O melanoma ungueal compreende cerca de 0,7 a 3,5% de todos os tipos de melanoma. Devido à dificuldade no diagnóstico precoce, seu prognóstico é reservado quando comparado às demais formas de melanoma. A amputação falangeana se propõe a extirpar o tumor respeitando os princípios da cirurgia oncológica, apesar de acarretar déficit funcional e estigmas sociais, além de não prolongar a sobrevida, particularmente nos casos iniciais. Abordagens mais conservadoras, como a cirurgia funcional, são utilizadas em casos in situ ou microinvasivos, que consistem na remoção de todo o complexo ungueal e preservação da falange distal, com bom resultado cosmético e funcional. Este estudo retrospectivo propõe comparar a sobrevida de pacientes tratados em cada uma das técnicas mencionadas, a partir de dados coletados de prontuários. Não houve alteração da sobrevida dos pacientes com melanoma ungueal tratados com amputação ou cirurgia funcional / Nail melanoma represents about 0.7-3.5% of all types of melanoma. Because its early diagnosis is difficult, the prognosis is conservative when compared with other forms of melanoma. The phalangeal amputation is intended to excise the tumor according to the cancer surgery principles, despite resulting in functional deficit and social stigmata and failing to extend survival, especially in early cases. More conservative approaches, such as functional surgery, have been used in \'in situ\' or microinvasive cases, which consist of removing the entire nail complex and preserving the distal phalange, provide good aesthetic and functional results. This retrospective study proposes to compare the survival of patients treated with each of these techniques by reviewing the data collected from their medical records. No changes were observed in the survival of nail melanoma patients treated with amputation or functional surgery

Västergarn is one of the smallest parishes on the island of Gotland. It’s a place of rich history and has been subject to numerous excavations throughout the years. The University of Gotland has conducted seminar excavations at Västergarn between the years of 2005-2012. During these excavations a lot of horse related finds have been found. By studying these finds archaeologist can learn a lot about the horses and the people who once lived in Västergarn. The purpose of this paper is to shed some light on the urban and rural horse in Västergarn. How big were the horses? Were the horses used for riding or farming? What can the finds tell us about the people who lived in Västergarn and their view on horse handling?

In this study, it is aimed to explore Akyaka&rsquo / s self-generated practice and its route of progress with the definitions of place. As the ignorance of Akyaka -as an unconventional body characterized with Nail &Ccedil / akirhan&rsquo / s Aga Khan Award winner traditional type of house in 1983- by the conventional architectural discourse prevents learning from it. Therefore, the research will focus on Akyaka&rsquo / s distinctive story which is taking its references from a place and producing the place of its own, out of the boundaries of the profession. Akyaka will be researched in the framework of several different aspects in relation to protection of coastal region, architectural representation, Aga Khan Award for Architecture, Turkish Architecture&rsquo / s identity quests, tourism&rsquo / s agendas, continuity of tradition and its controversy with modern, locality&rsquo / s sustainability, and pastiche in architecture. The town will be listened to in terms of its geographical, socio-cultural and architectural/architectonic bases. In this context, if this unrecognized formation has something to say after 25 years will be studied introducing the place phenomenon reproduced by the settlement as a field of discussion.

Project (D. Min.)--Perkins School of Theology, Southern Methodist University, 1989. / Includes bibliographical references (leaves 128-129).

Η παρούσα διδακτορική διατριβή περιγράφει το σχεδιασμό και την ανάπτυξη ενός εκπτυσσόμενου Ενδομυελικού Ήλου Επιμήκυνσης των Μακρών Οστών των Κάτω Άκρων. Η επιμήκυνση των κάτω άκρων είναι μία χειρουργική διαδικασία βαθμιαίας επιμήκυνσης των μακρών οστών των κάτω άκρων και των μαλακών μορίων που τα περιβάλουν. Γενικά, η επιμήκυνση των κάτω άκρων στοχεύει στην εξίσωση των σκελών ή αύξηση του μήκους των οστών και στα δύο άκρα. Η τεχνική αύξησης του μήκους των οστών των κάτω άκρων επινοήθηκε από τις αρχές του περασμένου αιώνα [1] και έχει καταξιωθεί στη μοντέρνα χειρουργική από τις αρχές του 1960, λόγω της ενασχόλησης του G.A.Ilizarov. Ο επιστήμονας και χειρουργός G.A.Ilizarov αφιέρωσε όλη τη θεωρητική και πρακτική του έρευνα [2] στη βελτίωση της διαδικασίας επιμήκυνσης των οστών και την ανάπτυξη εξωτερικής συσκευής σταθεροποίησης που φέρει το όνομα του. Η μέθοδος αυτή καθώς και η συσκευή Ilizarov χρησιμοποιήθηκαν πάρα πολύ για να διορθώσουν τόσο βλάβες όσο και παραμορφώσεις των κάτω άκρων. Η ευελιξία αυτής της συσκευής την κάνει ένα εξαιρετικό εργαλείο το οποίο μπορεί να χρησιμοποιηθεί για τη διόρθωση διαφόρων βλαβών όπως π.χ. σταθεροποίηση συνθέτων καταγμάτων, στροφικές διορθώσεις, διορθώσεις οστών με διαφορές μήκους. Τόσο όμως η συσκευή του Ilizarov όσο και οι υπόλοιποι μονόπακτοι εξωτερικοί σταθεροποιητές που παρουσιάσθηκαν αργότερα παρουσιάζουν μειονεκτήματα [3] όπως είναι π.χ. οι σύνθετες χειρουργικές διαδικασίες, οι συνδέσεις και οι βελόνες που διαπερνούν το δέρμα και που οδηγούν σε μολύνσεις, η μειωμένη δυνατότητα φόρτισης και η ταλαιπωρία λόγω του μεγέθους του σταθεροποιητή ειδικά στις περιπτώσεις εκείνες που η ευελιξία του σταθεροποιητή δεν είναι απαραίτητη. Πολλοί ασθενείς που χρειάζονται μία διόρθωση του μήκους ενός άκρου χωρίς άλλες παραμορφώσεις θα μπορούσαν να βοηθηθούν και από μία συσκευή μικρότερης ευελιξίας χωρίς τα μειονεκτήματα των εξωτερικών μονόπακτων σταθεροποιητών. / The technique to increase the length of the long bones is the subject of research for the orthopedic surgeons for many years. The technique is used for the treatment of a limb shortening due to malformation or to a deficit for other reasons e.g. the fracture of a long bone after a car accident, osteomyelitis, or malignancy. The procedure to increase the length of a bone is difficult and may become quite hazardous for the soft tissues surrounding the area. The two parts of the bone are stabilized to eliminate the possibility of relative torsion and bending. Then they align axially with respect to each other and move with a constant rate of elongation of 1mm per day. The elongation is usually achieved by 4 steps of 0,25mm every 6 hours. The application of internal distraction osteogenesis using shape memory alloys has all the advantages of internal osteosynthesis. The only part of these mechanisms that is found externally is the activation mechanism that is connected by the necessary cables of activation with the interior of the bone where the internal distraction device is placed. The basic problem of all designs is the high constructional complexity of activation and control of shift of the two parts of the bone, something that makes this systems non user friendly and with continuous fractures and blockings of the elements of the mechanisms. In the present work, all the advantages of the mechanism of internal distraction osteogenesis are combined with the fundamental advantage; the simplicity of manufacture of the mechanism and the simplicity of operation via the restriction of the moving elements.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / The aim of this research was to evaluate the interlocking nails technique in femoral fractures in dogs and evaluate the use of femoral intramedullary reaming byproducts as an adjuvant to bone healing. Twelve dogs, weighing between 15 and 18 kg, were randomly distributed in three groups according to the type of graft used in the fracture denominated I (control- untreated), II (the byproducts of femoral intramedullary reaming) and III(autogenous cancellous bone). Transverse osteotomy was performed in the middle portion of the femur and posterior osteosynthesis with inrelocking nails. After was carried out the grafting with by-products of intramedullary reaming or autogenous cancellous bone in sufficient quantity to fill the surface of the fracture. In order to compare the performance of the groups treatment were performed radiographic evaluations at 15, 30, 60 and 90 days postoperatively (PO), and clinical evaluation of the daily march up to the 7th postoperative day, and after weekly until the 60th days after surgery. The radiographic analysis revealed that at 30 postoperatively day the mean scores of consolidation in the dogs of the group that received grafts of intramedullary reaming by-products were higher than the other groups. At 45 and 60 postoperative days radiographic images also indicated the superiority of group II in relation to other groups. Clinical evaluation of the march on the 15th postoperative day showed the best performance of the dogs treated with grafting of femoral reaming by-products. 75% of these animals were in grade V of lameness. There was no statistical difference between the grafting of femoral intramedullary reaming byproducts and autogenous cancellous bone in relation to radiographic consolidation scores and degrees of lameness, at different times after surgery. The interlocking nails were considered an efficient method for osteosynthesis of femoral diaphyseal fractures in dogs, without alterations or inconvenience in postoperative period. The grafting of femoral intramedullary reaming byproducts proved to be a viable and effective adjuvant in healing bone fractures of long bones of dogs and we recommend this technique to be evaluated in dogs from traumatic fractures. / O objetivo desta pesquisa foi avaliar a técnica de hastes bloqueadas na osteossíntese de fraturas femorais em cães e avaliar o uso de subprodutos da fresagem intramedular femoral como adjuvante na cicatrização óssea. Foram utilizados 12 cães, pesando entre 15 e 18 kg, distribuídos aleatoriamente em três grupos iguais de acordo com o tipo de enxerto utilizado no foco da fratura, denominados de I (controle não tratado), II (subprodutos da fresagem intramedular femoral) e III (osso esponjoso autógeno). Foi realizada osteotomia transversa na porção média da diáfise femoral e posterior osteossíntese com hastes bloqueadas. Após realizou-se a enxertia de subprodutos da fresagem intramedular ou de osso esponjoso autógeno em quantidade suficiente para preencher a superfície do foco da fratura. Para comparar o desempenho dos grupos tratados, foram realizadas avaliações radiográficas nos períodos de 15, 30, 60 e 90 dias de pós-operatório (PO), e avaliação clínica da marcha diária até o 7º dia de PO, e após semanalmente até os 60 dias de PO. A análise radiográfica revelou que aos 30 dias de PO a média dos escores de consolidação no grupo que recebeu enxerto dos subprodutos fresagem intramedular foi superior à dos outros grupos. Aos 45 e 60 dias de PO as imagens radiográficas também indicaram a superioridade do Grupo II em relação aos demais grupos. A avaliação clínica deambulatória no 15º dia de PO evidenciou o melhor desempenho dos cães tratados com enxerto de subprodutos da fresagem femoral, dos quais 75% dos animais encontravam-se em grau V de claudicação. Não foi encontrada diferença estatística entre a enxertia de subprodutos da fresagem intramedular femoral e de osso esponjoso autógeno com relação aos escores de consolidação radiográfica e graus de claudicação, nos diferentes tempos de PO. As hastes bloqueadas foram consideradas um método eficiente para a osteossíntese de fraturas femorais diafisárias em cães, não possuindo alterações ou inconvenientes no pós-operatório. O enxerto de subprodutos da fresagem intramedular femoral revelou-se uma opção viável e eficiente de adjuvante cicatricial ósseo em fraturas de ossos longos de cães, recomendando-se sua avaliação na rotina clínica.

Background. Operative stabilisation of paediatric supracondylar elbow fractures is most commonly achieved through the use of percutaneous Kirschner wires. These implants are inert, cheap and simple to use. However, the requirement for removal and the possibility of pin site infection provides opportunity for the development of new techniques that eliminate these drawbacks. Bioabsorbable pins that remain in situ and allow definitive closure of skin at the time of surgery could provide such advantages. However, their ability to maintain fracture reduction and their effect on the growth plate has not been adequately evaluated. Hypotheses. The Acumed® Biotrak Helical Nail (a bioabsorbable fixation implant) has comparable strength to Kirschner wires and does not result in significant disruption of the growth plate or subsequent growth. Studies. Three complementary studies were performed. (1) A retrospective cohort analysis was performed to establish the prevalence of complications related to Kirschner wire fixation of paediatric supracondylar elbow fractures. (2) A saw-bone model was designed to compare the mechanical performance of the Helical Nail and Kirschner wires. (3) An ovine model was designed to assess the in vivo effects of the Helical Nail on limb growth and physeal morphology. The surgical practicalities of the device and its potential for use in the paediatric setting were evaluated. The primary outcome was femoral length six months after Helical Nail insertion. Micro-CT evaluation of growth plate thickness, percentage disruption and bony infiltration was undertaken – the first time this technique has been used in a large animal study. Traditional histopathological techniques complimented the Micro-CT analysis and offered comment on the microscopic appearance of the growth plate immediately adjacent to the bioabsorbable nails. Results. The infection rate within a large tertiary referral centre was 9.6%, which was marginally higher than previous cohort studies. Mechanical testing demonstrated that the Helical Nail had comparable strength in rotation, but inferior resistance to posterior translation, when compared to Kirschner wires. In the ovine model, the Helical Nail disrupted 3.4% of the physis. The nails had no effect on femoral growth during the six month study period. Micro-CT analysis of both the helical nail and Kirschner wire groups demonstrated multiple bony bridges, with two cases of physeal tethering in the Helical Nail group. There was no difference in physeal thickness or bony infiltration of the physis. Histopathology did not reveal any significant inflammatory or foreign body reaction adjacent to the nails. Conclusion. The Helical Nail demonstrated a number of encouraging attributes which indicate its potential. However, in its current state the device is not suitable for use in the stabilisation of paediatric supracondylar elbow fractures.

Psoriasis is a chronic disease that presents in individuals of all ages, affecting skin, nails and joints. Nail changes are estimated to be present in 10-80% of psoriatic patients at some point in their lives, with consequent aesthetic and functional repercussions and quality of life impairment. In Brazil, there are only a few epidemiological studies on nail psoriasis (NP) so far. The aim of this study is to evaluate the nails of a sample of psoriatic patients from the south of Brazil, determining the prevalence of nail involvement, its main characteristics and clinical associations. This is a cross-sectional study that evaluated 65 outpatients with plaque-type psoriasis treated at the Hospital Universitário de Santa Maria - RS, from January 2012 to March 2013. Skin severity was evaluated using the PASI method and the nail changes were assessed using the NAPSI score. Psoriatic arthritis was determined by CASPAR criteria. Demographic variables were assessed by specific questionnaire. The prevalence of NP was 46.1%. Patients with NP had an average of 8.1±5 nails affected and the main morfological sign found was onycholysis (80%). Most patients (63.3%) reported functional or aesthetic discomfort related to nails involvement. When compared to patients without nail changes, patients with NP showed lower mean age of onset of psoriasis (27,6±14,9 vs. 42,7±15,9 years, p=0.001) and longer duration of the disease (17,5±10,7 vs. 9,1±9,7 years, p=0.003). Patients with NP also had higher PASI score (11,1±8,3 vs. 6,5±6,1, p=0.024), higher frequency of family history of psoriasis (40% vs. 7,4%, p=0.011) and higher frequency of psoriatic arthritis (43,3 vs. 3,7, p=0,002). The NP is still poorly studied, despite its clinical consequences such as pain, functional limitation and aesthetic disorders. Its importance as a predictor of joint involvement and more severe cutaneous disease was demonstrated by this study. Family history and early onset of disease were also associated with NP. / A psoríase, doença de curso crônico que afeta indivíduos de todas as idades, acomete pele, unhas e articulações. Estima-se que 10-80% dos pacientes apresentem alterações ungueais em algum momento de suas vidas, com consequentes repercussões estéticas, funcionais e na qualidade de vida. No Brasil, existem escassos estudos epidemiológicos sobre as formas ungueais até o presente momento. O objetivo deste estudo foi avaliar as unhas de uma amostra de pacientes portadores de psoríase, determinando a prevalência do acometimento ungueal, suas principais características e associações clínicas. Trata-se de um estudo transversal que avaliou 65 portadores de psoríase vulgar atendidos no Hospital Universitário de Santa Maria - RS, no período de janeiro de 2012 a março de 2013. Os pacientes tiveram seu quadro cutâneo quantificado pelo escore de PASI e o ungueal avaliado através do NAPSI. O diagnóstico de artrite psoriásica (AP) levou em conta os critérios de CASPAR. A prevalência de psoríase ungueal (PU) foi de 46,1%. Os portadores de PU tiveram em média 8,1±5 unhas acometidas e o principal sinal encontrado foi a onicólise (80%). A maioria dos pacientes (63,3%) relatou incômodo estético ou funcional associado ao quadro. Quando comparados aos pacientes sem acometimento ungueal, os pacientes portadores de PU apresentaram menor média de idade ao início da psoríase (27,6±14,9 vs. 42,7±15,9 anos, p=0,001) e maior tempo de evolução da doença (17,5±10,7 vs. 9,1±9,7 anos, p=0,003). Os pacientes com PU apresentaram também maior escore de PASI (11,1±8,3 vs. 6,5±6,1, p=0,024), maior frequência de relato de história familiar (40% vs. 7,4%, p=0,011) e de AP (43,3 vs. 3,7, p=0,002). A PU ainda é pouco estudada, apesar das consequências clínicas como dor e limitação funcional e dos transtornos estéticos. Sua importância como fator preditor de acometimento articular e de quadros cutâneos extensos foi demonstrada através deste estudo. A associação da PU com história familiar e início mais precoce da doença também foi significativa.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-18T13:21:42Z No. of bitstreams: 1 evertonsoaresrocha.pdf: 712182 bytes, checksum: 97a37b4b654611a7c6bee4c33692baf6 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-01T18:38:44Z (GMT) No. of bitstreams: 1 evertonsoaresrocha.pdf: 712182 bytes, checksum: 97a37b4b654611a7c6bee4c33692baf6 (MD5) / Made available in DSpace on 2016-07-01T18:38:44Z (GMT). No. of bitstreams: 1 evertonsoaresrocha.pdf: 712182 bytes, checksum: 97a37b4b654611a7c6bee4c33692baf6 (MD5) Previous issue date: 2012-12-11 / FUNDAMENTOS: As alterações no exame clínico das unhas são frequentes nos adultos e mais raras nas crianças. Existem poucos trabalhos investigando a frequência e a natureza de alterações ungueais em pacientes pediátricos. OBJETIVO: Investigar a prevalência e a natureza de onicodistrofias em crianças escolares e identificar quais são as mais prevalentes. MÉTODOS: Estudo transversal realizado de setembro/2011 a março/2012. Foram examinadas 177 crianças, de 7 a 10 anos, de uma escola pública de Juiz de Fora-MG, Brasil. As alterações encontradas foram registradas com fotografias. As análises estatísticas foram realizadas no SPSS, 15.0. RESULTADOS: Pelo menos um tipo de alteração em uma das unhas de 91 crianças (51,4%) foi detectado. As unhas dos dedos dos pés foram mais afetadas que nas mãos (32,2% contra 24,9%). Constatou-se também uma maior variedade de alterações ungueais nos pés. Foram observadas mais alterações entre as crianças do gênero masculino que entre as do feminino. No grupo de indivíduos melanodérmicos, a percentagem de alterações encontradas foi maior que nos demais grupos de cor da pele. A leuconíquia foi o sinal clínico mais encontrado nas unhas das mãos, enquanto o grupo “onicodistrofias provocadas por traumatismos” constituiu a alteração mais frequente nas unhas dos pés. Nestas, a melanoníquia foi também um sinal clínico frequente. O hábito de roer as unhas (onicofagia) foi relatado por 34 estudantes (19,2%). CONCLUSÃO: Os achados mostram uma prevalência significativa de alterações no exame das unhas. Portanto, recomenda-se que a inspeção das unhas das mãos e dos pés faça parte do exame clínico dermatológico pediátrico. / BACKGROUND: Changes in the clinical examination of the nails are frequent in adults and rarer in children. There are few studies investigating the frequency and nature of nail alterations in infant patients. OBJECTIVE: To investigate the prevalence and nature of onychodistrophies in schoolchildren and to identify which are the most prevalent. METHODS: a cross-sectional study was carried out from September 2011 to March 2012. One hundred and seventy-seven children have been examined, aged 7-10 years, from a public school of Juiz de Fora-MG, Brazil. The alterations were recorded by photographs. The statistical analysis was performed in SPSS, 15.0. RESULTS: At least one type of change in one of the nails of 91 children (51.4%) was detected. The nails of the toes were more affected (32.2%) than in the hands (24.9%). A greater variety of nail changes in the feet was also observed. Most changes were noted among male children than among females. The percentage of changes found in the group of melanodermic individuals was greater than in the other groups of colored skin. Leukonychia was the most frequent clinical sign found in fingernails, while the group "onychodistrophies caused by trauma" was the most frequent change in the toenails. In these, the melanonychia was also a frequent clinical sign. The habit of nail biting (onychophagy) was reported by 34 students (19.2%). CONCLUSION: The findings show a significant prevalence of alterations in the examination of the nails. Therefore, it is recommended that the inspection of the nails of the hands and feet takes part of pediatric dermatological clinical examination.

This diploma thesis is focused on designing innovation of manufacturing calcaneal nail C-NAIL. The thesis contains analysis of technological processes of current manufacturing. There is also information about materials which are used for the manufactory. Finally, the thesis contains a designed technological process for manufacturing calcaneal nail C-NAIL.