Resumo: Nas últimas três décadas muitas pesquisas têm sido realizadas com o objetivo de compreender o processo cicatrização dos tendões flexores e ainda hoje, a reabilitação envolve processos complexos e não compreendidos totalmente. As incertezas em colocar a sutura central na face dorsal vascularizada ou na face palmar avascularizada, persistem ainda na prática clínica e nos experimentos das técnicas de reparo dos tendões flexores dos dedos da mão na região da bainha digital. O objetivo deste estudo foi analisar as propriedades mecânicas e histopatológicas da colocação de um ponto de sutura simples no tendão flexor profundo dos dedos do pé de coelhos, verificando os efeitos na interface sutura-tendão e comparar a colocação deste ponto na região do tendão fibroso, vascularizada e na região do tendão fibrocartilaginoso avascular. Foram estudados 88 coelhos machos divididos em dois grupos de acordo com o local de colocação do ponto de sutura e em mais três subgrupos de acordo com o tempo de seguimento pós- operatório de sete, 14 e 21 dias. O procedimento cirúrgico consistiu na colocação de um único ponto na região de tendão fibroso (Grupo TF) e na região de tecido fibrocartilaginoso (Grupo TFC) no tendão flexor profundo dos dedos do pé do coelho. Em ambos os grupos, os tendões estavam íntegros, sem lesão e os animais permaneceram livres de imobilização. As propriedades mecânicas estudadas foram carga máxima, tensão na carga máxima, módulo de elasticidade, energia na carga máxima e energia por área. Três tendões de cada grupo foram submetidos à análise histológica descritiva por meio de microscopia óptica com ênfase no progresso das etapas da cicatrização tendinosa. A análise das propriedades mecânicas demonstrou comportamento semelhante em ambos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In the last three decades many studies have been undertaken with the aim of understanding the process of flexor tendon healing and even now, the rehabilitation involves a complex and not fully understood process. The doubts concerning placing the core suture in the vascularized dorsal region than of the palmar avascularized region remain in clinical practice and in the experimental techniques in the repair of flexor tendons of the finger in the digital sheath. The aim of this study was to evaluate the mechanical and histopathologic properties of placing a single suture on the deep flexor tendon in rabbit toes, examining the effects on suture-tendon interface and compare the placement of this point at normal vascularized tendon as well as at the avascular fibrocartilagenous tendon. Eighty-eight male rabbits were studied and divided into two groups according to the local of the point of suture and in three subgroups according to the time of postoperative segment of seven, fourteen and twenty-one days. The surgical procedure was inserting a single point in the region of fibrous tendon (TF Group) and the region of fibrocartilagenous tissue (TFC Group) in deep flexor tendon in rabbit toes. In both groups, the tendons were intact without injury and the animals were allowed free movement. The mechanical properties were maximum load, stress at maximum load, elasticity modulus (Young modulus), energy at maximum load and energy per area. Three tendons from each group were subjected to descriptive histological analysis by an optical microscopy emphasizing the process of tendon healing stages. The analysis of mechanical properties showed similar trend in both groups, with increasing values in accordance with the periods of seven, fourteen and twenty-one days in most of the variables. The control group showed relative similarity than operated group except in TFC twenty one days group that operated... (Complete abstract click electronic access below) / Orientador: Sérgio Swain Muller / Coorientador: Trajano Sardenberg / Banca: Ivan Chakkour / Banca: Antonio Carlos da Costa / Banca: Gilberto Hiroshi Ohara / Banca: Paulo Roberto de Almeida Silvares / Doutor

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-11-09T09:57:22Z No. of bitstreams: 2 Tese - Filipe Augusto Sales Gomes - 2017.pdf: 1914139 bytes, checksum: da7b6d8f638ab8b24c9e26f881b99673 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-11-09T09:57:51Z (GMT) No. of bitstreams: 2 Tese - Filipe Augusto Sales Gomes - 2017.pdf: 1914139 bytes, checksum: da7b6d8f638ab8b24c9e26f881b99673 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-11-09T09:57:51Z (GMT). No. of bitstreams: 2 Tese - Filipe Augusto Sales Gomes - 2017.pdf: 1914139 bytes, checksum: da7b6d8f638ab8b24c9e26f881b99673 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-08-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Chitosan based materials are a class in development because they possess excellent characteristics for use in the biomedical sciences. Regarding chitosan suture, few studies have been performed and no studies have evaluated its response to systemic inflammation and mechanical resistance. Therefore, the aim of this thesis is to analyze the possible systemic inflammatory reactions in adult rats subjected to laparorrhaphy with chitosan suture by means of the electrophoretic analysis of polyacrylamide gel (SDS-PAGE) and its relation with the hematological findings and biochemical. In addition, investigate the mechanical resistance of the abdominal wall, the probable local inflammatory changes and the formation of collagen, through the tensiometric and histopathological analyzes. To that end, 54 adult rats (Rattus norvegicus) were divided into three groups, basel group (without surgery), chitosan and polydioxanone (gold standard), evaluated at three, seven, 14 and 21 days after laparorrhaphy. The result was that the chitosan and polydiaxonone wires have similar behaviors in the systemic and local inflammatory response, although the polydioxanone thread has a more intense response. In the evaluation of resistance, they also presented similar results, and with polydioxanone, resistance was better on the twenty-first day, with the conclusion that chitosan suture, despite the small number of researches, is a promising thread. With this, perspectives are opened for the use of chitosan suture in surgeries in veterinary medicine. However, as this is a new product, other studies should be carried out, even in different areas, as well as in other species / tissues and at different evaluation periods. / Os materiais à base de quitosana são uma classe em desenvolvimento por possuírem excelentes características para utilização nas ciências biomédicas. Em relação ao fio de quitosana, poucas pesquisas foram realizadas e não há estudos que avaliaram sua resposta à inflamação sistêmica e à resistência mecânica. Diante disso, a presente tese tem por objetivo analisar, em ratas adultas submetidas à laparorrafia com fio de quitosana, as possíveis reações inflamatórias sistêmicas, por meio da análise eletroforética em gel de poliacrilamida (SDS- PAGE) e sua relação com os achados hematológicos e bioquímicos. Além disso, investigar a resistência mecânica da parede abdominal, as prováveis alterações inflamatórias locais e a formação do colágeno, por meio das análises tensiométrica e histopatológica. Para tal, 54 ratas adultas (Rattus norvegicus) foram divididas em três grupos, basal (sem cirurgia), quitosana e polidioxanona (padrão ouro), avaliados com três, sete, 14 e 21 dias pós- laparorrafia. O resultado foi que os fios de quitosana e polidiaxonona possuem comportamentos semelhantes na resposta inflamatória sistêmica e local, apesar do fio de polidioxanona ter resposta mais intensa. Na avaliação de resistência, também apresentaram resultados semelhantes, sendo que com a polidioxanona, a resistência foi melhor no vigésimo primeiro dia, tendo como conclusão que o fio de quitosana, apesar do pequeno número de pesquisas realizadas, é um fio promissor. Com isso, abrem-se perspectivas para a utilização do fio de quitosana em cirurgias na medicina veterinária. Todavia, por tratar-se de um novo produto, outros estudos devem ser realizados, mesmo que em áreas distintas, bem como, em outras espécies/ tecidos e em diferentes períodos de avaliação.

No parto normal, o trauma provocado por episiotomia ou roturas, é freqüente e a anestesia local é bastante utilizada no reparo das lesões da região vulvoperineal. Na literatura especializada, os estudos sobre as soluções anestésicas mais adequadas são escassos para essa anestesia. No entanto existem recomendações para a adoção de anestésicos com vasoconstritor pela permanência mais prolongada da solução anestésica no local, garantindo maior ação e redução da concentração plasmática da droga, mas na prática seu uso é restrito. O objetivo do estudo foi comparar a quantidade de anestésico necessária para inibir a dor durante a sutura do trauma perineal, em mulheres com episiotomia ou laceração espontânea de primeiro ou segundo graus, conforme o uso ou não de vasoconstritor na solução anestésica. Trata-se de uma pesquisa aleatorizada e controlada com mascaramento duplo, realizada no Centro de Parto Normal do Amparo Maternal na cidade de São Paulo. Foram incluídas 96 parturientes, alocadas em três blocos - laceração de primeiro grau, laceração de segundo grau e episiotomia. Em cada bloco, constituído por 32 mulheres, 16 receberam solução anestésica com vasoconstritor e 16 sem vasoconstritor. Os resultados mostraram que, na laceração de primeiro grau, a média de anestésico com vasoconstritor apresentou diferença estatisticamente significante (p=0,002), com 1,0 ml (I.C. -1,6; -0,4) menos que a média do anestésico sem vasoconstritor; em 95% dos casos, foram usados de 1 a 2 ml de solução com vasoconstritor, e em 87,5% dos casos para o anestésico sem vasoconstritor, o volume usado variou de 2 a 4 ml. Para a laceração de segundo grau, a média do anestésico com vasoconstritor foi 3,7 ml (I.C. -5,8; -1,6) menos que a média do anestésico sem vasoconstritor, sendo estatisticamente significante (p=0,001); em 87,5% dos casos, a quantidade máxima de anestésico com vasoconstritor administrada foi 6 ml, e 81,3% das mulheres que receberam anestésico sem vasoconstritor, a dose administrada foi de 7 ml ou mais. Considerando a extensão da laceração, adotou-se o tamanho da episiotomia praticada nas mulheres do estudo, como parâmetro para classificar a extensão da laceração. Foram agrupadas como pequenas as lacerações de menor extensão, como médias aquelas com tamanho semelhante à episiotomia e como grandes aquelas cuja extensão superou o tamanho da episiotomia. Para a episiotomia, a média de anestésico com vasoconstritor foi 0,3 ml (I.C. -2,1; 1,5) a menos que a média do anestésico sem vasoconstritor, considerada sem significância estatística (p=0,724). Os resultados permitiram confirmar a hipótese de que uso de anestésico com vasoconstritor na anestesia local para a sutura de lacerações perineais no parto normal aumenta a eficácia da anestesia local. Embora o volume de anestésico utilizado na sutura de laceração de primeiro e segundo graus seja significativamente reduzido pela associação com vasoconstritor, a relevância clínica desse resultado deve ser considerada. / The perineal trauma, caused by episiotomy or ruptures, is quite frequent during the spontaneous delivery, being the local anesthesia widely utilized when repairing lesions in the vulvo-perineal region. Throughout the specialized literature, scarce are the studies on the most suitable anesthetic solutions for this kind of anesthesia. Even though there are recommendations for the adoption of the anesthetic with vasoconstrictor, because of the prolonged permanence of the anesthetic solution in the region, thus ensuring a bigger time of action, and because of the reduction in the plasmatic concentration of the drug, its utilization in practice is restricted. The goal of the study was to compare the necessary quantity of anesthetic to inhibit pain during the suture of the perineal trauma in women with an episiotomy or with first or second degree spontaneous lacerations, according to the use or not of vasoconstrictor in the anesthetic solution. This is a randomized and controlled research, with double blind trial, performed in the Birth Centre at Amparo Maternal, in the city of Sao Paulo. There were 96 parturients included in the study and then divided into three blocks: first degree laceration, second degree laceration and episiotomy. In each block, constituted of 32 women, 16 women were administered the anesthetic solution with vasoconstrictor and 16 with no vasoconstrictor. Results show that in the first degree laceration block the average of anesthetic with vasoconstrictor presented a statistically significant difference (p=0,002), with 1,0 ml (C.I. -1,6; -0,4) less than the average of the anesthetic without vasoconstrictor; in 95% of the cases, 1 to 2 ml of the solution with vasoconstrictor was utilized, while in 87,5% of the cases, the anesthetic without vasoconstrictor varied from 2 to 4 ml. In the second degree laceration block, the average of anesthetic solution with vasoconstrictor was 3,7 ml (C.I. -5,8; -1,6) less than the average of the anesthetic without vasoconstrictor, being statistically significant (p=0,001); in 87,5% of the cases, the maximum quantity of anesthetic with vasoconstrictor administered was 6 ml, while in 81,3% of the cases, women who were given the anesthetic without vasoconstrictor, received 7 ml or more. Considering the extent of the laceration, the size of the episiotomy practiced on the women of the study was adopted as a parameter to classify the extent of the laceration. The lacerations of a smaller extent were grouped as small-sized, the ones in which the size was similar to the size of the episiotomy were grouped as medium-sized, and as large-sized the ones that oversized the episiotomy. For the episiotomy, the average of anesthetic with vasoconstrictor was 0,3 ml (C.I. -2,1; 1,5) less than the average of the anesthetic without vasoconstrictor, with no statistic significance (p=0,724). Results allow us to confirm the hypothesis that the utilization of the anesthetic with vasoconstrictor in the local anesthesia during the suture of the perineal lacerations in the spontaneous delivery increases the effectiveness of the local anesthesia. Although the volume of anesthetic utilized in the suture of the first and second degree lacerations is significantly reduced by the association with vasoconstrictor, the clinical relevance of this result must be taken into further consideration.

O presente estudo avaliou por meio de teleradiografias em norma lateral as alterações do perfil facial frente à cirurgia Le Fort I com avanço e impactação da maxila utilizando fixação rígida e sutura V-Y, em 18 pacientes, com de classe III, leucoderma, com média de idade de 23 anos e 7 meses. As radiografias foram obtidas com os dentes em máxima intercuspidação, lábios em repouso, na fase précirúrgica imediata (M1) e 1 ano após a cirurgia (M2). Para responder o objetivo do estudo os valores das estruturas ósseas e tegumentares foram comparadas antes e depois da cirurgia por meio do teste t de Student pareados e foi aplicado o teste de correlações de Pearson entre as medidas ósseas e tegumentares de interesse. As relações entre as variações foram avaliadas com uso de regressão linear. Concluí-se após a análise dos resultados que não houve alteração estatisticamente significativa no sentido vertical, para os valores dentoesqueléticos e tegumentares estudados, exceto para o valor do ângulo do plano mandibular. Entretanto, houve correlação direta das alterações entre eles, exceto para os valores do plano mandibular com a espinha nasal anterior e posterior e do ângulo nasolabial com o incisivo superior. No sentido horizontal, houve alteração estatisticamente significativa entre os valores dentoesqueléticos e tegumentares relacionadas à maxila e não houve entre os valores relacionados à mandíbula. A previsibilidade numérica das alterações tegumentares decorrentes do avanço e impactação da maxila está sujeita a alterações individuais. / The purpose of this study was to determine retrospectively, by means of lateral cephalograms, the postsurgical changes in the facial soft tissue profile in class III patients (n=18) submitted to Le Fort I osteotomy, for maxillary impaction and advancement within the ?V-Y? suture. Caucasian individuals constituted the sample, and average age was 23 years old and 7 months. The cephalograms were obtained in maximum intercuspation with the lips at rest. The patients were evaluated in two times, the first period was in the immediate pre-surgical (M1) and, one year after the surgical procedure (M2). In order to answer the purpose of this study, skeletal and facial soft tissue measurements were compared before and after the surgery, by means of paired Student t tests, and the Pearson?s correlation coefficient for skeletal and facial soft tissue relevant measurements, using the variations (after and before) between the values. The relationship between the significant variations was evaluated by means of linear regression analysis. The findings indicated that there was not statically significant difference in the vertical plane, for the studied dentalskeletal and facial soft tissue values, exception for the value of the mandibular plane angle. However, there was direct correlation between then, except for the values of the mandibular plane angle-ANS; mandibular plane angle-PNS, and nasolabial angleupper incisors. In the horizontal plane, there was statically significant difference between the dental-skeletal values and facial soft tissue, related to the maxilla and there was not in the values related to the mandible. The numerical prediction of the facial soft tissue changes occasioned by the impaction and maxillary advancement is subject to individual responses.

Abstract The purposes of the present research were to compare the outcome after Achilles tendon rupture repair in two postoperative regimens, to compare Achilles tendon elongation in two postoperative treatment methods, to compare the effects of two postoperative methods on motor performance aspects such as simple reaction time, choice reaction time, speed of movement, foot tapping speed and coordination, to test the mechanical properties of the recently developed poly-L/D-lactide (PLDLA) sutures and Maxon® sutures when implanted in the Achilles tendons of rabbits, and to study the histological tissue reactions and biodegradation of these sutures under the same conditions. Isokinetic calf muscle strength scores at the last control check-up were excellent in 56% of the patients in the early motion group, good in 32%, fair in 8%, and poor in 4%, whereas the scores in the cast group were excellent in 29% of cases, good in 50% and fair in 21%. The ankle performance scores were excellent or good in 88% of the patients in the early motion group, fair in 4% and poor in 8%, whereas the scores in the cast group were excellent or good in 92% of cases and fair in 8%. No significant differences were seen between the two groups at 3 months and at the last control checkups with regard to pain, stiffness, subjective calf muscle weakness, footwear restrictions, range of ankle motion, isokinetic calf muscle strength or overall outcome. The complications included 1 re-rupture in the early motion group and 1 deep infection and 2 re-ruptures in the cast group. AT elongation occurred in both groups, but was somewhat less marked in the early motion group. The AT elongation curves rose at first and then fell slowly in both groups. The patients who had less AT elongation achieved a better clinical outcome. AT elongation did not correlate significantly with age, body mass index or isokinetic peak torques. The recovery of motor performance functions such as simple reaction time, choice reaction time, speed of movement, foot tapping speed and coordination did not depend on the two postoperative regimens. The motor functions of the operated leg had obviously recovered to the level of the non-operated leg 12 weeks after the operation. Sutures made of PLDLA were used successfully for Achilles tendon repair in rabbits. There was no significant difference between the in vitro and in vivo tensile strength retention of the sutures. By comparison with Maxon®, PLDLA was found to have a lower initial tensile strength but more prolonged strength retention. The breaking strength values of the Achilles tendons repaired with sutures of these types were not significantly different at 6 weeks. Intratendinous PLDLA sutures formed a thinner fibrous capsule during the 12-week follow-up period than did Maxon® sutures of the same diameter. The suture materials had not been totally absorbed by 12 weeks.

Abstract Early motion is crucial for tendon healing and functional results after flexor tendon repair in the fingers. Motion, however, causes stress in the repair site, which can result in failure of the repair. A flexor tendon repair is made with fine calibre sutures, which sets exceptional requirements for the suture materials used in flexor tendon repair. Nitinol (nickel-titanium alloy) is a shape memory alloy, which can exist in two temperature-dependent forms, soft martensite and stiff austenite. It is possible to fabricate a nitinol wire that is soft and pliable, yet has high tensile strength. It also has excellent biocompatibility. Therefore, it is a potential candidate flexor tendon repair suture material. This study evaluates biomechanical aspects of martensite nitinol wire as a flexor tendon repair suture material. The study hypothesis was that nitinol wire improves the strength of the repairs compared with the repairs made with conventional suture materials. It was found that nitinol core repairs and circumferential repairs performed significantly better when compared with repairs made with commonly used braided polyester and polypropylene of equal calibre. To further optimise the performance of the nitinol wire in tendon surgery, two experimental models were developed to study the suture-tendon interface. The aim was to prevent pull-out of the suture loop so that surgeons could have full advantage of the tensile strength of the nitinol suture. First, it was tested whether it is possible to improve the suture’s ability to grip the tendon tissue by changing the suture type from monofilament to multifilament. Multifilament suture loops reached higher pull-out strength when compared with round monofilament loops when a locking loop was used. Subsequently, the grip of four different previously reported core repair loops was tested. Based on their failure mechanism, two novel loops were developed. The novel loops demonstrated superior ability to grip the tendon. The novel loops can be useful with high tensile strength suture materials and in repairs, which are prone to suture pull-out. / Tiivistelmä Varhainen korjauksen jälkeinen aktiivinen kuntoutus on osoittautunut hyödylliseksi jänteen paranemiselle. Varhainen liike altistaa korjauksen kuormitukselle, joka voi johtaa korjauksen pettämiseen. Korjaukset tehdään ohuilla langoilla. Tämä asettaa erityisiä vaatimuksia jännekorjauksessa käytettävälle ommelainemateriaalille. Nikkeli-titaani (nitinoli) on nk. muistimetalli. Sillä on kaksi lämpötilariippuvaista muotoa: pehmeä martensiitti ja jäykkä austeniitti. Nitinolista voidaan valmistaa ohutta pehmeää ja taipuisaa lankaa, jonka vetolujuus on suuri. Nitinolin siedettävyys jännekudoksessa on todettu hyväksi, minkä vuoksi se on lupaava materiaali käytettäväksi jännekorjauksissa. Tässä tutkimuksessa kokeiltiin martensiittisen nitinolilangan käyttöä jänteen ydinompeleena ja pintaompeleena. Olettamuksena oli, että nitinolilangalla saadaan kestävämpiä korjauksia kuin nykyään käytössä olevilla langoilla. Tulosten mukaan nitinolilangalla tehdyt korjaukset olivat kestävämpiä, kun niitä verrattiin saman paksuiseen punottuun polyesteriin ja polypropyleeniin. Lisäksi kehitimme kaksi mallia, joiden tarkoituksena oli parantaa nitinolilankasilmukan pitoa jännekudoksesta. Tarkoituksena oli löytää keinoja, joilla langan otetta jännekudoksesta voidaan parantaa ja langan hyvät vetolujuusominaisuudet pääsevät oikeuksiinsa. Ensin muutimme langan muotoa perinteisestä yksisäikeisestä pyöreästä monisäikeiseen muotoon. Monisäikeisen langan läpileikkausvoima oli huomattavasti suurempi kuin yksisäikeisen pyöreän langan. Ero oli havaittavissa vain, kun käytettiin lukitsevaa silmukkaa. Tämän jälkeen testasimme neljän perinteisesti käytetyn korjaustekniikan silmukan pitokykyä ja tulosten perusteella kehitimme kaksi uutta silmukkaa. Työssä kehitetyt silmukat pitivät kiinni jänteestä huomattavasti paremmin kuin perinteiset silmukat. Työssä kehitetyillä silmukoilla voidaan optimoida vahvojen ommelainemateriaalien suorituskyky jännekirurgiassa.

<p>UVOD: Ingvinalna hernioplastika predstavlja najučestaliju operaciju u abdominalnoj hirurgiji. U istorijatu herniologije su se razvijale različite ideje, te iz njih nastale operativne metode, koje su imale za cilj formiranje kvalitetnog vezivnog tkiva na mestu kilnog defekta. Danas postoje brojne hirur&scaron;ke tehnike, bazirane na tenzionim ili beztenzionim principima, uz primenu hirur&scaron;kih mrežica, otvorenim pristupom, kao i laparoskopskim tehnikama. Zajednički cilj navedenih metoda je kreiranja idealne hernioplastike ingvinalnih kila. I pored postojanja ogromnog broja hirur&scaron;kih procedura i tehnika, jo&scaron; uvek ne postoji tzv. &raquo;prava hernioplastika&laquo; koja bi zadovoljila sve potrebne zahteve vezane za problem ingvinalnih hernija. CILJ I HIPOTEZA: Cilj rada je bio da se napravi uporedna analiza između dve različite hirur&scaron;ke tehnike otvorenim pristupom, konvencionalne tenzione suturne hernioplastike, te beztenzione tehnike, uz kori&scaron;ćenje hirur&scaron;kih mrežica ( mesh ). Kori&scaron;ćeni su sledeći parametri tokom istraživanja: određivanje nivoa postoperativnog bola prema numeričkoj skali, vizuelno-analognoj te kategorijskoj skali bola; određivanje samostalne fizičke aktivnosti; (savijanje nogu, naprezanje trbu&scaron;nih mi&scaron;ića, ustajanje) u neposrednom postoperativnom periodu; gradacija nivoa mi&scaron;ićne snage, određivanje vremenskog perioda kada se pacijenti uspevaju vratiti svojim svakodnevnim aktivnostima i radnim obavezama; određivanje stope postoperativnog morbiditeta i mortaliteta te određivanje stope ranog recidiva bolesti. RADNA HIPOTEZA: Beztenzionu ingvinalnu hernioplastiku karakteri&scaron;e znatno manja operativna trauma, &scaron;to ima za posledicu manji lokalni i generalizovani odgovor organizma na stres. Kod bolesnika operisanih beztenzionom metodom očekuje se manji intenzitet bola, kraće zadržavanje u hospitalnim uslovima, manji procenat postoperativnih komplikacija, brži povratak uobičajenim fizičkim i radnim aktivnostima i znatno manji stepen recidiva bolesti. Pretpostavlja se da beztenziona ingvinalna hernioplastika u poređenju sa konvencionalnom uzrokuje manju nelagodnost za pacijente, znatno manji postoperativni bol i bolju mi&scaron;ićnu aktivnost. Pobolj&scaron;anje mi&scaron;ićne aktivnosti ogleda se u lak&scaron;oj vertikalizaciji, kvalitetnijem kretanju uz manje bolan hod, bez povijanja tela na stranu operativne rane. MATERIJAL I METODE: Istraživanje je prospektivna, kliničko- statistička studija sa praćenjem parametara (preoperativnih, intraoperativnih i postoperativnih) kod svakog operisanog bolesnika. Studija je obuhvatila seriju od 200 pacijenata hospitalizovanih na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju Kliničkog centra Vojvodine, od decembra 2002. do avgusta 2007.godine, svrstanih u dve jednake grupe po 100 pacijenata, odabranih metodom slučajnog izbora. Prva, ispitivana grupa obuhvatila je pacijente operisane beztenzionim procedurama, druga, kontrolna grupa je obuhvatila pacijente operisane konvencionalnim, tenzionim tehnikama. Kori&scaron;ćeni metod rada je kliničko statistički sa praćenjem svih potrebnih fiziolo&scaron;kih parametara, a dobijeni rezultati su analizirani i međusobno upoređivani statističkim metodama multifaktorijalne analize. Pronađene vrednosti su međusobno upoređene parametrijskim i neparametrijskim testovima značajnosti na nivou p&lt;0.05. REZULTATI: komparacija između dve ispitivane grupe je vr&scaron;ena tokom preoperativnog, intraoperativnog i postoperativnog perioda, različitim statističkim parametrima. Konstatovana je, statističkom analizom, homogenost grupa u smislu starosne dobi i polne distribucije, kao i lokalnog preoperativnog nalaza vezanog za tip, veličinu i lokalizaciju kila, kao i spram klasifikacije hernija. U sledećim parametrima je ustanovljena statistički signifikantna razlika: postoperativni bol, gradacija mi&scaron;ićne snage, rana fizička aktivnost, količina utro&scaron;enih analgetika, dužina hospitalizacije, prisutnost obostranih kila, povratak radnim aktivnostima i obavezama, postoperativne komplikacije i recidiv bolesti. Dobijeni podaci su prikazani tabelarno, te delom u vidu grafikona i dijagrama. ZAKLJUČCI: 1. Kod pacijenata operisanih beztenzionom metodom evidentan je znatno manji postoperativni bol i brži oporavak i povratak uobičajnim dnevnim i radnim aktivnostima 2. Proceduru treba izvoditi u svim slučajevima sa prisutnim velikim defektima i razorenim zadnjim zidom ingvinalnog kanala 3 Beztenzionu hernioplastiku karakteri&scaron;e manji broj recidiva u poređenju sa otvorenim tenzionim hernioplastikama. 4. Pacijenti sa bilateralnim ingvinalnim i recidivnim hernijama imaju punu indikaciju za izvođenje beztenzione herioplastike sa ugradnjom mesh-a. 5. Preduslov za uspe&scaron;no obavljenu beztenzionu hernioplastiku je primena dovoljno velike proteze, odnosno mesh-a, dimenzija 15 x 10 cm.</p> / <p>INTRODUCTION: Inguinal hernioplasty is the most common surgical procedure in abdominal surgery. In the history of herniology have developed different ideas, and from them emerged operational methods, which are aimed at educating quality of connective tissue at the site of the hernia defect. Nowadays, there are numerous surgical techniques, based on the tensioned or tension-free principles, with the use of surgical mesh for open access as well as laparoscopic techniques. Common goal of these methods is creating ideal inguinal hernioplasty despite the existence of a huge number of surgical procedures and techniques, there is still no so-called &raquo;Proper hernioplasty &quot; that would satisfy all the necessary requirements related to the problem of inguinal hernia. AIM AND HYPOTHESIS: The aim of this study was to make a comparative analysis between two different open access surgical techniques conventional tension hernioplasty and tension-free techniques, with the use of surgical mesh .The following parameters were used during the research: determining the level of postoperative pain according to a numerical scale, visual analogue scale and categorical scale of pain; determining the initial independent physical activities: (bending the legs, straining abdominal muscles, getting up) in the immediate postoperative period; gradation levels of muscular strength, determination period when patients can return to their usual daily activities and work duties; determining the rate of postoperative morbidity and mortality and to determine rates of early recurrence of the disease. WORKING HYPOTHESIS: Tension-free inguinal hernioplasty characterized by significantly less operative trauma, which results in smaller local and generalized body&#39;s response to stress. In patients operated by the tension. free method is expected to lower the intensity of pain, a shorter stay in the hospital setting, a smaller percentage of postoperative complications, faster return to normal physical and occupational activities and much lower degree of disease recurrence. It is assumed that the tensional. free inguinal hernioplasty compared with conventional causes less discomfort for patients, significantly less postoperative pain and better muscle activity. Better muscle activity is reflected in a facilitated mobilization, quality of movement and less painful gait, without bending the body at the side of the surgical wound. MATHERIAL AND METHODS: The research was a prospective, clinical-statistical study of the monitoring parameters (preoperative, intraoperative and postoperative) in each of the operated patients. The study involved a series of 200 patients hospitalized at the Clinic for Abdominal, Endocrine and Transplantation Surgery, Clinical Center Vojvodine, from December 2002 to August 2007, divided into two groups of 100 patients, randomly chosen. First, the test group consisted of patients operated by the tension-free procedures, the other, the control group consisted of patients operated on conventional techniques. The method used is the work of clinical statistical tracking of all necessary physiological parameters, and the results were analyzed and compared with each other with multivariate statistical methods of analysis. Found values are compared with each other parametric and non-parametric tests of significance at p &lt;0.05. RESULTS: The comparison between the two study groups was performed during the preoperative, intraoperative and postoperative period, using various statistical parameters. It was noted using the statistical analysis, the homogenity of the groups in terms of age and sex distribution, as well as local preoperative findings related to the type, size and location pounds as well as towards the classification of hernias. In the following parameters is statistically significant difference: postoperative pain, graduations of muscle strength, healing of physical activity, the quantity of analgesics, length of hospitalization, the presence of bilateral hernias, the return of work activities and responsibilities, postoperative complications and recurrence. The data are presented in tables, and partly in the form of graphs and charts. CONCLUSIONS: 1. In patients operated by the tension-free obvious method is significantly less postoperative pain and faster recovery and return to usual daily and work activities 2. The procedure should be performed in all cases with the presence of large defects and lacerated back wall of the inguinal canal 3. Tension-free hernioplasty is characterized by a smaller number of recurrence compared with conventional hernioplasty 4. Patients with bilateral inguinal hernias and recurrent have a full indication of the performance of the tension-free hernioplasty with the installation of mesh. 5. A prerequisite for the successful work carried out tension-free hernioplasty application is large enough prosthesis ( mesh ), measuring 15 x 10 cm.</p>

Objectif—Comparer les effets de la stérilisation au plasma de gaz de peroxyde d’hydrogène (HPGP) à l’oxyde d’éthylène (EO) et à la vapeur (ST) sur les propriétés physico-chimiques et d’adhésion bactérienne de fils de nylon et de polyéthylène. Design expérimental—Etude in vitro. Matériel—Des brins non stérilisés, stérilisés au HPGP, à l’EO et ST; de fil nylon leader (FNL), de fil de nylon pêche (FNP) et de fil de polyéthylène (PE) ont été utilisés. Méthodes—Une analyse de surface au spectroscope photo-électronique à rayons X (XPS), une mesure de l’angle de contact, une analyse par microscopie à force atomique (AFM) et l’adhésion bactérienne de Staphylococcus intermedius et d’Escherichia Coli ont été testés sur les brins. Résultats—Une oxydation de la surface de tous les échantillons stérilisés a été observée quelque soit la méthode de stérilisation. La stérilisation a augmenté significativement l’angle de contact pour tous les types de fil quelque soit la méthode. La rugosité n’a pas été affectée significativement par la méthode de stérilisation pour le FNL et FNP. L’adhésion bactérienne a été affectée significativement par la méthode de stérilisation. Le PE a un angle de contact, une rugosité et une adhésion bactérienne significativement plus élevée que le FNL et FNP, peu importe la méthode de stérilisation. Conclusion—La stérilisation au HPGP constitue une alternative intéressante à la vapeur et l’EO. Le PE n’est peut être pas un matériel idéal par sa capacité d’adhésion bactérienne. De futures études sont nécessaires pour déterminer la signification clinique de ces trouvailles. / Objective—To compare the effects of hydrogen peroxide gas plasma (HPGP), ethylene oxide (EO) and steam (ST) sterilizations on the physicochemical and bioadhesive properties of nylon and polyethylene lines used for stabilization of the canine stifle joint. Study Design—In vitro study. Samples—Non-sterilized, HPGP-, EO- and ST- sterilized samples of 36.3-kg test nylon leader line (NLL), 57.8-kg test nylon fishing line (NFL) and 2-mm Ultra High Molecular Weight Polyethylene (UHMPE) were used. Methods—Surface analysis of NLL, NFL and UHMPE non-sterilized and HPGP-, EO- and ST-sterilized samples was carried out by X-ray photoelectron spectroscopy (XPS), contact angle (CA) measurement, and atomic force microscopy (AFM). Staphylococcus intermedius and Escherichia Coli bacterial adherence were also tested. Results—Surface oxidation was observed on all samples sterilized with HPGP, EO or ST process. All sterilization methods significantly increased the CA for the NLL, NFL and UHMPE. The roughness was not significantly affected by the method of sterilization for NLL, NFL and UHMPE. Bacterial adherence was significantly affected by the method of sterilization for NLL, NFL and UHMPE. UHMPE had significantly higher CA, roughness and bacterial adherence compared to NLL and NFL, no matter which sterilization method was used. Conclusion—The effects of HPGP on the chemico-physical and bioadhesive properties of nylon and polyethylene lines compared positively to EO or ST, making HPGP an attractive alternative. UHMPE may not be a suitable material for suture prostheses regarding bacterial adherence properties. Future studies are required to determine the clinical significance of these findings.

INTRODUÇÃO: A displasia do desenvolvimento do quadril (DDQ) é uma das patologias mais relevantes e polêmicas que acometem as crianças desde o nascimento. A anatomia tridimensional, a complexidade da articulação do quadril, o pouco conhecimento sobre o potencial de remodelação acetabular após luxação ou sub-luxação e as sequelas na marcha e na movimentação suscitam várias discussões sobre esse tema. A revisão bibliográfica a respeito dos diferentes tipos de capsulorrafia é muito pouco discutida entre os pesquisadores. Técnicas menos agressivas e que possibilitem maior resistência à recidiva da luxação após a redução cruenta devem ser pesquisadas. OBJETIVO: a presente pesquisa busca, por meio de ensaios biomecânicos, comparar as capsulorrafias com sutura simples e com âncoras, em quadris de coelhos. MATERIAL E MÉTODO: Foram utilizados 13 coelhos, 26 quadris, todos machos da raça Nova Zelândia albinos (Oryctolagus cuniculus). Inicialmente, realizamos um projeto piloto em três coelhos (06 quadris). Este experimento constou de 10 coelhos, divididos em 02 grupos: o grupo 1 submetido à capsulorrafia (quadris direito e esquerdo) com sutura simples utilizando fio absorvível de ácido poliglicólico e o grupo 2 submetido a capsulorrafia (quadris direito e esquerdo) com âncora de titânio. Após o período de quatro semanas de operados, todos animais foram submetidos à eutanásia e seus quadris congelados. Após um descongelamento prévio das peças no mesmo dia das análises biomecânicas, foram avaliados os parâmetros da rigidez (Rig), força máxima (Fmax), deformidade máxima (Dmax) e energia (E). RESULTADO: não houve diferença estatisticamente significante em relação à força no limite de proporcionalidade, rigidez e força máxima entre os grupos com sutura simples e com âncora. CONCLUSÃO: Por meio dos ensaios biomecânicos, tendo como parâmetro a rigidez (Rig), força máxima (Fmax), deformidade máxima (Dmax) e energia (E), ficou demonstrado que as capsulorrafias em quadris de coelhos com sutura simples e com âncora são semelhantes entre si. / INTRODUCTION:HDD (Hip Development Dysplasia) is one of the most important and controversial pathologies which affect children. The threedimensional anatomy and complexity of the hip joint, as well as the little understanding of the potential of acetabular reconstruction after luxation or sub-luxation and the later effects on the child\'s gait and movement, raise various points of discussion. Little literature exists about the different types of capsulorrhaphy. Techniques which are less aggressive or decrease risk of luxation after surgical reduction must be researched. OBJECTIVE: Using biomechanical studies, this research aims to compare hip capsulorrhaphy in rabbits, carried out with two different techniques: capsulorrhaphy with simple sutures and with anchors. MATERIAL AND METHOD: Thirteen New Zealand Albino (Oryctolagus cuniculus) male rabbits, twenty-six hip joints, were used. First, a pilot project was performed with three rabbits (six hip joints). The experimental group consisted of ten rabbits and was divided in two sub-groups: group 1 underwent capsulorrhaphy on both right and left hips with simple suture using polyglocolic acid absorbable thread, and group 2 underwent capsulorrhaphy with titanium anchors. After a four-week postoperation period, the animals were euthanized and the hip joints were frozen. On the same day the hip joints were unfrozen, a biomechanical study was carried out, evaluating the following parameters: rigidity, maximum force, maximum deformity and energy. RESULTS: There was no relevant statistical difference in rigidity, maximum force, maximum deformity and energy between the simple suture and anchor groups. CONCLUSION: Through biomechanical analyses, using parameters of rigidity, maximum force, maximum deformity and energy, it has been shown that a capsulorrhaphy with simple suture and with an anchor has similar results in rabbit hip joints.

RESUMO A Expansão Rápida da Maxila é um recurso clínico adotado pelos ortodontistas no tratamento das más oclusões com deficiência transversa real ou relativa da maxila. Esta, inclui uma fase ativa, promovendo a desarticulação dos ossos maxilares por meio da sutura, e uma fase passiva, onde uma série de eventos levam à remodelação óssea e restauração da sutura, com o aumento clínico na largura do palato. Discute-se qual a melhor época para a disjunção e o tempo necessário para que haja a perfeita remodelação óssea. A radiografia oclusal assume aqui um importante papel, pois é por meio desta que se obtém a imagem da sutura palatina mediana permitindo uma análise descritiva de suas condições em todas as etapas do tratamento A nossa proposta no presente estudo, foi a de medir as densidades ópticas da sutura palatina mediana antes da disjunção (Fase I), imediatamente após a disjunção, (Fase II) e após contenção de três meses (Fase III), usando um sistema de imagem digital, comparando-as e correlacionando-as com a radiografia oclusal convencional. A amostra, constituída por 31 (trinta e um) pacientes que se submeteriam à disjunção palatina e que se encontravam em fase de crescimento, foi dividida em:grupo I, constituído pelos pacientes de dentadura mista e grupo II, pelos pacientes de dentadura permanente. Foram obtidas radiografias oclusais e imagens digitais nas fases Fase I, Fase II e na Fase III. Áreas de interesse foram demarcadas nas radiografias digitais, procedendo-se a leitura das densidades ópticas pelo programa Digora for Windows-2.1, e comparando os resultados entre si e com a avaliação subjetiva feita nas radiografias oclusais. Após a análise dos dados pelo teste t de Student pareado, pode-se concluir que 1) as densidades ópticas da sutura palatina mediana na fase final, mostram valores inferiores aos da fase inicial nos pacientes do grupo I; 2) as densidades ópticas da sutura palatina mediana na fase final, mostram valores semelhantes aos da fase inicial nos pacientes do grupo II; 3) as densidades ópticas finais da sutura palatina mediana não correspondem às iniciais nos pacientes do sexo feminino do grupo I; 4) as densidades ópticas finais da sutura palatina mediana são semelhantes às iniciais nos pacientes do sexo masculino do grupo II; 5) para os pacientes do grupo II não houve diferença significante entre os valores de densidade óptica inicial e final, tanto no sexo masculino como feminino; 6) os resultados encontrados nas imagens digitais são compatíveis com os encontrados nas radiografias oclusais convencionais. / SUMMARY The Fast Expansion of the Jaw is a clinical resource adopted by the ortodontists in the treatment of the bad occlusions with real or relative deficiency transversal, of the jaw. This, includes a phase, promoting the disarticulation of the maxilarys bones by means of the suture, and a passive phase, where a series of events takes to the bone remodelling and restoration of the suture, with the clinical increase in the width of the palate. The best time for the disjunction and the necessary time is argued which so that it has the perfect bone remodelling. The oclusal radiography assumes an important role here, therefore it is for way of this that if gets the image of the medium palatine suture allowing to a descriptive analysis of its conditions in all the stages of the treatment our proposal in the present study, was to measure the optic densities of the medium palatine suture before the disjunction (Phase I), immediately after the disjunction, (Phase II) and after containment three months (Phase III), using a system of digital image, comparing and correlating them with the conventional oclusal radiography. The sample, consisting of 31 (thirty one) patient that would submitted the palatine disjunction and that found in growth phase, divided in Grave I, constituted of the patients of mixing set of teeth and group II, for the permanent set of teeth patients. Oclusal radiography and digital images in the phases had been gotten Phase I, Phase II and in Phase III. Areas of interest had been demarcated in the digital x-rays, proceeding it reading from the optic densities for the Digora program for Windows-2.1, and comparing the results among themselves. With the subjective evaluation in the oclusal radiographies.(After the analysis of the data by student T test could be concluded that1) the opitic densities of the medium palatine suture in the final phase, show inferior values to the ones of the initial phase in the patients of group I;2) the optic densities of the medium palatine suture in the final phase, show similar values to the ones of the initial phase in the patients of group II;3) the final optic densities of the medium palatine suture do not correspond to the initials in the patients of the female groupI;4) the final opitic densities of the medium palatine suture are similar to the initials in the patients of the male group II;5) for the patients of group II it did not have significant difference betweenthe values of initial and final opitic density, as much in the male and female groups6) the results found in the digital images are compatible wit those found in the conventional oclusal radiographics.