Burst abdomen (BA) is a severe complication after abdominal surgery, which often requires urgent repair. However, evidence on surgical techniques to prevent burst abdomen recurrence (BAR) is scarce. We conducted a retrospective analysis of patients with BA comparing them to patients with superficial surgical site infections from the years 2015 to 2018. The data was retrieved from the institutional wound register. We analyzed risk factors for BA occurrence as well as its recurrence after BA repair and surgical closure techniques that would best prevent BAR.:1 Abkürzungsverzeichnis 2 Einführung 2.1 Aufbau der Bauchwand und operative Zugangswege in der Abdominalchirurgie 2.1.1 Anatomie 2.1.2 Zugangswege 2.2 Wundinfektionen 2.3 Definition „Platzbauch“ 2.4 Risikofaktoren und Ursachen von Fasziendehiszenzen 2.4.1 Biochemische Einflüsse auf die Wundheilung 2.4.2 Mechanische und technische Faktoren 2.4.3 Allgemeine individuelle Faktoren 2.5 Management des Platzbauchs 2.6 Spätkomplikationen des Platzbauches 2.6.1 Narbenhernien 2.6.2 Intestinale Fisteln 2.6.3 Netzinfektion 2.6.4 Re-Dehiszenzen 3 Zielsetzung der vorliegenden Arbeit 4 Publikation 5 Zusammenfassung der Arbeit 5.1 Einleitung 5.2 Wundregister nosokomialer Wundinfektionen der Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie am Universitätsklinikum Leipzig 5.3 Risikofaktoren für Platzbäuche 5.4 Platzbauchentstehung 5.5 Chirurgische Verschlusstechnik 5.6 Re-Dehiszenzen 5.7 Limitationen der Analyse 6 Literaturverzeichnis 7 Anlagen 7.1 Darstellung des eigenen Beitrags 7.2 Selbstständigkeitserklärung 7.3 Lebenslauf 7.4 Publikationen 8 Danksagung

Objetivo: Determinar los principales factores asociados a las complicaciones postoperatorias de apendicitis aguda en el Hospital José Agurto Tello de Chosica, durante el periodo comprendido de Enero de 2012 a Diciembre del 2014. Métodos: Se realizó un estudio retrospectivo, analítico de tipo descriptivo, en 961 pacientes. Se determinara asociaciones entre pacientes intervenidos quirúrgicamente de apendicitis aguda a una complicación postoperatoria. Resultados: El 15,8 % de la serie sufrió algún tipo de complicación, principalmente en la infección del sitio operatorio. Las complicaciones se vieron asociadas al grupo etario comprendido entre 14 a 30 años, así como en las formas histopatológicas más avanzadas de la afección. La aparición de tales complicaciones puede ser causa de re-intervenciones y de aumento de la estadía hospitalaria. Conclusiones: El diagnóstico precoz de la enfermedad y la apendicetomía inmediata con una técnica quirúrgica adecuada previenen la aparición de complicaciones posquirúrgicas y determinan el éxito del único tratamiento eficaz contra la afección más común que causa el abdomen agudo, cuyo pronóstico depende en gran medida y entre otros factores, del tiempo de evolución preoperatoria y de la fase en que se encuentre el proceso al realizar la intervención.

This study compares the effectiveness of three selected exercises (curl-up, conventional hook sit-up and modified hook sit-up) in building abdominal strength and endurance in upper elementary school girls. Ninety-nine subjects were randomly divided into four groups. The study was designed to determine (1) whether an eight week exercise program can increase abdominal strength and endurance; (2) the most effective exercise; (3) if muscle action intensity affects the results. A cable tensiometer measured abdominal strength and a timed sit-up measured abdominal endurance. An analysis of covariance determined significance. Significant gains in abdominal strength and endurance were shown by the conventional hook sit-up. Further study on the relationship between muscle development and maturation in young children is recommended.

Respiratory motion poses significant problems in the radiotherapy of tumors located at sites (lung, liver, pancreas, breast) that are affected by such motion. Effects of respiratory motion on the different stages of the radiotherapy process (imaging, treatment planning and treatment delivery), has formed the focus of significant research over the last decade. Results from such research have revealed that respiratory motion affects the instantaneous position of almost all structures in the thorax and abdomen to different degrees based on their corresponding anatomic location and muscular attachments. As an example, diaphragm motion was found to be of the order of 1.5 cm, predominantly in the superior-inferior (SI) direction during normal breathing. This indicates a similar magnitude of motion for tumors located in the lower lobes of the lung and in the abdomen.The conventional method of accounting for such motion is to add a margin (based on an estimate of the expected range of organ motion) around the clinical target volume (CTV) that is delineated from the image data. This margin also includes errors due beam-bony anatomy alignment during radiation delivery and errors in patient position between simulation and subsequent treatment delivery sessions. Such a margin estimate may or may not encompass the "current" extent of motion exhibited by the tumor, resulting in either a higher dose to the surrounding normal tissue or a potential cold spot in the tumor volume. Several clinical studies have reported the existence of a direct relationship between the reduction in mean dose to the lung and the incidence of radiation induced pneumonitis. Therefore, subjecting additional normal lung tissue to high dose radiation by adding large margins based on organ motion estimates may result in an increased risk of radiation induced lung injury.Monitoring and accounting for respiratory motion can however potentate a reduction in the amount of normal tissue that receives high dose radiation, thereby decreasing the probability of normal tissue complication and also increasing the possibility for dose escalation to the actual tumor volume. The management (monitoring and accounting) of respiratory motion during radiation oncology forms the primary theme of this dissertation.Specific aims of this thesis dissertation include (a) identifying the deleterious effects of respiratory motion on conventional radiation therapy techniques (b) examining the different solutions that have been proposed to counter the deleterious effects of respiratory motion during radiotherapy (c) summarizing the relevant work conducted at our institution as part of this thesis in addressing the issue of respiratory motion and (d) visualizing the future direction of research in the management of respiratory motion in radiation oncology.Among the various techniques available to manage respiratory motion in radiation oncology such as respiratory gated and breath hold based radiotherapy, our research initially focused on respiratory gated radiotherapy, employing a commercially available external marker based real time position monitoring system. Multiple session recordings of simultaneous diaphragm motion and external marker motion revealed a consistent linear relationship between the two signals indicating that the external marker motion (along the anterior-posterior (AP) direction) could be used as a "surrogate" for motion of internal anatomy (along the SI direction). The predictability of diaphragm motion based on such external marker motion both within and between treatment sessions was also determined to be of the order of 0.1 cm.Analysis of the parameters that affected the accuracy and efficacy of respiratory gated radiotherapy revealed a direct relationship between the amount of residual motion and the width of the "gate" window. It also followed therefore that a trade-off existed between the width of the "gate" and the accuracy of gated treatments and also the overall "Beam ON" time. Further, gating during exhale was found to be more reproducible than gating during inhale. Although, it was evident that a reduction in the width of the "gate" implied a reduction in the margins added around the clinical target volume (CTV), such a reduction was limited by setup error.A study of the potential gains that could be derived from respiratory gating (based on motion phantom experimental set up) indicated a potential CTV-PTV margin reduction of 0.2-1.1 cm while employing gating alone in combination with an electronic portal imaging device, thus decreasing the amount of healthy tissue receiving radiation. In addition, gating also improved the quality of images obtained during simulation by reducing the amount of motion artifacts that are typically seen during conventional spiral CT imaging.Imparting some form of training was hypothesized to better enable patients to breathe in a reproducible fashion, which was further thought to increase the accuracy and efficacy of gated radiotherapy, especially when the "gate" was set close to the inhale portion of the breathing cycle. An analysis of breathing patterns recorded from five patients over several sessions under conditions of normal quiet breathing, breathing with audio instructions and breathing with visual feedback indicated that training improved the reproducibility of amplitude or frequency of patient breathing cycles.An initial exploration into respiration synchronized radiotherapy was thought to facilitate realization of reduced margins without having to hold the radiation beam delivery during a breathing cycle (as is the case with gating). A feasibility study based on superimposition of respiratory motion of a tumor (simulated by a sinusoidal motion oscillator) onto the initial beam aperture as formed by the multileaf collimator (MLC) revealed that tumor dose measurements obtained with such a set up were equivalent to those delivered to a static tumor by a static beam.Finally, a feasibility study for a method to acquire respiration synchronized images of a motion phantom and a patient (in order to perform respiration synchronized treatment planning and delivery) yielded success in the form of a 4D CT data set with reduced motion artifacts.In summary, respiratory gated radiotherapy and respiration synchronized are both viable approaches to account for respiratory motion during radiotherapy. While respiratory gated radiotherapy has been successfully implemented in some centers, several technical advances are required to enable similar success in the implementation of respiration synchronized radiotherapy. However, the potential clinical gains that can be obtained from either of the above approaches and their relative contributions to margin reduction will determine their future applicability as routine treatment procedures.

Orientador: Maria Jaqueline Mamprim / Banca: Carlos Roberto Teixeira / Banca: Sheila Canevese Rahal / Banca: Cibele Figueira Carvalho / Banca: Ricardo Coelho Lehmkuhl / Resumo: O gato do mato (Leopardus tigrinus) é considerado uma espécie ameaçada de extinção no território brasileiro, sendo mais vulnerável em algumas regiões. A coleta de informações desta espécie é fundamental para originar conhecimentos sobre peculiaridades da mesma e assim, contribuir para reverter esse quadro atual. Pesquisas relacionadas ao diagnóstico por imagem no gato do mato são raras assim como o conhecimento de sua anatomia e enfermidades. Portanto, o estudo pela ultrassonográfica abdominal desta espécie irá proporcionar uma fonte de dados de normalidade, os quais poderão ser utilizados para diagnosticar enfermidades, colaborando para a preservação e manutenção da espécie. O grupo foi composto por 20 Leopardus tigrinus clinicamente sadios que foram submetidos ao exame ultrassonográfico abdominal com a finalidade de obtenção de parâmetros de normalidade de bexiga, baço, adrenal, rins, estômago, fígado e vesícula biliar, bem como parâmetros dopplerfluxométricos de vasos hepáticos e renais. Desse grupo dois gatos do mato tiveram intercorrências anestésicas e foram excluídos do projeto. O objetivo do presente estudo foi descrever a anatomia ultrassonográfica abdominal em gatos do mato criados em cativeiro, para que essa informação possa ser utilizada como referência no diagnóstico de enfermidades que tenham envolvimento abdominal e, como consequência, possam ajudar na manutenção e preservação da espécie. A hipótese foi que a anatomia ultrassonográfica abdominal do gato do mato é similar ao gato doméstico / Abstract: The oncilla (Leopardus tigrinus) is considered an endangered species in the Brazilian territory, being more vulnerable in some regions. Collecting information of this specie is essential to provide knowledge about its peculiaritie and help to reverse the current frame. Studies related to diagnostic imaging in the oncillas are rare as well as knowledge of their anatomy and diseases. Therefore, the abdominal ultrasound study of this species will provide a source of normality parameters, which may be used to diagnose diseases, contributing to the preservation and maintenance of the species. Twenty clinically healthy oncilla were selected for the abdominal ultrasound examination in order to obtain normal parameters of bladder, spleen, adrenal, kidney, stomach, liver and gallbladder, and Doppler parameters of liver and kidneys vessels. Two oncillas had anesthesia issues and were no included in the study. The aim of this study was to describe the normal abdominal echoanatomy of the oncilla. This study provides information of normal abdominal anatomical structures which can be basis for the study of diseases that cause abdominal involvement and to assist in the routine of centers of veterinary medicine in wild animals and/or cats. The hipothesis was that the echoanatomy of the oncilla was similar to the domestic cat / Mestre

A abdominoplastia é uma das cirurgias plásticas mais realizadas. A associação entre a lipoaspiração e o descolamento reduzido trouxe uma nova perspectiva em relação à maior preservação da inervação cutânea sensitiva. Novos métodos de avaliação de sensibilidade têm permitido melhor quantificação e uma análise mais completa da evolução pós-operatória. Foi realizado um estudo do tipo caso-controle comparando-se um grupo controle de pacientes não operadas, um grupo de pacientes que realizou abdominoplastia convencional e um grupo que realizou abdominoplastia associada a lipoaspiração e descolamento reduzido. Para a avaliação da sensibilidade, utilizou-se o PSSD (dispositivo específico de sensibilidade de pressão), testes para sensibilidade térmica e dolorosa (agulhas). O PSSD foi aplicado em nove regiões da parede abdominal anterior para determinação do limiar cutâneo de pressão (LCP) em duas modalidades sensoriais: um ponto estático (1PE), para avaliação de fibras de adaptação lenta, e um teste dinâmico (1PD), para avaliação de fibras de adaptação rápida. Quanto maior o LCP, menor a sensibilidade na região. Foram incluídas 46 pacientes nos três grupos. O grupo controle continha 10 pacientes, cujos limiares cutâneos de pressão (LCP) variaram de 0,82 a 0,84 e de 0,77 a 0,79 g/mm2 para 1PE e 1PD, respectivamente. O grupo de abdominoplastia convencional (AC) continha 14 pacientes com medidas em dois momentos de pós-operatório, precoce (5,75 meses) e tardio (17,36 meses). Os resultados demonstraram LCPs entre 1,02 e 39,94 para a medida precoce e 0,79 e 20,07 g/mm2 para a medida tardia. O grupo de abdominoplastia associada a lipoaspiração (LA) continha 22 pacientes com acompanhamento de 5,72 meses (precoce) e 14,91 meses (tardio). Os resultados demonstraram LCPs entre 0,62 e 4,98 para a medida precoce e 0,67 e 1,91 g/mm2 para a medida tardia. A análise estatística usou método de análise de variância com medidas repetidas. O nível de significância adotado foi de 0,05. A análise estatística para a medida de 1PE revelou redução da sensibilidade significante no grupo AC em todas as regiões (precoce e tardia). No grupo LA, houve redução da sensibilidade apenas nas regiões de mesogastro e hipogastro na medida precoce com regularização total na análise tardia. Entretanto, a análise estatística para 1PD revelou, no grupo AC, redução na medida precoce em todas as regiões e redução apenas das regiões centrais (mesogastro e hipogastro) na análise tardia. Já no grupo LA, todas as medidas estavam normalizadas na análise precoce e tardia. A análise da sensibilidade térmica e dolorosa revelou reduções centrais, especialmente nas regiões de mesogastro e hipogastro no grupo AC. O grupo LA revelou áreas de anestesia térmica e dolorosa apenas em pequena área do hipogastro. Concluiu-se que as três modalidades sensoriais (tátil, térmica e dolorosa) são mais preservadas no grupo LA que no grupo AC. A recuperação da medida 1PD é mais rápida que a medida de 1PE / Abdominoplasties are common plastic surgery procedures. New techniques associating lipoaspiration with selective undermining are bringing new perspectives with regard to the preservation of cutaneous sensibility. New methods of evaluation of cutaneous sensibility have allowed researchers to do a more complete analysis. This is a case-control study comparing a control group of patients non operated with one group submitted to conventional abdominoplasty and another group submitted to abdominoplasty associating lipoaspiration with selective undermining. The abdominal surface was divided into nine regions for sensibility evaluation. Superficial tactile sensibility was tested using the Pressure Specified Sensory Device (PSSD) which allows the determination of the cutaneous pressure threshold (static and moving). Tests of pain and thermal sensibility were also performed. A total of 46 patients were divided in three groups. In the control group, with 10 patients, the cutaneous pressure thershold (CPT) oscilated from 0.82 to 0.84 and from 0.77 to 0.79 g/mm2 for one point static and one point moving sensibility evaluations, respectively. The group of patients submitted to conventional abdominoplasty (AC), with 14 patients, was evaluated in two moments of follow-up: early (mean of 5.75 months after surgical procedure) and late (17.36 months). The results showed CPTs betwen 1.02 and 39.94 in the early follow-up, versus 0.79 to 20.07 g/mm2 in the late follow-up. The group submitted to abdominoplasty associated with lipoaspiration and selective underminig (LA) had 22 patients, with a mean follow-up period of 5.75 (early) and 14.91 (late) months. The results showed CPTs betwen 0.62 and 4.98 (early) and 0.67 and 1.91 g/mm2 (late). The statistical analysis was conducted with the analysis of variance with repeated measurements. The level of significance adopted was p < 0.05. The estatistical analysis for one point static showed significant reduction of sensibility in the group AC in all abdominal regions (in the early and late follow-up periods). The group LA presented reduced CPT only in the mesogastric and hypogastric in the early evaluation; the late evaluation was normal. On the other hand, the analisis of one point moving showed, in the group AC, a reduction of early evaluation measurement in all abdominal regions and a reduction only in central regions (mesogastric and hypogastric) in the late. The LA group presented normal in all measurements. The analysis of pain and thermal sensibility shows that the centermost regions of the abdomen, mesogastric and hypogastric, presented the highest anesthesia index in the AC group. The LA group showed just some islands in the hipogastric regions. The recuperation of the 1PD evaluation was faster than the 1PE. In conclusion, the three sensibilities (tactile, thermal and pain) were more preservated in the LA group. Abdominoplasty with lipoaspiration could be considered a better choice than conventional abdominoplasty considering the preservation of cutaneous sensibility

Made available in DSpace on 2016-04-28T20:15:26Z (GMT). No. of bitstreams: 1 2007-Tiago Marques dos Santos.pdf: 2575604 bytes, checksum: e88af70c2740e40f39ed1fb8bd423ec5 (MD5) Previous issue date: 2007-02-26 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This work aimed to evaluate gastrointestinal and systemic disturbances, and mucosa and gut contents of gastrointestinal tract of horses subjected to overload carbohydrate. Eight crossbreed mature horses were used with body weight (BW) average of 364kg, geldings, adapted to diet composed by grass hay and concentrate, in a 60:40 proportion. A complete randomized design was used with horses allocated in three treatments. Treatment I: (Control) (n=2) horses were slaughtered without overload carbohydrate; Treatment II (n=3) and III (n=3), horses subjected to overload carbohydrate, with gastric infusion of 17.6 g starch/kg BW, and slaughtered after 24 and 36 hours, respectively. Horses were subjected to clinical, hematological and fecal evaluations before the overload and 2, 4, 8, 12, 16, 20, 24, 28, 32 and 36 hours after overload. Four hours after overload horses became depressed and keeping until the end of evaluation, and one horse presented lameness 36 hours after overload. Any difference (P>0.05) were observed in heart rate, respiratory rate, body temperature and hoof temperature. Increase in packed cell volume and plasma protein concentration were observed 24 hours after overload, varying from 26.7 to 32.0% and 7.1 to 8.1 g/dL, respectively (P<0.05). Differences were observed (P<0.05) in plasmatic lactate concentration in zero, 20 and 28 hours after overload, with values of 0.7, 1.04 and 1.22 mmol/L, respectively. Plasma endotoxin concentration didn't cross 0.1000 EU/mL and may be not present. There were any difference (P>0.05) in fecal and digesta water content, however, fecal pH reduced along 36 hours post-overload (P <0.01), varying from 6.09 to 4.46. Content of large intestine in horses subjected to overload presented whitish-green color, milk aspect, with gas bubbles and acid odor. There weren t difference (P>0.05) in water content of feces and digesta, however, fecal pH reduced along 36 hours post-overload (P <0.01), varying from 6.09 to 4.46. Buffering capacity of ceco-colon digesta and feces were reduced in horses subjected to overload. Right dorsal colon, transverse colon and descendent colon were segments, except stomach, that presented lower pH values, varying from 4.49 to 4.56. Eosinophils infiltration were presented in mucosa and submucosa of all horses, however, only horses submitted to overload presented neutrophils and eosinophils leucocitoestase with neutrophils predominance restricted to large intestine. Tract gastrointestinal circulatory alterations observed were congestion, edema and lymphatic vessels dilatation, more evident in submucosa, with larger inflammatory cells infiltration in horses subjected to overload. Intestinal mucosa 36 hours after overload presented larger degree of imunorreactivity anti-myeloperoxidase, followed by horses evaluated at 24 hours after overload and control horses, varying from 2.7 to 4.0, 1.0 to 3.7 and 1.0 to 2.5, respectively. Overload carbohydrate in horses promoted intensive fermentation in ceco-colon, predisposing clinical disturbances, digesta alterations and mucosa and submucosa lesions at gastrointestinal tract of horses with light to moderate degree,36 hours after overload. / Este trabalho teve como objetivo avaliar as altera??es sist?micas, da mucosa e conte?do do trato gastrointestinal de eq?inos submetidos ? sobrecarga diet?tica com amido. Foram utilizados oito eq?inos adultos castrados, com peso vivo m?dio de 364 kg, adaptados a dieta composta por feno de Coastcross e concentrado, na propor??o de 60:40. Foi utilizado um delineamento experimental com tr?s tratamentos: Tratamento I (Controle) (n=2), eutan?sia dos animais sem sobrecarga com amido; Tratamentos II (n=3) e III (n=3), animais submetidos ? sobrecarga com amido, com infus?o g?strica de 17,6 g amido/kg de peso corporal e eutan?sia ap?s 24 e 36 horas, respectivamente. Os eq?inos foram submetidos a avalia??es cl?nicas, hematol?gicas e f?sico-qu?micas das fezes antes da sobrecarga e 2, 4, 8, 12, 16, 20, 24, 28, 32 e 36 horas p?s-sobrecarga. Os animais apresentaram-se ap?ticos quatro horas ap?s a sobrecarga permanecendo assim at? o final da avalia??o e apenas um animal apresentou claudica??o, 36 horas p?s-sobrecarga. N?o houve diferen?a (P>0,05) na freq??ncia card?aca, freq??ncia respirat?ria, temperatura corporal e temperatura dos cascos. Houve aumento (P<0,05) no volume globular e prote?na plasm?tica total, 24 horas p?s-sobrecarga, variando de 26,7 a 32,0% e de 7,1 e 8,1 g/dL, respectivamente. Houve diferen?a (P<0,05) na concentra??o plasm?tica de lactato no tempo zero, 20 e 28 horas p?s-sobrecarga, com valores de 0,7, 1,04 e 1,22 mmol/L, respectivamente. A concentra??o plasm?tica de endotoxinas n?o ultrapassou 0,1000 EU/mL, podendo estar at? mesmo ausente. O conte?do do intestino grosso nos eq?inos submetidos ? sobrecarga apresentou cor verde esbranqui?ada, aspecto leitoso, com bolhas de g?s e odor ?cido. N?o houve diferen?a (P>0,05) no teor de ?gua das fezes e do conte?do da digesta, no entanto, o pH fecal reduziu ao longo de 36 horas p?s-sobrecarga (P<0,01), variando de 6,09 a 4,46. Houve redu??o na capacidade de tamponamento das fezes nos eq?inos submetidos ? sobrecarga e, de forma similar, ocorreu no conte?do do ceco-c?lon. O c?lon dorsal direito, c?lon transverso e c?lon descendente foram os segmentos, com exce??o do est?mago, que apresentaram a digesta com menores valores de pH, variando de 4,49 a 4,56. ? histopatologia, a infiltra??o de eosin?filos esteve presente na mucosa e submucosa de todos os eq?inos, no entanto, somente em dois eq?inos submetidos ? sobrecarga, observou-se leucocitoestase de neutr?filos e eosin?filos, com predomin?ncia de neutr?filos no intestino grosso. As altera??es circulat?rias observadas no trato gastrointestinal foram congest?o, edema e dilata??o de vasos linf?ticos, sendo mais evidentes na submucosa, local de maior infiltra??o de c?lulas inflamat?rias nos eq?inos submetidos ? sobrecarga. A mucosa dos segmentos do trato gastrointestinal dos eq?inos eutanasiados 36 horas p?ssobrecarga apresentou maior grau de imunorreatividade anti-mieloperoxidase, seguido dos eq?inos avaliados 24 horas p?s-sobrecarga e dos eq?inos do tratamento controle, variando de 2,7 a 4,0, 1,0 a 3,7 e 1,0 a 2,5, respectivamente. A sobrecarga diet?tica com amido em eq?inos promove fermenta??o intensa no ceco-c?lon, predispondo ao aparecimento de dist?rbios cl?nicos, altera??es do conte?do da digesta e les?es de leve a moderada na mucosa e submucosa do trato gastrointestinal dos eq?inos, ap?s 36 horas da sobrecarga.

University of Macau / Faculty of Science and Technology / Department of Computer and Information Science

Reproduction de : Thèse de doctorat : Automatique et Informatique industrielle : Lille 1 : 2004. / N° d'ordre (Lille 1) : 3510. Résumé en français et en anglais. Titre provenant de la page de titre du document numérisé. Bibliogr. f. 142-158. Liste des publications.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (p. 234-239).