Fundamentação: Pacientes após o Acidente Vascular Encefálico (AVE) em fase aguda apresentam disfagia orofaríngea com risco de aspiração traqueal. Objetivos: Verificar a prevalência de sinais ou sintomas sugestivos de disfagia orofaríngea medidos através de avaliação clínica da deglutição em pacientes adultos, após o Acidente Vascular Encefálico, internados na Enfermaria de Neurologia do Hospital de Pronto Socorro de Porto Alegre. Métodos: Foram incluídos neste estudo os pacientes internados na Enfermaria de Neurologia de um Hospital Público, entre maio de 2009 e novembro de 2010, com diagnóstico de AVE isquêmico ou hemorrágico, que tiveram sua dieta via oral liberada pela equipe médica. Foram avaliados 101 pacientes (56 homens), até 72 horas após o evento, à beira do leito. Através de um protocolo da deglutição foram testadas consistências líquidas e pastosas para observar a presença de preditores clínicos que, seguramente, podem indicar risco de aspiração. Resultados: A média de idade dos pacientes avaliados foi de 64 anos. Trinta e seis destes tinham idade abaixo de 60 anos. Foram avaliadas 45 mulheres e 56 homens. Observou-se uma prevalência de 448,5% (49/101; IC 95%:3:8,9,% a 5,24%) de disfagia orofaríngea nestes pacientes. A predominância de gênero foi masculina e o tipo de AVE predominante foi o isquêmico. Observou-se uma correlação entre mulheres com disfagia (57,1%) e AVE hemorrágico neste grupo. Conclusão: Sinais clínicos de disfagia orofaríngea e risco para aspiração pós AVE podem ser identificados na avaliação clínica da deglutição através de um protocolo de deglutição com preditores clínicos validados na literatura. / Background: Patients after stroke in acute phase present oropharyngeal dysphagia having risk of tracheal aspiration. Objectives: To verify the prevalence of signs or symptoms suggesting oropharyngeal dysphagia with risk of tracheal aspiration with clinical evaluation of swallowing in adult patients after stroke interned in the Neurology Ward of the Hospital de Pronto Socorro de Porto Alegre. Methods: In this study patients interned in a Neurology Ward of a Public Hospital, between May 2009 and November 2010, diagnosed with ischemic or hemorrhagic stroke, having their oral diet released by the medical team. It was evaluated 101 patients (56 men), within the first 72 hours after being admitted to hospital, at bedside. Using a swallowing protocol, liquid and pudding consistencies were tested in order to observe the presence of clinical predictors which can indicate aspiration risk. Results: The mean age of the evaluated patients was 64 years old. Thirty six of these patients were under 60 years old. Forty five women and 56 men were evaluated. It was observed a prevalence of 48.5% (CI (49/101;IC 95%:38,9,% to 58,2%) of oropharingeal swallowing in those patients. The predominance was the male gender and the prevailing kind of stroke was the ischemic. In this group, it was observed a correlation among women with dysphagia (57.1%) and hemorrhagic stroke. Conclusion: Clinical signs of Oropharingeal dysphagia and aspiration risk after stroke can be identified in the clinical evaluation of swallowing through a swallowing protocol with clinical predictors validated in the literature.

Fundamentação: Pacientes após o Acidente Vascular Encefálico (AVE) em fase aguda apresentam disfagia orofaríngea com risco de aspiração traqueal. Objetivos: Verificar a prevalência de sinais ou sintomas sugestivos de disfagia orofaríngea medidos através de avaliação clínica da deglutição em pacientes adultos, após o Acidente Vascular Encefálico, internados na Enfermaria de Neurologia do Hospital de Pronto Socorro de Porto Alegre. Métodos: Foram incluídos neste estudo os pacientes internados na Enfermaria de Neurologia de um Hospital Público, entre maio de 2009 e novembro de 2010, com diagnóstico de AVE isquêmico ou hemorrágico, que tiveram sua dieta via oral liberada pela equipe médica. Foram avaliados 101 pacientes (56 homens), até 72 horas após o evento, à beira do leito. Através de um protocolo da deglutição foram testadas consistências líquidas e pastosas para observar a presença de preditores clínicos que, seguramente, podem indicar risco de aspiração. Resultados: A média de idade dos pacientes avaliados foi de 64 anos. Trinta e seis destes tinham idade abaixo de 60 anos. Foram avaliadas 45 mulheres e 56 homens. Observou-se uma prevalência de 448,5% (49/101; IC 95%:3:8,9,% a 5,24%) de disfagia orofaríngea nestes pacientes. A predominância de gênero foi masculina e o tipo de AVE predominante foi o isquêmico. Observou-se uma correlação entre mulheres com disfagia (57,1%) e AVE hemorrágico neste grupo. Conclusão: Sinais clínicos de disfagia orofaríngea e risco para aspiração pós AVE podem ser identificados na avaliação clínica da deglutição através de um protocolo de deglutição com preditores clínicos validados na literatura. / Background: Patients after stroke in acute phase present oropharyngeal dysphagia having risk of tracheal aspiration. Objectives: To verify the prevalence of signs or symptoms suggesting oropharyngeal dysphagia with risk of tracheal aspiration with clinical evaluation of swallowing in adult patients after stroke interned in the Neurology Ward of the Hospital de Pronto Socorro de Porto Alegre. Methods: In this study patients interned in a Neurology Ward of a Public Hospital, between May 2009 and November 2010, diagnosed with ischemic or hemorrhagic stroke, having their oral diet released by the medical team. It was evaluated 101 patients (56 men), within the first 72 hours after being admitted to hospital, at bedside. Using a swallowing protocol, liquid and pudding consistencies were tested in order to observe the presence of clinical predictors which can indicate aspiration risk. Results: The mean age of the evaluated patients was 64 years old. Thirty six of these patients were under 60 years old. Forty five women and 56 men were evaluated. It was observed a prevalence of 48.5% (CI (49/101;IC 95%:38,9,% to 58,2%) of oropharingeal swallowing in those patients. The predominance was the male gender and the prevailing kind of stroke was the ischemic. In this group, it was observed a correlation among women with dysphagia (57.1%) and hemorrhagic stroke. Conclusion: Clinical signs of Oropharingeal dysphagia and aspiration risk after stroke can be identified in the clinical evaluation of swallowing through a swallowing protocol with clinical predictors validated in the literature.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Teve-se como proposta construir e validar as definiÃÃes conceituais e os referentes empÃricos dos Resultados de Enfermagem (RE) relacionados ao Estado da deglutiÃÃo e à PrevenÃÃo da aspiraÃÃo em pacientes apÃs acidente vascular cerebral (AVC). Estudo metodolÃgico, realizado em trÃs etapas: anÃlise de conceito, validaÃÃo por especialistas e validaÃÃo clÃnica. Para a AnÃlise de Conceito, realizou-se RevisÃo Integrativa, com acesso on-line a seis bases de dados: Pubmed, Cinahl, Scopus, EMBASE, Web of science e Lilacs, bem como dissertaÃÃes e teses disponibilizadas no site da CAPES e na BDTD. Na busca utilizaram-se os descritores: Deglutition, Deglutition Disorders e Stroke e sua sinonÃmia em portuguÃs. ApÃs leitura crÃtica e aplicaÃÃo dos critÃrios de inclusÃo e exclusÃo, foram obtidos 29 artigos, cinco dissertaÃÃes e uma tese. O conceito em estudo inicialmente foi a âDeglutiÃÃoâ, e os atributos crÃticos: conteÃdo oral (alimento, lÃquido ou saliva); estÃmulos motor e sensitivo; fase oral, farÃngea e esofÃgica; e transporte da boca atà o estÃmago. Foi elaborado um caso modelo e um caso contrÃrio e identificados antecedentes e consequentes para DeglutiÃÃo no contexto de pacientes com AVC. Ao final da etapa, foram identificados 14 indicadores para o Estado da deglutiÃÃo e revisada a sua definiÃÃo. O conceito de aspiraÃÃo jà havia sido estudado, e nÃo foi ressubmetido à AnÃlise de Conceito. Assim, para o RE PrevenÃÃo da aspiraÃÃo foram identificados seis indicadores e revisados o tÃtulo e a definiÃÃo. Ao final da AnÃlise de Conceito, construiu-se um instrumento de avaliaÃÃo dos dois RE com seus indicadores, definiÃÃes conceituais e referentes empÃricos. ApÃs avaliaÃÃo por Comità de Ãtica em pesquisa, o instrumento foi submetido à apreciaÃÃo de 14 profissionais. Os dados da apreciaÃÃo foram compilados no programa Excel e analisados pelo SPSS versÃo 20.0. A maioria dos juÃzes era do sexo feminino (85,71%), enfermeiros (92,86%), com tempo de formaÃÃo de 6,64 anos (Â6,72), trabalhavam no Cearà (92,86%). Os especialistas propuseram revisÃo em todos os indicadores e definiÃÃes para melhor atender aos critÃrios da psicometria; agrupamento dos indicadores ProduÃÃo de saliva e ManutenÃÃo do conteÃdo oral na boca; exclusÃo dos indicadores FormaÃÃo do bolo alimentar, NÃmero de deglutiÃÃes e MudanÃa na qualidade da voz, por considerarem que eram possÃveis de serem avaliados por outros indicadores, e a elaboraÃÃo do indicador Utiliza sondas gÃstricas e enterais de forma adequada. Exceto o Ãltimo indicador, os demais foram validados clinicamente em 81 pacientes com AVC, os quais eram avaliados por duas duplas de enfermeiros, uma com instrumento com as definiÃÃes construÃdas e a outra com instrumento sem definiÃÃes. As avaliaÃÃes foram comparadas pelo Coeficiente de CorrelaÃÃo Intraclasse, teste de Friedman e pela DiferenÃa MÃnima Significante. A dupla com definiÃÃes apresentou concordÃncia total na avaliaÃÃo dos resultados. Apenas o indicador Refluxo nasal foi avaliado de forma similar pelos dois grupos. A anÃlise de cluster demonstrou agrupamento preferencial dos indicadores do RE PrevenÃÃo da aspiraÃÃo respiratÃria. Diante desses achados, recomenda-se a continuaÃÃo do processo de validaÃÃo destes resultados para confirmar o agrupamento dos seus indicadores, bem como sua validaÃÃo para condiÃÃes clÃnicas diferentes do AVC. / The study aimed to build and validate the conceptual definitions and empirical referents of nursing outcomes (NO) related to the State of swallowing and the Prevention of aspiration in patients after stroke. This is a methodological study carried out in three stages: concept analysis, validation by experts and clinical validation. The concept analysis was performed by integrative literature review through online access to six databases: PubMed , CINAHL , Scopus , EMBASE , Web of science and Lilacs, and dissertations and theses available on the website of CAPES and BDTD. The following descriptors were used: deglutition , deglutition disorders and stroke and their synonyms in Portuguese. After a critical reading and the application of inclusion and exclusion criteria, 29 articles, five dissertations and one thesis were obtained. Initially the concept of study was âSwallowingâ and its critical attributes: oral content (food, liquid or saliva), motor and sensory stimulation; oral, pharyngeal and esophageal phases; and transport from the mouth to the stomach. A case model and a opposite case were elaborated and antecedents and consequential for swallowing in the context of stroke patients. At the end, 14 indicators were identified for the swallowing state and its definition was reviewed. The concept of aspiration has already been studied and it was not submitted again to the analysis concept. Thus, for the NO Prevention of aspiration, six indicators were identified and their titles and definitions were revised. After the concept analysis, a tool was built with the concepts and empirical references of both NO. After evaluation by the Research Ethics Committee, the tool was submitted to 14 professionals. The date were compiled in the Excel software and analyzed by the SPSS software version 20.0. According to the sample profile: most experts were female (85.71%), nurses (92.86%), graduated in an average of 6.64 years ago ( 6.72), working in Cearà (92.86%). The experts proposed revision for all the indicators and definitions in order to fit the psychometrics criteria, clustering the indicators Saliva production and Maintains food in mouth; exclusion of the indicators Bolus formation, Number of swallows and Changes in voice quality. The changes happened because the experts considered the possibility to evaluated those indicators by other indicators; and the development of the indicator Uses gastric and enteral tube properly. With the exception of the last indicator, the others were clinically validated in 81 patients with stroke, who were evaluated by two pairs of nurses, one with the tool with the definitions built and the other without the definitions. The evaluations were compared by intraclass correlation coefficient, Friedman test and Minimum Significant Difference. The pair of nurses with the definitions presented total agreement on the evaluation of the results. Only the indicator Nasal reflux was evaluated similarly by both groups. The cluster analysis showed preferential grouping of indicators to the NO Prevention of aspiration. Then, it is recommended the continuation of the validation process of these results in order to confirm the grouping of its indicators, as well as its validation for clinical conditions other than stroke.

Fundamentação: Pacientes após o Acidente Vascular Encefálico (AVE) em fase aguda apresentam disfagia orofaríngea com risco de aspiração traqueal. Objetivos: Verificar a prevalência de sinais ou sintomas sugestivos de disfagia orofaríngea medidos através de avaliação clínica da deglutição em pacientes adultos, após o Acidente Vascular Encefálico, internados na Enfermaria de Neurologia do Hospital de Pronto Socorro de Porto Alegre. Métodos: Foram incluídos neste estudo os pacientes internados na Enfermaria de Neurologia de um Hospital Público, entre maio de 2009 e novembro de 2010, com diagnóstico de AVE isquêmico ou hemorrágico, que tiveram sua dieta via oral liberada pela equipe médica. Foram avaliados 101 pacientes (56 homens), até 72 horas após o evento, à beira do leito. Através de um protocolo da deglutição foram testadas consistências líquidas e pastosas para observar a presença de preditores clínicos que, seguramente, podem indicar risco de aspiração. Resultados: A média de idade dos pacientes avaliados foi de 64 anos. Trinta e seis destes tinham idade abaixo de 60 anos. Foram avaliadas 45 mulheres e 56 homens. Observou-se uma prevalência de 448,5% (49/101; IC 95%:3:8,9,% a 5,24%) de disfagia orofaríngea nestes pacientes. A predominância de gênero foi masculina e o tipo de AVE predominante foi o isquêmico. Observou-se uma correlação entre mulheres com disfagia (57,1%) e AVE hemorrágico neste grupo. Conclusão: Sinais clínicos de disfagia orofaríngea e risco para aspiração pós AVE podem ser identificados na avaliação clínica da deglutição através de um protocolo de deglutição com preditores clínicos validados na literatura. / Background: Patients after stroke in acute phase present oropharyngeal dysphagia having risk of tracheal aspiration. Objectives: To verify the prevalence of signs or symptoms suggesting oropharyngeal dysphagia with risk of tracheal aspiration with clinical evaluation of swallowing in adult patients after stroke interned in the Neurology Ward of the Hospital de Pronto Socorro de Porto Alegre. Methods: In this study patients interned in a Neurology Ward of a Public Hospital, between May 2009 and November 2010, diagnosed with ischemic or hemorrhagic stroke, having their oral diet released by the medical team. It was evaluated 101 patients (56 men), within the first 72 hours after being admitted to hospital, at bedside. Using a swallowing protocol, liquid and pudding consistencies were tested in order to observe the presence of clinical predictors which can indicate aspiration risk. Results: The mean age of the evaluated patients was 64 years old. Thirty six of these patients were under 60 years old. Forty five women and 56 men were evaluated. It was observed a prevalence of 48.5% (CI (49/101;IC 95%:38,9,% to 58,2%) of oropharingeal swallowing in those patients. The predominance was the male gender and the prevailing kind of stroke was the ischemic. In this group, it was observed a correlation among women with dysphagia (57.1%) and hemorrhagic stroke. Conclusion: Clinical signs of Oropharingeal dysphagia and aspiration risk after stroke can be identified in the clinical evaluation of swallowing through a swallowing protocol with clinical predictors validated in the literature.

L'étude effectuée au cours de cette thèse s'inscrit dans le contexte du contrôle des écoulements en turbomachines. Suite à l'intérêt avéré de l'aspiration de la couche limite en compresseurs axiaux pour en améliorer les performances, elle vise à évaluer si cette méthodologie de contrôle est pertinente en géométrie radiale. Elle s'appuie pour cela sur un compresseur centrifuge transsonique Turbomeca. Le fonctionnement du compresseur est d'abord analysé sur la base de simulations numériques stationnaires et instationnaires chorochroniques, réalisées grâce au code de calcul elsA développé par l'Onera et en utilisant le modèle de turbulence k-l de Smith. La validité des résultats numériques est vérifiée par comparaison avec les données expérimentales disponibles : performances mono-dimensionnelles et signaux de pressions instationnaires. Ces données sont issues à la fois de la caractérisation expérimentale du compresseur effectuée par Turbomeca et de campagnes de mesures menées a l'ISAE, ou le compresseur est monté sur un banc de recherche dédié à l'étude des interactions entre le rouet et le diffuseur radial. L'analyse détaillée des résultats numériques révèle le développement d'un décollement de coin dans le diffuseur, entre la paroi moyeu et la face en dépression des aubages, lorsque le point de fonctionnement se rapproche du pompage. L'étude topologique du spectre du frottement pariétal permet d'en préciser le lieu et la structure, et de localiser les points singuliers ainsi que la ligne de séparation principale. En stationnaire, la croissance du décollement aboutit au décrochage du diffuseur, et compromet les performances de l'étage de compression et finalement la stabilité numérique. L'exploitation des résultats instationnaires permet de préciser le comportement temporel de l'écoulement : l'étendue du décollement fluctue sous l'effet du défilement des ondes de pression générées par l'interaction rouet-diffuseur, mais les trajectoires des particules fluides impliquées dans le décollement sont en accord avec les lignes de courant du champ de l'écoulement moyenné temporellement. Le décollement instationnaire est fixe, et sa topologie correspond à celle prévue par les simulations stationnaires. En particulier, le lieu du décollement est prévu de façon similaire par les modèles stationnaires et instationnaires. Une stratégie d'aspiration est ensuite développée sur la base de ces observations : une fente de prélèvement est positionnée au voisinage du col de séparation principal, dont le lieu correspond à celui du maximum du gradient de pression adverse stationnaire. Cette stratégie est implémentée au sein des modèles numériques stationnaires et instationnaires. En stationnaire, un prélèvement de 1 % de la valeur totale du débit traversant le rouet permet un contrôle total du décollement dans le diffuseur, et conduit à une augmentation significative de la plage de stabilité numérique. La réduction du débit de prélèvement à 0,3 % du débit total permet un contrôle partiel du décollement, et conduit également à une augmentation de la plage de stabilité numérique. En instationnaire, le décollement de coin initial est contrôlé. Mais les résultats mettent en évidence le rôle majeur joue par le défilement des ondes de pression le long des aubages du diffuseur. Celles-ci se renforcent au passage du col du diffuseur, et engendrent l'existence d'un important gradient de pression adverse instantané. Ce maximum du gradient de pression instantané conduit au développement d'un nouveau décollement de coin, en aval de la fente de prélèvement, et la plage de stabilité des calculs instationnaires n'est pas augmentée. Ces résultats mettent en évidence la possibilité d'agir sur les décollements se produisant dans les diffuseurs radiaux à l'aide de la technique d'aspiration de la couche limite. […] / The study presented in this manuscript takes place in the context of flow control within tur - bomachinery. Following the demonstration of the effectiveness of the boundary layer suction technique in axial compressors for improving their performance, the present work aims at determining if this same technique may be relevant in radial compressors. Boundary layer suction is then applied on a centrifugal compressor stage, designed and built by Turbomeca, Safran group. The working of the compressor is first analyzed thanks to steady-state and unsteady numerical simulations, performed using the elsA solver developed by Onera, the French Aerospace Laboratory. The turbulence is modeled with the two equations k-l model of Smith. The validity of the numerical results is ensured by comparison with available experimental measurements results: one-dimensional performance coefficients and time-dependent pressure signals. This data were obtained by both Turbomeca, during the characterization of the compressor, and the fluid mechanics laboratory of ISAE, Université de Toulouse, were the compressor is mounted in an experimental test rig dedicated for studying the impeller-diffuser interactions. The detailed analysis of the numerical results reveals the growth of a corner separation within the diffuser between the hub endwall and the vane suction side when the operating point moves toward surge. The precise location and the internal structure of that boundary layer separation are then elucidated thanks to a topological study, which allows to identify the singular points and the separating lines of the skin-friction pattern. In steady-state numerical simulations, the development of that corner separation leads to the stall of the diffuser, which compromises the compressor stage performance and finally the stability of the numerical model. Unsteady numerical simulations results allow to specify the temporal behavior of the corner separation: the extent of the separated zone is modulated by the scrolling of pressure waves created by the impeller-diffuser interaction, but the trajectories of fluid particles within the separation match with the streamlines of the time-averaged flow field. The unsteady separation is then fixed, and its topology is in agreement with the prediction of the steady-state numerical simulations. In particular, the location of the separation is predicted similarly by the steady-state and the unsteady numerical models. Afterward, a control strategy using suction technique is developed thanks to the previous conclusions. The suction slot is set in the neighborhood of the main saddle of the separation, which corresponds to the location of the maximum of the time-averaged adverse pressure gradient. This strategy is implemented within both the steady-state and unsteady numerical models. The steady-state numerical model predicts the complete control of the separated zone with a removal of 1% of the total massflow through the compressor. This leads to a significant increase of the numerical stable range. With a removal of 0.3% of the compressor total massflow, the numerical model predicts only a partial control of the corner separation, but it also leads to a significant increase of the numerical stable range. With the unsteady numerical model, the initial hub corner separation is again controlled thanks to aspiration. But the results also highlight the major role played by the scrolling of pressure waves. They reinforce when crossing the diffuser throat, and generates a strong instantaneous adverse pressure gradient. This maximum provokes a new boundary layer separation, further downstream of the suction slot. The stable range of the unsteady numerical model is not increased. These results put into evidence the possibility to act on boundary layer separation that occur in radial diffusers thanks to the boundary layer suction technique. [...]

No description available.

The problem of this thesis is the degree of aspiration (level of aspiration) exhibited by students with high or low levels of academic performance. With these levels established by the use of a standardized test designed for this purpose, this study is concerned more specifically with testing two hypotheses.

There have been few investigations employing the level of aspiration as a motivational independent variable. The problem of the present study was to investigate the effect of an expressed level of aspiration on a subsequent level of performance on a cancellation task and to relate this effect to socio-economic classifications.

The detection or exclusion of metastatic liver involvement is critical in the management and prognosis of patients with malignant disease. Noninvasive imaging modalities such as computed tomography, ultrasound, and technetium colloid liver scan are highly sensitive but nonspecific. Serum alkaline phosphatase is of similar value. A blind liver biopsy by the Menghini technique is often done to confirm the diagnosis, but its yield is low. We prospectively evaluated 74 patients using blind Menghini needle biopsy and concurrent Chiba fine-needle aspiration biopsy (FNAB) techniques. A positive diagnosis of malignancy was made in 30 patients (41%). In only 25 (34%) was the diagnosis made by Menghini biopsy, while Chiba FNAB confirmed the diagnosis in all 30 patients. Thus, concurrent use of both needles increased the diagnostic accuracy by 7%. Seven additional patients, considered to have one or more contraindications for the Menghini biopsy, underwent Chiba FNAB alone; the diagnosis was confirmed in all without complication. We conclude that FNAB alone or in combination with Menghini biopsy is valuable and safe in the diagnosis of metastatic liver disease.

Metastatic carcinomas to the thyroid are quite rare in daily cytology practice. However, when present they may produce a diagnostic dilemma, particularly when they share some morphologic similarities with primary thyroid lesions and when occurring in patients with occult malignant history. Herein, we report a case of metastatic gastric signet ring cell carcinoma to the thyroid. Our patient presented with an isolated right thyroid nodule, which was clinically considered to be a primary thyroid neoplasm. Fine-needle aspiration (FNA) cytology of the nodule revealed a cellular specimen with cohesive fragments and scattered individual neoplastic cells. The neoplastic cells had enlarged nuclei, fine chromatin, and inconspicuous nucleoli. Nuclear crowding, molding, and grooving were prominent. Intranuclear inclusion-like clearance was identified. Some tumor cells also had eccentric nuclei, creating a signet ring cell appearance. The colloid was scant. These cytological features may be seen in cases of papillary thyroid carcinoma or signet ring cell follicular adenoma; however, the presence of the signet ring cells is unusual in primary thyroid lesions and raises the possibility of a metastatic lesion to the thyroid. In our case, the tumor cells were positive for AE1/AE3, mucicarmine, and periodic acid-Schiff, but negative for thyroglobulin and thyroid transcription factor-1. The patient was also found to have a 3.7-cm mass in the distal esophagus/proximal stomach. Biopsy of this mass showed an invasive signet ring cell carcinoma. The purpose of our study is to discuss the cytological features and the differential diagnosis of this unusual thyroid FNA case.