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  • 1.
    Baban, Bayar
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Särndahl, Eva
    Örebro University, School of Medical Sciences. iRiSC – Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Inflammasome activation, colonic cancer and glucose metabolism2016In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 12, article id e37Article in journal (Refereed)
    Abstract [en]

    Objectives: To study the association between inflammasome activation (a potent initiator of inflammation acting via caspase-1 and maturation of interleukin-1β), colonic cancer and glucose metabolism.

    Methods: Five patients with colon cancer and ten matched controls without cancer were measured for insulin sensitivity using the hyperinsulinemic euglycemic clamp. For detection of inflammasome activation the caspase-1 activity, determined by detecting FLICA using flow cytometry, was measured in both monocytes and granulocytes at the start of, and at 120 minutes into the clamp. Descriptive and analytical statistics were performed using nonparametric methods by SPSS.

    Results: There was no difference in levels of insulin sensitivity between the two groups (p=0.09). The cancer patients had significantly lower levels of caspase-1 both in monocytes (p<0.05) and granulocytes (p<0.05) compared with the controls. However both patients and controls had significantly higher levels of both mono- and granulocyte caspase-1 activity at 120 minutes into the clamp as compared to at start (p<0.05). Patients showed an overall higher relative increase in caspase-1 during the clamp, however this finding did not reach statistical significance (monocytes; p=0.27, granulocytes; p=0.22).

  • 2.
    Mc Loughlin, S.
    et al.
    Anaesthesia Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
    Terrasa, S. A.
    Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Sanchez, G.
    Anaesthesia Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
    Garcia Fornari, G.
    Anaesthesia Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
    Alvarez, A. O.
    Anaesthesia Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
    Nausea and vomiting in a colorectal ERAS program: Impact on nutritional recovery and the length of hospital stay2019In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 34, p. 73-80Article in journal (Refereed)
    Abstract [en]

    Background & aims: Postoperative nausea and vomiting (PONV) and its impact on the hospital length of stay (LOS), have been extensively studied. However, most previous publications focused their studies on PONV during the first 24 h, and less is known about this complication during the ensuing days, its impact on nutritional recovery or its relation to other complications and the course of care.

    Methods: An observational study involving 806 consecutive patients in a colorectal Enhanced Recovery After Surgery (ERAS) programme was performed. The primary objective was to analyse the incidence of early PONV on the day of surgery and the following 2 postoperative days (late PONV). Secondary objectives included evaluation of the influence of late PONV over the LOS and the nutritional recovery adjusted for confounding factors.

    Results: PONV tended to increase over time (7% vs 7% and 10%, postop days 0, 1 and 2, respectively; p < 0.05). PONV on day 2 was associated in an adjusted analysis with poor oral intake, delayed solid food tolerance and an average increase in LOS of 2 nights. Risk factors for the presence of PONV on day 2 were the use of opioids on the same day, PONV on the day of the surgery and rectal procedures.

    Conclusions: PONV continues to be frequent after the first 24 h in colorectal surgery despite high compliance to current anti emetic recommendations. PONV during day 2 negatively affects the nutritional postoperative recovery and independently prolongs the hospital stay. The findings of the current study highlight the adverse effects of opioids and the need of further discussion on how to best audit, prevent and treat late PONV in ERAS colorectal programmes.

  • 3.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Dept of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Dept of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Dept of Surgery,Dept of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Robotic versus abdominal hysterectomy; metabolic and inflammatory responses and subsequent recovery: A randomised controlled study2016In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 12, article id e47Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to study if robotic assisted total hysterectomy (RTLH) would induce less insulin resistance than abdominal hysterectomy (AH). In addition, inflammatory response and clinical recovery were compared.

    Methods: We conducted a randomised controlled study at the Department of Obstetrics & Gynaecology, Örebro University Hospital; Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy, between October 2014 and May 2015, were randomly allocated to robotic assisted laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycemic clamp method. Inflammatory response was measured in blood samples and clinical recovery outcomes registered.

    Results: There were no differences in development of insulin resistance (mean ± SD) for robotic group (39±22%) vs abdominal group (40±19%; p=0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days, p=0.005). Inflammatory reaction differed in form of significantly greater increase in serum interleukin 6 levels and white blood cell count, from preoperative value to postoperative peak value, in abdominal group compared with robotic group.

    Conclusion: Robotic assisted hysterectomy reduced inflammatory responses and recovery time but these changes were not accompanied by less insulin resistance.

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