Zielsetzung: In dieser Studie wurde an 15 gesunden Rindern die Methode der Thorakoskopie erprobt mit dem Ziel, eine Grundlage für den weiteren Einsatz dieses Verfahrens am bovinen Thorax zu schaffen. Im Mittelpunkt standen die Entwicklung einer geeigneten Untersuchungstechnik und die Beschreibung der endoskopisch dargestellten, im Pleuraspalt gelegenen Organe sowie möglicher pathologischer Befunde. Weiterhin galt es Komplikationen zu ermitteln und anhand der Erfahrungen aus diesem Versuch Indikationen für den Einsatz dieses minimal-invasiven Verfahrens beim Rind zu formulieren. Methodik: Alle Tiere wurden einer links- und rechtsseitigen Thorakoskopie jeweils mit und ohne intrapleurale Insufflation von Kohlenstoffdioxid über einen interkostalen Zugang unterzogen. Im Rahmen des Versuches fanden folglich vier Thorakoskopien je Rind und insgesamt 60 Thorakoskopien mit einer Wartezeit von 24 Stunden zwischen den einzelnen Untersuchungen statt. Die Untersuchungen erfolgten am im Zwangsstand fixierten, lokal anästhesierten Tier. Der endoskopische Zugang lag stets auf Höhe des Tuber coxae und variierte vom 8. bis zum 10. Interkostalraum. Nach interkostaler Schnittinzision wurde eine Zitzenkanüle bis in den Pleuraspalt vorgeschoben. Der spontane Einstrom von Raumluft in das Cavum pleurae führte zum Teilkollaps des ipsilateralen Lungenflügels. Die Kanüle wurde durch eine Trokar-Hülsen-Einheit ersetzt und die Hülse stellte nach Entfernung des Trokars den Zugang für die Optik. Je Hemithorax wurde die Untersuchungszeit auf 20 Minuten festgelegt. Sie begann im kranialen Pleuraspalt, wurde über (dorso)-kranial, (dorso)-medial, (dorso)-kaudal, ventrokaudal und ventral fortgeführt und endete mit ventrokranial ausgerichteter Optik. Ergebnisse: Die meisten im Cavum pleurae gelegenen Organe konnten ohne die Insufflation von CO2 ausreichend adspiziert werden. Während der links- und rechtsseitigen Thorakoskopien gelang die Adspektion großer Bereiche der Pleura costalis mit den Mm. intercostales interni sowie den Aa. et Vv. intercostales dorsales, Anteile der Lungenflügel und des Ligamentum pulmonale, der Aorta thoracica, des thorakalen Ösophagus, des M. longus colli, von Lymphknoten des Lc. thoracicum dorsale sowie der Lnn. mediastinales caudales, der Pars thoracica des Truncus sympathicus und des Truncus vagalis dorsalis des N. vagus. Des Weiteren konnten der M. psoas major, Anteile des Diaphragmas und der V. phrenica cranialis, der Hiatus aorticus, der Arcus lumbocostalis sowie unregelmäßig die A. et V. bronchoesophagea adspiziert werden. Die Untersuchung des rechten kranialen Pleuraspaltes war mit Einschränkungen behaftet und spiegelte sich in einer reduzierten Darstellung der sympathische Nervenfasern aus dem Ggl. cervicothoracicum, des Truncus costocervicalis dextra sowie der V. costocervicalis dextra wider. Linksseitig war die Betrachtung dieser Organe bzw. der korrespondierenden linksseitig angelegten Organe regelmäßig möglich. Weiterhin gelang während der linksseitigen Untersuchung die Adspektion des Ln. tracheobronchalis sinister, des Truncus brachiocephalicus sowie der V. azygos sinistra. Rechtsseitig konnte die V. azygos dextra stets adspiziert werden. Die Darstellung des Ductus thoracicus erfolgte nur bei einem der untersuchten Rinder infolge einer pathologischen Kompression. Während der Untersuchungen unter passivem Lungenkollaps war das Perikard nur bei einer rechtsseitigen Thorakoskopie zu sehen. Die Zweituntersuchungen des ipsilateralen Pleuraspaltes fanden während der Insufflation von CO2 bis zu einem Überdruck von 5 mm Hg statt. Dies sollte einen stärkeren Lungenkollaps bewirken und damit die Sicht auf intrapleural gelegene Organe verbessern. Während der Insufflation waren beidseits größere Anteile der Rippen und des Zwerchfells sowie das Perikard linksseitig bei drei Rindern und rechtsseitig bei einem Rind darstellbar. Postoperative Röntgenaufnahmen dienten dem Ausschluss des Vorhandenseins eines ipsi- oder kontralateralen Pneumothorax. Schlussfolgerung: Die Studie zeigt, dass Thorakoskopien an stehenden, gesunden Rindern sicher und komplikationsarm durchzuführen sind. Die beschriebene, minimal-invasive Technik stellt eine wertvolle, zusätzliche Methode zur tierschonenden Abklärung intrathorakaler Erkrankungen beim Rind dar. Der diagnostische, palliative oder therapeutische Nutzen muss in weiterführenden Untersuchungen ermittelt werden. / Objective: A study on 15 healthy cows was conducted to prove the thoracoscopic technique with the aim to establish a basis for further application of this procedure on cattle. Focus was on developing an adequate examination technique, displaying and describing of physical as well as pathological findings on intrathoracic organs examined endoscopically. Furthermore perioperative complications and indications of this minimally invasive method on cattle should be presented. Methods: The animals underwent a left and right side thoracoscopy under passive lung collapse and under insufflation of CO2. Therefore four thoracoscopies at each cow and a total of 60 thoracoscopies were performed with a waiting time of 24 hours between each examination. The cows were restrained in a stock and locally anesthetized. The endoscopic portal was lined up horizontally with the level of the ventral margin of the coxal tuber, at the point where the local anaesthetic had been injected and varied between the eighth and the tenth intercostal space. After a vertical stab incision through the skin and subcutaneous tissues a blunt stainless teat cannula was introduced into the pleural space. At this point air streamed spontaneously into the pleural space following by an ipsilateral lung collapse. The teat cannula was then removed and replaced by a sharp guarded trocar. After that the trocar was removed and the endoscope was passed through the remaining cannula. The time assessment for examination of each thorax was 20 minutes, started in the cranial pleural space, was continued in the (dorso)-cranial, (dorso)-medial, (dorso)-caudal, ventrocaudal und ventral direction and ended with ventrocranially aligned optic. Results: Most of the intrathoracic organs were seen without additional CO2 insufflation. During left and right side thoracoscopies large parts of the costal pleura, the internal intercostal muscles, the dorsal intercostal veins and arteries, parts of the lungs and the pulmonary ligament, the thoracic aorta, the thoracic part of the esophagus and the longus colli muscle, caudal mediastinal lymph nodes and lymph nodes associated with the dorsal thoracic lymph center, the thoracic part of the sympathic trunk and the dorsal vagus nerve were seen. Furthermore the psoas major muscle, parts of the diaphragm and the cranial phrenic vein, the aortic hiatus, the lumbocostal arch and intermittently the broncho-esophageal artery and vein could be identified. There were some constraints during right side thoracoscopy of the cranial pleural space which caused a limited view at the sympathic nerve fibres associated with the cervicothoracic ganglion, the right costocervical trunk and the right costocervical vein. At the left side these organs, the corresponding left side organs respectively, were constantly seen. Moreover during the exam at the left pleural space the left tracheobronchial lymph node, the brachiocephalic trunk and the left azygos could be well identified. During right side thoracoscopy the right azygos vein was always visible. In one case the presentation of the thoracic duct succeeded as a result of its pathological compression. During examination under passive lung collapse the pericard was visualized in one cow during right side thoracoscopy. The second thoracoscopies of the ipsilateral pleural space were conducted during insufflation of CO2 with a pressure of 5 mm Hg. A stronger lung collapse should result during insufflation with an enhanced view of the organs located intrapleurally. During insufflation at both sides larger parts of the ribs and diaphragm as well as the pericard on the left side at three cattle and on the right side at one cattle could be seen. Postoperative radiographies ensured the absence of an ipsi- or contralateral pneumothorax. Conclusion: This study shows that thoracoscopies on standing healthy cattle could be safely performed without major perioperative complications or side effects. The described minimally invasive procedure is a valuable, gentle and additional method to diagnose intrathoracic diseases in cattle. The use of thoracoscopy as diagnostic tool, for curative and palliative therapy should be identified in further studies.

Cette étude aborde le problème de l’aggravation du risque de fractures de côtes chez les automobilistesâgés en choc frontal. L’analyse de la bibliographie fait ressortir que les moyens actuels d’évaluationdu risque de fractures ne permettent pas de prendre en compte les différences anatomiques et depropriétés mécaniques du thorax observées chez les personnes âgées. Les modèles éléments finis (EF)personnalisés du corps humain offrent un grand potentiel en tant qu’outil avancé d’évaluation durisque de blessures. Toutefois, des données expérimentales sont nécessaires pour valider ces modèlesdans des conditions réalistes. De plus, le choix du niveau de personnalisation et la sensibilité de laréponse du modèle à celle-ci doivent être évaluées.Des expérimentations in vivo menés sur des volontaires ceinturés en choc léger, de différents âges etanthropométries, ont été réalisées. Ces tests ont permis d’étudier l’influence de l’âge et de lacorpulence sur la réponse mécanique du thorax et ont permis l’obtention de corridors nécessaires à lavalidation de modèles EF personnalisés. La géométrie du modèle numérique THUMS a été adaptée àcelle des volontaires et les propriétés mécaniques du thorax ont été modifiées au vu du vieillissementpour effectuer une analyse similaire dans le domaine lésionnel. Les simulations numériques ont mis enévidence un risque accru de fracture de côtes pour certains modèles personnalisés.Cette étude devrait permettre de mieux estimer le risque de blessure pour les automobilistesvulnérables. Elle devrait contribuer ainsi à promouvoir les modèles personnalisés du corps humaincomme outil avancé d’évaluation du risque de blessures. / This study deals with the topic of increased risk of rib fractures among elderly drivers infrontal impact. The analysis of the literature reveals that actual thorax injury assessment tools do nottake into account for the differences in anatomical features and biological material properties observedbetween adults and elderly. Personalized human body finite element (FE) models have great potentialas improved thorax injury assessment tools. However, experimental data are needed to validate thesemodels under real-world conditions. In addition, the choice of the level of personalization of the modeland the sensibility of the model response to this personalization must be assessed to predict thoracicinjury risk.In vivo sled tests were performed on belted volunteers of various anthropometries and age. These testswere used to assess the influence of age and corpulence on thorax mechanical response and allowed toobtain corridor responses needed to validate personalized FE models. The geometry of the FE modelTHUMS was adapted to the volunteers and the thorax material properties were modified consideringaging to carry out a similar analysis in the injurious domain. Numerical simulations highlighted anincreased risk of rib fractures for specific personalized models.This study should help to better estimate the injury risk for car occupants. It should contribute topromote personalized human body models as attractive thorax injury assessment tool ofvulnerable individuals.

La recherche en biomécanique des chocs est une nécessité pour améliorer la sécurité dans les transports. Pour une meilleure évaluation des critères lésionnels lors des simulations de crash, le manque de représentativité des modèles EF du thorax humain pourrait être comblé par une démarche de personnalisation aussi bien au niveau géométrique que mécanique. Cette thèse se base sur l’étude de 18 sujets humains post-mortem. A partir des données d’imagerie, les différentes dimensions des côtes sont analysées. La corrélation de ces paramètres aboutit à la prédiction de 192 dimensions à partir d’un unique paramètre d’entrée. A une échelle inférieure, un protocole innovant a permis de coupler des informations microstructurales issues d’un μCT avec la forme extérieure des côtes. 2 hémi-thorax ont été micro-scannés afin de générer une cartographie complète des épaisseurs d’os cortical. Une stratégie a été mise en place pour proposer un algorithme prédisant l’intégralité de cette géométrie locale d’après un seul tronçon de côte. La pertinence de cette personnalisation a été évaluée par une étude de sensibilité sur des modèles EF. Les résultats d’essais de traction sur os cortical montrent un comportement différent entre les éprouvettes prélevées sur la table interne ou externe des côtes. Une caractérisation précise de la structure interne de l’os cortical, couplé à des essais de micro-traction in-situ, a pu apporter des éléments de réponse sur cette différence. Unalgorithme de personnalisation a été aussi proposé pour les propriétés mécaniques, complétant ainsi la démarche d’adapter les modèles EF du thorax à chaque individu afin d’améliorer leur biofidélité. / For a better assessment of injury criteria on the human thorax, realistic numerical simulations need accurate geometrical characterization and an understanding of the mechanical behavior of the rib. Thelack of representation of the FE models of the human thorax could be filled by a personalization of these two aspects. This thesis is based on the study of 18 post-mortem human subjects. From medical data (CT-scans), the different dimensions of the ribs were analyzed. The correlation of the measurements led to the prediction of 192 dimensions from a single input parameter. At a lower scale, an innovative protocol enabled us to combine microstructural information obtained from a μCT with the external shape of the ribs. 2 hemi-thoraxes were scanned to generate a complete map of the thickness of cortical bone and cross-section area evolution. A strategy was implemented to provide an algorithm, predicting this entire local geometry from a single rib’s sample. The relevance of this customization was evaluated by a sensitivity analysis on FE models. The results of tensile tests on cortical bone showed different behaviors between the samples harvested from the inner or outer side of the rib. A precise characterization of the internal structure of the cortical bone, coupled with in-situ micro-tensile device, revealed certain answers about this difference. An algorithm is also proposed topersonalize the mechanical properties, completing the approach of adapting the FE models of the thorax of each individual to improve their biofidelity.

Abstrakt Inledning: DT går snabbt och bilderna ges i 3D format vilket är en vidareutveckling från konventionell röntgen som ges i 2D bilder. DT thoraxundersökning är en metod som har visat fler fördelar än konventionell röntgen, dock ges det en högre stråldos. Syfte: Syftet med studien var att sammanställa tekniska åtgärder som röntgensjuksköterskan kan använda för att minska stråldosen till patienten vid DT thoraxundersökning. Metoden: Studien utfördes som en allmän litteraturstudie. Tio vetenskapliga artiklar kvalitetsgranskades, analyserades och resultatet presenterades i tre kategorier. Resultat: Det är möjligt att sänka stråldosen till patienten på olika sätt. Röntgensjuksköterskan kan ändra på exponeringsparametrar, använda sig av olika algoritmer samt positionera patienten rätt från början i ISO-centret med hjälp av ett automatiskt positioneringsverktyg. Inställningen av exponeringsparametrar avgör stråldosen till patienten. Med att ändra exponering parametrarna till lägre nivåer minskas stråldosen till patienten. Algoritmer som ASIR eller MBIR går även att använda vid efterfrågan av reducerad stråldos samt bevara bildkvalitén. Vid en DT undersökning avgörs patientpositionering för vilken mängd stråldos patienten utsätts för. Det är väldigt viktigt att röntgensjuksköterskan positionerar rätt och med hjälp av automatisk patientpositionering minskas risken för fel centrering samt onödig strålmängd. Slutsats: Litteraturstudien identifierade 3 tekniska åtgärder för att minska stråldosen med bibehållen bildkvalité. Med denna kunskap kan stråldosen reduceras till patienten, vilket är förenligt med Röntgensjuksköterskans kompetensbeskrivning och ALARA- principen.

The objective of this study is to develop a finite element model of the human thorax with a protective body armor system so that the model can adequately determine the thorax's biodynamical response from a projectile impact. The finite element model of the human thorax consists of the thoracic skeleton, heart, lungs, major arteries, major veins, trachea, and bronchi. The finite element model of the human thorax is validated by comparing the model's results to experimental data obtained from cadavers wearing a protective body armor system undergoing a projectile impact. When the model is deemed valid, a parametric study is performed to determine the components of the model that have the greatest effect on its biodynamical response to a projectile impact.

Th.--Méd.--Nancy 1, 1983. N°: 205.

Revisión por pares

The objective of this study was to evaluate the effects of sex, loading rate, and age on the compressive and tensile material properties of human costal cartilage over a wide range of subject ages and sexes. Cylindrical compression samples and dog-bone shaped tension samples were tested to failure on a material testing system using target strain rates of 0.005 strain/s and 0.5 strain/s. Compression data were obtained from forty (n = 40) subjects (M = 26, F = 14) ranging in age from 11 – 69 years (Avg. = 39.1 ± 18.2 yrs.), and matched loading rate data were obtained for thirty-four (n = 34) samples. Tension data were obtained from forty-one (n = 41) subjects (M = 30, F = 11) ranging in age from 10 – 59 years (Avg. = 32.9 ± 14.9 yrs.), and matched loading rate data were obtained for seventeen (n = 17) samples. For both compression and tension, load and sample deflection data were collected and used to calculate stress and strain. For the compression data, the toe region was fit using a second-order polynomial, and the toe transition stress, toe transition strain, second-order polynomial coefficient A, and second-order polynomial coefficient B were calculated. In addition, the elastic modulus, ultimate stress, ultimate strain, and strain energy density (SED) were also calculated for each test. For the tension data, only the elastic modulus, ultimate stress, ultimate strain, and SED were calculated for each test. There were no effects of sex on the material properties for either method of loading or strain rate. Therefore, male and female data were combined for the age and loading rate analyses. For compression, toe transition stress, toe transition strain, A, elastic modulus, ultimate stress, and SED were all found to be significantly higher at 0.5 strain/s compared to 0.005 strain/s. For tension, no material properties were found to differ with respect to loading rate. Regarding the effects of age, toe transition stress, toe transition strain, A, B, ultimate stress, ultimate strain and SED were found to significantly decrease with advancing age for the 0.005 strain/s compression data. At 0.5 strain/s, toe transition stress, toe transition strain, elastic modulus, ultimate stress, ultimate strain, and SED all significantly decreased with advancing age. For tension, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age at 0.005 strain/s and 0.5 strain/s. Comparing the two loading modes, the ultimate stress, elastic modulus, and SED were significantly higher in compression than in tension. For the compression samples, sample density and percent calcification were also obtained for each sample using physical measurements and micro-CT scans, respectively. However, since there were only a few samples with large calcifications, no meaningful trends were found. This is the first study of its kind to analyze the effects of sex, loading rate, and age on both the compressive and tensile material properties on human costal cartilage from such a wide range of subject ages. The results from this study can be used to develop more accurate finite element models of the human body, which will allow researchers to better evaluate human occupant response and injury risk in motor vehicle collisions for both young and old individuals. / Master of Science / Serious thorax injuries are often observed in motor vehicle collisions. Although a considerable amount of research has investigated the material and structural properties of rib cortical bone and whole rib sections, only a limited number of studies have focused on characterizing the material properties of costal cartilage, which comprises a substantial portion of the anterior region of the thorax. The studies that do exist include small subject pools and/or are limited to sub-failure indentation tests. Indentation tests are limited to low deflections and focal loading and are unable to obtain the failure material properties of costal cartilage. Therefore, the purpose of this study was to quantify the compressive and tensile material properties of human costal cartilage at two loading rates for a wide range of subject demographics. These properties were then evaluated with respect to sex, loading rate, and age. Cylindrical compression samples and dog-bone shaped tension samples were tested to failure on a material testing system at target strain rates of 0.005 strain/s and 0.5 strain/s. Compression data were obtained from forty (n = 40) subjects ranging in age from 11 – 69 years, and tension data were obtained from twenty-eight (n = 28) subjects ranging in age from 10 – 59 years. For both compression and tension, load and sample deflection data were collected and used to calculate stress and strain. For the compression data, the magnitude and shape of the initial loading region (i.e., the toe region), elastic modulus, ultimate stress, ultimate strain, and strain energy density (SED) were quantified for each test. For the tension data, the elastic modulus, ultimate stress, ultimate strain, and SED were calculated for each test. There were no significant effects of sex on the material properties for either method of loading or strain rate. Therefore, male and female data were combined for the age and loading rate analyses. For compression, the toe region transition point (i.e., stress and strain), toe region shape coefficient A, elastic modulus, ultimate stress, and SED were all found to be significantly higher at 0.5 strain/s compared to 0.005 strain/s. For tension, no material properties were found to differ with respect to loading rate. Regarding the effects of age, toe region transition point (i.e., stress and strain), toe region shape coefficients A and B, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age for the 0.005 strain/s compression data. For the 0.5 strain/s compression data, toe transition stress, toe transition strain, elastic modulus, ultimate stress, ultimate strain, and SED all significantly decreased with age. For tension, ultimate stress, ultimate strain, and SED were found to significantly decrease with advancing age at 0.005 strain/s and 0.5 strain/s. The ultimate stress, elastic modulus, and SED were higher in compression than in tension. Overall, this is the first study to evaluate the effects of sex, loading rate and age on the compressive and tensile material properties of human costal cartilage from a wide range of ages. These data can be used to assess differences in the response and tolerance of the human rib cage for occupants of various age in motor vehicle collisions.

No description available.

No description available.