Thèse Médecine Montpellier, 1876 numéro 12.

Thesis (M.S.)--University of Wisconsin--Madison, 1981. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves B-1-B-6).

Thesis (M.S.P.H.)--University of Michigan, 1941.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Made available in DSpace on 2014-06-11T19:31:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-03Bitstream added on 2014-06-13T19:47:15Z : No. of bitstreams: 1 canola_pa_dr_jabo.pdf: 1174710 bytes, checksum: ceb7b448614608389d3ccd9a1212af20 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A cavidade torácica, a exemplo do abdômen, também pode ser sede de afecções que comprometem as funções vitais do equinos. A principal preocupação é o desenvolvimento do pneumotórax, cuja causa mais comum é o traumatismo torácico. Pensando nisto, buscou-se entender as repercussões clínicas da entrada de ar na cavidade torácica nesta espécie. Ademais, averiguou-se a possibilidade de reparo de lesões torácicas, mantendo o animal em posição quadrupedal, mediante utilização de neuroleptoanalgesia. Para tal utilizou-se acepromazina e meperidina, em associação ao bloqueio anestésico local paracostal com bupivacaína. Para isso, foram utilizados sete equinos adultos, hígidos, com idade entre 4,5 a 9 anos e peso corpóreo de 270 a 330 kg. Estes foram submetidos à toracotomia experimental para indução do pneumotórax, simulando o traumatismo torácico agudo. Valores da pressão pleural (Ppl) foram obtidos diretamente por punção das porções dorsal, média e ventral do 8º espaço intercostal (EIC) esquerdo. Posteriormente, foram comparados com a pressão esofágica (Pes). Esta também foi utilizada para avaliar a eficácia do dreno em restaurar a pressão negativa no interior do tórax. Similarmente, a pressão intravesical (PIV) e intraabdominal (PIA) foram correlacionadas, para fins de avaliação indireta das repercussões do aumento da pressão intratorácica sobre a cavidade abdominal. Ainda, foram registrados os valores da frequência cardíaca (FC), respiratória (ƒ), temperatura retal (To), tempo de preenchimento capilar (TPC) e coloração das mucosas oral, nasal e ocular. Ademais, avaliou-se a presença de dor na ferida cirúrgica e mensuração da pressão arterial (PA) e artéria pulmonar (PAP) sistólica, média e diastólica. Também, foi avaliada a função do ventrículo esquerdo mediante exame... / Similarly to the abdomen, the equine thoracic cavity might as well be a site of which could promote disturbances to the animal´s health. Traumas to the thoracic cavity resulting in development of pneumothorax are the main concern in these cases. Therefore, we evaluated the clinical repercussions of the entrance of air into the thoracic cavity of horses. Furthermore, we attempted to maintain the animals in standing, awake position by using neuroleptoanalgesy with acepromazine and meperidine in association with local anesthetic blocks with bupivacaine. To that purpose seven healthy adult horses, aging 4.5 to 9 years, and weighting 270 to 330 kg were used. Pneumothorax was experimentally-induced by thoracotomy procedure to simulate an acute thoracic trauma. Pleural pressure (Ppl) was recorded by direct thoracic puncture in three distinct regions of the 8th left intercostal space (dorsal, medial and ventral). As follows, Ppl was correlated to esophageal pressure (Pes). Esophageal pressure was used for means of evaluating the efficacy of a thoracic drain in restoring the negative pressure inside the thoracic cavity. We also correlated intravesical (PIV) and intra-abdominal (PIA) pressures as an attempt to indirectly access the effects of the increased thoracic pressure on the abdominal cavity. Heart (FC) and respiratory (ƒ) rates, rectal temperature (To), capillary refill time (TPC) and ocular, nasal and oral mucous membranes coloration were recorded. We also investigated the scale of pain on the surgery. Additionally, we measured both arterial and pulmonary artery systolic, mean and diastolic pressures. Left ventricular function was observed indirectly by echocardiography, and arterial and mixed bloods were collected for means of blood gas analysis. Venous blood was collected for purposes of plasmatic fibrinogen quantification and... (Complete abstract click electronic access below)

Orientador: Carlos Augusto Araújo Valadão / Banca: Raquel Yvonne Arantes Baccarin / Banca: Rafael Resende Faleiros / Banca: Juliana Regina Peiro / Banca: José Correa de Lacerda Neto / Resumo: A cavidade torácica, a exemplo do abdômen, também pode ser sede de afecções que comprometem as funções vitais do equinos. A principal preocupação é o desenvolvimento do pneumotórax, cuja causa mais comum é o traumatismo torácico. Pensando nisto, buscou-se entender as repercussões clínicas da entrada de ar na cavidade torácica nesta espécie. Ademais, averiguou-se a possibilidade de reparo de lesões torácicas, mantendo o animal em posição quadrupedal, mediante utilização de neuroleptoanalgesia. Para tal utilizou-se acepromazina e meperidina, em associação ao bloqueio anestésico local paracostal com bupivacaína. Para isso, foram utilizados sete equinos adultos, hígidos, com idade entre 4,5 a 9 anos e peso corpóreo de 270 a 330 kg. Estes foram submetidos à toracotomia experimental para indução do pneumotórax, simulando o traumatismo torácico agudo. Valores da pressão pleural (Ppl) foram obtidos diretamente por punção das porções dorsal, média e ventral do 8º espaço intercostal (EIC) esquerdo. Posteriormente, foram comparados com a pressão esofágica (Pes). Esta também foi utilizada para avaliar a eficácia do dreno em restaurar a pressão negativa no interior do tórax. Similarmente, a pressão intravesical (PIV) e intraabdominal (PIA) foram correlacionadas, para fins de avaliação indireta das repercussões do aumento da pressão intratorácica sobre a cavidade abdominal. Ainda, foram registrados os valores da frequência cardíaca (FC), respiratória (ƒ), temperatura retal (To), tempo de preenchimento capilar (TPC) e coloração das mucosas oral, nasal e ocular. Ademais, avaliou-se a presença de dor na ferida cirúrgica e mensuração da pressão arterial (PA) e artéria pulmonar (PAP) sistólica, média e diastólica. Também, foi avaliada a função do ventrículo esquerdo mediante exame... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Similarly to the abdomen, the equine thoracic cavity might as well be a site of which could promote disturbances to the animal's health. Traumas to the thoracic cavity resulting in development of pneumothorax are the main concern in these cases. Therefore, we evaluated the clinical repercussions of the entrance of air into the thoracic cavity of horses. Furthermore, we attempted to maintain the animals in standing, awake position by using neuroleptoanalgesy with acepromazine and meperidine in association with local anesthetic blocks with bupivacaine. To that purpose seven healthy adult horses, aging 4.5 to 9 years, and weighting 270 to 330 kg were used. Pneumothorax was experimentally-induced by thoracotomy procedure to simulate an acute thoracic trauma. Pleural pressure (Ppl) was recorded by direct thoracic puncture in three distinct regions of the 8th left intercostal space (dorsal, medial and ventral). As follows, Ppl was correlated to esophageal pressure (Pes). Esophageal pressure was used for means of evaluating the efficacy of a thoracic drain in restoring the negative pressure inside the thoracic cavity. We also correlated intravesical (PIV) and intra-abdominal (PIA) pressures as an attempt to indirectly access the effects of the increased thoracic pressure on the abdominal cavity. Heart (FC) and respiratory (ƒ) rates, rectal temperature (To), capillary refill time (TPC) and ocular, nasal and oral mucous membranes coloration were recorded. We also investigated the scale of pain on the surgery. Additionally, we measured both arterial and pulmonary artery systolic, mean and diastolic pressures. Left ventricular function was observed indirectly by echocardiography, and arterial and mixed bloods were collected for means of blood gas analysis. Venous blood was collected for purposes of plasmatic fibrinogen quantification and... (Complete abstract click electronic access below) / Doutor

Thesis (M.S.)--University of Michigan, 1978.

Thesis (M.S.)--University of Michigan, 1978.

Le pneumothorax spontané (PS) est une pathologie le plus souvent bégnine quand elle survient chez un sujet sain. Le principal risque est la récidive dans environ 30 % des cas. L'évolution des connaissances concernant sa physiopathologie, associée aux résultats des études cliniques évaluant sa prise en charge en ambulatoire, font reconsidérer les stratégies de traitement initial et de prévention des récidives. Nos travaux de recherche sur le PS ont plusieurs axes relatifs aux aspects épidémiologiques, diagnostiques et thérapeutiques de sa prise en charge initiale, en particulier dans les services d'urgence. Cette thèse s'articule autour de 3 volets. Le premier volet correspond à l'identification de facteurs associés à la récurrence du PS. Si le tabac, le sexe ou l'intoxication au cannabis sont des facteurs de risque reconnu d'occurence, leur impact sur la récidive n'est pas consensuel. C'est pourquoi nous avons mené une étude rétrospective multicentrique dans des services d'urgence français. Sur cette série de 1491 PSP, dont respectivement 62 et 38% correspondaient à un premier épisode et à une récidive, aucun facteur de risque clinique n'était lié à la récidive. Malgré des limites méthodologiques liées notamment à son caractère rétrospectif, cette série représente la plus importante quantitativement jamais publiée. Un deuxième axe concerne l'étude de la prise en charge thérapeutique initiale du PS aux urgences. Bien que des études préliminaires aient montré des taux de succès de plus de 70% en cas de prise en charge ambulatoire, en l'absence de consensus au niveau international ni de recommandations françaises, le choix du traitement initial revient au praticien prenant en charge le patient. Très peu de données existent sur cette prise en charge initiale dans la vraie vie, qu'il s'agisse de la décision thérapeutique, du matériel employé ou du spécialiste impliqué. Ainsi, nous avons mené une étude rétrospective à propos de 1849 PS pris en charge dans 14 services d'urgence en France afin de documenter la filière de prise en charge. Cette étude a montré que la prise en charge était pluridisciplinaire, que l'abstention était la stratégie thérapeutique de première intention pour la moitié des patients. et qu'en cas de geste le drainage était choisi dans près de 80% des cas. La stratégie ambulatoire ne concernait que 239 patients, dont 230 PS primitifs et 9 PS secondaires (4%), très majoritairement en cas d'abstention thérapeutique. Le troisième volet concerne l'évaluation médico-économique de deux stratégies de traitement d'un premier PS primitif: drainage thoracique standard versus une stratégie combinée avec exsufflation en première intention (étude EXPRED). L'étude a porté sur une série de 379 patients, randomisés en deux bras. Les résultats de cette étude multicentrique ont montré que les deux stratégies étaient équivalentes en ce qui concerne le succès immédiat, évalué sur le recollement pleural, et le taux de récidive à un an. L'évaluation médico économique, conduite avec une approche de minimisation des coûts et avec l'hypothèse d'une équivalence des deux stratégies, dans la perspective du payeur, a montré que l'exsufflation était une stratégie plus coût efficace que le drainage. Au final, les résultats de ces travaux montrent qu'en pratique, actuellement, dans les services d'urgences en France, l'abstention thérapeutique et le drainage thoracique sont préférentiellement choisis lors de la prise en charge du PS, à l'inverse des stratégies ambulatoires. Les connaissances apportées par l'étude EXPRED et celles sur les facteurs de risque de récidive sont de nature à influencer les recommandations françaises à venir. De futurs travaux de recherche devront s'attacher à identifier les freins à l'implantation de ces recommandations, ainsi que ceux relatifs à l'adhésion à une stratégie ambulatoire de prise en charge / Spontaneous pneumothorax (SP) is usually a benign pathology, when it occurs at a healthy subject. Recurrence is the main risk, in approximately 30% of the cases. Current knowledge concerning physiopathology, associated with the results of clinical trials estimating ambulatory treatment, make reconsider the strategies of initial treatment and prevention of recurrence. Our research on SP have several topics related to epidemiological, diagnostic and therapeutic aspects of initial management in the Emergency Department (ED). This work treats three axis. The first axis corresponds to identification of factors associated with recurrence of primary spontaneous pneumothorax (PSP). If tobacco, gender or use of cannabis are identified as a risk factor of occurrence, their impact on recurrence are not consensual. Then, we conducted a retrospective multicenter study in 14 french ED. In this population of 1491 PSP, among whom respectively 62 and 38% corresponded to a first episod and to a recurrence, no clinical risk factor of recurrence was highl ighted. In spite of methodological limits, in particular in line with its retrospective design, this series represents the most larger never published. The second axis concerns the study of initial treatrnent of PS in 14 ED. Although preliminary studies showed rates of success of more than 70% in case of ambulatory management, in the absence of international consensus and French recommandations, the choice of initial treatment depends on physicians decision. Few data exist on this initial management in real life condition, concerning therapeutic action, material devices used, or speciality of physicians implied. Again, we conducted a second retrospective study with 1849 PS in 14 french ED in France to precise healthcare pathways. The study showed that the management was multidisciplinary, abstention was the frst therapeutic strategy for half of patients and in case of intervention, chest tube was chosen in about 80% of cases. Ambulatory strategy concerned only 239 patients (14%), among whom 230 PSP and 9 secondary PS, mostly in case of abstention. The third axis concerns medical economic evaluation of two treatments strategies of first primary PS : chest tube drainage versus aspiration as first therapeutic action (EXPRED study).The study concerned a serie of 379 patients, randomized in Iwo arms. The results of this multicenter study showed that both strategies are equivalent concerning immediat success estimated on pneumothorax resolution and the rate of recurrence at one year. The medicoeconomic evaluation as a minimization of the costs and with the hypothesis of an equivalence of both strategies with the prospect of the payer, showed that aspiration was a strategy more cost effective than chest tube. Finally, results of these works showed that actually in practice, abstention and chest tube drainage are preferentially chosen for the management of PS in ED in France, compare to ambulatory strategy. Results of EXPRED study and knowledge about risk factors of recurrence can influence future french recommandations. Future research are necessary to identify barriers to implementation of these recommandations, as well asthose relative to adhesion of ambulatory management.

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