Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Kalp Damar Cerrahisi Anabilim Dalı, 2005. / Bibliyografya var.

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Thesis (Ph.D.)--Drexel University, 2008. / Includes abstract and vita. Includes bibliographical references (leaves 102-122).

Thesis (M.S.)--University of Michigan, 1988.

Thesis (Ph.D.)--Virginia Commonwealth University, 2009. / Prepared for: Dept. of Health and Human Performance. Title from resource description page. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1988.

Made available in DSpace on 2014-06-11T19:23:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-28Bitstream added on 2014-06-13T18:50:43Z : No. of bitstreams: 1 biagioni_mfg_me_botfm.pdf: 802579 bytes, checksum: 9594c1b08b81555be0b3afc4794cb9ab (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A obesidade é uma doença crônica e de caráter epidemiológico, repercutindo de maneira importante na saúde do indivíduo e na sociedade. Atualmente, a cirurgia bariátrica, em especial a Bypass gástrico em Y de Roux (BGYR), vem se popularizando como uma forma de tratamento dessa condição, garantindo perda do excesso de peso superior às terapias convencionais, com manutenção em longo prazo. Contudo, observa-se que, por se tratar de uma cirurgia com componentes restritivos e disabsortivos, o BGYR, pode levar a redução na absorção e ingestão de nutrientes essenciais a homeostase corporal e em especial, a homeostase óssea. Com isso, podem ocorrer alterações no metabolismo ósseo e, consequentemente na estrutura óssea. Os objetivos do presente estudo foram avaliar o efeito da referida cirurgia sobre a ingestão de nutrientes e parâmetros relacionados à remodelação óssea de pacientes obesas antes e após três e seis meses do procedimento, averiguando se existe associação entre a ingestão alimentar e a evolução destes parâmetros. Neste estudo, prospectivo e observacional, foram estudadas 25 mulheres, submetidas ao procedimento de BGYR, no período de maio de 2009 a maio de 2010, no Hospital das Clínicas da Faculdade de Medicina de Botucatu, Unesp. Para avaliação da ingestão energética e de cálcio, magnésio, fósforo, vitamina D e macronutrientes, foi aplicado um registro alimentar de 72 horas, nos três momentos de avaliação, calculando-se as variáveis por meio do software de nutrição Dietpro 5.i Profissional. Os dados comportamentais foram coletados por meio de um protocolo de avaliação, desenvolvido pela equipe, considerando-se uso de tabaco, álcool e prática de atividade física. Foi realizada avaliação antropométrica, aferindo-se circunferências da cintura, abdominal e quadril, além do peso corporal e seus componentes, analisados pelo método... / Obesity is a chronic disease and an epidemic, resulting in a significant way in the health of the individual and society. Nowadays, bariatric surgery in special gastric bypass Roux-Y (BGYR) has become popular as a treatment, ensuring loss of overweight superior to conventional therapies, with long term maintenance. However, it was observed that, because it is a surgery with disabsorptive and restrictive components, the RYGB may lead to reduced absorption and intake of essential nutrients, necessary for the body homeostasis and, specially, bone homeostasis. Thus, changes in bone metabolism may occur and, consequently, changes in bone structure. The objectives of the present study were to evaluate the effect of the surgery on nutrients intake and on parameters related to bone remodeling in obese patients, before and after three and six months of the procedure, by examining the association between food intake and evolution of these parameters. A prospective and observational study evaluated 25 women who underwent the RYGB procedure, from May 2009 to May 2010, at the Hospital of the Medical School of Botucatu, UNESP. For evaluation of energy, calcium, magnesium, phosphorus, vitamin D and macronutrients consumption, a 3 days food record was carried out before and after surgery, and calculated on DietPro 5.i Professional nutrition software. Behavioral data were collected by an assessment protocol, developed by the team, considering use of tobacco, alcohol and physical activity. Anthropometric assessment was performed by measuring waist circumference, waist, hip and body weight, and components of body weight were analyzed by bioelectrical impedance method. Laboratory tests of bone metabolism were also conducted, such as: calcium (urine and serum), serum magnesium and phosphorus, total alkaline phosphatase and bone specific alkaline phosphate (BSAP), parathyroid hormone (PTH), carboxy-te... (Complete abstract click electronic access below)

Background: Coronary Artery Bypass Grafting (CABG) surgery is one of the most commonly performed surgical procedures to improve the symptoms of coronary artery disease. The Long Saphenous Vein (LSV) is typically used as a graft to bypass the blocked coronary arteries. The traditional way of harvesting the LSV is to make a long skin incision in the patient's leg. This technique has a high rate of incidence of wound complications and postoperative pain and poorer patient satisfaction. Endoscopic Vein Harvesting (EVH) techniques, introduced more than a decade ago, reduce these complications and improve quality of life. Findings regarding the safety and efficacy of EVH techniques and the quality of the vessel harvested by this technique are contradictory. Adoption of EVH techniques is still inconsistent globally and it is not completely accepted by all cardiac centres. Many studies are available in the literature measuring either histological outcome or clinical outcome in relation to different harvesting techniques. However, there remains no definitive randomised data available directly correlating harvesting-induced vein damage with clinical outcome. The aim of this Vein Integrity and Clinical Outcome (VICO) randomised trial was designed to assess the direct relationship between the histological damage caused during different methods of vein harvesting and clinical outcome post coronary artery bypass surgery. Methods: 100 patients were randomised in each group: Group 1 consists of closed tunnel CO2 endoscopic vein harvesting (EVH) (CT-EVH) and Group 2 consists of open tunnel CO2 EVH (OT-EVH) with the control Group 3 consists of standard open vein harvesting (OVH) with a total of 300 patients in this study. All the veins were harvested by an experienced practitioner who has performed &gt;2000 OVH and &gt;250 EVH. 1cm x 3 segments from three different parts of the vein were obtained for all patients (n=900). The histological levels of damage (endothelial and muscular layers) of the harvested vein and post clinical outcome for Major Adverse Cardiac Events (MACE) were measured using validated measuring tools. Health economic (cost effectiveness, EQ-5D) and health-related quality of life (SF-36) data were also recorded to assess the impact of these surgical techniques. Results: The level of endothelial disruption was greatest in the OT-EVH group in the proximal, distal and random samples (all p < 0.001). Internal muscle migration was greatest in OT-EVH compared to the other groups for proximal, distal and random samples (all p < 0.001). Smooth muscle circular layer detachment was observed on a much greater scale in the endoscopic groups compared to OVH in proximal (p=0.008), distal (p < 0.001) and random (p=0.001). Smooth muscle longitudinal layer detachment was consistent between groups in proximal (p=0.113) and distal (p=0.380) samples but was greater in endoscopic groups compared to OVH (p=0.012). Secondary clinical outcomes demonstrated no significant differences in composite MACE scores at 3, 6, 12, 18 and 24 months. The quality adjusted life in years (QALYs) gain per patient was: 0.11 (p < 0.001) for closed tunnel CO2 EVH and 0.07 (p=0.003) for open tunnel CO2 EVH compared with open vein harvesting. The likelihood of being cost-effective, at a pre-defined threshold of £20,000 per QALYs gained was: 75% for closed tunnel EVH, 19% for open tunnel EVH and 6% for open vein harvesting. Conclusion: In this study, open vein harvesting was associated with better preservation of vein layers in non-distended proximal samples than endoscopic vein harvesting. Both EVH groups displayed some degree of histological damage; OT-EVH was associated with more endothelial disruption. Clinical outcomes suggest that histological findings do not directly contribute to MACE outcomes. Gains in health status were observed and cost-effectiveness was better with CT-EVH compared with the other two surgical techniques. These results suggest that EVH can be utilised safely, but with careful selection of patients.

Made available in DSpace on 2014-06-11T19:25:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-31Bitstream added on 2014-06-13T20:53:03Z : No. of bitstreams: 1 freschi_l_me_botfm.pdf: 749128 bytes, checksum: 75984be6da9edf1d52a38b056eecc519 (MD5) / Universidade Estadual Paulista (UNESP) / A doença arterial coronariana (DAC) é uma das principais causas de óbito e de perda de qualidade de vida ao longo do tempo. Seu tratamento pode ser clínico ou por meio de técnicas como a angioplastia percutânea ou a revascularização cirúrgica do miocárdio. Multidimensional, a DAC exerce fortes impactos físicos, emocionais e sociais. Por isso, além das avaliações clínicas, são indispensáveis as informações sobre a qualidade de vida e funcionalidade dos pacientes para uma análise mais precisa de suas condições após o tratamento. O objetivo deste estudo foi avaliar a percepção da qualidade de vida e a funcionalidade em pacientes com DAC nos momentos antes da revascularização cirúrgica ou da angioplastia, na alta hospitalar e 60 dias após a intervenção. Foram avaliados 90 pacientes divididos em grupos por procedimento. Utilizou-se uma ficha com perfil demográfico, questionário genérico de avaliação da qualidade de vida “The Medical Study 36-item Short-Form Health Survey” (SF-36) e escala de “Medida de Independência Funcional” (MIF). Observou-se, no perfil demográfico, a predominância do gênero masculino (58,9%), escolaridade com o ensino fundamental incompleto (64,4%) e índice de massa corporal (IMC) acima do ideal (37,8% sobrepeso e 25,6% obesidade). O grupo de angioplastia apresentou os melhores escores de qualidade de vida antes do procedimento nos domínios “aspectos físicos”, “dor”, “vitalidade”, “aspectos sociais” e na questão de avaliação da saúde anterior. Na alta isso se manteve com o acréscimo do domínio “capacidade funcional”. No momento 60 dias após o procedimento, a angioplastia obteve melhores escores em “aspectos físicos” e “aspectos sociais”. Na comparação entre os momentos, os domínios “capacidade funcional” e “dor” pioraram na alta para o grupo cirurgia, e melhoraram após 60 dias... / Coronary artery disease (CAD) is a leading cause of death and loss of quality of life over time. The treatment is clinical in early stages of disease or the technique is percutaneous angioplasty or coronary artery bypass grafting. The DAC is a multidimensional disease, which has strong physical, emotional and social impacts. Besides to clinical assessments, information about the quality of life and functionality of patients are essential for a more precise analysis of their condition after treatment. The aim of this study was to evaluate the perceived quality of life and functionality in patients with CAD in the moments before surgical revascularization or angioplasty, at discharge and 60 days after the intervention. We evaluated 90 patients divided into groups by procedure. We used a form with demographic profile, generic questionnaire for assessing quality of life The Medical Study 36-item Short-Form Health Survey (SF-36) and scale of Functional Independence Measure (FIM). It was observed in the demographic, the predominance of males (58.9%), schooling and incomplete primary education (64.4%) and body mass index (BMI) above the ideal (37.8% overweight and 25.6% obese). The angioplasty group had the best scores of quality of life before the procedure in the domains physical aspects, pain, vitality and social aspects and the issue of evaluation of previous health. These results remained at hospital discharge with the addition of domain functional capacity. At present 60 days after the procedure, angioplasty had higher scores in physical aspects and social aspects. Comparing the times, the domains physical functioning and pain got worse at the group of discharge for surgery and improved after 60 days for both groups. In the domains general health and vitality, both groups improved in the third stage of evaluation. Angioplasty only group showed improvement... (Complete abstract click electronic access below)