MMed (Otorhinolargngology). Faculty of Health Sciences, University of the Witwatersrand / Introduction The bulk of the surgical literature about laryngeal cancer is concerned with cure rates or five-year survival rates. While this is important, the five year survival rate is only one measure of success of laryngeal cancer surgery. Whereas, postoperative morbidity and mortality are also very important. Pharyngocutaneous fistula (PCF) is the most frequent complication in the early post operative period after total laryngectomy. It creates a communication between the pharynx and the cervical skin or less frequently with the stoma of the tracheostomy. The pharyngeal contents, usually saliva, flow through the fistula emerging from the cutaneous orifice. This study aims to determine the incidence and the predisposing factors for the development of pharyngocutaneous fistula (PCF); and to review the management and outcome of such cases following total laryngectomy at Ear, Nose and Throat (ENT) department, Chris Hani Baragwanath Hospital. Patients and methods This is a retrospective study. The medical records of 30 patients who underwent total laryngectomy surgery for squamous cell carcinoma of the larynx with no local neck metastases between June 2000 and May 2008 were assessed. iii All patients had similar (standard) preoperative and post operative care. I studied a number of factors that could influence pharyngocutaneous fistula formation such as age, smoking habit, alcohol consumption, tumour stage, preoperative tracheostomy, preoperative hemoglobin and associated systemic diseases (gastroesophageal reflux, chronic obstructive pulmonary disease, systemic high blood pressure and diabetes mellitus) Results Pharyngocutaneous fistula appeared in 20% (6/30 patients). Spontaneous closure with local wound care was noted in 5 patients (83.3%), whereas a surgical closure was necessary in one patient . Conclusion The results of our study concluded that pharyngocutaneous fistula remains a troublesome complication of the early post-operative period after total laryngectomy. There are many conflicting reports in the literature concerning the pharyngoctaneuos fistula predisposing factors, but our study data (table 1 page 22) of age, smoking habit, alcohol consumption, tumor stage, preoperative tracheostomy, preoperative hemoglobin and associated systemic diseases( gastroesophageal reflux, chronic pulmonary obstructive disease, systemic high blood pressure and diabetes mellitus) did not show any significant value. Our experience confirmed that most pharyngocutaneous fistulas can be successfully treated conservatively.

Thesis (M.D.)--Columbia College, 1805. / Microform version available in the Readex Early American Imprints series.

Thesis (M.A.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Obstetric Fistula (OF) is a devastating condition, normally caused by obstructed labor, which results in uncontrollable urinary and fecal incontinence and affects thousands of women every year. Most of the women affected by OF reside in small isolated, rural villages, creating challenges to diagnosis and treatment. Due to lack of standardization of therapy approaches, many women undergoing OF-repair often redevelop incontinence or other complications. This paper analyzes both vaginal and abdominal approaches to OF, evaluating their outcomes and the challenges they present. The therapies analyzed are: the Latzko approach, the layered-closure, and the Martius flap procedure. The goal of this paper is to determine which procedure is most appropriate to use for specific types of OF in order to establish therapeutic standardization. This study reviewed a significant amount of literature evaluating all three therapy approaches. It was determined that the Latzko approach should be utilized as the first approach to vesicovaginal fistula (WF) and vesicouterine fistula (VUF) due to its simplicity, avoidance of major operative complications, and successful postoperative repair results. Layered-closure approaches should be refrained from use, unless the Latzko approach is impossible or in specific cases of urethrovaginal fistula. Due to its more extensive operation and post-operative follow-up, the Martius flap procedures should be used only for significantly complex fistulas, such as those that involve multiple organs, are exceptionally large or recurrent. Surgical approaches, however, cannot repair the OF problem on its own, due to a number of challenges and ethical considerations. Therefore, challenges to OF treatment and repair were also considered and analyzed. A final evaluation determined that the creation of permanent infrastructure, such as women's reproductive health and delivery clinics will provide the greatest improvements to the current OF status. By solving problems such as surgeon shortages, cost issues, and the lack of follow-up and mental health services, it was determined that permanent delivery clinics with established transportation methods will produce the most significant reduction of obstructed labor, and therefore OF occurrence, and the most promising OF prevention method as well. / 2031-01-01

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Orientadores: Ângela Cristina Malheiros Luzo, Joaquim Murray Bustorff Silva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T07:41:35Z (GMT). No. of bitstreams: 1 Volpe_BrunoBosch_M.pdf: 3151194 bytes, checksum: afd54e9f5fdcdd55a24ddfa4b90d02a7 (MD5) Previous issue date: 2013 / Resumo: As fístulas enterocutâneas (FE) são de difícil cicatrização e seu tratamento cirúrgico frequentemente falha, fazendo com que a fistula volte a abrir. Estudos recentes têm demonstrado que a terapia celular pode ser uma nova forma de tratamento nesta área. As células tronco mesenquimais (MSCs) são capazes de se auto- renovar tem alta capacidade proliferativa, podendo se diferenciar em várias linhagens celulares. Ainda apresentam capacidade imunomodulatória. A medula óssea, o sangue de cordão umbilical e o tecido adiposo são as principais fontes de MSCs. O tecido adiposo (TA) é de fácil acesso, sendo que o procedimento de lipoaspiração é um procedimento comum. O tratamento de fístulas enterocutâneas com AT-MSCs já foi testado algumas vezes, porém a fístula em sua grande maioria não se fecha totalmente. O objetivo deste estudo foi analisar o potencial terapêutico das MSCs aderidas a fios de sutura no intuito de melhorar a cicatrização e recuperação no tratamento de FE. O TA foi obtido através do procedimento de lipoaspiração. O TA foi submetido ao processo de digestão com colagenase. As células ficaram em meio de cultura DMEM com baixa glicose e com SFB durante 3 dias. Quando atingiram 80% de confluência, as células aderentes foram tratadas com tripsina e ressuspendidas com o meio citado acima. Na 4ª passagem essas células foram caracterizadas com citometria de fluxo, microscopia confocal e diferenciadas nas três linhagens mesodérmicas para confirmação que realmente são MSCs. Após, a confirmação de que as células eram realmente células tronco mesenquimais, elas foram aderidas em fios de sutura de poliglactina (4-0 Poly Vicryl / Poliglactina 910). Foram gotejadas 106 MSCs em cima de cada fio de sutura e logo em seguida foi adicionada a cola de fibrina (20uL Fibrinogênio, 30uL Trombina e 10uL Cloreto de Cálcio) para ajudar na fixação das células. Os fios de sutura com MSCs aderidas ficaram em meio de cultura durante 24 horas para proliferação celular. As amostras foram analisadas por microscopia confocal de imnunofluorescência e eletrônica de varredura. O experimento animal utilizou ratos Wistar com 10 semanas de vida que foram distribuídos em três grupos: Grupo Controle (GC) que incluiu 5 animais onde a formação da fístula foi através de cirurgia sem nenhum tipo de suporte. Grupo Injeção (GI) que incluiu 8 animais que receberam uma injeção de 106 AT-MSCs ao redor do local de formação da fístula. Grupo Sutura (GS) que incluiu 9 animais que receberam sutura de 4-0 Vicryl (poliglactina) com 106 AT-MSCs aderidas com a ajuda de cola de fibrina. Após a exposição do ceco foi realizada enterotomia de 5mm, sendo então realizada a sutura da abertura a abertura da parede abdominal (superfície interna da pele) com 4 pontos separados com 4-0 Vicryl - Poly J-304 Polyglactin 910. No grupo GS, o fio para confecção da fístula, como descrita acima, continha 106 AT-MSCs aderidas. As fístulas foram fotografadas no dia da cirurgia e no 3°, 6°, 9°, 12°, 15°, 17°, 19° e 21° dias, onde foram anestesiados e sacrificados. O tamanho da área da fístula foi mensurado através do software ImageJ. Foram utilizados dois métodos estatísticos para analisar os dados do modelo animal. O primeiro método foi o Two-way Anova, fazendo a análise comparativa da cicatrização entre os três grupos, e o segundo o One-way analysis of variance, fazendo a análise comparativa da cicatrização entre os três grupos nos dias D0, D12 e D21. As microscopias confocal de imunofluorescência e eletrônica de varredura demonstraram a presença de AT-MSCs aderidas aos fios de sutura. No experimento animal mostrou que a média de redução do tamanho da área da fístula no 21º dia foi de 46,54% no GC, 71,80% no GI e 90,34% no GS (p<0,05), demonstrando que as MSCs foram eficazes na cicatrização das fístulas enterocutâneas tanto no grupo que recebeu a injeção de células quanto no grupo que utilizou as células aderidas ao fio de sutura. As MSCs foram capazes de se fixarem nos fios de sutura. Quando as fístulas enterocutâneas receberam a sutura com MSCs aderidas, elas mostraram uma melhor recuperação e cicatrização da fístula. AT-MSCs aderidas a fios de sutura pode ser uma nova e efetiva forma no tratamento de fístulas enterocutâneas / Abstract: Enterocutaneous fistulas (EF) are difficult to resolve and surgical failure is frequent. Cell therapy could be a new approach in this area. Mesenchymal stem cells (MSCs) have high proliferative capacity, can differentiate into several lineages and have immunomodulatory capacity. Adipocyte tissue (AT) is an easy source of them. Enterocutaneous fistula (EF) treatment with MSCs was yet performed but sometimes, the fistula did not close completely. The aim of this study is to analyze if AT-MSCs could attached in the suture filament in order to be used for EF treatment. AT obtained from lipoaspirate procedure was submitted to collagenase digestion. Cells were cultured in DMEM low glucose medium, with FBS during 3 days. At the 4ª passages, cells were characterized by flow cytometry, confocal microscopy, differentiated to mesodermal lineages to confirm MSCs and telomerase enzyme activity and karyotype analysis. The experiments were performed with polyester suture filament. MSCs, 106 cells, were fixed in the suture filament by adding fibrin glue.Filaments was led in the medium described above during 3 days. Samples were analyzed by confocal and scanning electron microscopy. The animal experiments were performed on 10 weeks old male Wistar rats divided into 3 groups. Control Group (CG): 5 animals undergoing fistula formation alone. Injection Group (IG):8 animals receiving 106 AT-MSCs injected around the suture line. Suture Filament Group (SG): 9 animals in which suture were performed using 4-0 Vicryl with 106 MSCs attached in the filament with fibrin glue. The cecum was accessed through a standard 7mm stab incision on the lower left side of the abdomen. Upon exposure, a 5mm enterotomy was performed and sutured to the abdominal wall in order to produce the fistula. To ensure normal closure of the fistula the opening in the cecum wall was fixed to the internal surface of the skin, without maturation, using four separate 4-0 Vicryl stitches (Poly J-304 Polyglactin 910 Ethicon). The fistulas were photographed on the day of operation and on the 3°, 6°, 9°, 12°, 15°, 17°, 19° and 21° day, in which they were anesthetized and sacrificed. Measure of the size of the fistula was performed using ImageJ software. Statistic comparison between the groups was performed by ANOVA. Confocal and scanning electronic microscopy results demonstrated that the cells were able to attach to the suture filaments. Animal experiments showed that the average size reduction of the fistula area at 21th day was: control group, 46.54%; injected group 71.80% and sutured group 90.34% (p<0,05). MSCs were able to attach to the suture filaments. When the fistulas were sutured with filaments containing MSCs they showed better recovery and healing than the injected and control group. Adipocyte tissue MSCs adhered to suture filament might be a new and effective approach for enterocutaneus fistulas treatment / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Introduction: Haemodialysis arterio-venous fistula aneurysm (AAVF) prevalence varies between 7-43%. When they are symptomatic, they should be referred for treatment. It is unclear which is the optimal surgical treatment and if fistula flow reduction is beneficial for heart remodeling in patients with high-flow AAVF. Aims: (1) introduction of a new surgical technique - aneurysmorrhaphy using exoprothesis (AuE) and evaluation of its patency and complication rates. (2) analysis of flow reduction impact on heart remodeling in high-flow AAVF. (3) systematic review and meta- analysis of various surgical techniques to identify the best treatment option of haemodialysis arterio-venous fistula aneurysm. Methods: (1) retrospective analysis with prospectively collected surgical and postoperative data, patency evaluation using Kaplan - Meier curve, early and late complication rates analysis. (2) retrospective analysis prospectively collected echocardiographic parameters before and after surgery. (3) systematic review and meta- analysis following the PRISMA guidelines - registered in the international prospective register of prospective reviews PROSPERO (registration number: CRD42016029692). Results: (1) primary assisted patency rate at 12 months was 80 %, infection rate was 4.5 % and AAVF recurrence rate was 0...

No description available.

Background: Perianal fistulae are common and cause significant symptoms and psychosocial morbidity. Current theory suggests two distinct types: idiopathic (no established cause) and secondary, which usually arise from Crohn's disease. Research to date has assumed that idiopathic and Crohn's perianal fistulae differ in their pathogenesis and pathophysiology. This fundamental hypothesis has not yet been adequately tested. We therefore aimed to test the broad hypothesis that idiopathic and Crohn's perianal fistulae differ in their pathogenesis and pathophysiology. Methods: We prospectively recruited a cohort of 61 participants (48 idiopathic, 13 Crohn's disease) and phenotyped them in detail using clinical assessment, Perineal Disease Activity Index, EQ-5D-5L, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), operative assessment, biopsy, and clinical follow-up. We interrogated the biopsy samples in the laboratory to characterize their profiles for 30 cytokines and 39 phosphoproteins. Over 12,000 clinical and 23,500 laboratory measurements were made. Results: We found no clear differences in the clinical characteristics or the overall cytokine or phosphoprotein profiles between idiopathic and Crohn's perianal fistulae. We also found no differences in the DCE-MRI measurements between the groups. Conclusions: We did not find good evidence to support our hypothesis. The alternative hypothesis offers a shift in the current research paradigm: idiopathic and Crohn's perianal fistulae are the same pathology on a spectrum across which the pathogenic and pathophysiological features are distributed in a skewed manner. This may be the key to unravelling our understanding of the disease's aetiology. It would also be a construct within which trials of biological therapy, such as infliximab, could be justified for idiopathic disease.

No description available.

SILVA, Leonira Morais da. Galactomanana de sementes de Cassia fistula: extração, caracterização e modificação. Um potêncial substituínte da galactomanana da Locusta bean. 2012. 90 f. Dissertação (mestrado em química)- Universidade Federal do Ceará, Fortaleza-CE, 2012. / Submitted by Elineudson Ribeiro (elineudsonr@gmail.com) on 2016-04-01T20:16:00Z No. of bitstreams: 1 2016_dis_lmsilva.pdf: 3372290 bytes, checksum: 7c141eef34955db9ed557b801296e729 (MD5) / Approved for entry into archive by José Jairo Viana de Sousa (jairo@ufc.br) on 2016-05-20T17:40:51Z (GMT) No. of bitstreams: 1 2016_dis_lmsilva.pdf: 3372290 bytes, checksum: 7c141eef34955db9ed557b801296e729 (MD5) / Made available in DSpace on 2016-05-20T17:40:51Z (GMT). No. of bitstreams: 1 2016_dis_lmsilva.pdf: 3372290 bytes, checksum: 7c141eef34955db9ed557b801296e729 (MD5) Previous issue date: 2012 / The demand for biodegradable materials extracted from renewable sources that have high performance and lower cost is increasingly growing. The galactomannan extracted from Cassia fistula seeds was characterized by several methodologies: Elemental Analysis; Protein content; Uronic acid content; Gel Permeation Chromatography (GPC); Intrinsic Viscosity; Rheological Studies;Turbidity; Thermogravimetry; Infrared and 1H, 13C NMR. The yield of the extraction was 26.5 % m/m. The values obtained for protein content, humidity and uronic acid content were: 2.5%, 11.9% and 3.6% respectively. The values of molar weight (Mw = 2.2 x106g/mol) and intrinsic viscosity (9.73 dL/g) found for GCF were close to those from locusta bean galactomannan. For galactomannan of locusta bean is the second galactomannan commercializes most in the world, for this reason a comparative between GCF was done andGLB. The rheological analysis showed that GCF solutions exhibited pseudoplastic behavior at concentrations higher than 1%. Thermogravimetry analysis for GCF showed three events: 1° related to water loss; 2° related to matter decomposition and the 3° related to loss of organic matter which is more resistant to degradation. The infrared spectrum showed characteristic bands for polysaccharide and the 1H and 13C NMR spectra showed galactomannan characteristic peaks. The ratio mannose/galactose of GCF determined by 1H NMR spectrum analysis was 3.2, value close to that one from locusta bean galactomannan. The GCF was modified by reacting with sodium periodate at several concentrations to obtain the modified polysaccharide with oxidation degrees of: 10%; 20%; 50%; 65% and 80% [(periodate molar rate/glycosidic unities) x100]. The yield values obtained for the reactions were around 70% w/w. The oxidated materials were characterized by Rheology; GPC and 1H ,13C NMR. It was observed a decrease of molar mass (Mw) of 2.3 x 106 g/mol (GCF) to 6.4 x 104 g/mol (GCFO10%). As the degree of oxidation increases there is a reduction of the molecular weight, confirming that there was a degradation of the polymeric chain by the oxidation reaction with sodium periodate. The rheological analysis for 1% (w/v) non-modified GCF solutions and of GCFOX’s showed a reduction of apparent viscosity with oxidation degree increase (at 596 s-1): of 60.0 mPa.s (GCF) to 14 and 1.7 mPa.s (GCFO10) and 80%, respectively. The 1H NMR spectra showed for samples until 20% a few signals on anomeric range, when compared with samples with oxidation degree higher than 50 %. The ratio Man/Gal increased from 3.2 for the original sample to 3.3 and 4.6 for those samples of 10 and 20%, respectively. That increase means that the oxidation takes place preferably at the galactose units. / A procura por materiais biodegradáveis, extraídos de fontes enováveis que apresentem alto desempenho e um menor custo é cada vez mais rescente. A galactomanana extraida das sementes de Cassia fistula (GCF) foi caracterizada através das análises elementar; teor de proteína; teor de ácido urônico;cromatografia de permeação em gel; viscosidade intrinseca; estudos reológicos; turbidez; análise termogravimétrica; espectroscopica na região do infravermelho e RMN de 1H e 13C. O rendimento da extração foi de 26,5 % em massa. Os valores de teor de proteína, umidade e ácido urônico obtidos foram de 2,5%, 11,9% e 3,6%, respectivamente. O valor da massa molar média (Mw) (2,2 x 106 g/mol) e viscosidade intríseca (9,73 dL/g) encontrado para GCF foram próximos aos valores encontrados para galactomanana de locusta bean. As análises reológicas mostraram que as soluções de GCF apresentam comportamento pseudoplático em concentrações acima de 1% m/v. Na análise termogravimétrica a amostra de GCF apresentou três eventos, o 1° referente à perda de água; o 2° evento referente à decomposição da matéria e o 3° evento referente à perda da matéria orgânica mais resistente a degradação. O espectro de infravermelho mostrou bandas características de polissacarídeo e os espectros de RMN de 1H e 13C mostraram picos característicos de galactomanana. A razão manose/galactose da GCF determinado pelo espectro de RMN de 1H foi de 3,2 razão próxima a galactomanana de locusta bean (GL). A galactomanana da locusta bean é a segunda galactomanana mais comercializada no mundo, por essa razão foi feito um comparativo entre a GCF e a GL. A GCF foi modificada através da reação com periodato de sódio em várias concentrações para obter o polissacarídeo modificado com graus de oxidação de 10%; 20%; 50%; 65% e 80% [(razão molar de periodato/unidades glicosídicas)x100]. Os valores obtidos do rendimento das reações foram em torno de 70% em massa. Os materiais oxidados foram caracterizados através das análises reológicas, por GPC e RMN 1H e 13C. Observa-se uma diminuição da massa molar (Mw) de 2,3 x 106 g/mol da GCF para 6,4 x 104 g/mol da galactomanana de Cassia fistula oxidada a 10% GCFO10%).A medida que aumenta o grau de oxidação ocorre uma redução da massa molar, confirmando que houve uma degradação da cadeia polimérica pela reação de oxidação com o periodato de sódio. A análise reológica de soluções 1% (m/v) de GCF não modificada e das galactomananas de Cassia fístula oxidadas (GCFOX’s) mostrou uma redução da viscosidade aparente com o aumento do grau de oxidação: de 60,0 mPa.s da GCF para 14 e 1,7 mPa.s da GCFO10% e GCFO80%, respectivamente. Os espectros de RMN 1H mostraram que para as amostras com o grau de oxidação até 20% aparecem poucos novos sinais na região de anomérico, quando comparados com as amostras com grau de oxidação acima de 50%. A razão Man/Gal aumenta de 3,2 da amostra original para 3,3 e 4,6 nas amostras de 10 e 20%, respectivamente. Esse aumento indica que a oxidação ocorre preferencialmente nas unidades de galactose.