Orientadores: Cassio Luis Zanettini Riccetto, Paulo Cesar Rodrigues Palma / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias / Made available in DSpace on 2018-08-12T17:44:11Z (GMT). No. of bitstreams: 1 Silveira_ArlonBrenoFigueiredoda_M.pdf: 2621259 bytes, checksum: 4ce31188b66f0429c0dd69afbac24d21 (MD5) Previous issue date: 2008 / Resumo: Objetivos: Com o objetivo de avaliar os resultados cirúrgicos e de modificação na qualidade de vida de mulheres submetidas ao tratamento de incontinência urinária de esforço com sling sintético de polipropileno com abordagem pré-púbica. Métodos: Foi desenvolvido estudo prospectivo, de intervenção, com seguimento por seis meses, envolvendo 20 pacientes, com idade mínima de 21 anos e com diagnóstico de incontinência urinária de esforço realizado no Serviço de Uroginecologia do Hospital das Clínicas da Universidade Estadual de Campinas, Campinas, São Paulo, com base em dados clínicos, urodinâmicos e de Pad-test compatíveis, as quais expressaram a vontade de se submeter à implantação de sling para correção cirúrgica; não gestantes; sem doença ou qualquer condição que pudesse comprometer o resultado da cirurgia, tal como: distúrbio de coagulação sanguínea, obstrução do trato urinário superior, insuficiência renal, comprometimento do sistema imune, infecção urinária ou vaginal; não submetidas a procedimento de sling sintético prévio; que concordaram em participar do estudo, por meio da assinatura do Termo de Consentimento Livre Esclarecido e em responder os questionários King's Health Questionnaire (KHQ) e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) antes da cirurgia e decorridos seis meses do procedimento. Para o tratamento de incontinência urinária de esforço, empregou-se tela manufaturada em fibras de polipropileno, classe I, monofilamentar com 42 µm de diâmetro e macroporos maiores que 75 mm, por abordagem pré-púbica. As variáveis estudadas incluíram: idade, avaliação urodinâmica, Pad-test e resultados dos questionários King's Health Questionnaire (KHQ) e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) . Os dados foram organizados por meio do programa Epi-INfo versão 6.04d e analisados com o programa Statistical Package for Social Sciences (SPSS), versão 13.0. As variáveis nominais e ordinais foram expressas em distribuição de freqüências absolutas e relativas e as quantitativas, pelos parâmetros da Estatística Descritiva. Para comparação dos parâmetros objetivos uroginecológicos e de qualidade de vida aferida pelos questionários International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) e King's Health Questionnaire (KHQ), do período pré-operatório e decorridos seis meses do procedimento cirúrgico, empregou-se teste de diferença de médias, em nível de significância de 0,05, determinando-se o intervalo de confiança em nível de confiança de 95%. Resultados: Comparando a avaliação pré-operatória àquela decorridos seis meses do procedimento cirúrgico, verificou-se redução significante da perda de urina mensurada através do Pad-test (p<0,001). A pressão de perda sob esforço foi negativa em 90% das pacientes decorridos seis meses da cirurgia. Os demais parâmetros urodinâmicos da cistometria não foram alterados significativamente comparando antes e depois da cirurgia. O fluxo máximo miccional despida de significância estatística (p = 0,034). Houve melhora de todos os parâmetros subjetivos avaliados pelo International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), com significância estatística da freqüência de perda de urina (0,009) e menor interferência na vida da pacientes (p= 0,001), assim como de todos os domínios do King's Health Questionnaire (KHQ). Houve 6 (30%) casos de complicações, que consistiram em extrusão vaginal do sling, instituindo-se tratamento cirúrgico por retirada do segmento da tela exposta e síntese da mucosa vaginal. Conclusão: Embora tenha havido a necessidade de interromper este estudo devido ao alto índice de complicações, confirmou-se o fato de ser a incontinência urinária um evento que compromete a qualidade de vida das pacientes exercendo tal impacto que, mesmo diante do insucesso do procedimento terapêutico, a avaliação subjetiva foi favorável, decorridos seis meses da cirurgia / Abstract: Objectives: A prospective study of intervention was developed aiming to evaluate the surgical results and impact in the quality of life of women submitted to stress urinary incontinence treatment with polypropylene synthetic sling with prepubic approach. Methods: Twenty patients were included in this study. Diagnosis of stress urinary incontinence were based on clinical data, urodynamics and Pad-test. Inclusion criteria included: minimum age of 21 years; non pregnant; without illness or any condition that could compromise surgery's result (sanguineous coagulation disorders, superior urinary tract obstruction, renal insufficiency, immune system disorder, urinary or vaginal infection); abcense of previous synthetic sling procedure; agreement to participate of the study, by means of Free Consent Term signature and to answer to the questionnaires King's Health Questionnaire (KHQ) e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) before the surgery and after six months of the procedure. Its was used a sling made of staple fibres of polypropylene, type I, monofilamentar (42 µm diameter) and macropores. All the procedures were performed under spinal anesthesia. The sling was placed and adjusted in midurethral area with minimal periurethral dissection. The proper tension and fixation was achieved by passing the sling arms through the prepubic subcutaneous fat tissue. The variables studied included: age; urodynamic evaluation; Pad-test; King's Health Questionnaire; and International Consultation on Incontinence Questionnaire. Data were recorded using Epi-INfo version 6.04d software and analyzed with Statistical Package for Social Sciences (SPSS), version 13.0. The nominal and ordinal variables were express in absolute and relative frequency distribution and the quantitative ones by parameters of descriptive statistics. Difference of means test was used (significance level of 0,05, 95% confidence interval) for comparison of the urogynecologic objective parameters and quality of life surveyed by ICIQ and KHQ questionnaires, of pre-operative and six months post-operative evaluation. Results: Comparing pre-surgical evaluations with those after six months of the surgical procedure, there were significant reduction of urine loss assessed by the pad-test (p<0,001). Comparing urodynamics evaluations before and after surgical procedure 90% patients no there were of urine loss. Other urodynamics parameters no there were significant alterations. The max flow there was significant reduction (p=0,034). There was an improvement of all subjective parameters evaluated by ICIQ-SF, with significance for frequency of urine loss (0,009) and minor interference in life (p= 0.001), as well as of all KHQ domains. Six patients (20%) presented complications which consisted of vaginal exposition of the sling. All of them were corrected surgically by excision of the mesh and suture of the vaginal wall. The study was interrupted after six months of follow up due to the high frequency of adverse effects. Conclusion: Although the decision of interrupting the study due to the high index of complication, it allowed to confirm that stress urinary incontinence compromises the quality of life of the patients significantly, and the treatmet could promote an improvement in the quality of life, even when objective results were unfavourable / Mestrado / Cirurgia / Mestre em Cirurgia

Le carcinome hépatocellulaire (CHC) est un cancer très fréquent - au 5ème rang de l’échelon mondial - dont l’incidence ne cesse d’augmenter. Lié aux maladies chroniques du foie (hépatite C, syndrome métabolique et, le plus souvent, cirrhose), il représente désormais un véritable problème de santé publique. C’est la nature du foie sous-jacent qui détermine les modalités de sa prise en charge. Lorsque le foie ne présente pas de maladie chronique (foie sain), on se trouve généralement devant une tumeur déjà évoluée; dans ce cas on a recours essentiellement à la résection hépatique. Lorsque le foie présente une maladie chronique (foie pathologique), qu’il s’agisse de fibrose, cirrhose ou hépatite, c’est le stade tumoral au moment du diagnostic qui oriente le choix du traitement ; à part la transplantation, limitée dans ses indications, les options thérapeutiques comportent la résection hépatique, la destruction par voie sous-cutanée (radio fréquence) et un traitement par voie artérielle (chimioembolisation). Cependant, ces traitements à visée curative, ne peuvent être envisagés actuellement que dans 30% des cas. Notre travail porte uniquement sur la résection hépatique. Partout disponible, cette intervention chirurgicale représente en effet le traitement de référence dans la prise en charge du CHC. Nous nous appuyons sur une vaste enquête nationale qui, développée sur une période de 15 ans – de 1990 à 2005 – à partir de 23 centres de chirurgie, à porté sur plus de 2590 dossiers de patients. Grâce à ces données de base, particulièrement précieuses par leur nombre et leur précisions, nous avons tenté de donner une image panoramique des pratiques (indications, techniques opératoires) et des résultats (survie, récidive, morbidité, mortalité) de la résection hépatique pour CHC en France. Il s’agit de la plus grande étude multicentrique chirurgicale menée sur le CHC en France à ce jour. On a classé 102 paramètres dans 6 groupes de données ont été colligés pour chaque malade inclus dans l’étude: Terrain, Bilan préopératoire, Chirurgie, Anatomopathologie, Morbidité et traitements adjuvants et Evolution. Au total, cette enquête a permis de recueillir une somme considérable de données dont l’analyse multivariée avait pour l’objectif d’aboutir à des critères prédictifs de mortalité opératoire et de survie après résection sur foie sain et pathologique. Cette analyse a confirmé le développent et la qualité de la chirurgie hépatique en France. Aussi, l’analyse a montré que la résection hépatique est un traitement efficace du CHC sur foie sain et pathologique. Ces résultats et leur implication pour l’approche multidisciplinaire en cancérologie contribueront à améliorer les connaissances et la prise en charge du CHC. Finalement, à coté de la transplantation hépatique, limitée par ses indications restreintes et la pénurie de greffons, la résection du CHC occupe une place importante qui doit continuer de croître du fait de ses bons résultats et de l’augmentation constante de l’incidence du CHC / Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, and the third most common cause of cancer-related death. It is a major health problem worldwide, which represents the most prevalent primary liver cancer and constitutes the third most frequent cause of cancer-related deaths. The major risk factor for HCC is cirrhosis. All types of cirrhosis predispose to HCC, but the incidence is particularly high in persistent infection with hepatitis B (HBV) and hepatitis C (HCV) and in alcoholic liver disease. The clinical presentation and management of HCC depends on whether the liver is cirrhotic and whether there is underlying viral hepatitis. Therapeutic options fall into four main categories (1) surgical interventions, including tumor resection and liver transplantation, (2) percutaneous interventions, including ethanol injection and radiofrequency thermal ablation, (3) transarterial interventions, including embolisation and chemoembolisation and (4) drugs as well as gene and immune therapies. Potentially curative therapies are tumor resection, liver transplantation, and percutaneous interventions that can result in complete responses and improved survival in a high proportion of patients. Liver resection offers the greatest impact on survival when patients do not meet transplantation criteria and this is considered as the optimal treatment for HCC. The objective of this thesis, based on a retrospective survey, was to give an overview on conditions of realization and the results of the resection of HCC in France, in the period from 1990-2005. All the French centers of excellence in the hepatobiliary surgery were contacted and most of them accepted to participate. All the contacted units were essentially localized in University Clinical Centers, all of them experts in hepatic surgery and most of them were centers for liver transplantation. More than 2590 cases with hepatic resection were collected in this study. The file consisted of 102 questions and contained following headings: demographic data, underlined liver pathology, circumstances of diagnosis, imaging, evaluation of underlined liver pathology: biological, morphological, histological, preparation for resection: neoadjuvant treatment of the tumor, portal embolization, surgical intervention: approach, clamping, vascular control, nature and the extent of the exeresis, anatomic or non-anatomic features, histopathological analysis of the removed tissues, results: mortality, morbidity, recurrence, survival, lost from analysis. In total, this survey enabled us to collect a considerable sum of data in order to give a more precise overview on predictive criteria of per operative mortality and survival, as well as recurrence rates, after the resection of normal and pathological livers. It confirmed the development and the quality of the hepatic surgery in France

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / The aim of this study was to determine the prevalence of nasal skin cancer, its location by facial aesthetic subunits and the type of reconstructive procedures performed for each nasal subunit after excision for nasal skin tumors. Observational cross-sectional study of all consecutive patients with the diagnosis of skin tumor located in the nasal unit, treated from 2018 to 2019 by the department of head and neck surgery of a general hospital. 60 patients were treated with nasal skin tumors excisions. A total of 52 patients (86,6%) had basal cell skin cancer, 7 (11,6%) had squamous cell skin cancer and 1 (1,6%) had melanoma. Fifty-nine patients (98.33%) presented a primary tumor and just 1 case (1,66%) recived a previous surgical treatment. Regardless of the type of tumor, the tip subunit was the most often involved with 29 (48,33%) cases in total. Despite of the nasal aesthetic subunit affected, the most frequent type of procedure used for reconstruction was the rotation or advancement flap, based on aesthetic nasal subunits, which was performed in 39 cases (65%). Nasal reconstruction after skin cancer can be very complex, especially since all patients have high expectations about the results. In order to achieve good results, there is a necessity for careful analysis of the defect, correct planning and excellent technical execution of the procedures Frequently, staged procedures will be needed to achieve an optimal result. / Revisión por pares

Tandimplantat utsätts för både tekniska och biologiska komplikationer; de senare innefattar mukosit och periimplantit. Ett stort antal periimplantitbehandlingar har utvärderats, ofta i samband med bensubstitut. Det finns dock ingen konsensus idag om effektiv periimplantitbehandling.Syfte: Syftet med studien är att utvärdera och jämföra om skillnader i behandlingsresultat föreligger när periimplantit behandlas kirurgiskt med bensubstitut eller utan bensubstitut.Material och Metoder: Trettiofyra patienter (22 kvinnor, 12 män) behandlades varav 12 patienter med bensubstitut och 22 patienter utan bensubstitut.Av totalt 198 implantat har 193 utvärderats: Avseende bennivån (100 implantat) Avseende fickdjup (PPD) och blödning vid sondering (BOP) (160 implantat).Resultat: Kirurgisk behandling i form av mekanisk depuration och användning av bensubstitut har bidragit till vinst av bennivån med en statistisk signifikans (p ≤ 0,05). Dessutom kan en statistiskt signifikant förbättring (p ≤ 0,05) av PPD noteras bland patienter som behandlades med bensubstitut jämfört med patienter som behandlats utan bensubstitut.Konklusion: Av de patientfallen i studien är slutsatsen att användning av bensubstitut vid kirurgisk periimplantitbehandling resulterar i betydligt större vinst i bennivå och PPD reducering i jämförelse med endast kirurgisk behandling. Nyckelord: Bensubstitut, Periimplantit, Kirurgisk behandling. / Dental implants are subjected to both technical and biological complications; the latter ones comprise peri-implant mucositis and peri-implantitis. Numerous peri-implantitis treatments have been evaluated, often involving implantation of a bone graft. However, as of today, no consensus exists regarding effective peri-implantitis treatment.Aim: The aim of the study is to retrospectively evaluate if there are differences in treatment results after surgical peri-implantitis treatment with or without a bone graft.Material and Methods: Thirty-four patients (22 female, 12 male) were treated whereas 12 patients were treated with bone graft and 22 patients were treated without bone graft. Out of a total of 198 implants, 193 were evaluated regarding peri-implant bone level (100 implants) and probing pocket depth(PPD) and bleeding on probing (BOP) (160 implants).Results: Surgical treatment including mechanical debridement and implantation of a bone graft contributed to statistical significant (p ≤ 0,05) bone level gain in comparison to the non-grafted group. Additionally, statistically significant (p ≤ 0,05) improvement in PPD could be noted among patients treated with bone graft compared to patients treated without a bone graft.Conclusion: Of the present case series, it can be concluded that implantation of a bone graft during surgical peri-implantitis treatment, results in significant larger bone level gain and PPD reduction comparing to only surgical treatment.Keywords: Bone graft, Peri-implantitis, Surgical treatment.

Krūties vėžys – pastaruoju metu dažniausia moterų onkologinė liga, susijusi su gyvensenos ir aplinkos pokyčiais. Ankstyvos diagnostikos ir taikomų naujų efektyvių ligos gydymo būdų dėka, krūties vėžiu sergančiosios moterys turi galimybę ilgiau išgyventi, tačiau svarbu ne tik išsaugoti krūties vėžiu sergančių moterų gyvybę, bet ir užtikrinti kokybišką jų gyvenimą: gerą savijautą, optimalias psichines ir socialines galimybes. Tyrimo tikslas: Įvertinti krūties vėžiu sergančių moterų gyvenimo kokybę po chirurginio gydymo. Šiam tikslui pasiekti iškelti tokie uždaviniai: įvertinti ir palyginti moterų, kurioms taikytas skirtingas krūties vėžio chirurginis gydymas (šalinta ar nešalinta krūtis) gyvenimo kokybės ypatumus, nustatyti gyvenimo kokybės priklausomybę nuo moterų amžiaus, krūties vėžio stadijos, gydymo metodo, šeimyninės padėties, išsilavinimo, emocinės būsenos ir streso bei nustatyti krūties vėžiu sergančių moterų nerimo ir depresijos lygį ir jų patiriamą stresą po chirurginio gydymo. Tyrimo objektas ir metodika: Apklaustos 126 krūties vėžiu sergančios moterys po chirurginio gydymo, ambulatoriškai besigydančios Vilniaus universiteto Onkologijos instituto Aukštųjų energijų spindulinės terapijos skyriuje. Tyrimui naudotas klausimynų rinkinys: gyvenimo kokybė buvo vertinama pagal EORTC QLQ-C30 ir QLQ-BR23 klausimynų atsakymus, emocinės būsenos vertinimui taikyti Ligoninės nerimo ir depresijos skalė (HADS) ir Distreso termometras (Distress Thermometer). Tyrimo rezultatai:... [toliau žr. visą tekstą] / Breast cancer has become the most common oncological disease among women, it is associated with lifestyle and environmental changes. Early diagnosis and effective new treatment for breast cancer provide a possibility to live longer, but it is important not only to save lives of women who are diagnosed with breast cancer, but also to ensure the quality of their lives: well-being, optimal mental and social opportunities. The aim of the research: to evaluate quality of life after surgical treatment of women with breast cancer. Objectives: to evaluate and compare aspects of quality of life of women who had different breast cancer surgery (breast removed or unremoved after surgery); to establish quality of life depending on age, breast cancer stage, treatment method, marital status, education, emotional condition and stress to determine anxiety, depression and stress after surgical treatment in women with breast cancer. Material and methods: A survey of 126 women with breast cancer receiving treatment in the Department of the High-energy radiation therapy of the Institute of Oncology, Vilnius University. A set of questionnaires was used: EORTC QLQ-C30 and QLQ-BR23 for assessment of quality of life and Hospital and Depression Scale (HADS) and the Distress Thermometer (DT) for assessment of emotional condition. Results: Analysis showed that women who had mastectomy consider the overall quality of life to be better than women with breast conserving treatment (BCT): the mastectomy... [to full text]

The aneurysma of abdominal aorta is a pathological amplification of the diameter of this artery. It is a serious illness which affects 2 -- 6 % men and 1 -- 2 % women over 60. In the case of a rupture there is the mortality of 80 -- 90 %. If the aneurysma is diagnosed in time it is necessary to solve this state with an adequate treatment. The surgical treatment consists in substitution of the afflected part with a vessel replacement. Thanks to the development of medicinal technologies the aorta aneurysma is more and more often treated by the help of stentgrapth by which the afflicted part of the aorta is set aside from the circulation. The theoretical (the first) part of this work deals with the issues of the aneurysma of abdominal aorta, and it also describes the methods of its treatment. Then the work describes costs analyses used in the medical service. The practical part of the work is dedicated to the cost analysis of the treatment by means of a cost minimalization method. The work processes data of a group of patients being treated during a certain period of time in the Olomouc University Hospital in the Department of Vessel Surgery and in the Department of Interventional Radiology. The aim of this work is to evaluate and compare objectively the costs of abdominal aorta aneurysma treatment by individual methods, and to compare the results with foreign studies.

Resumo: O Câncer de mama (CM) vem ocupando lugar de destaque entre as doenças mamárias, as estatísticas mostram um aumento tanto nos países desenvolvidos quanto nos países em desenvolvimento, se tornando um problema de saúde pública. No Brasil, 60% dos diagnósticos de CM são descobertos em estádios avançados, aumentando assim o índice de mortalidade da doença. Avaliar as pressões respiratórias máximas e expansibilidade pulmonar antes e após tratamento cirúrgico de CM; Investigar a prevalência de complicações pulmonares das pacientes no pós-operatório de CM. Estudo prospectivo de 41 pacientes com CM e tratadas por cirurgia no HC- Faculdade de Medicina de Botucatu- Unesp, entre Março de 2008 e Dezembro de 2009. As pacientes foram avaliadas no pré-operatório através de um questionário clinico e na seqüência a avaliação das pressões respiratórias máximas (PImax e PEmax) e expansibilidade pulmonar. Depois de quarenta dias do pós-operatório as pacientes eram novamente avaliadas. Houve diferença significativa nas PImax e PEmax no pósoperatório com relação ao pré-operatório. Não houve diferença estatística na avaliação da expansibilidade pulmonar e complicações respiratórias no pósoperatório. Nas pacientes portadoras de CM de mama e tratadas por cirurgia observamos que houve uma diferença significativa entre as PImax e PEmax no pós-operatório em relação ao pré-operatório e quanto as demais variáveis avaliadas, não houve diferença significativa. Não houve também incidência significativa de complicações respiratórias no pós-operatório / Abstract: Breast Cancer (BC) has been placing a prominent issue among the breast diseases, statistics show a considerable increase in both developed and undeveloped countries, being now considered a problem of public health. In Brazil, 60% of the diagnoses of BC are discovered in advanced stage, increasing its mortality rates. To evaluate the maximum respiratory pressures and pulmonary expansibility before and after surgical treatment of the BC; To investigate the prevailing of pulmonary complications in patients on post-surgical of BC.Prospective study of 41 patients with BC and treated surgically in HC - Faculdade de Medicina de Botucatu - Unesp, from March, 2008 through December, 2009. Patients have been evaluated on presurgical through a clinical questionnaire and in the sequence the evaluation of the maximum respiratory pressures (Plmax and PEmax) and pulmonary expansibility. After forty days of post-surgical the patients were evaluated again. There was a significant difference on the Plmax and PEmax in postsurgical compared to pre-surgical. There was no statistic difference on the evaluation of the pulmonary expansibility and respiratory complications on postsurgical. In patients with BC and treated surgically we noted there was a significant difference on PImax and PEmax in post-surgical compared to pre-surgical and when it comes to other variables evaluated, there was no significant difference, and no significant difference on respiratory complications on post-surgical treatment / Orientador: Gilberto Uemura / Coorientador: Victor Zunica Dourado / Banca: José Ricardo Paciência Rodrigues / Banca: Tânia Terezinha Scudeller Prevedel / Mestre

Resumo ARAÚJO, D Contribuição das medidas volumétricas das estruturas temporais mesiais e neocorticais ao tratamento cirúrgico das epilepsias do lobo temporal. 2003. 120 p. Tese de doutorado. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. A epilepsia do lobo temporal é a forma mais comum de epilepsia focal sintomática e a esclerose mesial temporal a sua causa mais freqüente. A volumetria por ressonância magnética pode ser útil na investigação da epileptogênese na epilepsia temporal, bem como na lateralização das alterações hipocampais em pacientes candidatos à cirurgia, como já relatado em diversas séries. Realizamos a volumetria das estruturas do lobo temporal em 69 pacientes com suspeita clínica de epilepsia mesial temporal, avaliados consecutivamente no Centro de Cirurgia de Epilepsia do Hospital de Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. As estruturas medidas foram o pólo temporal, o lobo temporal, a amígdala, o hipocampo e o giro parahipocampal. Estas medidas foram comparadas às variáveis clínicas e neurofisiológicas dos pacientes, buscando fatores de bom prognóstico para o tratamento cirúrgico, bem como de variáveis clínicas que permitissem a correlação entre comprometimento estrutural e funcional. Nossos resultados mostraram uma importância central do hipocampo na epileptogênses temporal, embora não esteja elucidado se este papel é primário e independente ou secundário a alterações conjuntas com as outras estruturas. Todos os nossos casos apresentaram comprometimento hipocampal absoluto, relativo ou de assimetria. O pólo temporal foi a estrutura neocortical mais comprometida e houve uma correlação entre sua perda volumétrica e o tempo de epilepsia, sugerindo um dano progressivo. Seu comprometimento correlacionou-se ainda a déficits cognitivos, com menor quociente geral de inteligência. A amígdala e o giro parahipocampal estiveram relacionados à presença de crises parciais simples evoluindo para complexas, correlacionando dados clínicos e estruturais. Palavras chave: Epilepsia temporal; Volumetria; Tratamento cirúrgico. / Temporal lobe epilepsy is the most commom form of focal epilepsy. Mesial temporal sclerosis is the usual etiology. Magnetic resonance volumetry may be a useful research tool, and may be used to lateralize hippocampal changes in surgical candidates, according to several reports. We performed temporal lobe volumetry in 69 consecutive patients of the Epilepsy Surgery Center of the Hospital of Ribeirão Preto of the University of São Paulo. We measured temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus. The volumes were compared to clinical and neurophysiologic variables, as an attempt to find variables that could predict surgical outcome. We also sought correlations between structural (volume), and functional (epileptogenesis and clinical features) changes. Our data suggest that the hippocampus has a very important role in temporal lobe epilepsy. The question as to wether this role is primary or secundary to changes in other structures remains to be solved. In all of our cases the hippocampal volume was altered, either as absolute or relative volumes, or as asymmetry index. The only variable that correlated with postsurgical outcome was the hippocampal asymmetry index, being greater in the group with best postsurgical evolution. The most involved neocortical structure was the temporal pole. There was a correlation between temporal pole and amygdala volume and duration of epilepsy. This suggests a progressive damabe, added to the initial precipitating injury (IPI). There was also significant difference between mesial structures contralateral to the surgery side and those of the controls. These data shows more widespread and bilateral damage, even in patients with unilateral epilepsy by EEG and clinical criteria.

The surgical treatment options in thoracolumbar spine degeneration: The importance of morphological and clinical classifications in preoperative decision making David Bludovský Abstract: Objective: The aim of our study was to investigate the relations between subjective difficulties, clinical findings and the MR imaging in patients who have been operated for symptomatic lumbar spinal stenosis (LSS), and the possibility of using these relations for surgical treatment decision. Methods: Patients operated for lumbar spinal stenosis in 2009-2010 were included in the study. Subjective difficulties were assessed using the Oswestry Disability Index (ODI), the clinical symptoms with the modified Neurological Impairment Score for Lumbar Spinal Stenosis (mNIS-LSS). We measured the spine canal area, dural sac area, and nerve root sedimentation classification on MR. By correlation analysis at significance level p <0.05, we tested the relations between these categories. 61 patients with a median age of 67 were included. Overall, we evaluated 162 spinal segments. Results: Median of ODI values were 48. Correlation coefficients for ODI, mNIS-LSS and graphical findings were less than 0.5. Correlation coefficients greater than 0.5 were between all the MR measurement methods. Conclusions: In the group of patients indicated...

Introduction: Oropharyngeal tumours belong to the most common malignancies situated in the head and neck area. In the past, their incidence has been associated with classical risk factors (smoking and alcohol use). In the recent years, the increase of oropharyngeal carcinomas resulting from HPV (human papilloma virus) infection incidence has been observed. The change of their aetiology also implies a number of clinical differences, the most important being a significantly better survival prognosis in patients with HPV+ carcinomas. Aims: The main goal of this thesis was to characterize correctly patients with oropharyngeal carcinomas and to identify different specifics of nursing intensive care for these patients. Methods: The quantitative prospective study involved 30 patients following their surgical treatment of oropharyngeal carcinoma, hospitalised in an intensive care unit. The patients were divided into 3 groups: HPV+ non-smokers, HPV+ smokers, HPV- smokers. Results: The study confirmed the demographic differences between individual patient groups. The HPV+ non-smokers group is characterized by a lower age in average, which is significantly reflected in a reduced duration of hospital stay. In addition, opioid administration rate, infection rates and postoperative complications incidences are...