Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2005. / Härtill 5 uppsatser.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Otorhinolaryngology.” Johannesburg, 2019 / INTRODUCTION: Laryngotracheal stenosis is rare but has become a well-recognized pathological otorhinolaryngological condition. It develops when scar tissue forms in the trachea and larynx. Laryngotracheal stenosis can cause significant morbidity and the management of it is often complex. Tracheal resection with end-to-end anastomosis is a well-recognized surgical procedure performed for treatment of larygotracheal stenosis and has been shown to have great success. AIM: To review the short-term outcomes of tracheal resection for larygotracheal stenosis at the Chris Hani Baragwanath Academic Hospital Otorhinolaryngology Department. METHOD: This was a retrospective study, reviewing 24 patients with larygotracheal stenosis who underwent segmental tracheal resection with end-to-end anastomosis at the Chris Hani Baragwanath Academic Hospital, performed between 2005 and 2015. RESULTS: The study included 24 patients with ages ranging from 18 to 64 years. There were 15 (62.5%) males and 9 (37.5%) females. The causes of larygotracheal stenosis were prolonged intubation in 22 (91.7%) and inhalation burns in 2 (8.3%) patients. Eleven patients (45.8%) had postoperative complications, of which 4 (36.4%) were minor complications and 7 (63.6%) were major complications. The outcomes of surgery were excellent in 13 (54.2%), satisfactory in 8 (33.3%) and unsatisfactory in 3 (12.5%). CONCLUSIONS: Prolonged intubation was found to be the most common cause of larygotracheal stenosis. Tracheal resection for larygotracheal stenosis has been shown to have satisfactory to excellent short-term outcomes in terms of successful decannulation, voice quality, and low morbidity. In our study, the surgery was successful in 21 (87%) patients, which is comparable to success rates shown in the literature. Preoperative tracheostomy and higher degree of stenosis Meyer Cotton (III and IV) were associated with high postoperative complications. Irrespective of the cause, tracheal resection is a good surgical option, for the treatment of patients with severe stenosis and those who have failed treatment from other alternative surgeries. / E.K. 2019

In contrast to other mammalians spontaneous endothelialization does not occur in humans. Since this lack of a functioning endothelium is thought to be a main reason for the unsatisfying performance of synthetic arterial grafts, we attempted to create an endothelium on the prosthetic surface by lining the graft with cultured endothelial cells. To provide sufficient cell-numbers for lining, a rapid and reliable harvest technique had to be developed first. In an initial series of 120 primary cultures, short segments of human saphenous veins were excised and cannulated before 0.1 % collagenase (CLS II) was instillated for 15 minutes to detach EC's. During the following growth under tissue culture conditions, we could demonstrate that a short transport time between vein excision and collagenase application is essential for a successful EC proliferation. In a subsequent study, evaluating risk factors, cell harvest and reproductive capacity of EC' s were markedly worse in smokers than in non-smokers. In order to further shorten the time span between vessel excision and collagenase application, an in situ canulation technique with immediate application of collagenase was developed. This harvest technique resulted in a 100% growth rate in 124 baboon primary cultures. Moreover, low plating densities not only achieved 43% shorter cell cycles than the usual plating densities, but also enabled mass-cultures after one single passage, thus reducing the cell damaging effect of trypsin. When the growth characteristics from 5 anatomically different sites were compared, the external jugular vein - which could be easily accessible and dispensable in each patient - proved to be an excellent source for EC cultures. The second goal of in-vitro endothelialization was the creation of shear stress resistant EC monolayers on the graft surface. A prerequisite for this is the use of a suitable underlying protein matrix, because EC do not adhere to uncoated surfaces of synthetic grafts. For that reason, primary adherence and cell attachment area of seeded human endothelial cells were determined on differently coated polytetrafluoroethylene (PTFE) grafts. Cell adherence and spreading was distinctly superior on two surface covering substrates: on fibronectin-treated type I/III collagen and on fibrinolytically inhibited fibrin glue (FG). Since FG is less thrombogenic than collagen, the shear stress resistance of cultured human endothelium was investigated on 6mm PTFE grafts, precoated with PG. EC seeding was performed in a microprocessor controlled seeding device, allowing a low inoculum of 12x10^4 EC/cm^2. A mock circulation simulated the flow patterns and the shear stress of the femoral artery. After 24 hours of perfusion, the grafts were still covered by a confluent endothelium. The in vivo persistence of cultured endothelium was then determined in the nonhuman primate model, using baboons. Since autologous in vitro lining requires a cell laboratory and is therefore confined to big centers, alogenic endothelialization with cryopreserved, pooled, blood-group identical endothelial cells was performed first. Bilateral femoral interpositions (10- 12cm) of experimental and control grafts were subsequently implanted into 18 baboons with the same blood group as that of the pooled cells. After 16 days of implantation the patency rate of grafts of the endothelialized group was similar to that of the control group (55.5 vrs 61.1 %; p> 0.1). Scanning electron microscopy revealed that 44.4% of experimental grafts were completely free of endothelium, while the remaining grafts showed a moderate cell coverage of 34.4+17.1 %. These remaining endothelial cells were found mainly as small cell islands, densely covered by leukocytes. For that reason, a similar series of baboon experiments was performed, using autologous EC from the external jugular vein. After 9 days of implantation, the patency rate of EC-lined and control grafts was 100% and 66.6%. Moreover, after both periods of observations, the endothelial coverage was shown to be intact in scanning electron microscopy and the underlying fibrin glue was well preserved in histological cross sections. An initially observed dense leukocyte adherence at the surface of the endothelium had disappeared after 4 weeks. In summary, we developed a method which results in endothelialized prosthetic vascular grafts with a significantly better patency rate than control grafts in the primate model. This method consists of the combination of in situ harvest of EC from external jugular veins, micro-grid follow-up, low density plating and microprocessor controlled seeding of endothelial cells onto fibrin glue coated PTFE grafts. We believe that these data provide a sufficient rational for initial clinical trials with autologous in vitro lining of prosthetic vascular bypass grafts.

Diss. (sammanfattning) Göteborg : Univ. , 2006. / Härtill 4 uppsatser.

The purpose of this phenomenological study was to determine the meaning parents give to their family's experience when they have a child awaiting corrective heart surgery. A secondary purpose was to identify appropriate interventions for nurses who deal with families during the transition period, from initial diagnosis of congenital heart disease until admission to hospital for corrective heart surgery. A convenience sample of six couples were interviewed at various times during the identified transition period, for a total of 11 interviews. An interview guide of open-ended questions provided some loose structure for the initial interviews. Analysis of the verbatim transcriptions began concurrently with data collection and continued during the formal analytic phase with meaning units emerging from the data. The parents described four facets of the experience: diagnosis of congenital heart disease, adjusting to caring for child once home, living with a child with a chronic condition, and waiting for corrective heart surgery. Not only did parents talk about how they felt during the four facets but they also described the range of coping strategies they employed through their experience. In discussing these findings within the context of other chronic illness experiences it became evident that parents draw from a common pool of coping strategies whether the child is in a chronic or more acute phase of an illness. Most of the parents in discussing their overall impressions of the experience had not found their child's illness to be as disruptive to family life as they had first anticipated. Those families with the most symptomatic infants seemed to have a particular need for an alliance with one health care professional to support them through the transition period. Generally, parents did not spend a lot of time dwelling on the corrective surgery until close to the anticipated date for that event; instead they employed various coping strategies which allowed them to normalize their lives. Implications for nursing practice which arise from these conclusions are multiple. Overall, nurses must assess the meaning that individual families give to their experience, assist families to employ suitable coping strategies, and offer support as necessary. General implications for nursing research are in the realm of studies which will further nurses' understanding of the waiting period for corrective heart surgery both from the parents' and the siblings' perspective. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis (doctoral)--Universität Hamburg, 1978.

This descriptive study was designed to investigate the problem of inadequate emotional recovery from open heart surgery. This problem has been defined by a number of earlier researchers who have noted adverse emotional reactions to the experience of cardiac surgery in both the early postoperative and the post-discharge periods. This investigation had as its purpose the examination of the pre-discharge recovery of patients, and the investigator intended to note whether there existed a common pattern of recovery among the patients studied (hence, a pattern of emotional response to surgery). It was anticipated that the discovery of similarities of behaviour might give insight into the responses to open heart surgery and provide information important to the study of long-term rehabilitation. Twenty adult patients scheduled for open heart surgery were selected as the sample for study. The principal setting for the investigation was the Cardiac Surgery Unit of a large metropolitan hospital. Subjects were interviewed one to two days prior to surgery and then every two to three days postoperatively until the time of discharge. The investigator obtained qualitative data with the aid of a data collection tool, noting the physiological status of the subjects but focusing most directly on verbal and nonverbal behaviours exhibited. The latter observations included focus of conversation, patterns of communication, affect, orientation, level of anxiety, and activity. Following analysis of the data, it was noted that a common pattern of recovery was indeed evident. Three phases of recovery - Somatic, Transition and Resolution - could be described for each subject in the sample. The phases indicated the subjects' general responses to surgery and their progression toward increased activity and independence at the time of discharge. In effect, the phases served to define the hospital course of emotional recovery from open heart surgery. The length and onset of these three phases were similar for patients with an uncomplicated recovery but varied with patients who experienced major physiologic difficulties. The implications of a recovery pattern have been discussed relative to nursing care of the cardiac surgical patient and specific recommendations for nursing intervention have been made. Subject areas worthy of further investigation have been enumerated by the investigator in light of the conclusions of the present study. / Applied Science, Faculty of / Nursing, School of / Graduate

A cirurgia de revascularização do miocárdio (CRVM) é um procedimento indicado para pacientes com angina pectoris não controlada com o tratamento clínico e para pacientes com elevado grau de obstrução das artérias principais. A cirurgia visa a melhorar a qualidade de vida relacionada à saúde (QVRS) dos pacientes, aliviar os sintomas da angina e aumentar a sobrevida, sobretudo dos pacientes de maior risco. No contexto do paciente coronariopata, a depressão tem sido relacionada como um preditor de pior QVRS, enquanto o senso de coerência (SC) tem sido associado a melhor QVRS e menor depressão. Objetivos: Avaliar a QVRS, depressão e SC, antes e seis meses após a CRVM e investigar as associações entre essas variáveis. Casuística e método: Estudo observacional e prospectivo, realizado em um hospital-escola no interior do Estado de São Paulo, desenvolvido entre os meses de setembro de 2006 e abril de 2008. A amostra foi constituída por 54 pacientes que fizeram parte das duas avaliações. Foram utilizados três instrumentos de medida: para avaliação da QVRS, o Medical Outcomes Study 36 - item Short-Form (SF-36), para a depressão, o Inventário de Depressão de Beck (IDB) e para o SC, o Questionário de Senso de Coerência de Antonovsky de 29 itens (QSCA). Os dados foram coletados por meio de entrevistas. Posteriormente, foram sumarizados por meio de estatística descritiva e analisados pelo teste de correlação de Pearson e teste t. A análise de regressão hierárquica foi realizada para verificar as associações entre a depressão, seis meses após a cirurgia, o sexo, idade, depressão préoperatória e SC, as quais se mostraram estatisticamente significantes nas análises bivariadas. O nível de significância adotado foi 0,05. Resultados: Os participantes eram, predominantemente, do sexo masculino, casados e com baixo nível de escolaridade. As médias obtidas, nos oito domínios do SF-36, foram maiores na segunda avaliação, quando comparadas ao pré-operatório, sendo as diferenças estatisticamente significantes. A medida de depressão foi maior antes do que após cirurgia (p=0,01) e não houve alteração na medida do SC (p=0,51). No préoperatório, as mulheres apresentaram menor avaliação da QVRS nos componentes do SF-36, exceto para Aspectos emocionais (p=0,68). A idade apresentou correlação moderada e positiva com o Estado geral de saúde (r=0,342, p=0,01) e com o SC (r=314, p=0,02), enquanto que moderada e negativa com a medida de depressão (r= -0,307, p=0,02). Após seis meses, os homens apresentaram melhor avaliação em todos os componentes do SF-36, sendo essa diferença estatisticamente significativa para Aspectos físicos (p=0,04), Dor (p=0,02), Estado geral de saúde (p=0,01) e Vitalidade (p=0,04). A idade demonstrou correlação positiva e forte com Estado geral de saúde (r=570, p=0,00) e moderada com Saúde mental (r=0,388, p=0,00). Para testar se a presença de depressão, seis meses após a cirurgia, associava-se com a depressão existente no pré-operatório, bem como com as variáveis sexo e idade, foi realizada regressão linear hierárquica cujo resultado mostrou que 49% da variância da medida de depressão, seis meses após a cirurgia, era explicada por essas variáveis. Com a inclusão da medida de SC no modelo constatou-se que essa variável explicou sozinha 18,7% da variância da medida de depressão, após o ajuste das demais variáveis. Conclusão: A QVRS melhora seis meses após a CRVM, assim como há diminuição da depressão, enquanto o SC não apresentou alteração, confirmando a estabilidade do constructo. Após o ajuste no modelo de regressão para as variáveis: sexo, idade e depressão no pré-operatório, o SC explica 18,7% da depressão pós-operatória, resultado importante em se tratando de uma variável psicossocial. / The myocardial revascularization surgery (MRS) is a recommended procedure for patients who suffer from angina pectoris which is not controlled under clinical treatment and for patients who have an elevated degree of obstruction of the main coronary arteries. The surgery aims at improving patients health-related quality of life, alleviating the symptoms of the angina and increasing their survival period, particularly of those at greater risk. As to the coronaropathy in patients, depression has been related to a predictor for worse HRQL, whereas the sense of coherence (SC) has been associated with a better HRQL and lower depression. Objectives: To evaluate the HRQL, depression and SC before MRS and six months after it and to investigate the associations among these variables. Casuistics and method: A prospective and observational study, which was carried out at a hospital school in the countryside of the State of São Paulo and developed between September 2006 and April 2008. The sample was constituted of 54 patients who took part in the two evaluations. Three instruments of measurement were utilized: to evaluate HRQL, the Medical Outcomes Study 36 - item Short-Form (SF-36), towards depression, the Beck Depression Inventary (BDI) and regarding SC, the Questionnaire of Sense of Coherence by Antonovsky of 29 items (QSCA). The data were collected by means of interviews. Later, they were summarized through descriptive statistics and analysed by our using the test of correlation by Peterson and the t test. The analysis of hierarchical regression was carried out to verify the associations among the depression, six months after the surgery, sex, age, pre-operatory depression and SC, which were shown to be statistically significant in the bivariate analyses. The adopted level of significance was 0,05. Results: The participants were predominantly male, married and had a low level of instruction. The averages obtained, in the eight domains of SF-36, were higher in the second evaluation when compared to the preoperatory period, being such differences statistically significant. The measurement of depression was higher before than after the surgery (p=0,01) and there was no alteration in the measurement of SC (p=0,51). In the pre-operatory period, women presented a lower evaluation of HRQL in the components of SF-36, except towards Emotional aspects (p=0,68). Age presented moderate and positive correlation towards the General state of health (r=0,342, p=0,01) and with the SC (r=314, p=0,02), whereas a moderate and negative one regarding the measurement of depression (r= -0,307, p=0,02). After six months, men showed a better evaluation in all the components of SF-36, being such a difference statistically significant towards Physical aspects (p=0,04), Pain (p=0,02), General state of health (p=0,01) and Vitality (p=0,04). Age demonstrated to have a strong and positive correlation with the General state of health (r=570, p=0,00) and a moderate one with Mental health (r=0,388, p=0,00). To test if the presence of depression, six months after the surgery, was associated with the existent pre-operatory depression, as well as with the variables sex and age, hierarchical linear regression was carried out whose result revealed that 49% of the variance of the measurement of depression, six months after the surgery, was explained by such variables. With the inclusion of SC measurement in the model, it was stated that this variable explained 18,7% of the variance of the measurement of depression by itself, after the adjustment of the other variables. Conclusion: The HRQL improves after six months of the MRS, depression diminishes, whereas the SC did not show any alteration, confirming the stability of the construct. After the adjustment in the model of regression towards the variables: sex, age and depression in the pre-operatory period, SC explains 18,7% of postoperatory depression, an important result regarding it is a psychosocial variable.

Sabe-se que o sistema imune, através de um fenômeno denominado imunossenescência, gradativamente diminui a sua capacidade de resposta durante a vida. Este fato pode tornar o indivíduo mais suscetível a infecções e outras patologias. Neste contexto, seria útil procurar por fatores que alterassem esta evolução natural, principalmente os capazes de acelerar este processo. Por esta razão, nós procuramos por diferenças nos parâmetros imunológicos entre o antes e o depois da cirurgia de valva cardíaca em idosos com mais de 65 anos. Nossos resultados não apontaram, no pós-operatório, para uma diminuição da capacidade imune, uma vez que os testes cutâneos de hipersensibilidade para o PPD, tricofitina e candidina não se alteraram. Quando a resposta linfoproliferativa foi avaliada in vitro, também não apresentou diferença. Por outro lado, nós observamos um aumento na porcentagem de células T CD3 +, T CD4 + e monócitos no sangue periférico, quando comparamos os períodos. Sendo que os marcadores de ativação cellular CD25 +, CD69 + e o CD95 também se apresentaram elevados. Quanto a secreção de citocinas, nossos resultados apontam para um amento de IL-4 e IL-8. Inversamente, concentrações reduzidas de IL-2, IL-12 e IFN- foram detectadas no sobrenadante de PBMCs quando estimuladas in vitro. Em suma, nossos dados demonstram que a cirurgia de valva cardiaca é capaz de alterar vários parâmetros da resposta immune, com um aumenrto da porcentagem de células, quanto da expressão de marcadores de ativação celular e secreção de citocinas / It is known that the immune system, through a phenomenon called immunosenescence, undergoes functional changes during life which may culminate in a diminished capacity of response, turning the subject more susceptible to infections and other pathologies. In this context, it is useful to search for factors that alter this natural evolution, mainly able to delay this process. For this reason, we assessed different immunologic parameters before and after cardiac valve surgery in 65 year-old patients. Our results did not point to a postoperative immunedeficiency-like state, once that the cutaneous tests to PPD, candidin and tricophytin remained positive for most of the subjects. When the proliferative response was assessed in vitro, there were also no differences. On the other hand, we observed a post-surgical increase in the percentage of T CD3 +, T CD4 + cells and in monocytes from peripheral blood when we compare both periods. Moreover, it is important to highlight that activation markers, such as CD25, CD69 and CD95 were also presented in higher levels. According to the cytokine secretion, our results appointed to a greater secretion of IL-4 and IL-8 postoperative. Conversely, reduced concentrations of IL-2, IL-12 and IFN- were detected in supernatant of PBMCs when stimulated in vitro. In summary, our data reveal that the cardiac valve surgery with extra corporeal procedure and anesthesia is able to alter several parameters of the immune response, with an increased percentage of the major assessed cells, as well as in the expression of activation markers and cytokine secretion