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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Avaliação transversal e vertical da maxila, por meio de radiografia posteroanterior padronizada, utilizando dois métodos de expansão rápida

Barreto, Gustavo Mattos [UNESP] 29 August 2006 (has links) (PDF)
Made available in DSpace on 2014-06-11T19:33:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-08-29Bitstream added on 2014-06-13T19:04:06Z : No. of bitstreams: 1 barreto_gm_dr_arafo.pdf: 993767 bytes, checksum: 08d8d7b32229388319ff407e93884b68 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A intervenção precoce na ortodontia vem sendo bastante realizada, evitando que alterações simples da oclusão necessitem tratamentos complexos futuramente. Dentre as más-oclusões mais frequentemente encontradas na infância e passíveis de intervenção precoce, estão as mordidas cruzadas posteriores que normalmente são caracterizadas por deficiência no crescimento transversal do arco superior. Nos casos de atresia maxilar o tratamento mais indicado é a expansão rápida, que pode ser realizada por diferentes terapias. Na presente pesquisa foram utilizados os aparelhos Hyras e Haas, tendo como objetivo avaliar as alterações transversais e verticais da maxila. Foram selecionados 40 pacientes de ambos os gêneros, entre 7 e 11 anos que apresentavam mordida cruzada posterior uni ou bilateral. Realizou-se telerradiografias em norma frontal (P.A.) antes e após a expansão. A fim de evitar que a falta de padronização dessas radiografias pudesse influenciar nos resultados, idealizou-se um método de padronização para tais radiografias. Os resultados, idealizou-se um método de padronização para tais radiografias. Os resultados mostraram que a correção da mordida cruzada posterior com ambos aparelhos ocorreu em todos os casos em função tanto da abertura da sutura palatina mediana como também pela inclinação dos molares. A medida JgE-JgD relacionada com a expansão maxilar esquelética aumentou significantemente em todos os casos tratados. Nas avaliações dentárias as medidas verticais não apresentaram diferenças significantes, o contrário das medidas transversais (FTE-FTD; FBE-FBD; LO.BTE; LO.BTD; BTE.BTD). A largura da cavidade nasal também aumentou significantemente (CNE-CND). Desta forma, podemos concluir com confiança que ambos os aparelhos tiveram efeitos similares. / Early treatment is frequently proposed in orthodontics as it prevent that mild malocclusions require more complex procedures furthermore. Among the most frequent malocclusion observed in childhood and that can be early treated are the posterior crossbites. These are usually characterized by a decreased transversal growth of the upper arch. In the constriction maxillary cases, the most indicated treatment is rapid maxillary expansion that can be achieved by different therapies. In the present research the Hyrax and Haas appliances was used in order to evaluate the transverse and vertical outcomes in maxillary base. Fourty patients of both gender, from 7 to 11 years old, presenting uni or bilateral posterior crossbite were selected. Posteroanterior radiographs were performed before and after expansion. These radiographs were standardized in order to avoid that problems with lack of standardization influence the results. The obtained data showed that the posterior crossbite correction with both appliances, observed in all the cases, was consequent either to midpalatal suture opening and molar buccal tipping. JgE-JgD measurement related to maxillary expansion increased significantly in all the treated cases. According to dental evaluation, vertical measurements did not show significant differences, which is in opposition to the transverse measurements (FTE-FTD; FBE-FBD; LO.BTE; LO.BTD; BTE.BTD). The nasal cavity width also increased significantly (CNE-CND). Therefore, we can to conclude with trust that the both appliances had the similar effects.
32

"Avaliação transversal e vertical da maxila, após expansão rápida, utilizando um método de padronização das radiografias posteroanteriores" /

Barreto, Gustavo Mattos. January 2002 (has links)
Orientador: Luiz Gonzaga Gandini Júnior / Banca: João Roberto Gonçalves / Banca: Marinho Del Santo Junior / Resumo: A intervenção precoce na ortodontia vem sendo bastante realizada, evitando que alterações simples da oclusão necessitem tratamentos complexos futuramente. Dentre as más-oclusões mais frequentemente encontradas na infância e passíveis de intervenção precoce, estão as mordidas cruzadas posteriores que normalmente são caracterizadas por deficiência no crescimento transversal do arco superior. Nos casos de atresia maxilar o tratamento mais indicado é a expansão rápida, que pode ser realizada por diferentes terapias. Na presente pesquisa utilizou-se o aparelho Hyrax tendo como objetivo avaliar as alterações transversais e verticais da maxila. Foram selecionados 20 pacientes de ambos os sexo, entre 7 e 11 anos que apresentavam mordida cruzada posterior uni ou bilateral. Realizou-se telerradiografias em norma frontal (P.A.) antes e após a expansão. A fim de evitar que a falta de padronização dessas radiografias pudesse influenciar nos resultados, idealizou-se um método de padronização para tais radiografias. Os resultados mostraram que a correção da mordida cruzada posterior como o aparelho Hyrax, que ocorreu em todos os casos, foi em função tanto da abertura da sutura palatina mediana como também pela inclinação dos molares. A medida JgE-JgD relacionada com a expansão maxilar aumentou significantemente em todos os casos tratados. Nas avaliações dentárias as medidas verticais não apresentaram diferenças significantes, o contrário das medidas transversais (FTE-FTD; FBE-FBD; LO.BTE; LO.BTD; BTE.BTD). A largura da cavidade nasal também aumentou significantemente (CNE-CND). O método de padronização proposto permite, portanto, utilizar as medidas que avaliam a expansão rápida da maxila, através das radiografias posteroanteriores, com segurança, inclusive no sentido vertical. / Abstract: Early treatment is frequently proposed in orthodontics as it prevent that mild malocclusions require more complex procedures futhermore. Among the most frequent malocclusion observed in childhood and that can be early treated are the posterior crossbites. These are usually characterized by a decreased transversal growth of the upper arch. In the constriction maxillary cases, the most indicated treatment is rapid maxillary expansion that can be achieved by different therapies. In the present research the Hyrax appliance was used in order to evaluate the transverse and vertical outcomes in maxillary base. Twenty patients of both gender, from 7 to 11 years old, presenting uni or bilateral posterior crossbite were selected. Posteroanterior radiographs were performed before and after expansion. These radiographs were standardized in order to avoid that problems with lack of standardization influence the results. The obtained data showed that the posterior crossbite correction with Hyrax appliance, observed in all the cases, was consequent either to midpalatal suture opening and molar buccal tipping. JgE-JgD measurement related to maxillary expansion increased significantly in all the treated cases. According to dental evaluation, vertical measurements did not show significant differences, which is in opposition to the transverse measurements (FTE-FTD; FBE-FBD; LO.BTE; LO.BTD; BTE.BTD). The nasal cavity width also increased significantly (CNE-CND). The standardization method proposed showed to be reliably useful for maxilla rapid expansion evaluation with posteroanterior radiographs even for vertical considerations. / Mestre
33

Estudo comparativo da cicatrização entre os fios poliglecaprone, algodão e poliglactina em anastomoses de intestino delgado de cães / Polyglecaprone, cotton and polyglactin sutures in intestinal anastomoses of dogs, a comparative study

Bernis Filho, Walter Octaviano 17 August 2018 (has links)
Orientador: Nelson Adami Andreollo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T03:26:16Z (GMT). No. of bitstreams: 1 BernisFilho_WalterOctaviano_D.pdf: 14146250 bytes, checksum: 666b2adc648706b4bb83ac6a397a6d6b (MD5) Previous issue date: 2010 / Resumo: Através dos anos muitos fios de sutura foram criados e, depois abandonados, em virtude dos bons resultados obtidos com novos fios. Ainda sim, até hoje não se encontrou um fio cirúrgico totalmente inócuo ao intestino, ou a outros tecidos de um modo geral, tornando sua escolha uma tarefa difícil. Justifica-se, a necessidade de pesquisa de novos materiais no intuito de se encontrar a opção ideal. Neste trabalho foi testado o fio poliglecaprone 25, nas anastomoses do intestino delgado de cão comparando com fios, tradicionalmente usados por outros autores na confecção de anastomoses intestinais, como os fios algodão e poliglactina 910. A cicatrização de anastomoses do intestino delgado foi avaliada, macroscópica e microscópicamente, utilizando três tipos de sutura distintos com os fios poliglecaprone 25, poliglactina 910 e o algodão. Vinte cães machos sem raça definida pesando entre 9 e 16 Kg foram submetidos, após anestesia geral inalatória, a três anastomoses no intestino delgado. A técnica empregada foi a extramucosa com pontos separados e utilizou-se, para cada uma, os fios poliglecaprone 25, a poliglactina 910 e o algodão. Os animais foram separados em 4 grupos de acordo com a avaliação do período pós-operatório: grupoI- 3 dias; grupoII- 7 dias; grupoIII- 14dias; grupo IV- 21dias. Após o período de observação, os animais foram submetidos a eutanásia para coleta de material para análise macroscópica e microscópica. Na avaliação macroscópica os três fios se comportaram bem, com boa coaptação das bordas, porém com moderado grau de aderência entre alças e epiploo, do 3º ao 21º dia do pós-operatório. A avaliação microscópica mostrou inflamação exsudativa com neutrófilos e fibrina que variou de discreta a moderada até o 14º dia; inflamação granulomatosa com presença de macrófagos, células gigantes multinucleadas e células epitelióides mais evidente ao 14º dia para o fio algodão; presença de tecido de granulação (fibroblastos) e fibras colágenas, de forma moderada, a partir do 7º dia para os três fios. Os três tipos de fios de sutura utilizados nesta pesquisa apresentaram comportamento semelhante e podem ser indicados em anastomoses do intestino delgado / Abstract: In this study was evaluate, macroscopically and microscopically, the healing process of intestinal anastomoses in dogs using polyglecaprone 25, polyglactin 910 and cotton sutures. Twenty mongrel dogs, weighting from 9 to 16 Kg were submitted, under general inhalatory anesthesia, to three small intestine anastomoses. The animals were divided into four groups, in accordance with the postoperative observation periods as follows: group I, three days; group II, seven days; group III, fourteen days; group IV, twenty one days. Extramucous technique was used, with those threads, in all four groups. After the observation period the animals were euthanized and samples from the operative site were collected for macroscopic and microscopic evaluations. Macroscopically, all three threads showed good behavior with good coaptation of the edges; however, there occurred a moderate level of adherence between loops of intestine and omentum, from day 3 to day 21, of postoperative period. Microscopically, there was exsudative inflammation, with neutrophils and fibrin, discrete to moderate until day 14. Granulomatous inflammation was also notice accompanied by macrophages, multinucleated giant cells and epithelioid cells, more evident on day 14 in the cotton group. Granulation tissue (fibroblasts) and collagen fibers were also observed, in a moderate pattern, for all three suture materials, from day 7. All three suture threads used in this research showed similar behavior and thus they can be indicated for anastomoses of the small intestine in dogs / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências
34

Sutura manual em cÃlon comparando os acessos laparoscÃpico e laparotÃmico: estudo experimental em cÃes / Manual Suture in cÃlon comparing the accesses Laparoscopyc and laparotÃmico: experimental study in dogs

Sthela Maria Murad Regadas 27 September 1999 (has links)
CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O objetivo deste trabalho foi desenvolver experimentalmente a tÃcnica laparoscÃpica de endo-sutura manual em colon comparando os resultados com o acesso laparotÃmico. Foram operados 28 cÃes machos, mestiÃos, com peso corporal mÃdio de 16 kg, distribuÃdos em dois grupos com 14 animais cada. Os animais do grupo I foram operados pelo acesso laparotÃmico enquanto os do grupo II pelo acesso laparoscÃpico. Cada grupo foi distribuÃdo em dois subgrupos com 7 animais cada. Os animais do subgrupo A foram relaparotomizados no 7 dia do pÃs-operatÃrio e os do subgrupo B no 14 dia do pÃs-operatÃrio. Sob anestesia geral endovenosa sem entubaÃÃo endo-traqueal, foi realizada uma incisÃo no cÃlon sigmoide com tesoura em aproximadamente 45% do diÃmetro da alÃa, sendo em seguida suturada em plano Ãnico, extra-mucoso, com pontos separados e com fio absorvÃvel de polidioxanona 000 (PDSÂ). A avaliaÃÃo da sutura consistiu da anÃlise macroscÃpica, do teste de tensÃo da sutura e do estudo histolÃgico qualitativo realizado por dois patologistas. O tempo operatÃrio mÃdio no acesso laparotÃmico foi de 25,3 minutos e de 36,4 minutos no acesso laparoscÃpico, sendo esta diferenÃa estatisticamente signicante (p= 0,001). NÃo ocorreu complicaÃÃo trans e / ou pÃs-operatÃria, constatando-se integridade da sutura em todos os animais de ambos os grupos. A pressÃo mÃdia do teste de tensÃo da sutura foi de 222,86 mmHg. em ambos os grupos, nÃo ocorrendo ruptura da sutura em nenhum animal. NÃo existe portanto diferenÃa significante entre as pressÃes registradas no teste de tensÃo da sutura. A anÃlise histolÃgica das amostras obtidas no 7 e 14 dia de pÃs-operatÃrio demonstrou resposta inflamatÃria mais extensa no grupo laparotÃmico pois a reaÃÃo inflamatÃria restringia-se à muscular externa e serosa no grupo laparoscÃpico. Conclui-se portanto que no presente modelo experimental, a endo-sutura manual laparoscÃpica pode ser utilizada pois apresentou os mesmos resultados do acesso laparotÃmico quanto à ocorrÃncia de complicaÃÃes e ao teste de tensÃo da sutura. O tempo operatÃrio nos procedimentos laparoscÃpicos foi maior embora com reduÃÃo significante e diretamente proporcional à obtenÃÃo de experiÃncia pela equipe cirÃrgica. TambÃm apresentou menor resposta inflamatÃria em extensÃo. / The aim of this study is to experimentally develop a technique of laparoscopic hand-sewn endosuture, as compared to the conventional method. Twenty-eight male dogs weighing an average of 16 kg. were operated on. They were divided into two groups with 14 animals each. Group I comprised animals operated on by the conventional method, while those in Group II were laparoscopically approached. Each of such groups was further divided into two ones, each comprising seven animals. Those belonging to Group A were sacrificed on the 7th postoperative day and those belonging to Group B were sacrified on the 14th postoperative day. General anesthesia was performed without endo-tracheal intubation. The sigmoid colon was severed with scissors to the extent of 45% of its diameter, followed by extramucosa, one-layer polydioxanona 000 (PDSÂ) suture. Suture evaluation was undertaken through macroscopic analysis, sutures tension test and qualitative histologic test carried out by two pathologists. The mean operative time for conventional procedures was 25,3 minutes, while the laparoscopic group required 36,4 minutes. No postoperative complications ensued. Sutures in both groups were intact. The mean pressure obtained by the suture tension test was 222,86 mmHg in animals of both groups, without any no suture rupture. Histologic analysis showed a more extensive inflammatory response in the conventional group; as for the laparoscopic one, inflammation was restricted to the serosa and the external muscular layers. No statistical test was required on account of the similarity of results concerning to sutureâs integrity and complications. Nonetheless, Leveneâs test was used to verify animalsâ weight, t-Student test compared the mean operative time and Kruskal-Wallis test verified the similar results of sutureâs tension test. One thus concludes that laparoscopic hand-sewn endosuture is a feasible alternative, yielding the same results obtained in the conventional group as far as the efficacy and the safety of the technique are concerned. This alternative procedure also produces a less inflammatory response. An intensive training in experimental animals is nonetheless required.
35

Medical Textiles: Application of an Absorbable Barbed Bi-Directional Surgical Suture

Dattilo, Philip P., King, Martin W., Cassill, Nancy L., Leung, Jeffrey C. 01 December 2002 (has links) (PDF)
Today's medical textile market is producing state of the art polymeric textile implantable devices that are redefining traditional materials and methods of surgery. These sophisticated high-tech polymer materials are engineered for specific uses in surgical and interventional procedures. One of the new biotextile products is an absorbable bi-directional barbed surgical suture that does not require surgical knots for wound closure. This novel idea has the attention of many physicians and surgeons where wound closure or tissue approximation is needed. The barbed suture has the potential to change the way wound closure is perceived in various clinical fields of surgery and veterinary medicine.
36

Assessing the Biomechanical Effect of Alveoli, Periodontal Ligaments, and Squamosal Sutures in Mammalian Crania

Wood, Sarah 01 January 2011 (has links) (PDF)
The research presented in this thesis focuses on understanding the biomechanical effects of various cranial features that are often ignored in finite element models (FEMs) because their size, position, and complex shapes make them difficult to model. Specifically, this work examines the effects of the alveoli (tooth sockets), periodontal ligament, and squamosal suture on the stress and strain distributions in a cranium under masticatory and dynamic tooth loads. Results from this research will help determine if these features have a significant effect on stress and strain patterns and will yield guidelines as to if or under what conditions they need to be modeled in future FE skull model analyses. As part of this research, three sets of FEMs were developed to address a hypothesis focusing on each cranial feature. The first set of models examined the effect of the tooth sockets on the stress and strain distributions in a cranium under static biting conditions to determine if improperly modeled sockets produce strong global effects in craniofacial regions. The second set of models were used to assess the effect of the PDL's material behavior on the stresses and strains in a cranium under static biting and dynamic tooth loading conditions to determine if the PDL plays an important role in reducing stresses and strains in a model. The final set of models were used to determine the effect of the squamosal suture size on the stresses and strain energies in a cranium under static biting conditions to see if an increase in suture size decreases the risk of separation of the temporal bone from the parietal bone. Results for all analyses indicate the effects of the cranial features are local (i.e. within the vicinity of the feature), with no meaningful global effects. This suggests the sockets, PDL, and squamosal suture do not play an important role in global stress and strain distributions in a cranium under masticatory and dynamic tooth loads. Therefore, it may be safe to ignore the sockets, PDLs, and squamosal sutures during the FE modeling process if the objective of the analysis is to understand global stress and strain patterns.
37

Studies in cranial suture biology

Premaraj, Sundaralingam 13 September 2006 (has links)
No description available.
38

Contribution à l'approche anthropologique et médico-légale des sutures viscérocrâniennes utiles dans l'estimation de l'âge au décès (Sutures palatines, fronto-naso-maxillaires et zygomatiques) / Contribution to a useful anthropological and medicolegal approach of the viscerocranial sutures for the age at death estimation (palatine, fronto-naso-maxillary and zygomatic sutures)

Beauthier, Jean-Pol 30 November 2009 (has links)
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
39

Contribution à l’approche anthropologique et médico-légale des sutures viscérocrâniennes utiles dans l’estimation de l’âge au décès (Sutures palatines, fronto-naso-maxillaires et zygomatiques). / Contribution to a useful anthropological and medico-legal approach of the viscerocranial sutures in the age at death estimation (palatine, fronto-naso-maxillary and zygomatic sutures).

Beauthier, Jean-Pol J.-P. R.A.G. 30 November 2009 (has links)
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.
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Triklosanbelagda suturers förebyggande effekt mot postoperativa sårinfektioner : En systematisk litteraturstudie med metaanalys

Manneklint, Anna January 2019 (has links)
Bakgrund: Postoperativa sårinfektioner drabbar ca 2,3 % av de patienter som genomgått ett kirurgiskt ingrepp i svensk hälso- och sjukvård. Dessa infektioner kan ge upphov till förlängd vårdtid, ytterligare kirurgiska ingrepp och ökad mortalitet. Postoperativa sårinfektioner innebär ett lidande för patienten samtidigt som det är kostsamt för sjukvården. Inom sjukvården används utarbetade arbetssätt för att minska riskerna för att patienten ska drabbas. Samtidigt utvecklas och studeras nya metoder i det preventiva arbetet mot postoperativa sårinfektioner, exempelvis suturer belagda med antibakteriella substanser. En av dessa är triklosanbelagda suturer. Dock råder viss oenighet om dess preventiva effekter och roll i det förebyggande arbetet mot postoperativa sårinfektioner. Syfte: Studiens syfte var att undersöka om suturer med beläggning av triklosan har en förebyggande effekt mot postoperativa sårinfektioner. Metod: Studien utformades som en systematisk litteraturstudie med metaanalys av 7 randomiserade kontrollerade studier. Dessa studier hade en uppföljningstid om 30 dagar samt använt bedömningskriterier för förekomst av postoperativa sårinfektioner enligt CDC, Centers for Disease Control and Prevention. Resultat: Inget statistiskt signifikant resultat kunde erhållas gällande triklosanbelagda suturers preventiva effekt mot postoperativa sårinfektioner. (RR=0,8, 95 % CI=0,63-1,02, p=0.07). Slutsats: Studien indikerar att triklosanbelagda suturer inte rutinmässigt bör användas i preventivt syfte mot postoperativa sårinfektioner. Ytterligare forskning behövs på området. / Background: Approximately 2,3 % of the patients undergoing surgery in Swedish healthcare develop surgical site infections. These infections are often associated with prolonged hospital stay, additional surgical procedures and increased mortality. Surgical site infections cause patient suffering and increase healthcare costs. In healthcare, standard guidelines and work methods are used to prevent patients from developing surgical site infections. New methods to reduce the risk of surgical site infections are being developed and studied, such as sutures with antibacterial coating. One of these is Triclosan-coated sutures. However, there is some disagreement on its preventive effects and role in reducing surgical site infections. Aim: The aim of this study was to investigate if Triclosan-coated sutures have a preventive effect against surgical site infections. Method: This study was conducted as a systematic literature review with meta-analysis of 7 RCT. These studies all had a follow up time of 30 days and used the criteria of CDC, Centers for Disease Control and Prevention, to identify surgical site infections. Result: This study showed no statistically significant results of Triclosan-coated sutures preventive effect against surgical site infections. (RR=0,8, 95 % CI=0,63-1,02, p=0.07). Conclusion: This study indicates that Triclosan-coated sutures should not be used routinely to prevent surgical site infections. More studies are needed.

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