Introdução: O acesso biliar ecoguiado é um método de drenagem alternativo à drenagem percutânea transhepática (DPTH) e à cirurgia em pacientes com obstrução biliar distal incurável que falharam drenagem por Colangiopancreatografia Endoscópica Retrógrada (CPRE). Nos casos em que a drenagem ecoguiada anterógrada transpapilar (ou transanastomótica) e o rendez-vous ecoguiado não podem ser realizados como primeira opção, a coledocoduodenostomia (CDT) e a hepaticogastrostomia (HPG) ainda podem ser realizadas em pacientes selecionados. Estas duas vias de drenagem não anatômicas criam uma fístula entra a via biliar e o estômago ou duodeno. Não há dados na literatura que determinem superioridade de uma ou outra técnica. Objetivo: Comparar o sucesso técnico, sucesso clínico e fatores associados entre as duas vias de drenagem em pacientes com obstrução da via biliar distal maligna incurável que não lograram sucesso na drenagem por CPRE ou rendez-vous ecoguiado. Métodos: Entre abril de 2010 e dezembro de 2013, 49 pacientes com obstrução biliar distal maligna incurável que falharam CPRE e rendez-vous ecoguiado foram randomizados para CDT ou HPG. Dados referentes ao sucesso técnico, sucesso clínico, tempo de procedimento, complicações, qualidade de vida e sobrevida foram coletados até três meses após o procedimento. Todos os procedimentos foram realizados em um centro terciário de endoscopia pelo mesmo endoscopista. Próteses biliares parcialmente recobertas (Boston Scientific, Wallflex, 10 mm, 8 cm ou 6 cm) foram utilizadas em todos os pacientes com sucesso técnico. Nos casos de HPG a punção ecoguiada foi intra-hepática no ducto hepático esquerdo. Nos casos de CDT a punção foi extra-hepática no segmento distal não obstruído do colédoco. Após a punção foi realizada colangiografia com introdução de um fio guia hidrofílico de 0,035 polegada. Dilatação com cateter e um dispositivo de needle knife foi realizada para permitir introdução do sistema de disparo da prótese biliar com 8,5 Fr. Resultados: Quarenta e nove procedimentos foram realizados (25 HPG e 24 CDT). Todos os pacientes tinham dilatação da via biliar intra e extra-hepática. A taxa de sucesso técnico foi de 96 % para HPG e de 91% para CDT (p = 0,609). A taxa de sucesso clínico foi de 91% para o grupo HPG e de 77% para o grupo CDT (p = 0,234). No grupo da HPG 5 pacientes (20%) tiveram complicações (3 sangramentos, 2 biliomas e uma bacteremia). No grupo da CDT 3 pacientes (12,5%) tiveram complicações (1 bilioma, 1 sangramento e 1 perfuração). Somente o caso da perfuração necessitou tratamento cirúrgico. As outras complicações foram tratadas clinicamente. O tempo de procedimento médio foi de 47,83 min para a HPG e de 48,88 min para a CDT (p = 0,843). Conclusão: O presente estudo não demonstrou diferença estatisticamente significante em relação ao sucesso técnico, sucesso clínico, complicações e tempo de procedimento entre os dois grupos estudados. Mais estudos são necessários para elucidar o papel de cada via de drenagem / Background: EUS-guided biliary access is an alternative for percutaneous access or surgery in patients with malignant unresectable distal biliary obstruction and failed ERCP. When rendezvous or anterograde transpapillary/transanastomotic intervention fails as primary drainage options, a Choledochoduodenostomy (CDT) or a Hepaticogastrostomy (HGT) can still be performed in selected patients. This procedure creates a new \" \" y I w one route or the other should be recommended. Aim: To compare technical and clinical success and possible associated factors between the two different drainage routes CDT and HGT in patients with distal unresectable malignant biliary obstruction that failed standard ERCP and EUS-guided rendez vouz (RV) maneuver. Methods: Between April/2010 and December/2013 49 consecutive jaundiced patients with distal unresectable malignant biliary obstruction that failed previous ERCP and EUS-guided RV maneuver were elected randomly to undergo either EUS-guided CDT or HGT. Data including indications, clinical and technical success, procedural times and complications with a three-month follow-up were prospectively collected in a database. All procedures were performed in a tertiary center by the same endoscopist. A partially covered SEMS (Boston Scientific, Wallflex, 10 mm, 8 cm or 6 cm) was used in all technically successful procedures. After puncture of left hepatic duct in case of HGT or the distal unobstructed segment of common bile duct in case of CDT a cholangiogram was obtained followed by advancement of a 0,035-inch guide wire into the biliary system. Bougies and wire-guided needle-knife were used to perform track dilation to allow passage of an 8.5 Fr stent delivery system. Results: Forty-nine cases (25 HGT and 24 CDT) were performed. All patients had intra and extra hepatic biliary dilation. Technical success rate was 96 % for HGT and 91% for CDT (p = 0.609). Clinical success rate was 91% for HPG and 77% for CDT (p = 0.234). In the HGT group five patients (20%) had complications (3 bleeding, 2 bilomas and 1 bacteremia). In the CDT group 3 patients (12.5%) had complications (1 biloma, 1 bleeding and 1 perforation). Only the perforation patient required surgery. All other complications were managed clinically. The median procedural time was 47.83 min for HGT and 48.88 min for CDT (p = 0.843). Conclusion: No significant difference was found in regards to technical or clinical success, complications and procedure time between the two drainage routes. More studies are needed to clarify situations in which the CDT or the HGT should be advocated

Made available in DSpace on 2017-07-10T14:17:04Z (GMT). No. of bitstreams: 1 Leonardo.pdf: 2065969 bytes, checksum: ecaa0d3dc812ef2017f1f16fc1f49d2a (MD5) Previous issue date: 2013-07-01 / The induction of obesity in experimental animals with cafeteria diet simulates the high-calorie food that humans eat, nowadays, thus enabling to study obesity and comorbidities resulting from this condition. The male reproductive system is directly affected by obesity with increased lipid peroxidation, increase of apoptotic bodies, changes in parameters espermatobioscópicos and reduced fertility. The aim of the study was to evaluate whether there are changes caused by obesity in epithelia of efferent ducts and epididymis , both in relation to morphology and expression of aquaporins 1 and 9 ( AQPs 1 and 9 ) in adult Wistar rats . After weaning , the animals were randomly divided into two groups : control group ( CON ) received standard diet and water ad libitum ( n = 10 ) and group cafeteria ( CAF ) , which received cafeteria diet soda and degassed ad libitum ( n = 10). The treatment group CAF began after the 12th week of life, totaling 40 weeks of consumption of cafeteria diet, being all dead animals with 52 weeks of age. The efferent ducts , along with initial segments ( Si ) , head ( Cç ) , body ( Co ) and tail ( Cd ) epididymis were submitted to routine histological and immunohistochemical staining for AQP- 1 and AQP- 9 . In the present study we evaluated the data: body mass, length nasoanal, waist circumference, Lee index and retroperitoneal fat mass and perigonadais; also evaluated dimensions, using morphometry and morphology of the epithelia of the efferent ducts and segments Si, Cç, Co and Cd epididymis and analyzed the expression of AQP- 9 and AQP- 1 in the efferent ducts and epididymal segments above. Changes in expression of AQPs in the efferent ducts and the epididymal epithelium were observed with increased expression of AQP- 1 and AQP- 9 reduction in efferent ducts and epididymal cauda, respectively, in animals treated with cafeteria diet. Also, there were morphological changes in the epididymal epithelium, such as increasing the number and size of cells and clear halo; increased endocytic organelles, and heterogeneous distribution of stereocilia, in animals with diet-induced obesity cafeteria. Given the results, it is believed that these changes should cause a profound impact on the luminal environment and interfere in the transport process, maturation, maintenance, protection and storage of sperm, being responsible for obesity alter the expression of AQP- 1 in efferent ducts, AQP- 9 in the epididymal cauda, the relative distribution of cells and clear halo and morphological characteristics of these parts via the sperm. However, more studies are needed to elucidate the specific mechanisms by which the cafeteria diet affects sperm morphology via specifically efferent ducts and epididymal ducts / A indução à obesidade, no modelo experimental animal com dieta de cafeteria, simula a alimentação com alto teor calórico que os seres humanos ingerem, na atualidade, possibilitando, assim, estudar a obesidade bem como as comorbidades advindas desta condição. O sistema genital masculino é afetado diretamente pela obesidade com aumento de peroxidação lipídica, aumento de corpos apoptóticos, mudanças nos parâmetros espermatobioscópicos e redução de fertilidade. O objetivo do estudo foi avaliar se há alterações causadas pela obesidade nos epitélios dos ductos eferentes e epididimário, tanto em relação à morfologia quanto à expressão de aquaporinas 1 e 9 (AQPs 1 e 9) em ratos Wistar adultos. Após o desmame, os animais foram divididos aleatoriamente em dois grupos: grupo controle (CON), que recebeu dieta padrão e água ad libitum (n=10) e grupo cafeteria (CAF), que recebeu dieta de cafeteria e refrigerante desgaseificado ad libitum (n=10). O tratamento do grupo CAF teve início depois da 12º semana de vida, totalizando 40 semanas de consumo da dieta de cafeteria, sendo todos os animais mortos com 52º semanas de idade. Os ductos eferentes, juntamente com segmentos inicial (Si), cabeça (Cç), corpo (Co) e cauda (Cd) do epidídimo, foram submetidos à rotina histológica e imunohistoquímica para AQP-1 e AQP-9. No presente estudo foram avaliados os dados: massa corporal, comprimento nasoanal, circunferência abdominal, índice de Lee e massa das gorduras retroperitoniais e perigonadais; também, avaliou-se dimensões, através de morfometria, e características morfológicas dos epitélios dos ductos eferentes e segmentos Si, Cç, Co e Cd do epidídimo, bem como foram analisadas as expressões de AQP-9 e AQP-1 nos ductos eferentes e segmentos epididimários supracitados. Alterações na expressão das AQPs, nos ductos eferentes e parte do epitélio epididimário, foram observadas com aumento na expressão de AQP-1 e redução de AQP-9 nos ductos eferentes e cauda epididimária, respectivamente, dos animais tratados com dieta de cafeteria. Também, ocorreram alterações morfológicas no epitélio epididimário, como aumento do número e tamanho de células halo e claras; aumento de organelas endocíticas; e distribuição heterogênea de estereocílios, nos animais com obesidade induzida por dieta de cafeteria. Em vista dos resultados, acredita-se que essas alterações devem causar um profundo impacto sobre o ambiente luminal e interferir no processo de transporte, maturação, manutenção, proteção e armazenamento dos espermatozoides, sendo a obesidade responsável por alterar a expressão de AQP-1 nos ductos eferentes, da AQP-9 na cauda epididimária, a distribuição relativa de células claras e halo e características morfológicas destas partes da via espermática. No entanto, mais estudos são necessários para esclarecer os mecanismos específicos pelos quais a dieta de cafeteria afeta a morfologia da via espermática, especificamente dos ductos eferentes e ductos epididimários

This thesis endeavors towards developing various concepts employed in analysis and design of acoustic filters for varied applications ranging from combination mufflers for automobiles to complex networks of gas carrying ducts to multiply connected complex automotive silencing devices to the noise control coatings for underwater applications. A two-dimensional wave modeling approach has been proposed to evaluate sound attenuation characteristics of dissipative mufflers of finite length with/without extended inlet and outlet tubes including very large mufflers. The correctness of the method has been validated through comparison with experimental results from literature. Two other frequently used approximate schemes have been discussed briefly with reference to the available literature. These three approaches have then been weighed against each other to show the effectiveness and limitations of each one. A thorough comparison study has been performed to investigate each one’s extent of applicability. A parametric study with different parameters suggests some useful design guidelines that can be put to use while designing such mufflers. Benefits and drawbacks of reactive and dissipative mufflers have been discussed with an intention of striking a compromise between them to achieve a better transmission quality over a broad frequency range. This has been accomplished by combining these two types of mufflers/filters explicitly. These combination mufflers are analyzed using a transfer matrix based approach by extending the aforesaid concept of two-dimensional wave modeling for finite dissipative ducts. The present approach has been used to analyze axi-symmetric circular lined plenum chambers also. The effectiveness of the bulk reaction assumption to model absorptive lining is illustrated. A parametric study has been carried out to investigate the effects of different thicknesses and placements of the absorptive lining. The contributions of reflective and absorptive portion of the combination mufflerto overall attenuation performance have been investigated from the designer’s point of view A generalized algorithm has been developed for studying the plane sound wave propa- gation in a system of interconnected rigid-walled acoustic filter elements. Interconnection between various elements is represented by a connectivity matrix. Equations of volume velocity continuity and pressure equilibrium at the interconnections are generated using this connectivity matrix and are solved using the Gauss-Jordan elimination scheme to get the overall transfer matrix of the system. The algorithm used for generalized labeling of the network and computation of Transmission Loss has also been discussed. The algorithm has been applied to investigate a multiply connected automobile mufflers as a network of acoustic elements which guides the way to a specialized application discussed next. Results for some configurations have been compared with those from the FEM analysis and experiments. A parametric study with respect to some geometric variables is carried out. The acoustical similarity between apparently different networks is discussed. The approach is flexible to incorporate any other acoustic elements, provided the acoustic variables at the junctions of the element can be related by a transfer matrix a priori. Commercial automotive mufflers are often too complex to be broken into a cascade of one dimensional elements with predetermined transfer matrices. The one dimensional (1-D) scheme presented here is based on an algorithm that uses user friendly visual volume elements to generate the system equations which are then solved using a Gauss-Jordan elimination scheme to derive the overall transfer matrix of the muffler. This work attempts and succeeds to a great extent in exploiting the speed of the one dimensional analysis with the flexibility, generality and user friendliness of three dimensional analysis using geometric modeling. A code based on the developed algorithm has been employed to demonstrate the generality of the proposed method in analyzing commercial muffers by considering three very diverse classes of mufflers with different kinds of combinations of reactive, perforated and absorptive elements. Though the examples presented in the thesis are not very complex for they are meant to be just representative cases of certain classes of mufflers, yet the algorithm can handle a large domain of commercial mufflers of high degree of complexity. Results from the present algorithm have been validated through comparisons with both the analytical and the more general, three-dimensional FEM based results. The forte of the proposed method is its power to construct the system matrix consistent with the boundary conditions from the geometrical model to evaluate the four pole parameters of the entire muffer and thence its transmission loss,etc. Thus, the algorithm can be used in conjunction with the transfer matrix based muffler programs to analyze the entire exhaust system of an automobile. A different kind of acoustic filter than the above mentioned cases is then taken up for investigation. These refer to the specialized underwater acoustic filters laid as linings on submerged bodies. These kind of underwater noise control linings have three different types of objectives, namely, Echo Reduction, Transmission Reduction (TL maximization) and a combination thereof. These coatings have been shown to be behaving very differently with different shape, size and number of air channels present in the layer. In this regard, a finite element model based methodology has been followed. An hybrid type finite element based on the Pian and Tong formulation has been modified and used so as to make the computational efforts less demanding as compared to the original one. The developed finite element has been shown to be immune to the difficulties that arise due to the near incompressible characteristics of the viscoelastic materials used and the high distortion of the elements of the FE mesh. The adequacy of this formulation has been shown by comparing its results with the analytical, FE based, and experimental results. Then, this methodology has been used to analyze and generate design curves to control various geometrical parameters for proper designing of these linings. Different unit cell representations for different types of distributions of air cavities on the linings have been discussed. Four different types of layers have been introduced and analyzed to address different objectives mentioned above. They have been termed as the Anechoic layer, Insulation layer and Combination Layer of coupled and decoupled type in this thesis. The first two layers have been designed to achieve very dissimilar characteristics and the next two layers have been designed to balance their disparities. A thorough parametric study has been carried out on the geometrical parameters of all the layers to come up with the design guidelines. For anechoic and the insulation layers, different distributions have been analyzed with different unit cell geometries and their usability in specific situations has been outlined. Effect of static pressure has also been studied by using an approximate finite element method. This method can be used to simulate deep-sea testing environment.

Noise control in the heating, ventilation and air-conditioning (HVAC) systems is one of the critical design parameters in measuring the occupant comfort. The noise generated by air-handling units propagates through the ducts in the axial as well as transverse direction. Noise radiated in the transverse direction from the duct walls excited by the internal sound field is called the breakout noise. An analytical formulation has been developed in this thesis in order to predict the breakout noise by incorporating three-dimensional effects along with the acoustical and structural wave coupling phenomena. The first step in the breakout noise prediction is to calculate the interior acoustic response and flexural vibration displacement of the compliant walls. Dynamic interaction between the internal acoustic subsystem and flexible structural subsystem has been expressed in terms of the modal characteristics of the uncoupled response of the acoustic and structural sub-systems. Solutions of the inhomogeneous wave equation are rearranged in terms of impedance and mobility, and the equations describing the complete system are expressed in terms of matrices, which result in a compact matrix formulation. Examples of the formulation are a rectangular cavity with one flexible wall and a rectangular cavity with four-flexible walls. The formulation is modified to incorporate complex boundary conditions by means of appropriate Green’s functions. It is implemented for flexible wall duct using the modified cavity Green’s function. Another objective of the present investigation is to understand the coupling phenomenon and its effect on the compliant wall vibration displacement. The developed three-dimensional analytical analysis of the breakout noise is convenient to implement on the computer, and also to extend the sub-system level model to the system level model in order to analyze a complex acoustic-structural system for the breakout noise problem. The extent of coupling is calculated using a transfer factor based on the uncoupled natural frequencies of the acoustic and structural subsystems. It is observed from the free vibration analysis that a coupling between the cavity and the flexible panel exists in the vicinity of an uncoupled acoustic natural frequency. If a strong coupling occurs between an acoustic mode and a panel mode, then damping of structural subsystem would control it. The cavity volume changes stiffness of the panel, which in turn affects noise radiation in the stiffness-controlled region. The second step is to calculate the sound power radiated from complaint wall. The wall vibration velocity is a linear combination of the uncoupled flexural modes of the structural subsystem. It is substituted into the Rayleigh integral and Kirchhoff– Helmholtz (KH) integral formulation to predict the sound pressure radiated by the vibrating duct wall. The radiated sound power can be obtained by integrating the acoustic intensity over the surface of the flexible duct wall making use of appropriate expressions for radiation impedance. The radiation impedance terms involve a quadruple integral. Evaluation of this integral is quite complex and poses formidable computational challenges. These have been overcome by means of a co-ordinate transformation. Sound power radiation from flexible walls of the plenum and duct walls has been calculated using an equivalent plate model. Analytical results are corroborated with numerical models. The second part of thesis deals with a one-dimensional model to predict the breakout noise from a thin rectangular duct with different end conditions like anechoic termination, rigid-end termination, and the open-end termination. This model incorporates acoustic reflection effects in the duct internal sound field by using standing wave pattern by means of the transfer matrix approach. A one-dimensional prediction method based on the four-pole parameters has been developed to evaluate the lagged duct performance in terms of the breakout noise reduction. Radiation impedance of a duct is calculated by three different methods: (i) finite line source model (ii) finite cylinder model, and (iii) equivalent plate model based on fundamental bending mode of the duct. It is observed that the proposed model that uses the equivalent plate model for the lagged duct and the line source model for the bare duct is appropriate to predict the transverse insertion loss of the lagging, particularly at the lower frequencies that are of primary interest for reducing the breakout noise of rectangular ducts. The bare duct breakout noise results are compared with those of the corresponding 3-D analytical models. It shows that the one-dimensional model captures the overall mean pattern of breakout noise very well. The third part of the thesis examines the internal acoustic field and thence the transmission loss (TL) of a rectangular expansion chamber, the inlet and outlet of which are situated at arbitrary locations of the chamber; i.e., the sidewall or the face of the chamber. The four-pole parameters have been expressed in terms of an appropriate Green’s function of a rectangular cavity with homogeneous boundary conditions. A transfer matrix formulation has been developed for the yielding-wall rectangular chambers by considering structural-acoustic coupling. It may be combined readily with the transfer matrices of the other constituent elements upstream and downstream in order to compute the overall transmission loss or insertion loss. Wherever applicable, parametric studies have been conducted to evolve the design guidelines for minimizing the breakout noise from the HVAC ducts, plenums and cavities.

Les travaux présentés dans cette thèse contribuent au développement du contrôle non destructif des conduits de précontrainte extérieure dans les ouvrages d'art. Une sonde capacitive a été développée pour ausculter ces conduits. L'objectif est d'en améliorer le diagnostic.Dans un premier temps, une cellule de mesure en transmission coaxiale a été développée pour caractériser les matériaux présents dans le conduit sur la bande de fréquence 50 MHz - 1 GHz. Le ciment, les produits de la ségrégation du ciment et la cire d'injection ont été étudiés.La deuxième partie du travail exploite ces résultats dans une modélisation directe du problème global. Une étude paramétrique nous a permis de proposer une méthode d'estimation de l'épaisseur de vide à l'intérieur du conduit à partir des signaux délivrés par la sonde, qui a pu être validée sur une maquette de conduit. A partir de ces résultats sont proposées plusieurs améliorations du dispositif visant à l'obtention de signaux plus riches issus des capteurs, afin de pouvoir estimer un plus grand nombre de paramètres. / The work presented in this report contributes to the development of Non Destructive Evaluation of the external post-tensioned ducts in bridges. A capacitive probe has been developed for bridge monitoring applications. The aim of this work is to improve its diagnostic.In a first step, a coaxial transmission line was developed to characterize the materials involved in the duct over the frequency range 50 MHz - 1 GHz. The cement grout, segregation products of the cement grout and the injection wax were studied.In the second part of this work the previous results are used in the modelling of the devices. A parametrical study has shown the ability to get from the signals an estimate of the thickness of the void in the duct. This estimation method has been validated using a laboratory duct. Further, several improvements of the probes are proposed to get signals containing more information in order to get a better estimation of the target parameters.

Introdução / Objetivos: O prognóstico do adenocarcinoma ampular pode ser influenciado por fatores como estadiamento e variáveis histopatológicas, como o padrão intestinal ou pancreatobiliar. O diagnóstico do padrão histopatológico pode ser auxiliado pela expressão de citoqueratinas, CK, 7 e 20 e do gene homeobox CDX2. O objetivo do estudo foi analisar associações entre características histopatológicas e sobrevida, e entre padrão histopatológico e expressão de CK7, CK20 e CDX2. Método: Estudo de coorte retrospectivo desenvolvido no Hospital de Clínicas de Porto Alegre entre 2000 e 2011. Foram avaliados dados histopatológicos, estadiamento pTNM, padrão histopatológico e expressão imunoistoquímica e sobrevida. Resultados: A amostra constou de 65 carcinomas ampulares (n = 65). Foi observado padrão intestinal em 46, pancreatobiliar em 16 e outros em três. Sobrevida em cinco anos após duodenopancreatectomia (n = 47) foi de 27%. Associaram-se à menor sobrevida na análise univariada: dois ou mais linfonodos metastáticos, razão de linfonodos, RL, maior ou igual a 20%; estágio IIB em relação a inferiores; tumor de alto grau; invasão linfovascular. Na análise multivariada, metástase linfonodal e RL ≥ 20% influenciaram sobrevida. Conclusões: O pior prognóstico foi associado à metástase linfonodal. Não foi observada associação entre padrão histopatológico e expressão imunoistoquímica. / Background / Objectives: The prognosis of patients with ampullary adenocarcinomas can be influenced by such factors as pTNM stage and histopathological variables, such as intestinal or pancreatobiliary patterns. The characterization of these patterns can be facilitated by the expression of cytokeratins 7 (CK7) and 20 (CK20) and caudal-related homeobox gene 2 (CDX2). The aim of the present study was to analyze the association between the histopathological characteristics and the survival of patients with ampullary adenocarcinomas, as well as the association between the histopathological patterns and CK7, CK20 and CDX2 expression. Methods: This retrospective cohort study was performed at the Clinics Hospital of Porto Alegre between 2000 and 2011 and examined the histopathological data, pTNM stage, histopathological patterns, immunohistochemical expression patterns and survival of patients with ampullary adenocarcinomas. Results: The sample patient population consisted of 65 ampullary carcinomas. Of these carcinoma samples, an intestinal pattern was observed for 46, a pancreatobiliary pattern was observed for 16 and other patterns were observed 3 of the samples. The 5-year survival rate for patients following pancreaticoduodenectomy (n = 47) was 27%. From the univariate analysis, the following variables were associated with shorter survival times: the presence of 2 or more metastatic lymph nodes; positive lymph node ratio (LR) ≥ 20%; stage IIB or greater; high-grade tumors; and lymphovascular invasion. From the multivariate analysis, lymph node metastases and a LR ≥ 20% were shown to influence survival significantly. Conclusions: Lymph node metastases were associated with poor patient prognoses, although no association was found between the histopathological pattern and immunohistochemical expression.

Made available in DSpace on 2014-06-11T19:26:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-23Bitstream added on 2014-06-13T19:54:10Z : No. of bitstreams: 1 moura_ca_me_rcla.pdf: 3362726 bytes, checksum: fdd365e71041de41355ac757f4cac817 (MD5) / Agência Nacional do Petróleo, Gás Natural e Biocombustíveis (ANP) / Este trabalho obteve a partir do zoneamento geoambiental da faixa de dutos Osplan/Osvat – nos municípios de São Sebastião e Caraguatatuba – a carta de Suscetibilidade Ambiental a processos gravitacionais e erosivos. Para isso efetuouse a integração dos seguintes produtos: Carta de Unidades Geoambientais, Carta Morfoestrutural e Carta de Lineamentos Estruturais e Traços de Juntas. Na Carta de Unidades Geoambientais classificou se cada unidade segundo os fatores: alterabilidade, declividade, permeabilidade e tropia, de forma a determinar entre estas unidades quais apresentam maior suscetibilidade a processos erosivos e gravitacionais. Já a Carta Morfoestrutural é baseada na interpretação dos elementos de drenagem e relevo e suas relações espaciais, onde as morfoestruturas surgem como anomalias no contexto regional, a partir desta carta pode se localizar pontos inadequados a instalação de dutos ou que necessitam de monitoria constante e detalhada de forma a evitar impactos a essas obras. A Carta de Lineamentos Estruturais e Traços de Junta determinou as principais deformações tectônicas da área e suas respectivas estruturas: lineamentos estruturais, sistemas de juntas, zonas de variação de traços de juntas (máximos 1 e 2), mediante esta carta pode se definir zonas consideradas como de instabilidade ambiental, pois sofreram ou sofrem forte influência deformacional rúptil, de compressão ou descompressão. Essas cartas foram integradas em um produto denominado Carta de Suscetibilidade Ambiental a processos gravitacionais e erosivos, a qual permitiu determinar na faixa de dutos áreas com possíveis problemas geotécnicos capazes de causar prejuízos ambientais sérios. Desta análise integrada pretendeu se elaborar uma ferramenta de gestão acessível a qualquer profissional da área ambiental, ou seja, tornar mais sistemática e operacional a utilização dos procedimentos de integração de dados ambientais. / This work got from the geoenvironment mapping of the strip of Osplan/Osvat ducts - in the cities of they are Sebastião and Caraguatatuba – of the ambient susceptibility the gravitational and erosive processes map. The procedure consists of fotointerpretation of images, according to the geoenvironment mapping, to obtaining the geoenvironmental units and its characteristics, the morfostructure map and the fractures map (lines of strikes and structural lineaments), for determine between these units which present greater susceptibility the erosive and gravitational processes. Already the morfostructure map is based on the interpretation of the elements of draining and relief and its space relations, where the morfoestruturas appear as anomalies in the regional context, from this map the installation of ducts can be situated inadequate points or that they need monitory constant and detailed of form to prevent impacts to these workmanships. The fractures map (lines of strikes and structural lineaments), determined the main tectônics deformations of the area and its respective structures. These maps had been integrated in a called product of the ambient susceptibility the gravitational and erosive processes map, which allowed determining in the strip of ducts areas with possible geotechnics problems capable to cause serious ambient damages. Of this integrated analysis a tool of accessible management to any professional of the ambient area intended to elaborate itself, that is, to become systematic and operational more the use of the procedures of integration of ambient data.

Made available in DSpace on 2014-10-09T12:44:01Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:07:20Z (GMT). No. of bitstreams: 1 06913.pdf: 2715369 bytes, checksum: 9d927e16226a25d1d362ba0ebc83502c (MD5) / Tese (Doutoramento) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP

Orientador: Juércio Tavares de Mattos / Banca: Cenira Maria Lupinacci da Cunha / Banca: Luis Eduardo de Oliveira / Resumo: Este trabalho obteve a partir do zoneamento geoambiental da faixa de dutos Osplan/Osvat - nos municípios de São Sebastião e Caraguatatuba - a carta de Suscetibilidade Ambiental a processos gravitacionais e erosivos. Para isso efetuouse a integração dos seguintes produtos: Carta de Unidades Geoambientais, Carta Morfoestrutural e Carta de Lineamentos Estruturais e Traços de Juntas. Na Carta de Unidades Geoambientais classificou se cada unidade segundo os fatores: alterabilidade, declividade, permeabilidade e tropia, de forma a determinar entre estas unidades quais apresentam maior suscetibilidade a processos erosivos e gravitacionais. Já a Carta Morfoestrutural é baseada na interpretação dos elementos de drenagem e relevo e suas relações espaciais, onde as morfoestruturas surgem como anomalias no contexto regional, a partir desta carta pode se localizar pontos inadequados a instalação de dutos ou que necessitam de monitoria constante e detalhada de forma a evitar impactos a essas obras. A Carta de Lineamentos Estruturais e Traços de Junta determinou as principais deformações tectônicas da área e suas respectivas estruturas: lineamentos estruturais, sistemas de juntas, zonas de variação de traços de juntas (máximos 1 e 2), mediante esta carta pode se definir zonas consideradas como de instabilidade ambiental, pois sofreram ou sofrem forte influência deformacional rúptil, de compressão ou descompressão. Essas cartas foram integradas em um produto denominado Carta de Suscetibilidade Ambiental a processos gravitacionais e erosivos, a qual permitiu determinar na faixa de dutos áreas com possíveis problemas geotécnicos capazes de causar prejuízos ambientais sérios. Desta análise integrada pretendeu se elaborar uma ferramenta de gestão acessível a qualquer profissional da área ambiental, ou seja, tornar mais sistemática e operacional a utilização dos procedimentos de integração de dados ambientais. / Abstract: This work got from the geoenvironment mapping of the strip of Osplan/Osvat ducts - in the cities of they are Sebastião and Caraguatatuba - of the ambient susceptibility the gravitational and erosive processes map. The procedure consists of fotointerpretation of images, according to the geoenvironment mapping, to obtaining the geoenvironmental units and its characteristics, the morfostructure map and the fractures map (lines of strikes and structural lineaments), for determine between these units which present greater susceptibility the erosive and gravitational processes. Already the morfostructure map is based on the interpretation of the elements of draining and relief and its space relations, where the morfoestruturas appear as anomalies in the regional context, from this map the installation of ducts can be situated inadequate points or that they need monitory constant and detailed of form to prevent impacts to these workmanships. The fractures map (lines of strikes and structural lineaments), determined the main tectônics deformations of the area and its respective structures. These maps had been integrated in a called product of the ambient susceptibility the gravitational and erosive processes map, which allowed determining in the strip of ducts areas with possible geotechnics problems capable to cause serious ambient damages. Of this integrated analysis a tool of accessible management to any professional of the ambient area intended to elaborate itself, that is, to become systematic and operational more the use of the procedures of integration of ambient data. / Mestre

Introdução / Objetivos: O prognóstico do adenocarcinoma ampular pode ser influenciado por fatores como estadiamento e variáveis histopatológicas, como o padrão intestinal ou pancreatobiliar. O diagnóstico do padrão histopatológico pode ser auxiliado pela expressão de citoqueratinas, CK, 7 e 20 e do gene homeobox CDX2. O objetivo do estudo foi analisar associações entre características histopatológicas e sobrevida, e entre padrão histopatológico e expressão de CK7, CK20 e CDX2. Método: Estudo de coorte retrospectivo desenvolvido no Hospital de Clínicas de Porto Alegre entre 2000 e 2011. Foram avaliados dados histopatológicos, estadiamento pTNM, padrão histopatológico e expressão imunoistoquímica e sobrevida. Resultados: A amostra constou de 65 carcinomas ampulares (n = 65). Foi observado padrão intestinal em 46, pancreatobiliar em 16 e outros em três. Sobrevida em cinco anos após duodenopancreatectomia (n = 47) foi de 27%. Associaram-se à menor sobrevida na análise univariada: dois ou mais linfonodos metastáticos, razão de linfonodos, RL, maior ou igual a 20%; estágio IIB em relação a inferiores; tumor de alto grau; invasão linfovascular. Na análise multivariada, metástase linfonodal e RL ≥ 20% influenciaram sobrevida. Conclusões: O pior prognóstico foi associado à metástase linfonodal. Não foi observada associação entre padrão histopatológico e expressão imunoistoquímica. / Background / Objectives: The prognosis of patients with ampullary adenocarcinomas can be influenced by such factors as pTNM stage and histopathological variables, such as intestinal or pancreatobiliary patterns. The characterization of these patterns can be facilitated by the expression of cytokeratins 7 (CK7) and 20 (CK20) and caudal-related homeobox gene 2 (CDX2). The aim of the present study was to analyze the association between the histopathological characteristics and the survival of patients with ampullary adenocarcinomas, as well as the association between the histopathological patterns and CK7, CK20 and CDX2 expression. Methods: This retrospective cohort study was performed at the Clinics Hospital of Porto Alegre between 2000 and 2011 and examined the histopathological data, pTNM stage, histopathological patterns, immunohistochemical expression patterns and survival of patients with ampullary adenocarcinomas. Results: The sample patient population consisted of 65 ampullary carcinomas. Of these carcinoma samples, an intestinal pattern was observed for 46, a pancreatobiliary pattern was observed for 16 and other patterns were observed 3 of the samples. The 5-year survival rate for patients following pancreaticoduodenectomy (n = 47) was 27%. From the univariate analysis, the following variables were associated with shorter survival times: the presence of 2 or more metastatic lymph nodes; positive lymph node ratio (LR) ≥ 20%; stage IIB or greater; high-grade tumors; and lymphovascular invasion. From the multivariate analysis, lymph node metastases and a LR ≥ 20% were shown to influence survival significantly. Conclusions: Lymph node metastases were associated with poor patient prognoses, although no association was found between the histopathological pattern and immunohistochemical expression.