Colorectal cancer is one of the commonest malignancies worldwide. Its prevention, diagnosis and treatments have attracted multidisciplinary attention. Surgery is the mainstay of treatment for colorectal cancer. It was estimated that up to 85% of colorectal cancer were amenable to surgical treatment, whether curative or palliative. Not surprisingly laparoscopic resection of colorectal cancer was reported soon after cholecystectomy. However, with the appearance of early port site recurrence, most authorities were concerned about the adequacy of tumour clearance and the long-term survival after laparoscopic resection. / In this thesis, comparative and randomized studies were conducted to answer the above questions. It was concluded that, as compared to conventional open surgery, laparoscopic assisted resection of recto-sigmoid carcinoma was less painful and allowed earlier post-operative recovery. Tissue trauma, as reflected by systemic cytokines response, was less after laparoscopic assisted resection. Some cellular components of immune system were also less suppressed. Most importantly, laparoscopic resection did not jeopardize the survival and disease control of patients. The justification of adopting laparoscopic technique would depend on the societal value of its effectiveness in improving the short-term post-operative outcomes. / Laparoscopic technology and its application may be the biggest advancement in nearly all surgical specialties in the last decade. Since the introduction of laparoscopic cholecystectomy, enthusiastic surgeons have attempted laparoscopic approach in almost every type of operations, and many of the techniques have gained public acceptance within a very short time. However, most of these developments were not based on good scientific evidence from comparative study. While laparoscopic cholecystectomy was shown to cause less pain and allow patients to recover earlier after operation, these benefits may or may not be conferred to other procedures and diseases. / Therefore, to justify the use of laparoscopic assisted colorectal resection for carcinoma, two criteria must be satisfied. Firstly the long term survival and the disease free interval of patients should not be adversely affected, as these are the most important endpoints in the success of tumour surgery. Secondly, the proposed benefits of minimally invasive surgery must be demonstrated, otherwise it is not worthwhile to adopt a new technique. / Leung Ka Lau. / "July 2005." / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0174. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 122-155). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

published_or_final_version / abstract / toc / Surgery / Master / Master of Surgery

Background and Objectives: The pathophysiology of post-operative pneumonia following lung resection is poorly understood despite it being the most common complication which may lead to death. The role of the acute inflammatory response following lung resection, in particular innate immune cells, was investigated and used to identify biomarkers for post-operative pneumonia. Comparison of inflammatory responses to resection undertaken by video-assisted thorascopic surgery (VATS) and thoracotomy was also evaluated. Methods: Patients undergoing lung resection for suspected bronchogenic carcinoma were recruited. Objective pre-defined criteria were used to diagnose pneumonia. Bronchoalveolar lavage (BAL) was conducted in the contra-lateral lung pre- and postoperatively to measure cellular composition and cytokines. Blood was sampled preoperatively and 6-, 24- and 48-hours post-operatively primarily to assess neutrophil phagocytic capacity, monocyte subsets, monocyte cytokine responses to lipopolysaccharide (LPS) stimulation and serum cytokine responses. Exhaled nitric oxide (eNO) was also measured at these time points. Patient groups were compared using paired or student t-tests together with ANOVA/ANCOVA modelling. The predictive strength of the biomarkers identified was tested. Results: 40 patients were recruited. 26 patients (65%) underwent major lung resection using VATS and 14 (35%) thoracotomy. There was a post-operative blood monocytosis (p<0.0005) with an absolute expansion of classical and intermediate monocytes (p=0.001) and a relative fall in non-classical monocytes (p<0.005). Post-operatively blood monocytes became more pro-inflammatory with an overall significant increase in IL-8 (p=0.034) and TNF-α (p=0.028) together with an increase in IL-6 (p=0.028) and IL-10 by 48 hours (p=0.010). VATS was associated with a smaller release of IL-10 only (p=0.011). There was a general trend towards post-operative reduction in neutrophil phagocytosis of zymosan (in suspension) on ANOVA modelling (p=0.047). Lung resection led to an increase in serum cytokines IL-6, IL-8 and IL-10 which peaked at 24hrs before falling (p<0.0005). ANOVA modelling confirmed significantly lower levels of serum cytokines in VATS patients compared with thoracotomy (p=0.026 for IL-6, p=0.018 for IL-8 p=0.047 for IL-10). No significant post-operative change was found for IL-1β, TNF-α and IL-12p70 (p>0.05). Bronchoalveolar lavage fluid (BALF) and blood samples demonstrated a relative post-operative leucocytosis due principally to neutrophilia. A relative blood lymphopenia and thrombocytopenia developed postoperatively (p<0.0005). VATS was associated with a lower fall in serum albumin (p=0.001). BALF from the non-operated lung became more pro-inflammatory immediately post-operatively with an increase in IL-6 (p<0.0005), IL-8 (p=0.017), IL- 10 (p=0.018) and IL-1β (p=0.002). eNO tended to fall post-operatively which reached significance at 48 hrs (p=0.029). 14 patients developed pneumonia. Pre-operatively, a blood neutrophil count above 5.04x109/L had a relative risk (RR) for pneumonia of 3.3 (95% confidence interval (CI95) 1.1-10.1), and a BAL cell count of greater than 1.04x105/ml had a RR of 3.4 (CI95 1.3-9.0), whilst LPS-stimulated monocyte secretion of IL-12 of less than 0.15 pg/ml/μg protein had a RR of 3.0 (CI95 1.2-7.3). At 24 hours post-operatively, LPS-stimulated release from monocytes of IL-10 greater than 1.99 pg/ml/μg protein (RR 4.1, CI95 1.3- 12.3) and IL-6 greater than 414 pg/ml/μg protein (RR 3.1, CI95 1.2-8.1) were predictive of pneumonia. Conclusion: Lung resection is associated with significant early pro- and antiinflammatory responses. VATS resection invoked significantly lower levels of serum cytokines and albumin changes compared with thoracotomy suggesting VATS lobectomy should be the surgical treatment strategy of choice for early stage lung cancer. No difference in neutrophil function or monocyte function was however observed between the surgical groups. Clinical benefits of this reduced inflammation need to be evaluated in a larger cohort of patients. Relative pre-operative leucocytosis in blood and BAL together with monocyte hyper-responsiveness in the early postoperative period is associated with the development of pneumonia. These findings warrant further investigation for their predictive power in accurately identifying postoperative pneumonia. Ultimately, they may be incorporated into a risk stratification model enabling targeted prophylactic or earlier therapeutic intervention.

Orientador: Marilza Vieira Cunha Rudge / Coorientador: Jose Ricardo Paciência Rodrigues / Coorientador: Jean Yves Petit / Banca: Gilberto Uemura / Banca: Luiz Henrique Gebrim / Banca: Angelo Gustavo Zucca Mathes / Banca: Luiz Antônio Guimarães Brondi / Resumo: Lipofilling ou enxerto de gordura é uma técnica muito utilizada para corrigir defeitos em qualquer região do corpo humano. O objetivo deste estudo foi analisar a segurança desta técnica para corrigir defeitos de reconstruções mamárias após câncer de mama. Foram analisados 158 pacientes que receberam 194 procedimentos de enxerto de gordura, segundo a técnica de Coleman e realizados por um único cirurgião (MR). 98% das pacientes desta série tinham cirurgia oncológica mamária precedente: conservadora ou mastectomia com reconstrução. A única complicação pós-operatória encontrada nesta série foi a liponecrose associada à mastite em sete casos (3.6%), todos tratados com terapia antibiótica e curativos diários. Nos pacientes com precedente de cirurgia conservadora e tratados com enxerto de gordura, somente quatro (5.9%) apresentaram pequenas alterações na mamografia, simulando alterações benignas. Conclusão: O enxerto gorduroso pode ser uma boa solução para reparar defeitos após reconstrução em pacientes tratados de câncer de mama e pode reduzir indicações de cirurgias maiores, como reconstruções com retalhos miocutâneos. A incidência de complicações pósoperatórias é muito baixa e não ocorrem alterações significativas nas mamografias de seguimento oncológico. Dois pontos ainda não estão elucidados: qual o percentual de gordura que é reabsorvida após o lipofilling e se existe a possibilidade das células-tronco de origem adiposa estimular células neoplásicas a induzirem recidiva local / Abstract: Fat grafting is largely used to correct soft-tissue defects in any region of the human body. This study analysed its safety when the technique is used to correct defects after breast cancer reconstruction. A total of 158 patients who underwent 194 breast fat grafting procedures were analysed. Almost all patients (98%) had a personal history of breast cancer treated with conservative surgery or mastectomy followed by breast reconstruction. In all cases, fat grafting was performed according to the Coleman's technique by a single surgeon. Immediate complications included liponecrosis and infection in seven cases (3.6%) that required only daily dressings and oral antibiotics administration. In cases of fat grafting after conservative surgery, only four patients (5,9%) showed minor alterations in the postoperative mammograms, consisting of the appearance of benign images. Breast fat grafting can be a good solution to repair defects after breast-cancer treatment and reconstruction, and can reduce the indication for more extensive surgeries such as myocutaneous flaps. Postoperative complication rates are very low and there is little alteration in the follow-up mammograms. Two points remain unclear - What is the percentual of the fat is absorbed after grafting and the potential risk of local "domant" tumour cells being stimulated to induce a local recurrence / Doutor

Over four years from 2002 to 2006, a series of concomitant studies were undertaken to explore the complications and outcomes of skin cancer surgery. Specifically: 1. Through prospective studies, to identify risk factors for bleeding and infectious complications following skin surgery. 2. To determine through a randomized controlled trial whether mupirocin ointment versus paraffin ointment versus no ointment on a wound following skin closure affords the patient benefit. 3. To determine whether patients are at increased post operative bleeding risk should they remain on warfarin and / or aspirin prior to skin surgery. 4. To develop and then trial a novel approach (reducing opposed multilobed [ROM] flap) for below knee wound closures that may reduce the incidence of skin surgery complications on the leg and foot. 5. To investigate whether patients who suffer surgical complications are less likely to be satisfied with the service provision.

In the treatment of early stage breast cancer, both mastectomy and lumpectomy followed by radiation therapy have been recognized as having similar survival rates. Increasingly, women are being given the opportunity to choose which of these surgical treatment options they wish to pursue. Decisions tend to be made rather quickly, and some women may later regret their treatment choice. In this study, an instrument (Breast Cancer Treatment Inventory (BCTI)) was developed that identified five primary sources of influence that affect women's breast cancer treatment decisions: cosmetic outcome, preparedness, physician's choice, short-term effects, and long-term effects. Items were generated and refined by oncology professionals and breast cancer survivors, followed by a pilot study conducted with members of a breast cancer support group. The resulting 28-item scale was completed by 139 early stage breast cancer patients. A series of oblique factor analyses yielded a five-factor solution with reliabilities ranging from .66 - .87. Content validity was enhanced by involving oncology experts and women with breast cancer in the item generation procedures. Use of the BCTI may assist women through a methodical and effective decision-making process. The BCTI may also be appropriate for research studiesinvolving the process and prediction of treatment selection since it meets requirements for ease of administration, brevity, reliability, and validity. / Department of Counseling Psychology and Guidance Services

Made available in DSpace on 2014-06-11T19:35:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-11-12Bitstream added on 2014-06-13T19:24:59Z : No. of bitstreams: 1 rietjens_m_dr_botfm.pdf: 3697637 bytes, checksum: f5c127c5ef85b386268af90c2b45484c (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Lipofilling ou enxerto de gordura é uma técnica muito utilizada para corrigir defeitos em qualquer região do corpo humano. O objetivo deste estudo foi analisar a segurança desta técnica para corrigir defeitos de reconstruções mamárias após câncer de mama. Foram analisados 158 pacientes que receberam 194 procedimentos de enxerto de gordura, segundo a técnica de Coleman e realizados por um único cirurgião (MR). 98% das pacientes desta série tinham cirurgia oncológica mamária precedente: conservadora ou mastectomia com reconstrução. A única complicação pós-operatória encontrada nesta série foi a liponecrose associada à mastite em sete casos (3.6%), todos tratados com terapia antibiótica e curativos diários. Nos pacientes com precedente de cirurgia conservadora e tratados com enxerto de gordura, somente quatro (5.9%) apresentaram pequenas alterações na mamografia, simulando alterações benignas. Conclusão: O enxerto gorduroso pode ser uma boa solução para reparar defeitos após reconstrução em pacientes tratados de câncer de mama e pode reduzir indicações de cirurgias maiores, como reconstruções com retalhos miocutâneos. A incidência de complicações pósoperatórias é muito baixa e não ocorrem alterações significativas nas mamografias de seguimento oncológico. Dois pontos ainda não estão elucidados: qual o percentual de gordura que é reabsorvida após o lipofilling e se existe a possibilidade das células-tronco de origem adiposa estimular células neoplásicas a induzirem recidiva local / Fat grafting is largely used to correct soft-tissue defects in any region of the human body. This study analysed its safety when the technique is used to correct defects after breast cancer reconstruction. A total of 158 patients who underwent 194 breast fat grafting procedures were analysed. Almost all patients (98%) had a personal history of breast cancer treated with conservative surgery or mastectomy followed by breast reconstruction. In all cases, fat grafting was performed according to the Coleman’s technique by a single surgeon. Immediate complications included liponecrosis and infection in seven cases (3.6%) that required only daily dressings and oral antibiotics administration. In cases of fat grafting after conservative surgery, only four patients (5,9%) showed minor alterations in the postoperative mammograms, consisting of the appearance of benign images. Breast fat grafting can be a good solution to repair defects after breast-cancer treatment and reconstruction, and can reduce the indication for more extensive surgeries such as myocutaneous flaps. Postoperative complication rates are very low and there is little alteration in the follow-up mammograms. Two points remain unclear – What is the percentual of the fat is absorbed after grafting and the potential risk of local “domant” tumour cells being stimulated to induce a local recurrence

Orientador: Cesar Cabello dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T14:18:12Z (GMT). No. of bitstreams: 1 Sbalchiero_JulianoCarlos_M.pdf: 1658503 bytes, checksum: e364486f66af09b9d6927c7700999eb1 (MD5) Previous issue date: 2008 / Resumo: Introdução: O Retalho Miocutâneo Transverso do Músculo Reto Abdominal (TRAM) Pediculado é uma técnica muito utilizada em reconstrução de mama, entretanto em situações em que é necessária a utilização das áreas II e IV do retalho as alternativas são os retalhos bipediculados de maior morbidade ou livres de maior complexidade. O TRAM turbinado com anastomose dos vasos epigástricos inferiores profundos na perfurante contralateral pode ser uma alternativa nestes casos. Objetivos: Apresentamos uma série de pacientes submetidas à reconstrução mamária tardia unilateral, com TRAM pediculado preservando a musculatura turbinada na perfurante contralateral e avaliado quanto aos resultados, tempo cirúrgico e complicações relacionadas à mama reconstruída e à área doadora.abdominal. Sujeitos e métodos: Durante o período de março de 2005 a abril de 2006, 22 pacientes foram selecionadas para reconstrução mamária tardia unilateral no Serviço de Cirurgia Plástica e Microcirurgia do Instituto Nacional de Câncer no Rio de Janeiro, Hospital do Câncer Unidade I, por apresentarem os seguintes critérios: 1. Grave seqüela produzida pela mastectomia com extensiva perda cutânea associada a alterações tróficas produzidas pela radioterapia 2. Necessidade de utilização das áreas II e IV do retalho abdominal para obtenção de simetria com a mama contralateral. Resultados: A técnica proposta foi realizada em 17 pacientes. A média de tempo de seguimento foi de 11 meses (9 a 18 meses). A média da idade foi de 47,7 (35 a 68 anos) anos e a média do Índice de Massa Corporal foi de 27,31% (18,75% a 31,7%). A porção lateral do músculo reto abdominal do lado pediculado foi preservada em 12 pacientes. Em todos os casos foram incluídas no retalho as áreas II e IV. A média do tempo cirúrgico foi de 7 horas e 15 minutos (de 5 horas e 20 minutos a 9 horas). A média do tempo de hospitalização foi de 8 dias (6 a 10dias). Foram observadas 4 complicações na área doadora abdominal em 3 pacientes, sendo um abaulamento contralateral; duas deiscências de sutura e uma epidermólise das bordas do retalho abdominal e da cicatriz umbilical. Na mama reconstruída foram observadas 3 perdas parciais de 10% em 2 casos e 30% em um caso; e duas liponecroses associadas a perdas parciais. Ocorreu um caso de TVP com embolia pulmonar de evolução favorável. Conclusões: O TRAM turbinado com anastomose microcirúrgica na perfurante contralateral demonstrou ser uma alternativa viável para reconstrução mamária, atingindo resultados satisfatórios na maioria das pacientes e com uma morbidade e tempo cirúrgico aceitáveis / Abstract: Background: The Transverse Rectus Abdominis Miocutaneous (TRAM) Flap is a technique widely used in breast reconstruction, however in situations where it required the use of flap areas II and IV the alternatives are bipedicle flaps or free flaps of greater morbidity and complexity. The turbocharged TRAM anastomosing the deep inferior epigastric artery and vein with contralateral perforators can be an alternative in these cases. Objective: We present a series of patients undergoing unilateral delayed breast reconstruction with TRAM preserving the muscle turbocharged on contralateral perforator vessels and evaluated on the results, operative time and surgical complications related to the reconstructed breast and abdominal donor site. Patients and methods: During the period March 2005 to April 2006, 22 patients were selected for unilateral delayed breast reconstruction at the Plastic Surgery and Microsurgery Department of the Instituto Nacional de Câncer in Rio de Janeiro, Brazil, Hospital de Câncer I, for present the following criteria: 1. Severe sequelae produced by mastectomy with extensive skin loss associated with trophic skin changes produced by radiotherapy. 2. Need to use the areas II and IV of the abdominal flap for obtaining symmetry with the contralateral breast. Results: The proposed technique was performed on 17 patients. Follow-up ranged from 9 to 18 months (average 11 months). The average patients age was 47.7 years (35 to 68 years) and the average Body Mass Index (BMI) was 27.31% (18.75% to 31.7%). The lateral portion of the rectus muscle was preserved in 12 patients. In all cases were included in the flap areas II and IV. The average surgical time was 7 hs and 15 min (5hs and 20 minutes to 9 hs). The average period of hospitalization was 8 days (6 to 10 days). There were 4 abdominal donor site complications in 3 patients: One abdominal bulging; two minor suture deiscences and a epidermolysis on the flap edge and umbilical scar. In the reconstructed breast were 3 partial loss of 10% in 2 cases and 30% in one case, and two minor fat necrosis associated with partial losses. There was a case of DVT with pulmonary embolism, with good outcome. Conclusions: The turbocharged TRAM with microsurgical anastomosis in contralateral perforators proved to be an effective alternative to breast reconstruction achieving satisfactory results in the majority of patients and with an acceptable morbidity and surgical time / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21016号 / 医博第4362号 / 新制||医||1028(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 小西 靖彦, 教授 福田 和彦, 教授 松村 由美 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Breast cancer is the most common cancer among Canadian women. Chronic neuropathic pain post breast surgery (PPBS), also known as chronic post mastectomy/lumpectomy pain syndrome, is a poorly understood complication posing a significant clinical challenge with major negative impact on patients' quality of life. This study aims to: 1) provide a preliminary determination of the prevalence rate of women who suffer from PPBS; and 2) explore potential risk factors associated with women developing PPBS. This pilot study used a prospective, longitudinal, quantitative survey design, with a demographic questionnaire and the Brief Pain Inventory. Seventeen women were recruited at a breast health clinic in Western Canada; 23.5% developed PPBS. Younger age (≤50 years), more invasive surgery, acute post-operative pain, and less analgesic use at the acute post-operative period, were more commonly found in the women who developed PPBS. Future research is required to confirm the significance of these potential risk factors.