Copies of author's previously published articles enclosed. Bibliography: leaves 217-258. Examines recent literature which describes cases of metastatic involvement of laparoscopic port sites, not only in patients with advanced tumors but in patients with early stage carcinoma, and even in patients following laparoscopic procedures during which tumors were not disturbed. This thesis utilises an established small animal model to investigate the aetiology of port site metasrases and the efficacy of preventative strategies in reducing tumor implantation following laparoscopy.

Although surgical and transcatheter interventions have significantly improved survival of patients with coarctation of the aorta (CoA) and interrupted aortic arch (IAA), long-term complications including left ventricular (LV) abnormalities and systemic arterial dysfunction remain issues of concern despite successful repair. While new indices of myocardial deformation that reflect diastolic and systolic function in terms of strain, strain rate, and torsion as detected by speckle tracking echocardiography have shown promise in the assessment of LV, left atrial (LA), and right ventricular (RV) mechanics, the understanding of ventricular myocardial deformation after repair of CoA is limited. In this thesis, studies were undertaken to test the hypotheses that LV, LA, and RV myocardial deformation is altered and related to structural and functional arterial alterations in adolescents and young adults late after successful intervention of CoA and IAA, and to explore the LV contractile reserve noninvasively by examining the force-frequency relationship (FFR) in these patients. The LV, LA, and RV mechanics were evaluated with tissue Doppler and speckle tracking echocardiography, while carotid arterial structure and function were determined by radiofrequency-based echocardiographic imaging and oscillometry techniques. Supine bicycle stress exercise testing was used to evaluate the FFR by tracking the changes in LV contractility with increase in heart rate. Patients after CoA and IAA repair had significantly greater carotid arterial stiffness and intima-media thickness when compared with controls. Furthermore, mitral annular systolic and diastolic velocities, LV longitudinal and radial strain and early diastolic strain rates, peak torsion and untwisting velocity, and LA peak positive and total strain, and LA strain rates at ventricular systole, early diastole, and atrial contraction were significantly lower in patients than controls. Increased arterial stiffness and intima-media thickness was associated with worse LV myocardial deformation, while LA total strain and LA strain rate at ventricular early diastole were associated with diastolic annular velocities and strain rates. Multivariate analysis further revealed arterial stiffness as an independent determinant of LA total strain. With regard to dynamic assessment of LV contractile reserve, at submaximal exercise, the systemic blood pressures were significantly greater in patients than controls, while mitral annular systolic and early diastolic velocities remained significantly reduced. The increase in LV myocardial isovolumic acceleration, a relative load independent index of contractility, with increase in heart rate during exercise stress was significantly reduced in patients compared with controls. Flattening of FFR in patients reflected impaired LV contractile reserve, which was found to be associated negatively with increment in systemic blood pressure during exercise. For RV mechanics, patients with CoA repaired exhibited significantly lower tricuspid annular systolic and early diastolic velocities, global RV systolic longitudinal strain, and strain rate during systole, early and late diastole, compared to controls. Impairment of RV deformation was further related to increased LV mass and RV thickness. In conclusion, these findings suggest arterial dysfunction, impaired LV, RV, and LA mechanics, and reduced LV contractile reserve, in patients late after CoA and IAA repair even in the absence of residual aortic narrowing and implicate abnormal arterial-LV-LA and LV-RV interactions. / published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Philosophy

Neurosensory deficit is a well-reported complication after lower third molar surgery. It is useful to know the outcomes of the available treatments for neurosensory deficit after third molar surgery. It is more important to prevent nerve injury from third molar surgery. This thesis aims1) to evaluate the outcomes of treatments for neurosensory deficit after lower third molar surgery; 2) to investigate the effect of permanent neurosensory deficit from the patient’s perspective;3) to identify radiographic signs as predictors of inferior alveolar nerve (IAN) deficit in third molar surgery; 4)to monitor the long-term root movement and morbidities of the retained roots following coronectomy of the lower third molars. (1) A systematic search on treatment modalities and their outcomes of neurosensory deficit after lower third molar surgery was performed. 4 surgical treatments and 2 non-surgical treatments were identified. Significant improvement in sensation was found in the majority of the subjects who received surgical or non-surgical treatment. Complete recovery was uncommon in all kinds of available treatments. (2) Forty-eight subjects (24 cases) were recruited in a prospective case-control study comparing the general and oral health-related quality of life (QoL), life satisfaction and depression symptoms of patients with persistent lingual nerve (LN)or IAN neurosensory deficit (12 months or more) after third molar surgery with those who did not have such deficit. It was found that patients with persistent neurosensory deficit after third molar surgery have significantly poorer general and oral health-related QoL, worse life satisfaction and more depression symptoms than those without such deficits. (3) Twelve patients with neurosensory deficit after lower third molar surgery (10 LN, 2 IAN) who received microsurgical repair of the affected nervewere recruited in a prospective longitudinal observational study of the treatmentoutcomes. Most patients with pain wererecovered after surgery. Subjective symptoms including numbness, taste sensation and speech were improved after LN repair. Improvement was noted in all three objective neurosensory tests at post-operative 12 months. (3) Twelve patients with neurosensory deficit after lower third molar surgery (10 LN, 2 IAN) who received microsurgical repair of the affected nervewere recruited in a prospective longitudinal observational study of the treatment outcomes. Most patients with pain were recovered after surgery. Subjective symptoms including numbness, taste sensation and speech were improved after LN repair. Improvement was noted in all three objective neurosensory tests at post-operative 12 months. (4) 178lower third molars with one or more of the five radiographic signs suggesting of close proximity of their roots to the IAN were analyzed. It was found that radiographic signs of “darkening of root(s)” and “displacement of inferior alveolar canal by the root(s)” were associated with increased risk of intraoperative IAN exposure. In addition, “darkening of the root(s)” or co-existing radiographic signs were associated with an increased risk of post-operative IAN deficit. (5) A phase 4 clinical trial with 612 lower third molar coronectomies was conducted to monitor the long term safety of the treatment. It was demonstrated that the technique has minimal morbidity in terms of infection, pain, dry socket or development of pathologies. Most retained roots (90.9%) migrated upward with the highest migration rate in the first 6 months, which gradually slowed down and stopped to migrate at 24months. 2.3% of the roots became exposed in the oral cavity and required removal. Re-operation to remove the exposed root did not cause any IAN deficit. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

No description available.

Copies of author's previously published articles enclosed. / Bibliography: leaves 217-258. / xxiv, 258 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines recent literature which describes cases of metastatic involvement of laparoscopic port sites, not only in patients with advanced tumors but in patients with early stage carcinoma, and even in patients following laparoscopic procedures during which tumors were not disturbed. This thesis utilises an established small animal model to investigate the aetiology of port site metasrases and the efficacy of preventative strategies in reducing tumor implantation following laparoscopy. / Thesis (Ph.D.)--University of Adelaide, Dept. of Surgery, 2000?

Accompanying CD-ROM contains image files and software. Bibliography: leaves 259-286. Explores the factors affecting the movement of tumour cells from a primary malignancy across the peritoneal cavity to the port-site following laparoscopic intervention. Filter methods and radio-labelled tumour cells provided the most useful way of following cell movement. Concludes spread of tumour cells to the port-site is more likely in the presence of disseminated disease, as well as with inappropriate surgical technique. Metastasis may be reduced by the use of intraperitoneal lavage and appropriate surgical technique.

In the present study the cognitive outcomes of cardiac surgery were examined in patients who did or did not develop delirium early post-operatively. The study expanded on previous research by investigating: (1) the relationship between delirium and functioning on specific cognitive domains; (2) the relationship between delirium and cognitive functioning after taking into account pre-existing cognitive impairment; and (3) the cognitive profile of delirium. The study employed a non-equivalent pre-test post-test design. Participants were 80 candidates for coronary artery graft replacement and/or heart valve repair or replacement operations who were 60 years of age or over. Participants underwent a neuropsychological assessment pre-operatively, daily assessments between post-operative days 2-5 for identification of delirium, and a follow-up neuropsychological assessment 12 weeks post-operation. Twenty-one participants met DSM-IV diagnostic criteria for delirium early post-operation. Participants who experienced delirium performed worse than participants who did not on one global cognitive measure and one specific cognitive domain at follow-up. However, this was likely due to the contribution of other factors such as age, years of schooling, pre-operative performance, and neurological events post-operation. There was no difference in the proportion of participants who did or did not develop delirium who met specified criteria for cognitive decline from pre-operation to follow-up. Significantly more participants who developed delirium, relative to those who did not, met criteria for pre-existing cognitive impairment. After taking into account pre-existing impairment and other potentially contributing variables, delirium was a significant predictor of performance on an attentional task at follow-up. There were no significant differences between the cognitive profiles of participants who did or did not develop delirium, at pre-operation or at follow-up. At both time points the profiles of these groups resembled the profile of a group of patients with vascular dementia. In conclusion, although participants who experienced delirium performed worse on certain cognitive domains, this appeared to be due to factors other than delirium. However, after taking pre-existing cognitive impairment, and other relevant variables into account, delirium adversely affected attentional performance. Delirium was associated with a vascular dementia profile, but this profile was not specific to delirium. Study findings have both theoretical and clinical implications. Consistent with the theoretical literature, the findings support impaired brain reserve as a risk factor for delirium, and the hypotheses that a combination of impaired brain reserve and events associated with delirium are responsible for subsequent cognitive performance. However, in the case of attention, events associated with delirium appear to be responsible for poorer performance, possibly due to the persistence of impaired attention, which is an essential feature of the delirium episode. A further theoretical implication is that individuals who experience delirium may be particularly vulnerable to developing vascular dementia, however, there needs to be further investigation of this risk in a non-cardiac surgery population. Clinically, study findings highlight the need to investigate possible cognitive impairment in individuals with cardiovascular disease, and in persons who experience delirium. When indicated, appropriate monitoring and/or treatment strategies should be employed to reduce the impact of cognitive deterioration.

No description available.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Extreme controversy surrounds the uncertainty of pelvic mesh and sling devices to essentially cure patients of stress urinary incontinence (SUI). A relatively new product that has taken the market by storm is the tension free Vaginal Tape‐ Obturator (TVT‐O) mesh by Ethicon, Gynecare. It has obtained Center for Disease Control approval and labeled a “clinically proven, safe product with a 90% cure rate for urinary incontinence,” according to the manufactures website (Ethicon, Gynecare)4, 8. One side effect that is known about this particular device is its ability to leave patients post surgery with unbearable, chronic pelvic pain2. Although the mesh is needed to prevent urinary incontinence, it is pivotal that the quality of life of our patients does not suffer appreciably with elective, non‐life threatening procedures. Another common mesh product is the pelvic sling by Monarc. One‐study reports more than 95 percent of patients who underwent elective surgery with the insertion of Monarc sling achieved complete dryness and did not require the use of pads following the procedure22. These are successful outcomes, but what occurs with the minority of patients that have unfavorable outcomes such as chronic pain12, 15, 16? A retrospective study was completed to deduce the onset of pain and severity of pain caused by the TVT‐O mesh and Monarc mesh‐utilizing data from Dr. Hibner’s patients. There were 19 chronic pelvic pain patients with an average age of 50, standard deviation of 11 years, seen by Dr. Hibner and his colleagues. These patients completed the International Pelvic Pain assessment form upon their first visit to the office and SF‐36 scores of physical and mental scores were obtained. Results found physical scores of 29.5 and mental scores of 36 in pelvic pain patients, which were higher than certain other chronic, medical diseases1. We were able to conclude that patients with pelvic pain from mesh have lower physical and mental SF‐36 scores than patients with other chronic diseases representing a decreased quality of life overall.

Accompanying CD-ROM contains image files and software. / Bibliography: leaves 259-286. / xvi, 286 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Explores the factors affecting the movement of tumour cells from a primary malignancy across the peritoneal cavity to the port-site following laparoscopic intervention. Filter methods and radio-labelled tumour cells provided the most useful way of following cell movement. Concludes spread of tumour cells to the port-site is more likely in the presence of disseminated disease, as well as with inappropriate surgical technique. Metastasis may be reduced by the use of intraperitoneal lavage and appropriate surgical technique. / Thesis (M.D)--University of Adelaide, Dept. of Surgery, 1999