Objective: To characterize the effect of the Ruby Joint Stabilization System (Ruby) on the motion of the cranial cruciate ligament (CrCL) deficient stifle. To compare the motion with the Ruby to that of the CrCL-intact and CrCL-deficient stifle. Study Design: Each canine pelvic limb was mounted in a loading jig under 30% body weight. Motion data was collected using an electromagnetic tracking system at stifle angles of 125o, 135o and 145o with the CrCL-intact, CrCL-deficient and the Ruby applied. Results: Total translation of the CrCL-deficient stifle following the Ruby was reduced, but remained greater than the CrCL-intact stifle at angles of 125o, 135o and 145o. Internal rotation of the Ruby groups was greater than the CrCL-intact group at 145o, but not 125o and 135o. Varus motion of the Ruby group was decreased compared to the CrCL-deficient group, but increased compared to the CrCL-intact group at angles of 125o, 135o and 145o. Conclusion: Total translation and internal rotation of the CrCL-deficient stifle following the Ruby differed from that of the CrCL-intact stifle. However, the Ruby reduced total translation and internal rotation of the tibia relative to the femur in the CrCL-deficient stifle to levels that may yield clinically acceptable results. / Master of Science / Cranial cruciate ligament disease is a common pathology of the canine stifle. Loss of this ligament results in instability of the stifle that results in pain and osteoarthritis, and can lead to damage of other intra-articular structures like the menisci. An abundant number of surgical procedures are described, with the goal of surgery being the restoration of normal stifle stability and function. A common surgical procedure for treatment is the lateral suture technique, which is an extracapsular method of stabilization. This procedure faces many complications; however, it remains a popular choice of stabilization due to its lower cost and less invasive nature. The Ruby Joint Stabilization procedure is a method of extracapsular repair that aims to restore stifle stability and circumvent several complications that plague the lateral suture. This cadaveric study sought to investigate how stifle motion of the normal canine stifle compared to that of the cranial cruciate ligament deficient stifle with the Ruby Joint Stabilization System applied. The results of this investigation demonstrated that the Ruby Joint Stabilization System adequately restored stifle motion to a level that could yield clinically acceptable results, as was demonstrated in a previously published clinical investigation of this technique.

Introdução: A catarata é a principal causa de cegueira reversível no mundo e seu tratamento é exclusivamente cirúrgico, cujas técnicas mais difundidas são a extração extracapsular do cristalino (EECC) e a facoemulsificação (FACO). Objetivo: Avaliar custos e desfechos clínicos na cirurgia ambulatorial de catarata por FACO e EECC quando realizadas por médicos residentes do terceiro ano (R3). Material e Métodos: Foram avaliados os custos desses procedimentos, que incluíram: valores pagos aos profissionais, taxas hospitalares, materiais, medicamentos e equipamentos, e analisados os prontuários de pacientes operados por R3, utilizando as técnicas de FACO (n=576) e EECC (n=274), para obtenção de dados referentes à avaliação da acuidade visual (AV) pré-operatória e pós-operatória durante seis meses após a cirurgia, taxa de complicações intraoperatórias e ao número de consultas pós-operatórias. Resultados: O custo médio foi maior na FACO (USD 416) do que na EECC (USD 284), utilizando-se a conversão de moeda do dia 30 de dezembro de 2011. A AV média pré-operatória foi pior na EECC (1,73±0,62 logMAR) do que na FACO (0,74±0,54; p<0,01). O melhor resultado da AV média pós-operatória foi encontrado na FACO (0.21±0.36 logMAR) e na ECCE (0,63±0,63; p<0.01). No grupo FACO, 85% dos casos atingiram AV<=0,30 logMAR, já na EECC esse índice ocorreu em 45% deles (p<0.01). A taxa de complicações intraoperatórias foi menor na FACO (7,6%) do que na EECC (21%; p<0,01). A média de consultas pós-operatórias foi menor na FACO (4,5±2,4) versus EECC (5,6±2,3; p<0,01). Conclusão: Apesar de o custo médio da cirurgia ambulatorial de catarata atingir valor 46% maior na FACO, o uso desta técnica no ensino de R3 mostrou índice de complicações três vezes inferior, menor número de consultas pós-operatórias e melhores resultados para a AV pós-operatória do que os observados nas cirurgias por EECC. / Introduction: Cataract is the leading cause of reversible blindness in the world and cataract surgery is the main performed procedure to its treatment; the most widespread techiniques being the extracapsular extraction of lens (ECCE) and phacoemulsification (PHACO). Objectives: To assess costs and outcomes of cataract surgery by PHACO and by ECCE performed by residents in ophthalmology. Material and Methods: The estimated costs of the procedures include wages, and hospital costs (fees, medicines, medical supplies and equipments). Medical records of patients operated by third-year residents (R3) using PHACO (n=576) and ECCE (n=274) were included in order to collect data on the assessment of visual acuity (VA) before and 6 months after surgery, along with rates of intraoperative complications and total number of postoperative visits. Results: Mean total costs were significantly higher for PHACO (USD 416) than for ECCE (USD 284) (currency exchange for December 30, 2011). The average preoperative VA (logMAR) was worse for eyes submitted to ECCE, 1.73 ± 0.62, than for eyes submitted to PHACO, 0.74 ± 0.54 (p<0.01). Mean postoperative VA was better for PHACO, 0.21 ± 0.36 logMAR than for ECCE, 0.63 ± 0.63 (p<0.01). VA of 0.30 logMAR or better was achieved in 85% of cases for PHACO and in 45% for ECCE (p<0.01). The rate of intraoperative complications was significantly higher for EECC (21%) than for PHACO (7.6%) (p<0.01), and the mean number of postoperative visits was higher for ECCE (5.6 ± 2.3) than for PHACO (4.5 ± 2.4) (p<0.01). Conclusion: Although the average cost of cataract surgery performed by R3 is 46% higher in PHACO when compared with ECCE, the use PHACO by senior residents in ophtalmology showed complication rates three times lower, fewer postoperative visits and, most importantly, better postoperative VA than observed for ECCE.

Introdução: A catarata é a principal causa de cegueira reversível no mundo e seu tratamento é exclusivamente cirúrgico, cujas técnicas mais difundidas são a extração extracapsular do cristalino (EECC) e a facoemulsificação (FACO). Objetivo: Avaliar custos e desfechos clínicos na cirurgia ambulatorial de catarata por FACO e EECC quando realizadas por médicos residentes do terceiro ano (R3). Material e Métodos: Foram avaliados os custos desses procedimentos, que incluíram: valores pagos aos profissionais, taxas hospitalares, materiais, medicamentos e equipamentos, e analisados os prontuários de pacientes operados por R3, utilizando as técnicas de FACO (n=576) e EECC (n=274), para obtenção de dados referentes à avaliação da acuidade visual (AV) pré-operatória e pós-operatória durante seis meses após a cirurgia, taxa de complicações intraoperatórias e ao número de consultas pós-operatórias. Resultados: O custo médio foi maior na FACO (USD 416) do que na EECC (USD 284), utilizando-se a conversão de moeda do dia 30 de dezembro de 2011. A AV média pré-operatória foi pior na EECC (1,73±0,62 logMAR) do que na FACO (0,74±0,54; p<0,01). O melhor resultado da AV média pós-operatória foi encontrado na FACO (0.21±0.36 logMAR) e na ECCE (0,63±0,63; p<0.01). No grupo FACO, 85% dos casos atingiram AV<=0,30 logMAR, já na EECC esse índice ocorreu em 45% deles (p<0.01). A taxa de complicações intraoperatórias foi menor na FACO (7,6%) do que na EECC (21%; p<0,01). A média de consultas pós-operatórias foi menor na FACO (4,5±2,4) versus EECC (5,6±2,3; p<0,01). Conclusão: Apesar de o custo médio da cirurgia ambulatorial de catarata atingir valor 46% maior na FACO, o uso desta técnica no ensino de R3 mostrou índice de complicações três vezes inferior, menor número de consultas pós-operatórias e melhores resultados para a AV pós-operatória do que os observados nas cirurgias por EECC. / Introduction: Cataract is the leading cause of reversible blindness in the world and cataract surgery is the main performed procedure to its treatment; the most widespread techiniques being the extracapsular extraction of lens (ECCE) and phacoemulsification (PHACO). Objectives: To assess costs and outcomes of cataract surgery by PHACO and by ECCE performed by residents in ophthalmology. Material and Methods: The estimated costs of the procedures include wages, and hospital costs (fees, medicines, medical supplies and equipments). Medical records of patients operated by third-year residents (R3) using PHACO (n=576) and ECCE (n=274) were included in order to collect data on the assessment of visual acuity (VA) before and 6 months after surgery, along with rates of intraoperative complications and total number of postoperative visits. Results: Mean total costs were significantly higher for PHACO (USD 416) than for ECCE (USD 284) (currency exchange for December 30, 2011). The average preoperative VA (logMAR) was worse for eyes submitted to ECCE, 1.73 ± 0.62, than for eyes submitted to PHACO, 0.74 ± 0.54 (p<0.01). Mean postoperative VA was better for PHACO, 0.21 ± 0.36 logMAR than for ECCE, 0.63 ± 0.63 (p<0.01). VA of 0.30 logMAR or better was achieved in 85% of cases for PHACO and in 45% for ECCE (p<0.01). The rate of intraoperative complications was significantly higher for EECC (21%) than for PHACO (7.6%) (p<0.01), and the mean number of postoperative visits was higher for ECCE (5.6 ± 2.3) than for PHACO (4.5 ± 2.4) (p<0.01). Conclusion: Although the average cost of cataract surgery performed by R3 is 46% higher in PHACO when compared with ECCE, the use PHACO by senior residents in ophtalmology showed complication rates three times lower, fewer postoperative visits and, most importantly, better postoperative VA than observed for ECCE.

Objective: To evaluate the relative position of the femur and tibia in cranial cruciate ligament (CCL) intact stifles, CCL deficient stifles, and stifles following a novel extracapsular procedure (lateral extracapsular suture system or LESSa) under load at specific joint angles. Study Design: In vitro biomechanical study. Methods: Twenty pelvic limbs from 11 dogs were used to evaluate the relative position of the femur and tibia between 3 stifle conditions (CCL intact, CCL deficient, and LESSa treated) at a load of 30 % and stifle angles of 125", 135", and 145" using electromagnetic tracking sensors. Results: Cranial cruciate ligament deficient stifles had significantly greater (p <0.0001) cranial displacement and internal rotation of the tibia relative to the femur than CCL intact stifles or LESSa treated stifles at all stifle angles. Cranial displacement of the tibia relative to the femur for CCL intact and LESSa treated were not significantly different from one another at stifle angles of 125", but were significantly different at stifle angles of 135" (p = 0.0182) and 145" (p = 0.0012). There was no significant difference in internal rotation of the tibia relative to the femur between CCL intact and LESSa treated stifles at any of the stifle angles. Conclusion: LESSa effectively decreases cranial tibial displacement and eliminates internal rotation of the tibia relative / Master of Science

Background: About five to 10% of cancers in the head and neck region are neck squamous cell carcinoma of unknown primary (NSCCUP). Their diagnosis and treatment are challenging given the risk of missing occult tumors and potential relapse. Recently, we described human papillomavirus (HPV)-related NSCCUP-patients (NSCCUP-P) as a subgroup with superior survival. However, standardized diagnostic workup, novel diagnostic procedures, decision-making in the multidisciplinary tumor board (MDTB) and multimodal therapy including surgery and post-operative radio-chemotherapy (PORCT) may also improve survival. Methods: For assessing the impact of standardized diagnostic processes simultaneously established with the MDTB on outcome, we split our sample of 115 NSCCUP-P into two cohorts treated with curative intent from 1988 to 2006 (cohort 1; n = 53) and 2007 to 2018 (cohort 2; n = 62). We compared diagnostic processes and utilized treatment modalities applying Chi-square tests, and outcome by Kaplan–Meier plots and Cox regression. Results: In cohort 2, the standardized processes (regular use of [18F]-FDG-PET-CT imaging followed by examination under anesthesia, EUA, bilateral tonsillectomy and neck dissection, ND, at least of the affected site) improved detection of primaries (P = 0.026) mostly located in the oropharynx (P = 0.001). From 66.0 to 87.1% increased ND frequency (P = 0.007) increased the detection of extracapsular extension of neck nodes (ECE+) forcing risk factor-adapted treatment by increased utilization of cisplatin-based PORCT that improved 5-years progression-free and overall survival from 60.4 and 45.3 to 67.7% (P = 0.411) and 66.1% (P = 0.025). Conclusions: Standardized diagnostic workup followed by ND and risk-factor adapted therapy improves survival of NSCCUP-P.