A perfuração gástrica por endoscopia é a consequência de alguns de seus procedimentos, e atualmente, com o advento das cirurgias endoscópicas translumenais por orifícios naturais, um meio de manipulação dos órgãos abdominais. Esse é o motivo pelo qual os endoscopistas estão procurando um reparo endoscópico seguro. O objetivo foi avaliar a factibilidade e os resultados do fechamento da abertura gástrica similar àquelas realizadas nos procedimentos cirúrgicos endoscópicos translumenais por orifícios naturais utilizando-se o T-Tag associado à câmara plástica protetora. Sob anestesia geral, dez porcos Landrace foram submetidos a uma perfuração gástrica calibrada em 18 mm de diâmetro. A abertura foi fechada pelo novo método apresentado, composto de fios cirúrgicos conectados em uma âncora metálica (T-Tag) posicionados pela parede gástrica através de uma agulha. Uma câmara protetora plástica foi adaptada à extremidade distal do endoscópio para proteger os órgãos abdominais adjacentes da punção da agulha fora do estômago. Seis dispositivos T-Tag foram posicionados na maioria dos casos e os fios atados com um apertador de nó metálico endoscópico formando três pontos de sutura. O teste de vazamento foi realizado com uma pinça endoscópica e distensão da câmara gástrica com ar. Os animais receberam líquidos no mesmo dia do procedimento. Uma dose de antibiótico diária por dois dias foi administrada. Nenhuma complicação foi detectada no período pós-operatório. Um mês depois, a endoscopia revelou a presença de cicatriz em todos os animais, e a maioria apresentava materiais da sutura aderidos à superfície mucosa da região. A região do antro gástrico apresentava poucas aderências identificadas na laparotomia realizada no mesmo momento. O reparo endoscópico utilizando o T-Tag e a câmara protetora plástica é factível, fácil de ser realizada e seguro. São necessários estudos adicionais para mostrar o real valor desse tipo de procedimento / The endoscopic gastric perforation is a consequence of some endoscopic procedures and now a way to manage abdominal organs. This is the reason why endoscopists are studying a safe endoscopic repair. The objective was to evaluate feasibility and results of the gastric opening closure similar to those performed in natural orifice translumenal endoscopic surgery procedures using T-Tag associated with the plastic protection chamber. Ten Landrace pigs underwent a gastric perforation of 1.8 cm in diameter under general anesthesia. The opening was repaired with stitch assembled in a T-Tag anchor placed through the gastric wall with a needle. A plastic transparent chamber, adapted to the endoscope tip protected the abdominal organs from the needle puncture outside the stomach. Six T-Tags were placed in most cases and the stitches were tied with a metallic tie-knot, forming three sutures. The leakage test was performed with a forceps and by air distention. The animals received liquids in the same operative day. One daily shot antibiotic during two days was used. No complication was detected in the postoperative course. One month later the endoscopy revealed a scar in all animals, and the majority of these with suture material. The antral anterior gastric wall was clear with few adhesions in the laparotomy performed in the same time. The endoscopic repair using T-Tag and a protector chamber is feasible, easy to perform and safe. Further studies are needed to show the real value of this kind of procedure

Abstract Despite numerous biomechanical and clinical studies on ankle fractures, the optimal treatment method for a stable fibula fracture is poorly known. Additionally, the clinical relevance and optimal fixation method of syndesmosis injury for different ankle fracture types is unclear. This thesis aimed: (I) to compare six weeks of cast immobilization with three weeks of immobilization (cast or orthosis) in a randomized controlled trial (RCT) of 247 patients with stable Weber B-type fibular fracture; (II) to compare mid-term outcome of syndesmosis transfixation with no fixation in an RCT of 24 patients with supination external rotation (SER) ankle fractures and syndesmosis injury; (III) to evaluate the significance of the syndesmosis injury on clinical outcome in a case-control study of 48 patients with SER ankle fractures; and (IV) to compare the syndesmosis fixation with a screw versus a suture-button device in terms of the accuracy and the maintenance of syndesmosis reduction in an RCT of 43 patients with pronation external rotation (PER) ankle fractures. Three weeks of immobilization in either a cast or an orthosis resulted in non-inferior outcomes compared to traditional six weeks’ immobilization in patients with stable Weber B-type fibula fracture. In patients with SER ankle fracture and unstable syndesmosis after fixation of bone fractures, leaving unstable syndesmosis unfixed resulted in similar outcomes compared to syndesmosis transfixation at mid-term follow-up. Patients with SER ankle fractures with or without an associated syndesmosis injury had similar clinical outcomes after a minimum of four years of follow-up. The syndesmotic screw and the suture-button fixation in patients with PER ankle fracture and unstable syndesmosis resulted in a low malreduction rate and both methods maintained reduction well. In conclusion, stable Weber B-type fibula fractures can safely be treated with only three weeks of cast immobilization or even with a simple orthosis. A syndesmosis injury in SER ankle fractures seems to be of minor therapeutic or prognostic importance and syndesmosis screw fixation has no effect on patient’s recovery compared to no syndesmosis fixation. An associated syndesmosis injury in PER ankle fractures can be fixed with a syndesmotic screw or a suture-button device with comparable outcomes. / Tiivistelmä Stabiilin nilkkamurtuman konservatiivisen hoidon toteutuksesta on hyvälaatuista tutkimustietoa tarjolla niukasti. Syndesmoosivamman kliininen merkitys ja sen hoitomenetelmät eri nilkkamurtumatyypeissä ovat kirjallisuuden perusteella vielä osittain epäselvät. Ensimmäisessä osatyössä vertailtiin kolmen viikon immobilisaatiota (kipsi tai ortoosi) perinteiseen kuuden viikon kipsihoitoon satunnaistetussa ja kontrolloidussa tutkimuksessa, joka käsitti 247 stabiilin Weber B-tyypin pohjeluun murtuman saanutta potilasta. Toisessa osatyössä vertailtiin syndesmoosin ruuvikiinnitystä kiinnittämättä jättämiseen satunnaistetussa ja kontrolloidussa tutkimuksessa, johon osallistui 24 SER (supinaatio-ulkorotaatio) -tyypin nilkkamurtumapotilasta, joilla todettiin syndesmoosin epävakaus leikkauksen aikaisessa rasituskokeessa. Kolmannessa osatyössä selvitettiin syndesmoosivamman kliinistä merkitystä SER-tyypin nilkkamurtumapotilailla tapaus-verrokki-asetelmassa. Neljännessä osatyössä vertailtiin syndesmoosin ruuvi- ja jännitelankakiinnitystä syndesmoosin kiinnitystarkkuuden ja kiinnityksen pysyvyyden suhteen satunnaistetussa ja kontrolloidussa tutkimuksessa, joka käsitti 43 PER (pronaatio-ulkorotaatio) -tyypin nilkkamurtuman saanutta potilasta. Stabiilin Weber B-tyypin pohjeluun murtuman hoidossa kolmen viikon immobilisaatio joko kipsillä tai ortoosilla oli yhtä hyvä ja turvallinen kuin perinteinen kuuden viikon kipsihoito. Syndesmoosin ruuvikiinnitettyjen ja kiinnittämättä jätettyjen SER-tyypin nilkkamurtumapotilaiden hoitotuloksissa ei todettu merkittäviä eroja keskipitkän aikavälin seurannassa. Syndesmoosivammalla ei todettu merkitystä SER-tyypin nilkkamurtuma-potilaiden hoitotulokseen tai ennusteeseen vähintään neljän vuoden seurannan jälkeen. Syndesmoosin reduktion suhteen ruuvi- ja jännitelankakiinnityksellä saadaan yhtä hyvät varhaisvaiheen tulokset PER-tyypin nilkkamurtumapotilailla ja molemmat kiinnitysmenetelmät säilyttävät syndesmoosin reduktion hyvin. Stabiilin Weber B -tyypin pohjeluun murtuman hoito voidaan toteuttaa turvallisesti ja tehokkaasti kolmen viikon immobilisaatiolla joko nilkkaortoosilla tai saapaskipsillä. Syndesmoosivammalla ei vaikuta olevan kliinistä merkitystä SER-tyypin nilkkamurtumapotilaan ennusteeseen, eikä vamman hoitaminen ruuvikiinnityksellä paranna potilaan hoitotulosta kiinnittämättä jättämiseen verrattuna. PER-tyypin nilkkamurtumiin liittyvän syndesmoosivamman korjauksessa voidaan käyttää joko ruuvikiinnitystä tai jännitelankasidosta yhtä hyvin hoitotuloksin.

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Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-04-05T19:25:23Z No. of bitstreams: 1 ALESSANDRO FERREIRA DO NASCIMENTO - DISSERTAÇÃO PPG-CEMat 2014..pdf: 1766148 bytes, checksum: 9952d3c1d40fa2b65189b5ac5fa3540f (MD5) / Made available in DSpace on 2018-04-05T19:25:23Z (GMT). No. of bitstreams: 1 ALESSANDRO FERREIRA DO NASCIMENTO - DISSERTAÇÃO PPG-CEMat 2014..pdf: 1766148 bytes, checksum: 9952d3c1d40fa2b65189b5ac5fa3540f (MD5) Previous issue date: 24-07-16 / Os fios para sutura cirúrgica são considerados produtos médicos invasivos utilizados para aproximação de tecido biológico e, devido ao contato com a pele, vasculatura e outros tecidos, são considerados um produto crítico. O presente trabalho propõe a avaliação de um dos fios com maior número de queixas técnicas notificadas à ANVISA, o fio de sutura de polipropileno, que é empregado em diversas intervenções cirúrgicas que requerem material inerte ao tecido e suporte mecânico, assim, uma avaliação da natureza físico-química do material empregado em amostras comerciais é importante para nortear um processo de certificação sanitária visando minimizar o risco aos pacientes. O fio de polipropileno foi adotado como modelo de análise , sendo escolhido o fio de número cirúrgico 0(zero) com 75cm de comprimento; foram selecionadas 4 amostras de fios de sutura de polipropileno de acordo com o padrão de notificações recebidas pela área de tecnovigilância da ANVISA como modelo para a execução de ensaios de difração de raio X, microscopia ótica, microscopia eletrônica de varredura com mapeamento por EDS, FTIR, microscopia de força atômica, análise termogravimétrica e ensaios mecânicos. Os resultados apresentados demonstraram perfis distintos nos aspectos morfológicos e mecânicos dos fios de sutura selecionados, suscitando a construção de um conjunto de análises distintas daquelas atualmente preconizadas para o registro desses produtos, assim como o estabelecimento de um processo certificador que seria realizado harmonizando parâmetros de ensaios mecânicos e caracterização morfológica dos fios de sutura, capaz de assegurar maior homogeneidade nos fios de sutura disponíveis comercialmente. / The suture threads are considered invasive medical products used for approximation of biological tissue and, due to contact with the skin, vasculature and other tissues, are considered a critical product. This paper proposes an evaluation of one of the wires with the largest number of technical complaints notified to ANVISA, the suture of polypropylene, which is used in various surgical procedures which require inert mechanical support to the tissue and thus a substantive assessment of the nature physical chemistry of the material used in commercial samples is important to guide a process of health certification in order to minimize the risk to patients. The polypropylene suture was used as the analysis model, being selected the surgical wire number 0 (zero) to 75cm long; 4 samples of polypropylene sutures were selected according to the pattern of notifications received by the area of technical surveillance of ANVISA as a model for the implementation of the testing of X-ray diffraction, optical microscopy, scanning with EDS mapping by electron microscopy, FTIR, atomic force microscopy, thermal analysis and mechanical testing. The results presented demonstrated distinct profiles on the morphological and mechanical suture wires of selected aspects, prompting the construction of a set of analyzes of those currently recommended for the registration of these products, as well as the establishment of a certification process that would be done by harmonizing testing parameters morphological and mechanical characterization of the suture capable of ensuring a greater homogeneity in the commercially available suture threads.

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[For the Abstract, please see the PDF files below, namely "front.pdf"] CONTENTS. Chapter 1 Introduction. Chapter 2 Gross and microscopic visceral anatomy of the male Cape fur seal with reference to organ size and growth. Chapter 3 Age determination and growth in the male Cape fur seal: part one, external body. Chapter 4 Age determination and growth in the male Cape fur seal: part two, skull. Chapter 5 Age determination and growth in the male Cape fur seal: part three, baculum. Chapter 6 Suture age as an indicator of physiological age in the male Cape fur seal. Chapter 7 Sexual dimorphism in the adult Cape fur seal: standard body length and skull morphology. Chapter 8 Reproduction in the male Cape fur seal: age at puberty and annual cycle of the testis. Chapter 9 Diet and foraging behaviour of the Cape fur seal. Chapter 10(a) The Impact of the fur seal industry on the distribution and abundance of Cape fur seals. Chapter 10(b) South African Airforce wildlife rescue: Cape fur seal pups washed from Black Rocks, Algoa Bay, during heavy seas, December 1976. Chapter 11(a) Operational interactions between Cape fur seals and fisheries: part one, trawl fishing. Chapter 11(b) Operational interactions between Cape fur seals and fisheries: part two, squid jigging and line fishing. Chapter 11(c) Operational interactions between Cape fur seals and fisheries: part three, entanglement in man-made debris. Chapter 12 Concentrations of heavy metals (Cd, Cu, Pb, Ni & Zn) and organochlorine contaminants (PCBs, DDT, DDE & DDD) in the blubber of Cape fur seals. Chapter 13 Endoparasites of the Cape fur seal. Chapter 14(a) Preliminary investigations of shark predation on Cape fur seals. Chapter 14(b) Aggressive behaviour of an adult male Cape fur seal towards a great white shark Carcharodon carcharias. Chapter 15 Conclusions and future directions.

Les sutures crâniennes ont été régulièrement étudiées au fil des siècles puisque déjà Vésale établissait une relation entre l’âge et la synostose suturale. Leur imprécision a quelque peu confiné l’observation de ces sutures dans un certain oubli, justifié en partie. Il est clair que leur fiabilité quant à l’estimation de l’âge au décès reste discutable et ce, pour diverses raisons. Leur observation est difficile et dès lors sujette à subjectivité dans l’appréciation de leurs stades de fusion. De plus, leur apparence sur le crâne sec peut être altérée par divers artéfacts de conservation (cire, vernis…). Outre l’observation des classiques sutures ectocrâniennes de voûte et l’utilisation des méthodes habituelles en la matière (méthode de Acsádi et Nemeskéri, méthode de Masset), nous avons orienté notre étude vers des sutures peu voire pas exploitées, à savoir les sutures palatines, les sutures fronto-naso-maxillaires et les sutures de l’os zygomatique. Ces trois groupes suturaux ont la particularité d’évoluer de manière très lente vers la fusion, à tel point que peu d’individus en présentent une oblitération complète. Face au vieillissement de la population et de par notre expérience médico-légale et anthropologique d’étude de pièces osseuses de personnes âgées, nous avons estimé qu’il était utile de se pencher sur des collections particulières de sujets d’âge avancé, afin d’apprécier l’évolution morphologique de ces sutures faciales. Si certaines personnes fort âgées gardent malgré tout des caractéristiques suturales peu évoluées, il existe dans l’ensemble, une progression suturale quasiment constante en fonction de l’âge. Nous avons tenté de la cerner, en attribuant à ces sutures, des degrés bien définis de cette progressive fusion et par là, l’aboutissement à un coefficient moyen d’oblitération suturale, se traduisant aisément en pourcentage d’oblitération ou pouvant être introduit dans des équations de régression. Tout en connaissant les limites de cette approche, nous pouvons estimer qu’elle peut rendre des services lors de l’étude de restes humains squelettisés, notamment s’ils appartiennent à des personnes fort âgées, dès lors qu’à ces stades de vieillissement, peu de méthodes restent encore applicables. D’autre part, l’approche en pourcentage d’oblitération suturale rend également des services lorsque les crânes étudiés sont fragmentés. C’est la situation que nous rencontrons actuellement lors de l’étude d’une très importante collection anthropologique à l’Institut royal des Sciences naturelles de Belgique. Cette observation suturale pourra également – à l’avenir – trouver un terrain d’approche fort utile par l’étude des sutures en CT-Scan ou en micro-CT. Enfin, grâce à ces techniques modernes d’imagerie médicale, les sutures trouvent un regain d’intérêt dans une application toute particulière, qui est celle de l’identification comparative, puisqu’il apparaît que le « dessin sutural » s’avère tout à fait propre à chaque individu.

Les sutures crâniennes ont été régulièrement étudiées au fil des siècles puisque déjà Vésale établissait une relation entre l’âge et la synostose suturale.<p><p>Leur imprécision a quelque peu confiné l’observation de ces sutures dans un certain oubli, justifié en partie.<p><p>Il est clair que leur fiabilité quant à l’estimation de l’âge au décès reste discutable et ce, pour diverses raisons.<p><p>Leur observation est difficile et dès lors sujette à subjectivité dans l’appréciation de leurs stades de fusion.<p><p>De plus, leur apparence sur le crâne sec peut être altérée par divers artéfacts de conservation (cire, vernis…).<p><p>Outre l’observation des classiques sutures ectocrâniennes de voûte et l’utilisation des méthodes habituelles en la matière (méthode de Acsádi et Nemeskéri, méthode de Masset), nous avons orienté notre étude vers des sutures peu voire pas exploitées, à savoir les sutures palatines, les sutures fronto-naso-maxillaires et les sutures de l’os zygomatique.<p><p>Ces trois groupes suturaux ont la particularité d’évoluer de manière très lente vers la fusion, à tel point que peu d’individus en présentent une oblitération complète.<p><p>Face au vieillissement de la population et de par notre expérience médico-légale et anthropologique d’étude de pièces osseuses de personnes âgées, nous avons estimé qu’il était utile de se pencher sur des collections particulières de sujets d’âge avancé, afin d’apprécier l’évolution morphologique de ces sutures faciales.<p><p>Si certaines personnes fort âgées gardent malgré tout des caractéristiques suturales peu évoluées, il existe dans l’ensemble, une progression suturale quasiment constante en fonction de l’âge.<p><p>Nous avons tenté de la cerner, en attribuant à ces sutures, des degrés bien définis de cette progressive fusion et par là, l’aboutissement à un coefficient moyen d’oblitération suturale, se traduisant aisément en pourcentage d’oblitération ou pouvant être introduit dans des équations de régression.<p><p>Tout en connaissant les limites de cette approche, nous pouvons estimer qu’elle peut rendre des services lors de l’étude de restes humains squelettisés, notamment s’ils appartiennent à des personnes fort âgées, dès lors qu’à ces stades de vieillissement, peu de méthodes restent encore applicables. D’autre part, l’approche en pourcentage d’oblitération suturale rend également des services lorsque les crânes étudiés sont fragmentés. C’est la situation que nous rencontrons actuellement lors de l’étude d’une très importante collection anthropologique à l’Institut royal des Sciences naturelles de Belgique.<p><p>Cette observation suturale pourra également – à l’avenir – trouver un terrain d’approche fort utile par l’étude des sutures en CT-Scan ou en micro-CT.<p><p>Enfin, grâce à ces techniques modernes d’imagerie médicale, les sutures trouvent un regain d’intérêt dans une application toute particulière, qui est celle de l’identification comparative, puisqu’il apparaît que le « dessin sutural » s’avère tout à fait propre à chaque individu.<p><p>/<p><p>Cranial sutures were regularly studied during centuries since Vésale already established a relationship between age at death and sutural fusion. <p><p>Their inaccuracy somewhat confined the observation of these joints in a certain lapse of memory, partly justified. <p><p>Various reasons clearly indicate that their reliability for age at death estimation remains debatable. <p><p>Their observation is difficult and consequently prone to subjectivity in the appreciation of their stages of fusion. <p><p>Moreover, their appearance on dry cranium can be modified by various artefacts from preserving methods (wax, varnished…). <p><p>In addition to the traditional observation of ectocranial sutures (with the usual methods such as Acsádi and Nemeskéri method and Masset method), we have directed our study towards not much exploited sutures, namely the palatine sutures, the fronto-naso-zygomatic sutures and the sutures of the zygomatic bone. <p><p>These three sutural groups are characteristic by evolving very slowly to fusion, and than, only few individuals present a complete obliteration of the latter. <p><p>Because of general population ageing and our medicolegal and anthropological experience of skeletal remains in elderly, we estimated the usefulness in studying particular collections of old people, in order to appreciate the morphological evolution of these facial joints. <p><p>Despite some very old people who present little evolved sutural characteristics, we consider as a whole, an almost constant sutural progression according to age. <p><p>We tried to define degrees of this progressive fusion and by the way, the result with a sutural obliteration average coefficient, can be easily translate as a percentage obliteration or able to be introduced into regression equations. <p><p>The limits of this approach are well known but we estimate that it is possible to help the examination of human skeletal remains in elderly, although at these stages of ageing, some methods remain still applicable. In addition, the approach expressed as a percentage of sutural obliteration is also very helpful when craniums are fragmented. This situation is currently observed on the anthropological collections at the Royal Belgian Institute of Natural Sciences. <p><p>Furthemore in the future, the sutural observation will find an interesting and useful approach by the study of the joints in CT-Scan or micro-CT. <p><p>At least, thanks to these modern techniques of medical imagery, the sutures find a renewed interest in a very particular application, such as comparative identification. It appears that the "sutural drawing" proves completely specific to each individual. <p><p> / Doctorat en sciences médicales / info:eu-repo/semantics/nonPublished