In der Veterinärmedizin wird sich in zunehmenden Maße der Vorteil besserer Ultraschalldiagnostik zunutze gemacht. Die Anschaffung der entsprechenden Technik ist aber oft mit einem hohen finanziellen Aufwand verbunden. Die vorliegende Untersuchung zeigt jedoch, daß mit Hilfe von normaler Sonographietechnik eine Erweiterung der diagnostischen Mittel möglich ist. In der vorliegenden Untersuchung konnte die intraoperative Ultraschalluntersuchung der Leber und der Gallenblase bei allen Rindern durchgeführt werden. Dabei sind fast immer alle Anteile der Leber und der Gallenblase zugänglich. Wichtig ist bei der intraoperativen Sonographie das Aufsetzen der Sonde mit dem minimal nötigen Druck, um das Parenchym und die Gefäße nicht zu komprimieren. Sowohl transkutan als auch intraoperativ konnte anhand der sonographisch erhobenen Parameter eine gute Einteilung in die drei Grade der Leberverfettung vorgenommen werden. Intraoperativ besteht jedoch generell die Möglichkeit, Sonden mit besseren Auflösungsvermögen verwenden zu können. So konnte bei der intraoperativen Beurteilung des Leberparenchyms zur Differenzierung der Grade der Leberverfettung einen leichte Überlegenheit der Bilder der 7,5 MHz Sonde, gegenüber der 3,0 MHz Sonde gefunden werden. Auch NICOLL et al. (1998) können bei ihren transkutan durchgeführten Untersuchungen zur qualitativen Sonographie der Fettleber der Katze eine, wenn auch nur subjektiv, bessere Differenzierungsmöglichkeit mit dem 7,5 gegenüber der 5,0 MHz Sonde feststellen. Eine Ursache für das Ausbleiben einer überragenden Verbesserung der intraoperativen gegenüber der transkutanen Fettleberdiagnostik wird darin gesehen, daß trotz der eindeutig besseren Bildqualität das Problem der subjektiven Beschreibung der Sonogramme dasselbe wie transkutan ist. Auch wird festgestellt, daß in der vorliegenden Arbeit die Prävalenz der Leberverfettung dritten Grades gegenüber den beiden geringeren Verfettungsgraden hoch ist. Dadurch wurde die Auswertung erschwert. Die Untersuchung der labordiagnostischen Parameter (AST, Bilirubin, Cholesterol, GLDH) erbrachte in der vorliegendem Untersuchung vergleichbare, gute Ergebnisse in der Differenzierung der Leberverfettung. Bei dem hier Dargelegten ist aber zu berücksichtigen, daß mit Hilfe der Ultraschalluntersuchung und teilweise auch der Laboruntersuchung lediglich diffuse Leberschäden ohne ätiologische Diagnose erkannt werden können, denn in der vorliegenden Arbeit konnte nur deshalb sicher von einer Leberverfettung ausgegangen werden, weil diese durch die histologische Untersuchung der Bioptate bestimmt worden war. Anhand der vorliegenden Untersuchungsergebnisse können die Laboruntersuchung und auch die transkutane Sonographie als vergleichbar gute Diagnostika für die Erkennung einer Leberverfettung angesehen werden. Jedoch sollte im Falle einer ohnehin nötigen Laparotomie eine intraoperative Leberuntersuchung, das heißt eine Palpation durchgeführt werden. Bei unklaren palpatorischen Befunden kann die IOUS genutzt werden. Der besondere Wert der intraoperativen Sonographie liegt in der Möglichkeit, auf einfachem Wege bei fehlendem oder nur suspekten Inspektions- und Palpationsbefund einen pathologischen Prozeß nachzuweisen oder auszuschließen (RÜCKERT u. KLOTTER 1986).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Dissertation (Ph.D.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 107 pages. Includes vita. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2006. / Härtill 5 uppsatser.

Zugl.: Aachen, Techn. Hochsch., Diss., 2008

Submitted by Larissa Lucas null (la.lucas@hotmail.com) on 2018-04-04T18:11:34Z No. of bitstreams: 1 LARISSA_DISSERTAÇÃO_FINAL.pdf: 656109 bytes, checksum: 201ec7a6f91159d093e4d4c83f3e85b1 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-04-06T13:50:16Z (GMT) No. of bitstreams: 1 lucas_l_me_bot.pdf: 656109 bytes, checksum: 201ec7a6f91159d093e4d4c83f3e85b1 (MD5) / Made available in DSpace on 2018-04-06T13:50:16Z (GMT). No. of bitstreams: 1 lucas_l_me_bot.pdf: 656109 bytes, checksum: 201ec7a6f91159d093e4d4c83f3e85b1 (MD5) Previous issue date: 2018-02-23 / Objetivo: Determinar se o treinamento prévio no simulador de cirurgia de catarata Eyesi diminui a ocorrência de complicações intraoperatórias nas primeiras cirurgias de catarata por facoemulsificação realizadas por residentes de oftalmologia. Métodos: Foi realizado um estudo retrospectivo no qual foram avaliadas as dez primeiras cirurgias de catarata realizadas por dois grupos de residentes do segundo ano (R2) de Oftalmologia no Hospital das Clínicas de Botucatu – UNESP. O primeiro grupo (G1) foi composto por R2 que não tiveram treinamento prévio no simulador. O segundo grupo (G2) foi formado por R2 que realizaram treinamento no simulador antes de iniciarem as cirurgias nos pacientes. Foi avaliada a ocorrência das principais complicações cirúrgicas intraoperatórias. Os dois grupos foram comparados e os resultados foram submetidos a análise estatística. Resultados: O número total de complicações foi de 19 (27%) no G1 e nove (12,86%) no G2, essa diferença foi significativa (p=0,031). Quatorze (20%) cirurgias de G1 e sete (10,00%) de G2 apresentaram complicações; a rotura de cápsula posterior ocorreu em 13 (18,57%) cirurgias do G1 e sete (10,00%) do G2; fragmentos de núcleo no vítreo ocorreram em três cirurgias (4,29%) do G1 e em uma cirurgia (1,43%) do G2; a conversão para FEC foi necessária em duas cirurgias (2,86%) do G1 e em uma cirurgia (1,43%) do G2. Conclusão: O treinamento prévio no simulador de cirurgias de catarata Eyesi reduziu significativamente o número total de complicações intraoperatórias nas dez primeiras cirurgias de catarata por facoemulsificação realizadas por residentes de oftalmologia em treinamento. / Purpose: To determine if previous training with the Eyesi® cataract surgery simulator decreases intraoperative complications rates from the first phacoemulsification surgeries performed by residents. Methods: A retrospective analysis of the ten first cataract surgeries performed by two groups of second-year residents (R2) from Hospital das Clínicas de Botucatu – UNESP Ophthalmology Residency Program. We assessed the results from two groups of residents. The first group (G1) consisted of residents who did not had previous virtual simulator training. The second group (G2) consisted of residents who had virtual simulator training before performing their surgeries. The occurrence of the main intraoperative complications were analyzed. The groups were compared and the results were submitted to statistical analysis. Results: The total amount of complications was 19 (27%) in G1 group and nine (12,86%) in G2 group, with statistical difference (p=0,031). Fourteen (20%) G1 surgeries and seven G2(10,00%) surgeries had complications; posterior capsule tear was observed 13 times (18,57%) in G1 surgeries and seven times (10,00%)in G2 surgeries; nuclear fragments into the vitreous cavity were observed in three (4,29%) G1 surgeries and in one (1,43%) G2 surgery; conversion to manual extracapsular cataract extraction was necessary in two (2,86%) G1 surgeries and in one (1,43%) G2 surgery. Conclusion: Eyesi® cataract surgery simulator training significantly decreased the amount of intraoperative complications from the ten first phacoemulsification surgeries performed by young surgeons.

Orientador: Antônio Carlos Lottelli Rodrigues / Resumo: Objetivo: Determinar se o treinamento prévio no simulador de cirurgia de catarata Eyesi diminui a ocorrência de complicações intraoperatórias nas primeiras cirurgias de catarata por facoemulsificação realizadas por residentes de oftalmologia. Métodos: Foi realizado um estudo retrospectivo no qual foram avaliadas as dez primeiras cirurgias de catarata realizadas por dois grupos de residentes do segundo ano (R2) de Oftalmologia no Hospital das Clínicas de Botucatu – UNESP. O primeiro grupo (G1) foi composto por R2 que não tiveram treinamento prévio no simulador. O segundo grupo (G2) foi formado por R2 que realizaram treinamento no simulador antes de iniciarem as cirurgias nos pacientes. Foi avaliada a ocorrência das principais complicações cirúrgicas intraoperatórias. Os dois grupos foram comparados e os resultados foram submetidos a análise estatística. Resultados: O número total de complicações foi de 19 (27%) no G1 e nove (12,86%) no G2, essa diferença foi significativa (p=0,031). Quatorze (20%) cirurgias de G1 e sete (10,00%) de G2 apresentaram complicações; a rotura de cápsula posterior ocorreu em 13 (18,57%) cirurgias do G1 e sete (10,00%) do G2; fragmentos de núcleo no vítreo ocorreram em três cirurgias (4,29%) do G1 e em uma cirurgia (1,43%) do G2; a conversão para FEC foi necessária em duas cirurgias (2,86%) do G1 e em uma cirurgia (1,43%) do G2. Conclusão: O treinamento prévio no simulador de cirurgias de catarata Eyesi reduziu significativamente o número total de c... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Purpose: To determine if previous training with the Eyesi® cataract surgery simulator decreases intraoperative complications rates from the first phacoemulsification surgeries performed by residents. Methods: A retrospective analysis of the ten first cataract surgeries performed by two groups of second-year residents (R2) from Hospital das Clínicas de Botucatu – UNESP Ophthalmology Residency Program. We assessed the results from two groups of residents. The first group (G1) consisted of residents who did not had previous virtual simulator training. The second group (G2) consisted of residents who had virtual simulator training before performing their surgeries. The occurrence of the main intraoperative complications were analyzed. The groups were compared and the results were submitted to statistical analysis. Results: The total amount of complications was 19 (27%) in G1 group and nine (12,86%) in G2 group, with statistical difference (p=0,031). Fourteen (20%) G1 surgeries and seven G2(10,00%) surgeries had complications; posterior capsule tear was observed 13 times (18,57%) in G1 surgeries and seven times (10,00%)in G2 surgeries; nuclear fragments into the vitreous cavity were observed in three (4,29%) G1 surgeries and in one (1,43%) G2 surgery; conversion to manual extracapsular cataract extraction was necessary in two (2,86%) G1 surgeries and in one (1,43%) G2 surgery. Conclusion: Eyesi® cataract surgery simulator training significantly decreased the amount of intraoperati... (Complete abstract click electronic access below) / Mestre

Red blood cells are a scarce resource whose demand often exceeds its supply. Intraoperative red cell salvage has proven to be a highly effective blood conservation strategy, as it can reduce the need for allogeneic blood transfusion. However, the use of cell saver alone is not sufficient. Without specific blood ordering guidelines, the amount of allogeneic blood product requested and cross&ndash;matched is often much greater than the real level of consumption. Efficient blood ordering guidelines have been developed in the past, and have succeeded in providing a more accurate prediction of actual need for intraoperative blood transfusion and minimizing waste. Few studies attempted to examine the blood ordering and utilization pattern with an emphasis on surgical cases that involve the use of intraoperative cell salvage. With the use of intraoperative cell salvage devices to reduce the amount of blood bank products required during surgery, considerable change in the practice of ordering cross&ndash;matched blood should be made. We retrospectively assessed the effectiveness of one Standardized Clinical Assessment and Management Plan (SCAMP) in improving the efficiency of blood utilization and reducing waste. This SCAMP was introduced at our Boston Children's Hospital in July 2012 as a blood ordering guideline for all pediatric orthopedic patients who are scheduled for intraoperative cell salvage. We retrospectively compared demographic variables, clinical characteristics, and blood utilization patterns of patients who underwent orthopedic procedure and received cell saver blood during the 17 months prior to the introduction of SCAMP (n = 455) and those who underwent similar procedures during the 15 months after the introduction of SCAMP (n = 487). Results suggested that demographic variables including age, weight, and sex were similar between the pre&ndash;SCAMP and post&ndash;SCAMP groups. It also demonstrated that after the introduction of SCAMP, the mean percentage utilization of blood (number of units used/number of units ordered x 100%) increased by 24.4% (p < 0.001), while the difference between the number of units ordered and number of units used reduced by 0.5 units (p < 0.001). In conclusion, the introduction of a SCAMP for blood product ordering has led to an increase in the efficiency of blood utilization and a reduction in blood waste. However, further evaluation and modification of the SCAMP need to be made in order to better predict actual level of utilization of blood products.

O objetivo do presente trabalho foi avaliar o valor diagnóstico e o impacto na modificação da conduta terapêutica do ultra-som intra-operatório (UIO) na cirurgia por neoplasia de fígado, vias biliares e pâncreas, comparando-se achados da avaliação pré-operatória de rotina com métodos de imagem convencionais (tomografia computadorizada e ressonância magnética) com achados obtidos por meio da exploração cirúrgica (inspeção e palpação). Foram analisados, retrospectivamente, exames realizados em 49 pacientes, sendo 15 portadores de neoplasia hepática secundária; 14, de neoplasia hepática primária; 14, de tumor neuroendócrino pancreático e seis de neoplasia cística pancreática. No grupo de pacientes com neoplasia hepática e de vias biliares, a TC identificou 65% dos tumores; a exploração cirúrgica, 69,5% e o UIO, 95,2%. Houve mudança da conduta, em decorrência dos achados do UIO, em 34,4% dos pacientes. No grupo de tumores neuroendócrinos pancreáticos, a TC identificou corretamente 44,4% dos tumores; a RM, 60,9%; a exploração cirúrgica com palpação, 72,7% e o UIO, 100%. Houve mudança de conduta em 42,9% dos pacientes. No grupo de neoplasia cística, o UIO não acrescentou informação adicional relevante em relação à TC e à RM, exceto no paciente com neoplasia papilífera intraductal. Apesar do grande avanço nos métodos de avaliação por imagem pré-operatórios e mesmo com toda a expertise do cirurgião, os resultados mostram que o UIO modifica positivamente o planejamento cirúrgico em um número significativo de pacientes, devendo, portanto fazer parte integrante da avaliação intra-operatória dos pacientes candidatos à ressecção hepática por neoplasia primária ou secundária e da cirurgia de neoplasia endócrina pancreática / Intraoperative sonography (IOU) is an imaging modality that has been showing rapid growth in the last decade that can has a variety of applications in different surgical specialities, particularly in abdominal surgery. The purpose of this study was to analyze the use o IOU in the setting of surgery for liver, biliary and pancreatic malignancies. To achieve that, the findings of routine preoperative state-of the-art imaging modalities (CT and MRI) and the findings of surgical exploration (inspection and palpation) were compared to those of IOU. The impact of IOU on preoperative plans based on CT and MRI and on management after surgical exploration were studied as well 49 patients were retrospectively studied. Of those 15 had metastatic liver disease and 14 primary liver cancer; 14 had pancreatic neuroendocrine tumours and 6 had cystic pancreatic neoplasms. In the group of hepatic and biliary malignancies CT identified 65% of the tumours, surgical exploration identified 69.5% and IOU 95.2% (including 3 false positives). IOU determined a change in management in 34.4% of the patients. In the group of pancreatic neuroendocrine tumours the rates of identification were 27.3% for CT, 60.9% for MRI, 72.7% for surgical exploration and 100% for IOU, with an alteration in surgical plans in 42.9% of patients after IOU. In the case of patients with cystic pancreatic neoplasia, IOUS did not add any relevant additional information in relation to CT or MRI, with exception to one patient that had a papiliferous intraductal neoplasia. In spite of the great advances on preoperatory imaging modalities and of the possibility of direct surgical exploration, IOU has shown that it positively modifies surgical planning. For that reason, it should be included as an essential adjunct in the intraoperatory evaluation of patients with pancreatic endocrine neoplasia and of candidates for hepatic resection in cases of primary and secondary malignancies