This thesis is an investigation of the impact of abdominal surgeries and assisted parturition in dairy cows on physiological and behavioural parameters, and the potential management of pain through the use of non-steroidal inflammatory drugs (NSAIDs) or a mechanical brush. This research is novel and necessary because of the paucity of pain research in dairy cows. Three abdominal surgery studies were conducted. The first was a randomized clinical field trial, conducted on commercial dairy herds in southern Ontario, Canada, to evaluate the effect of ketoprofen following correction of left displaced abomasum. The second and third studies were randomized clinical trials evaluating NSAIDs following the first stage of a two-stage fistulation surgery. The second tested ketoprofen versus saline, while the third compared ketoprofen and meloxicam. The key findings from these studies were that there were indicators of pain following surgery (such as decreased milk production, dry matter intake, and changes in lying behavior) and that there were beneficial effects of administering NSAIDs following abdominal surgery(improved eating and lying behavior), although these effects were not sufficient to alleviate all of the surgical pain. Two trials were conducted in parturient cows. The first trial examined the effects of meloxicam administration 24 h following assisted calving. There were beneficial effects of NSAID on feeding behavior, however, further research is needed to investigate the full potential of providing an NSAID as a post-calving pain therapy. The second trial described the use of a mechanical brush by parturient cows. This study yielded insight on the brush use of these cows, as well as on their maternal, auto-grooming, and scratching behaviors. Cows used the brush before parturition, and when the calf was present, auto-grooming and scratching behaviors were significantly reduced, and calf licking time was greater in the brush group compared to the no brush group. The findings described in this dissertation provide insights into the expression and assessment of pain and its management following abdominal surgery in dairy cattle. This study has also identified areas of future research for both assessment and management of pain following abdominal surgery and following assisted calving. / NSERC IPS II, Boehringer-Ingelheim (Canada) Ltd., OMAFRA, Merial Canada Inc.

INTRODUCTION Internal abdominal hernias are infrequent but an increasing cause of bowel obstruction still often underdiagnosed. Among adults its usual causes are congenital anomalies of intestinal rotation, postsurgical iatrogenic, trauma or infection diseases. PRESENTATION OF CASE We report the case of a 63-year-old woman with history of chronic constipation. The patient was hospitalized for two days with acute abdominal pain, abdominal distension and inability to eliminate flatus. The X-ray and abdominal computerized tomography scan (CT scan) showed signs of intestinal obstruction. Exploratory laparotomy performed revealed a trans-mesenteric hernia containing part of the transverse colon. The intestine was viable and resection was not necessary. Only the hernia was repaired. DISCUSSION Internal trans-mesenteric hernia constitutes a rare type of internal abdominal hernia, corresponding from 0.2 to 0.9% of bowel obstructions. This type carries a high risk of strangulation and even small hernias can be fatal. This complication is specially related to trans-mesenteric hernias as it tends to volvulize. Unfortunately, the clinical diagnosis is rather difficult. CONCLUSION Trans-mesenteric internal abdominal hernia may be asymptomatic for many years because of its nonspecific symptoms. The role of imaging test is relevant but still does not avoid the necessity of exploratory surgery when clinical features are uncertain. / Revisión por pares

In dieser Arbeit wurde das Signalement, die Jahreszeit bei Klinikeinweisung, die Diagnose, die Operationstechnik, die Operationskomplikationen und der Therapieerfolg von laparotomierten Fohlen im Alter bis zu einem Jahr ausgewertet. Grundlage war das Patientengut der Chirurgischen Tierklinik der Universität Leipzig in den Jahren 2001 bis 2011. Neben intestinalen Erkrankungen wurden auch extraintestinale Erkrankungen involviert.

Orientadores: Mario Mantovani, Gustavo Pereira Fraga / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T15:12:38Z (GMT). No. of bitstreams: 1 Diorio_AlanCesar_M.pdf: 1137102 bytes, checksum: b0a2abd56269b379b6f1220fd52906c3 (MD5) Previous issue date: 2007 / Resumo: O trauma é um evento muito freqüente em jovens, com acometimento freqüente do fígado. O objetivo do estudo foi avaliar os fatores preditivos de má evolução em pacientes operados com trauma hepático. Para tanto, foram estudados 638 pacientes no período de Janeiro de 1990 a Dezembro de 2003, com seus parâmetros epidemiológicos, fisiológicos e anatômicos comparados e os valores preditivos para ocorrência de má evolução analisados através de estudo estatístico apropriado. O trauma penetrante foi o agente agressor mais freqüente. A instabilidade hemodinâmica esteve presente em 21,1% das vítimas, com RTS médio de 7,02, ATI médio 17,4 e ISS médio de 20,7. A maioria das lesões hepáticas foi grau III e os órgãos e estruturas abdominais mais frequentemente lesados em associação às mesmas foram o diafragma (33,4%), o estômago (20,5%), o cólon/reto (17,9%) e o baço (13,6%). As lesões não abdominais localizaram-se mais freqüentemente nos segmentos craniencefálico e torácico. A morbidade global foi de 50,4%, sendo que as complicações relacionadas ao fígado mais freqüentes foram o sangramento persistente (9,8%), o abscesso intraperitoneal (3,8%) e a fístula biliar (3%). As complicações não hepáticas ocorreram em 273 pacientes (42,8%) e as mais freqüentes foram as pulmonares, sepse e as complicações relativas ao SNC. Os fatores preditivos de ocorrência de complicações hepáticas foram a idade superior a 60 anos, a instabilidade hemodinâmica à admissão, o RTS alterado, a presença de lesões hepáticas complexas (grau>III), o ATI > 25 e o ISS = 25. Todas estas variáveis, a presença de lesões associadas abdominais e não abdominais e o mecanismo de trauma fechado foram preditivos de ocorrência de complicações não hepáticas. A mortalidade foi de 22,1% (141 casos), e ocorreram principalmente por sangramento persistente, sepse, FMOS e pelo TCE. Todos os fatores estudados, exceto a presença de lesões associadas abdominais, foram preditivos para a evolução a óbito. Estas vítimas apresentaram-se ainda, mais instáveis na admissão, com o RTS médio mais baixo (5,35), lesões hepáticas mais complexas, o ATI e ISS maiores (média de 24,7 e 30,6, respectivamente) além de TRISS médio de 0,64 (menor), quando comparadas às demais vítimas da amostra / Abstract: Trauma is a very common event in young people, often with involvement of the liver. The aim of this study was to evaluate the predictive factors of poor prognosis in patients operated with liver trauma. In order to this, 638 patients were studied from January 1990 to December 2003, regarding their epidemiologic, physiologic and anatomic data and the predictive values for poor prognosis were statistically analyzed. The penetrating trauma was the most frequent mechanism of trauma. Hemodynamic instability occurred in 21,1% of the victims, with a mean RTS of 7,02, mean ATI of 17,4 and mean ISS of 20,7. Most liver injuries was grade III and the organs and abdominal structures often affected were the diaphragm (33,4%), the stomach (20,5%), the colon/rectum (17,9%) and spleen (13,6%). The non abdominals structures often affected were most frequently located in the craniencephalic and thoracic segments. Morbidity was 50,4% and the most common liver related complications were: persistent bleeding (9,8%); intra-peritoneal abscess (3,8%) and biliary fistula (3%). Complications not related to the liver occurred in 273 patients (42,8%) and the most commom were pulmonary, sepsis and SNC related diseases. The predictive factors for liver complications were: age higher than 60, hemodynamic instability during admission, altered RTS, complex liver injuries (grade>III), ATI>25 and ISS= 25. All these variables, the existence of associated abdominal and extra-abdominal injuries and the mechanism of closed trauma were predictive of the occurrence of liver unrelated complications. Mortality was 22,1% (141 cases), and it occurred mainly due to bleeding, sepsis, multiple systems organ failure and head trauma. All the studied factors, with the exception of associated abdominal injuries, were predictive of death. Fatal victims were more unstable during admission, with lower mean RTS (5,35), more complex liver injuries and higher ATI and ISS ( average 24,7 and 30,6, correspondingly), besides TRISS medium of 0,64 (lower), when compared to the other patients / Mestrado / Cirurgia / Mestre em Cirurgia

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23755号 / 医博第4801号 / 新制||医||1056(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 小濱 和貴, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

ABSTRAKT Bakgrund: Efter att regelbundet under studierna på sjuksköterskeprogrammet stöttpå informationen om att postoperativ mobilisering är en viktig omvårdnadsåtgärdhar författarna saknat information och kunskap kring vad för effekter denpostoperativa mobiliseringen faktiskt har på patienterna. Författarna valde attundersöka dessa effekter utifrån de patienter som undergått någon typ avbukkirurgiskt ingrepp. För att sjuksköterskor och övrig sjukvårdspersonal skallkunna arbeta evidensbaserat anser författarna att denna typ av information ärviktig att framföra och stärka med just evidens för att på ett så bra och säkert sättsom möjligt kunna implementeras i det postoperativa omvårdnadsarbetet. Syfte: Att belysa effekter av postoperativ mobilisering efter bukkirurgi. Metod: Examensarbetet är en litteraturstudie med kvantitativ ansats. Resultatetbaseras på totalt tio artiklar hämtade från databaserna Chinal, PudMed ochMedline. Alla artiklar har granskats via SBU:s kvalitetsgranskningsmall ochanalyserat enligt Fribergs (2006) analysmetod där teman och subteman skapades. Resultat: Resultatet redovisades via de teman som skapades under analysen.Längd på sjukhusvistelse, respiratorisk påverkan, cirkulatorisk påverkan ochgångförmåga. Ett samband av effekt mellan dessa teman och postoperativmobilisering efter bukkirurgi visades endast vid längd för sjukhusvistelsen, femav åtta P-värden visade på detta. Konklusion: Längden på sjukhusvistelsen sågs bli kortare hos patienter sommobiliserades postoperativt efter bukkirurgi i en högre grad än de sommobiliserades i mindre grad. Gällande övriga teman som tagits upp i studien krävsvidare studier då ett lågt antal artiklar inkluderade dessa och författarna anser attfler artiklar behövs för att kunna anse att resultatet är evidensbaserat. Nyckelord: Postoperativ, mobilisering, bukkirurgi. / ABSTRACT Background: During our studies at the nursing program the authors often heardand read that postoperative mobilization is an important part of postoperative care.The issue that the authors had regarding this information was that they never gotthe information regarding what kind of effect the postoperative mobilizationactually has on the patients. The authors decided to examine the postoperativeeffect of mobilization in patients that have undergone abdominal surgery. Thiskind of information is important both for nurses and other hospital staff so thatthey can work in an evidence based way and implement mobilization in a correctway in the postoperative care. Purpose: To illustrate the effect of postoperative mobilization after abdominalsurgery. Method: This is a literature study with a quantitative approach. The result is basedon ten articles retrieved from the databases, Chinal, PubMed and Medline. Allarticles have undergone a quality review template from SBU and they have alsobeen analyzed according to Fribergs ́s (2006) analysis method where themes andsub themes were created. Results: The results were presented in the themes that we created during theanalysis. Length of hospital stay, respiratory effects, circulation effects andwalking ability. The only connection that we saw was between postoperativemobilization after abdominal surgery and length of hospital stay, five out of eightP-values showed that. Conclusion: The length of stay was shorter in the patients that got mobilized morethan the patients in the test group. Regarding the other themes in this study theauthors think that it needs to be studied further with more articles to present aevidenced based result. Keywords: Postoperative, mobilization, abdominal surgery.

Submitted by GABRIEL ISAAC PEREIRA DE CASTRO (trictracxliv@yahoo.com.br) on 2018-04-17T12:18:55Z No. of bitstreams: 1 Tese 21.03.18.pdf: 1553454 bytes, checksum: 89c4b5893f1bc14f7a96b6f5ca380ca9 (MD5) / Rejected by Luciana Pizzani null (luciana@btu.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: problema 1: o arquivo contem comentários de correção no lado direito do texto. Favor retirar esses comentários e submeter novamente o arquivo em formato PDF. Agradecemos a compreensão. on 2018-04-17T13:30:42Z (GMT) / Submitted by GABRIEL ISAAC PEREIRA DE CASTRO (trictracxliv@yahoo.com.br) on 2018-04-17T18:56:55Z No. of bitstreams: 1 Tese Doutorado.pdf: 1503986 bytes, checksum: f8b0cc23707db09cc8a52db7ac2da0f0 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-19T12:00:33Z (GMT) No. of bitstreams: 1 castro_gip_dr_bot.pdf: 1503986 bytes, checksum: f8b0cc23707db09cc8a52db7ac2da0f0 (MD5) / Made available in DSpace on 2018-04-19T12:00:33Z (GMT). No. of bitstreams: 1 castro_gip_dr_bot.pdf: 1503986 bytes, checksum: f8b0cc23707db09cc8a52db7ac2da0f0 (MD5) Previous issue date: 2018-02-22 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A reposição volêmica é necessária em praticamente todos os pacientes submetidos à cirurgia, porém o manejo perioperatório adequado permanece controverso, com grande variabilidade na prática clínica. O volume administrado inadequadamente aumenta as complicações pós-operatórias, assim, o desenvolvimento e a implementação de protocolos para reposição volêmica, baseado em variáveis hemodinâmicas, individualizando o tratamento, é recomendado. O objetivo do estudo foi avaliar os efeitos de duas estratégias de reposição volêmica: uma, “convencional”, baseada em infusão contínua de fluidos e outra na administração de bolus com volumes pré-determinados, guiada por parâmetros hemodinâmicos específicos (TAC), na evolução perioperatória e na incidência de complicações pós-operatórias de pacientes submetidos a cirurgias abdominais de médio e grande porte por via aberta. Foi realizado estudo clínico, randomizado, prospectivo, controlado no Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP entre maio de 2012 a dezembro de 2014, após aprovação do comitê de ética. Os critérios de inclusão foram pacientes classificados como ASA I, II ou III, submetidos a cirurgias abdominais de médio e grande porte por via aberta com duração mínima de 120 minutos, sob anestesia geral. Os critérios de exclusão foram IMC > 35kg/m2, gestação, doença pulmonar obstrutiva crônica ou infecção brônquica, coagulopatias, histórico de alterações da função renal pré-operatória, sepsis ou sinais de síndrome da resposta inflamatória sistêmica, sinais de insuficiência hepática, pacientes submetidos a cirurgias de urgência ou emergência e aqueles que se recusaram a participar do estudo. Foram incluídos 85 pacientes, randomizados em dois grupos (infusão contínua ou controle (C) e bolus (B)). Em ambos os grupos os alvos hemodinâmicos foram: pressão arterial média (PAM) entre 65 a 80mmHg e delta-PP ≤12%. No grupo C, o anestesiologista estava livre para administrar fluidos de acordo com seu julgamento crítico, em forma de infusão contínua de fluidos, ou seja, sem protocolo. No grupo B, a administração de fluidos foi guiada por um protocolo baseado em administração de bolus fixos. Os fluidos disponíveis em ambos os grupos foram os mesmos. O volume total e a qualidade de fluidos administrados em cada grupo foram avaliados, bem como, o tempo em que permaneceram dentro dos parâmetros pré-estabelecidos. Em seguida, os pacientes foram analisados quanto à presença de complicações pós-operatórias e ao retorno da função do trato gastrointestinal. Os grupos foram homogêneos em relação aos parâmetros antropométricos, ao sexo, à duração da cirurgia, à classificação “ASA” e às comorbidades. O grupo B recebeu uma quantidade total menor de fluidos graças à menor quantidade de cristaloides administrados. Porém, este regime mais restritivo não cursou com menor tempo de internação, em retorno mais precoce da função gastrointestinal ou na diminuição de mortalidade. No grupo B houve uma menor taxa de complicações pulmonares (2% vs 36%; p=0,001), não houve diferença quanto às demais complicações pós-operatórias. Assim, a fluidoterapia realizada pela infusão de bolus e baseada em protocolo previamente estabelecido mostrou-se tão eficiente e segura quanto a reposição volêmica usual, porém resultou em menor volume infundido e na diminuição das complicações pulmonares pós-operatórias. / Volume replacement is necessary in almost all patients submitted to surgery. However, adequate preoperative procedure remains controversial, with several variants in clinical practice. Administered volume, if inadequate, can significantly increase postoperative related complications. Therefore, development and implementation of protocols for volume replacement, based on hemodynamic evaluation, individualizing treatment, is recommended. The objective of the study was to evaluate the effect of two different strategies for volume replacement: one based on continuous infusion of fluids and another based on administration of bolus with pre-determined volumes, and guided by goal-directed fluid therapy (GDFT), on perioperative evolution and on the incidence of postoperative related complication in patients submitted to medium and major open abdominal surgery. A prospective randomized controlled clinical trial was made, at the Clinic Hospital of Botucatu Medical School - UNESP, between May 2012 and December 2014, after approval from the ethics committee. Criteria for patient inclusion were classification as ASA I, II or III, submission to medium or major open abdominal surgery, with minimum duration of 120 minutes, under general anesthesia. Criteria for patient exclusion were BMI > 35kg/m2, pregnant women, chronical obstructive pulmonary disease or bronchial infection, coagulopathies, a history of pre operatory kidney function alteration, sepsis or signs of systemic inflammatory response syndrome, signs of hepatic insufficiency, submission to urgent or emergency surgeries, and those who refused to participate. 85 patients were included, and then randomized into two groups (continuous infusion (C) and bolus (B)). In both groups, hemodynamic goals were mean arterial pressure (MAP) between 65 and 80 mmHg and delta-PP ≤ 12%. On group C, the anesthesiologist was free to administer fluids continuously, according to his critical judgement, with no pre-determined protocol. On group B, fluid administration was guided by a fixed bolus administration protocol. Available fluids were the same for both groups. Total volume and quality of administered fluid on each group was assessed, as well as how long patients remained within the specified parameters. Next, patients were analyzed for the presence of post operatory complications and return of gastrointestinal tract function. Groups were homogeneous regarding anthropometric parameters, gender, surgery duration, "ASA" classification and comorbidities. B group received a smaller total fluid volume, due to a less amount of crystalloids. However, this restrictive regime did not course with a shorter hospitalization period, earlier recovery of gastrointestinal function or a decreased mortality rate. Group B showed a smaller rate of pulmonary complication (2% vs 36%; p=0.001), there was no difference for the other post operatory complications. Therefore, fluid therapy based on a previously determined fixed bolus infusion protocol showed to be as efficient and safe as usual volume replacement therapy. However, it resulted on a smaller volume of infused fluid and diminished post operatory pulmonary complications. / FAPESP : 2012/18870-9

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The main goal of the present study is to assess and compare the data obtained from ventilometry, espirometry and vital signs of patients who undergoing DAPE under inhalation anesthesia, and its specific goal is to verify the existence of a co-relation between anesthetic and surgical procedure lengths and pulmonary volumes measured by ventilometry and espirometry during the DAPE post-operative period. The subjects were adult patients between 43,3 ± 13,4 years of age, being 8 males and 5 females admitted at the surgery clinic of the Federal University Hospital in Aracaju, Sergipe, Brazil, with a previous diagnosis of portal hypertension. It is a prospective study, with the data collection being carried out in two phases: pre-operative and post-operative stages. Researched variables: age; gender; heart rate (HR); respiratory frequency (RF); blood pressure (BP); partial oxygen saturation (PSO2); minute volume (MV); current volume (CV); forced expiratory volume in 1 second (FEV1); forced vital capacity (FVC); tifeneau index (FEV1/ FVC); surgery length; anesthesia length. The statistical analysis was performed by the Origin 6.2. software. To compare the averages of BP, HR, PSO2, MV, CV, FEV1, FVC and FEV1/ FVC in both pre and post-operative stages the T test Dependent or Paired Student test. To analyses the variance the Fisher test was applied. For the co-relation between anesthetic and surgical procedure length and MV, CV, FEV1 and FVC in the post-operative stage the Pearson simple linear co-relation test was applied. For statistical tests, a 95% (α=0,05) significance level was utilized. Results showed that there was a significant difference between the mean values of HR, RF, BP, MV, CV, FEV1, FVC and PSO2. There was no significant difference between the mean values of FEV1/ FVC. Reversely, the co-relation between surgery length and the pulmonary values measured on day 2 of the post-operative period was significant of strong aspect when compared to FEV1 and FVC, and suggested a non-significant co-relation in regular aspect when compared to MV and CV. Anesthesia length showed a significant co-relation in a strong aspect when compared to FEV1 and FVC, and suggested a non-significant co-relation of weak aspect when compared to MV and of regular aspect when compared to CV. It has been concluded that patients who have undergone portal hypertension surgery present significant reduction in MV, CV, FEV1, FVC and PSO2, in addition to a significant rise in HR, BP and RF when compared to the preoperational and day 2 of post-operative period. Moreover, a significant co-relation of strong aspect was detected when anesthetic and surgical procedure lengths were compared to post-operative FEV1 and FVC values. / A pesquisa teve como objetivos avaliar e comparar os dados fornecidos através dos sinais vitais, ventilometria e espirometria dos pacientes submetidos à DAPE sob anestesia geral, e verificar se existe correlação entre a duração anestésica e cirúrgica com os volumes pulmonares fornecidos pelos testes de função pulmonar. Foram avaliados pacientes adultos com idade média de 43,3 ± 13,4 anos, sendo 8 homens e 5 mulheres, admitidos na clínica cirúrgica do Hospital Universitário na cidade de Aracaju-SE, com diagnóstico prévio de hipertensão portal. Foi um estudo prospectivo, sendo a coleta de dados efetuada no pré e pósoperatório. Variáveis pesquisadas: idade; gênero; FC; FR; PA; SpO2; VM; VC; VEF1; CVF; VEF1/CVF; duração de cirurgia; duração da anestesia. A análise estatística foi efetuada através do programa estatístico Origin 6.2. Para comparação entre as médias da PA, FR, FC, SpO2, VM, VC, VEF1, CVF e VEF1/CVF no pré e pós-operatório foi aplicado o teste t de Student pareado ou dependente. Para análise das variâncias foi utilizado o teste de Fisher. Para correlação entre o tempo de anestesia e o tempo de cirurgia em relação ao VM, VC, VEF1 e CVF no pós-operatório foi aplicado o teste de correlação linear simples (correlação de Pearson). Foi utilizado um nível de significância de 95% (α=0,05). Os resultados mostraram que houve diferença significativa entre as médias da FC, FR, PA, VM, VC, VEF1, CVF e SpO2. Não houve diferença significativa entre as médias do VEF1/CVF e entre as variâncias. Já a correlação entre o tempo de cirurgia e os volumes pulmonares mensurados no 2° dia pós-operatório, mostrou-se significativa de aspecto forte quando comparado com o VEF1 e com o CVF, e sugeriu correlação não significativa de aspecto regular quando comparado com o VM e com o VC. O tempo de anestesia mostrou correlação significativa de aspecto forte quando comparado ao VEF1 e com o CVF, e sugeriu correlação não significativa de aspecto fraco quando comparado ao VM e de aspecto regular quando comparado ao VC. Concluímos que pacientes submetidos à cirurgia de hipertensão portal apresentam redução significativa do VM, VC, VEF1, CVF e SpO2, além de aumento significativo da FC, PAS e FR, quando comparadas as médias do pré e 2° dia pós-operatório. Houve correlação significativa quando comparadas duração anestésica e cirúrgica com o VEF1 e a CVF mensuradas no pós-operatório. .

In dieser Arbeit wurde das Signalement, die Jahreszeit bei Klinikeinweisung, die Diagnose, die Operationstechnik, die Operationskomplikationen und der Therapieerfolg von laparotomierten Fohlen im Alter bis zu einem Jahr ausgewertet. Grundlage war das Patientengut der Chirurgischen Tierklinik der Universität Leipzig in den Jahren 2001 bis 2011. Neben intestinalen Erkrankungen wurden auch extraintestinale Erkrankungen involviert.