Orientador: Doris Hissako Sumida / Resumo: Este trabalho teve como objetivo avaliar a gravidade da Doença Periodontal (DP) em mulheres obesas, vivendo em uma uma mesma comunidade, com semelhantes hábitos e condições de vida e com amplo acesso à assistência médico-odontológica, considerando a distribuição de gordura corporal. Foram avaliadas 39 mulheres, 15 com obesidade visceral (OBV), 10 com obesidade glúteo-femoral (OBF) e 14 com peso normal (CON). Todas foram submetidas à avaliação periodontal e classificadas de acordo com o Índice Periodontal Comunitário (IPC). Medidas antropométricas e bioimpedanciometria foram realizadas para discriminar a regionalização da gordura corporal. Uma coleta de amostra sanguínea foi feita para dosagem glicemia de jejum e insulinemia a fim de se obter o cálculo do HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) e quantificação laboratorial da resistência à insulina. Os três grupos foram comparados em relação à gravidade da DP. Foram realizadas análises de correlação entre o IPC e os seguintes parâmetros: Índice de Massa Corporal (IMC), circunferência da cintura (C), relação enter a circunferência da cintura/ e a circunferência do quadril (C/Q), percentual de gordura visceral em relação ao peso corporal (%GV) e HOMA -IR. O escore média do IPC foi significativamente maior (p = 0,0045) no grupo OBV do que no grupo CON. Não houve diferença no grupo OBF quando comparado ao grupo OBV e ao grupo CON. Houve correlação positivamente significativa entre o escore IPC (p = 0,0173), C... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aim to evaluate the severity of Periodontal Disease (PD) in obese women from the same community, sharing the same life habits and life conditions and with broad access to dental-medical assistance, considering the distribution of body fat. 39 women were evaluated, 15 with visceral obesity (VOB), 10 with gluteofemoral obesity (FOB) and 14 with normal weight (CON). All were submitted to periodontal evaluation and scored according to the Community Periodontal Index (CPI). Anthropometric measurements and bioimpedanciometry were performed in order to discriminate the regionalization of body fat. A collect of blood sample was made for fasting dosage of glycemia and insulinemia for calculation of HOMA-IR determination and laboratory quantification of insulin resistance. The three groups were compared in relation to the severity of PD. Correlation analyzes were performed between CPI and the following parameters: Body Mass Index (BMI), waist circumference (WC), waist/hip circumference ratio (W/H), percentage of visceral fat in relation to body weight (%GV) and HOMA-IR. The mean CPI score was significantly higher (p = 0.0045) in the VOB group than in the CON group. There was no difference in the FOB group when compared to the VOB group and the CON group. There was a significant positive correlation between the CPI score (p = 0.0173), W/H (p = 0.0004), and WC (p = 0.0082). It was possible to conclude that the present study agrees with previous literature data associating Obes... (Complete abstract click electronic access below) / Mestre

Bei der internen, extramedullären Osteosynthese des distalen Femurs, auf die sich diese Arbeit fokussiert, haben sich in den letzten Jahren interessante Entwicklungen vollzogen. Ausgehend von unzufriedenstellenden Komplikationsraten wurden neue Wege in der Versorgung dieser schwierigen Frakturen gesucht. Osteosynthesematerialien, Repositionstechniken, die Technik der Implantatplatzierung und die Implantate selbst, bei denen die Entwicklung zu winkelstabilen Systemen gegangen ist, haben sich grundlegend geändert. Die vorliegende Arbeit analysiert in einer retrospektiven Studie distale Femurfrakturen, die zwischen dem 1.1.1995 und 31.9.2000 entweder mit einem Fixateur interne (LISS) oder mit der konventionellen Plattenosteosynthese versorgt wurden. In die Studie konnten 51 Patienten mit 54 distalen Femurfrakturen eingeschlossen werden. Die Infektionsrate war in der LISS-Gruppe (0% versus 11,1%) nichtsignifikant geringer, die Rate der verzögerten Frakturheilungen war nichtsignifikant höher. Die einzige verzögerte Frakturheilung (LISS-Gruppe), die einer sekundären chirurgischen Intervention bedurfte, wurde bei einer Patientin mit einem großen Knochendefekt gesehen, der ohne primäre Spongiosaplastik therapiert worden war. Pseudarthrosen traten in beiden Gruppen nicht auf. Die Rate des Materialversagens unterschied sich nicht signifikant. Beim LISS kam es nicht, wie bei den konventionellen Implantaten zu sekundären Repositionsverlusten, es wurden aber im Anfang der klinischen Einführung proximale Schraubenausrisse aufgrund einer Fehlplatzierung gesehen. Es konnte gezeigt werden, dass es durch die Verwendung des LISS und die indirekten Repositionstechniken zu keiner Zunahme der Achsfehlstellungen oder der Operationszeit kam. Die funktionellen Einzelergebnisse und die Punktzahl der erhobenen Scores (Neer-Score und Lysholm-Score) unterschieden sich nicht signifikant. / Internal, extramedullary osteosynthesis of distal femoral fractures which are focussed on in this study has been influenced by interesting developments in recent years. Driven by unsatisfying complication rates new fracture treatments have been looked for. Osteosynthesis materials, reduction techniques, techniques of implant placement and implants themselves - where development went to angular stable systems - have changed decisively. This study analyzes in a retrospective setting distal femoral fractures which were treated between 1.1.1995 and 31.9.2000 either with an internal fixator (LISS) or with conventional plate osteosynthesis. In this study 51 patients with 54 distal femoral fractures could be included. The Infection rate was non significantly lower in the LISS group (0% versus 11,1%), the rate of delayed union was non significantly higher. The only delayed union in the LISS group which needed secondary surgical intervention was seen in a patient with considerate bone loss which was not treated by primary bone grafting. Non-unions were not seen in either group. The rate of implant failure did not differ significantly. In the LISS group no secondary loss of reduction (like in the group with conventional plate osteosyntesis) was seen but proximal screw pull out due to malplacement was reported in the beginning of clinical introduction. It could be demonstrated the LISS and indirect reduction leading not to a higher rate of malalignement nor to prolonged theatre times. Functional results and the point score of the Neer Score and the Lysholm Score showed no significant difference.

Made available in DSpace on 2016-04-27T18:47:08Z (GMT). No. of bitstreams: 1 Ana Elisa Sena Klein da Rosa.pdf: 1325679 bytes, checksum: ff0ceea43091284f2a08c54cdfbf60d9 (MD5) Previous issue date: 2012-02-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The relationship of the body in old age is very particular to each individual. Norbert Elias (2001) discussed the difficulty that our own body, so full of freshness and often pleasant sensations, can be slow, tired and clumsy. We cannot imagine it, and basically we do not want it. The fall followed by femoral fracture causes huge strangeness, an image in which the elder cannot identify himself, resulting in a disconnection between the image of the unconscious of the body and the image that the mirror gives him back. The objective of this study was to delineate the socio-demographic profile of 40 elders (31 females and 9 males) with femur fracture in surgical indication for pre operative phase, attended by the Service of Orthopedics of the Hospital of the State Public Servant of São Paulo (HSPESP). It is a cross-sectional observational study, and the data were collected through visits to files of medical records and semi-structured interviews, during the period of October 2010 to February 2011. All statistical analyzes were performed by SPSS for Windows, version 15.0. The age of the subjects studied ranged from 62 to 97 years old, with an average age equal to 78.9 years old, 77.5% were female, and 72.5% cared by a family caregiver. A factor of extreme relevance was that 97.5% of the subjects use more than 3 concomitant medicines daily. These and many others facts were raised with the intention of cross factors that reflect in the trial of human ageing. For the Gerontology, old age is to be understood by different looks. The social, cultural and subjective aspects permeate and intertwine in old age. With this study was possible to notice that a public health policy is necessary for that the rate of falls can be reduced by taking actions which are intended to give the elderly a better self-awareness of his body, and identify situations that can be harmful in relation to increase the risk of falls / A percepção sobre o corpo na velhice é muito particular para cada ser. A esse respeito, Norbert Elias (2001) discorre sobre a dificuldade sentida pelas pessoas quando seus corpos, tão cheios de frescor e muitas vezes de sensações agradáveis, passam a ficar vagarosos, cansados e desajeitados. Não se pode imaginar tal mudança e, no fundo, não se quer. Nesse sentido, a queda acompanhada de fratura femoral causa enorme estranheza, pois há uma imagem com a qual o idoso não se identifica, ocorrendo uma desconexão entre a imagem do inconsciente do corpo e a imagem que o espelho devolve-lhe. O objetivo deste estudo foi traçar o perfil sociodemográfico de 40 idosos (31 do sexo feminino e nove do sexo masculino) com fratura de fêmur, em indicação de tratamento cirúrgico em fase pré-operatória, atendidos pelo Serviço de Ortopedia do Hospital do Servidor Público Estadual de São Paulo. Trata-se de um estudo observacional de corte transversal, com coleta de dados através de visita a arquivos de prontuários médicos e entrevistas semiestruturadas, no período de outubro de 2010 a fevereiro de 2011. Todas as análises estatísticas foram feitas pelo Software Statistical Package for the Social Sciences para Windows, na versão 15.0. A idade dos sujeitos estudados variou de 62 a 97 anos, com média de idade de 78,9 anos, prevalecendo 77,5% do sexo feminino, e 72,5% dos idosos eram cuidados por um cuidador familiar. Um fator de extrema relevância foi que 97,5% dos sujeitos faziam uso de mais de três medicamentos concomitantes diariamente. Esses e muitos outros dados foram levantados com o intuito de cruzar fatores que incidem no processo de envelhecimento humano, pois, para a Gerontologia, a velhice deve ser entendida sob diferentes olhares, uma vez que os aspectos sociais, culturais e subjetivos permeiam e se entrelaçam na velhice. Com este estudo, foi possível notar que uma política de saúde pública faz-se necessária, com o desenvolvimento de ações que tenham como finalidade proporcionar ao idoso um melhor autoconhecimento de seu corpo, assim como identificar situações que possam lhe ser prejudiciais em relação ao maior risco de quedas, para que o índice de quedas possa ser reduzido

This work describes advanced fabrication of custom orthopaedic implants using unconventional additive manufacturing technology - Selective Laser Melting (SLM). There was a main focus on custom knee replacement and certainly on its femoral component. The study investigated three general issues within the domain of the usage of additive manufacturing technology in medical application. First, there was an evaluation of process parameters influences of SLM fabrication method on surface and mechanical properties of titanium Ti6Al4V ELI specimens. This material was used because of its biocompatibility and its wide use within implant fabrication. Then, a proposal of the manufacturing strategy was carried out and the fabrication of customized knee femoral component prototype by SLM technology was done. The elaboration of the numerical chain prior the SLM implant fabrication, from patient's CT knee scan to final femoral replacement model, was also done. Then, a proposal of different 3-axis and 5-axis strategies of machining of the fitting femoral surface of bone prototype (3D printed from the powder) using CNC machines FV 25 CNC and TAJMAC ZPS MCV 1210 was projected and also, the 3-axis spiral machining was realised. The individual machining tool paths were generated by software Power Mill from Delcam group. Finally, these machining strategies were generated as a prior step before a machining of real patient’s bone, therefore the machining tests of cartilage and bone were done.

<p>The overall aim of this thesis was to evaluate the outcome when treating children for displaced femoral fractures with external fixation.</p><p>In a consecutive and prospective study during the period 1993-2000, 96 children aged 3-15 years with 98 displaced femoral fractures were treated with external fixation and early mobilisation. The mean age was 8.1 years, the mean hospital stay was 8.7 days and the mean treatment time was 61 days. All fractures healed. Minor complications included pin tract infections (18%), clinical insignificant malunions, heterotopic ossification and two re-reductions. Major complications (6%) included two re-fractures after significant trauma and three plastic deformations after premature fixator removal leading to an osteotomy.</p><p>Radiological evaluation was performed up to one year for the whole group and for a subgroup up to two years. The evaluation showed that malunions were few and prone to remodelling almost completely. Although the fractures were fixated without shortening, as recommended earlier, the overgrowth was far less than expected.</p><p>Isokinetic muscle strength was measured in both hamstrings and quadriceps in 31 of the patients and compared with 31 matched children without previous injury to the legs. Early mobilisation seems to prevent residual muscle weakness previously shown after treatment with traction or cast for femoral fractures in children.</p><p>A cost analysis was performed, comparing three different treatment modalities of femoral shaft fractures: traction in hospital, traction in hospital/at home and external fixation. The analysis included both total medical costs and costs for the care provider. The most important factors were days spent at the hospital and the sick leave for the care provider. Treatment that can minimise these factors will contribute strongly to a lowering of health care costs.</p><p>Conclusion: External fixation of displaced femoral fractures in children can be used as standard treatment in children aged 3-15 years. The treatment provides satisfactory results with a low rate of major complications. Early mobilisation seems to prevent residual muscle weakness. The treatment reduce the number of days in hospital and the number of days of sick leave for the care provider and contributes strongly to lowering health care costs.</p>

The overall aim of this thesis was to evaluate the outcome when treating children for displaced femoral fractures with external fixation. In a consecutive and prospective study during the period 1993-2000, 96 children aged 3-15 years with 98 displaced femoral fractures were treated with external fixation and early mobilisation. The mean age was 8.1 years, the mean hospital stay was 8.7 days and the mean treatment time was 61 days. All fractures healed. Minor complications included pin tract infections (18%), clinical insignificant malunions, heterotopic ossification and two re-reductions. Major complications (6%) included two re-fractures after significant trauma and three plastic deformations after premature fixator removal leading to an osteotomy. Radiological evaluation was performed up to one year for the whole group and for a subgroup up to two years. The evaluation showed that malunions were few and prone to remodelling almost completely. Although the fractures were fixated without shortening, as recommended earlier, the overgrowth was far less than expected. Isokinetic muscle strength was measured in both hamstrings and quadriceps in 31 of the patients and compared with 31 matched children without previous injury to the legs. Early mobilisation seems to prevent residual muscle weakness previously shown after treatment with traction or cast for femoral fractures in children. A cost analysis was performed, comparing three different treatment modalities of femoral shaft fractures: traction in hospital, traction in hospital/at home and external fixation. The analysis included both total medical costs and costs for the care provider. The most important factors were days spent at the hospital and the sick leave for the care provider. Treatment that can minimise these factors will contribute strongly to a lowering of health care costs. Conclusion: External fixation of displaced femoral fractures in children can be used as standard treatment in children aged 3-15 years. The treatment provides satisfactory results with a low rate of major complications. Early mobilisation seems to prevent residual muscle weakness. The treatment reduce the number of days in hospital and the number of days of sick leave for the care provider and contributes strongly to lowering health care costs.

The mechanical behavior of the arterial wall is determined by the composition and structure of its internal constituents as well as the applied traction-forces, such as pressure and axial stretch. The purpose of this work is to develop new theoretical frameworks and experimental methodologies to further the understanding of arterial mechanics and role of the various intrinsic and extrinsic mechanically motivating factors. Specifically, residual deformation, matrix organization, and perivascular support are investigated in the context of their effects on the overall and local mechanical behavior of the artery. We propose new kinematic frameworks to determine the displacement field due to residual deformations previously unknown, which include longitudinal and shearing residual deformations. This allows for improved predictions of the local, intramural stresses of the artery. We found distinct microstructural differences between the femoral and carotid arteries from non-human primates. These arteries are functionally and mechanically different, but are geometrically and compositionally similar, thereby suggesting differences in their microstructural alignments, particularly of their collagen fibers. Finally, we quantified the mechanical constraint of perivascular support on the coronary artery by mechanically testing the artery in-situ before and after surgical exposure.

Bei der Behandlung kindlicher Femurfrakturen ist es wichtig die Besonderheiten des kindlichen Knochens zu berücksichtigen. Resultierende Beinlängendifferenzen sowie die psychosoziale Belastung der Kinder stellen Probleme in der Therapie dar. Ziel der vorliegenden Studie war es unter Berücksichtigung dieser Aspekte einen Vergleich konservativer und operativer Therapieverfahren im Verlauf der Jahre herzustellen. Zugrunde gelegt wurden die Daten von 210 Kindern und Jugendlichen, die in dem Zeitraum von 1992 bis 2008 in der Universitätsmedizin Göttingen an einer Femurfraktur behandelt wurden. Als komplikationsarmes und kindgerechtes Verfahren hat sich in den letzten Jahren die Elastisch Stabile Intramedulläre Nagelung (ESIN) immer mehr durchgesetzt. Sie stellt mittlerweile bei Kindern über vier Jahren das Verfahren der Wahl dar. Die Verwendung der Plattenosteosynthese und des Fixateur externe hat deutlich abgenommen und sollte nur noch Spezialindikationen vorbehalten sein. Bei Kindern unter vier Jahren kann ebenfalls die ESIN mit guten Ergebnissen verwendet werden. Eine Alternative stellt in dieser Altersgruppe der Beckenbeingips dar. Die Extensionsverfahren werden auf Grund der vielen Nachteile, vor allem in psychosozialer Hinsicht, so gut wie nicht mehr verwendet.

Η οστεοαρθρίτιδα αποτελεί μια συχνά εμφανιζόμενη εκφυλιστική ασθένεια. Εντοπίζεται κυρίως στις μεγάλες αρθρώσεις (πχ ισχύο και γόνατο) και χαρακτηρίζεται από προοδευτική φθορά του αρθρικού χόνδρου. Στην παρούσα εργασία έγινε χαρτογράφηση του υγιούς και του οστεοαρθριτικού τμήματος ανθρώπινης κεφαλής μηριαίου οστού η οποία αφαιρέθηκε κατά τη διάρκεια αρθροπλαστικής επέμβασης. Η τεχνική που χρησιμοποιήθηκε ήταν η φασματοσκοπία micro-Raman η οποία παρέχει πληροφορίες που αφορούν στις δονήσεις μορίων. Συγκεκριμένα έγινε δυνατή η ανάπτυξη μεθοδολογίας για τη διαφοροποίηση κολλαγόνου Ι (οστό) και κολλαγόνου ΙΙ (χόνδρος) εξετάζοντας τις φασματικές περιοχές της προλίνης και υδροξυπρολίνης, κάμψεων CH2, CH3 και των αμιδίων Ι και ΙΙΙ. Επίσης η μελέτη των δονήσεων των φωσφορικών ιόντων και των ανθρακικών υποκατασταστατών τους έκανε δυνατή τη διαφοροποίηση του βιοαπατίτη του οστού από τον ασβεστοποιημένο χόνδρο. Η ανάλυση των δεδομένων έδειξε την απουσία αρθρικού χόνδρου στο κέντρο της κεφαλής, που υφίσταται το μέγιστο φορτίο, και την πλήρη αποκάλυψη του υποχόνδρινου οστού. Την εικόνα αυτή διαδέχονται, καθώς κινούμαστε περιμετρικά προς τα άκρα, περιοχές όπου κυριαρχεί ασβεστοποιημένος χόνδρος ή και συνύπαρξη οστού και χόνδρου σαν ένα ενδιάμεσο στάδιο οστεοαρθρίτιδας. Υγιείς περιοχές με εμφανές στρώμα αρθρικού χόνδρου δεν εντοπίζονται παρά μόνο πολύ μακριά από το κέντρο της κεφαλής του μηριαίου οστού. Η χαρτογράφηση περιοχών εσωτερικά, στην επιφάνεια μιας τομής, έδειξε μια σχετικά απότομη μετάβαση από το χόνδρο στο υποχόνδρινο οστό στις υγιείς περιοχές, εικόνα που συνάδει με τα όσα είναι γνωστά για τη δομή της άρθρωσης. Αντίθετα, οι οστεοαρθριτικές περιοχές χαρακτηρίζονταν από την απουσία των φασματικών περιοχών του κολλαγόνου τύπου ΙΙ (χόνδρος) στα εξωτερικά στρώματα αλλά και τη συνύπαρξη των δύο τύπων κολλαγόνου Ι και ΙΙ (οστού και χόνδρου) ή την παρουσία ασβεστοποιημένου κολλαγόνου ΙΙ σε διαδοχικές ζώνες και σε βάθος αρκετών χιλιοστών σε αρκετές περιπτώσεις προς το εσωτερικό της τομής. Τα φασματοσκοπικά αποτελέσματα, τέλος, επιβεβαιώθηκαν από ιστολογική εξέταση με χρώση safranin O της κάθε χαρτογραφημένης περιοχής στην εξεταζόμενη τομή οστεοαρθριτικής κεφαλής μηριαίου οστού. / Osteoarthritis is a very common degenerative disease, characterized by gradual degeneration of the articular cartilage and mainly affecting knees and hip joints. In the present work, a human osteoarthritic femoral head, removed during replacement surgery, was used for the mapping of its healthy and osteoarthritic areas. Laser Raman microscopy, a technique that provides information on molecules’ vibrations, was employed for the study. The development of a methodology for the distinction between collagen I (bone) and collagen II (cartilage) was accomplished through the study of proline, hydroxyproline, CH2, CH3 bending and amide I and III bands. On the other hand, the study of phosphate and carbonate substituents made the distinction between bone bioapatite and calcified cartilage feasible. Data analysis revealed the absence of articular cartilage and the full exposure of subchondral bone in the middle of the outer surface of femoral head section, where maximum friction due to movement is observed. Moving perimetrically from the middle of the outer surface to the rims of the section, areas of calcified cartilage and coexistence of bone and cartilage are observed, possibly as an intermediate disease stage. Healthy areas with distinct layer of articular cartilage are located only on the extreme rims of the section. Mapping of areas in depth of the femoral head section, revealed a relatively abrupt transition from cartilage to subchondral bone in healthy areas, which is consistent with our knowledge about joint structure. On the contrary, osteoarthritic areas were characterized by the absence of collagen II (cartilage) characteristic bands on the outer layers and in the same time by the coexistence of collagen I and II (bone and cartilage) or the presence of calcified collagen II through successive layers in some millimeters depth towards the interior of the femoral head section. Finally, spectroscopic results were confirmed by histological examination and Safranin O histochemical staining of each area mapped of the human femoral head section.

No description available.