O cuidador familiar é aquela pessoa da família com ou sem experiência na área da saúde, que assume os cuidados ao familiar no domicílio, ajudando-o a suprir suas necessidades proporcionando conforto, lazer e garantindo o bem-estar a pessoa necessitada. Neste sentido este estudo caracteriza o cuidador familiar de pacientes submetidos à cirurgia gastro-intestinal de grande porte quanto a idade, sexo, religião, parentesco, estado marital, ocupação, grau de instrução e também quanto a pessoa que ajuda, experiências anteriores e tempo de dedicação aos cuidados. Outro objetivo proposto foi identificar os cuidados realizados no domicílio pelos cuidadores familiares quanto a higiene e conforto, sono e repouso, cuidados com a pele, cuidados com sondas e/ou drenos e/ou catéteres e/ou bolsas coletoras, alimentação e hidratação, eliminações intestinal e urinária, administração de medicamentos, atividade física e de lazer. Identifica, ainda, a utilização de materiais e equipamentos, bem como de adaptações feitas no ambiente físico no domicílio do doente e o uso de terapias complementares desenvolvidas para a realização do cuidado. Por fim, identifica as vias de contato utilizadas pelos cuidadores familiares voltadas para esclarecimento de dúvidas. É um estudo do tipo descritivo, exploratório, correlacional, de campo, longitudinal com abordagem quantitativa, constando de uma amostra de 15 cuidadores que residiam no município de São Paulo, tinham como cuidador principal alguém da família e concordavam em participar do estudo. Os dados foram coletados pela pesquisadora no período de janeiro a abril de 2001 no domicílio dos doentes em dois momentos, sendo o primeiro entre o 2o e 4o dia após a alta hospitalar e o segundo entre o 10o e 12o dias. O estudo mostrou que os cuidadores familiares deixaram de lado suas atividades profissionais ou não, para estarem disponíveis ao familiar durante o dia e a noite, realizando atividades até então só observadas durante a internação hospitalar. Durante as entrevistas constatou-se estarem inseguros, com dúvidas no cuidar, sozinhos, indecisos, inseguros, com dúvidas no cuidado, mas permaneciam firmes superando todos os obstáculos. / The familiar caregivers is the person from the family with or without experience in the health area that assumes the cares to the family in the home, helping her/him to provide their needs giving comfort, spare time and assuring the person well being. In this course this study characterizes the family caregiver of patients underwent to a large gastrointestinal surgery related to age, sex, religion, relationship, marital status, occupation, education level and about the person that care, her/his previous experiences and period of dedication to the cares. Another proposed aim was to identify the achieved cares in the home by family caregivers regarding to the hygiene and comfort, sleep and rest, skin cares, probe and/or drain and/or catheter and/or collect bag, nutrition and hydration, urinary and intestinal elimination, medicine administration, physical and spare time activities This study identifies yet the use of material and equipments as well as adaptation realized in the physical environment. In the patient home and the use of complementary therapies developed for the care realization. At last it identifies the contact ways used by family caregivers turned to the doubts explanation. It is a descriptive, exploratory, co-relational and longitudinal study, of field, with quantitative approach, consisting of a sample of 15 caregivers that lived in São Paulo City and that have as a main caregiver the family member and they agreed with participate of this study. Researcher collected the data in the period from January to April 2001, on patients home in two moments, being the first between the 2th and 4th day after the discharge from hospital. The second moment occurs between the 10th and 12th days. The study showed that the family caregivers have laid aside their professional activities or not aiming to be available to the family during the day and the night, realizing activities up until then only observed during the nosocomial admission. During the interviews it was verified that the caregivers were alone, hesitant, insecure, with doubts about the care, they have no one to help them, but they stay resolute to overcome difficulties.

Les rotavirus et les norovirus sont les principaux agents étiologiques des gastro-entérites en Tunisie. Pendant l’hiver 2011-2012, nous avons collecté les selles et les salives de 114 enfants âgés de moins de 6 ans, souffrant de gastro-entérites et admis à l’Hôpital Fattouma Bourguiba de Monastir. L’analyse des salives a montré que la cohorte se répartissait entre 79% de sécréteur et 21% de non-sécréteur (absence d’antigène dans les salives). Parmi les sécréteurs, les individus du groupe O étaient les plus représentés (42%) suivis des groupes A (30%), B (21%) et AB (7%) alors que 96% des patients étaient positifs pour l’antigène Lewis. Pour 98 patients, l’analyse génétique du sang a montré que le gène FUT2 se répartissait entre 77.6% de sécréteur (Se+/Se+ et Se+/se-) et 22.4% de non-sécréteurs (se-/se-, N=22).L’analyse des fèces a montré que les rotavirus et les norovirus étaient responsables respectivement de 22% et 31% des cas, les infections mixtes représentant 6% des cas. Parmi les norovirus, le génotype GII.3 était prédominant (69% de tous les NoV) tandis que le génotype G9P[8] était le plus fréquemment détecté de tous les rotavirus (37,5%). Les rotavirus ont été détectés chez les individus sécréteurs (N=28) mais aussi chez 4 patients non-sécréteurs (3 souches G9P[8] et une souche G3P[8]). Nous n’avons pas observé de distribution particulière des rotavirus en fonction des antigènes A, B et H parmi les enfants sécréteurs. En revanche, nous avons constaté que l'infection à rotavirus ne s’était produite que chez les individus positifs pour l’antigène Lewis (P=0.017). La présence de génotype P[8] chez des non-sécréteurs est inédite, elle a été confirmée par le séquençage du segment correspondant à VP8* de ces rotavirus.La majorité des infections à norovirus a été détectée chez les patients sécréteurs et cela sans distribution particulière en fonction des antigènes A, B, H et Lewis. Cinq GII.3, un GII.1 et un norovirus de génotype GII.7 ont été détectés chez les non-sécréteurs, Lewis-positifs. La production de particules de synthèse (VLP) de norovirus GII.3 en baculovirus à partir des selles d’un des patients non-sécréteurs nous a permis de tester les échantillons salivaires de toute la cohorte. L’absence d’attachement de ces VLP sur les salives des non-sécréteurs montre que la présence ou l’absence des antigènes de groupe ne reflète pas nécessairement le pouvoir infectieux des norovirus chez les jeunes enfants. Les résultats obtenus sur les rotavirus et les norovirus suggèrent qu’ils existent des voies alternatives aux antigènes de groupe sanguin pour l’attachement des rotavirus et des norovirus dans l’intestin. / Rotavirus and norovirus are the main aetiological agents of gastroenteritis in Tunisia. Stool specimens and saliva were collected from children younger than 6 years of age, admitted to the Fattouma Bourguiba Hospital (Monastir, Tunisia) for gastroenteritis during the winter 2011-12. Saliva analysis showed that 79% and 21% patients had secretor and non-secretor phenotypes, respectively. Group O blood type was predominant (42%) followed by groups A (30%), B (21%) and AB (7%), whilst 96% of the patients were positive for Lewis antigen. For 98 patients, blood samples were available and were used for FUT2 genotyping. 77.6% of the cohort were secretor (Se+/Se+ and Se+/se-) and 22.4% were non-secretor (se-/se-).Rotavirus and norovirus were found alone in 22% and 31% of the stool specimens, respectively. Mixed rotavirus-norovirus infections accounted for 6% of the cases. GII.3 noroviruses were predominant among the noroviruses whilst the G9P[8] genotype was predominant for the rotaviruses.Rotaviruses were detected in secretor (N=28) as well as in non-secretor individuals (three G9P[8] strains and one G3P[8]). No significant association was found between ABO antigens or the secretor status and RV infection. Inversely, we observed that RV infection always occurred in Lewis-positive patients (P=0.017). The presence of the P[8] genotype was confirmed by sequencing part of the VP8* coding region.There was no significant association between norovirus infection and ABO antigens and the FUT2 genotype. Five GII.3, one GII.1 and one GII.7 noroviruses were found in Lewis-positive non-secretor patients. Virus-like particles from a GII.3 norovirus infecting a non-secretor patient from the cohort were expressed in baculovirus and used for binding assay with the 114 saliva samples of the study group. VLP binding with non-secretor saliva was negative and suggested that saliva binding assay might not reflect norovirus infectivity. Overall, our data suggested that rotavirus and norovirus infection might involve non-HBGA binding pathways as well as the canonical HBGA ligands.

This diploma thesis focuses on the description of a chosen gastro-intestinal disease - colorectal carcinome, unspecified chronic intestinal infections, and ulcerous gastroduodenal disease. It pursues the causes, symptoms, diagnosis, treatment, and most attention is given to the prevention of a chosen disease in gastro-intestinal tract. Concerning prevention, it focuses also on nutrition because that is what plays a significant role in keeping human population healthy. The empiric part of the thesis has been processed using a qualitative research survey, using the method of an in-depth semi-standardized interview. The first research group was formed by healthy individuals. The second research group was formed by nurses working with a practical doctor at the internal department and at the gastro-enterological department. The third research group was formed by patients suffering from gastroduoenal disease. The fourth research group was formed by patients sufferring from non-specific chronic intestinal infections. The fifth research group was formed by patients suffering from colorectal carcinome. The obtained results have proven that people know what a healthy lifestyle is, but compliance to it is rather difficult. One of its positive effects is that most people get their medical check-up regularly. The research group of ill individuals proves that the area of terciary or quarterly prevention is not made clear to the probands. The nurses´ research group has proven the fact that the prevention area is not made properly clear to the nurses, thus they do not provide the patients with sufficient information about their illness. This diploma thesis should aim at nurses and make sure they do not ignore the necessity of gastro-intestinal disease preention. T inform patients about options of prevention they have available. Patients themselves also need to realize how important their health is in their lives. Research survey results have been processed to form an information brochure meant for gastro-intestinal disease patients. To deepe knowledge about this issue we suggest offering the obtained results to be published in an expert magazine called Gastroenterology and Haemathology - Czech Gastroenterological Society.

La rupture spontanee de l'oesophage (RSO), le syndrome Boerhaave - une<br />pathologie rare, mais avec une haute mortalite, et, selon les donnees des differents<br />auteurs, varie entre 21 % et 67 %.<br />Les tentatives de reproduire experimentalement le mecanisme de la rupture<br />de l'oesophage etaient entreprises par differents auteurs, mais a chaque fois les<br />conditions experimentales se distinguaient. Toutes les etudes n'etaient pas a notre<br />avis tout a fait correctes sur le plan du mecanisme d'influence sur la paroi de<br />l'oesophage. Premierement, la rupture de l'oesophage se provoque par<br />augmentation de la pression hydraulique, deuxiemement, il est necessaire de<br />prendre en consideration non seulement les particularites anatomiques de<br />l'oesophage et du hiatus oesophagien du diaphragme, mais aussi l'etat de la<br />muqueuse de l'oesophage chez les cadavres humains.<br />Malgre les succes atteints en chirurgie de l'oesophage, on constate toujours<br />un haut pourcentage de l'inconsistance des sutures chez les malades ayant une<br />RSO, 30-50 %. A notre avis cela est lie a l'absence de la prevention du reflux<br />gastro-oesophagien et de la prevention de la precarite des sutures de l'oesophage.<br />Cette these est consacree a la definition des facteurs du risque de la rupture<br />spontanee de l'oesophage et l'amelioration des resultats de son traitement.

<p>The extension of laparoscopic procedures into the chest may induce specific pathophysiologic effects.</p><p>In pigs, we have demonstrated how devastating a combined thoraco-laparoscopic approach can be for gas exchange. Furthermore, the transmission of elevated pressure intra-cranially is a potential danger. The application of positive end-expiratory pressure (PEEP) was found to improve gas exchange and, more importantly, hypoxemia could be avoided. The application of PEEP did not increase intra-cranial pressure further; nor did it adversely affect cerebral circulation.</p><p>Even before the introduction of the laparoscopic technique, there was a substantial increase in the annual number of antireflux procedures. Therefore, the threefold increase of the incidence of antireflux surgery recorded during the past decade cannot solely be explained by the introduction of minimal access surgery. However, a clear shift in the preferred methodology took place. This change was not scientifically supported at the time of the transition and, surprisingly, it is still not supported today. In comparison with open surgery, patients do not seem to derive significant long-term benefits from having the antireflux procedure done laparoscopically. As was demonstrated, laparoscopy might even be an inferior approach in some patients. Nevertheless, it is reasonable to assume that laparoscopy can yield equally good results as open surgery despite our failure to confirm that in our studies. Determination of the effectiveness of minimal access surgery in the treatment of GORD is critical, before minimal access techniques become the standard for antireflux surgery in the community.</p>

The extension of laparoscopic procedures into the chest may induce specific pathophysiologic effects. In pigs, we have demonstrated how devastating a combined thoraco-laparoscopic approach can be for gas exchange. Furthermore, the transmission of elevated pressure intra-cranially is a potential danger. The application of positive end-expiratory pressure (PEEP) was found to improve gas exchange and, more importantly, hypoxemia could be avoided. The application of PEEP did not increase intra-cranial pressure further; nor did it adversely affect cerebral circulation. Even before the introduction of the laparoscopic technique, there was a substantial increase in the annual number of antireflux procedures. Therefore, the threefold increase of the incidence of antireflux surgery recorded during the past decade cannot solely be explained by the introduction of minimal access surgery. However, a clear shift in the preferred methodology took place. This change was not scientifically supported at the time of the transition and, surprisingly, it is still not supported today. In comparison with open surgery, patients do not seem to derive significant long-term benefits from having the antireflux procedure done laparoscopically. As was demonstrated, laparoscopy might even be an inferior approach in some patients. Nevertheless, it is reasonable to assume that laparoscopy can yield equally good results as open surgery despite our failure to confirm that in our studies. Determination of the effectiveness of minimal access surgery in the treatment of GORD is critical, before minimal access techniques become the standard for antireflux surgery in the community.

Quattro diversi esperimenti sono stati eseguiti per investigare i fattori che influenzano la fermentazione ruminale delle diete altamente fermentescibili e per sviluppare un modello per studiare la permeabilità gastro-intestinale nei ruminanti. Nello studio 1, quattro ibridi di mais sono stati valutati per la digeribilità ruminale delle loro frazioni. I risultati suggeriscono che i genotipi e le fasi di maturità influenzano fortemente la digeribilità della sostanza secca e dell’amido nel rumine. Nello studio 2, i risultati della fermentazione in vitro di diversi zuccheri ha rivelato che il lattulosio può essere uno zucchero indicatore per studiare la permeabilità intestinale nei ruminanti, grazie alla sua bassa fermentescibilità ruminale. Nello studio 3, per la prima volta un modello di enteropatia indotta da indometacina è stato utilizzato per valutare nei ruminanti la permeabilità dell’intestino tenue attraverso il test del lattulosio. I risultati mostrano che il lattulosio è passato dall'intestino al sangue modificando alcuni parametri metabolici e dell'infiammazione. Nello studio 4, una acidosi acuta è stata indotta in pecore per testare la permeabilità gastro-intestinale con il test del lattulosio. I risultati hanno dimostrato che l'acidosi acuta compromette il funzionamento della barriera gastro-intestinale consentendo l'assorbimento e la traslocazione di LPS e altre sostanze nocive e incrementa l'infiammazione. / Four different experiments were performed for the better understanding of the factors that affect rumen fermentation of highly fermentable diets and to develop a model to study GI permeability in ruminants. In study 1, four corn hybrids recommended for corn silage were evaluated for ruminal starch digestibility of their grain fractions. Results suggest that the genotypes and maturity stages greatly influenced the DM and starch digestibility in rumen. In study 2, the results of the in vitro rumen fermentation of different naturally occurring and synthetic sugars revealed that lactulose can be a good probe sugar to study GI tract permeability in ruminants due to its low and slow fermentation rate in rumen. In study 3, for the first time an indomethacin-induced enteropathy model was used in ruminants to assess small intestinal permeability by the lactulose test. The results established that lactulose passed from the intestine to blood with perturbation of some metabolic parameters and inflammation. In study 4, acute acidosis was induced in sheep to test GI permeability during acidosis condition by lactulose test. The results demonstrated that acute acidosis impair the GI barrier function which allow absorption and translocation of LPS and other harmful substances and increase inflammation.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2007. / Titre provenant de l'écran-titre. 74 f. : ill. Bibliogr. f. 71-74.

Th.--Méd.--Nancy 1, 1984. N°: 73.

O cuidador familiar é aquela pessoa da família com ou sem experiência na área da saúde, que assume os cuidados ao familiar no domicílio, ajudando-o a suprir suas necessidades proporcionando conforto, lazer e garantindo o bem-estar a pessoa necessitada. Neste sentido este estudo caracteriza o cuidador familiar de pacientes submetidos à cirurgia gastro-intestinal de grande porte quanto a idade, sexo, religião, parentesco, estado marital, ocupação, grau de instrução e também quanto a pessoa que ajuda, experiências anteriores e tempo de dedicação aos cuidados. Outro objetivo proposto foi identificar os cuidados realizados no domicílio pelos cuidadores familiares quanto a higiene e conforto, sono e repouso, cuidados com a pele, cuidados com sondas e/ou drenos e/ou catéteres e/ou bolsas coletoras, alimentação e hidratação, eliminações intestinal e urinária, administração de medicamentos, atividade física e de lazer. Identifica, ainda, a utilização de materiais e equipamentos, bem como de adaptações feitas no ambiente físico no domicílio do doente e o uso de terapias complementares desenvolvidas para a realização do cuidado. Por fim, identifica as vias de contato utilizadas pelos cuidadores familiares voltadas para esclarecimento de dúvidas. É um estudo do tipo descritivo, exploratório, correlacional, de campo, longitudinal com abordagem quantitativa, constando de uma amostra de 15 cuidadores que residiam no município de São Paulo, tinham como cuidador principal alguém da família e concordavam em participar do estudo. Os dados foram coletados pela pesquisadora no período de janeiro a abril de 2001 no domicílio dos doentes em dois momentos, sendo o primeiro entre o 2o e 4o dia após a alta hospitalar e o segundo entre o 10o e 12o dias. O estudo mostrou que os cuidadores familiares deixaram de lado suas atividades profissionais ou não, para estarem disponíveis ao familiar durante o dia e a noite, realizando atividades até então só observadas durante a internação hospitalar. Durante as entrevistas constatou-se estarem inseguros, com dúvidas no cuidar, sozinhos, indecisos, inseguros, com dúvidas no cuidado, mas permaneciam firmes superando todos os obstáculos. / The familiar caregivers is the person from the family with or without experience in the health area that assumes the cares to the family in the home, helping her/him to provide their needs giving comfort, spare time and assuring the person well being. In this course this study characterizes the family caregiver of patients underwent to a large gastrointestinal surgery related to age, sex, religion, relationship, marital status, occupation, education level and about the person that care, her/his previous experiences and period of dedication to the cares. Another proposed aim was to identify the achieved cares in the home by family caregivers regarding to the hygiene and comfort, sleep and rest, skin cares, probe and/or drain and/or catheter and/or collect bag, nutrition and hydration, urinary and intestinal elimination, medicine administration, physical and spare time activities This study identifies yet the use of material and equipments as well as adaptation realized in the physical environment. In the patient home and the use of complementary therapies developed for the care realization. At last it identifies the contact ways used by family caregivers turned to the doubts explanation. It is a descriptive, exploratory, co-relational and longitudinal study, of field, with quantitative approach, consisting of a sample of 15 caregivers that lived in São Paulo City and that have as a main caregiver the family member and they agreed with participate of this study. Researcher collected the data in the period from January to April 2001, on patients home in two moments, being the first between the 2th and 4th day after the discharge from hospital. The second moment occurs between the 10th and 12th days. The study showed that the family caregivers have laid aside their professional activities or not aiming to be available to the family during the day and the night, realizing activities up until then only observed during the nosocomial admission. During the interviews it was verified that the caregivers were alone, hesitant, insecure, with doubts about the care, they have no one to help them, but they stay resolute to overcome difficulties.