A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico. / Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.

Orientadores: Sophie Françoise Mauricette Derchain, Joana Fróes Bragança Bastos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T20:06:15Z (GMT). No. of bitstreams: 1 Barreta_Amilcar_M.pdf: 1818838 bytes, checksum: 256372229a80e175fc6ba44b44075f4f (MD5) Previous issue date: 2012 / Resumo: Introdução: O câncer de ovário é o sétimo câncer mais comum em mulheres. A sensibilidade e especificidade dos exames laboratoriais e de imagem não são adequadas para o diagnóstico de câncer de ovário. Atualmente o padrão-ouro para o diagnóstico do câncer de ovário é o exame histopatológico em parafina. Por este motivo, aproximadamente 10% das mulheres terão que ser operadas devido a um tumor anexial durante sua vida. A laparoscopia é comumente usada na tentativa de reduzir a morbidade cirúrgica nestes casos. Objetivo: Avaliar as diferenças nas características clínicas, no diagnóstico histopatológico, na duração da cirurgia e na incidência de complicações cirúrgicas em mulheres submetidas à laparoscopia e à laparotomia para diagnóstico e tratamento de tumores anexiais, e avaliar os fatores associados à falha da laparoscopia (conversão à laparotomia). Sujeitos e métodos: Para este estudo prospectivo foram convidadas a participar 210 mulheres com tumor anexial, dentre as quais foram incluídas 133 mulheres com indicação cirúrgica. Oitenta e oito mulheres foram submetidas à laparotomia e 45 foram submetidas à laparoscopia. Catorze das 45 laparoscopias foram convertidas à laparotomia durante o procedimento cirúrgico. Foi avaliado se idade, índice de massa corpórea (IMC), número de cirurgias abdominais prévias, níveis do marcador tumoral CA-125, valores do Índice de Risco de Malignidade (IRM), maior diâmetro do tumor, diagnóstico histopatológico, duração da cirurgia e número de complicações cirúrgicas diferiram entre o grupo de mulheres submetidas à laparoscopia e o grupo submetido à laparotomia, e se estes fatores estiveram associados à conversão da laparoscopia em laparotomia. Foram também avaliados os motivos intraoperatórios para conversão da laparoscopia em laparotomia conforme relatado pelos cirurgiões nos registros cirúrgicos. Resultados: A prevalência de tumores malignos neste estudo foi de 30%. Os níveis do CA-125, os valores do IRM, o maior diâmetro do tumor e a duração da cirurgia foram maiores no grupo da laparotomia que no grupo da laparoscopia. A incidência de complicações foi similar quando comparados os grupos de laparotomia e laparoscopia e quando comparados os grupos de laparoscopias bem sucedidas com o grupo de laparoscopias convertidas à laparotomia. Quando foram analisadas mulheres com tumores anexiais benignos, a incidência de complicações foi menor no grupo da laparoscopia quando comparado ao grupo da laparotomia. Os fatores associados à falha da laparoscopia (conversão à laparotomia) foram o maior diâmetro do tumor e a presença de tumor maligno. Durante a laparoscopia, os principais motivos relatados nos registros cirúrgicos como causa de conversão em laparotomia foram: o diâmetro do tumor e a presença de aderências peritoneais. Conclusões: Este estudo sugere que o diâmetro do tumor, a presença de aderências peritoneais e a presença de um tumor maligno são as principais causas de conversão de uma laparoscopia em laparotomia. A conversão, entretanto, não aumenta a incidência de complicações cirúrgicas / Abstract: Introduction: Ovarian cancer is the seventh most common cancer in women. Imaging and laboratorial exams do not have adequate sensitivity and specificity to diagnose adnexal cancer. The gold-standard for adnexal cancer diagnose is the histopathological exam at paraffin section. For this reason about 10% of the women will have to be operated by an adnexal tumor during their lifetime. Laparoscopy is frequently used to reduce surgical morbidity at those cases. Objective: To assess the differences in clinical factors, histopathologic diagnose, operative time and complication rates between women undergoing laparoscopy or laparotomy to diagnose and treat an adnexal mass and to evaluate the factors that are associated with laparoscopy failure and conversion to laparotomy. Subjects and methods: In this prospective study, 210 women were invited to participate, of which 133 women with adnexal masses were included. Eighty-eight women underwent laparotomy and 45 women underwent laparoscopy. Fourteen of the 45 laparoscopies were further converted to laparotomy during the surgical procedure. We assessed whether age, body mass index (BMI), previous abdominal surgeries, CA-125 levels, Index of Risk of Malignancy (IRM), tumor diameter, histological diagnose, operative time and surgical complication rates differed from laparoscopy to laparotomy group and whether those factors were associated with conversion of laparoscopy to laparotomy. We also assessed surgical logs to evaluate the intraoperative reasons, as stated by the surgeons, to convert a previously indicated laparoscopy to laparotomy. Results: 30% of women at our study had malignant tumors. CA-125 levels, IRM values, tumor diameter and operative times were higher for the laparotomy group compared to the laparoscopy group. Complication rates were similar for the laparoscopy and laparotomy groups and also for successful laparoscopy and laparoscopy converted to laparotomy groups. Surgical complication rate in women with benign tumors was lower for the laparoscopy group compared to that for the laparotomy group. The clinical factors associated with laparoscopy failure (conversion to laparotomy) were the largest tumor diameter and malignancy. During laparoscopy, adhesions and the largest tumor diameter were the principal factors reported as causes of conversion. Conclusions: This study suggests that tumor diameter, peritoneal adhesions and the presence of a malignant tumor were the principal causes of laparoscopy conversion to laparotomy. However the conversion did not increase complication rates / Mestrado / Oncologia Ginecológica e Mamária / Mestre em Ciências da Saúde

M.Cur. / In the cardiothoracic critical care unit, the respiratory management, post-extubation forms an important component of the total nursing care of the patient. To ensure optimal respiratory management the critical care nurse needs guidelines through which quality and continuity of nursing care can be ensured. Through the effective management of the respiratory system of the patient the critical care nurse contributes to maintaining, promoting and restoring health. In this way the critical care nurse facilitates the patient's strive towards reaching his/her objective of obtaining wholeness and he/she obtains his/her objective of quality nursing. The aim of this study is to formulate guidelines for the respiratory mangement of the cardiothoracic patient, post-extubation. A qualitative-descriptive contextual spesific reseach was followed in which a focus group interview, the opinions of field specialists and the deductive analysis of a literture study were used to formulate guidelines for the respiratory management of the cardiothoracic patient, post-extubation. An analysis was done through which the focus group interview was coded and categories were formulated. These main categories and subcategories were then further explored and described by the literature and by die opinions of the field specialists. The guidelines which were formulated must relieve the uncertainty that exists among different critical care nurses and it must ensure continuity of nursing care. After the guideliness have been established to promote the nursing practice recommendations were made for nursing practice, nursing education and for further research.

The events of cardiac surgery combined with moderate hypothermia hemodilution perfusion and postoperative respiratory care provide the stimuli for the alteration of K+ levels in red blood cells, plasma, and urine. The purpose of this study was to measure the deviations from normal potassium ion concentrations in an attempt to understand the physiological processes involved.

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Question: What are the effects of Intermittent Positive Pressure Breathing (with and without a Positive End Expiratory Pressure [PEEP] Valve), compared to deep breathing exercises, on ventilation distribution in high-risk adults following open upper abdominal surgery (UAS)? Design: This study comprised an observational descriptive component as well as a prospective triple blind randomised controlled crossover trial with concealed allocation and patient, assessor and statistician blinding Participants: Seven patients at high risk for postoperative pulmonary complications following UAS Intervention: Deep breathing exercises (DBExs) were compared to Intermittent Positive Pressure Breathing (IPPB), with IPPB further applied with and without a PEEP Valve, using a randomised cross-over design with 30 minute washout duration between periods. Outcome measures: Global and regional impedance changes in the lungs were measured using Electrical Impedance Tomography. Vital signs, visual analogue pain scale (VAS) and modified Borg scale (MBS) were measured pre– and post-intervention. Results: A greater mean global lung impedance change ( Z) was detected with IPPB compared to DBExs (mean difference in Z 2803.8; 95% CI 5189.9 to 8512.5 and 2046 to 96047.9; P<0.01). These changes in lung impedance lasted 30 minutes before returning to baseline. There was no difference in Z when patients received IPPB with 5cmH20 PEEP compared to IPPB with no PEEP. No specific regional ventilation changes were noted. IPPB did not increase VAS, MBS scores or adversely affect vital signs. Conclusion: IPPB is an effective technique to improve lung volumes compared to deep breathing exercises. Further studies are required to investigate the effect of IPPB on clinical outcome. / AFRIKAANSE OPSOMMING: Vraag: Watter uitwerking het onderbroke positiewe-drukasemhaling (met én sonder ’n positiewe-endekspiratoriesedruk-[PEEP-]klep) in vergelyking met diepasemhalings-oefeninge op ventilasieverspreiding by hoërisikovolwassenes ná bo-buikchirurgie? Ontwerp: ’n Waarnemingsgegronde, vergelykende en ondersoekende, driedubbelblinde, verewekansigde gekontroleerde oorskakelproef, met verborge toewysing en blinding van pasiënte, die assesseerder en statistikus Deelnemers: Sewe pasiënte met ’n hoë risiko vir post-operatiewe pulmonêre komplikasies na bo-buikchirurgie Intervensie: Diepasemhalingsoefeninge (DBEx) is vergelyk met onderbroke positiewedrukasemhaling (IPPB), wat op sy beurt met én sonder ’n PEEP-klep toegepas is, met behulp van ’n verewekansigde oorskakelstudie met ’n halfuur lange uitspoeling tussen oorskakelings. Uitkomsmetings: Algehele en regionale impedansieveranderinge in die longe is met behulp van elektriese impedansietomografie gemeet. Vitale tekens, die visuele analoogskaal (VAS) en die aangepaste Borg-skaal (MBS) is voor, sowel as na die intervensie afgeneem. Resultate: ’n Groter gemiddelde algehele impedansieverandering ( Z) is opgemerk met IPPB in vergelyking met DBEx (gemiddelde verskil 2803.8; 95% CI 5189.9: 8512.5 en 2046: 96047.9; P<0.01). Hierdie veranderinge in longimpedansie het ’n halfuur of langer geduur voordat dit na die basislyn teruggekeer het. Daar was geen verskil in Z toe pasiënte IPPB met ’n PEEP-klep van 5cmH20 ontvang het teenoor IPPB sonder ’n PEEP-klep nie. Geen spesifieke regionale voorkeure is opgemerk nie. IPPB het nie die VAS- of MBS-tellings verhoog of vitale tekens verswak nie. Stellenbosch University https://scholar.sun.ac.za iv Gevolgtrekking: In vergelyking met DBEx, is IPPB ’n doeltreffende tegniek om longvolumes te verbeter. Verdere studies word vereis om die uitwerking van IPPB op kliniese uitkomste te ondersoek.

Introduction: Coronary artery bypass grafting surgery is an effective treatment for coronary heart disease for many patients; however, evidence suggests that there are some patients who do not report a good post-operative recovery. Although several studies have begun investigating possible reasons for these observations, little is known about the impact of CABG on quality of life and there still remains a lack of information that can help clinicians identify those people more likely to experience poorer recovery so that interventions can be targeted appropriately. Aims: The overall aim was to investigate barriers to and facilitators of recovery after CABG. Method: Phase 1 was a retrospective qualitative study involving semi-structured interviews with eleven patients who had undergone CABG and with ten health professionals experienced in caring for these patients. Data were analysed using thematic analysis. Phase 2 was a prospective study comprising two components, questionnaire and interview. The questionnaire included measures of quality of life, perceived recovery, demographic and psychosocial variables and was administered prior to surgery and at six and twelve months post-surgery. A sample of ten people who completed questionnaires were interviewed at the same time points and data analysed using framework analysis. Results: Interview data described the patient experience of undergoing CABG and identified components of a good recovery from the patient perspective. Patient and health professional participants identified numerous barriers and facilitators to recovery at three key time points - prior to surgery, during the hospital inpatient stay and post-CABG - and noted the complex inter-relationships between them, thus emphasising the need for a holistic approach to investigating recovery. Questionnaire data described the pattern of psychosocial functioning, quality of life and perceived recovery across the surgical pathway and identified depression and self-efficacy as the main predictors of post-CABG quality of life and perceived recovery. Using interview and questionnaire data a model of recovery is proposed. Conclusions: Findings from this research have identified a complex inter-related network of barriers and facilitators to recovery, suggested the possible mechanisms by which they impact on post-CABG outcome and identified recommendations for clinical practice.

Bibliography: leaves 160-171. / xii, 171 leaves, [9] leaves of plates : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Evaluates the effect of an anterior surgical approach and antero-lateral inter-body fusion of the cervical spine on spinal cord blood flow and electrical function using a sheep model. / Thesis (M.D.)--University of Adelaide, Dept. of Orthopaedic Surgery & Trauma, 1993?

Orientador: Edmea Rita Temporini Nastari / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-07T02:25:27Z (GMT). No. of bitstreams: 1 Senne_FirmaniMelloBentode_D.pdf: 2133397 bytes, checksum: 05da70735ad5bd1022b72b3f03385933 (MD5) Previous issue date: 2006 / Resumo: Realizou-se um estudo transversal com intervenção com os objetivos de identificar a influência da capsulotomia posterior unilateral com Neodímio: Ítrio-Alumínio-Granada (Nd:YAG) laser na função visual e em relação à percepção de dificuldades nas atividades diárias, e verificar a relação entre as medidas subjetivas e objetivas da função visual após a intervenção. A amostra, prontamente acessível, foi composta por 48 pacientes entre 40 e 80 anos, média de 68 anos, mediana de 70 anos, pseudofácicos uni ou bilaterais, com opacificação de cápsula posterior e acuidade visual menor ou igual a 0,30 (logMAR) em um olho, atendidos consecutivamente em um hospital universitário no Brasil. Todos os pacientes foram submetidos a capsulotomia posterior com Nd:YAG laser. Um questionário, elaborado a partir de estudo exploratório, foi aplicado antes e depois da intervenção. Após a capsulotomia posterior, a acuidade visual e a estereoacuidade melhoraram significativamente. Na percepção dos sujeitos, houve redução das dificuldades relacionadas às atividades diárias ligadas à visão, exceto passar roupas, tomar banho sem ajuda e pentear os cabelos. As medidas objetivas e a auto-avaliação da visão apresentaram congruência de resultados e todos os pacientes declararam ter valido a pena a realização do procedimento laser / Abstract: An interventional survey was conducted to assess the influence of Neodymium: Yttrium-Aluminium-Garnet (Nd: YAG) laser unilateral posterior capsulotomy on visual function and perception of difficulties with vision-related daily life activities, and to verify the association between objective and subjective measures of visual function after intervention. The readily accessible sample comprised 48 patients aged between 40 and 80 years, with uni- or bilateral pseudophakia, posterior capsule opacification and visual acuity equal to or less than 0,30 (logMAR) in one eye, consecutively seen at a Brazilian university hospital. All the patients were submitted to posterior capsulotomy by Nd:YAG laser. Before and after intervention, patients were asked to answer a questionnaire developed from data obtained in an exploratory study. After posterior capsulotomy, visual acuity and stereoacuity improved significantly. According to the subjects' perception, they found less difficulty in vision-related daily activities, except for ironing, bathing without help and combing the hair. Objective measures of visual function and self-rated visual function showed congruent results after intervention. All the subjects interviewed stated that the posterior capsulotomy procedure had been ¿worthwhile¿ / Doutorado / Oftalmologia / Doutor em Ciências Médicas

Esse trabalho teve como objetivos avaliar as características odontologicas, verificar a ocorrência de complicações sensitivas orofaciais e determinar os aspectos funcionais mandibulares de 105 doentes com neuralgia idiopática do trigêmeo (NIT) submetidos \'a compressão radiculo-ganglionar com balão inflável. Foram realizadas 5 avaliações para cada doente: uma pré-cirúrgica e 4 pós-cirúrgicas (7, 30, 120 e 210 dias). Ocorreu comprometimento sensitivo mais intenso no território dos ramos maxilar e mandibular do nervo trigêmeo (p < 0,001) e poucas anormalidades no território do ramo oftálmico (p = 0,1815). As qualidades sensitivas calor, frio, tato, e dor foram afetadas. As queixas subjetivas de dormência foram mais frequentes do que as objetivadas durante o exame de sensibilidade facial (p < 0,001). foi elevada a ocorrência de disfunção oclusal (62,9%); 42,6% dos doentes apresentaram queixas espontâneas relacionadas à mastigação; houve intensificação da dor miofascial na musculatura mastigatória após a cirurgia (p < 0,001), que retornou aos valores iniciais após os 210 dias; a mobilidade mandibular também agravou-se (p < 0,001). Os autores concluiram que o procedimento é eficaz e seguro quando aplicado em doentes com NIT envolvendo o ramo oftálmico. Entretanto, recidiva é frequente e as complicações sensitivas e ou motoras orofaciais poderiam comprometer a qualidade de vida e dificultar a reabilitação funcional dos doentes. / The aim of this study was to determine dental characteristics, abnormalities in masticatory function and ocurrence of orofacial sensorial complications in 105 patients with trigeminal neuralgia treated with radiculo-ganglionar compression of the trigeminal ganglion with balloon. The patients were evaluated in the pre-operative period and in 4 post-operative evaluations (7, 30, 120 and 210 days). Sensory deficits were more severe in the area innervated by the maxillary and the mandibular trigeminal branches (p < 0.001); the ophthalmic branch presented abnormalities in few cases. The sensory qualities heat, cold, tactile and pain were affected. Subjective numbness was more frequent than sensory abnormalities findings at the post-operative sensitive evaluation (p < 0.001). Dental occlusion abnormalities were observed in 62.9% of the patients and 42.6% of patients\' complaints were spontaneous masticatory difficulties. During the post-operative period, myofascial pain of the masticatory muscles was statistically significant (p < 0.001), but normalized after 210 days in average. It also compromised the jaw mobility (p < 0.001). It was concluded that this procedure is safe for patients with idiopathic trigeminal neuralgia involving the ophthalmic branch; however, sensory and motor complications of the method can affect the quality of life and rehabilitation of the patient.

[Truncated abstract] Approximately 35% of women worldwide have stress incontinence, which is defined as involuntary leakage of urine on effort, exertion, or on sneezing and coughing. There are various surgical techniques for stress incontinence; however, minimally invasive operations are increasingly being chosen by surgeons and their patients. Of these procedures, tension-free vaginal tape (TVT) has a cure rate of approximately 90% and is now perceived as the standard technique for stress incontinence. Reported complications of TVT include arterial laceration, bladder perforation, bowel perforation, de novo urgency, dyspareunia, excessive blood loss, haematoma, nerve injuries, urethral erosion, urge incontinence, urinary tract infection, vascular injury, vaginal mesh erosion, voiding dysfunction and death. Suprapubic urethral support sling (SPARC) is a very similar minimally invasive operation and early indications suggested that the success rate for treating stress incontinence was expected to be identical or better than those obtained with the earlier TVT approach, with possibly fewer adverse perioperative events. Our trial sought to establish equivalence between TVT and SPARC in relation to short-term complications and efficacy. OBJECTIVES The primary outcome was bladder perforation. Secondary outcomes were blood loss, voiding difficulty, urgency, and cure of stress incontinence symptoms. METHOD A randomised controlled one-sided equivalence trial (RCT) was conducted in Perth, Western Australia during 2003 and 2004 by researchers in the School of Population Health, University of Western Australia (UWA) and King Edward Memorial Hospital (KEMH). Patients were recruited from the public Urology/Urogynaecology Clinic at the primary women's hospital and the consultant surgeons' private practices. ... However, acute urinary retention requiring a return to theatre to loosen the tape (TVT 0%, SPARC 6.5%; OR: [infinity], 95% CL: 2.2, [infinity]; p=0.002) and subjective short-term cure (TVT 87.1%, SPARC 76.5%; OR: 2.07, 95% CL: 1.13, 3.81; p=0.03) were statistically significantly different. CONCLUSIONS The results are consistent with clinical equivalence between TVT and SPARC in relation to the incidence of bladder perforation. No statistically significant difference was found between TVT and SPARC in blood loss, urgency or short-term objective cure of stress incontinence at the six week post-discharge visit to the surgeon. However, the tapes were more difficult to adjust correctly in SPARC procedures and a statistically significant number of patients required a return to theatre for loosening of the tape (TVT 0/147, 0% and SPARC 10/154, 6.5%, p=0.002). Compared with SPARC, TVT was statistically significantly higher for subjective short-term cure. In ii relation to vaginal mesh erosion, TVT was lower than SPARC, though not statistically significantly. Overall, voiding difficulty (loosening of the tape), urgency and vaginal mesh erosion were the most important clinical problems. This randomised controlled trial demonstrates the importance of testing new devices which appear to be similar, but which may have clinically relevant differences. A follow up study to assess the long-term efficacy of tension-free vaginal tape and suprapubic urethral support sling and associated complications is planned.