Browsing by Subject "Gastrokirurgia"

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  • Javanainen, Mervi (Helsingin yliopisto, 2019)
    Since 1975, the prevalence of obesity has nearly tripled, and 39% of the world’s population is now overweight. Bariatric surgery has proven to be the most effective treatment for obesity and obesity-related diseases. Roux-en-Y gastric bypass (RYGB) is one the most popular and well-studied operation types worldwide. However, in recent years, the popularity of sleeve gastrectomy (SG) has risen rapidly, surpassing the RYGB. Bariatric surgery has proven to be safe; however, there is still limited information about some of the complication types. The complications that occur after bariatric surgery can be divided into early complications (under 30 days after the operation) and late ones (over 30 days after the operation); late complications can further be divided into surgical and non-surgical complications. This thesis consists of four different studies on the common complication types related to bariatric surgery. Study I analyses the relationship between bleeding/venous thromboembolic complications and different enoxaparin protocols, and Study II reviews the changes in pulmonary complications under different perioperative protocols. The last two studies compare late complications, vitamin deficiencies, and fractures between RYGB and SG operations. In Study IV, we also compare the number of fractures that occur after surgery to fractures in non-surgically treated patients. All the data from the patients were collected between 2007 and 2016 at Peijas Hospital, affiliated to Helsinki University Hospital. The patient characteristics and the data from the first two years were collected prospectively and later retrospectively. In addition to analyzing the patients who underwent operations, Study IV includes 199 non-surgically treated obese patients as a control group. In Studies I and II, the follow-up times were 30 days. In Study III, the follow-up time was two years, and, in Study IV, the follow-up time was at least six years. The results of Study I showed that enoxaparin was safest when administered in a 40-mg dose once a day. Study II revealed that, alongside avoiding the use of drains and urinary catheters, fast mobilization was favorable to prevent postoperative pneumonia and shorten the hospital stay. The last two studies compared RYGB to SG. It was observed that, compared to the SG patients, the RYGB patients had more late complications treated surgically or endoscopically. In Study IV, vitamin D, albumin, and B12 levels were at an acceptable level two years after either operation. It was shown that the bariatric patients had a higher risk of fractures compared to the non-surgically treated patients. Higher age, bariatric surgery, and lower body mass index (BMI) at the two-year control mark increased the risk of fracture after obesity treatment.
  • Laitinen, Alli (Helsingin yliopisto, 2018)
    Gastric cancer is a highly malignant disease and one of the leading causes of cancer-related mortality worldwide. The course of the disease can vary, making the accurate prediction of its progression difficult. New biomarkers could help us assess cancer aggressiveness and behavior, which would be of value when evaluating the prognosis of each individual patient with gastric cancer. Podocalyxin-like protein (PODXL) is a cell-adhesion glycoprotein associated with an aggressive tumor phenotype and a poor prognosis in several forms of cancer. Prospero homeobox protein 1 (PROX1) is a transcription factor involved in the development of various organs, and also plays an important role in colorectal cancer progression. Ubiquitin carboxyl-terminal hydrolase L5 (UCHL5) is a cysteine protease being a part of the protein homeostasis network, and is found both in healthy and in cancer tissue. Matrix metalloproteinase-8 (MMP-8) belongs to the collagenase subgroup of MMPs and is capable of degrading the extracellular matrix (ECM). MMP-8 participates in the proteolytic processing of inflammatory mediators in a wide variety of biological processes and is also associated with various diseases including cancer. Tissue inhibitor of metalloproteinase-1 (TIMP-1) is an important regulator of MMPs and the extracellular environment. The aim of this study was to evaluate the expression and prognostic value of these potential biomarkers in gastric cancer. A total of 650 gastric cancer patients were included in this study. Two separate tissue microarray (TMA) series prepared from tumor tissue specimens from these patients were the material for immunohistochemical staining of studied antibodies. The expression of studied markers were evaluated and compared to clinicopathological variables and patient survival. From preoperative blood samples from 233 patients, serum levels of MMP-8 underwent determination with an immunofluorometric assay (IFMA) and TIMP-1 with enzyme-linked immunosorbent assay (ELISA). PODXL positivity indicated impaired gastric cancer-specific 5-year survival compared to that of patients with PODXL negativity. The result in multivariable analysis remained significant. Patients with high PROX1 expression had significantly better cancer-specific 5-year survival than did those with low expression, a result that remained significant in multivariable analysis. Patients with positive cytoplasmic UCHL5 tumor expression showed increased survival in the subgroups of small (<5 cm) tumors, of disease stages I-II, and of age over 66. Patients with low (<31 ng/ml) or high (>131 ng/ml) serum MMP-8 level had an unfavorable prognosis compared to those with an intermediate (31-131 ng/ml) serum level. Those patients with high (≥170 ng/ml) serum TIMP-1 levels also had a poor prognosis, and the latter remained significant in multivariable analysis. The molar ratio of serum MMP-8 and TIMP-1 levels with low (<0.07) or high (>0.30) molar ratios predicted a worse prognosis. The prognosis remained the same despite of MMP-8 tissue immunoreactivity. In gastric cancer tissue, positive PODXL expression is an independent marker of poor prognosis, high cytoplasmic PROX1 expression is an independent marker of better prognosis, and positive cytoplasmic UCHL5 is linked to better prognosis in certain subgroups. For prediction of prognosis in gastric cancer, serum MMP-8 and TIMP-1 are promising biomarkers.