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Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Reproduction de : Thèse d'exercice : Médecine : Nancy 1 : 2003. / Titre provenant de l'écran-titre.

Mémoire d'orthophonie : Médecine : Nantes : 2008. / Bibliogr.

Thèse (Ph. D.)--Université Laval, 1997. / Bibliogr.: f. [224]-232. Publié aussi en version électronique.

This thesis conducts a legal analysis of the Duchy of Cornwall and how its perceived status has changed over the centuries. The roots of the Duchy date back nearly a thousand years therefore an understanding of the roots of the Duchy and its evolution, focussing on the significant legal issues, over time is necessary to comprehend its present position. The thesis concludes by exploring issues surrounding the contemporary legal status of the Duchy and identifies areas in which there is a convenient ambiguity. In doing so it establishes that while the Duchy and Government describe it as a “private estate” it enjoys privileges and rights which are unique to a “private estate”. In addition it has a significant role in supporting the United Kingdom’s Head of State, the Sovereign, and the heir to the throne. The associated research undertaken in connection with this thesis presents new information which challenges the arguments of those who claim via the Duchy a special constitutional status for Cornwall. The evidence also suggests that the Duchy is not, despite claims to the contrary, publicly accountable in way that is expected in the 21st Century. The possibilities suggested by the Freedom of Information Act 2000 have been utilised and the experience gained will be of value to future researchers. As a consequence of the refusal of public authorities to provide information five complaints have been made to the Information Commissioner and there have been, at the time of writing, four cases in front of the First Tier Tribunal (Information Rights). The material contained within the National Archives has been comprehensively investigated for the first time by anyone with any interest in the Duchy. This has revealed significant new information which although publicly available was not generally known and casts new light on the status of the Duchy. An exploration of the Parliamentary Archives, not previously undertaken, raises questions about the basis of the privileges enjoyed by the Duchy. A similarly detailed review of the legal material, including important court cases challenges the “rights” claimed for the Duchy.

Orientador: Luiz Gonzaga [Unesp] Gandini Júnior / Resumo: Objetivo: Quantificar, in vitro e tridimensionalmente, o sistema de força gerado durante o uso da barra palatina de beta-titânio 0,032' x 0,032' (BP) e arco continuo (AC) níquel titânio 0,016' (NiTi) para giro-versão e expansão do primeiro molar superior. Materiais e Métodos: Duas pesquisas científicas foram realizadas e redigidas em dois artigos científicos para avaliar os objetivos apresentados. Resultados: A BP quando utilizada para correção da giro-versão do primeiro molar produziu força vestíbulo palatina, mésio-distal e momento no centro de resistência (Net Mz) maiores que o AC. Nos segundos molares não foram encontradas diferenças em relação a força mésio-distal e momento, mas o AC apresentou força vestíbulo palatal (0,04N). Para expansão do primeiro molar superior as forças mésio distais foram aproximadas para as duas mecânicas a força mésio-distal foi maior na BP (-0,60N) quando comparada ao AC (-0,08N) já o momento foi calculado pelo centro de resistência onde Net Mz da BP teve resultados maiores que o AC. No segundo molar não existiram forças significantes com a mecânica de BP enquanto no AC observou-se forças colaterais de distalização e lingualização além de um Net Mz bastante baixo. Conclusão: Para giro-versão do primeiro molar superior a BP gera forças e momentos de maior magnitude que o AC. No entanto, no segundo molar, forças vestíbulo palatais são maiores no AC. Na mecânica de expansão no primeiro molar as forças transversais são parecidas nas duas mecâni... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To quantify, in vitro and three-dimensional, the force system generated by a palatine bar (PB) beta-titanium 0.032 "x 0.032" and continuous arch (CA) NiTi 0.016 to derotation and expansion of the maxillary first molar. Methods and Materials: Two research were written in two scientific articles to evaluate the objectives. Results: The PB when used to derotation the molar produced vestibular palatine, mesio-distal force and moment in the center of resistance (Net Mz) greater than the CA. In second molars were not found moment, just vestibular palatine force (0.04N). For the molar expansion mesio-distal force was higher in PB (-0.60N) than in CA (-0.08N) and the momentum was calculated by the center of molar resistance. Net Mz of PB had higher results than CA. In the second molar there were no significant forces with PB mechanics while in CA we observed forces of distalization and lingualization besides a low Net Mz. Conclusion: For the first molar derotation PB generates forces and moments of greater magnitude than the CA. However, in the second molar, palatal vestibular forces are higher in CA. In the expansion mechanics in the first molar, the transverse forces are similar in two mechanicals and there is a greater unwanted moment of rotation in the PB than in CA. While in the second molar side effects are only felt in the mechanics of CA. / Mestre

Adenotonsillar hypertrophy (ATH) seems to be more frequent and persistent in children with sickle cell disease (SCD), which causes a negative impact since it increases the recurrence of pharyngitis and leads to sleep-disordered breathing (SDB), thus increasing the risk of polymerization of hemoglobin S and thereby vaso-occlusive crisis and other complications. The objectives of the study were to determine the frequency of ATH in preschool children with SCD; observe whether there is an association between ATH and age within the age group studied, assess whether the subscale of SDB is associated with the diagnosis of ATH in preschool children with or without SCD and correlate the presence of ATH with features and clinical complications in preschool children with SCD. It is an analytical observational study, consisting of a study group composed of 48 children with SCD and a control group of 35 children without such disease. All children underwent oropharyngoscopy with front light and nasal video endoscopy, while parents and / or guardians answered the questions of SDB subscale of the Sleep Disturbance Scale for Children (SDSC). The presence of ATH was considered when palatine tonsils were grades three or four of Brodsky scale (1989) and / or when pharyngeal tonsil occluded choanaes in at least 70% (1st criterion) or 50% (2nd criterion). In children with SCD were also surveyed on records the following characteristics and clinical complications of SCD: level of hemoglobin F (HbF), child's age when they began presenting specific symptoms of SDC, history of transfusions and hospitalizations due to painful crises, cerebrovascular accident (CVA) and acute chest syndrome (ACS). Twelve children from the study group (25%) and eight children in the control group (20%) had ATH when we used the 1st criterion of obstruction by the pharyngeal tonsil. When used the 2nd criterion, 18 (37.5%) children in the study group and 13 (37.1%) children in the control group received this diagnosis, with no significant difference between the frequencies in both groups regardless of the obstruction criteria used (p = 0.246 and p = 0.061, respectively). There was only association between ATH and age in the control group and only when the 1st criterion of obstruction by the pharyngeal tonsil was used (p = 0.043). The SDB subscale of EDSC joined the diagnosis of ATH regardless of pharyngeal obstruction criteria used both in the study group (p = 0.0025 for 1st criterion and p = 0.008 for the 2nd), as in the control group (p = 0.0026 for 1st criterion and p = 0.0018 for 2nd). Among the features and clinical complications of SDC, the ATH showed a correlation only with a higher percentage of HbF. It was concluded that ATH was not associated with SDC in preschool children in the study sample; the age of five years was the most affected by ATH in children without the diagnosis of SDC, when used 1st criterion of pharyngeal obstruction; the SDB subscale of SDSC presented itself as a useful tool for the suspected diagnosis of ATH in preschool children with or without SDC; ATH was associated with a higher percentage of HbF in children with SCD. / A hipertrofia adenotonsilar (HAT) parece ser mais frequente e com tendência a prolongar-se em crianças com doença falciforme (DF), o que traz um impacto negativo na medida em que aumenta a recorrência de faringites e leva a distúrbios respiratórios do sono (DRS), elevando assim o risco de polimerização da hemoglobina S e, consequentemente, fenômenos vasoclusivos e outras complicações. Os objetivos do trabalho foram: verificar a frequência de HAT em pré-escolares portadores de DF; observar se há associação entre HAT e idade dentro da faixa etária estudada, avaliar se a subescala de DRS associa-se ao diagnóstico de HAT em pré-escolares com ou sem DF e correlacionar a presença de HAT com características e complicações clínicas nos pré-escolares portadores de DF. Trata-se de um estudo observacional analítico, constituído por um grupo-estudo composto por 48 crianças com DF e de um grupo-controle formado por 35 crianças sem a referida doença. Todas as crianças foram submetidas a orofaringoscopia com luz frontal e vídeo-endoscopia nasal, enquanto os pais e/ou responsáveis responderam às três questões da subescala de DRS da Escala de Distúrbio do Sono em Crianças (EDSC). A presença de HAT era considerada quando as tonsilas palatinas situavam-se nos graus três ou quatro da escala de Brodsky (1989) e/ou quando a tonsila faríngea ocluía as coanas em no mínimo 70% (1º critério) ou 50% (2º critério). Em relação às crianças com DF foram ainda pesquisadas em prontuário as seguintes características e complicações clínicas da doença: porcentagem de hemoglobina F (HbF), idade da criança quando se iniciaram os sintomas específicos da DF, histórico de transfusões e internamentos decorrentes de crises álgicas, acidente vascular encefálico (AVE) e síndrome torácica aguda (STA). Doze crianças do grupo-estudo (25%) e oito crianças do grupo-controle (20%) apresentaram HAT quando foi utilizado o 1º critério de obstrução pela tonsila faríngea. Quando utilizado o 2º critério, 18 (37,5%) crianças do grupo-estudo e 13 (37,1%) crianças do grupo-controle receberam este diagnóstico, não havendo diferença significativa entre as frequências nos dois grupos independentemente do critério de obstrução utilizado (p=0,246 e p=0,061, respectivamente). Só houve associação entre HAT e idade no grupo-controle e somente quando utilizado o 1º critério de obstrução pela tonsila faríngea (p=0,043). A subescala de DRS da EDSC associou-se ao diagnóstico de HAT independentemente do critério de obstrução faríngea utilizado, tanto no grupo-estudo (p=0,0025 pelo 1º critério e p=0,008 pelo 2º), quanto no grupo-controle (p=0,0026 pelo 1º critério e p=0,0018 pelo 2º). Dentre as características e complicações clínicas da DF, a HAT demonstrou associação somente com uma porcentagem mais alta de HbF. Concluiu-se que a HAT não esteve associada à DF em pré-escolares na amostra estudada; a idade de cinco anos foi a mais acometida por HAT em crianças sem o diagnóstico de DF, quando utilizado o 1º critério de obstrução faríngea; a subescala de DRS da EDSC apresentou-se como um instrumento útil para a suspeita diagnóstica de HAT em pré-escolares com ou sem DF; a HAT esteve associada a uma maior porcentagem de HbF nas crianças com DF.

Introduction: The palate is a well-established donor site for obtaining graft tissue in periodontal plastic surgery procedures. However, proximity to the adjacent teeth on the lateral aspect and the greater palatine neurovascular bundle (GPB) on the medial aspect limit the amount of graft tissue that can be obtained from the palate. Previous studies have been concerned with the location of the greater palatine foramen as well as the greater palatine artery (GPA) and have established guidelines on how to estimate the distance between the teeth and the GPB. Traditionally, clinicians follow these guidelines and choose to avoid removing graft tissue in the area close to the GPB out of fear of possible complications such as hemorrhaging and paresthesias. Objectives: The purpose of the present investigation is to locate the position of the greater palatal artery (GPA) in relation to surrounding anatomical landmarks and determine if the tissue thickness covering the GPA is sufficient to permit gingival grafts to be obtained in the area close to the GPB. Materials and methods: Cadaver dissections were performed on a total of ten (n=10) cadaver hemifaces of which 7 were partially and 3 were completely edentulous. From the greater palatine foramen to the incisive foramen, the palatal tissues of the cadavers were dissected into vertical slices of 3 mm in width perpendicular to the median palatine raphe using a double bladed scalpel. On each tissue slice, the distance from the epithelial surface to the superior border of the vessel, the diameter of the vessel, the distance from the inferiorborder of the vessel to the palatal bone, the distance from median palatine raphe to the GPA and the distance from teeth or midline of the alveolar crest to the GPA were measured using both a periodontal probe and a digital caliper. The measurements were correlated to each other, the angle of the palatal vault, an estimate of the palatal depth and the head length of the cadavers. Results: The mean thickness of the tissue above the GPA was 4.30 ± 1.61 mm with a range of 1.92 – 8.72 mm. The tissue thickness decreased consistently from the 3rd molar to the canine area with the thickest mean tissue being in the 2nd molar region with 6.25 ± 1.09 mm and shallowest mean tissue thickness in the region of the lateral incisor with 2.92 ± 0.46 mm. The mean distance of the GPA from the median palatine raphe is 10.34 ± 3.41mm ranging from 13.77 ± 1.67 mm to 6.02 ± 0.83 mm with the greatest distance being from the 3rd molar region and smallest distance being from the lateral incisor area. No statistically significant correlations were found between the angel of the palatal vault, the estimate of the palatal depth and the head length. A significant correlation (R2=0.92) was found between the total palatal tissue thickness and tissue thickness above the GPA. Discussion: There was adequate gingival tissue above the GPA to harvest tissue for free gingival grafts of 1 - 1.5 mm in thickness in the entire palate. Donor tissue for 1.5 mm thick connective tissue grafts with a 1.5 mm epithelial flap could be obtained opposing the 1st molar and posterior to it staying above the GPA. Donor site for palatal grafts can be extended in a medial and posterior direction.A Formula (Tissue Thickness above the GPA = (Total Thickness of palatal tissue - 0.967) x 0.9) has been derived, which accurately locates the GPA based on the thickness of the palatal tissue. Unique to this study were measurements from the median palatine raphe, which will provide the clinician with a new landmark to more reliably locate the GPA at various locations on the palate. Conclusion: This descriptive pilot study on human cadavers provides a formula to locate the GPA within the palate using the total palatal tissue thickness and suggests that graft tissue can be harvested from the tissue above the GPA in the entire palate for FGGs and opposing to the 1st molar and posterior to it for CTGs not exceeding 3 mm in depth.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.