden f.o.m 2008 t.o.m 2018. Vi ønsker spesifikt å se om innføring av laparoskopisk teknikk har ført til endringer i komplikasjonsrater eller økt andel ufrie reseksjonsmarginer (R1).
Materiale og metode: Studien er en retrospektiv gjennomgang av prospektivt samlede data i Elektronisk pasientjournal (EPJ). Alle pasienter i DIPS UNN Tromsø 2008-2018 med NCSP- prosedyrekode tilsvarende «leverreseksjon» er inkludert i studien. Biopsier feilkodet som reseksjon er ekskludert. Pasientdemografi, peroperative- og postoperative variabler er innhentet, analysert og sammenlignet mellom pasienter operert med åpen og laparoskopisk teknikk. Analyser er gjort i SPSS.
Resultater: Totalt 369 leverreseksjoner fordelt på 323 unike pasienter ble utført ved UNN Tromsø i studieperioden. Blant disse var 242 operert med åpen teknikk, mens 127 var påbegynt laparoskopisk. I studieperioden har det vært en økning i årlig volum av leverreseksjoner totalt, og en økende andel utføres laparoskopisk. Inngrep startet laparoskopisk hadde signifikant kortere liggetid (p = 0,001) og færre korttidskomplikasjoner sammenholdt med åpne operasjoner (p = 0,019, OR 0,3 (CI 0,1-0,8)). I løpet av studieperioden forelå det en signifikant reduksjon av komplikasjoner for alle inngrep samlet, mens man så en økning av total R1-rate i studiepopulasjonen. Det var ingen signifikant forskjell i fordeling R0/R1 mellom gruppene.
Konklusjon: Med henblikk på postoperative komplikasjoner og reseksjonsmarginer, har laparoskopisk teknikk i løpet av studieperioden blitt vellykket implementert som standard klinisk praksis ved UNN Tromsø. Den økende andelen ufrie render for leverreseksjoner totalt er imidlertid bekymringsverdig, og bør forbedres
Dialysekvalitet og dialysetilgangsproblemer hos pasienter ved dialyseenheten på UNN 2002-2005
No full textTimeline of changes in appetite during weight loss with a ketogenic diet
No full textBackground/objective: Diet-induced weight loss (WL) leads to increased hunger and reduced fullness feelings, increased ghrelin and reduced satiety peptides concentration (glucagon-like peptide-1 (GLP-1), cholecystokinin (CCK) and peptide YY (PYY)). Ketogenic diets seem to minimise or supress some of these responses. The aim of this study was to determine the timeline over which changes in appetite occur during progressive WL with a ketogenic very-low-energy diet (VLED).
Subjects/methods: Thirty-one sedentary adults (18 men), with obesity (body mass index: 37±4.5 kg m−2) underwent 8 weeks (wks) of a VLED followed by 4 wks of weight maintenance. Body weight and composition, subjective feelings of appetite and appetite-related hormones (insulin, active ghrelin (AG), active GLP-1, total PYY and CCK) were measured in fasting and postprandially, at baseline, on day 3 of the diet, 5 and 10% WL, and at wks 9 and 13. Data are shown as mean±s.d.
Results: A significant increase in fasting hunger was observed by day 3 (2±1% WL), (P<0.01), 5% WL (12±8 days) (P<0.05) and wk 13 (17±2% WL) (P<0.05). Increased desire to eat was observed by day 3 (P<0.01) and 5% WL (P<0.05). Postprandial prospective food consumption was significantly reduced at wk 9 (16±2% WL) (P<0.01). Basal total PYY was significantly reduced at 10% WL (32±8 days) (P<0.05). Postprandial active GLP-1 was increased at 5% WL (P<0.01) and CCK reduced at 5 and 10% WL (P<0.01, for both) and wk 9 (P<0.001). Basal and postprandial AG were significantly increased at wk 13 (P<0.001, both).
Conclusions: WL with a ketogenic VLED transiently increases the drive to eat up to 3 weeks (5% WL). After that, and while participants are ketotic, a 10–17% WL is not associated with increased appetite. However, hunger feelings and AG concentrations increase significantly from baseline, once refeeding occurs.© The Author(s) 2017. This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in thisarticle are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0
Timeline of adaptive physiological responses with progressive weight loss in individuals with obesity on a very-low energy diet
No full textRelapse after weight loss remains the biggest challenge in obesity management, likely due to a combination of reduced compliance with diets and exercise regimes and adaptive physiological responses to weight loss. Despite reduced total energy expenditure, the drive to eat is known to increase after weight loss. However, when weight loss is induced with ketogenic diets the expected increase in appetite seems to be absent.
The aim of this PhD thesis was to identify the timeline of changes in both appetite and energy expenditure variables with progressive weight loss in individuals with obesity on a ketogenic very-low energy diet (VLED).
One hundred adult (43±10 years of age) participants (45 males) with obesity (BMI: 37±4 kg/m2) underwent 8 weeks of a ketogenic VLED, followed by 4 weeks refeeding and 1 -year weight maintenance program. Body weight and composition, resting metabolic rate (RMR), exercise induced energy expenditure (EIEE) and appetite (subjective appetite feelings and plasma concentration of appetite hormones: active ghrelin (AG), glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and cholecystokinin (CCK)) were assessed at baseline and week 13, and 1-year (Study III). In a sub-study (31 participants) the same variables were additionally collected at day-3, 5 and 10 % weight loss and week 9 (Studies I and II).
In study I: Hunger and desire to eat feelings in fasting were increased at day-3 and 5 % weight loss despite ketosis and no changes in basal AG plasma concentration (compared with baseline). After refeeding and with a 17 % weight loss, both fasting hunger and AG plasma concentration were increased compared with baseline.
In study II: RMR was reduced for the first time at 5 % weight loss, and EIEE at all levels of power (10, 25 and 50 Watt (W)) reduced at 10 % weight loss, followed by stabilisation. Adaptive thermogenesis was only seen transiently at 10 % weight loss. Refeeding had no significant impact on the above variables.
In study III: A 16 % WL outside of ketosis was associated with an increase in fasting and postprandial hunger ratings and postprandial fullness. These were accompanied by a significant rise in basal and postprandial AG concentrations and a reduction in postprandial CCK. At 1-year follow-up, with sustained WL, fasting hunger and postprandial fullness ratings remained increased. Basal and postprandial AG remained elevated, while postprandial CCK was increased and PYY decreased.
In conclusion, an increased drive to eat should be expected up to 3 weeks (5 % weight loss) on a ketogenic VLED, but thereafter, appetite feelings return to baseline levels for as long as participants are ketotic. A fall in RMR should be anticipated at ≥ 5 % weight loss and a reduction in EIEE at >10 % weight loss. With refeeding, the drive to eat increases and this is sustained up to 1-year follow-up with weight loss maintenance, but it may be balanced out by increased fullness after a meal.
Patients with obesity, and health professionals working with this patient group, should be aware of these findings. This should be discussed against patient’s expectations and strategies need to be put in place to support those undergoing weight loss during the critical periods
Priority and prejudice: does low socioeconomic status bias waiting time for endoscopy? A blinded, randomized survey
No full textButtresses on Flat-Slab Dams - Planning of Shear Tests
No full textThe shear strength of a bonded concrete-rock interface below a concrete dam consists of two parts: friction from the self-weight of the dam and cohesion due to the glue in the cement paste binding the surfaces together. For flat-slab buttress dams with low self-weight, the cohesive strength becomes extra significant for the sliding resistance. However, the Norwegian authorities on dam safety does not allow the use of cohesion in sliding stability calculations, unless the cohesive strength can be documented through tests. Yet, no proposal is given on how such tests should be carried out.
Consequently, the main scope of this thesis have been to develop and propose a test methodology to estimate the cohesive strength of Norwegian flat-slab buttress dams. The proposed testing procedure uses rock samples from the dam site to get the occurring roughness and strength of the bedrock. Furthermore, the test-specimen are prepared and concrete replicating the concrete of the dam are then cast on the natural surfaces of the rock samples. A series of shear tests is then carried out to measure the shear strength of the concrete-rock interfaces. Finally, the value of the cohesion is extrapolated out of the τ-σ curve. Preliminary testing of the methodology revealed the importance of thorough preparation of the test-specimen beforehand, but in the end left the author optimistic regarding the test methodology s future use.
Additionally, to investigate the effect of including cohesion in sliding stability calculations, the sliding safety of one of Statkrafts flat-slab buttress dams, Kalhovd dam, was assessed with a combination of FE-analysis and simplified hand calculations. The results showed that by assuming reasonable values for the cohesion, the dam managed to meet the requirements from the Norwegian dam authorities. One problem when applying cohesion in calculations, however, is to determine the compressive zone of the dam. Assuming a linearly distributed normal stress seemed to overestimate the compressive area compared to the results from the finite element analysis, indicating that the latter might be the best tool for this purpose
Buttresses on Flat-Slab Dams - Planning of Shear Tests
No full textThe shear strength of a bonded concrete-rock interface below a concrete dam consists of two parts: friction from the self-weight of the dam and cohesion due to the glue in the cement paste binding the surfaces together. For flat-slab buttress dams with low self-weight, the cohesive strength becomes extra significant for the sliding resistance. However, the Norwegian authorities on dam safety does not allow the use of cohesion in sliding stability calculations, unless the cohesive strength can be documented through tests. Yet, no proposal is given on how such tests should be carried out.
Consequently, the main scope of this thesis have been to develop and propose a test methodology to estimate the cohesive strength of Norwegian flat-slab buttress dams. The proposed testing procedure uses rock samples from the dam site to get the occurring roughness and strength of the bedrock. Furthermore, the test-specimen are prepared and concrete replicating the concrete of the dam are then cast on the natural surfaces of the rock samples. A series of shear tests is then carried out to measure the shear strength of the concrete-rock interfaces. Finally, the value of the cohesion is extrapolated out of the τ-σ curve. Preliminary testing of the methodology revealed the importance of thorough preparation of the test-specimen beforehand, but in the end left the author optimistic regarding the test methodology s future use.
Additionally, to investigate the effect of including cohesion in sliding stability calculations, the sliding safety of one of Statkrafts flat-slab buttress dams, Kalhovd dam, was assessed with a combination of FE-analysis and simplified hand calculations. The results showed that by assuming reasonable values for the cohesion, the dam managed to meet the requirements from the Norwegian dam authorities. One problem when applying cohesion in calculations, however, is to determine the compressive zone of the dam. Assuming a linearly distributed normal stress seemed to overestimate the compressive area compared to the results from the finite element analysis, indicating that the latter might be the best tool for this purpose
Buttresses on Flat-Slab Dams - Planning of Shear Tests
No full textThe shear strength of a bonded concrete-rock interface below a concrete dam consists of two parts: friction from the self-weight of the dam and cohesion due to the glue in the cement paste binding the surfaces together. For flat-slab buttress dams with low self-weight, the cohesive strength becomes extra significant for the sliding resistance. However, the Norwegian authorities on dam safety does not allow the use of cohesion in sliding stability calculations, unless the cohesive strength can be documented through tests. Yet, no proposal is given on how such tests should be carried out.
Consequently, the main scope of this thesis have been to develop and propose a test methodology to estimate the cohesive strength of Norwegian flat-slab buttress dams. The proposed testing procedure uses rock samples from the dam site to get the occurring roughness and strength of the bedrock. Furthermore, the test-specimen are prepared and concrete replicating the concrete of the dam are then cast on the natural surfaces of the rock samples. A series of shear tests is then carried out to measure the shear strength of the concrete-rock interfaces. Finally, the value of the cohesion is extrapolated out of the τ-σ curve. Preliminary testing of the methodology revealed the importance of thorough preparation of the test-specimen beforehand, but in the end left the author optimistic regarding the test methodology s future use.
Additionally, to investigate the effect of including cohesion in sliding stability calculations, the sliding safety of one of Statkrafts flat-slab buttress dams, Kalhovd dam, was assessed with a combination of FE-analysis and simplified hand calculations. The results showed that by assuming reasonable values for the cohesion, the dam managed to meet the requirements from the Norwegian dam authorities. One problem when applying cohesion in calculations, however, is to determine the compressive zone of the dam. Assuming a linearly distributed normal stress seemed to overestimate the compressive area compared to the results from the finite element analysis, indicating that the latter might be the best tool for this purpose
