Orientadores: Antonio Luis Eiras Falcão, Marcos Mello Moreira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T21:59:16Z (GMT). No. of bitstreams: 1 Toneloto_MariaGabrielaCavicchia_D.pdf: 6088561 bytes, checksum: 28d45739cb4aa005498eba4b6e7a8317 (MD5) Previous issue date: 2012 / Resumo: A fístula broncopleural (FBP) é uma complicação que cursa com elevada mortalidade hospitalar, potencialmente grave quando associada à ventilação mecânica (VM). Desta forma, o presente estudo teve por objetivo, avaliar a eficácia de um sistema valvular de oclusão inspiratória regulável através da avaliação de parâmetros hemodinâmicos, gasométricos e respiratórios, na indução cirúrgica de FBP experimental sob ventilação mecânica invasiva. Foram estudados seis porcos (25kg) submetidos à entubação endotraqueal (TOT), sob VM e monitorado hemodinamicamente com cateter Swan-Ganz. Entre o TOT e o circuito da VM foi conectado o sensor do capnógrafo. Os dados de gasometria arterial e venosa foram registrados antes do ato cirúrgico, após a indução da FBP com débito superior a 50% do volume inspirado e a cada tratamento com a válvula de oclusão inspiratória regulável (VOIr); esta, em diferentes posições de regulagem de fluxo (cinco posições, portanto, cinco tratamentos). Uma extremidade da válvula foi acoplada ao dreno de tórax, enquanto a outra foi colocada entre o TOT e circuito do respirador mecânico. Estatisticamente (p<0,05), as variáveis que apresentaram significância foram o volume corrente alveolar e o débito da FBP. O presente modelo mostrou-se eficaz em sua proposta, sem prejuízos hemodinâmicos, apesar da não constatação da normalização das gasometrias, bem como a não evidência de piora em relação ao tratamento com selo d'água / Abstract: The bronchopleural fistula (BPF) is a complication that takes to higher hospital mortality, potentially severe when associated with mechanical ventilation (MV). Thus, the purpose of this study evaluating the efficacy of a valve system inspiratory occlusion adjustable through evaluation of hemodynamic parameters, arterial blood gas and respiratory in the surgical induction of experimental BPF mechanically ventilated. Were studied six pigs (25kg) underwent endotracheal intubation (ET) under MV and hemodynamically monitored with Swan-Ganz catheter. Between ET and the circuit was connected to the MV capnography sensor. Data from arterial and venous blood gases were recorded before surgical act, after induction of BPF with debt exceeding 50% of the inspired volume and each treatment with inspiratory occlusion valve regulated this in different positions of flow regulation. One end of the valve was attached to the chest tube, while the other was placed between the ET and the circuit of MV. Statistically (p <0.05), the variables that were significant were the alveolar tidal volume and rate of BPF. This model proved effective in its proposal without cause hemodynamic despite not finding the normalization of blood gases as well as no evidence of worsening compared to treatment with water seal / Doutorado / Fisiopatologia Cirúrgica / Doutora em Ciências

Abstract Biliary carcinoma, biliary fistula with occasional gallstone ileus and primary sclerosing cholangitis (PSC) are serious diseases and present specific diagnostic and therapeutic challenges. Stenting of biliary obstruction has also involved problems, but the reports are contradictory and partly limited. The aim of the present work was to evaluate and compare various imaging modalities in biliary diseases. The study also aimed to evaluate the usefulness of metallic stents in malignant biliary obstruction. The study population consisted of 210 patients with gallbladder carcinoma, bile duct carcinoma, biliary fistula, PSC or malignant biliary obstruction and eight control patients with various hepatobiliary diseases. The imaging findings of 80 patients with gallbladder carcinoma, 58 patients with bile duct carcinoma, and 16 patients with biliary fistula were reviewed. Nine patients with PSC underwent magnetic resonance cholangiography (MRC) and magnetic resonance imaging (MRI) of the liver, ultrasonography (US) of the liver and the bile ducts and endoscopic retrograde cholangiography (ERC). Eight control patients had had MRC and MRI of the liver and ERC. The medical records and radiographs of 39 patients with malignant biliary obstruction treated with percutaneously inserted metallic stents were also analysed. The stents included 48 Wallstents and seven Memotherm stents. In cases of gallbladder carcinoma, US visualised the primary tumour in 68 % and computed tomography (CT) in 57 % of the cases examined, but both methods were insufficient for accurate staging. In bile duct carcinoma, US revealed the primary tumour in 63 % and CT in 44 % of the cases examined. Both methods were sensitive in diagnosing peripheral intrahepatic cholangiocarcinoma, but inaccurate for more distal bile duct carcinoma or abdominal spread. The infiltrating type of gallbladder carcinoma and bile duct carcinoma were difficult to detect. US and CT were sensitive in revealing bile duct obstruction. The patients with biliary fistula and gallstone ileus had undergone various examinations with pathological, but not diagnostic results, and there was often a delay to diagnosis. Imaging did not reveal any of the ten spontaneous fistulas, but CT showed one of the five cases of gallstone ileus, and Gastrografin® meal revealed the single case of Bouveret's syndrome. Fistulography or cholangiography revealed all but one of the six iatrogenic fistulas. A nonvisualised or shrunken gallbladder at US should raise a suspicion of biliary enteric fistula in an appropriate clinical setting. MRC-MRI depicted the changes of PSC correctly in nine patients (radiologist 1) and in eight patients with one false positive finding (radiologist 2) in a blinded analysis. In the segmental comparison MRC missed especially bile duct dilatations. MRC was too pessimistic in the evaluation of the predictors of poor outcome. US detected features suggestive of PSC in eight patients (radiologist 3). US was unable to indicate the predictors of poor outcome. Of the patients with metallic stents in malignant biliary obstruction, 30 % had early and 66 % late complications, including stent obstructions, which occurred in 27 % of the patients at a mean of 4.4 months. The cause was mostly tumour ingrowth or overgrowth. The 25-week and 50-week patency rates were 71 % and 42 %. The patency rates of the patients with cholangiocarcinoma were significantly the lowest. There was also a tendency towards lower patency with less dilatation of the stents, an increasing number of the stents, longer strictures and hilar strictures. Many other complications were infectious. 31 % of the patients had late reinterventions.

Deep-sea corals have long been regarded as cold-water coral; however a reevaluation of their habitat limitations has been suggested after the discovery of deep-sea coral in the Red Sea where temperatures exceed 20˚C. To gain further insight into the biology of deep-sea corals at these temperatures, the work in this PhD employed a holotranscriptomic approach, looking at coral animal host and bacterial symbiont gene expression in Dendrophyllia sp., Eguchipsammia fistula, and Rhizotrochus sp. sampled from the deep Red Sea. Bacterial community composition was analyzed via amplicon-based 16S surveys and cultured bacterial strains were subjected to bioprospecting in order to gauge the pharmaceutical potential of coralassociated microbes. Coral host transcriptome data suggest that coral can employ mitochondrial hypometabolism, anaerobic glycolysis, and surface cilia to enhance mass transport rates to manage the low oxygen and highly oligotrophic Red Sea waters. In the microbial community associated with these corals, ribokinases and retron-type reverse transcriptases are abundantly expressed. In its first application to deep-sea coral associated microbial communities, 16S-based next-generation sequencing found that a single operational taxonomic unit can comprise the majority of sequence reads and that a large number of low abundance populations are present, which cannot be visualized with first generation sequencing. Bioactivity testing of selected bacterial isolates was surveyed over 100 cytological parameters with high content screening, covering several major organelles and key proteins involved in a variety of signaling cascades. Some of these cytological profiles were similar to those of several reference pharmacologically active compounds, which suggest that the bacteria isolates produce compounds with similar mechanisms of action as the reference compounds. The sum of this work offers several mechanisms by which Red Sea deep-sea corals cope with environmental conditions in which no other deep-sea corals have yet to be reported. These deep-sea coral are associated with rich microbial communities, which produce molecules that induce bioactivity. The aggregate of this work provides direction for future research of Red Sea deep-sea coral and highlights the potential pharmacological benefit of conserving these species and their unique ecosystem.

La fístula arteriovenosa se considera la primera vía de acceso vascular de elección en los pacientes que requieren hemodiálisis. La calidad del acceso vascular condiciona la eficiencia y efectividad de la hemodiálisis, así como la morbilidad y calidad de vida de los pacientes sometidos a este tratamiento. La presente investigación secundaria tuvo como objetivo: Identificar los factores que influyen en la supervivencia de la fistula arteriovenosa en personas con tratamiento de hemodiálisis. Se utilizó la metodología EBE, formulándose la pregunta clínica a través del esquema PS: ¿Cuáles son los factores que influyen en la supervivencia de la fístula arteriovenosa en personas con tratamiento de hemodiálisis? . Las búsqueda de información se realizó en bases de datos: PuBMed, Epistemonikos, Science Direct y Scielo, seleccionando 2421 artículos de investigación que cumplieron con los criterios de búsqueda, de los cuales se seleccionó 10 artículos que cumplieron con los criterios de validez y utilidad de Gálvez Toro, el comentario del revisor se desarrolló utilizando las listas de chequeo Astete, de acuerdo a la metodología de cada artículo, para valorar la calidad metodológica, de la cual se obtuvo nivel de evidencia 2+ y un nivel bajo de recomendación.

Traumatic arteriovenous fistulas of the neck are a relatively uncommon injury, whose ramifications can include immediate or delayed neurological insults, massive bleeding, or death. Angiography and embolization have been increasingly used to manage this complex injury pattern. In this particular case, the patient underwent management of bilateral communicating arteriovenous fistulae using a commercially available plug occlusion device. Epidemiology, with an emphasis on patient management and outcomes, is discussed.

El presente trabajo de investigación titulado Revisión Crítica: “Complicaciones más comunes de la fístula arteriovenosa en pacientes con tratamiento de hemodiálisis” tiene como objetivo: Identificar las complicaciones más comunes en las fístulas arteriovenosas. Se utilizó como metodología la Enfermería Basada en la Evidencia, y para la formulación de la pregunta se aplicó el esquema PIS, después se procedió a realizar una búsqueda bibliográfica exhaustiva de investigaciones que estuvieran relacionadas o dieran respuesta al presente trabajo; obteniéndose 12 investigaciones relacionadas a la pregunta clínica, las cuales se sometieron a la lista de validación de Gálvez Toro; finalmente se eligió para realizar el comentario crítico la Guía Clínica Española del Acceso Vascular para Hemodiálisis, donde se utilizó la metodología AGREE. El artículo seleccionado demostró un nivel de evidencia I y grado de recomendación A; considerándose una gran referencia para contrastar sus resultados relacionados al tema en cuestión, realizándose una crítica constructiva acerca de las complicaciones más comunes de la FAV, que según la Guía Clínica son la estenosis y la trombosis; donde se puede observar la presencia de tratamientos de forma generalizada, sin considerar la individualidad de los pacientes que recurren al tratamiento de H.D. así como sus posibles causas.

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