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No description available.

Die Single Port-Operationsmethode stellt eine neue Technik auf dem Gebiet der Minimal-invasiven Chirurgie dar. Hierbei werden operative Eingriffe über nur einen Zugang durchgeführt. Über diese Minimalisierung des Zugangstraumas werden die Ziele eines besseren kosmetischen Ergebnisses durch weniger und kleinere Narben, einer schnelleren Rekonvaleszenz mit kürzerer Hospitalisierung und einer daraus resultierenden höheren Patientenzufriedenheit verfolgt. In dieser Arbeit wurde diese Operationsmethode anhand von Patienten evaluiert, die sich einer Cholecystektomie oder einer Adrenalektomie in Single Port-Technik am Klinikum St. Georg in Leipzig unterzogen. Zur Analyse der potentiellen Vor- und Nachteile dieser Methode wurden die intra- und postoperativen Daten der Patienten retrospektiv ausgewertet und es fanden Nachuntersuchungen statt. Im Rahmen dieser Nachuntersuchungen wurde das kosmetische Ergebnis der Operationsnarben anhand der Vancouver Scar Scale beurteilt. Weiterhin kam zu der Beantwortung zweier Fragebögen durch die Patienten, bei denen die postoperative Lebensqualität und die subjektive Patientenzufriedenheit ermittelt wurde. In der Auswertung aller Ergebnisse zeigte sich, dass es sich bei dem Single Port-Verfahren innerhalb unseres Patientenkollektivs um eine gut durchführbare und sichere Technik handelt, die mit einem verbesserten kosmetischen Ergebnis und einer sehr hohen Patientenzufriedenheit einhergeht. Nachteilig steht dem eine derzeitig noch signifikant längere Operationszeit, bedingt durch die anspruchsvollere operative Handhabung und die höheren Materialkosten gegenüber.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19176号 / 医博第4018号 / 新制||医||1010(附属図書館) / 32168 / 京都大学大学院医学研究科医学専攻 / (主査)教授 小川 修, 教授 柳田 素子, 教授 三森 経世 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Habilitacijos procedūrai teikiamoje mokslo darbų apžvalgoje apibendrinama minimaliai invazinės endokrininių liaukų chirurgijos patirtis Vilniaus universiteto Pilvo chirurgijos centre. Apžvelgtos minimaliai invazinės skydliaukės operacijos, išanalizuoti ir apibendrinti dviejų klinikinių studijų rezultatai. 2004-2006 m. atliktoje perspektyvioje atsitiktinių imčių studijoje ,,Endoskopinės adrenalektomijos dviejų metodų įvertinimas“ pateikti ir išanalizuoti 70 pacientų, operuotų dėl įvairios antinksčių patologijos dviem minimaliai invaziniais būdais (laparoskopiniu bei endoskopiniu retroperitoniniu), rezultatai. Išanalizuota operacijos trukmės priklausomybė nuo antinksčio naviko dydžio, paciento kūno masės, palyginta kraujo netektis operacijos metu, operacinių komplikacijų skaičius. Įvertinus visus duomenis, prieita išvados, kad abu operacijos būdai geri, tačiau laparoskopinės adrenalektomijos išmokstama greičiau. 2005-2007 m. atliktame darbe ,,Minimaliai invazinė fokusuota ir tradicinė paratiroidektomija, gydant pirminį hiperparatiroidizmą: perspektyvioji, atsitiktinių imčių studija“ pateikiami pirminiu hiperparatiroidizmu sergančių pacientų, operuotų dviem būdais, gydymo rezultatai. Atsitiktinių imčių būdu 47 pacientai suskirstyti į dvi grupes: operuotų minimaliai invaziniu būdu (24 pacientai) ir operuotų tradiciniu Kocherio būdu (23 pacientai). Išanalizuota prieskydinės liaukos adenomos instrumentinių tyrimų diagnostinė vertė, palyginta operacijos trukmė, komplikacijų... [toliau žr. visą tekstą] / The experience of minimally invasive endocrine surgery accumulated at Vilnius University Centre of Abdominal Surgery is presented in this review of scientific publications submitted for habilitation procedure. The material concerning minimally invasive thyroid gland operations is summarized and the results of two clinical trials are evaluated. The results of prospective randomized study “Evaluation of two methods endoscopic adrenalectomy” were presented and analyzed; this study included 70 patients who underwent surgery for various pathology of adrenal glands; one group of the patients underwent laparoscopic minimally invasive operation and another one – endoscopic retroperitoneal minimally invasive surgery. The relationship between the size of adrenal gland tumour, patients’ body weight and duration of operation was analyzed; blood loss and rate of operative complications were compared. The evaluation of all data showed that both methods of surgery were acceptable; however, laparoscopic adrenalectomy was more was easier to learn. Clinical study “Minimally invasive focused and traditional parathyroidectomy for treatment of primary hyperparathyroidism: a prospective randomized study” was performed during the period since 2005 till 2007; the results of treatment of patients by means of two methods of surgery were presented. The patients (n = 47) were randomized into two groups; one group included 24 patients who were operated on using minimally invasive technique and another... [to full text]

Stress has been shown to influence learning and memory in humans and rats (Diamond et al, 1996; Diamond et al, 1999; Krugers et al, 1997; Kirschbaum et al, 1996; Lupien et al, 1997). The hippocampus and is an area of the brain involved in memory function in humans and rats (Kirschbaum et al, 1996; Lupien et al, 1997) and is highly susceptible to stress (Diamond et al, 1990). Research has indicated that a number of stressors such as exposure to a predator (Diamond et al, 1999) can lead to stress effects. Recently efforts have been made to counteract the effects of stress on brain function and related behavioral performance. The antidepressant drug tianeptine has been used in this setting. Little is known about tianeptine's role in blocking stress effects on behavior and memory performance with regard to interactions with stress hormones, such as corticosterone. Here a set of experiments delineates the role of corticosterone and its link to stress effects on memory as well as an investigation into the actions of tianeptine and ADX in the blockade of stress effects on memory. First, I examined the effects of tianeptine on multi-day RAWM working memory training and a novel one-day learning and memory training task. Second, the effects of propranolol, an anti-anxiety medication, were tested with regard to the alleviation of stress effects on memory, allowing for a comparison between two anti-anxiety drugs, tianeptine and propranolol. Third, adrenalectomy (ADX) and the resultant depletion of adrenal hormones were examined in connection with learning and memory in the one-day learning task. Fourth, the effects and interactions of tianeptine and ADX were examined to see if tianeptine can exert its effects in the absence of adrenal hormones. Tianeptine blocked stress-induced memory errors in two different tasks and under ADX conditions. All effects were independent of corticosterone levels. In contrast, propranolol was ineffective in blocking stress-induced memory changes. The current data may prove useful in the development of antidepressant drugs and further the study of the mechanisms by which stress affects memory.

In Primary Aldosteronism (PAL) excessive amounts of aldosterone cause sodium and water retention and, in many individuals, this leads to moderate to severely high blood pressure. Although the chemistry and physiology are increasingly well understood, including the outcomes of treatment on physical health, there has been no systematic study of the psychological dimension of PAL. Anecdotally, patients exhibit symptoms such as angry outbursts, irritability, anxiety and defensiveness, and partners of these patients sometimes mention poor anger control and brittle or unpredictable moods. This thesis reports a systematic study of anger and anxiety among patients undergoing treatment for PAL. Eighty-three patients were recruited over an 11-month period to a prospective, pre-post design study to determine if treatment was associated with change in psychological state. Participants completed the State-Trait Anger Expression Inventory (STAXI-2), State-Trait Anxiety Inventory (STAI) and Psychosocial Adjustment to Illness Scale (PAIS) questionnaires. Adrenal Vein Sampling confirmed overproduction of aldosterone in one or both adrenal glands. Patients with Aldosterone Producing Adenoma (APA) were offered adrenalectomy. As per usual treatment protocols, patients with Bilateral Adrenal Hyperplasia (BAH) were prescribed spironolactone or amiloride depending predominantly on severity of blood pressure and potassium levels. Post-test questionnaires were completed after 6-8 months. Analysis was by mixed design (between-within subjects) ANOVA. Participant numbers in the adrenalectomy group fell far short of expectations. Fourteen past patients who had undergone unilateral adrenalectomy completed a retrospective semi-structured questionnaire. This qualitative data was analysed to identify themes similar to quantitative data. At baseline, 'non-completers' (ie those who did not complete the post-test; n=19), were significantly more angry than 'completers' (n=50) in State Anger (p< .01), Trait Anger (p< .05) and Anger Expression Index (p< .001). Trait Anxiety was also higher (p< .05), as was Psychological Distress (p< .05). Among those who participated at both interviews, there was small but statistically significant adverse treatment effect with higher scores for State Anger (p< .05), and Feeling Angry (p< .05). However for Trait Anger (p< .01), and 2 of its 3 sub-scales Angry Temperament (p< .05) and Angry Reaction (p< .01) there was a slight to moderate decrease in negative affect with treatment. Psychological Distress scores also improved (p< .05). Across all ANOVAs, there were no significant interaction effects, suggesting that any treatment effect was equivalent for the two drugs. Qualitatively collected data elucidated participants' changes in approach to life and relationships since adrenalectomy. Themes that emerged in the data included improved ability to cope with external stress, better control of emotions, more relaxed relationships and attitude to work, and a greater vitality and quality of life. Generally the comments were consistent with the drug treatments; there was noticeable benefit, including perceived better anger control and less anxiety. Positive psychological effects of treatment observed in the two drug groups were triangulated with data from a qualitative study. The combined evidence suggests that when excess circulating aldosterone is reduced (adrenalectomy), or blocked (spironolactone), or aldosterone's salt and water retaining effects are minimised (amiloride), then nervous irritability and its subsequent psycho-behavioural manifestations are reduced. The effect however is slight and the conclusions are weakened by an apparent attrition bias, and the absence of a control group. Implications for further research are discussed.

Die Single Port-Operationsmethode stellt eine neue Technik auf dem Gebiet der Minimal-invasiven Chirurgie dar. Hierbei werden operative Eingriffe über nur einen Zugang durchgeführt. Über diese Minimalisierung des Zugangstraumas werden die Ziele eines besseren kosmetischen Ergebnisses durch weniger und kleinere Narben, einer schnelleren Rekonvaleszenz mit kürzerer Hospitalisierung und einer daraus resultierenden höheren Patientenzufriedenheit verfolgt. In dieser Arbeit wurde diese Operationsmethode anhand von Patienten evaluiert, die sich einer Cholecystektomie oder einer Adrenalektomie in Single Port-Technik am Klinikum St. Georg in Leipzig unterzogen. Zur Analyse der potentiellen Vor- und Nachteile dieser Methode wurden die intra- und postoperativen Daten der Patienten retrospektiv ausgewertet und es fanden Nachuntersuchungen statt. Im Rahmen dieser Nachuntersuchungen wurde das kosmetische Ergebnis der Operationsnarben anhand der Vancouver Scar Scale beurteilt. Weiterhin kam zu der Beantwortung zweier Fragebögen durch die Patienten, bei denen die postoperative Lebensqualität und die subjektive Patientenzufriedenheit ermittelt wurde. In der Auswertung aller Ergebnisse zeigte sich, dass es sich bei dem Single Port-Verfahren innerhalb unseres Patientenkollektivs um eine gut durchführbare und sichere Technik handelt, die mit einem verbesserten kosmetischen Ergebnis und einer sehr hohen Patientenzufriedenheit einhergeht. Nachteilig steht dem eine derzeitig noch signifikant längere Operationszeit, bedingt durch die anspruchsvollere operative Handhabung und die höheren Materialkosten gegenüber.

Intravenous injection of 3-33 nmol/kg of substance P (SP) caused pressor and tachycardic responses in anesthetized rats. The responses were not blocked by a ganglion nicotinic receptor antagonist or by pithing. Pretreatment with reserpine blocked both responses. β-Adrenoceptor blockade attenuated only the tachycardic response, and α-adrenoceptor blockade attenuated only the pressor response. These findings indicated that the effects of SP to increase blood pressure and heart rate are due to sympathetic ganglion stimulation. Studies with adrenalectomized rats showed that stimulation of the adrenals by SP contributes to both responses but makes a greater contribution to the tachycardic response. These observations raise the possibility that the tachykinin innervation of sympathetic ganglia and the adrenal medulla may be involved in the local regulation of blood pressure and heart rate.