Thesis (Ph.D.)--University of Nebraska-Lincoln, 2009. / Title from title screen (site viewed February 25, 2010). PDF text: 1 v. (ca. 280 p. : ill.). UMI publication number: AAT 3386755. Includes bibliographical references. Also available in microfilm and microfiche formats.

Submitted by IGOR RIBEIRO DE CASTRO BIENERT (bienert@terra.com.br) on 2016-01-29T14:19:19Z No. of bitstreams: 2 Tese Igor R C Bienert versao final para arquivamento.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Bienert_et_al BMJ Innovations.pdf: 1803372 bytes, checksum: 31c4180b21a1482a1a0afcc7856c9b78 (MD5) / Rejected by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: Foram submetidos 2 arquivos PDF’s, apenas 1 arquivo deve ser submetido (o que contém a Tese ou Dissertação) Corrija estas informações e realize uma nova submissão contendo o arquivo correto. Agradecemos a compreensão. on 2016-02-02T12:39:46Z (GMT) / Submitted by IGOR RIBEIRO DE CASTRO BIENERT (bienert@terra.com.br) on 2016-02-19T20:50:56Z No. of bitstreams: 2 Tese Igor R C Bienert versao final para arquivamento.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Bienert_et_al BMJ Innovations.pdf: 1803372 bytes, checksum: 31c4180b21a1482a1a0afcc7856c9b78 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-02-23T13:21:58Z (GMT) No. of bitstreams: 1 bienert_irc_dr_bot.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) / Made available in DSpace on 2016-02-23T13:21:58Z (GMT). No. of bitstreams: 1 bienert_irc_dr_bot.pdf: 2600270 bytes, checksum: 99be667aca0d1c9255e8b1f9002d9a85 (MD5) Previous issue date: 2016-01-26 / Introdução: A cardiologia intervencionista requer necessariamente um acesso vascular invasivo, sendo esta via de acesso uma escolha do médico operador. Nesta escolha interfere o tipo de procedimento, impacto ao paciente, risco ao profissional e experiência técnica. O acesso via artéria femoral é o mais difundido globalmente e a técnica de acesso pela artéria radial tem sido progressivamente adotada devido ao maior conforto para o paciente, menores taxas de complicações e em alguns cenários, de mortalidade. Um dos focos de interesse crescente é a exposição à radiação ionizante e medidas para minimizar o risco ao paciente e ao profissional. Escassa é a literatura disponível na área e conflitantes são seus resultados. Objetivo: Avaliar os níveis de radiação recebidos pelo médico operador de acordo com as diferentes técnicas de acesso, bem como mapear áreas de escape de radiação. Após essa etapa, o estudo visou desenvolver e validar dispositivo de radioproteção dedicado à técnica radial (TRIPTable) voltado à redução da radiação ao médico operador, comparando o seu impacto à técnica femoral e radial padrão no cenário de pacientes portadores de síndrome coronária aguda randomicamente alocados para cateterismo com intenção de tratamento percutâneo. Métodos: A fase inicial pré-clínica do estudo foi constituída de avaliação em ambiente controlado dos níveis de radiação em pontos pré-especificados de um operador simulado com phantom de água. A fase clínica do estudo foi um ensaio clínico prospectivo, randomizado, unicêntrico, comparativo entre três grupos denominados técnica femoral, técnica radial e técnica radial com dispositivo radioprotetor TRIPTable, recrutados no Hospital das Clínicas de Marília (Marília/SP) e randomizados na proporção 1:1:1 (108 pacientes - 36 por grupo) avaliando a radiação recebida pelo operador em três diferentes pontos (gônadas, tireoide e olhos). Os resultados foram comparados com o grupo controle de 108 pacientes provenientes de coorte randomizada externa entre técnica radial e femoral 1:1, utilizando critérios similares, porém com operadores cegos aos objetivos de avaliação de radiação visando detecção de vieses de técnica (efeito Hawthorne) e validação de resultados. Resultados: Não houve diferença entre o estudo e a coorte externa ou entre os grupos do estudo quanto a características clínicas, desfechos dos procedimentos ou parâmetros de exposição radiológica ao paciente. Os resultados indicam maior radiação recebida pelo operador com a técnica radial (12,5 mSv), seguida da femoral (10,1 mSv) e TRIPTable (6,8 mSv). Em relação aos locais de exposição, o território de gônadas teve maior sensibilidade radiológica com uso da técnica radial (p=0,001). Com uso da técnica femoral não houve diferença entre os três territórios (p=0,398), porém na análise ad hoc o território de gônadas foi mais sensível quando comparado à exposição aos olhos (p=0,016) e limítrofe em comparação à tireoide (p=0,056). No grupo do dispositivo TRIPTable não houve diferença significativa entre qualquer um dos territórios analisados (p=0,180). Conclusões: O estudo indica equivalência entre os resultados do procedimento entre os grupos e quanto à exposição radiológica ao paciente. Contudo, demonstrou maior impacto radiológico para o operador que utilizou a técnica radial, em comparação à técnica femoral e à técnica radial com uso do dispositivo TRIPTable. O uso do dispositivo reduziu o impacto radiológico comparado ainda à técnica femoral. Tais diferenças derivaram primordialmente da variação em território de gônadas. Os achados demonstram um campo de exposição radiológica heterogêneo ao corpo do operador, benefício do dispositivo testado e oportunidade de novas formas de desenvolvimento de medidas de radioproteção. Registros: UTN/OMS - U1111-1158-8591 Plataforma Brasil - CAAE 32767514.0.1001.5413 Clinical Trials - NCT 02200783. / Background: Interventional cardiology requires an invasive vascular access, a choice of medical operator. This choice is affected by type of procedure, patient impact, professional risk and technical experience. Interventional procedures via radial technique have progressively increased due to improved patient comfort, lower complication rates, and reduced mortality in some scenarios. One area of interest is radiation exposure and ways to minimizing it. Most studies focusing on patient radiation risk demonstrated conflicting results, and there is no consensus for increased exposure with any technique. Objective: The aim of this study was to evaluate radiological exposure under controlled radial and femoral access simulation tests, mapping radiation paths. After this stage, the study developed a radiological protection device for the transradial technique (TRIPTable), comparing its impact as compared to standard femoral and radial techniques in the setting of patients with acute coronary syndrome randomly assigned for catheterization with intent to percutaneous treatment. Methods: Radiation exposure was simulated under controlled conditions for femoral and radial techniques using a pressurized ionization chamber and water phantom. Different measurement points were defined according to standard positions to simulate radiation received by the operator in the gonads, thyroid, and eyes at different angles during real procedures. The clinical phase of the study is a prospective clinical trial, single-center, randomized, and comparing three groups (femoral technique, radial technique, and radial technique with radioprotective device), admitted in the Emergency Department of Hospital das Clinicas de Marilia (Marilia / SP – Brazil). Patients were randomized in a 1:1:1 proportion (108 patients - 36 per group) evaluating the radiation received by the operator measured by dosimetry at three different points (gonads, thyroid and eyes). As it is impossible to blind operators to study techniques, the results were compared to an external control cohort of patients including 108 individuals with similar inclusion and exclusion criteria, randomized for radial and femoral technique, but with blinded operators to radiation objectives, aiming technical bias detection (Hawthorne effect) and validation of results. Results: There was no difference between groups regarding clinical characteristics, procedures or patient radiation exposure outcomes. The results indicate higher radiation received by the operator with the radial technique (12.5 mSv) as compared to femoral technique (10.1 mSv) and TRIPTable technique (6.8 mSv). Regarding exposure locations, the gonad region had a higher radiation sensitivity with radial technique (p=0.001). With femoral technique there was no difference between the three territories (p=0.398) but the ad hoc analysis indicated higher radiosensibility in gonads when compared to eyes exposure (p=0.016) and borderline compared to thyroid exposure (p=0.056). In the TRIPTable device group there was no significant difference between any of the territories analyzed (p=0.180). Conclusions: The study indicates no difference of radiation exposure to the patients between the groups. However, there was a greater radiologic impact to the operator who used the radial technique, compared to the femoral technique and TRIPTable device technique. The device reduced the radiological impact even compared to the femoral technique. Such differences derived primarily from variation in gonads exposure. The findings demonstrate a heterogeneous radiation exposure to the operator body, device benefit and an opportunity to develop new ways to improve radiation protection. Registration: UTN/OMS - U1111-1158-8591 Plataforma Brasil - CAAE 32767514.0.1001.5413 Clinical Trials - NCT 02200783.

Orientador: Katashi Okoshi / Resumo: Introdução: A cardiologia intervencionista requer necessariamente um acesso vascular invasivo, sendo esta via de acesso uma escolha do médico operador. Nesta escolha interfere o tipo de procedimento, impacto ao paciente, risco ao profissional e experiência técnica. O acesso via artéria femoral é o mais difundido globalmente e a técnica de acesso pela artéria radial tem sido progressivamente adotada devido ao maior conforto para o paciente, menores taxas de complicações e em alguns cenários, de mortalidade. Um dos focos de interesse crescente é a exposição à radiação ionizante e medidas para minimizar o risco ao paciente e ao profissional. Escassa é a literatura disponível na área e conflitantes são seus resultados. Objetivo: Avaliar os níveis de radiação recebidos pelo médico operador de acordo com as diferentes técnicas de acesso, bem como mapear áreas de escape de radiação. Após essa etapa, o estudo visou desenvolver e validar dispositivo de radioproteção dedicado à técnica radial (TRIPTable) voltado à redução da radiação ao médico operador, comparando o seu impacto à técnica femoral e radial padrão no cenário de pacientes portadores de síndrome coronária aguda randomicamente alocados para cateterismo com intenção de tratamento percutâneo. Métodos: A fase inicial pré-clínica do estudo foi constituída de avaliação em ambiente controlado dos níveis de radiação em pontos pré-especificados de um operador simulado com phantom de água. A fase clínica do estudo foi um ensaio clíni... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Interventional cardiology requires an invasive vascular access, a choice of medical operator. This choice is affected by type of procedure, patient impact, professional risk and technical experience. Interventional procedures via radial technique have progressively increased due to improved patient comfort, lower complication rates, and reduced mortality in some scenarios. One area of interest is radiation exposure and ways to minimizing it. Most studies focusing on patient radiation risk demonstrated conflicting results, and there is no consensus for increased exposure with any technique. Objective: The aim of this study was to evaluate radiological exposure under controlled radial and femoral access simulation tests, mapping radiation paths. After this stage, the study developed a radiological protection device for the transradial technique (TRIPTable), comparing its impact as compared to standard femoral and radial techniques in the setting of patients with acute coronary syndrome randomly assigned for catheterization with intent to percutaneous treatment. Methods: Radiation exposure was simulated under controlled conditions for femoral and radial techniques using a pressurized ionization chamber and water phantom. Different measurement points were defined according to standard positions to simulate radiation received by the operator in the gonads, thyroid, and eyes at different angles during real procedures. The clinical phase of the study is a prospective cli... (Complete abstract click electronic access below) / Doutor

Orientador: Wilson Nadruz Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T18:42:20Z (GMT). No. of bitstreams: 1 Gemignani_Tiago_M.pdf: 1392345 bytes, checksum: 25697107f179a8a592c3843115eec95e (MD5) Previous issue date: 2008 / Resumo: A aterosclerose de artérias periféricas tipicamente afeta vasos dos membros inferiores, sugerindo que estímulos locais tenham função importante neste processo. O presente estudo avaliou os efeitos das mudanças posturais na tensão circunferencial das artérias poplítea e carótida e investigou a correlação entre a tensão circunferencial vascular local e a espessura íntima-média destas artérias. Cento e dezessete indivíduos não diabéticos, não hipertensos, não fumantes foram avaliados (48 homens e 69 mulheres). A pressão arterial foi mensurada em braço e panturilha dos pacientes, nas posições supina e ortostática. Análise com Eco-Doppler foi realizada em artérias carótida comum e poplítea após medida de pressão arterial. A tensão circunferencial foi calculada de acordo com a Lei de Laplace. Foi encontrado que a mudança da posição supina para a ortostática aumentou a tensão circunferencial poplítea, mas não em artérias carótidas. Análises de correlação parcial, ajustadas por idade e índice de massa corpórea, revelaram que os valores de tensão circunferencial média obtidos em posição supina e ortostática exibiram correlação similar com a espessura íntima-média carotídea, enquanto que a tensão circunferencial sistólica ortostática revelou correlação mais forte com a espessura íntima-média poplítea, que a tensão circunferencial obtida em posição supina. Estes resultados foram confirmados após análise de regressão múltipla incluindo idade, sexo, índice de massa corpórea e níveis de lípides e glicemia como variáveis independentes. Em conclusão, a tensão circunferencial ortostática foi melhor preditor hemodinâmico da espessura íntima-média poplítea do que a tensão circunferencial supina. Estes dados sugerem que a posição ereta seja um fator de risco potencial para aterosclerose poplítea devido ao aumento da sobrecarga hemodinâmica local. / Abstract: Atherosclerosis of peripheral arteries typically affects vessels of the lower limbs, suggesting that local hemodynamic stimuli play a role in this process. The present study evaluated the effects of body posture changes on carotid and popliteal circumferential wall tension (CWT) and investigated the relationship between local CWT and intima-media thickness (IMT) of these arteries. One hundred seventeen nondiabetic, nonhypertensive, nonsmoker subjects (48 men and 69 women) were evaluated. Blood pressure was measured in the arm and calf of subjects in supine and orthostatic positions. Echo-Doppler analysis evaluated the common carotid and popliteal arteries after blood pressure measurements. CWT was calculated according to Laplace's law. Changing from supine to orthostatic posture increased CWT in popliteal but not in carotid arteries. Partial correlation analysis controlled for age and body mass index revealed that supine and orthostatic CWT exhibited comparable correlation coefficients with carotid IMT, while orthostatic CWT displayed a stronger relationship with popliteal IMT than supine CWT. These results were further confirmed by multiple linear regression analysis including age, sex, body mass index, lipid fractions and glucose as independent variables. Orthostatic CWT is a better hemodynamic predictor of popliteal IMT in comparison to supine CWT. These data suggest that orthostatic posture may be a potential risk factor for popliteal atherosclerosis by increasing local hemodynamic burden. / Mestrado / Clinica Medica / Mestre em Clinica Medica

Abstract The aim of this study was to analyze angiographic findings and the presence and topography of cerebral ischemic and/or hemorrhagic lesions in cerebral CT or MRI, and to assess the long-term clinical outcome of a series of 136 consecutive cervicocephalic artery dissection (CCAD) patients. Pulsatile tinnitus was evaluated as a symptom of CCAD. Medical records and films were reviewed retrospectively. Irregular stenosis was found in angiography in 50% and occlusion in 33% of the dissected cervicocephalic arteries. Irregular stenosis normalized in 81% and occlusion recanalized in 34%. Other findings, such as pseudoaneurysms, intimal flaps, double lumens, and irregular dilatations were rare and often remained unchanged in follow-up. Pulsatile tinnitus was a presenting symptom in 12% of the CCAD patients, but the majority of patients had concomitant head or neck pain, ischemic brain symptoms, Horner's syndrome, or cranial neuropathies. Of the 131 patients who underwent brain imaging, 73 (56%) had signs of infarction in cerebral CT or MRI. Occlusion of the dissected vessel was accompanied by infarction in 76%, irregular stenosis in 40%, and other findings only rarely. Of the anterior circulation infarctions, 95% (39/41) were territorial, subcortical, or territorial infarctions with fragmentation and could thus be considered embolic. Subarachnoid hemorrhage was found in CT in 5 of the 22 patients (23%) with intracranial dissection. The patient's long-term clinical outcome was assessed using two methods: a classification into categories based on neurological symptoms and defects and the modified Rankin Scale (mRS). Of the 136 CCAD patients, 60% recovered with no or mild disability and 79% scored 0–2 on mRS. In the case of dissection of one or more cervicocephalic arteries without occlusion, the figures were 75% and 89%. In the case of occlusive dissection of one or more arteries, only about 35% of the patients recovered well, having no or mild disability, and 61% scored 0–2 on mRS. No significant differences were seen in recovery after intra- and extracranial dissections. In conclusion: irregular stenosis, which is the most common angiographic finding in CCAD, is associated with brain infarction less frequently than occlusion, and the long-term clinical outcome is good in most cases. Occlusion of the dissected vessel causes more brain infarctions, and only about 35% of the patients recover well, having no or mild disability. More than 10% of CCAD patients have pulsatile tinnitus as a presenting, and sometimes the only symptom.

M.Cur. / The emotional state of health of pre-operative patients about to have coronary artery bypass graft (CABG) is a decisive factor in the outcome of the procedure. Nel (1989) carried out quantitative research to determine the effect of a pre-operative education programme on CABG patients. This education programme is based on the fact that a person's emotional disposition is a critical variable in his successful recovery from coronary disease. However, the researcher is of the opinion that although Nel's study made a positive contribution regarding this phenomenon, a quantitative research design does not reflect the real experience of the patients that follow a pre-operative education programme. In the researcher's view, a qualitative research design is more appropriate. The aim of the present qualitative, exploring, descriptive, contextual research is to explore and describe the experience of CABG patients exposed to a pre-operative education programme and to lay down guidelines for nursing staff in practice The research was conducted in three phases. One private hospital in Pretoria was use for the research.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13259号 / 論医博第2177号 / 新制||医||1037(附属図書館) / (主査)教授 横出 正之, 教授 富樫 かおり, 教授 湊谷 謙司 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Traumatic arteriovenous fistulas of the neck are a relatively uncommon injury, whose ramifications can include immediate or delayed neurological insults, massive bleeding, or death. Angiography and embolization have been increasingly used to manage this complex injury pattern. In this particular case, the patient underwent management of bilateral communicating arteriovenous fistulae using a commercially available plug occlusion device. Epidemiology, with an emphasis on patient management and outcomes, is discussed.

Percutaneous dilatational tracheostomy (PDT) has become an appropriate alternative to conventional surgical tracheostomy. It is now performed worldwide by a diverse array of physician specialists. Although adverse events are relatively uncommon, serious complications can arise from this bedside procedure. We report a patient who suffered life-threatening hemorrhage from a common carotid artery laceration and pseudo-aneurysm formation in the innominate artery following an elective PDT procedure.

No description available.