Submitted by RAQUEL GALVAO BEZERRA (raquelgbezerra@gmail.com) on 2018-08-20T03:48:26Z No. of bitstreams: 1 Dissertação Corrigida Pela Banca Pós Defesa.pdf: 818740 bytes, checksum: a1ecb695e00e0b5ca1cb59e7fb07b2dd (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-20T18:10:40Z (GMT) No. of bitstreams: 1 bezerra_rg_me_bot.pdf: 818740 bytes, checksum: a1ecb695e00e0b5ca1cb59e7fb07b2dd (MD5) / Made available in DSpace on 2018-08-20T18:10:40Z (GMT). No. of bitstreams: 1 bezerra_rg_me_bot.pdf: 818740 bytes, checksum: a1ecb695e00e0b5ca1cb59e7fb07b2dd (MD5) Previous issue date: 2018-07-17 / Objetivo: estabelecer valores-padrão para a aplicação do laser de diodo verde para o tratamento da triquíase menor e maior, assim como avaliar a taxa de sucesso com o tratamento realizado. Método: estudo prospectivo, com intervenção, realizado nos anos de 2016 e 2017, envolvendo portadores de triquíase com até 10 cílios alterados por pálpebra e que foram submetidos ao tratamento de termoablação dos cílios utilizando o laser de diodo Zeiss Visulas 532s com emissão de luz verde com comprimento de onda de 532nm. Os parâmetros utilizados foram definidos empiricamente, com tempo de aplicação de 200 ms, mira de 50 μm, intervalo de 150 a 200 ms, potência de 600 a 750 mW. O número de tiros aplicados foi definido pela a profundidade de ablação de 2,5 mm para cílios na pálpebra superior e 1,5 mm para os da pálpebra inferior. Os pacientes foram seguidos por até 15 meses, com reavaliações a cada 3 ou 4 meses. Dados demográficos, características da triquíase, bem como a taxa de sucesso no tratamento foram analisados estatisticamente. Resultados: Noventa e oito pacientes, 130 olhos, 135 pálpebras acometidas e 337 cílios triquiáticos foram estudados. A média de idade dos pacientes foi de 72,1 ± 12,3 anos, a maioria do sexo masculino (54,1%), da raça branca (98%), com triquíase menor (91,8%), unilateral (67,3%), sendo o olho direito (54,6%) e a pálpebra inferior (85,9%) os mais acometidos. A causa mais comum da triquíase foi a blefarite (64,3%), seguida de causas idiopáticas (15,3%). Não houve significância estatística na comparação das variáveis idade, sexo, raça, olho acometido e etiologia com a presença ou quantidade de cílios triquiáticos (p>0,05). Houve perda de seguimento em 11,2% dos pacientes. Utilizando os parâmetros citados, do total que permaneceu até o final do estudo, 69% obtiveram cura com 1 sessão, 13,8% com 2 e 1,1% com 3 ou 4 sessões. Considerando apenas os indivíduos que concluíram o tratamento e excluindo os que perderam seguimento, a taxa de cura foi de 85%. Houve redução de 2,5 para 0,7 cílios triquiáticos por pálpebra com apenas 1 sessão (p<0,001) e o número médio de tiros por cílio foi de 60,7. Pacientes submetidos a tratamentos prévios e com etiologia idiopática tiveram as maiores taxas de cura, 98,1% e 91,7% respectivamente. Conclusão: a termoablação com laser de diodo, usando os parâmetros observados neste estudo, é efetiva, apresentando altas taxas de cura no tratamento da triquíase. / Purpose: to establish standard parameters for laser application as well as to evaluate the success rate of treatment of minor and major trichiasis using green diode laser. Method: a prospective study with intervention, was carried out in the years 2016 and 2017, involving trichiasis carriers with up to 10 misdirected lashes per eyelid that were submitted to the thermoablation treatment of the misdirected lashes using Zeiss Visulas 532s diode laser with green light emission with wavelength of 532nm. The parameters used were empirically defined, with an application time of 200 ms, 50 μm size, range of 150 to 200 ms and power of 600 to 750 mW. The number of shots applied was defined by the depth of ablation of 2.5 mm for upper eyelid lashes and 1.5 mm for lower eyelid lashes. The patients were followed for up 15 months, with revaluations every 3 or 4 months. Demographic data, trichiasis characteristics, as well as the success rate with treatment were statistically analyzed. Results: ninety eight patients, 130 eyes, 135 affected eyelids and 337 trichiatic eyelashes were studied. The mean age was 72.1 ± 12.3 years old, the majority male (54.1%), Caucasian (98%), with minor trichiasis (91,8%) unilateral (67,3%), being the right eye (54,6%) and the lower eyelid (85,9%) the most affected. The most common etiology was blepharitis (64.3%), followed by idiopathic causes (15.3%). There was no statistical significance in the comparison of age, gender, race, affected eye, and etiology with the presence or quantity of the trichiatic eyelashes (p>0,05). Around 11.2% of patients lost follow-up. Using the mentioned parameters, of the total remaining until the end of study, 69% of patients achieving cure with 1 session, 13.8% with 2 and 1.1% with 3 or 4 sessions. Considering only the individuals who completed the treatment and excluding those who lost follow-up, the cure rate was 85%. There was a reduction of 2.5 to 0.7 trichiatic eyelashes per eyelid with only 1 session (p<0,001) e the average number of shots per eyelash was 60.7. Patients submitted to previous treatments and with idiopathic etiology had the highest cure rates, 98.1% and 91.7%, respectively. Conclusion: thermoablation with diode laser, using the parameters observed in this study, is effective, with high cure rates in the treatment of trichiasis.

Orientador: Silvana Artioli Schellini / Resumo: Objetivo: estabelecer valores-padrão para a aplicação do laser de diodo verde para o tratamento da triquíase menor e maior, assim como avaliar a taxa de sucesso com o tratamento realizado. Método: estudo prospectivo, com intervenção, realizado nos anos de 2016 e 2017, envolvendo portadores de triquíase com até 10 cílios alterados por pálpebra e que foram submetidos ao tratamento de termoablação dos cílios utilizando o laser de diodo Zeiss Visulas 532s com emissão de luz verde com comprimento de onda de 532nm. Os parâmetros utilizados foram definidos empiricamente, com tempo de aplicação de 200 ms, mira de 50 μm, intervalo de 150 a 200 ms, potência de 600 a 750 mW. O número de tiros aplicados foi definido pela a profundidade de ablação de 2,5 mm para cílios na pálpebra superior e 1,5 mm para os da pálpebra inferior. Os pacientes foram seguidos por até 15 meses, com reavaliações a cada 3 ou 4 meses. Dados demográficos, características da triquíase, bem como a taxa de sucesso no tratamento foram analisados estatisticamente. Resultados: Noventa e oito pacientes, 130 olhos, 135 pálpebras acometidas e 337 cílios triquiáticos foram estudados. A média de idade dos pacientes foi de 72,1 ± 12,3 anos, a maioria do sexo masculino (54,1%), da raça branca (98%), com triquíase menor (91,8%), unilateral (67,3%), sendo o olho direito (54,6%) e a pálpebra inferior (85,9%) os mais acometidos. A causa mais comum da triquíase foi a blefarite (64,3%), seguida de causas idiopáticas (15,3%). Não hou... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Purpose: to establish standard parameters for laser application as well as to evaluate the success rate of treatment of minor and major trichiasis using green diode laser. Method: a prospective study with intervention, was carried out in the years 2016 and 2017, involving trichiasis carriers with up to 10 misdirected lashes per eyelid that were submitted to the thermoablation treatment of the misdirected lashes using Zeiss Visulas 532s diode laser with green light emission with wavelength of 532nm. The parameters used were empirically defined, with an application time of 200 ms, 50 μm size, range of 150 to 200 ms and power of 600 to 750 mW. The number of shots applied was defined by the depth of ablation of 2.5 mm for upper eyelid lashes and 1.5 mm for lower eyelid lashes. The patients were followed for up 15 months, with revaluations every 3 or 4 months. Demographic data, trichiasis characteristics, as well as the success rate with treatment were statistically analyzed. Results: ninety eight patients, 130 eyes, 135 affected eyelids and 337 trichiatic eyelashes were studied. The mean age was 72.1 ± 12.3 years old, the majority male (54.1%), Caucasian (98%), with minor trichiasis (91,8%) unilateral (67,3%), being the right eye (54,6%) and the lower eyelid (85,9%) the most affected. The most common etiology was blepharitis (64.3%), followed by idiopathic causes (15.3%). There was no statistical significance in the comparison of age, gender, race, affected eye, and etiology with... (Complete abstract click electronic access below) / Mestre

Un applicateur ultrasonore interstitiel IRM compatible a été développé pour le traitement percutané du CHC sous contrôle de l'imagerie. Deux grands axes expérimentaux ont été abordés : 1) au cours d'une première expérimentation réalisée in vivo sur le foie de porc, des macro lésions correspondant à la fusion de lésions élémentaires par rotation du transducteur sur 360° ont pu être réalisées par voie percutanée sous contrôle échographique. Les macro lésions obtenues possédaient une taille voisine de celles obtenues en pratique clinique par la RF. De plus, les lésions élémentaires se montraient relativement indifférentes à l'effet de vol de chaleur ; 2) au cours d'une seconde expérimentation réalisée in vitro puis in vivo sur le foie de porc, un contrôle actif par IRM de température a pu être obtenu pour la création de lésions ultrasonores de taille et aspect similaires quelle que soit la direction du faisceau ultrasonore. Ce contrôle de température est apparu d'autant plus important que les puissances appliquées et du temps d'application pour l'obtention de lésions de taille similaire étaient extrêmement variables selon la direction du faisceau ultrasonore. / A MR compatible interstitial US applicator was developed for percutaneous treatmentof hepatocellular carcinoma (HCC) under imaging control. This work was based on two experimentations : 1) In the first experimentation, performed in vivo on pig liver,macro-lésions corresponding to the fusion of several elementary lesions on 360° were realized percutaneously under echo-guidance. The macrolésions obtainedshowed a size similar to those obtained with RF in clinical practice. Moreover, in this study, the elementary lesions proved to be quite indifferent to the heat sink effect oflarge hepatic blood-vessels; 2) In the second experimentation, performed in vitro andin vivo on pig liver, MR temperature active control was obtained for the creation oflesions similar in size and aspect in all directions. This MR temperature active control appeared extremely interesting since the power applied and the time of application were very different according to the direction of the ultrasonic beam.

Das Pankreaskarzinom hat bei steigender Inzidenz eine äußerst schlechte Prognose und ist häufig bei Diagnosestellung nicht mehr kurativ operabel. Die laserinduzierte Thermotherapie (LITT) gewann in den letzten Jahren zunehmend an Bedeutung als ein minimal invasives Verfahren zur perkutanen Ablation von parenchymatösen Tumoren. Dabei ist die Magnetresonanztomographie (MRT) eine Methode, mit der eine präzise Prozesskontrolle der Thermoablation und eine suffiziente Erfolgskontrolle zur Verfügung stehen. Ziel der vorliegenden Studie war es, im Tierexperiment die Anwendung der LITT zur Ablation von Pankreasgewebe am Schwein zu erproben, sowie die Möglichkeiten der MRT als Online-Monitoringverfahren mit Hilfe einer histopathologischen Korrelation zu untersuchen. Dazu wurde an 15 Läuferschweinen das Pankreas einer perkutanen laserinduzierten Thermotherapie mit einer Leistung von 5, 10 und 20 Watt sowie zwei mal 5 Watt in Multiapplikatortechnik unter MRT Prozesskontrolle unterzogen. Anschließend wurde das Pankreasgewebe histologische aufgearbeitet und die magnetresonanztomographisch detektierten Läsionen histopathologisch korreliert. Das Auftreten einer schwerwiegenden Komplikation wie einer generalisierten Pankreatitis, Peritonitis oder Blutung wurde nicht beobachtet. Die durchgeführten Korrelationsanalysen zeigen eine hohe Übereinstimmung zwischen magnetresonanztomographisch dokumentiertem Thermoeffekt und histopathologisch verifizierter thermisch induzierter Nekrose. Interessanterweise wurden bei Anwendung von zwei Lasern niedriger Leistung in Multiapplikatortechnik, im Vergleich zur Anwendung von einem Laser mit höherer Leistung, größere Nekrosen induziert. Unsere Ergebnisse zeigen, dass die LITT ein geeignetes und sicheres minimalinvasives Verfahren zur Ablation von Pankreasparenchym unter MRT-Monitoring ist. Weiterführende Untersuchungen zur Durchführbarkeit und Ermittlung der Genauigkeit der MRT als Monitoringverfahren sind erforderlich. / Pancreatic carcinoma has an increasing incidence and a poor prognosis. Frequently at diagnosis pancreatic tumors are surgically unresectable. Laser-induced thermotherapy has become an area of considerable interest during the past few years as a minimally invasive method for percutanous ablation of parenchymatous tumors. With magnetic resonance imaging (MRI) an accurate process control of thermocoagulation and a sufficient control of performance are possible. Control of carcinoma growth of is still a problem. Therefore the aim of this study was to investigate the application of laser induced thermotherapy for ablation of pancreas in a porcine model and the possibility of MRI as an online-monitoring with histopathologic correlation. Laser applicators with energy of 5, 10, 20 and two lasers of 5 watt were placed in the pancreas of 15 female pigs. After sacrifice a pathological examination was performed and histological lesions were correlated with magnetic resonance detected lesions. No serious adverse event like generalized pancreatitis, peritonitis or bleeding was observed. Correlation analysis showed a high correspondence between magnetic resonance documented thermoeffects and histopathologic verified lesions. Thermally induced lesions were best visualised on contrast-enhanced T1-weighted images. Interestingly application of two lasers with each 5 watt, greater lesions were generated than on application of one laser with higher energy. Over a period of 7 days increasing inhomogeneity and contraction of lesions were observed. Our results show that laser-induced thermotherapy of pancreatic tissue was feasible in this porcine model, and online monitoring was practicable. Further studies are necessary to increase the accuracy of online MR imaging of thermal effects.

Un applicateur ultrasonore interstitiel IRM compatible a été développé pour le traitement percutané du CHC sous contrôle de l'imagerie. Deux grands axes expérimentaux ont été abordés : 1) au cours d'une première expérimentation réalisée in vivo sur le foie de porc, des macro lésions correspondant à la fusion de lésions élémentaires par rotation du transducteur sur 360° ont pu être réalisées par voie percutanée sous contrôle échographique. Les macro lésions obtenues possédaient une taille voisine de celles obtenues en pratique clinique par la RF. De plus, les lésions élémentaires se montraient relativement indifférentes à l'effet de vol de chaleur ; 2) au cours d'une seconde expérimentation réalisée in vitro puis in vivo sur le foie de porc, un contrôle actif par IRM de température a pu être obtenu pour la création de lésions ultrasonores de taille et aspect similaires quelle que soit la direction du faisceau ultrasonore. Ce contrôle de température est apparu d'autant plus important que les puissances appliquées et du temps d'application pour l'obtention de lésions de taille similaire étaient extrêmement variables selon la direction du faisceau ultrasonore.

Thermoablationsverfahren werden in der klinischen Routine zur Therapie bei Patienten mit primären Lebertumoren und Lebermetastasen eingesetzt, bei denen von einer Operation abgesehen wird. Die laserinduzierte Thermotherapie (LITT) ist ein minimal invasives radiologisches Verfahren zur perkutanen Tumorablation. Mit der Magnetresonanztomographie (MRT) am Hochfeldtomographen (1.5 Tesla) steht eine radiologische Methode mit der Option einer präzisen Prozesskontrolle der Thermoablation und einer suffizienten Erfolgskontrolle zur Verfügung. Ziel dieser Arbeit war es, im Tierexperiment die Anwendung der LITT zur Ablation von Pankreasgewebe zu erproben, das Potenzial der MRT für die Prozesskontrolle der LITT am Pankreas zu bestimmen und neue MRT-Sequenzen mit neuen Kontrastmitteln für die Optimierung der Erfolgskontrolle zu erforschen. Die LITT am Pankreas im Rahmen einer Pilotstudie an 15 Läuferschweinen war perkutan komplikationsarm durchführbar, generalisierte Pankreatitiden oder Blutungen traten nicht auf. Die qualitative Prozessbeobachtung mittels thermosensitiver Sequenzen zeigte eine hohe Übereinstimmung zwischen magnetresonanztomographisch dokumentierten Thermoeffekten und histopathologisch verifizierten thermisch induzierten Nekrosen. Die Untersuchung und invasive Kalibrierung verschiedener Messmethoden in vivo zur quantitativen MRT-Thermometrie ergab Vorteile für den Einsatz der Protonenresonanzfrequenz-Methode. Zur Optimierung der Erfolgskontrolle nach LITT von Lebergewebe im Tierexperiment sowie klinisch bei Lebermetastasen wurden die MRT-Kontrastmittel Gadomesoporphyrin, Eisenoxid und Gadobutrol erprobt. Mittels Spätaufnahmen 6 - 18 h post injectionem wurden mit Gadobutrol thermisch induzierte Nekrosen präzise visualisiert. / Thermoablation of primary liver tumors and liver metastases is widely used in patients without surgical options. The laser-induced thermotherapy (LITT) is a minimal invasive radiologic procedure for percutaneous tumor ablation. With high field magnetic resonance imaging at 1.5, monitoring of thermoablation and visualization of thermal induced ablation zones can be performed precisely. Aim of this work was to investigate the feasibility of MR-guided LITT of pancreatic tissue and to optimise the contrast between thermal induced lesions, residual tumor and normal tissue after LITT procedure. MR-guided LITT was feasible in 15 female pigs, generalized pancreatitis or bleeding did not occur. MR monitoring by thermosensitive sequences precisely visualized thermal induced ablation zones verified by histopathologic examination. Best results of MR thermometry (thermo-mapping) were obtained by proton resonance frequency method. Gadolinum- mesoporphyrine, superparamagnetic iron oxides (SPIO) and gadobutrol were used to optimise ablation control. Late enhanced imaging 6 - 18 hours after injection of gadobutrol precisely visualized thermal induced necrosis. In conclusion, percutaneous MR guided LITT of pancreatic tissue of female pigs was feasible and monitoring of thermoablation could be performed accurately. In contrast to other imaging methods, MR using new contrast agents enables accurate visualization of thermal induced necrosis.