Made available in DSpace on 2014-06-11T19:35:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-19Bitstream added on 2014-06-13T19:25:21Z : No. of bitstreams: 1 imbelloni_le_dr_botfm.pdf: 1083712 bytes, checksum: 1d2f66de73e838257e456cd7956ff1bd (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Anestesiologistas freqüentemente realizam peridural torácica para os diversos tipos de cirurgia. A ressonância magnética de imagem tem estudado os nervos dentro do saco dural da cauda eqüina. Poucos estudos têm correlacionado a medula espinal com a dura-máter na região torácica. Punção acidental da dura-máter pode ocorrer durante tentativa de punção torácica e raramente cursa com lesão neurológica definitiva. O objetivo desta investigação, com ressonância magnética de imagem (RMI), é avaliar a distância entre a dura-máter e a medula espinal, em pacientes sem doenças da medula ou coluna vertebral nos 2º, 5º e 10º segmentos torácicos. Cinqüenta pacientes foram estudados com RMI realizada na posição supina. Corte sagital nos 2º, 5º e 10º segmentos torácicos foram medidos com aparelho 1.5 T com sistema super condutor (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands). Em 10 pacientes foi medido o ângulo relativo à tangente no ponto de inserção na pele. A distância posterior da dura-máter até a medula espinal foi significativamente maior (Bonferroni’s valor-p<0,015) na região torácica média (5ª torácica = 5,808 ± 0,840 mm) do que na região torácica alta (2ª torácica = 3,909 ± 0,802 mm) e região torácica baixa (10a torácica = 4,129 ± 0,967 mm). Não foi encontrada diferença entre os interespaços T2 e T10 (Bonferroni’s p-values=0,225). Não foi observada correlação entre a idade a distância medida entre a dura-máter e a medula espinal (todos os valores de p ≥ 0,166). O ângulo da entrada da agulha em T2 foi observado valor de 9,00±2,49 graus, em T5 de 45,00±7,45 graus e em T10 de 9,50±4,17 graus. A correção do espaço pelo ângulo de entrada da agulha aumentou a distância entre a dura-máter e a medula nos três interespaços vertebrais. Este estudo demonstrou que existe um grande espaço na região posterior... / Anesthesiologists frequently give thoracic epidural blocks for a variety of surgeries. MRI has provided studies of the nerves (cauda equina) inside the dural sac. But there are only a few correlating the spinal cord with the duramater in the thoracic region. With the use of Magnetic Resonance Imaging (MRI), this study investigated the distance of the duramater to the spinal cord in patients without spinal or medullar disease at the 2nd, 5th and 10th thoracic segments. Fifty patients in the supine position were underwent MRI. Medial sagittal slices of the 2nd, 5th and 10th thoracic segments were measured for the relative distances through the 1.5 T super-conducting system (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands). In ten patients the angles relative to the tangent at the insertion point on the skin was measured. The posterior dural-spinal cord distance is significantly greater the midthoracic region (5th thoracic = 5.808 ± 0.840 mm) than at upper (2nd thoracic = 3.909 ± 0.802 mm) and lower thoracic levels (10th thoracic = 4.129 ± 0.967 mm) (p<0.015). There were no differences between interspaces T2 and T10. There was no correlation between the age and the measured distance between the duramater and the spinal cord.

Cocaine- and amphetamine-regulated transcript (CART) is widely expressed in the rat central nervous system, notably in areas involved in control of autonomic and neuroendocrine functions. The aim of this study was to evaluate the effects of CART peptide fragment 55-102, referred to herein as CARTp, by intrathecal injection on blood pressure (BP) and heart rate (HR) before and after intrathecal glutamate in urethane-anesthetized male Sprague-Dawley rats. CARTp (0.1-10 nmol) administered intrathecally caused no or a small, statistically insignificant increase of blood pressure and heart rate, except at the concentration of 10 nmol, which caused a significant increase of blood pressure and heart rate. Intrathecal glutamate (0.1-10 nmol) produced a dose-dependent increase in arterial pressure and heart rate. Pretreatment with CARTp dose-dependently potentiated the pressor effects of glutamate (1 nmol), which by itself elicited a moderate increase of blood pressure and heart rate. Further, CARTp significantly potentiated the tachycardic effect of glutamate at 1 and 5 nmol, but attenuated the response at 10 nmol. The effect of CARTp was long-lasting, as it enhanced glutamatergic responses up to 90 min after administration. Prior injection of CARTp antiserum (1:500) but not normal rabbit serum nullified the potentiating effect of CARTp on glutamatergic responses. The result suggests that CARTp, whose immunoreactivity is detectable in sympathetic preganglionic neurons as well as in fibers projecting into the intermediolateral cell column, augments spinal sympathetic outflow elicited by glutamate at lower concentrations and may directly excite neurons in the intermediolateral cell column at higher concentrations.

O presente estudo objetivou avaliar o efeito da dexmedetomidina, associada ou não à bupivacaína, na raquianestesia de fêmeas felinas submetidas à ovariohisterectomia. Foram utilizadas 34 gatas, jovens e adultas, sem raça definida, saudáveis submetidas a anestesia inalatória com isofluorano e aos seguintes tratamentos, após distribuição aleatória: grupo bupivacaína (GB) - raquianestesia com a bupivacaína isolada (0,5 mg/kg), grupo dexmedetomidina (GD) - raquianestesia com dexmedetomidina (1 mcg/kg) e grupo de dexmedetomidina bupivacaína (GDB) - raquianestesia com dexmedetomidina (1 mcg/kg) e bupivacaína (0,5 mg/kg). Após a indução da anestesia e manutenção com isofluorano, os animais foram posicionados em decúbito lateral direito para punção subaracnoide realizada no espaço lombossacro com agulha espinhal 25G. Os animais foram mantidos em decúbito dorsal até o final do procedimento cirúrgico e os atributos fisiológicos foram avaliados no período pré, trans e por 3 horas no período pós-operatório. Nenhum animal apresentou arritmia ou hipotensão arterial. O GDB apresentou redução significativa da frequência cardíaca e incremento pressórico quando comparado ao GB (p&lt;0,01). Não houve diferença significativa no consumo de fentanil e no requerimento de isofluorano entre os grupos durante o procedimento cirúrgico. Na dose e diluição empregadas, a bupivacaína não determinou bloqueio motor significativo. As associações utilizadas promoveram analgesia adequada no período pós-operatório. O GDB apresentou maior grau de sedação durante parte da recuperação da anestesia (90min) (p&lt;0,05), sem aumento no tempo de extubação. A adição da dexmedetomidina à bupivacaína na raquianestesia não aumentou o bloqueio motor e sensitivo; entretanto aumentou o grau de sedação dos animais promovendo melhor qualidade na recuperação anestésica sem deflagrar complicações cardiorrespiratória ou neurológica. / The present study aimed to evaluate the effect of dexmedetomidine, associated or not to bupivacaine, on spinal anesthesia in female felines submitted to ovariohysterectomy. Thirty four mixed breed healthy cats, young and adult, underwent inhalation anesthesia with isoflurane and the following treatments, after random distribution: bupivacaine group (BG) - spinal anesthesia with bupivacaine alone (0.5 mg/kg), dexmedetomidine group (DG) - spinal anesthesia with dexmedetomidine (1 mcg/kg). and dexmedetomidine/bupivacaine group (DBG) - spinal anesthesia with dexmedetomidine (1 mcg/kg) and bupivacaine (0.5 mg/kg). After anesthetic induction and maintenance with isoflurane, the animals were positioned in the right lateral recumbency for subarachnoid puncture performed in the lumbosacral space with a 25G spinal needle. The animals were kept in dorsal recumbency until the end of the surgical procedure and the physiological parameters were assessed in the pre, trans and 3 hours postoperative period. No animal presented arrhythmia or arterial hypotension. DBG presented a significant reduction in heart rate and pressure increase when compared to BG (p &lt;0.01). There was no significant difference in fentanyl consumption and in the isoflurane requirement between groups during the surgical procedure. At the dose and dilution used, bupivacaine did not determine significant motor blockage. The associations used promoted adequate analgesia in the postoperative period. DBG had a higher degree of sedation during part of the anesthetic recovery (90min) (p &lt;0.05), without an increase in extubation time. The addition of dexmedetomidine to bupivacaine in spinal anesthesia did not increase motor and sensory blockage; however, it increased the sedation level of the animals, promoting better quality of anesthetic recovery without triggering cardiorespiratory or neurological complications.

Orientador: Eliana Marisa Ganem / Banca: Norma Sueli Pinheiro Módolo / Banca: Tolomeu Artur Assunção Casali / Banca: Eneida Maria Vieira / Banca: Antonio Fernando Carneiro / Resumo: Anestesiologistas freqüentemente realizam peridural torácica para os diversos tipos de cirurgia. A ressonância magnética de imagem tem estudado os nervos dentro do saco dural da cauda eqüina. Poucos estudos têm correlacionado a medula espinal com a dura-máter na região torácica. Punção acidental da dura-máter pode ocorrer durante tentativa de punção torácica e raramente cursa com lesão neurológica definitiva. O objetivo desta investigação, com ressonância magnética de imagem (RMI), é avaliar a distância entre a dura-máter e a medula espinal, em pacientes sem doenças da medula ou coluna vertebral nos 2º, 5º e 10º segmentos torácicos. Cinqüenta pacientes foram estudados com RMI realizada na posição supina. Corte sagital nos 2º, 5º e 10º segmentos torácicos foram medidos com aparelho 1.5 T com sistema super condutor (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands). Em 10 pacientes foi medido o ângulo relativo à tangente no ponto de inserção na pele. A distância posterior da dura-máter até a medula espinal foi significativamente maior (Bonferroni's valor-p<0,015) na região torácica média (5ª torácica = 5,808 ± 0,840 mm) do que na região torácica alta (2ª torácica = 3,909 ± 0,802 mm) e região torácica baixa (10a torácica = 4,129 ± 0,967 mm). Não foi encontrada diferença entre os interespaços T2 e T10 (Bonferroni's p-values=0,225). Não foi observada correlação entre a idade a distância medida entre a dura-máter e a medula espinal (todos os valores de p ≥ 0,166). O ângulo da entrada da agulha em T2 foi observado valor de 9,00±2,49 graus, em T5 de 45,00±7,45 graus e em T10 de 9,50±4,17 graus. A correção do espaço pelo ângulo de entrada da agulha aumentou a distância entre a dura-máter e a medula nos três interespaços vertebrais. Este estudo demonstrou que existe um grande espaço na região posterior... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Anesthesiologists frequently give thoracic epidural blocks for a variety of surgeries. MRI has provided studies of the nerves (cauda equina) inside the dural sac. But there are only a few correlating the spinal cord with the duramater in the thoracic region. With the use of Magnetic Resonance Imaging (MRI), this study investigated the distance of the duramater to the spinal cord in patients without spinal or medullar disease at the 2nd, 5th and 10th thoracic segments. Fifty patients in the supine position were underwent MRI. Medial sagittal slices of the 2nd, 5th and 10th thoracic segments were measured for the relative distances through the 1.5 T super-conducting system (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands). In ten patients the angles relative to the tangent at the insertion point on the skin was measured. The posterior dural-spinal cord distance is significantly greater the midthoracic region (5th thoracic = 5.808 ± 0.840 mm) than at upper (2nd thoracic = 3.909 ± 0.802 mm) and lower thoracic levels (10th thoracic = 4.129 ± 0.967 mm) (p<0.015). There were no differences between interspaces T2 and T10. There was no correlation between the age and the measured distance between the duramater and the spinal cord. / Doutor

A laringoscopia e a intubação traqueal produzem intensa resposta de estresse. Este estudo comparou o efeito da administração intratecal de 10 µg, 1,0 µg/Kg e 2,0 µg/Kg na resposta de estresse induzida pela intubação. Os pacientes foram casualizados em três grupos distintos, de acordo com a quantidade de sufentanil administrada pela via intratecal. Após administração de 0,05 mg/Kg de midazolam pela via venosa, todos os pacientes receberam sufentanilintratecal na quantidade determinada por um sorteio prévio. Aguardou-se o tempo de 10 minutos, nos quais os pacientes foram mantidos sob observação e, em seguida, a anestesia geral foi induzida com propofol (2,5 mg/Kg) e vecurônio (0,1 mg/Kg). Após ventilação sob máscara durante quatro minutos, os pacientes foram intubados mediante uma única tentativa, com laringoscopia de no máximo 20 segundos. A observação dos pacientes ocorreu em dois períodos distintos: um que contemplou o período compreendido entre a administração do sufentanil pela via subaracnóidea até imediatamente antes da indução anestésica e outro que compreendeu o período após a indução anestésica até seis minutos após a intubação orotraqueal. No primeiro período, avaliou-se o impacto do sufentanil subaracnóideo no comportamento hemodinâmico, no grau de sedação e no grau de ventilação. No segundoperíodo foi avaliado o comportamento hemodinâmico dos pacientes após a indução anestésica e a intubação traqueal. A glicemia foi quantificada nos dois períodos e serviu como parâmetro da resposta de estresse. Os pacientes foram avaliados em 15 momentos distintos (M1 - antes da punção venosa, M2 - um minuto após a administração do midazolam, M3 - imediatamente após a punção subaracnóidea, M4 - 2 minutos após a administração do sufentanil, M5 - 4 minutos após o sufentanil, M6 - 6 minutos após, M7 - 8 minutos após, M8 - 10 minutos após, M9 - 2 minutos após a indução anestésica, M10 - 4 minutos após, M11 - 30 segundos após a intubação, M12 - 1 minuto após, M13 - 2 minutos após, M14 - 4 minutos após e M15 - 6 minutos após). No primeiro período de observação, o comportamento hemodinâmico entre os três grupos foi semelhante. Houve diminuição da pressão arterial diastólica, pressão arterial média e da frequência cardíaca após administração do sufentanil, mas a pressão arterial sistólica manteve-se inalterada, exceto no grupo que recebeu 2,0 µg/Kg. Este grupo apresentou maior porcentagem de pacientes com depressão do grau de consciência e ventilação. Após intubação traqueal, o comportamento da frequência cardíaca foi semelhante nos três grupos e não houve aumento da pressão arterial sistólica, diastólica ou média no grupo que recebeu 2,0 µg/Kg. Somente este grupo teve diferença significativa da glicemia entre M1 e M15. Dentre as doses testadas, somente a de 2,0 µg/Kg atenua a resposta de estresse após intubação orotraqueal. / Laryngoscopy and orotracheal intubation produce intense stress response. This study compared the effect of intrathecal administration of 10 µg, 1,0 µg/Kg and 2,0 µg/Kg on stress response induced by intubation. Patients were assigned into three groups, according to the amount of sufentanil administered intrathecally. After administration of 0,05 mg/Kg intravenous midazolam, all patients received the previous selected dose of intrathecal sufentanil. Patients were kept under observation for the next ten minutes, and then general anesthesia was induced with propofol (2,5 mg/Kg) and vecuronium (0,1 mg/Kg). After being ventilated under facial mask for four minutes, patients were intubated on a first attempt basis, with laryngoscopy duration of 20 seconds maximum. Observation period was divided into twodistinct phases: the first one comprised the interval between intrathecal injection of sufentanil and general anesthesia induction, and the second one unrolled from anesthesia induction until six minutes after orotracheal intubation. Throughoutthe first phase, intrathecal sufentanil impact on haemodynamics, sedation and respiration was analized. During the second phase, the haemodynamic behavior after general anesthesia induction and orotracheal intubation was assessed. Glucose levels were measured on both phases and worked as a stress response parameter. Patients were evaluated at 15 predetermined moments (M1 - before venous cannulation, M2 - one minute after administration of midazolam, M3 - immediately after intrathecal injection of sufentanil, M4 - 2 minutes after intrathecal injection of sufentanil, M5 - 4 minutes after intrathecal injection of sufentanil , M6 - 6 minutes after intrathecal injection of sufentanil, M7 - 8 minutes after intrathecal injection of sufentanil, M8 - 10 minutes after intrathecal injection of sufentanil, M9 - 2 minutes after anesthesia induction, M10 - 4 minutes after anesthesia induction, M11 - 30 seconds after intubation, M12 - 1 minute after intubation, M13 - 2 minutes after intubation, M14 - 4 minutes after intubation e M15 - 6 minutes after intubation). At the first period of observation, haemodynamic profile between all three groups was similar. Diastolic arterial pressure levels, mean arterial pressure levels and heart rate decreased after intrathecal administration of sufentanil and sistolic arterial pressure levels remained the same, except in the 2,0 µg/Kg group. This group had the highest incidence of patients undergoing sedation and respiratory depression. After orotracheal intubation, heart rate was similar in all three groups, and there was no increase of SAP, DAP and MAP levels in the 2,0 µg/Kg group. Glucose levels presented significant differences between M1 and M15 only in the 2,0 µg/Kg group. Among all tested doses, the 2,0 µg/Kg dose was the only to attenuate stress response to tracheal intubation.

A laringoscopia e a intubação traqueal produzem intensa resposta de estresse. Este estudo comparou o efeito da administração intratecal de 10 µg, 1,0 µg/Kg e 2,0 µg/Kg na resposta de estresse induzida pela intubação. Os pacientes foram casualizados em três grupos distintos, de acordo com a quantidade de sufentanil administrada pela via intratecal. Após administração de 0,05 mg/Kg de midazolam pela via venosa, todos os pacientes receberam sufentanilintratecal na quantidade determinada por um sorteio prévio. Aguardou-se o tempo de 10 minutos, nos quais os pacientes foram mantidos sob observação e, em seguida, a anestesia geral foi induzida com propofol (2,5 mg/Kg) e vecurônio (0,1 mg/Kg). Após ventilação sob máscara durante quatro minutos, os pacientes foram intubados mediante uma única tentativa, com laringoscopia de no máximo 20 segundos. A observação dos pacientes ocorreu em dois períodos distintos: um que contemplou o período compreendido entre a administração do sufentanil pela via subaracnóidea até imediatamente antes da indução anestésica e outro que compreendeu o período após a indução anestésica até seis minutos após a intubação orotraqueal. No primeiro período, avaliou-se o impacto do sufentanil subaracnóideo no comportamento hemodinâmico, no grau de sedação e no grau de ventilação. No segundoperíodo foi avaliado o comportamento hemodinâmico dos pacientes após a indução anestésica e a intubação traqueal. A glicemia foi quantificada nos dois períodos e serviu como parâmetro da resposta de estresse. Os pacientes foram avaliados em 15 momentos distintos (M1 - antes da punção venosa, M2 - um minuto após a administração do midazolam, M3 - imediatamente após a punção subaracnóidea, M4 - 2 minutos após a administração do sufentanil, M5 - 4 minutos após o sufentanil, M6 - 6 minutos após, M7 - 8 minutos após, M8 - 10 minutos após, M9 - 2 minutos após a indução anestésica, M10 - 4 minutos após, M11 - 30 segundos após a intubação, M12 - 1 minuto após, M13 - 2 minutos após, M14 - 4 minutos após e M15 - 6 minutos após). No primeiro período de observação, o comportamento hemodinâmico entre os três grupos foi semelhante. Houve diminuição da pressão arterial diastólica, pressão arterial média e da frequência cardíaca após administração do sufentanil, mas a pressão arterial sistólica manteve-se inalterada, exceto no grupo que recebeu 2,0 µg/Kg. Este grupo apresentou maior porcentagem de pacientes com depressão do grau de consciência e ventilação. Após intubação traqueal, o comportamento da frequência cardíaca foi semelhante nos três grupos e não houve aumento da pressão arterial sistólica, diastólica ou média no grupo que recebeu 2,0 µg/Kg. Somente este grupo teve diferença significativa da glicemia entre M1 e M15. Dentre as doses testadas, somente a de 2,0 µg/Kg atenua a resposta de estresse após intubação orotraqueal. / Laryngoscopy and orotracheal intubation produce intense stress response. This study compared the effect of intrathecal administration of 10 µg, 1,0 µg/Kg and 2,0 µg/Kg on stress response induced by intubation. Patients were assigned into three groups, according to the amount of sufentanil administered intrathecally. After administration of 0,05 mg/Kg intravenous midazolam, all patients received the previous selected dose of intrathecal sufentanil. Patients were kept under observation for the next ten minutes, and then general anesthesia was induced with propofol (2,5 mg/Kg) and vecuronium (0,1 mg/Kg). After being ventilated under facial mask for four minutes, patients were intubated on a first attempt basis, with laryngoscopy duration of 20 seconds maximum. Observation period was divided into twodistinct phases: the first one comprised the interval between intrathecal injection of sufentanil and general anesthesia induction, and the second one unrolled from anesthesia induction until six minutes after orotracheal intubation. Throughoutthe first phase, intrathecal sufentanil impact on haemodynamics, sedation and respiration was analized. During the second phase, the haemodynamic behavior after general anesthesia induction and orotracheal intubation was assessed. Glucose levels were measured on both phases and worked as a stress response parameter. Patients were evaluated at 15 predetermined moments (M1 - before venous cannulation, M2 - one minute after administration of midazolam, M3 - immediately after intrathecal injection of sufentanil, M4 - 2 minutes after intrathecal injection of sufentanil, M5 - 4 minutes after intrathecal injection of sufentanil , M6 - 6 minutes after intrathecal injection of sufentanil, M7 - 8 minutes after intrathecal injection of sufentanil, M8 - 10 minutes after intrathecal injection of sufentanil, M9 - 2 minutes after anesthesia induction, M10 - 4 minutes after anesthesia induction, M11 - 30 seconds after intubation, M12 - 1 minute after intubation, M13 - 2 minutes after intubation, M14 - 4 minutes after intubation e M15 - 6 minutes after intubation). At the first period of observation, haemodynamic profile between all three groups was similar. Diastolic arterial pressure levels, mean arterial pressure levels and heart rate decreased after intrathecal administration of sufentanil and sistolic arterial pressure levels remained the same, except in the 2,0 µg/Kg group. This group had the highest incidence of patients undergoing sedation and respiratory depression. After orotracheal intubation, heart rate was similar in all three groups, and there was no increase of SAP, DAP and MAP levels in the 2,0 µg/Kg group. Glucose levels presented significant differences between M1 and M15 only in the 2,0 µg/Kg group. Among all tested doses, the 2,0 µg/Kg dose was the only to attenuate stress response to tracheal intubation.

No description available.

Neurodegeneration describes the progressive loss of structure and function of neurons, leading ultimately to cell and organism death. Although the initiating factors of neurodegenerative diseases such as Alzheimer’s, Parkinson’s, Huntington’s, and Amyotrophic Lateral Sclerosis may be different, they share common pathophysiologies. Proteinopathies, as these diseases are now termed, are characterized by atypical deposits of proteins, often due to misfolding. Associated with these deposits are dysfunctional mitochondria, oxidative stress, disrupted axonal transport, inflammation, and apoptotic cell death. If this occurs in motor neurons, as in ALS, ataxia precedes death with little or no change in cognition. On the other hand, if the deposits are found in cortical neurons, as in Alzheimer’s disease, the outcome is dementia and motor function remains largely intact. Each disease is selective for particular types of neurons and brain regions. Although research has elucidated much of the molecular biology involved in these diseases, their initiating causes remain largely unknown. Most of our current understanding originated with the identification of gene mutations that cause rare familial forms of these diseases. As a result, numerous strains of transgenic animals have been developed to study neurodegenerative disease phenomena and were central to the studies presented in this body of work. Novel routes of drug and gene delivery are described here as well as characterization of the mouse models studied. In particular, this work demonstrates that the blood brain barrier is disrupted in ALS followed by the formation of autorosettes in ALS mice. In various Alzheimer’s disease mouse models, it was demonstrated that the acute phase reactant alpha-1-antichymotrypsin (ACT) not only interacts with amyloid plaques, but also induces tau phosphorylation in vivo; tying together these disease hallmarks. It was also shown that small fragments of Aβ (1-11) could disrupt the formation of mature amyloid plaques in these mice. Lastly, it was demonstrated that mature plaques could also be decreased by intracranial delivery of granulocyte-macrophage stimulating factor (GM-CSF). My dissertation research goal was to understand and develop these treatment strategies based on protein disaggregation, neuroprotection, and inflammation, meanwhile developing novel methods for targeted delivery of molecules into the CNS of mice.

Local infiltration analgesia (LIA) is a new technique for postoperative pain management following knee arthroplasty. LIA involves a long-acting local anesthetic (ropivacaine), a non-steroid anti-inflammatory drug (ketorolac) and epinephrine infiltrated into the knee joint during surgery and injected postoperatively via a catheter. In the first two studies, LIA was compared with placebo in unicompartmental (I) and total (II) knee arthroplasty. Postoperative pain levels, morphine consumption and the incidence of side effects were lower in the LIA groups. In addition, we found a shorter length of hospital stay in the LIA group following unicompartmental knee arthroplasty compared with placebo (I), while the time to home readiness was shorter in the LIA group following total knee arthroplasty (II). In this study, we found that the unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations in a sub-group of patients. In the third study, LIA was compared with intrathecal morphine for postoperative pain relief following total knee arthroplasty (III). Pain scores and morphine consumption were lower, length of hospital stay was shorter and patient satisfaction was higher in the LIA group. In the final study, we investigated the effect of minimally invasive surgery (MIS) compared with conventional surgery in unicompartmental knee arthroplasty (IV). Both groups received LIA. We found no statistically significant differences in postoperative pain, morphine consumption, knee function, home readiness, hospital stay or patient satisfaction. In conclusion, LIA provided better postoperative pain relief and earlier mobilization than placebo, both in unicompartmental and total knee arthroplasty. When compared to intrathecal morphine, LIA also resulted in improved postoperative pain relief and earlier mobilization. Minimally invasive surgery did not improve outcomes after unicompartmental knee arthroplasty, when both groups received LIA.

<p>In Europe, Lyme disease<em> </em>is caused by the species <em>Borrelia (B.) burgdorferi</em> sensu stricto,<em> B. garinii </em>and <em>B. afzelii.</em> The disease is the most common vector-borne infection in Europe and the United States,<em> </em>and the resulting manifestation can involve the skin, nervous system, heart and joints. The symptoms that arise are associated with the <em>Borrelia </em>species causing the infection. The species most associated with neuroborreliosis is <em>B. garinii</em> whilst <em>B. burgdorferi </em>sensu stricto is associated with arthritis and <em>B. afzelii </em>is associated with dermatological symptoms. Lyme disease normally has three phases in untreated patients. The first phase is characterised by erythema migrans, a reddening of the skin around the area of the tick bite. If the disease develops to the second phase the patient will suffer from neuroborreliosis which is characterised by neurological symptoms such as headache and peripheral facial paralysis. Cerebrospinal fluid (CSF) analysis is used to diagnose neuroborreliosis. The diagnosis is complicated by variations between the different <em>Borrelia</em> species and that many healthy individuals have antibodies directed against <em>Borrelia</em>. Antibodies in CSF can be found in different diseases. The antibodies can be produced in the central nervous system or come across the blood-brain barrier and thus derive originally from the blood. By measuring the concentration of total albumin in serum and in CSF it can be determined if the antibodies present in the CSF have been produced in the central nervous system or if they originate from the blood. The typical manifestation in the last phase of Lyme disease is severe arthritis. The aim of this examination project was to compare two ELISAs for detection of antibodies directed to <em>Borrelia</em>. Indirect ELISAs from DAKO and Euroimmun were compared for the diagnosis of neuroborreliosis in 100 individuals. <em>Borrelia </em>specific antibodies of class IgM or IgG were found in 16 of 100 patients by DAKO’s ELISA and in 20 of the same 100 patients by Euroimmun’s ELISA. The reason that Euroimmun’s method detected more cases of neuroborreliosis is probably that this method detects antibodies directed to all three pathological species of <em>Borrelia </em>while DAKO’s method only detects antibodies directed to <em>B. burgdorferi</em>. In conclusion, this study indicates that Euroimmun’s method to detect antibodies of class IgM and IgG directed to <em>Borrelia </em>is superior to DAKO’s method. The obtained results were confirmed by Western blot analysis which gave results in accordance with those of Euroimmun’s ELISA.</p>