A técnica cirúrgica endoscópica transluminal por orifícios naturais (NOTES) envolve o acesso à cavidade abdominal através de uma perfuração intencional de uma víscera (p.ex. estômago, reto, vagina, bexiga urinária) com um endoscópio flexível para acessar a cavidade abdominal e realizar uma exploração intra-abdominal. O presente estudo teve por objetivo verificar a viabilidade de se realizar a técnica cirúrgica endoscópica transvaginal híbrida em éguas para a exploração da cavidade abdominal posicionados em estação e distribuídos em dois grupos conforme o acesso laparosópico pelo flanco direito ou esquerdo e pela incisão do saco fundo vaginal à esquerda da cérvix na posição horária de 9 horas ou à direita da cérvix na posição horária de 3 horas. O abdômen foi explorado sob visualização endoscópica utilizando um endoscópio flexível de 2 metros por 14 mm de diâmetro. A incisão vaginal foi realizada sob visualização indireta pelo laparoscópio acessado via flanco. Foram utilizados 6 éguas hígidas e 1 égua com histórico de lesão abdominal por arma de fogo. Os animais foram submetidos a jejum alimentar de 24 a 36 horas, distribuídos em dois grupos. No grupo 1 foram incluídos animais que foram acessado o flanco esquerdo para a introdução do laparoscópico e realizado a incisão do saco vaginal à esquerda da cérvix, enquanto no grupo 2, o acesso do flanco para a introdução abdominal do laparoscópio foi pelo lado direito e a incisão vaginal à direita da cérvix. Os animais foram sedados com a combinação de cloridrato de xilazina e butorfanol e para dessensibilização cutânea e muscular realizada no flanco esquerdo e direito e a execução da epidural baixa foi utilizada lidocaína. A técnica cirurgia realizada foi a cirurgia endoscópica transluminal híbrida pelo acesso vaginal utilizando uma cânula vaginal que permitiu a introdução do endoscópio flexível e facilitando a passagem para o lado contralateral da incisão vaginal do endoscópio flexível para realizar a visualização da cavidade abdominal. Foi possível visualizar em todos os animais o diafragma, o estômago, o lobo hepático esquerdo, direito e processo caudato, o baço, projeções do rim esquerdo e direito, o cólon menor, o ovário esquerdo e direito, o ligamento largo do útero, o corno uterino e as tubas uterinas esquerda e direita, o duodeno, a base do ceco, o cólon dorsal direito e as alças do intestino delgado. Não foi identificadoo forame epiplóico, o pâncreas, o reto e a bexiga em nenhum dos animais do estudo. O procedimento endoscópico transvaginal híbrido para a exploração da cavidade abdominal em éguas hígidas não evidenciou dificuldade em sua execução nem complicações pós-cirúrgicas, sendo viável nos dois diferentes grupos propostos, como também auxiliou no diagnóstico de lesões intra-abdominais em uma égua causadas por arma The natural orifice translumenal endoscopic surgery (NOTES) technique involves the access to the abdominal cavity through an intentional perforation of a viscus (i.e. stomach, rectus, vagina, urinary bladder) with an endoscope in order to access the abdominal cavity and perform an intra-abdominal exploration. Until now, abdominal surgery in horses using minimally invasive techniques has been performed through laparoscopy. The objective of this study was to confirm the availability to perform the hybrid transvaginal endoscopic surgery technique in mares in order to explore the abdominal cavity in the standing position. The mares were divided in two groups according to the laparoscopic access through the left or right flank. / The natural orifice translumenal endoscopic surgery (NOTES) technique involves the access to the abdominal cavity through an intentional perforation of a viscus (i.e. stomach, rectus, vagina, urinary bladder) with an endoscope in order to access the abdominal cavity and perform an intra-abdominal exploration. Until now, abdominal surgery in horses using minimally invasive techniques has been performed through laparoscopy. The objective of this study was to confirm the availability to perform the hybrid transvaginal endoscopic surgery technique in mares in order to explore the abdominal cavity in the standing position. The mares were divided in two groups according to the laparoscopic access through the left or right flank. An incision was performed on the posterior vaginal fornix on the left side of the cervix in a 9 o’clock position or on the right side of the cervix on a 3 o’clock position. The abdomen was explored under endoscopic visualization using a 2 meters long flexible endoscope by 14 mm in diameter. The vaginal incision accessed via flank was performed under indirect visualization using a laparoscope. Six healthy mares and one mare with the history of abdominal lesion by gun fire were used. The horses were subjected to fasting from 24 to 36 hours and they were divided in two groups according to the laparoscopic access through the flank and vaginal incision. In group 1, horses were accessed on the left flank to the introduction of the laparoscope and it was performed an incision on the vaginal fornix in the left side of the cervix. In group 2, the access of the flank to the abdominal introduction of the laparoscope was through the left side and the vaginal incision in the left side of the cervix. The horses were sedated using a combination of xylazine chloride and butorphanol. Lidocaine was used for skin and muscular anesthesia on the left and right flank and for the execution of low epidural. The surgery technique used was the hybrid NOTES through the vaginal access using a vaginal cannula which allowed the introduction of the flexible endoscope making it rigid and the passage of the endoscope to the contralateral side of the vaginal incision to visualize the abdominal cavity. In all the animals of the experiment, it was possible to see the diaphragm, stomach, left, right and caudate liver lobe, spleen, left and right kidney projection, small colon, left and right ovaries, broad ligament of the uterus, uterine horn and right and left uterine tubes, duodenum, base of the cecum, left dorsal colon, and bowel loops of the small intestine. There were not identified foramen epiploicum, pancreas, rectus, and bladder in none of the animals in the experiment. The hybrid transvaginal endoscopic procedure for the exploration of the abdominal cavity in healthy mares did not demonstrate difficulties in its execution not even post-surgery complications. The procedure was considered viable in both different proposed groups.

Made available in DSpace on 2014-06-12T16:29:01Z (GMT). No. of bitstreams: 2 arquivo5712_1.pdf: 3234461 bytes, checksum: 00c3fd0dd5a23bf6e3820175688c4e68 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2007 / A hipermobilidade da junção uretrovesical responde por aproximadamente 95% dos casos de incontinência urinária de esforço e a ultra-sonografia transvulvar vem sendo usada cada vez mais para estudar a mobilidade da junção uretrovesical e da uretra proximal. No tratamento da incontinência urinária de esforço as colpossuspensões retropúbicas mais conhecidas são as de Burch e Marshall-Marchetti-Krantz, sendo a primeira considerada o padrão ouro. A combinação das duas técnicas no tratamento da incontinência urinária de esforço foi referida em uma série de casos com percentual de cura de 96%, mas suas repercussões na mobilidade da junção uretrovesical e uretra proximal são desconhecidas. Com o objetivo de estudar por meio da ultrasonografia transvulvar as modificações da junção uretrovesical e da uretra proximal promovidas pela cirurgia combinada de Marshall-Marchetti-Krantz e Burch, 32 pacientes com incontinência urinária de esforço foram selecionadas. O método do estudo consistiu em fazer exame ultrasonográfico transvulvar em todas as pacientes antes da cirurgia e 30 dias após. O exame foi feito para avaliar a distância pubo-uretral, o comprimento da uretra proximal, a distância horizontal e vertical da junção uretrovesical, os seus deslocamentos, estando a paciente em repouso e durante a manobra de Valsalva. A cirurgia de Marshall-Marshall-Krantz-Burch reduziu a distância pubouretral e a distância horizontal da junção uretrovesical, no repouso e no esforço; Aumentou o comprimento da uretra proximal no repouso e no esforço; Aumentou a distância vertical da junção uretrovesical no esforço, sem interferir durante o repouso. Pelos resultados obtidos pode-se concluir que a cirurgia de Marshall-Marchetti-Krantz-Burch reduziu significantemente a mobilidade vertical e horizontal da junção uretrovesical, sem elevar a junção uretrovesical

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Aproximadamente metade dos pacientes constipados apresenta sintomas de evacuaÃÃo obstruÃda, sendo o anismus uma das principais causas. O objetivo à demonstrar uma nova tÃcnica utilizando a ultra-sonografia anorretal tridimensional dinÃmica (USD-3D) para o diagnÃstico do anismus e comparando os resultados com a eletromanometria anorretal. Foram utilizadas neste estudo prospectivo e comparativo 70 mulheres adultas com sintomas de evacuaÃÃo obstruÃda provenientes do ServiÃo de Coloproctologia do Hospital UniversitÃrio Walter CantÃdio da Universidade Federal do CearÃ, no perÃodo entre maio de 2005 a agosto de 2006. A idade variou de 23-79, na mÃdia de 48.72 anos. Todas as pacientes foram inicialmente submetidas à eletromanometria anorretal e, a partir dos resultados, divididas em grupo I, constituÃdo por 40 pacientes normais apresentando relaxamento da musculatura esfincteriana estriada ao esforÃo evacuatÃrio e grupo II com as 30 pacientes restantes com diagnÃstico de anismus. Em seguida, as pacientes de ambos os grupos foram submetidas à ultra-sonografia anorretal tridimensional dinÃmica. A tÃcnica consistiu em dois escaneamentos e as imagens estÃticas e dinÃmicas foram devidamente analisadas nos planos axial e longitudinal, observando-se as posiÃÃes do mÃsculo PR entre o repouso e o esforÃo evacuatÃrio. Visando quantificar de forma objetiva os movimentos do mÃsculo PR, foi desenvolvido no plano longitudinal mediano um Ãngulo constituÃdo por uma linha traÃada paralela à borda interna do PR ( 1.5cm ) com uma outra linha vertical, longitudinal ao eixo do canal anal. Esse Ãngulo à calculado no repouso e no esforÃo evacuatÃrio, sendo a mÃdia no repouso de 88.37   4.05 no grupo I e de 89.13   5.73 no grupo II. NÃo houve diferenÃa significativa entre os dois grupos no repouso ( p=0.51 ). A mÃdia do Ãngulo no esforÃo evacuatÃrio no grupo I foi de 98.19   1.18 e no grupo II, de 84.94   1.31, ocorrendo diferenÃa estatisticamente significante entre os dois grupos ( p<0.001 ). A ultra-sonografia anorretal tridimensional dinÃmica demonstrou resultados concordantes com a eletromanometria anorretal em 92,86 % com relaÃÃo ao diagnÃstico de anismus em pacientes com sintomas de evacuaÃÃo obstruÃda. Conclui-se que a tÃcnica de ultra-sonografia anorretal dinÃmica apresentada neste estudo pode ser considerada eficaz no diagnÃstico do anismus e com a vantagem de demonstrar simultaneamente a conformaÃÃo anatÃmica dos mÃsculos esfincterianos. . / Aproximadamente metade dos pacientes constipados apresenta sintomas de evacuaÃÃo obstruÃda, sendo o anismus uma das principais causas. O objetivo à demonstrar uma nova tÃcnica utilizando a ultra-sonografia anorretal tridimensional dinÃmica (USD-3D) para o diagnÃstico do anismus e comparando os resultados com a eletromanometria anorretal. Foram utilizadas neste estudo prospectivo e comparativo 70 mulheres adultas com sintomas de evacuaÃÃo obstruÃda provenientes do ServiÃo de Coloproctologia do Hospital UniversitÃrio Walter CantÃdio da Universidade Federal do CearÃ, no perÃodo entre maio de 2005 a agosto de 2006. A idade variou de 23-79, na mÃdia de 48.72 anos. Todas as pacientes foram inicialmente submetidas à eletromanometria anorretal e, a partir dos resultados, divididas em grupo I, constituÃdo por 40 pacientes normais apresentando relaxamento da musculatura esfincteriana estriada ao esforÃo evacuatÃrio e grupo II com as 30 pacientes restantes com diagnÃstico de anismus. Em seguida, as pacientes de ambos os grupos foram submetidas à ultra-sonografia anorretal tridimensional dinÃmica. A tÃcnica consistiu em dois escaneamentos e as imagens estÃticas e dinÃmicas foram devidamente analisadas nos planos axial e longitudinal, observando-se as posiÃÃes do mÃsculo PR entre o repouso e o esforÃo evacuatÃrio. Visando quantificar de forma objetiva os movimentos do mÃsculo PR, foi desenvolvido no plano longitudinal mediano um Ãngulo constituÃdo por uma linha traÃada paralela à borda interna do PR ( 1.5cm ) com uma outra linha vertical, longitudinal ao eixo do canal anal. Esse Ãngulo à calculado no repouso e no esforÃo evacuatÃrio, sendo a mÃdia no repouso de 88.37   4.05 no grupo I e de 89.13   5.73 no grupo II. NÃo houve diferenÃa significativa entre os dois grupos no repouso ( p=0.51 ). A mÃdia do Ãngulo no esforÃo evacuatÃrio no grupo I foi de 98.19   1.18 e no grupo II, de 84.94   1.31, ocorrendo diferenÃa estatisticamente significante entre os dois grupos ( p<0.001 ). A ultra-sonografia anorretal tridimensional dinÃmica demonstrou resultados concordantes com a eletromanometria anorretal em 92,86 % com relaÃÃo ao diagnÃstico de anismus em pacientes com sintomas de evacuaÃÃo obstruÃda. Conclui-se que a tÃcnica de ultra-sonografia anorretal dinÃmica apresentada neste estudo pode ser considerada eficaz no diagnÃstico do anismus e com a vantagem de demonstrar simultaneamente a conformaÃÃo anatÃmica dos mÃsculos esfincterianos. . / Aproximadamente metade dos pacientes constipados apresenta sintomas de evacuaÃÃo obstruÃda, sendo o anismus uma das principais causas. O objetivo à demonstrar uma nova tÃcnica utilizando a ultra-sonografia anorretal tridimensional dinÃmica (USD-3D) para o diagnÃstico do anismus e comparando os resultados com a eletromanometria anorretal. Foram utilizadas neste estudo prospectivo e comparativo 70 mulheres adultas com sintomas de evacuaÃÃo obstruÃda provenientes do ServiÃo de Coloproctologia do Hospital UniversitÃrio Walter CantÃdio da Universidade Federal do CearÃ, no perÃodo entre maio de 2005 a agosto de 2006. A idade variou de 23-79, na mÃdia de 48.72 anos. Todas as pacientes foram inicialmente submetidas à eletromanometria anorretal e, a partir dos resultados, divididas em grupo I, constituÃdo por 40 pacientes normais apresentando relaxamento da musculatura esfincteriana estriada ao esforÃo evacuatÃrio e grupo II com as 30 pacientes restantes com diagnÃstico de anismus. Em seguida, as pacientes de ambos os grupos foram submetidas à ultra-sonografia anorretal tridimensional dinÃmica. A tÃcnica consistiu em dois escaneamentos e as imagens estÃticas e dinÃmicas foram devidamente analisadas nos planos axial e longitudinal, observando-se as posiÃÃes do mÃsculo PR entre o repouso e o esforÃo evacuatÃrio. Visando quantificar de forma objetiva os movimentos do mÃsculo PR, foi desenvolvido no plano longitudinal mediano um Ãngulo constituÃdo por uma linha traÃada paralela à borda interna do PR ( 1.5cm ) com uma outra linha vertical, longitudinal ao eixo do canal anal. Esse Ãngulo à calculado no repouso e no esforÃo evacuatÃrio, sendo a mÃdia no repouso de 88.37   4.05 no grupo I e de 89.13   5.73 no grupo II. NÃo houve diferenÃa significativa entre os dois grupos no repouso ( p=0.51 ). A mÃdia do Ãngulo no esforÃo evacuatÃrio no grupo I foi de 98.19   1.18 e no grupo II, de 84.94   1.31, ocorrendo diferenÃa estatisticamente significante entre os dois grupos ( p<0.001 ). A ultra-sonografia anorretal tridimensional dinÃmica demonstrou resultados concordantes com a eletromanometria anorretal em 92,86 % com relaÃÃo ao diagnÃstico de anismus em pacientes com sintomas de evacuaÃÃo obstruÃda. Conclui-se que a tÃcnica de ultra-sonografia anorretal dinÃmica apresentada neste estudo pode ser considerada eficaz no diagnÃstico do anismus e com a vantagem de demonstrar simultaneamente a conformaÃÃo anatÃmica dos mÃsculos esfincterianos. . / Approximately half of the constipated patients shows symptoms of obstructed defecation and anismus is one of the main causes. The aim of this study is to demonstrate a new technique using dynamic three-dimensional anorectal ultrasonography for diagnosis of anismus and compare the results with anorectal manometry. This prospective and comparative study was carried out by seventy women with symptoms of obstructed defecation selected from the Colorectal Unit of the Walter CantÃdio University Hospital of the Federal University of the CearÃ, between may 2005 and august 2006. The mean age was 48 years old (range 23 â 79). All the patients were initially submitted to anorectal manometry and then, depending on the results, separated into two groups. Group I, consisting of forty patients with normal results and presenting anal striated muscles relaxation during straining and group II with the thirty remaining patients with diagnosis of anismus. Subsequently, the patients from both groups were submitted to dynamic three-dimensional anorectal ultrasonography. The method consisted of two automatic scans at rest and during straining. Then, both images were analyzed in the axial and longitudinal planes in order to identify the PR movements. The technique consisted to determine an angle between a line traced parallel to the internal edge of the PR ( 1.5cm ) with another vertical and perpendicular line with the anal canal axis. This angle is calculated at rest and during straining and the average resting angle size was 88.37   4.05 in group I and 89.13   5.73 in group II, without significant difference between them ( p=0.51 ). The mean angle size during straining was of 98.19   1.18 in group I and 84.94   1.31 in group II, showing significant statistical difference ( p<0.001 ). Thus, the dynamic three-dimensional anorectal ultrasonography showed the same results of the anal manometry in 92.86 % of the patients regarding anismus diagnosis in patients with symptoms of obstructed defecation. As a conclusion, the dynamic ultrasonography technique showed to be considered efficient for anismus diagnosis, with the advantage to simultaneously demonstrate the anatomical conformation of the anal canal. / Approximately half of the constipated patients shows symptoms of obstructed defecation and anismus is one of the main causes. The aim of this study is to demonstrate a new technique using dynamic three-dimensional anorectal ultrasonography for diagnosis of anismus and compare the results with anorectal manometry. This prospective and comparative study was carried out by seventy women with symptoms of obstructed defecation selected from the Colorectal Unit of the Walter CantÃdio University Hospital of the Federal University of the CearÃ, between may 2005 and august 2006. The mean age was 48 years old (range 23 â 79). All the patients were initially submitted to anorectal manometry and then, depending on the results, separated into two groups. Group I, consisting of forty patients with normal results and presenting anal striated muscles relaxation during straining and group II with the thirty remaining patients with diagnosis of anismus. Subsequently, the patients from both groups were submitted to dynamic three-dimensional anorectal ultrasonography. The method consisted of two automatic scans at rest and during straining. Then, both images were analyzed in the axial and longitudinal planes in order to identify the PR movements. The technique consisted to determine an angle between a line traced parallel to the internal edge of the PR ( 1.5cm ) with another vertical and perpendicular line with the anal canal axis. This angle is calculated at rest and during straining and the average resting angle size was 88.37   4.05 in group I and 89.13   5.73 in group II, without significant difference between them ( p=0.51 ). The mean angle size during straining was of 98.19   1.18 in group I and 84.94   1.31 in group II, showing significant statistical difference ( p<0.001 ). Thus, the dynamic three-dimensional anorectal ultrasonography showed the same results of the anal manometry in 92.86 % of the patients regarding anismus diagnosis in patients with symptoms of obstructed defecation. As a conclusion, the dynamic ultrasonography technique showed to be considered efficient for anismus diagnosis, with the advantage to simultaneously demonstrate the anatomical conformation of the anal canal. / Approximately half of the constipated patients shows symptoms of obstructed defecation and anismus is one of the main causes. The aim of this study is to demonstrate a new technique using dynamic three-dimensional anorectal ultrasonography for diagnosis of anismus and compare the results with anorectal manometry. This prospective and comparative study was carried out by seventy women with symptoms of obstructed defecation selected from the Colorectal Unit of the Walter CantÃdio University Hospital of the Federal University of the CearÃ, between may 2005 and august 2006. The mean age was 48 years old (range 23 â 79). All the patients were initially submitted to anorectal manometry and then, depending on the results, separated into two groups. Group I, consisting of forty patients with normal results and presenting anal striated muscles relaxation during straining and group II with the thirty remaining patients with diagnosis of anismus. Subsequently, the patients from both groups were submitted to dynamic three-dimensional anorectal ultrasonography. The method consisted of two automatic scans at rest and during straining. Then, both images were analyzed in the axial and longitudinal planes in order to identify the PR movements. The technique consisted to determine an angle between a line traced parallel to the internal edge of the PR ( 1.5cm ) with another vertical and perpendicular line with the anal canal axis. This angle is calculated at rest and during straining and the average resting angle size was 88.37   4.05 in group I and 89.13   5.73 in group II, without significant difference between them ( p=0.51 ). The mean angle size during straining was of 98.19   1.18 in group I and 84.94   1.31 in group II, showing significant statistical difference ( p<0.001 ). Thus, the dynamic three-dimensional anorectal ultrasonography showed the same results of the anal manometry in 92.86 % of the patients regarding anismus diagnosis in patients with symptoms of obstructed defecation. As a conclusion, the dynamic ultrasonography technique showed to be considered efficient for anismus diagnosis, with the advantage to simultaneously demonstrate the anatomical conformation of the anal canal.

El síndrome del párpado laxo (SPL) y el glaucoma son las patologías oculares más frecuentemente asociadas al síndrome de apnea-hipopnea del sueño (SAHS), que se han evaluado en cuatro estudios. En el primer estudio, la prevalencia de SPL entre pacientes con SAHS fue del 16% y la prevalencia de SAHS entre pacientes con SPL fue del 85%, de los cuales, el 65% tenían SAHS severo. Los pacientes con SAHS presentaron mayor hiperlaxitud palpebral. En el segundo estudio, la prevalencia de glaucoma entre los pacientes con SAHS pero sin SPL fue del 5.3%, mientras que entre los pacientes con SAHS y con SPL, alcanzó el 23%. En el tercer estudio, los pacientes con SPL presentaron una histéresis corneal significativamante más baja. En el cuarto estudio, los pacientes con SPL presentaron unos cambios significativos en el epitelio conjuntival caracterizados por aumento de la metaplasia escamosa y disminución de las células caliciformes. / Floppy eyelid syndrome (FES) and glaucoma are the most common ocular disorder associated with obstructive sleep apnea (OSA) and it has been done four studies. The results of the first study showed a prevalence of FES in OSA patients of 16% and a prevalence of OSA in FES patients of 85%, in those 65% had severe OSA. Patients with OSA had a significantly higher incidence of eyelid hyperlaxity. The second study showed that the prevalence of glaucoma in OSA patients without FES was 5.3%, and the prevalence of glaucoma in patients with OSA and with FES raised 23%. The results of the third study showed that patients with FES had statistically lower corneal hysteresis values. In the last study, patients with FES were more likely to exhibit abnormal conjunctival cytology characterized by an increase in squamous metaplasia and a decrease in the number of goblet cells. / La síndrome de la parpella laxa (SPL) i el glaucoma són les patologies oculars més freqüentment associades a la síndrome de l’apnea-hipopnea del son (SAHS), que s’han evaluat en quatre estudis. En el primer estudi, la prevalença de SPL entre pacients amb SAHS fou del 16% i la prevalença de SAHS entre pacients amb SAHS i amb SPL fou del 85%, dels quals, el 65% tenien SAHS sever. Els pacients amb SAHS van presentar major hiperlaxitud palpebral. En el segon estudi, la prevalença de glaucoma entre pacients amb SAHS però sense SPL fou del 5.3%, mentre que entre pacients amb SAHS i SPL, va arribar al 23%. En el tercer estudi, el pacients amb SPL van presentar una histèresis corneal significativament més baixa. En el quart estudi, els pacients amb SPL presentaren canvis significatius en l’epiteli conjuntival caracteritzats per augment de la metaplasia escamosa i disminució de les cèl.lules caliciformes.

Objetivos La evaluación del resultado de la cirugía de DCR externa es controvertida haciendo difícil la comparación de los resultados entre los diferentes estudios. El objetivo principal de esta tesis doctoral es determinar la capacidad de la tomografía de coherencia óptica en la medición de la altura del menisco lagrimal para la evaluación postoperatoria de la DCR. Analizaremos también la sensibilidad y especificidad de esta prueba diagnóstica en la evaluación del éxito anatómico y funcional de la DCR; la asociación de la altura del menisco lagrimal medida con OCT con otros parámetros clínicos como la epífora o el test de irrigación; y la utilidad de la medida como factor pronóstico de la cirugía. Material y métodos Estudio prospectivo descriptivo intervencional y comparativo antes-después con datos apareados en una muestra de 55 ojos de 52 pacientes con diagnóstico de obstrucción de la vía lagrimal baja completa descartándose otras causas de epífora. Se evalúan los cambios en altura del menisco lagrimal tras la cirugía de DCR externa, realizándose una medida basal antes de la cirugía, a la semana después de la misma y a los dos meses. La variable principal es la altura del menisco lagrimal mediante OCT (FDRT OCT). Como variables secundarias se han recogido la medida del menisco lagrimal en lámpara de hendidura (FDRT), la presencia de epífora y el resultado del test de irrigación. Para el análisis de los datos se ha utilizado el test de los rangos signados, el test de la U de Mann Whitney-Wilcoxon, curvas ROC para el análisis de sensibilidad/especificidad, el coeficiente de correlación de Pearson, el test de Bland-Altman y regresión logística en forma de odds ratio. Resultados La mediana preoperatoria de la variable FDRT OCT es de 0.679 mm. Los valores postoperatorios a la semana y a los 2 meses son 0,471 mm (p=0,6160) y 0,452 mm (p=0,096) respectivamente. La curva ROC para la valoración del éxito anatómico (irrigación positiva) muestra una AUC de 0,8864 con una sensibilidad y especificidad obtenidas del 84,62% y del 78,57%. Los valores predictivos positivo y negativos son del 55% y del 94,29% para cada caso. Para la valoración del éxito funcional (epifora negativa) la curva ROC presenta una AUC de 0,8963 con una sensibilidad y especificidad del 82,35% y del 84,21% y unos valores predictivos positivo y negativo del 70% y del 91,43% respectivamente. La altura del menisco lagrimal con OCT ha mostrado diferencias significativas con las variables epífora (p=0,0024 y p<0,0001) e irrigación (p< 0,0001 y p<0,0001) a la semana y a los dos meses; así los pacientes con epífora e irrigación negativas presentaban valores claramente más elevados en la variable FDRT OCT. En el análisis de regresión logística de la variable FDRT OCT a la semana se han obtenido un odds ratio (OR) de 10,789 y de 6,366 para la presencia de una irrigación negativa y epífora a los dos meses. Conclusiones El OCT puede evaluar de forma cuantitativa y no invasiva los cambios perioperatorios del menisco lagrimal en la cirugía de DCR. Presenta una elevada exactitud diagnóstica de casi el 90% para la evaluación del éxito anatómico y funcional de manera que valores bajos del menisco lagrimal (por debajo de 0,49 mm) nos permiten asegurar el éxito de la técnica en un 95% de los casos. La medición a la semana tiene valor pronóstico del éxito de la cirugía a los dos meses. Como conclusión, el OCT debe ser incluido dentro de las herramientas de evaluación del resultado de la cirugía de DCR. / Aims The evaluation of the results of external DCR remains controversial which makes difficult comparison among different studies. The main purpose of this doctoral thesis is to assess the ability of the OCT to measure the height of the lacrimal meniscus for the postoperative evaluation of the DCR surgery. The secondary purposes are to perform an analysis of sensibility and specificity of this diagnostic technique to assess the functional and anatomical success of the DCR procedure; to determine the association between this measurement and other parameters used to evaluate the patency of DCR surgery such as the presence of epiphora and the irrigation test; and to study the usefulness of the measurement of height of the lacrimal meniscus with OCT one week after surgery as a prognostic factor of final success of this surgery. Methods This is a prospective interventional descriptive study with paired data (before and after surgery). The sample size is 55 eyes from 52 patients with a diagnosis of complete acquired nasolacrimal obstruction having excluded other causes of epiphora. Changes in the height of the lacrimal meniscus after DCR surgery are examined and measurements before, the week after and two months after surgery are evaluated. The main variable is the height of the lacrimal meniscus with OCT (FDRT OCT). The secondary variables are the height of the lacrimal meniscus at the slit lamp (FDRT), the presence of epiphora and the result of the irrigation test. The data are summarised in terms of mean, median, standard deviation, first and third quartil and range for quantitative variables and bar charts for qualitative variables. The data were analyzed using the signed-rank test, the Mann Whitney-Wilcoxon test, ROC curves, the Pearson´s correlation coefficient, the Bland-Altman plot for agreement and logistic regression in terms of odds ratio. Results The preoperative median value of the variable FDRT OCT is 0,679 mm. Postoperative values at first week and two months are 0,471 (p=0,6160) and 0,452 (p= 0,096) respectively. ROC curve to evaluate the anatomic success (positive irrigation test) shows an AUC of 0,8864 with a sensitivity and specificity of 84,62% and 78,57%. Positive and negative predictive values are 55% and 94,29% . To assess the functional success (absence of epiphora) the AUC obtained is 0,8963 with a sensitivity and specificity of 82,35% and 84,21%; and the positive and negative predictive values are 70% and 91,43%. The tear meniscus height with OCT has shown significant differences with the value of the variables epiphora (p=0.0024 and p>0,0001) and irrigation (p<0,0001 and p<0,0001) at the first week and the second month after surgery; so patients with clinical epiphora and a negative irrigation test have significant higher values for the FDRT OCT variable. The logistic regression analysis for the FDRT OCT values at the first week showed an odds ratio of 10,789 for the presence of a negative irrigation test and 6,366 for the presence of epiphora at the two months. Conclusions OCT can evaluate noninvasively and quantitatively perioperative tear meniscus changes in external dacryocystorhinostomy. It has a diagnostic ability of 90% to assess anatomical and functional success in DCR surgery; considering our results we conclude that low values of tear meniscus (inferior to 0,49 mm) have a probability of success in 95% of cases. Measurements made at first week have a prognostic value as a marker of success of the surgical technique. As a conclusion, we recommend to include OCT as a diagnostic tool in assessing the result of DCR surgery.

Propósito: Presentar, basándose en la publicación ya realizada de tres artículos indexados en Medline, cuáles son los resultados anatómicos y visuales de la queratoprótesis de Boston tipo I en las indicaciones de alto riesgo, cómo el diagnóstico primario y las complicaciones influyen en la agudeza visual y cuáles son las complicaciones post-operatorias más frecuentes. Asimismo se estudia si la queratoprótesis de Boston tipo I puede ser empleada como indicación primaria en situaciones en las que una queratoplastia convencional está destinada al fracaso. Además, se comparan los resultados anatómicos y funcionales de esta técnica con otras queratoprótesis. Fundamentos: Se describen los diferentes modelos de queratoprótesis que se han desarrollado a lo largo de la Historia, su evolución, los materiales empleados, sus principales resultados y complicaciones. Se detallan sus indicaciones en función del estado ocular del paciente. Se desarrollan capítulos sobre la evolución de la queratoprótesis de Boston a lo largo del tiempo, los dos tipos existentes actualmente, sus principales indicaciones actuales, la técnica quirúrgica y cuidados postoperatorios, así como las principales complicaciones descritas, su tratamiento y prevención. Metodología: Se revisan un total de 117 pacientes operados de queratoprótesis de Boston tipo I en dos centros especializados (Barcelona y Salzburgo). Se empleó la técnica quirúrgica de implantación estándar descrita y se administró un protocolo terapéutico post-operatorio. En cada caso se determinaron los datos demográficos individuales, la indicación o causa primaria, la agudeza visual pre- y post-operatorias según escalas logMAR y decimal desarrolladas para este tipo de pacientes con baja visión, la presencia de complicaciones postoperatorias y el resultado anatómico y funcional al final del periodo de seguimiento. Resultados: Se describen los resultados obtenidos en cuanto al éxito anatómico y funcional mediante curvas de supervivencia de Kaplan-Meier. Se analizan el éxito anatómico (definido como la retención de la prótesis) y el éxito visual (definido coma una agudeza visual mejor corregida > 0.05 en escala decimal) en función del diagnóstico principal y de la presencia de complicaciones post-operatorias. Se describen las principales complicaciones observadas tales como la membrana retro-protésica, el glaucoma, la infección y la necrosis estromal, y las complicaciones retinianas, su incidencia y tratamiento. Conclusiones: La implantación de la queratoprótesis de Boston tipo I tiene mejor pronóstico en aquellos casos con buen funcionalismo palpebral, adecuada película lagrimal y ausencia de fenómenos autoinmunes en la superficie ocular. La mayoría de pacientes presentan una mejora notable en su función visual. La presencia de complicaciones es frecuente y pueden incluso provocar la pérdida de la visión. Es una opción adecuada en aquellos casos en los que una queratoplastia no tiene un pronóstico adecuado. Los resultados anatómicos y funcionales son comparables con otros tipos de queratoprótesis. / Objectives: To present the long-term results of the Boston Keratoprosthesis (Boston KPro) Type I based on 3 peer-reviewed manuscripts published in Medline, in challenging indications like chemical burns and autoimmune cases, and how the primary diagnosis and post-operative complications affect the visual acuity results over time. Moreover, the most common postoperative complications are presented and the possibility of using the Boston KPro Type I as a primary surgery for cases wherein a conventional keratoplasty is predicted to fail is evaluated. The anatomical and visual outcomes, and post-operative complications of the Boston KPro Type I are compared with other artificial corneas. Fundamentals: The history of keratoprosthesis is presented by discussing the evolution of types of materials and types of fixation, along with results and complications presented in literature. The general indications are discussed based on the status of the ocular surface of the patient, and common post-operative complications are cited. The development of the Boston Keratoprosthesis is reviewed and its types and designs, indications, pre-operative evaluation, surgical procedure and post-operative care are described in detail. Methodology: 117 cases that underwent Boston KPro Type I implantation from two referral eye centers (Barcelona and Salzburg) were reviewed. Surgical technique and post-operative treatment protocols were followed as described by the Boston KPro team. Demographic data, primary diagnosis, visual acuity results pre-operatively and post-operatively were gathered using decimal and LogMar scales. The presence of post-operative complications and anatomical and functional outcomes were tabulated until last follow-up. Results: Anatomical and functional outcomes are presented using Kaplan-Meier survival curves. Anatomical success (defined as retention of the prosthesis) and functional success (defined as best-corrected visual acuity > 0.05 on decimal scale) are presented based on primary diagnosis and based on the presence of post-operative complications. The most common complications encountered were retroprosthetic membrane, glaucoma, infection and stromal necrosis, and posterior segment complications. Incidence of each complication and corresponding treatment are discussed as well. Conclusions: The best indications for a Boston KPro Type I are non-inflamed eyes with good lid closure and no severe dry eye, meaning non-autoimmune graft failure. The majority of patients achieved visual improvement. The post-operative complications are common and may affect visual acuity results. It is a viable option as a primary procedure in cases condemned to a high risk of failure with a conventional corneal graft. The good anatomical and visual outcomes of the Boston KPro Type I are comparable with other artificial corneas

Objetivo Evaluar los resultados refractivos, funcionales y relacionados con la calidad de visión en un grupo de pacientes operados mediante la técnica de cirugía refractiva de cristalino trasparente con implante de lente trifocal (LIOtri) Método Análisis retrospectivo de los resultados en un grupo de 135 ojos de 71 pacientes, 34% varones y 66% mujeres, de edad media 55.8 años, operados mediante facoaspiración de cristalino trasparente con implante de LIOtri FineVision Micro F® (PhysIOL, Liège, Belgium), con un seguimiento mínimo de 12 meses. Todas las operaciones realizadas por el mismo cirujano (FDM) en el Departamento de Cirugía Refractiva de Institut Català de Retina entre Febrero de 2012 y Junio de 2014. Para los resultados refractivos se han evaluado cambios en esfera, cilindro y equivalente esférico (EE), su predictibilidad y estabilidad. Para los resultados funcionales cambios en agudeza visual lejana, intermedia y próxima (AVL, AVI, AVP), mono y binocular (mono, bino), con y sin corrección (cc, sc). Se han definido unos criterios de éxito para AVL y AVP (eficacia ≥85% monocular y ≥95% binocular) y para AVI (morfología en meseta de la curva de desenfoque), y considerado su estabilidad, predictibilidad y cambio en número de líneas. La calidad visual se ha evaluado de forma cuantitativa mediante los cambios en las aberraciones de alto orden (AAO) y sensibilidad al contraste (SC), y de forma cualitativa mediante el test VF-14 y una encuesta de satisfacción general. Se ha registrado la incidencia, tipo y resultado de las complicaciones observadas. Resultados A los 12 meses los resultados medios de esfera, cilindro y EE han sido de 0.29±0.41, -0.44±0.33 y 0.07±0.4, con un descenso estadísticamente significativo respecto a sus valores preoperatorios. Un 89.4% han presentado valores finales de EE en el rango de ±0.50D. Los valores medios en escala decimal de AVLsc, AVIsc y AVPsc han sido de 0.86±0.14, 0.96±0.2 y 0.89±0.15 con una mejoría estadísticamente significativa para la AVL y AVP y una curva de desenfoque con perfil en meseta que demuestra la mejoría de la AVI. Los valores del índice de eficacia han sido para la AVL mono y bino del 86% y 95% , y para la AVP mono y bino del 87% y 96%, superando el criterio de éxito (≥85%). El índice de seguridad ha sido para la AVLbino del 100% y para la AVPbino del 96%, superando el criterio de éxito (≥95%). Los valores medios de las AAO a los 12 meses han sido de 0.47±0.19 y de las frecuencias de SC (3,6,12,18 cpg) de 4.10±1.1, 3.53±1.24, 2.02±1.37 y 2.22±1.50, presentando todos un descenso estadísticamente significativo. La puntuación final del test VF14 ha sido de 92.5±7.53 y del test de satisfacción general de 9.05±1.28, con un grado de independencia de la corrección del 98%, 98% y 95% para AVL, AVI y AVP. El 94.1% de los pacientes repetirían o recomendarían la operación. Se han observado 3 complicaciones postoperatorias (2.2%) con afectación transitoria de la AV. No se han observado complicaciones intraoperatorias ni postoperatorias con afectación permanente de la agudeza visual. Conclusiones La cirugía de cristalino trasparente con implante de lente trifocal mejora de modo significativo la agudeza visual sin corrección y se asocia a una buena calidad de vida del paciente operado, superando los criterios de éxito para los índices de eficacia y obteniendo un perfil en meseta de la curva de desenfoque que demuestra la efectividad del foco para visión intermedia. / Purpose To evaluate the refractive, functional and quality of vision related results in a group of patients with refractive lens exchange and implantation of a trifocal intraocular lens (IOL). Method Retrospective analysis of the results in a group of 135 eyes of 71 patients, 34% men and 66% women, mean age55.8, who underwent clear lens phaco-aspiration and implantation of the trifocal IOL Micro F® (PhysIOL, Liège, Belgium), with a minimum follow-up period of 12 months. All surgeries performed by the same surgeon (FDM) at the Refractive Surgery Department of the InstitutCatalà de Retina, between February 2012 and June 2014. Refractive results were evaluated according to the changes in sphere, cylinder and spherical equivalent (SE), predictability and stability. Functional results were evaluated according to the changes in distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), monocular and binocular, corrected and uncorrected. Success criteria were defined for DVA and NVA (efficacy index ≥85% monocular and ≥95% binocular), and for IVA(plateu morphology for the defocus curve). Stability, predictability and changes in lines of vision were considered. Quantitative quality of vision was evaluated according to the chances in high order aberrations (HOA) and changes in contrast sensitivity (CS). Qualitative quality of vision was analyzed using the VF-14 test and a general satisfaction survey. Incidence, type, and results of complications were registered. Results Twelve months postoperatively the results of sphere, cylinder and SE were 0.29±0.41, -0.44±0.33 and0.07±0.4, with a statistically significant decrease compared to preoperative values. Eighty-nine point four (89.4%) presented final SE results between±0.50D. Average values (decimal) for UDVA, UIVA and UNVA were 0.86±0.14, 0.96±0.2 and 0.89±0.15with a statistically significant improvement for the DVA and NVA, and a defocus curve with a final morphology that demonstrated the improvement of the IVA. The efficacy indexes for DVA mono and binocular were 86% y 95%, and for NVP mono and binocular 87% and 96%, exceeding the success criteria (≥85%). The safety indexes were 100% for binocular DVA and 96% for binocular NVA, exceeding the success criteria (≥95%). Average values for HOA were0.47±0.19 and for the frequencies of CS (3,6,12,18 cpg) 4.10±1.1, 3.53±1.24, 2.02±1.37 y 2.22±1.50, all of them showing a statistically significant decrease. The final score of the VF-14 was 92.5±7.53 and 9.05±1.28 for the general satisfaction survey. Patients reported spectacle independence of 98%, 98% y 95% for DVA, IVA and NVA. The average of patients that would repeat or recommend the procedure was 94.1%. Three postoperative complications with transitory decrease of vision were observed (2.2%). Nointraoperative or postoperative complications with permanent decrease of vision were observed. Conclusions Refractive lens exchange surgery with implantation of a trifocal intraocular lens produces a significant improvement of uncorrected visual acuity and provides a good quality of life for the patient. The results exceed the success criteria for the efficacy index and obtain a defocus curve profile that demonstrates the improvement in intermediate vision.

La presente tesis por compendio de publicaciones analiza los estudios realizados por el doctorando en los que se ponen de manifiesto que variaciones en el volumen orbitario por ausencia o cambio de tamaño o disposición de sus componentes más significativos, pueden provocar, en una gran mayoría de casos, un cambio de disposición anatómica del resto de los componentes así como un cambio en la relación anatómica entre ellos que se traducirá en alteraciones funcionales y estéticas de la órbita, tanto oftálmica como anoftálmica. La afectación oncológica sobre el globo ocular puede llevar a la necesidad de la extracción del globo ocular, ya sea por medio de una enucleación o bien, en casos muy determinados, por una evisceración. Se estudian los efectos que dicha extracción tiene sobre la cavidad orbitaria en el paciente oncológico, así como las diferentes opciones reconstructivas con el fin de reducir el impacto, tanto funcional como estético, sobre la cavidad orbitaria. En esta misma línea, se presenta un estudio sobre la motilidad de los posibles implantes orbitarios donde se determina que la propia presencia del implante implica un aumento de motilidad de las estructuras orbitarias que se traduce en una mayor motilidad de la cascarilla estética sustitutiva del globo ocular, y donde la composición del implante no influye en dicha motilidad. La presencia de motilidad dará un mejor resultado estético del sustituto ocular en la cavidad anoftámica. Siguiendo con la importancia del volumen en la cavidad orbitaria, ahora con presencia de globo ocular, se demuestra con el caso presentado que la disminución del volumen de grasa orbitaria implica una variación sobre la disposición de los anejos oculares anteriores con consecuencias directas sobre la supervivencia del globo ocular. Nuevamente, y como se comenta, el volumen juega un papel fundamental, tanto desde el punto de vista estético como funcional. / This Thesis by compendium of publications analyses the studies realized by the author and where it is demonstrated that variations on the orbital volume, by absence or change in disposition of its more relevant components may lead, on a majority of cases, to a change on the anatomical disposition of other orbital structures and a change of its relation between them that will translate on functional and aesthetic implications in both, the anophthalmic and in the ophthalmic orbit. An Oncologic process over the eye globe may result in the necessity of the removal of the eye, by means of enucleation or, under determined circumstances, of evisceration. The effects of such a removal in the oncologic patient as well as the different reconstructive techniques for volume restoration with the goal of reducing the functional and aesthetic impact in this patients, are studied in this thesis. In this same line, a study on orbital implant motility is also presented and analysed. The presence of the implant in the anophthalmic orbital cavity translates by itself in an increase on motility despite the implant material. This motility will provide a good aesthetic result for the conceptual restoration of the eye in the anophthalmic cavity. Continuing with the relevance of the volume in the orbital cavity, now in the presence of an eye globe, our case helps to demonstrate that a decrease in orbital fat implies a change on the anterior soft orbital structures with a direct implication on the survival of the eye globe. Once again, as it is discussed, orbital volume plays a paramount role from both, the functional as well as the aesthetic point of view.

Introducción: La eficacia clínica y la seguridad de los adhesivos biológicos y sintéticos en las suturas digestivas ya han sido evaluadas. Sin embargo, poco se sabe acerca de su papel en las suturas y anastomosis gástricas. Por otra parte, la utilización de nuevos tipos de adhesivos sintéticos a partir del n-butil-cianoacrilato no se han evaluado todavía. Materiales y Métodos: Se realizó una gastrotomía de un centímetro en 24 ratas macho tipo Wistar, que se dividieron en función del tipo de método de sutura empleado: Sutura manual de 5/0 de seda discontínua versus sutura con adhesivo sintético tipo Histoacryl ™ flexible (n-butil-cianocrilato con “softener”) o tipo Histoacryl ™ Doble Componente (n-butil-cianoacrilato con “softener” y “hardener”). El objetivo de la valoración principal fue identificar las diferencias en la incidencia de fugas anastomóticas, la formación de adherencias y hallazgos microscópicos durante el proceso de cicatrización. Durante 8 semanas de seguimiento se estudiaron aspectos clínicos e histopatológicos, así como también perfiles hematológicos, iónicos y marcadores inflamatorios. Resultados: No se observaron diferencias significativas entre los grupos cuando se compararon los aspectos clínicos, analíticos o histopatológicos evaluados. Sólo se evidenció una mayor tasa de incidencia de adherencias en el grupo Histoacryl doble componente en comparación con el grupo de sutura manual (p = 0,04). Nuestros resultados indican que ambos tipos de n-butil-cianoacrilato son materiales fiables para el cierre gástrico sin efectos secundarios significativos ni locales ni sistémicos. / Background: Clinical effectiveness and safety of biological and synthetic adhesives in digestive closures have been evaluated. However, little is known about their role in gastric and anastomotic closures. Moreover, usefulness of novel types of synthetic adhesives as n-butyl-cyanoacrylate has not been assessed yet. Materials and Methods: One centimeter long gastrotomy was performed in 24 male Wistar rats which were divided depending on the type of closure method employed: manual USP 5/0 silk interrupted suture versus suture-less closure with Histoacryl™ flexible (n-butyl-cyanoacrylate with softener ) or Histoacryl™ Double Component (n-butyl-cyanoacrylate with softener and hardener ). The primary endpoint was to identify differences in the incidence of anastomotic leaks, adhesion formation and microscopic findings during the cicatrization process. During an 8-week follow-up clinical and histopathological aspects as well as hematologic, ionic and inflammatory markers were studied. Results: No differences among groups where found in any of the clinical, analytical or histopathological issues assessed except for a higher incidence rate of adhesions in the Histoacryl Double Component group when compared with hand-sewn suture group (p = 0.04). Our results indicate that both types of n-butyl-cyanoacrylate are reliable materials for gastric closure without significant neither local nor systemic side effects.

El concepte de “cirurgia cardíaca Ultra Fast-Track” inclou l’extubació precoç al mateix quiròfan i nous models de recuperació postoperatòria. La nostra hipòtesi és que el protocol UFT és tan viable, eficaç i segur en pacients joves com en octogenaris. Metodologia Es tracta d’un estudi descriptiu i prospectiu realitzat en cirurgies de substitució valvular aòrtica a l’Hospital Universitari Germans Trias i Pujol de Badalona. Els fàrmacs utilitzats a la inducció eren Midazolam 0,01mg/Kg iv, Fentanil 4-6 μg/Kg iv, Sevoflurane 2-4% i Rocuroni 0,6-1 mg/kg iv. El manteniment es realitzava amb Sevoflurane 1-2% i Remifentanil 0,05-0,5 μg/Kg/min. Com analgèsia postoperatòria s’utilitzava: morfina 0,1 mg/Kg, metamizol 2g, dexketoprofè 50 mg iv i una bomba elastomèrica d’anestèsic local a través d’un catèter multiperforat supraesternal. Els criteris d’extubació eren: estabilitat hemodinàmica i respiratòria, sagnat i anèmia descartats, temperatura nasofaríngia mantinguda i estat de consciència comprovat. Resultats i Discussió Un total de 131 pacients menors de 80 anys i 29 majors o iguals de 80 anys van participar a l’estudi (la mitjana d’edat d’aquest treball és superior a la majoria d’estudis publicats sobre FT i UFT). No trobem diferències estadísticament significatives entre els dos grups en el percentatge de pacients extubats (75%), en els minuts entre l’últim punt de la cirurgia i l’extubació (14 minuts), en les causes del fracàs d’aquesta extubació inicial ni en la necessitat d’una reintubació. Un cop a la Unitat de Vigilància Intensiva tampoc vam trobar diferències significatives en el temps a ser extubats aquells que havien sortit intubats del quiròfan ni en la necessitat d’una reintubació o d’un reingrés a UCI. Entre els conceptes principals dels protocols FT tampoc vam obtenir diferències significatives (insuficiència respiratòria, control del dolor, sagnat i començament d’ingesta/fisioteràpia respiratòria/deambulació). La mitjana d’hores d’ingrés a UCI (77,53 respecte 78,14 dels octogenaris) i l’estada total hospitalària (7,42 respecte 8,14 dels més ancians) no van resultar estadísticament diferents entre les dues poblacions però la majoria d’articles FT i UFT publicats prèviament mostren ingressos menors. La mortalitat hospitalària va ser 3,1 i 3,4% respectivament. Dues complicacions postoperatòries, la transfusió de concentrats d’hematies i el vessament pleural diagnosticat per radiografia, van resultar ser els dos únics conceptes estadísticament diferents entre els dos grups. Les limitacions del nostre estudi són: haver tingut lloc en un únic centre hospitalari, el nombre relativament petit d’octogenaris i l’absència d’una “n” mostral calculada prèviament al començament de la investigació. Conclusió: El protocol Ultra Fast-Track aplicat a cirurgia cardíaca és tan viable, eficaç i segur en pacients joves com en octogenaris. / The concept “Ultra Fast-track cardiac surgery” (UFT) means extubation in the operating room (OR) and new approaches in postoperative recovery. Our hypothesis assumes that the UFT protocol is as viable, effective and safe in not octogenarian patients as in octogenarians. Method It is a descriptive, prospective study of consecutive patients scheduled for aortic valve replacement surgeries at University Hospital Germans Trias i Pujol in Badalona. Patients were allocated into different groups depending on their age (octogenarian or not). Induction drugs administered were: midazolam 0.01mg/Kg iv, fentanil 4-6 µg/Kg iv, sevoflurane 2-4% and rocuronium 0.6-1 mg/kg iv; anaesthetic maintenance was done with sevoflurane 1-2% and remifentanil 0.05-0.5 µg/Kg/min. As postoperative analgesia was given: morphine 0.1 mg/Kg, metamizol 2g, dexketoprofen 50 mg IV and one suprasternal multiperforated catheter was inserted by the surgeon for local anaesthetic administration through an elastomeric bomb. Extubation criteria were: respiratory and haemodynamic stability, normothermia, consciousness and neither bleeding nor anaemia. Results and Discussion A total of 131 patients younger than 80 years and 29 patients equal to or older than 80 years were included in this study (main age higher than other UFT published trials). No statistically significant differences were observed among groups in terms of demographics, percentages of extubated patients (75%), time between end of surgery and extubation (14 minutes), causes for failed primary extubation and reintubation requirements. Once at the ICU, no significant differences were found regarding time for extubation, reintubation rates and ICU readmission. Crucial FT concepts like respiratory insufficiency, pain control, bleeding, begin of feeding, respiratory physiotherapy and walking were very similar among groups. Mean ICU stay in hours (77.53 vs 78.14 in octogenarians) and global hospital stay in days (7.42 vs 8.14 in oldies) were not statistically different but most of the UFT published studies showed lower values. Hospital mortality was 3.1 and 3.4% respectively. Postoperatively, only red blood cells transfusion rates and pleural effusions on chest X-ray were statistically different among groups. Limitations of our study include the fact that it is a single-centre study; there is a relative small study population over 80 years and finally, the lack of a sample size calculation at the beginning of study. Conclusion Our UFT protocol in cardiac surgery is as viable, effective and safe in young patients as in octogenarians.