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- Ljungqvist, Olle, 1954-, et al.
(författare)
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Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance
- 1994
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Ingår i: Journal of the American College of Surgeons. - 1072-7515 .- 1879-1190. ; , s. 329-336
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Tidskriftsartikel (refereegranskat)abstract
- In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present after elective surgical treatment, more pronounced with increasingly greater magnitude of operation performed. Results of recent animal experiments have shown that even short periods of food deprivation, reducing carbohydrate reserves, alter responses to stress. This notion resulted in our questioning the rationale of carbohydrate depletion associated with overnight preoperative fasting. Twelve patients undergoing elective open cholecystectomy were randomly given no infusion (control group) or 5 milligrams per kilogram per minute of glucose infusion (glucose group) during preoperative overnight fasting. Insulin sensitivity (M value, milligram per kilogram per minute) was determined using the hyperinsulinemic normoglycemic clamp (plasma insulin level, 65 microunits per milliliter and blood glucose level, 4.5 millimoles per liter) before and the first postoperative day. Preoperative insulin sensitivity was similar in the two groups. Postoperatively, M values decreased by 55±3 percent (control group) and by 32±5 percent (glucose group) (p<0.01). Plasma levels of insulin, c- peptide, glucagon, growth hormone, catecholamines and cortisol in connection with clamps were similar in both groups preoperatively and postoperatively. The present results indicate that active preoperative carbohydrate preservation may improve postoperative metabolism because postoperative occurrence of insulin resistance was reduced with preoperative glucose infusion.
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- Sluys, Kerstin, 1956-
(författare)
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Adult and pediatric trauma : outcomes and health-related quality of life
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Trauma is the number one killer of children and young adults and the most common cause for hospital admissions for these age-groups in Sweden. Trauma is also one of the most common causes for hospital care and early death for older people. In the last decades trauma care has advanced and improved short-term survival of injured but knowledge of the long-term outcome is limited.The overall aim of this thesis is to investigate long-term outcome and health-related quality of life after injuries in different age groups and to identify factors associated with outcome.Methods: The thesis is based on four studies. In the first study patients with major trauma were contacted 5 years after injury and HRQL was measures using the SF-36 questionnaire and compared to an age and sex-matched reference group. In the second study data was collected on children with injuries to describe demographic and injury characteristics and outcome. The sample in the second study was the source for the third and fourth study. The third study measured HRQL using the PedsQL 4.0 in a cohort of children 6 years after injury and determined the relationship within subgroups in the cohort. The fourth study measured child HRQL in a sample of children after injury and their parent´s and determined the relationship within scoring results and the impact of parents reported mental health status.Results: The adult major trauma patients (n=205) reported significantly lower HRQL scores in all eight domains compared to the reference group. A large number of patients suffered from physical (68%) and psychological disabilities (41%) and nearly half reported the need for better follow-up after discharge from hospital. The severity of the injury did not anticipate a lower health-related quality of life. In the pediatric group (n=432) the median injury severity score was 4 (IQR 1-9), 50% sustained head injuries and the most severe head injuries were seen in the youngest age group. Mortality rate was low (1%), 19% stayed in a PICU and the median length of hospital stay was two days. In the follow-up study (n=204) the youngest children had the lowest PedsQL scores. Children who suffered from extremity injuries had lower scores in the school functioning compared to children with head injuries. The levels of agreement between child self-report and parent proxy report of PedsQL 4.0 scales were excellent (ICC≥0.80) for all scales with the exception of children´s self-reported emotional functioning. Multiple regression analyses showed that poor parental mental health status contributed to worse child self-report and parent proxy report of children´s HRQL.Conclusion: Adult major trauma patients have significant disabilities 5 years after injury. Improved follow-up by trauma specialist teams are needed. Children´s HRQL 6 years after trauma seems to in parity or better than healthy peers. Parent´s mental health status can possibly impact on children´s HRQL long after an injury. Further studies are recommended to evaluate the PedsQL 4.0versions for self-report in pediatric trauma population.
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- Sluys, Kerstin, 1956-, et al.
(författare)
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Outcome and quality of life 5 years after major trauma
- 2005
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Ingår i: Journal of Trauma. - Baltimore : Lippincott Williams & Wilkins. - 0022-5282 .- 1529-8809. ; 59:1, s. 223-232
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study aimed to determine quality of life after injury and identify factors potentially associated with outcome.METHODS: Five years after injury from blunt or penetrating trauma, patients received a questionnaire based on the SF-36 Health Survey.RESULTS: Two hundred five patients (83%) replied. Most were men, median age 39 years, 93% injured by blunt energy, median Injury Severity Score 14 (range 9-57). Mean SF-36 scores were significantly lower than in a matched reference group. Poor outcome was associated with: in-hospital days, intensive care days, surgical procedures, in-hospital major complications, age, recurrent injury, and inadequate information. Subjects reported considerable physical (68%) and psychologic (41%) disabilities. Near half reported need of improved follow-up care. Injury severity did not predict poor health-related quality of life 5 years later.CONCLUSION: Adequate information, sufficient pain management and follow-up by trauma specialist teams are needed. Certain factors can help identify patients in need of additional help and support.
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- Thorell, Anders, et al.
(författare)
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Development of post-operative insulin resistance is associated with the magnitude of the operation
- 1993
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Ingår i: European Journal of Surgery. - : Taylor & Francis Scandinavia. - 1102-4151 .- 1741-9271. ; 159:11-12, s. 593-599
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To study the development of insulin resistance and changes in stress hormone concentrations in patients undergoing elective operations of different magnitude.DESIGN:Prospective open study.SETTING:University hospital, Sweden.SUBJECTS:12 otherwise healthy patients, undergoing elective surgery for cholecystectomy (n = 6) and inguinal hernia repair (n = 6).INTERVENTIONS:Insulin sensitivity was measured by the normoglycaemic, hyperinsulinaemic glucose clamp technique before operation (control) and on the first postoperative day.MAIN OUTCOME MEASURE:Relative insulin sensitivity (compared with preoperative) on the day after each operation. Changes in stress hormone concentrations in relation to the relative change in insulin sensitivity.RESULTS:After hernia repair, mean (SEM) insulin sensitivity was reduced by 32 (4)%, p < 0.05 compared with baseline, and after open cholecystectomy by 56 (3)%, (p < 0.05). The difference between the two groups was highly significant (p < 0.01). The changes in concentrations of catecholamines, glucagon, cortisol and growth hormone after operation were only small, and did not correlate with the relative changes in insulin sensitivity.CONCLUSIONS:Insulin resistance develops even after a minor elective operation, (inguinal hernia repair). The degree of postoperative insulin resistance was more pronounced after open cholecystectomy. The alteration in insulin sensitivity could not be related to simultaneous changes in the hormones studied.
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