Contamination is a prevalent issue with reprocessed levered endoscopes. The number of infections caused by resistant enterobacteriaceae in patients due to contaminated endoscopes increased to the point that the United States Food and Drug Administration released a safety alert to health care facilities that perform endoscopic retrograde cholangiopancreatography (ERCP). The purpose of this descriptive project was to evaluate if levered endoscopes used in ERCP procedures met high level disinfection criteria, were properly processed, and were germ free after reprocessing. The project was supported by 2 theories: the middle range theory of patient advocacy and the germ theory. Data (counts and percentages) were collected from testing 150 endoscopes at each of 4 facilities within an organization regarding the effectiveness of the reprocessing of the levered endoscopes. According to the project findings, there was a 7% average germ-free failure rate across the sites after the initial reprocessing. The cleaning process of the levered endoscopes allowed bacteria to remain on the scopes after the manufacturer-recommended cleaning was completed at the sites. Standardization of the organization's cleaning process and improvement in the national protocols were recommended. The project supported protecting the safety of endoscopy patients by identifying that the cleaning process could be improved to prevent introduction of infectious bacteria through a procedure. The results will be informative for laboratory staff who clean levered endoscopes, physicians who use the scopes in patient procedures, patients who undergo the procedures, and nurses who are tasked with improving patient safety in perioperative environments.

Colonoscopy is essential for colorectal cancer screening and disease surveillance. It can remove pre-cancerous colon polyps to reduce a patient’s cancer risk. This thesis aims to improve colonoscopy’s localization using motion tracking and colonoscopy’s coverage using surface mapping. Chapter 4 describes an endoscope motion tracker that records the scope’s insertion length, rotation, and speed during a colonoscopy. The endoscope tracker’s motion record can be combined with the endoscope’s video to localize colon polyps or cancers. In the future, the device could record highly skilled manoeuvres performed by endoscopists to help train medical residents. It is difficult to image the colon’s mucosa because the colonoscope’s camera has a limited field of view. Chapter 3 uses a 180° fisheye camera to unwrap high resolution panoramas of a colon phantom. The panoramas are then combined into a mosaic map of the colon phantom’s surface. The colon’s surface is approximated as a cylinder. Follow up experiments could test our mapping algorithm using imagery from a wide-angle, high-definition colonoscope. Chapter 2 describes another technique to localize locations where polyps have been removed—blood vessel landmarks. Colonic blood vessels from a pig were imaged to determine if they could be used to fingerprint locations on the colon’s wall. Blood vessels are also useful image features for surface mapping. The proof-of-concept experiments successfully imaged large arteries but further work is needed to image the small capillaries in the colonic mucosa and to image the veins. In summary, we have visualized colonic blood vessels to test if they could be useful landmarks, tested using an extended field of view camera to create an unwrapped map of the colon wall, and designed an endoscope tracker to help localize abnormal tissue. Combining the endoscope tracker with the other two techniques should make is possible to accurately map the colon. / Thesis / Doctor of Philosophy (PhD) / Colonoscopy is a powerful tool for colon cancer screening. A colonoscopy can decrease the chance of developing advanced cancers by removing pre-cancerous polyps before they grow. This research works to improve colonoscopy’s localization using motion tracking and its coverage using surface mapping. We have developed an endoscope motion tracker that records the scope’s insertion length, rotation, and speed during a colonoscopy. It is In described in Chapter 4. The recorded motion can be combined with the endoscope’s video to improve colon cancer localization. Next, it is difficult to image the colon’s mucosa because the colonoscope’s camera has a limited field of view. Chapter 3 uses a 180° fisheye camera to unwrap high resolution panoramas of a colon phantom. The panoramas are then combined into a cylindrical surface map. Finally, Chapter 2 images the colon’s blood vessels to determine if they can fingerprint locations on the colon’s wall.

Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-04-17T12:25:43Z No. of bitstreams: 1 ANTÔNIO AUGUSTO FRAGA DE ANDRADE - DISSERTAÇÃO PPG-CEMat 2014..pdf: 2871535 bytes, checksum: c0965a012ab765af77feb84c2c22a016 (MD5) / Made available in DSpace on 2018-04-17T12:25:43Z (GMT). No. of bitstreams: 1 ANTÔNIO AUGUSTO FRAGA DE ANDRADE - DISSERTAÇÃO PPG-CEMat 2014..pdf: 2871535 bytes, checksum: c0965a012ab765af77feb84c2c22a016 (MD5) Previous issue date: 2014-12-18 / O aparelho endoscópico utilizado atualmente para estudo do trato gastro-intestinal (o video-endoscópio) é resultado de quase 200 anos de evolução tecnológica. Estes endoscópios não podem ser esterilizados pelos métodos clássicos. Por sua complexidade, o processo de limpeza e desinfecção de endoscópios não é somente uma preocupação da enfermagem, ela se tornou multidisciplinar, pois exige discussão sobre riscos físicos, biológicos e químicos, tanto para o paciente quanto para a equipe. A borracha da ponta flexível dos endoscópios é uma peça fundamental para a preservação da vedação do endoscópio e principalmente preservação do paciente. Esta borracha sofre desgaste tanto durante o exame como pelos processos de desinfecção do equipamento que acabam agredindo a superfície do material. O seu desgaste ou ruptura pode acarretar na queima do gerador de imagem. A troca da borracha da ponta é considerada uma manutenção parcial e deve sempre ser executada periodicamente. Baseado no exposto este trabalho teve como objetivo principal estudar e avaliar a degradação ocorrida em ponteiras flexíveis de endoscópios digestivos submetidos a procedimentos médicos. Como resultados pode-se verificar nas microscopia, tanto ótica como eletrônica, morfologia rugosa com presença de poros para a ponteira virgem, nas ponteiras utilizadas por diferentes períodos de tempo verificou-se intensificação destas rugosidades. Por DRX pode-se observar um perfil praticamente amorfo típico de elastômero, além de identificar a presença de compostos de carga no polímero. Por FTIR pode-se comprovar diferentes estruturas para as amostras estudadas, levando a crer que algumas possuem polidimetilsiloxana em excesso com relação ao fluorelastômero. Por EDS pode-se verificar a exteriorização de compostos presentes no interior do elastômero após o período de degradação. No ensaio de tração foi verificada diminuição das propriedades físicas do elastômero devido a degradação ocorrida. No ensaio de ângulo de molhabilidade verificou-se que mesmo após o processo de degradação todas as amostras ainda apresentavam-se hidrofóbicas. Em síntese, este trabalho observou a necessidade de se desenvolver um material específico para utilização como ponteiras de endoscópios, já que os existentes no mercado aparentemente não tem destino especifico para aplicações biológicas. Ou seja, mesmo em sua forma virgem o elastômero em questão já apresenta fatores que não tornam sua utilização em meio biológico tão viável. / The endoscopic device currently used to study the gastrointestinal tract (the videoendoscope) is the result of nearly 200 years of technological evolution. These endoscopes can not be sterilized by the classical methods. Due to its complexity, the process of cleaning and disinfection of endoscopes is not only a concern of nursing, she became multidisciplinary, since it requires discussion of physical, biological and chemical hazards, both for the patient and for the team. The flexible rubber tip of the endoscope is a key piece to preserve the seal of the endoscope and especially preservation of the patient. This rubber wears out both during the test as the disinfection of equipment that processes attacking the end surface of the material. Your wear or breakage may result in the image generator burns. The replacement of the rubber tip is considered a partial maintenance and must always be performed periodically. Based on the above this work aimed to study and evaluate the degradation occurred in flexible tips of digestive endoscopes undergoing medical procedures. The results can be seen in microscopy, both optical and electronic, rough morphology with the presence of pores to the virgin tip, the tips used for different periods of time there was intensification of these ridges. XRD can observe typical listing a substantially amorphous elastomer, and identify the presence of compounds in the polymer charge. FTIR can prove different structures for the studied samples, leading to the belief that some have polydimethylsiloxane in excess with respect to the fluoroelastomer. EDS can verify the externalization of compounds within the elastomer after the degradation period. In the tensile test was observed decrease in physical properties of the elastomer due to degradation occurred. On test wetting angle was found that even after the degradation process all the samples still had become hydrophobic. In summary, this study observed the need to develop a specific material for use as tips of endoscopes, since on the market apparently has no specific target for biological applications. That is, even in its virgin form the elastomer in question already has factors that do not make their use in biological environment as possible.

Made available in DSpace on 2015-07-22T20:49:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-12-31. Added 1 bitstream(s) on 2015-08-11T03:25:33Z : No. of bitstreams: 1 Publico-0144.pdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A cirurgia dos tumores selares é tradicionalmente um campo de atuação dos neurocirurgiões. Contudo, desde a retomada da abordagem transeptaltransesfenoidal para acessar a sela túrcica, na década de sessenta do século passado, os otorrinolaringologistas têm exercido importante parceria neste procedimento. A divulgação da cirurgia endoscópica nasossinusal na otorrinolaringologia criou o interesse pela sua aplicação na cirurgia da região selar. a uso do endoscópio permitiu acesso transnasal direto ao seio esfenoidal sem a necessidade de descolamento do septo nasal, com menor desconforto para o paciente, além de morbidade pós-operatória inferior aos métodos tradicionais. Objetivo: O objetivo deste trabalho foi verificar as dificuldades técnicas, intercorrências e complicações pós-operatórias, no manejo otorrinolaringológico do acesso transnasal endoscópico à sela túrcica. Método: Foram analisados retrospectivamente os prontuários e imagens de arquivo de 159 pacientes submetidos à cirurgia da região selar entre março de 2001 e dezembro de 2005, na Universidade Federal de São Paulo / Escola Paulista de Medicina. Foram incluídos neste estudo 91 pacientes submetidos a um total de 95 procedimentos por via transnasal endoscópica. Resultados: Foi possível a realização da técnica endoscópica transnasal em todos os pacientes estudados, independente de idade, presença de variações anatômicas, características e etiologia do tumor, e antecedente de cirurgia prévia. Não houve necessidade de remoção da concha média ou correção de desvios septais para realização do procedimento cirúrgico em nenhum dos casos. A principal intercorrência foi a abertura do diafragma selar durante a remoção de tumores, causando fístula liquórica intra-operatória em 13,68 por cento dos casos. As complicações pós-operatórias encontradas foram: sangramento nasal (8,42 por cento), fístula liquórica (8,42 por cento), e meningite (2,19 por cento). Conclusão: O acesso endoscópico transnasal aos tumores selares pôde ser realizado de forma minimamente invasiva, preservando-se as estruturas nasais nos 95 procedimentos estudados, independente da idade do paciente, características e etiologia do tumor. / Sellar tumor surgery is traditionally a neurosurgeon´s field. However, since the renewed interest in the transseptal-transsphenoidal approach to access the sellar region in the sixties, otolarynngologists have played an important partnership in this procedure. Divulging of endoscopic sinus surgery in otolaryngology created an interest in its application in sellar region surgery. The use of endoscopes allowed a direct transnasal approach to the sphenoidal sinus without need of dissection of the septal mucosa, with less post-operative discomfort and morbidity inferior to that of traditional methods. Objective: The objective of this work was to verify the technical difficulties, intercurrences and post-operative complications in the otolaryngological handling of the endoscopic transnasal approach to the sellar region. Method: The analisys comprised both the files and archive images of 159 patients submitted to sellar region surgery between march 2001 and December 2005, at Universidade Federal de São Paulo / Escola Paulista de Medicina. 91 patients submitted to a total of 95 endoscopic transnasal procedures were included in this study. Results: It was possible to apply the endoscopic transnasal tecnique in all studied patients, independent of age, anatomical variations, tumor characteristics and etyology, and previous surgery history. There was no need of middle turbinate removal, or septal deviations corrections for the surgical procedure in any of the cases. The main intercurrence was the opening of the sellar diaphragm during the removal of the the tumors, causing intra-operative CSF leak in 13.68% of the cases. The post-operative complications encountered were: nasal bleeding (8.42%), CSF leak (8,42%), and meningitis (2.19%). Conclusion: Transnasal endoscopic approach to sellar tumors was done in a minimally invasive form, preserving the nasal structures in the 95 studied procedures, independently of patient age, tumor characteristics and etyology. / TEDE / BV UNIFESP: Teses e dissertações

O Glutarldeído é usado como desinfetante de endoscópios, mas por ser irritante, deve ser substituído por outro produto alternativo. A água ácida eletrolisada (AAE) possui efeito bactericida, tecnologia essa desenvolvida no Japão para lavadoras de endoscópios. No nosso estudo, a contaminação endoscópica após o seu uso clínico foi examinada através de cultura para bactérias, micobactérias e fungos, tanto antes quanto após a desinfecção com glutaraldeído por 20 minutos ou água ácida eletrolizada por 7 minutos. As colônias de bactérias foram identificadas e contadas após 48 horas de incubação a 37o C. A contaminação microbiana dos colonoscópios foi detectada após 30 (trinta) procedimentos endoscópicos, contudo o tratamento com a AAE conseguiu erradicar todos os microorganismos. A atividade microbiana da AAE mostrou-se ser similar ao glutaraldeído a 2%. Os resultados indicam que a AAE é um eficiente desinfetante depois da limpeza mecânica dos colonoscópios, podendo ser usado nas unidades de endoscopias como uma alternativa ao glutaraldeído / Efficient disinfection is important given the multiplicity of bacterial exposures to equipment used in endoscopy. Glutaraldehyde is used as a disinfectant for endoscopes, but is an irritant and so should be replaced by an alternative. Electrolized cid water (EAW) has bactericidal effect, and an endoscopic washing device using EAW has been developed in Japan. In our study, endoscopic contamination after clinical use was examinated by culture for bacteria, mycobacteria and fungi before and after exposing to glutaraldehyde (20min) and electrolized acid water (7min). The bacterial colonies were identified and counted after 48 hours of incubation at 37oC. Microbial contamination of colonoscopes was detected after 30 endoscopic procedures, but the treatment of the endoscope with EAW eradicated the microbes. The microbicidal activities of EAW was similar to that of glutaraldehyde. These results indicate that EAW is effective disinfectant after mechanical cleaning of colonoscopes, and can, therefore, be used in the endoscopy unit as an alternative to glutaraldehyde

O Glutarldeído é usado como desinfetante de endoscópios, mas por ser irritante, deve ser substituído por outro produto alternativo. A água ácida eletrolisada (AAE) possui efeito bactericida, tecnologia essa desenvolvida no Japão para lavadoras de endoscópios. No nosso estudo, a contaminação endoscópica após o seu uso clínico foi examinada através de cultura para bactérias, micobactérias e fungos, tanto antes quanto após a desinfecção com glutaraldeído por 20 minutos ou água ácida eletrolizada por 7 minutos. As colônias de bactérias foram identificadas e contadas após 48 horas de incubação a 37o C. A contaminação microbiana dos colonoscópios foi detectada após 30 (trinta) procedimentos endoscópicos, contudo o tratamento com a AAE conseguiu erradicar todos os microorganismos. A atividade microbiana da AAE mostrou-se ser similar ao glutaraldeído a 2%. Os resultados indicam que a AAE é um eficiente desinfetante depois da limpeza mecânica dos colonoscópios, podendo ser usado nas unidades de endoscopias como uma alternativa ao glutaraldeído / Efficient disinfection is important given the multiplicity of bacterial exposures to equipment used in endoscopy. Glutaraldehyde is used as a disinfectant for endoscopes, but is an irritant and so should be replaced by an alternative. Electrolized cid water (EAW) has bactericidal effect, and an endoscopic washing device using EAW has been developed in Japan. In our study, endoscopic contamination after clinical use was examinated by culture for bacteria, mycobacteria and fungi before and after exposing to glutaraldehyde (20min) and electrolized acid water (7min). The bacterial colonies were identified and counted after 48 hours of incubation at 37oC. Microbial contamination of colonoscopes was detected after 30 endoscopic procedures, but the treatment of the endoscope with EAW eradicated the microbes. The microbicidal activities of EAW was similar to that of glutaraldehyde. These results indicate that EAW is effective disinfectant after mechanical cleaning of colonoscopes, and can, therefore, be used in the endoscopy unit as an alternative to glutaraldehyde

This thesis deals with the diagnosis of a residential building from the late nineteen twenties for the needs of reconstruction. The methods generally used in the diagnosis of structures are briefly described in the theoretical part. More deeply this section describes the methods that were used during this particular research. The practical part deals with the diagnosis of the object itself. The first section describes the layout of the villa, its design solution, its faults and defects detected during the inspection. The next section deals with evaluating the current state of construction materials. Static reports of several structural parts were calculated in the last section.