Amendments appended. / Bibliography: leaves 140-165. / xi, 165 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Microbiology and Immunology, 2005

Author's previously published articles appended. / Bibliography: leaves 292-341. / xviii, 388 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, 2005

Background The last decade has witnessed a renaissance of functional stereotactic neurosurgery in the treatment of patients with movement disorders, especially advanced Parkinson’s disease (PD), essential tremor (ET) and dystonia. Ablative lesions such as thalamotomy and pallidotomy have been gradually replaced by the technique of chronic deep brain stimulation (DBS) applied to targets in the basal ganglia and thalamus, and assumed to be more lenient to the brain than stereotactic radiofrequency lesions. Since the aim of functional neurosurgery is to alleviate symptoms of these chronic, progressive, non-fatal diseases, and to improve life quality of the patients, it is imperative that the surgical procedures remain safe and do not result in complications mitigating any anticipated positive effect of the surgery on the symptoms of the disease. Aim The aim of this thesis is to evaluate, compare and analyse the safety of various surgical procedures used to treat patients with movement disorders, and to document side effects and complications both peri operatively and in a long term follow-up. Further to compare the effects of pallidotomy and pallidal DBS, and to evaluate the longterm efficacy of Vim-DBS. Method 256 consecutive surgical procedures, 129 DBS and 127 stereotactic lesions, were reviewed with respect to complications in 197 treated patients. In a series of 119 patients operated on with DBS during a 10 year period, the occurrence of hardware related complications (infection, breakage, erosion etc) was documented and analysed. Additionally, the interference of external magnetic field with the stimulation was documented. In one patient operated on with subthalamic nucleus DBS, a highly unusual and unexpected psychiatric side effect was carefully analysed. In 5 patients operated on with both methods (lesion and DBS) on each hemisphere, respectively, the effect and side effects of each method were compared. The long term effect and side effects of thalamic DBS was analysed in a series of patients with ET followed for 7 years. Results There were no deaths and few severe neurological complications in this material. Unilateral ablative lesions in the pallidum were well tolerated by patients with advanced PD, while for tremor, thalamic DBS was much safer than thalamotomy, even if its effect on certain aspects of tremor could show some decrease of efficacy over time. Some of the side effects of lesioning are transient while most but not all side effects of DBS are reversible. Hardware-related complications were not uncommon especially in the early “learning curve” period, and the DBS technique, being a life-long therapy, will necessitate a life long follow up of patients. Provided safety protocols are followed and provided patient’s and carer’s education and awareness, external electromagnetic interference should not constitute a risk for patients with DBS. PD patients undergoing STN DBS should be carefully selected to avoid psychiatric or cognitive side effects, due to this brain target´s proximity to, and involvment in, non-motor associative and limbic circuitry. Conclusions In terms of mortality and morbidity, modern stereotactic neurosurgery for movement disorders, both ablation and DBS, is a safe procedure even in advanced stages of disease. Symptoms of PD, ET and dystonia can be alleviated mainly with DBS and even unilaterally with pallidal lesions, at the expense of, in most cases, minor side-effects.

This was a two part study. Part one was a retrospective chart review to ascertain the prevalence and predictors of peri-operative complications in PWD receiving their dental care under general anesthesia (GA). Part two was a prospective survey of parents/caregivers regarding their satisfaction with the service as well as to ascertain the prevalence of post-operative symptoms incurred by patients. In Part 1, the prevalence of complications in PWD was 4 times higher than the 6% stated in the literature for the general population. Time under GA, and no previous history of dental care under GA were significantly related to complications. In Part 2, 100% of patients experienced post-operative symptoms; nonetheless, 92.7% of parents/caregivers were satisfied with the service provided. There prevalence of complications in the PWD in this study was high. Prior to treatment under GA, adequate pre-operative medical evaluations must be completed and time under GA minimized.

This was a two part study. Part one was a retrospective chart review to ascertain the prevalence and predictors of peri-operative complications in PWD receiving their dental care under general anesthesia (GA). Part two was a prospective survey of parents/caregivers regarding their satisfaction with the service as well as to ascertain the prevalence of post-operative symptoms incurred by patients. In Part 1, the prevalence of complications in PWD was 4 times higher than the 6% stated in the literature for the general population. Time under GA, and no previous history of dental care under GA were significantly related to complications. In Part 2, 100% of patients experienced post-operative symptoms; nonetheless, 92.7% of parents/caregivers were satisfied with the service provided. There prevalence of complications in the PWD in this study was high. Prior to treatment under GA, adequate pre-operative medical evaluations must be completed and time under GA minimized.

Diabetes mellitus is a chronic disease associated with vascular complications. Vascular endothelial dysfunction caused by increased endothelial cell apoptosis contributes to diabetic cardiovascular complications. The glucose metabolic by-product, D-lactate, is elevated in diabetics and it is unknown whether it contributes to endothelial cell apoptosis. We hypothesized that diabetic D-lactate levels induce apoptosis in human vascular endothelial cells (HUV-EC-C). HUV-EC-C were incubated with 0.2 mM D-lactate (DLA) and mRNA expression of PI3K/AKT pathway members (AKT1, Bcl-2, BAD, eNOS, PI3K) were measured using Quantitative RT-PCR. DLA downregulated all genes at 6 and 24 hours, followed by increase in expression after 48 hours except PI3K, which remained below control. To further investigate apoptosis, the Human Apoptosis PCR Array was used and expression of all proapoptotic genes (TNF family members) and antiapoptotic genes (IAP family members) were decreased and increased, respectively, at 24 hours followed by an increase and decrease, respectively, at 48 hours. Caspase activity, measured using the Caspase-Glo® 3/7 Assay after HUV-EC-C exposure to 0.2 mM DLA alone or in combination with 20 mM glucose (GLU) or 5 µM methylglyoxal (MG), was increased after 1, 72, and 96 hours. Furthermore, to know whether DLA (0.2 mM) and DLA (0.2 mM), GLU (20 mM) and MG (5 µM) combined cause changes in cellular energy metabolism, creatine (Cr) and high-energy phosphate substrates (CrP, ATP, ADP, AMP) were quantified using HPLC and no changes were observed. We further measured ROS production in HUV-EC-C treated with 0.06-2 mM DLA alone or 0.2 mM DLA with 5-30 mM GLU or 5-160 μM MG. All DLA concentrations increased ROS production by 160% to 216%. DLA with GLU or MG significantly increased ROS production compared to GLU or MG alone. Lastly, D-lactate dehydrogenase (D-LDH) expression was determined using Quantitative RT-PCR and D-LDH was not detected in HUV-EC-C. In conclusion, DLA altered expression of different pro- and anti-apoptotic genes in HUV-EC-C. Furthermore, exposure of HUV-EC-C to DLA levels typically present in diabetics resulted in time-dependent changes in caspase activity, possibly due to excessive ROS production. Whether these changes eventually lead to endothelial dysfunction in diabetes needs further investigation.

Syfte: Syftet med denna litteraturöversikt var att beskriva hur litteraturen skildrar sjuksköterskans roll i vården av den äldre patienten i den pre- och postoperativa fasen, med fokus på nutritionens betydelse för rehabiliteringen och risken för komplikationer. Metod: Studien genomfördes som en litteraturöversikt och artiklarna söktes via CINAHL och MEDLINE.  Studiens resultat innehöll ett urval på 14 artiklar med kvantitativ ansats. Resultat: Undervisning och handledning med fokus på nutritionens betydelse för rehabiliteringen och risken för komplikationer var av vikt, även bedömningsinstrument underlättade sjuksköterskans nutritionsbedömning.  I omvårdnaden var energi- och näringstillskott, individuellt anpassade vårdplaner och måltidssituationer viktiga komponenter. Förebyggande åtgärder inom både omvårdnad och medicin hade en korrelation mellan förbättrad nutrition, rehabilitering och minskade risken för komplikationer hos äldre patienter i den pre- och postoperativa vården. Slutsats: Personer över 65 år var en utsatt patientgrupp gällande undernäring och postoperativa komplikationer. Vården bör därför vara anpassad efter den enskilda äldre individens villkor och innehålla information till patienten för att möjliggöra dennes aktiva roll i den egna vården. I det preventiva arbetet behöver sjuksköterskan fortlöpande utbildning och handledning angående hur medicinska och fysiologiska faktorer tillsammans påverkar den äldre individen samt hur sjuksköterskan i ett tidigt skede kan påvisa undernäring hos äldre.

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Reproduction de : Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2008. / Titre provenant de l'écran-titre. Bibliogr. f. 34-38.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 70-78).