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231	The efficiency of ultrasonorgraphy in monitoring ovarian structures and foetal development in goats, sheep and cattle as verified through laparoscopy and laparotomy Siphugu, Steven Mbonalo 18 May 2018 (has links) MSCAGR (Animal Science) / Department of Animal Science / The main purpose of this study was to assess the efficiency of ultrasonography in monitoring reproductive organs, pregnancy diagnosis, and foetal gender identification and to verify its reliability by laparoscopy and laparotomy, where applicable. Reproductive organs, pregnancy diagnosis and gender of the foetus were examined by A-mode ultrasound using 3.0 - 8.0 MHz trans-rectal transducer. A Sony Olympus Model laparoscope with a camera transducer was used to monitor the reproductive organs and pregnancy diagnosis. In monitoring the follicular dynamics, daily ultrasonography (ULTS) scanning was done for 17 days in sheep and for 21 days in both goats and cattle. Follicles of diameter ≥ 3 mm were selected for analysis of growth, ovulation and regression. For determining the efficiency of the techniques, laparoscopy (LAPSC) and laparotomy (LAPT) were used on days 3 and 10 of the goats and sheep oestrous cycle. The follicles were grouped into three categories according to their diameter as 3 - 4.9 mm, 5 - 7.9 mm and ≥ 8 mm, whereas the follicles of cattle were grouped as 3 - 4.9 mm, 5 - 9.9 mm and ≥ 10 mm. Early pregnancy diagnosis examinations were carried out from day 18 post insemination until pregnancy was confirmed. Foetal gender examinations were conducted from day 40 of pregnancy until the day the gender of the foetus was confirmed. Follicular development was accompanied by the occurrence of waves of follicular growth at different period of the oestrous cycle. The first follicular wave emerged on day 1.0 ± 0.4 in goats, 1.2 ± 0.4 in sheep and 2.2 ± 0.4 in cattle. The maximum diameter of the dominant follicles of observed follicular waves in goats was 7.3 ± 0.4 mm, 6.6 ± 0.2 mm, 7.3 ± 0.2 mm; in sheep was 6.4 ± 0.4 mm, 6.6 ± 0.4 mm and 6.7 ± 0.7 mm and in cattle was 13.1 ± 0.8 mm, 14.2 ± 0.6 mm and 15.7 ± 0.6 mm in wave 1, 2 and 3, respectively. However, the maximum size of the dominant follicle of the ovulatory wave in cattle was larger than the dominant follicles of both first and second waves, but in goats and sheep the dominant follicles were of similar size throughout the waves. In cattle, the ovulatory wave was shorter (p ˂ 0.05) than the duration of the first and second waves, while in sheep and goats were similar throughout the waves. In goats the total number of follicles counted in right and left ovaries under category 3 - 4.9 mm was lower with ULTS and LAPSC than with LAPT method (p ˂ 0.05). In sheep the mean number of follicles between 3 - 4.9 mm category in both right and left ovaries were different (p ˂ 0.05) between ULTS and LAPT. However, for categories 5 - 7.9 mm and ≥ 8 mm in both goats and sheep the mean numbers of follicles observed by all techniques were similar (p ˃ 0.05). In goats, pregnancy diagnosis accuracy improved from zero percent on day 18 to 100% on day 26 - 28, in sheep pregnancy diagnosis was 40% on day 18 and improved to 100% on day 20 - 22 vi of gestation. In cattle accuracy of pregnancy diagnosis was not possible at day 18 and gradually increased to 100% on day 30 - 32 of gestation. Out of 5 (100%) goat’s foetuses whose gender was determined, the diagnosis was correct in 100% (3/3) of the male foetuses and 100% (2/2) of the female foetuses. In sheep two foetuses were sexed as males while the other three were sexed as females and were both 100%. Out of 60% (3/5) of foetuses examined in cattle, 1 (100%) was identified as male and the remaining 2 (100%) were identified as females. The results obtained confirmed that the accuracy for foetal gender by ultrasonography was 100% in all foetuses observed. The current study demonstrated that trans-rectal ultrasonography examination is an efficient method for monitoring follicular dynamics, diagnosing pregnancy and foetal gender identification and that it is as reliable as laparoscopy and laparotomy where they were applied together. / NRF Follicular dynamics Pregnancy diagnosis Foetal gender identification Ultrasonography Laparoscopy Laparotomy Sheep Goats Cattle 616.0743 Ultrasonic in medicine Ultranomic in obstetrics Fetus -- Ultrasonic imaging Fetal growth disorders Sheep Goats Livestock Ultrasonic imaging Acoustic imaging Ultrasonics Diagnosis, Ultrsonic
232	Prospektiv randomisierte, kontrollierte, einfach verblindete Studie zum Vergleich postoperativer Schmerzen nach mikrolaparoskopischer und laparoskopischer Cholezystektomie Motz, Rudolf 30 May 2002 (has links) Der technische Fortschritt führte in jüngster Vergangenheit zur Neuentwicklung kleinerer Kamerasysteme und laparoskopischer Instrumente. So ist seit einiger Zeit die Durchführung der Cholezystektomie durch Inzisionen von 2-5 mm Größe (mikrolaparoskopische Cholezystektomie) anstatt der sonst üblichen 5-10 mm großen Hautschnitte (laparoskopische Cholezystektomie) möglich. Methoden: 25 Patienten wurden nach Randomisierung der laparoskopischen Gruppe und 25 der mikrolaparoskopischen Gruppe zugeordnet. Das Hauptzielkriterium der Studie war der postoperative Schmerzmittelverbrauch unter der patienten-kontrollierten Analgesie untersucht. Zusätzlich wurden die Häufigkeit von Konversionen, die Dauer des operativen Eingriffs, der postoperative Krankenhausaufenthalt, die perioperativen Schmerzen, die Fatigue, das kosmetische Resultat und die postoperative Arbeitsunfähigkeitsdauer untersucht. Ergebnisse: Alter, Body Mass Index und die Geschlechtsverteilung beider Gruppen waren vergleichbar. In jeder Gruppe erfolgte jeweils 1 Konversion (mikrolaparoskopische Cholezystektomie zur laparoskopischen Cholezystektomie; laparoskopische zu konventionellen Cholezystektomie). Der postoperative Krankenhausaufenthalt, die postoperative Arbeitsunfähigkeitsdauer, die Eingriffs- und die Narkosedauer zeigten für das mikrolaparoskopische und laparoskopische Verfahren keine wesentlichen Unterschiede. Die subjektive Schmerzwahrnehmung war beim Husten mit 340,5(204-410) in der mikrolaparoskopischen Gruppe niedriger als in der laparoskopischen Gruppe mit 406(357-514)(p / Background: Laparoscopic instruments have been minimised for abdominal videoendoscopic surgery. Whether micro-laparoscopic surgery will actually result in clinically relevant benefits for patients, has not yet been proven. Methods: Fifty patients were randomised to elective laparoscopic (MINI; n = 25) or micro-laparoscopic (MICRO; n = 25) cholecystectomy in a blinded fashion. Analgetic consumption during PCA, pain perception (visual analog score), and cosmetic result (patient's self-assessment) were evaluated postoperatively as clinically relevant endpoints. Results: Age, sex, BMI and operative time were not different between both groups. From surgery to the 3rd postoperative day, cumulative PCA morphine doses were comparable (MINI: 0,2(0,1-0,23) mg/kg bw; MICRO: 0,2(0,1-0,46) mg/kg bw; p>0,05) but overall VAS for pain while coughing was higher in the laparoscopic 406(357-514) compared to the micro-laparoscopic group 340,5(204-410) (p mikrolaparoskopische Cholezystektomie laparoskopische Cholezystektomie subjektive Schmerzwahrnehmung kosmetische Ergebnis postoperative Schmerzmittelverbrauch laparoscopic cholecystectomy micro-laparoscopy analgetic consumption pain perception cosmetic result 610 Medizin und Gesundheit 33 Medizin YI 8700 ddc:610
233	Análise comparativa dos resultados de duas técnicas de nefrectomia laparoscópica de doador vivo de dois centros de referência em transplante renal / Comparative analysis of results of two techniques of laparoscopic live donor nephrectomy in two reference centers of renal transplantation Siqueira Junior, Tibério Moreno de 16 September 2004 (has links) Foram coletados prospectivamente os dados das primeiras nefrectomias totalmente laparoscópicas (NTL) de doadores renais vivos realizadas no Hospital das Clínicas da Universidade Federal de Pernambuco (HCFMUFPE) e comparadas com os dados recentemente publicados do Hospital das Clínicas da Universidade de São Paulo (HCFMUSP). Da mesma forma, a função renal, a taxa de necrose tubular aguda e rejeição e a taxa de complicações dos receptores também foram analisadas e comparadas. Entre Janeiro e Outubro de 2003, foram realizadas 11 NTL de doadores vivos (4 mulheres e 7 homens) no HCFMUFPE. A idade média foi de 31.5 ± 8 anos e o índice de massa corpórea (IMC) de 20,1 ± 4,1 kg/m2. Em todos os casos, o lado esquerdo foi o escolhido para doação. O tempo cirúrgico até a retirada do rim da cavidade abdominal, o tempo cirúrgico total, o tempo anestésico total e o tempo de isquemia quente (TIQ), foram 189 ± 36 minutos (min), 231 ± 39 min, 299 ± 43 min e 289 ± 111s, respectivamente. A perda sanguínea foi de 214 ± 98mL. Em 2 casos, foi observada, no trans-operatório, a presença de vasos supranumerários: 01 caso- 02 veias; 01 caso- 02 artérias. O pedículo renal foi considerado de bom padrão em todos os enxertos, assim como o comprimento e vascularização ureteral. O controle vascular do pedículo renal foi feito com clips metálicos e de polímero (Hem-O-Lok®, Weck Closure Systems, Research Triangle, CA). Houve uma complicação trans-operatória considerada maior (sangramento do coto da artéria renal), levando à uma conversão urgente para o procedimento aberto (9,1%). Nenhum caso necessitou hemotransfusão. A dose média de dipirona no período pós-operatório e o tempo para realimentação foram de 5,1 doses (2-12) e 15,4 horas (12-24), respectivamente. No período pós-operatório, 04 doadores tiveram 6 complicações menores: 01 caso - úlcera duodenal; 01 caso - distensão muscular da parede abdominal esquerda; 01 caso - cervicalgia, enfisema subcutâneo e infecção de ferida operatória e; 01 caso - infecção de ferida operatória por pseudomonas aeruginosa. Houve uma complicação considerada maior (9.1%), pois acarretou na necessidade de laparotomia exploradora no 11º dia de pós-operatório (DPO): hematoma subaponeurótico ao nível da incisão de Pfannenstiel com rompimento interno, levando a abdome agudo. Estas complicações foram tratadas adequadamente, obtendo bom resultado. O tempo médio de alta hospitalar e retorno às atividades habituais foi 2,8 (2-5) e 19,7 dias (12-30), respectivamente. Todos os enxertos foram considerados de bom padrão e funcionaram de imediato após o implante, com exceção de um caso, o qual demorou 09 horas para iniciar diurese (fez uma sessão de hemodiálise pós-operatória). Este atraso foi atribuído a uma complicação transoperatória no receptor (sangramento agudo de ramo venoso da veia ilíaca interna). Entre os receptores houve 02 óbitos (18.2%). O nono receptor foi a óbito no 5º DPO devido a uma ruptura parcial da anastomose arterial, levando ao choque hipovolêmico, refratário a todas as medidas tomadas, inclusive o tratamento cirúrgico emergencial. O segundo óbito foi observado no décimo receptor, devido a uma encefalite provocada por ciclosporina. Nenhuma complicação ureteral foi observada. A taxa de necrose tubular aguda e de rejeição foi 27.3% (3 casos). Houve uma transplantectomia devido a infecção do enxerto por Pseudomonas aeruginosa (9.1%). A creatinina média dos receptores no 1º, 3º, 5º, 10º e 30º DPO foi de 4.0 ± 2.2, 1.9 ± 0.9, 1.8 , 1.7 e 1.2 ng/dl, respectivamente. Comparando a série dos doadores do HCFMUFPE com à do HCFMUSP, observou-se diferença estatisticamente significante em todos os dados trans-operatórios: tempo cirúrgico até a retirada do rim da cavidade abdominal (189 ± 36 min versus 144 ± 32 min, p ....), tempo cirúrgico total (231 ± 39 min versus 179 ± 30 min, p ....), tempo anestésico total (299 ± 43 min versus 223 ± 31 min, p ....), TIQ (289 ± 111 versus 199 ± 95 seg, p .....) e perda sanguínea (214 ± 98 versus 141 ± 82 ml, p..... ). Houve uma complicação transoperatória considerada maior em cada grupo (9.1% e 2%, respectivamente) e uma conversão para procedimento aberto no grupo do HCFMUFPE (9.1%). Para fins de análise estatística, o quadragésimo sétimo caso do grupo do HCFMUSP foi excluído, pois apresentou uma complicação trans-operatória maior, a qual acarretou em longo tempo de isquemia quente e conseqüente taxa de função renal alterada no receptor. No período pós-operatório dos doadores, houve diferença estatisticamente significante exclusivamente na escala subjetiva de dor no período pós-operatório imediato (POI): 4.3 ± 2.2 e 2.4 ± 2.3 (p ....), no HCFMUFPE e HCFMUSP, respectivamente. Houve um óbito (2%) na série do HCFMUSP. Em média, houve economia de R$ 3.985,00 no procedimento cirúrgico adotado no HCFMUFPE, pois grampeadores vasculares e sacos extratores não foram utilizados. Entre os receptores, a taxa de diurese imediata após o implante do enxerto, bem como a taxa de necrose tubular aguda e rejeição, foram semelhantes em ambos os grupos: 91% versus 92% e 27.3% versus 30%, no HCFMUFPE e HCFMUSP, respectivamente. Houve uma transplantectomia no grupo do HCFMUFPE (9.1%) e duas no grupo do HCFMUSP (4%). Ocorreram quatro complicações ureterais nos receptores do HCFMUSP (8%) e nenhuma nos receptores do HCFMUFPE. Não houve diferença significativamente estatística na taxa de função renal (creatinina) entre o grupo do HCFMUFPE e HCFMUSP, no 1º, 3º, 5º, 10º e 30º dias de pós-operatório: 4.0 ± 2.2 versus 4.0 ± 3.0, 1.9 ± 0.9 versus xxxxxx, 1.8 versus 3.4, 1.7 versus 2.6 e 1.2 versus 1.57, respectivamente. Os dados obtidos evidenciam que o grupo do HCFMUFPE ainda não ultrapassou a curva de aprendizado em nefrectomia laparoscópica do doador renal vivo (NLDV), não obstante não houve prejuízo à integridade dos doadores ou à função renal dos enxertos, após implante nos receptores. A ocorrência de complicações graves obtidas em ambos os grupos, inclusive com um óbito no grupo do HCFMUSP demonstram que a NLDV é um procedimento cirúrgico de alta complexidade, na qual é necessário aprimoramento dos cuidados perioperatórios nos doadores, na tentativa de minimizar tais complicações. A técnica cirúrgica desenvolvida pelo grupo do HCFMUFPE demonstrou ser segura e eficaz, apresentando resultados funcionais semelhantes à técnica utilizada pelo grupo do HCFMUSP, com a vantagem de ter um custo financeiro menor. / Data of the first 11 laparoscopic live donor nephrectomy performed at Clinics Hospital of Federal University of Pernambuco (HCFMUFPE) between January and October, 2003 were prospectively recorded and compared with the first 50 laparoscopic live donor nephrectomy performed at Clinics Hospital of State University of São Paulo (HCFMUSP) between April, 2000 and August, 2003. Overall operative time (231 ± 39 min versus 179 ± 30 min, p ....), overall anesthesia time (299 ± 43 min versus 223 ± 31 min, p ....), average warm ischemia time (289 ± 111 versus 199 ± 95 seg, p .....) and blood loss (214 ± 98 versus 141 ± 82 ml, p..... ) were considered statistically significant better for the HCFMUSP group when compared with the HCFMUFPE group. One major complication was observed in each group (HCFMUFPE- 9.1% and HCFMUSP- 2%) and only one open conversion in the HCFMUFPE group (9.1%). Postoperatively, only pain scale at immediate post-operative day had statistically significant difference: 4.3 ± 2.2 versus 2.4 ± 2.3 (p ....). The HCFMUFPE group saved about R$ 3.985,00 per procedure due to the lack of use of disposable equipments. There were no statistically significant difference in time to initiate diuresis after graft implant (91% versus 92%) and acute tubular necrosis (27.3% versus 30%), with or without acute or chronic rejection, between the HCFMUFPE and HCFMUSP groups, respectively. One graft loss occurred in the HCFMUFPE group (9.1%) and two in the HCFMUSP group (4%). Four ureteral complications were seen in the HCFMUSP group (8%) whereas none in the HCFMUFPE group. No statistical difference was observed related to the recipient renal function after transplantation at 1º, 3º, 5º, 10º e 30º post operative days: 4.0 ± 2.2 versus 4.0 ± 3.0, 1.9 ± 0.9 versus xxxxxx, 1.8 versus 3.4, 1.7 versus 2.6 e 1.2 versus 1.57, respectively. In conclusion, the HCFMUFPE data shows that the learning curve is still to be overcome. Nonetheless, there were no major problems for the donors and no loss of renal graft function after transplantation. The occurrence of major complications in both groups and one death in the HCFMUSP group, highlight the complexity of this procedure. Finally, the HCFMUFPE surgical technique showed to be a safe, cheap and an attractive procedure to be used in undeveloped countries. Comparative study Estudo comparativo Hospitais de ensino Hospitals Kidney transplantation/mortality Laparoscopia/métodos Laparoscopy/methods Nefrectomia/métodos Nephrectomy/methods Pernambuco Pernambuco São Paulo (SP) São Paulo (SP) teaching Transplante de rim/mortalidade
234	Técnica laparoscópica versus técnica aberta para adrenalectomia experimental em suínos / Laparoscopic techniques versus open technique for swines in experimental adrenalectomy GAMA FILHO, José Belarmino da 22 December 2009 (has links) Made available in DSpace on 2014-07-29T15:13:56Z (GMT). No. of bitstreams: 1 TESE SAULO FERNANDES MANO DE CARVALHO.pdf: 5897981 bytes, checksum: 9ded1ddc23ddf1eb697350aee8c49480 (MD5) Previous issue date: 2009-12-22 / Adrenalectomy is a highly complex surgical procedure. In order to perform it, surgeons must have a profound knowledge of the anatomophysiologic aspects of the adrenal glands, especially their vascular diversity, as well as full understanding of diagnostic means so as to properly identify their diseases. Open adrenalectomy is the most widely used method in veterinary medicine, while laparoscopic adrenalectomy usually is the method of choice in human medicine. Hyperadrenocorticism, whether hypophysis-dependent or not, is the most the most common adrenal disease. Treatment involves stopping the growth of tumors either surgically or chemically. Treatment of choice will depend on tumor functionality, type and size, as well as on its image. The swine model has proven adequate for surgical procedures, since it possesses standardized experimentation protocols and physiological parameters. Among the main benefits of laparoscopic adrenalectomy versus open adrenalectomy is rapid recovery and diminished hospitalization time. Laparoscopic adrenalectomy is the procedure of choice in human medicine, and it is nowadays considered to be the gold standard. In veterinary medicine more research is needed so as to better establish its advantages over open adrenalectomy. In this study open adrenalectomy was compared to laparoscopic adrenalectomy. 32 swines, divided into four groups of eight animals each, underwent surgery; being it that one group underwent open and the other laparoscopic adrenalectomy, with their respective control groups (sham). Parameters such as surgical time, body temperature, haematocrit, surgical intercurrences and XXXXX, as well as physiological, hormonal and metabolic responses were evaluated in young swines, both in open and laparoscopic adrenalectomy. There were no significant differences in surgical times. Most frequent intercurrences were accidents with intestinal loops, lesions to adrenal vessels and renal haematoma. Blood losses were not significant and, even though there was hypothermia it did not lead to any unfavorable clinical outcome. Deambulation time was longer for the open adrenalectomy group, although the difference was not significant. Significant differences were found in leucometry values of the laparoscopic sham group, which were higher when compared to laparoscopic groups; SpO2 of the G3 group was lower than that of the other groups, and PCR of the laparoscopic groups were lower postoperatively. There were no significant differences in mean blood pressure in all of four groups. Laparoscopy is a reliable technique for experimental adrenalectomy in swines and can be used as a reference for surgical treatment of adrenal diseases in other animal species. Metabolic parameters did not show significant differences. These results indicated that the laparoscopic technique is beneficial over open surgery, and that it can be considered a safe procedure for other species. Adrenalectomy is a highly complex surgical procedure. In order to perform it, surgeons must have a profound knowledge of the anatomophysiologic aspects of the adrenal glands, especially their vascular diversity, as well as full understanding of diagnostic means so as to properly identify their diseases. Open adrenalectomy is the most widely used method in veterinary medicine, while laparoscopic adrenalectomy usually is the method of choice in human medicine. Hyperadrenocorticism, whether hypophysis-dependent or not, is the most the most common adrenal disease. Treatment involves stopping the growth of tumors either surgically or chemically. Treatment of choice will depend on tumor functionality, type and size, as well as on its image. The swine model has proven adequate for surgical procedures, since it possesses standardized experimentation protocols and physiological parameters. Among the main benefits of laparoscopic adrenalectomy versus open adrenalectomy is rapid recovery and diminished hospitalization time. Laparoscopic adrenalectomy is the procedure of choice in human medicine, and it is nowadays considered to be the gold standard. In veterinary medicine more research is needed so as to better establish its advantages over open adrenalectomy. In this study open adrenalectomy was compared to laparoscopic adrenalectomy. 32 swines, divided into four groups of eight animals each, underwent surgery; being it that one group underwent open and the other laparoscopic adrenalectomy, with their respective control groups (sham). Parameters such as surgical time, body temperature, haematocrit, surgical intercurrences and XXXXX, as well as physiological, hormonal and metabolic responses were evaluated in young swines, both in open and laparoscopic adrenalectomy. There were no significant differences in surgical times. Most frequent intercurrences were accidents with intestinal loops, lesions to adrenal vessels and renal haematoma. Blood losses were not significant and, even though there was hypothermia it did not lead to any unfavorable clinical outcome. Deambulation time was longer for the open adrenalectomy group, although the difference was not significant. Significant differences were found in leucometry values of the laparoscopic sham group, which were higher when compared to laparoscopic groups; SpO2 of the G3 group was lower than that of the other groups, and PCR of the laparoscopic groups were lower postoperatively. There were no significant differences in mean blood pressure in all of four groups. Laparoscopy is a reliable technique for experimental adrenalectomy in swines and can be used as a reference for surgical treatment of adrenal diseases in other animal species. Metabolic parameters did not show significant differences. These results indicated that the laparoscopic technique is beneficial over open surgery, and that it can be considered a safe procedure for other species. / Adrenalectomia é um procedimento operatório de alto grau de complexidade. Para sua execução o cirurgião deve ter conhecimento dos aspectos anatomofisiológicos das glândulas adrenais, especialmente sua diversidade vascular, deve ainda ter pleno entendimento sobre os recursos diagnósticos necessários para identificação das suas enfermidades. Adrenalectomia aberta é o método mais utilizado em medicina veterinária, enquanto na medicina humana a abordagem laparoscópica é a de eleição. O hiperadrenocorticismo, que pode ser hipófise dependente ou não, é enfermidade adrenal de maior frequência. Seu tratamento consiste na contenção da evolução dos tumores por meio de fármacos ou cirúrgico. A escolha do tratamento depende da funcionalidade, tipo e tamanho do tumor e da caracterização dos estudos de imagem. O modelo suíno mostrou-se adequado para a execução dos procedimentos operatórios, visto possuir protocolo de experimentação e parâmetros fisiológicos padronizados. Dentre os principais benefícios da adrenalectomia laparoscópica (AL) frente à adrenalectomia aberta (AA) destaca-se a rápida recuperação dos pacientes com diminuição do tempo de internação. A adrenalectomia laparoscópica é o procedimento de escolha em medicina humana, sendo caracterizada atualmente como padrão ouro. Em medicina veterinária, ainda há necessidade de melhor caracterização dos seus resultados afim de que seus benefícios em relação à adrenalectomia aberta possam ser conhecidos. Neste estudo foi comparada a AA com a AL. Foram operados 32 suínos, divididos em quatro grupos de oito animais, sendo um grupo submetido à AA e outro grupo à AL, com seus respectivos grupos controle (sham). Foram avaliados parâmetros referentes a tempo operatório, temperatura corporal, hematócrito, intercorrências operatórias e tempo de deambulação. Bem com as respostas fisiológicas, hormonais e metabólicas oriundas da adrenalectomia laparoscópica e aberta em suínos jovens. Não houve diferença significativa entre os tempos operatórios. As intercorrências mais frequentes foram acidentes em alças intestinais, lesões em vasos adrenais e hematoma renal. As perdas sanguíneas não foram significativas e apesar de ter ocorrido hipotermia esta não teve repercussão clínica. O tempo de deambulação foi maior para o grupo AA, mas sem diferença significativa em relação ao AL. As diferenças significativas encontradas se relacionaram aos valores de leucometria, os quais apresentaram elevação no grupo sham laparotômico em relação aos grupos laparoscópicos; a SpO2 do grupo G3 foi inferior aos demais grupos; os valores de PCR dos grupos laparoscópicos foram menores no pós operatório. Não houve diferença significativa na pressão arterial média dos quatro grupos. A laparoscopia para adrenalectomia experimental em suínos é uma técnica confiável podendo servir como referência para o tratamento cirúrgico nas outras espécies animais. Os parâmetros metabólicos analisados não apresentaram diferenças significativas. Estes resultados indicaram benefícios da abordagem laparoscópica em relação à aberta, podendo ser considerado um procedimento seguro para utilização em outras espécies. 1. Glândula adrenal 2.Irrigação sanguínea 3.Laparoscopia 4. Modelos animais 5. Pneumoperitôneo 1. Acute-phase response 2. Adrenal gland 3. Animal models 4. Blood irrigation 5. Laparoscopy 5. Mean arterial pressure 5. Pneumoperitoneum CNPQ::OUTROS::CIENCIAS
235	Análise comparativa dos resultados de duas técnicas de nefrectomia laparoscópica de doador vivo de dois centros de referência em transplante renal / Comparative analysis of results of two techniques of laparoscopic live donor nephrectomy in two reference centers of renal transplantation Tibério Moreno de Siqueira Junior 16 September 2004 (has links) Foram coletados prospectivamente os dados das primeiras nefrectomias totalmente laparoscópicas (NTL) de doadores renais vivos realizadas no Hospital das Clínicas da Universidade Federal de Pernambuco (HCFMUFPE) e comparadas com os dados recentemente publicados do Hospital das Clínicas da Universidade de São Paulo (HCFMUSP). Da mesma forma, a função renal, a taxa de necrose tubular aguda e rejeição e a taxa de complicações dos receptores também foram analisadas e comparadas. Entre Janeiro e Outubro de 2003, foram realizadas 11 NTL de doadores vivos (4 mulheres e 7 homens) no HCFMUFPE. A idade média foi de 31.5 ± 8 anos e o índice de massa corpórea (IMC) de 20,1 ± 4,1 kg/m2. Em todos os casos, o lado esquerdo foi o escolhido para doação. O tempo cirúrgico até a retirada do rim da cavidade abdominal, o tempo cirúrgico total, o tempo anestésico total e o tempo de isquemia quente (TIQ), foram 189 ± 36 minutos (min), 231 ± 39 min, 299 ± 43 min e 289 ± 111s, respectivamente. A perda sanguínea foi de 214 ± 98mL. Em 2 casos, foi observada, no trans-operatório, a presença de vasos supranumerários: 01 caso- 02 veias; 01 caso- 02 artérias. O pedículo renal foi considerado de bom padrão em todos os enxertos, assim como o comprimento e vascularização ureteral. O controle vascular do pedículo renal foi feito com clips metálicos e de polímero (Hem-O-Lok®, Weck Closure Systems, Research Triangle, CA). Houve uma complicação trans-operatória considerada maior (sangramento do coto da artéria renal), levando à uma conversão urgente para o procedimento aberto (9,1%). Nenhum caso necessitou hemotransfusão. A dose média de dipirona no período pós-operatório e o tempo para realimentação foram de 5,1 doses (2-12) e 15,4 horas (12-24), respectivamente. No período pós-operatório, 04 doadores tiveram 6 complicações menores: 01 caso - úlcera duodenal; 01 caso - distensão muscular da parede abdominal esquerda; 01 caso - cervicalgia, enfisema subcutâneo e infecção de ferida operatória e; 01 caso - infecção de ferida operatória por pseudomonas aeruginosa. Houve uma complicação considerada maior (9.1%), pois acarretou na necessidade de laparotomia exploradora no 11º dia de pós-operatório (DPO): hematoma subaponeurótico ao nível da incisão de Pfannenstiel com rompimento interno, levando a abdome agudo. Estas complicações foram tratadas adequadamente, obtendo bom resultado. O tempo médio de alta hospitalar e retorno às atividades habituais foi 2,8 (2-5) e 19,7 dias (12-30), respectivamente. Todos os enxertos foram considerados de bom padrão e funcionaram de imediato após o implante, com exceção de um caso, o qual demorou 09 horas para iniciar diurese (fez uma sessão de hemodiálise pós-operatória). Este atraso foi atribuído a uma complicação transoperatória no receptor (sangramento agudo de ramo venoso da veia ilíaca interna). Entre os receptores houve 02 óbitos (18.2%). O nono receptor foi a óbito no 5º DPO devido a uma ruptura parcial da anastomose arterial, levando ao choque hipovolêmico, refratário a todas as medidas tomadas, inclusive o tratamento cirúrgico emergencial. O segundo óbito foi observado no décimo receptor, devido a uma encefalite provocada por ciclosporina. Nenhuma complicação ureteral foi observada. A taxa de necrose tubular aguda e de rejeição foi 27.3% (3 casos). Houve uma transplantectomia devido a infecção do enxerto por Pseudomonas aeruginosa (9.1%). A creatinina média dos receptores no 1º, 3º, 5º, 10º e 30º DPO foi de 4.0 ± 2.2, 1.9 ± 0.9, 1.8 , 1.7 e 1.2 ng/dl, respectivamente. Comparando a série dos doadores do HCFMUFPE com à do HCFMUSP, observou-se diferença estatisticamente significante em todos os dados trans-operatórios: tempo cirúrgico até a retirada do rim da cavidade abdominal (189 ± 36 min versus 144 ± 32 min, p ....), tempo cirúrgico total (231 ± 39 min versus 179 ± 30 min, p ....), tempo anestésico total (299 ± 43 min versus 223 ± 31 min, p ....), TIQ (289 ± 111 versus 199 ± 95 seg, p .....) e perda sanguínea (214 ± 98 versus 141 ± 82 ml, p..... ). Houve uma complicação transoperatória considerada maior em cada grupo (9.1% e 2%, respectivamente) e uma conversão para procedimento aberto no grupo do HCFMUFPE (9.1%). Para fins de análise estatística, o quadragésimo sétimo caso do grupo do HCFMUSP foi excluído, pois apresentou uma complicação trans-operatória maior, a qual acarretou em longo tempo de isquemia quente e conseqüente taxa de função renal alterada no receptor. No período pós-operatório dos doadores, houve diferença estatisticamente significante exclusivamente na escala subjetiva de dor no período pós-operatório imediato (POI): 4.3 ± 2.2 e 2.4 ± 2.3 (p ....), no HCFMUFPE e HCFMUSP, respectivamente. Houve um óbito (2%) na série do HCFMUSP. Em média, houve economia de R$ 3.985,00 no procedimento cirúrgico adotado no HCFMUFPE, pois grampeadores vasculares e sacos extratores não foram utilizados. Entre os receptores, a taxa de diurese imediata após o implante do enxerto, bem como a taxa de necrose tubular aguda e rejeição, foram semelhantes em ambos os grupos: 91% versus 92% e 27.3% versus 30%, no HCFMUFPE e HCFMUSP, respectivamente. Houve uma transplantectomia no grupo do HCFMUFPE (9.1%) e duas no grupo do HCFMUSP (4%). Ocorreram quatro complicações ureterais nos receptores do HCFMUSP (8%) e nenhuma nos receptores do HCFMUFPE. Não houve diferença significativamente estatística na taxa de função renal (creatinina) entre o grupo do HCFMUFPE e HCFMUSP, no 1º, 3º, 5º, 10º e 30º dias de pós-operatório: 4.0 ± 2.2 versus 4.0 ± 3.0, 1.9 ± 0.9 versus xxxxxx, 1.8 versus 3.4, 1.7 versus 2.6 e 1.2 versus 1.57, respectivamente. Os dados obtidos evidenciam que o grupo do HCFMUFPE ainda não ultrapassou a curva de aprendizado em nefrectomia laparoscópica do doador renal vivo (NLDV), não obstante não houve prejuízo à integridade dos doadores ou à função renal dos enxertos, após implante nos receptores. A ocorrência de complicações graves obtidas em ambos os grupos, inclusive com um óbito no grupo do HCFMUSP demonstram que a NLDV é um procedimento cirúrgico de alta complexidade, na qual é necessário aprimoramento dos cuidados perioperatórios nos doadores, na tentativa de minimizar tais complicações. A técnica cirúrgica desenvolvida pelo grupo do HCFMUFPE demonstrou ser segura e eficaz, apresentando resultados funcionais semelhantes à técnica utilizada pelo grupo do HCFMUSP, com a vantagem de ter um custo financeiro menor. / Data of the first 11 laparoscopic live donor nephrectomy performed at Clinics Hospital of Federal University of Pernambuco (HCFMUFPE) between January and October, 2003 were prospectively recorded and compared with the first 50 laparoscopic live donor nephrectomy performed at Clinics Hospital of State University of São Paulo (HCFMUSP) between April, 2000 and August, 2003. Overall operative time (231 ± 39 min versus 179 ± 30 min, p ....), overall anesthesia time (299 ± 43 min versus 223 ± 31 min, p ....), average warm ischemia time (289 ± 111 versus 199 ± 95 seg, p .....) and blood loss (214 ± 98 versus 141 ± 82 ml, p..... ) were considered statistically significant better for the HCFMUSP group when compared with the HCFMUFPE group. One major complication was observed in each group (HCFMUFPE- 9.1% and HCFMUSP- 2%) and only one open conversion in the HCFMUFPE group (9.1%). Postoperatively, only pain scale at immediate post-operative day had statistically significant difference: 4.3 ± 2.2 versus 2.4 ± 2.3 (p ....). The HCFMUFPE group saved about R$ 3.985,00 per procedure due to the lack of use of disposable equipments. There were no statistically significant difference in time to initiate diuresis after graft implant (91% versus 92%) and acute tubular necrosis (27.3% versus 30%), with or without acute or chronic rejection, between the HCFMUFPE and HCFMUSP groups, respectively. One graft loss occurred in the HCFMUFPE group (9.1%) and two in the HCFMUSP group (4%). Four ureteral complications were seen in the HCFMUSP group (8%) whereas none in the HCFMUFPE group. No statistical difference was observed related to the recipient renal function after transplantation at 1º, 3º, 5º, 10º e 30º post operative days: 4.0 ± 2.2 versus 4.0 ± 3.0, 1.9 ± 0.9 versus xxxxxx, 1.8 versus 3.4, 1.7 versus 2.6 e 1.2 versus 1.57, respectively. In conclusion, the HCFMUFPE data shows that the learning curve is still to be overcome. Nonetheless, there were no major problems for the donors and no loss of renal graft function after transplantation. The occurrence of major complications in both groups and one death in the HCFMUSP group, highlight the complexity of this procedure. Finally, the HCFMUFPE surgical technique showed to be a safe, cheap and an attractive procedure to be used in undeveloped countries. Estudo comparativo Hospitais de ensino Laparoscopia/métodos Nefrectomia/métodos Pernambuco São Paulo (SP) Transplante de rim/mortalidade Comparative study Hospitals Kidney transplantation/mortality Laparoscopy/methods Nephrectomy/methods Pernambuco São Paulo (SP) teaching
236	Investigating the Application and Sustained Effects of Stochastic Resonance on Haptic Feedback Sensitivity in a Laparoscopic Task Wilcox, Kara Liane 08 June 2023 (has links) No description available. Biomedical Engineering Biomedical Research Engineering Health Health Care Mechanical Engineering Surgery stochastic resonance weak signals random noise non-linear system human motor control system laparoscopy laparoscopic surgery haptic feedback performance improvement palpation tumor detection sustained effects after effects haptic feedback sensitivity piezoelectric actuator
237	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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