Abstract The purpose of the present research was (I-II) to evaluate the effects of clinical, hand-held Doppler (HHD) and duplex ultrasonographic examinations on the planning of operative procedure for primary varicose veins, (III) to assess the feasibility, safety and efficacy of endovenous saphenous vein obliteration with radiofrequency-resistive heating and (IV) to compare endovenous saphenous vein obliteration with conventional stripping operation in terms of short-term recovery and costs. Sixty-two legs (in 49 consecutive patients) and 142 legs (in 111 consecutive patients) with primary uncomplicated varicose veins were examined clinically and with HHD and duplex ultrasonography for planning the subsequent treatment. At the saphenous-femoral junction (SFJ) and at the saphenous-popliteal junction (SPJ), sensitivity was 56-64% and 23%, specificity 93-97% and 96%, positive predictive value 97-98% and 43% and negative predictive value 44-45% and 91%, respectively. In 9% of the cases, the treatment plan was modified on the basis of the duplex ultrasound findings. The present study showed that, in primary uncomplicated varicose veins, the accuracy of HHD is unsatisfactory. Thirty legs of 27 patients with varicose veins were treated using an endovenous catheter (Closure® System, VNUS Medical Technologies, Inc., Sunnyvale, CA), which was inserted under ultrasound guidance via a percutaneous puncture or a skin incision. The persistence of vein occlusion and complications potentially attributable to the endovenous treatment were assessed at 1-week, 6-week, 3-month, 6-month and 1-year follow-up visits. By the time of the last follow-up visit, occlusion of the treated segment of the LSV had been achieved in 22 (73.3%) legs. Persisting patency or recanalization of LSV was detected in 8 legs (26.7%). Postoperative complications included saphenous nerve paresthesia in 3 legs (10%) and thermal skin injury in one limb (3.3%). Twenty-eight selected patients admitted for operative treatment of varicose veins in the tributaries of the primary long saphenous were randomly assigned to endovenous obliteration (n = 15) or stripping operation (n = 13). The patients were followed up for 7-8 weeks postoperatively and examined by duplex ultrasonography. The comparison of costs included both direct medical costs and costs due to lost of productivity. All operations were successful, and the complication rates were similar in the two groups. The sick leaves were significantly shorter in the endovenous obliteration group [6.5 (SD 3.3) vs. 15.6 (SD 6.0), 95 % CI 5.4 to 12.9, p < 0.001, t-test]. When the value of the lost working days was included, the endovenous obliteration was societally cost-saving.

Abstract This study aimed to assess the value of B-mode, nonenhanced and enhanced power Doppler ultrasonography (US), fine-needle aspiration biopsy (FNAB) and magnetic resonance (MR) imaging as adjunctive tools in breast diagnostics. The findings were compared to histology. The mammograms and US images of 84 palpable breast lesions were retrospectively reviewed, 63 of them also blindly. The cytologic reports of 57 lesions were reviewed. Eighty-one (96%) of all the 84 lesions, and 52 of the 53 cancers were visible as a local abnormality at US. The sensitivity, specificity, and overall accuracy of FNAB cytology was 92%, 83%, and 88%, respectively. There were no false negative malignancies in the three modalities combined. Sixty-five lesions not unequivocally benign at mammography were examined with B-mode, unenhanced and enhanced power Doppler US. Vascularity was also analyzed quantitatively. The sensitivity, specificity, and overall accuracy of the morphologic evaluation was 100%, 10%, and 57%, respectively. Rounded lesions were more vascular than spiculated lesions, but vascular assessment was only helpful when supporting a benign morphology. Forty breast lesions were examined with dynamic MR imaging and power Doppler US by obtaining time-signal intensity curves, which were analyzed morphologically and quantitatively. The shape of the MR curve acchieved 90% accuracy in differentiating between benign and malignant lesions. It enabled also differentiation between fibroadenomas and malignancies. The accuracy of the US curve was 38%. Quantitatively, statistically significant differences were found using all the MR variables, except between fibroadenomas and malignancies. Using the US variables, no significant difference was found. Twenty-eight patients (34 breasts) were examined by dynamic low-field and high-field MR imaging. The images were analyzed separately by two radiologists paying attention to lesion morphology and enhancement kinetics. In 27 breasts, results were compared to biopsy. Kappa statistics was used to compare the performance between the MR-scanners and readers. The sensitivity was 100% and 100%, the specificity 82% and 73%, and the accuracy 93% and 89% at low and high field, respectively. The inter-MR-scanner kappa value was 0.77 (substantial agreement), while the inter-observer kappa value was 0.86 and 0.81 at low and high field, respectively (almost perfect agreement).

Abstract The purpose of the present study was to find reliable non-invasive methods for imaging salivary glands and diagnosing primary Sj?gren's syndrome (SS) and to evaluate autonomic function and central nervous system (CNS) disorders in patients with primary SS. The patient population consisted of consecutive patients with primary SS, who fulfilled the International classification criteria for primary SS, from the Division of Rheumatology, Department of Internal Medicine in Oulu University Hospital. Magnetic resonance (MR) imaging and MR sialography of parotid glands were performed on 27 patients and 7 healthy controls and ultrasonography (US) of major salivary glands on 27 patients, 27 healthy controls, and 27 symptomatic controls with sicca symptoms or salivary gland swellings without SS. MR imaging and US showed heterogeneous parenchyma or adipose degeneration of the gland in 81% and 78% of patients, respectively. MR sialography showed ductal system changes, narrowings and dilatations, or cavities in 96% of patients. One healthy control and 2 symptomatic controls had abnormal findings of parotid or submandibular glands on US. Other controls had normal findings. The diagnostic specificity of US was 94%. Parenchymal structural changes on MR imaging and US were associated with anti-Ro/SSA positivity and weakly with the focus score index, but not with salivary or tear secretion, age, disease duration, or features of systemic activity of the disease, such as hypergammaglobulinemia or systemic complications. A comprehensive package of cardiovascular tests, including 24-hour heart rate variability, baroreflex sensitivity test with phenylephrine, Valsalva manoeuvre, deep breathing tests, and active orthostatic test, were conducted on 30 patients and 30 healthy, age and sex-matched, randomly selected population-based controls. No signs of autonomic dysfunction were found in patients compared to controls in any of the tests. The test results were not associated with saliva or tear secretion, age, disease duration, or clinical features of systemic activity of the disease. A case of severe inflammatory CNS disease associated with primary SS was described, and an investigation of the relevant literature was made. Though inflammatory CNS disease is a possible complication of primary SS, there is no consensus regarding its prevalence or significance in the literature. Diagnostics and treatment are empiric. In conclusion, MR imaging, MR sialography, and US yield such a definitive picture of the glandular changes in primary SS that they are promising alternatives for invasive examinations in the diagnostics of primary SS. Comprehensive cardiovascular tests revealed no signs of autonomic dysfunction in patients with primary SS compared to general population.

Abstract Collagen XIII is a type II transmembrane protein, which has a short intracellular domain and a large, mainly collagenous ectodomain. It is located at many cell-matrix junctions and in focal adhesions in cultured cells and it has a function in cell adhesive processes. Overexpression of collagen XIII molecules with an 83 amino acid deletion in part of the ectodomain leads to fetal lethality in Col13a1del transgenic mice. Doppler ultrasonography was performed at 12.5 days of gestation on fetuses resulting from heterozygous matings and matings between heterozygous and wild-type mice. Some fetuses had atrioventricular valve regurgitation (AVVR) and all of them were transgene positive. In addition, fetuses had pathological changes in functional parameters. Histological analysis showed the trabeculation of the ventricles to be reduced and the myocardium to be thinner in the fetuses with AVVR. Based on in situ hybridization (ISH), collagen XIII mRNA are normal constituents of these structures. Overexpression of mutant collagen XIII results in mid-gestation cardiac dysfunction in fetuses, and these disturbances in cardiac function may lead to death in utero. The heterozygous mice that were initially of normal appearance had an increased susceptibility to develop B cell lymphomas, which originated in the mesenteric lymph node. Collagen XIII protein was not detected in normal lymph nodes or in the lymphomas. The incidence of lymphomas was higher in conventional conditions than in a specific pathogen-free facility. In addition, the expression of collagen XIII was localized in the intestine and the basement membrane was highly abnormal. These findings suggest that collagen XIII is a critical determinant of lymphanogenesis. Using ISH, antibody staining and RT-PCR techniques collagen XIII expression was analyzed during carcinogenesis in mice and in man. Collagen XIII expression increased during carcinogenesis in mice and in man. In the malignant process collagen XIII mRNA localized in the basal epithelium and in the invasive cells. According to antibody staining malignant invasive cells were positive. Results may reflect the disturbed adhesion of epithelial cells and ECM and that may affect the behaviour of the malignant cells, suggesting that collagen XIII has a significant role in the initiation of the invasion.

Abstract Knowledge of the effects of maternally administered vasopressors on human fetal and placental haemodynamics is sparse and limited to elective Caesarean deliveries in uncomplicated pregnancies. We hypothesized that, after short-term fetal hypoxaemia, which activates fetal cardiovascular compensatory mechanisms, treatment of maternal hypotension with ephedrine or phenylephrine results in divergent responses in fetal and placental haemodynamics. Chronically instrumented near-term sheep fetuses with either normal placental function or increased placental vascular resistance following placental embolization were exposed to two subsequent periods of decreased fetal oxygenation caused by maternal hypoxaemia and epidural-induced hypotension. The fetuses that underwent placental embolization were also chronically hypoxaemic. Fetal and placental haemodynamics were assessed by invasive techniques and by noninvasive Doppler ultrasonography. Our results show that umbilical artery blood flow velocity waveforms cannot be used to derive information of fetal cardiac function. Furthermore, the changes in placental volume blood flows and vascular resistances caused by maternal vasopressor treatment cannot be reliably recognized based on uterine and umbilical artery pulsatility index values. In response to acute hypoxaemia, a fetus with normal placental function redistributes its right ventricular cardiac output from the pulmonary to the systemic circulation and is able to increase its combined cardiac output, with a concomitant relative decrease in the net forward flow through the aortic isthmus. However, fetal haemodynamic responses to subsequent hypoxaemic insults may vary. Furthermore, the compensatory responses of fetuses with increased placental vascular resistance differ from those of normal fetuses. In these fetuses, repeated episodes of a further decrease in oxygenation lead to lactataemia. The effects of ephedrine on uteroplacental and umbilicoplacental circulations were more favourable than those of phenylephrine. Ephedrine restored the changes in fetal cardiovascular haemodynamics caused by maternal hypotension to the baseline conditions in both embolized and nonembolized fetuses. Phenylephrine did not reverse fetal pulmonary vasoconstriction or the relative decrease in the net forward flow through the aortic isthmus. Moreover, fetal left ventricular function was impaired by phenylephrine. Although no significant differences in fetal acid-base status were observed in fetuses with normal placental function, the lactate concentrations of the embolized fetuses increased further when maternal hypotension was treated with phenylephrine.

La manipulation robotique d'une sonde échographique a été un important sujet de recherche depuis plusieurs années. Plus particulièrement, des méthodes d'asservissement visuel guidé par échographie ont été développées pour accomplir différentes tâches, telles que la compensation de mouvement, le maintien de la visibilité d'une structure pendant la téléopération, ou le suivi d'un instrument chirurgical. Cependant, en raison de la nature des images échographiques, garantir une bonne qualité d'image durant l'acquisition est un problème difficile, qui a jusqu'ici été très peu abordé. Cette thèse traite du contrôle de la qualité des images échographiques acquises par une sonde robotisée. La qualité du signal acoustique au sein de l'image est représentée par une carte de confiance, qui est ensuite utilisée comme signal d'entrée d'une loi de commande permettant d'optimiser le positionnement de la sonde échographique. Une commande hybride est également proposée pour optimiser la fenêtre acoustique pour une cible anatomique qui est détectée dans l'image. L'approche proposée est illustrée dans le cas d'un scénario de télé-échographie, où le contrôle de la sonde est partagé entre la machine et le téléopérateur. / The robotic guidance of an ultrasound probe has been extensively studied as a way to assist sonographers in performing an exam. In particular, ultrasound-based visual servoing methods have been developed to fulfill various tasks, such as compensating for physiological motion, maintaining the visibility of an anatomic target during teleoperation, or tracking a surgical instrument. However, due to the specific nature of ultrasound images, guaranteeing a good image quality during the procedure remains an unaddressed challenge. This thesis deals with the control of ultrasound image quality for a robot-held ultrasound probe. The ultrasound signal quality within the image is represented by a confidence map, which is used to design a servo control law for optimizing the placement of the ultrasound probe. A control fusion is also proposed to optimize the acoustic window for a specific anatomical target which is tracked in the ultrasound images. The method is illustrated in a teleoperation scenario, where the control is shared between the automatic controller and a human operator.

Orientador: Maria Beatriz Duarte Gavião / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-18T16:08:10Z (GMT). No. of bitstreams: 1 Strini_PaulinneJunqueiraSilvaAndresen_D.pdf: 1270015 bytes, checksum: ce570be92994879d1100cbb088608e3e (MD5) Previous issue date: 2011 / Resumo: As desordens temporomandibulares (DTM) consistem em um grupo de alterações que afetam o sistema estomatognático, especialmente o componente muscular. O objetivo deste trabalho foi avaliar a força máxima de mordida (FMM), a atividade eletromiográfica (EMG) e a espessura dos músculos mastigatórios e cervicais por meio da ultrassonografia (US), além da influência clínica da postura de cabeça, em adultos com e sem a presença de DTM. A amostra foi composta por 47 indivíduos, de ambos os gêneros, sendo 19 incluídos no grupo DTM (idade de 25,4±3,8 anos), classificados de acordo com o Research Diagnostic Criteria (RDC/TMD) e 28 incluídos no grupo controle (idade de 25,9±4,7 anos). Uma linha de prumo foi usada como referência para verificar o alinhamento e identificar clinicamente o lado de inclinação da cabeça. A FMM foi determinada por um transdutor de pressão posicionado entre os arcos dentais até o nível dos primeiros molares e os valores foram convertidos em Newtons. A EMG e a US foram avaliadas para os músculos masseter, temporal e esternocleidomastóideo (ECM), no repouso e em contração voluntária máxima (CVM), bilateralmente. A normalidade dos dados foi verificada pelo teste de Shapiro-Wilks e a comparação entre os dados realizada por testes paramétricos e não paramétricos, sendo a correlação obtida pela Correlação de Spearman (p?0.05). Os resultados demonstraram diferenças estatisticamente significantes quando comparados os valores de FMM entre o grupo DTM (285,5±98,8 N) e controle (353,4±69,6 N). Diferenças significativas também foram observadas para a espessura do músculo masseter, entre o grupo DTM (11,2±1,9 mm, repouso; 13,4±1,9 mm, CVM) e o controle (12,7±1,8 mm, repouso; 14,8±2,0 mm, CVM) e entre o estado de repouso e contração, em ambos os grupos, para os músculos mastigatórios. Em relação ao gênero, a FMM foi menor nos indivíduos do sexo feminino com DTM, bem como a espessura dos músculos analisados, em ambos os grupos. Os valores de EMG para o ECM demonstraram diferenças significativas entre o estado de repous o (100,6±28,0%) e de CVM (105,6±101,9%) para o grupo controle, com maiores escores durante o apertamento dentário. Da mesma forma, diferenças significativas foram observadas entre o grupo controle e DTM para a EMG do ECM, durante a flexão de cabeça, para o ECM do lado direito (77,0 ±34,2%, DTM; 115,6 ±56,8%, controle) e esquerdo (80,7±46,1%, DTM; 113,1±49,5%, controle), e na espessura do ECM na extensão, para o lado esquerdo (10,0±2,0 mm, DTM; 10,9 ±1,5 mm, controle) e no repouso para o lado direito (10,4±1,8 mm, DTM; 11,5±1,8 mm, controle). Adicionalmente, correlações significativas foram encontradas entre os valores de FMM, US e EMG do masseter, temporal e ECM para o grupo DTM e também quando considerado o lado de inclinação de cabeça para o ECM. Pode-se concluir que pacientes com DTM apresentaram menores valores de FMM e alterações na função muscular capazes de afetar os músculos mastigatórios e cervicais, especialmente durante os movimentos mandibulares, revelando a existência de uma ligação funcional entre eles / Abstract: Temporomandibular disorders (TMD) are a group of changes that affect the stomatognathic system, especially the muscular component. The aim of this study was to evaluate the maximum bite force (MBF), the electromyographic activity (EMG) and the thickness of masticatory and neck muscles by means of ultrasonography (US), in addition to clinical influence of head posture, in adults with and without TMD. The sample consisted of 47 individuals of both genders, with 28 included in the control group (mean age 25.9±4.7 years old) and 19 in the TMD group (25.4±3.8 years old), classified according the Research Diagnostic Criteria (RDC / TMD). A plumb line was used as reference to verify the alignment and to define the side of head tilt. MBF was determined by a pressure transducer positioned between the dental arches to the level of first molars and the values were converted into Newtons. EMG and US were evaluated for the masseter, temporalis and sternocleidomastoid (SCM) at rest and at maximal voluntary contraction (MVC), bilaterally. Data normality was checked by Shapiro-Wilks and the comparison between the data done by parametric and nonparametric tests, with the correlation obtained by Spearman's correlation (p ? 0.05). The results showed statistically significant differences when comparing values of MBF between TMD (285.5 ±98.8 N) and controls (353.4 ±69.6 N). Significant differences were also observed for thickness of the masseter muscle between the TMD (11.2±1.9 mm, rest; 13.4±1.9 mm, MVC) and the control group (12.7±1.8 mm, rest; 14.8±2.0 mm, MVC) and between the state of rest and contraction in both groups for the masticatory muscles. In relation to gender, MBF was lower in female subjects with TMD as well the thickness of the muscles analyzed, in both groups. The values of EMG for the SCM showed significant differences between the resting state (100.6 ±28.0 %) and MVC (105.6 ±101.9 %) in the control group, with greater scores during dental clenching. In the same way, significant differences were observed between the control and TMD for SCM activity during head flexion for right (77.0±34.2 %, TMD; 115.6 ±56.8 %, control) and left SCM (80.7 ±46.1 %, DTM; 113.1±49.5 %, control) and for the thickness of the SCM during extension, to the left side (10.0±2.0 %, TMD; 10.9±1.5 %, control) and at rest to the right side (10.4±1.8 %, TMD; 11.5±1.8 %, control). Additionally, a significant correlation was found between values of the MBF, US and EMG of the masseter, temporal and SCM for TMD group and also when considered the side of head tilt for SCM. Thus, it can be concluded that patients with TMD showed smaller values of MBF and changes in muscle function that may affect the masticatory and neck muscles, especially during the mandibular movements, revealing the existence of a functional link between them / Doutorado / Anatomia / Doutor em Biologia Buco-Dental

Orientador: Antonio de Azevedo Barros Filho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:09:02Z (GMT). No. of bitstreams: 1 Krahenbuhl_Tathyane_M.pdf: 1218668 bytes, checksum: beba474098f52b445cd7d16e61335fc4 (MD5) Previous issue date: 2014 / Resumo: Objetivos: Analisar quais os principais fatores que influenciam a massa óssea de crianças e adolescentes avaliada pelo ultrassom quantitativo de falanges, e avaliar a massa óssea de adolescentes do sexo feminino, envolvidas em esportes com e sem sobrecarga corporal, utilizando o ultrassom quantitativo de falanges para verificar a influência da prática esportiva no tecido ósseo. Métodos: Este trabalho foi escrito no método alternativo, onde consiste de uma introdução, um artigo de revisão sobre o tema e um artigo original com os dados da pesquisa. No primeiro capítulo foi realizada uma revisão sistemática da literatura utilizando como referência as normas propostas pelo PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). No segundo capítulo foi realizado um estudo transversal, no qual 192 adolescentes do sexo feminino divididas em três grupos: atletas de handebol (n=67), atletas de natação (n=62) e grupo controle (n=63) foram avaliadas pelo ultrassom quantitativo de falanges para avaliar a massa óssea através dos parâmetros AD-SoS e BTT, além de avaliados as variáveis de peso, altura, IMC e estádios de Tanner. Resultados: No primeiro capítulo foram incluídos 21 artigos na revisão sistemática, que apresentaram valores superiores de AD-SoS para as meninas em relação aos meninos durante o desenvolvimento fisiológico puberal. Os valores dos parâmetros do QUS de falanges aumentavam com o incremento do estágio maturacional. Variáveis antropométricas como idade, peso, altura, índice de massa corporal (IMC), massa magra demonstraram correlações positivas com os valores do QUS de falanges. A atividade física também demonstrou estar positivamente relacionada com o aumento da massa óssea. No segundo capítulo foram encontrados valores superiores de AD-SoS para as nadadoras em relação ao grupo controle, os dois grupos de atletas apresentaram valores superiores de BTT em relação ao grupo controle. Também foram encontrados valores superiores de AD-SoS para as atletas quando comparados os grupos pelos estádios de Tanner. Não houve diferença estatística entre os grupos de atletas e os parâmetros ósseos. Considerações finais: Na revisão da literatura os parâmetros AD-SoS e BTT como indicadores de massa óssea em crianças e adolescentes saudáveis demonstraram ser influenciados por variáveis como idade, altura, peso e desenvolvimento puberal, além de que o QUS de falanges demonstrou ser indicado para avaliar a massa óssea em populações pediátricas, podendo ser útil na identificação precoce de doenças osteogênicas. No estudo transversal foi possível observar que os parâmetros ósseos do QUS de falanges tem correlação com as variáveis de desenvolvimento maturacional, entretanto a atividade física frequente e programada exerce influencia positiva na massa óssea, sendo que a ação está mais associada com o tempo de prática e a frequência semanal de treinamento do que com as características das modalidades, seja com ou sem sobrecarga corporal / Abstract: Objectives: To analyze the main factors that influence bone mass in children and adolescents assessed by quantitative ultrasound of the phalanges, and to evaluate bone mass in female adolescents involved in sports with and without body burden using quantitative ultrasound of the phalanges to verify the influence of sports practice in the bone tissue. Methods: This dissertation was written in the alternative method, which consists of an introduction, a review article on the topic and a original article with the survey data. In the first chapter a systematic literature review using as reference the standards proposed by the PRISMA was performed. In the second chapter a cross-sectional study in which 192 female adolescents divided into three groups was performed: handball players (n=67), swimmers (n=62) and control group (n=63) were evaluated by ultrasonography quantitative phalanges to assess bone mass through the AD-SoS and BTT parameters, and evaluated the variables weight, height, BMI and Tanner Stage. Results: In the first chapter 21 articles was included in the systematic review, this articles showed higher values of AD-SoS for girls than boys during the pubertal development. The values of the parameters of QUS of phalanx increased with the increase of the maturational stage. Anthropometric variables such as age, weight, height, body mass index (BMI) and lean mass showed positive correlations with the values of QUS of the phalanges. Physical activity has also been shown to be positively associated with increased bone mass. In the second chapter, swimmers showed higher values of AD-SoS compared with the control group, the two groups of athletes had higher values of BTT compared to the control group. Higher values of AD-SoS for athletes were also found when comparing the groups by Tanner Stage. There was no statistical difference between the groups of athletes and bone parameters. Conclusions: In the literature review the AD-SoS and BTT parameters as indicators of bone mass in healthy children and adolescents. These parameters were influenced by variables such as age, height, weight and pubertal development, and that QUS of phalanx proved to be suitable for measuring bone mass in pediatric populations, and may be useful in early diagnosis of osteogenic diseases. In cross-sectional study we observed that bone parameters of the QUS phalanges correlates with variables of maturational development, however frequent and scheduled physical activity exerts a positive influence on bone mass, and the action is more associated with the practice time and weekly frequency of training than with the characteristics of modalities, either with or without body weight-bearing / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Orientador: Ana Terezinha Guillaumon / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T11:44:57Z (GMT). No. of bitstreams: 1 Oliveira_GermanodaPaz_M.pdf: 4750891 bytes, checksum: 517650637fcacb4ffebc12ad859189bb (MD5) Previous issue date: 2014 / Resumo: Objetivos: Analisar a distribuição temporal de sinais de microembolias (SM) ao longo de diferentes estágios da endarterectomia carotídea (EC) e da angioplastia carotídea (AC) e as variáveis associadas com a ocorrência destes sinais, além de avaliar as mudanças na velocidade média aferida na artéria cerebral média (ACM) durante os dois tipos de intervenção. Material e métodos: Trinta e três pacientes com estenose carotídea foram submetidos ou a EC (17) ou a AC (16). Os SM bem como as velocidades médias na ACM foram adquiridas utilizando o US doppler transcraniano (DTC) e esses dados então analisados e associados a diferentes estágios cirúrgicos (pré-proteção, durante a proteção e pós-proteção), tipos de intervenção (EC ou AC) e diferentes variáveis para encontrar potenciais fatores de risco para embolização. Para análise estatística, foram usados os testes de Qui-quadrado, de Fisher e de Mann-Whitney, além de análise por medidas repetidas das variâncias com transformação por postos (ANOVA), seguido de teste de perfil por contrastes e análise de regressão linear múltipla ajustada para o grupo. Resultados: Uma diferença significativa foi encontrada para o número de SM em ambos os grupos. Houve, em média, 89,8 (± 171,4) sinais por procedimento no grupo EC, enquanto a média no grupo AC foi de 597,5 (± 343,3) sinais por procedimento. A média da velocidade média na ACM foi, em ambos os grupos, significantemente menor no estágio durante a proteção. Anestesia local correlacionou-se positivamente (p=0,003) com aumento dos SM, e, associado a isso, o histórico de tabagismo importante (desde que houvesse a cessação do vício há mais de um ano) correlacionou-se negativamente (0,014) com a ocorrência de SM. Conclusão: EC por semi-eversão, à luz do DTC, provocou uma menor incidência de SM por procedimento do que AC com filtro distal, em todos os estágios cirúrgicos. A média da velocidade média na ACM se comportou de maneira similar em ambos os grupos (EC e AC). Anestesia geral e histórico de tabagismo importante (desde que o paciente houvesse cessado por menos um anos antes da intervenção) foram as únicas duas variáveis no estudo que se correlacionaram significativamente (negativamente) com a ocorrência de SM / Abstract: Objectives: To analyze the temporal distribution of microembolic signals throughout the different stages of both the semi-eversion carotid endarterectomy (CEA) and the carotid artery stenting (CAS) procedures and the variables associated with occurrence of them and to evaluate changes in mean blood flow velocity, for both CAS and CEA, within the ipsilateral middle cerebral artery (MCA). Methods: Thirty three patients with carotid stenosis underwent either a CEA (17) or a CAS (16). Microembolic signals, as well as mean blood flow velocity, were acquired using a Transcranial Doppler scan (TCD) and these data were then analyzed and associated to different surgical stages (pre-protection, during protection, and post-protection), types of procedure (CAS or CEA) and different variables to find potential risk factors. To statistical analysis, chi-squared test, Fisher test, Mann-Whitney test, repeated measures analysis of variance with rank transformation (ANOVA) followed by contrast test and multiple linear regression analysis were used. Results: A significant difference was found for the number of microembolic signals in both groups. There were, on average, 89.8 (± 171.4) signals per procedure in the CEA group, while the average in the CAS group was 597.5 (± 343.3) signals per procedure. The average blood flow in the MCA was, in both groups, significantly lower during the stage of protection. Local anesthesia correlated positively (p= .003) with increase in microembolic signals and history of prolonged tobacco use having dropped the addiction for over a year correlated negatively (p= -.014) with the frequency of microembolic signals. Conclusion: Semi-eversion CEA, in light of our TCD findings, evoked a smaller incidence of hyperintense microemboli per procedure than CAS with a distal filter in all the protection stages. The average of the mean blood flow velocity within the MCA has behaved similarly between both groups (CAS and CEA). General anesthesia and the history of tobacco use (as long as the patient had quit for a year or more prior to surgery) were the only two variables in the study that correlated significantly (negatively) with the frequency of microembolic signals / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Orientador: Maria Jaqueline Mamprim / Banca: Raquel Sartor Marcelino / Banca: Carlos Roberto Teixeira / Resumo: A população de quatis tem aumentado consideravelmente, principalmente em parques públicos, fato que aumenta a preocupação com relação a ocorrência das doenças de caráter zoonótico. Existem poucos relatos do emprego da ultrassonografia convencional e Doppler na avaliação renal desses animais, assim como auxilio no diagnóstico das doenças nessa espécie. Portanto, o trabalho teve por objetivo avaliar pela ultrassonografia convencional as características de ecogenicidade comparativa dos rins e detectar, ao exame Doppler, um perfil do índice de resistividade das artérias intrarrenais de quatis de vida livre, sob contenção química. Foram avaliados 17 quatis, 4 machos e 13 fêmeas. Uma correlação positiva foi observada entre o peso (2,5 até 9,3 Kg) e comprimento dos rins (2,73 a 4,07 cm). Todos os quatis apresentaram adequada definição e proporção córtico-medular, com córtex hiperecogênico em relação à medular, mantiveram a mesma relação de ecogenicidade entre parênquima esplênico, hepático e córtex renal que os observados em cães e gatos. Foi obtido o índice de resistividade (IR) das artérias intrarrenais, com média de 0,63 ± 0,06 (variando de 0,49 a 0,82) e com pressão arterial sistêmica (PAS) média de 94 mmHg, valores de IR superiores aos encontrados nos cães e gatos não sedados. Não foi observado correlação positiva entre a PAS e o IR intrarrenal nos animais submetidos a combinação de cetamina, xilazina e midazolam. O IR desses animais deverá ser mensurados com outras combinações químicas de anestésicos / Abstract: Coati's population has increased considerably, especially in public parks, which increases the concern about the occurrence of zoonotic diseases. There are few reports of the use of conventional and Doppler ultrasound in renal evaluation of these animals, as well as an aid in the disease diagnosis in this species. Therefore, the study aimed to assess by conventional ultrasound the characteristics of comparative echogenicity of the kidneys and to detect at Doppler examination, a profile of the resistivity index of intrarenal arteries of free ranging coatis under chemical restraint. Seventeen coatis, 4 males and 13 females, were evaluated. A positive correlation was observed between body weight (from 2.5 to 9.3 kg) and renal length (from 2.73 to 4.07cm). All coatis had adequate cortico-medullary definition and ratio, with a hyperechoic cortex relative to the medulla, maintaining the same echogenicity relationship between splenic and hepatic parenchyma and renal cortex than those observed in dogs and cats. The resistive index (RI) was obtained from the intrarenal arteries, averaging 0.62 ± 0.06 (range 0.49 to 0.71) and mean systemic arterial pressure (SAP) of 95.06 mmHg, a higher RI than those found in dogs and cats not sedated. There was no positive correlation between SAP and renal RI in the animals submitted to a combination of ketamine, xylazine and midazolam. The RI of these animals should be measured with other chemical combinations of anesthetics / Mestre