Orientador: Silvia Regina Brandalise / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T02:02:46Z (GMT). No. of bitstreams: 1 Deneno_BiancaPratelezzi_M.pdf: 2701966 bytes, checksum: 77adce634cd407570541182cd2a6232b (MD5) Previous issue date: 2007 / Resumo: Os tumores ósseos malignos perfazem 7% dos tumores em pacientes menores de 20 anos de idade, sendo 10 a 15% deles, localizados em pelve. Com o advento da poliquimioterapia, radioterapia e novas técnicas cirúrgicas, a taxa de sobrevida livre de doença, em cinco anos, das crianças e adolescentes acometidos por tumor ósseo não metastático, está ao redor de 70%. Atualmente, pode ser observado o impacto dos efeitos estéticos e funcionais decorrentes do tratamento, e sua interferência na qualidade de vida desses indivíduos. O objetivo do presente estudo foi avaliar retrospectivamente, os resultados funcionais em crianças e adolescentes portadores de tumores pélvicos, submetidos à hemipelvectomia interna tipo II, com ou sem reconstrução do anel pélvico. Foram avaliados 31 pacientes portadores de tumor pélvico, tratados no Centro Boldrini e no Hospital A.C. Camargo, entre 1994 e 2005. O resultado funcional foi baseado no Sistema de Avaliação Funcional, padronizado por Enneking et al (1993). Os critérios analisados foram: dor, função, aceitação emocional, necessidade de suporte, capacidade de deambulação e marcha. Dos 31 casos seguidos, 12 (38,7%) fizeram a reconstrução do anel pélvico com enxerto de fíbula e 19 (61,3%) não a fizeram. A média de idade dos pacientes foi de 11,4 anos (4-17,8 anos). A média de seguimento para os 31 casos foi de 41 meses. O resultado funcional final obtido aos 12 meses do pós-operatório, foi excelente em 17,4 % dos pacientes (todos com reconstrução do anel pélvico), bom em 60,9% dos pacientes, regular em 17,4% e ruim em 4,3%. A média do escore foi melhor no grupo de pacientes com a reconstrução com autoenxerto de fíbula, comparativamente ao grupo de pacientes que não tiveram esta reconstrução, sendo significativa a diferença entre os grupos (p=0,008) / Abstract: Seven percent of all malignant tumors in patients less than 20 years old are bone tumors, being 10 to 15% of them localized in pelvis. The overall survival of these non metastatic patients, with polichemoterapy, radiation and new surgery approach is 70% in 5 years. Nowadays, the impact of esthetical and functional effects due to treatment interfere in their quality of life. The objective of this study was to assess, retrospectively, the functional results in children and adolescents with pelvic tumors, who underwent type II internal hemipelvectomy, with or without reconstruction of the pelvic ring. Thirty-one patients with pelvic tumor were treated at Boldrini¿s Hospital and A.C. Camargo Hospital during the period of 1994 and 2005. The functional result was evaluated based on the System for the Functional Evaluation, standardized by Enneking et al (1993). The analyzed criteria were: pain, function, emotional acceptance, need to support, walking ability and gait. Out of the 31 cases analyzed, 12 (38,7%) underwent reconstruction of the pelvic ring with fibular graft and 19 (61,3%) did not have reconstruction. The mean age of the patients was 11. 4 years (4 - 17,8 years). The mean of follow-up for the 31 cases was 41 months. The functional result, obtained 12 months after the surgery, was excellent in 17,4 % of the patients (all of them with pelvic ring reconstruction), good in 60,9% of the patients, regular in 17,4% and poor in 4,3%. The mean of score was better in the group of patients who underwent reconstruction with fibular autograft, comparatively to the group of patients who did not have pelvic ring reconstruction. The global functional result showed significant difference among the groups with and without reconstruction of the pelvic ring (p = 0,008) / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Hip disarticulations and hemipelvectomies are the highest level of lower limb amputations. As such, these amputations create ambulation difficulties and current prosthetic solutions are limited. Powered prosthetic joints have successfully improved lower limb amputee gait; however, no powered hip joints are available on the market. This thesis presents the design and evaluation of a microprocessor-controlled powered hip joint for hip-level amputees. A rope and pulley system was used to transmit power from an actuator located at the prosthetic thigh to rotate the prosthetic leg around an anteriorly-located prosthetic hip joint. The pulley system features an innovative tensioning system using multiple keyways, allowing the system to be tensioned without external tensioning devices. The powered hip prosthesis passed ISO 15032:2000 mechanical strength tests that simulated 100 kg user loads. The joint was also tested by able-bodied individuals using a hip disarticulation simulator to walk with the powered hip-knee-ankle-foot prosthesis. Though the participants had asymmetrical gait with shorter intact-side swing time, the device successfully allowed the participants to ambulate. The final device weighed 3.9 kg and respected geometric design constraints to fit comfortably under pants. Future work is needed to implement a gait control system, resolve a rope slack issue, and test the device with hip-level amputees.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-25T13:14:49Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Mestrado Alfredo Haack versão banca (1).pdf: 9768094 bytes, checksum: 3bdb2e65d438668333f45e16b3d76845 (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-25T13:14:58Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Mestrado Alfredo Haack versão banca (1).pdf: 9768094 bytes, checksum: 3bdb2e65d438668333f45e16b3d76845 (MD5) / Made available in DSpace on 2017-09-25T13:14:58Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Mestrado Alfredo Haack versão banca (1).pdf: 9768094 bytes, checksum: 3bdb2e65d438668333f45e16b3d76845 (MD5) Previous issue date: 2016 / Universidade Federal Fluminense. Hospital Universitário Antonio Pedro / Fundamentos: Hemipelvectomia (externa ou interna) é uma cirurgia ortopédica de grande porte, indicada em sarcomas pélvicos primários do osso ou de tecidos conectivos. Devido à perda significativa de sangue e fluidos, extenso trauma tecidual, distúrbios da coagulaçã o e dor intensa pós-operatória, os cuidados perioperatórios e a anestesia são desafiadores. Objetivo: Analisar variáveis perioperatórias e as estimativas de sobrevida em cirurgias de hemipelvectomia. Métodos: Estudo retrospectivo de 35 pacientes consecutivos, submetidos a hemipelvectomia no Instituto Nacional de Câncer José Alencar Gomes da Silva entre 2000 e 2013. Foram analisadas variáveis perioperatórias. Realizada análise descritiva dos dados, expressos em médias±desvios-padrão e medianas. Para análise da sobrevida foram construídas curvas de Kaplan-Meier e realizada análise de regressão de Cox para identificar os preditores independentes de sobrevida. Resultados: Hemipelvectomia externa realizada em 23 (65,7%) pacientes. Dados pré-operatórios: mediana de idade 40 anos; peso mediano 70 kg; sexo masculino 68,5%; radioterapia pré-operatória 28,6%; quimioterapia pré-operatória 17,1%; tabagismo 42,8%; hipertensão arterial 25,7%; diabetes mellitus 5,7%; doença coronariana aterosclerótica 2,8%; asma 2,8%; insuficiência renal crônica 2,8%; refluxo gastroesofágico 2,8%; metástase pulmonar 11,4%; e depressão 5,7%. Anestesia geral combinada com regional realizada em 31 (88,57%) pacientes. Dados intraoperatórios: 23 (65,7%) pacientes apresentaram instabilidade hemodinâmica e medicamentos vasopressores foram necessários em 12 (34,2%); 6 (17,1%) apresentaram distúrbios da coagulaçã o. A mediana de infusão de cristaloides foi 3500 mL e a administração de coloides ficou entre 500 -1500 mL. Vinte pacientes (57,1%) receberam concentrado de hemácias e 4 (1,4%) necessitaram de outros hemoderivados. Trinta e três (94,2%) pacientes foram extubados na sala de operaçã o. Dados do pós-operatório: dor aguda intensa em 31,4% dos casos; 40% desenvolveram dor crônica. Dezessete pacientes (48,5%) foram transfundidos. Um paciente (2,8%) desenvolveu insuficiência renal aguda, 2 (5,7%) apresentaram distúrbios neurológicos, 1 (2,8%) apresentou arritmias e 9 (25,7%) apresentaram complicações de ferida operatória. A mediana do tempo de internaçã o após a cirurgia foi 6 dias. A média de sobrevida após a cirurgia foi 30,5±4,9 meses. Na análise bivariada, apenas estágio avançado da doença teve significância como preditor independente para morte (p=0,001, HR=6,0, IC95% para HR =2,03–17,6). Na análise multivariada ao nível de 5%, apenas os estágios avançados 3 e 4 da doença foram fator de risco independente para taxa de sobrevida reduzida. Conclusões: O tempo cirúrgico, o volume de fluidos e transfusões sanguíneas e o tempo até a alta foram menores quando comparados aos previamente reportados. A hemipelvectomia externa foi mais prevalente e apresentou menor sobrevida que a interna. Estágio avançado da doença foi preditor significativo para redução da sobrevida após hemipelvectomia / indicated in primary pelvic sarcomas of the bone or connective tissues. Due to significant loss of blood and fluids, extensive tissue trauma, coagulation disorders and severe postoperative pain, perioperative care and anesthesia are challenging. Objective: To analyze perioperative variables and survival estimates in hemipelvectomy surgeries.Methods: Retrospective study of 35 consecutive patients undergoing hemipelvectomy at Instituto Nacional de Câncer José Alencar Gomes da Silva between 2000 and 2013. Perioperative variables were analyzed. Descriptive data analysis was conducted. Data are expressed as mean±standard deviation and medians. For survival analysis, Kaplan-Meier curves were constructed and Cox regression analysis was performed to identify independent predictors of survival. Results: External hemipelvectomy was conducted in 23 (65.7%) patients. Preoperative data: median age 40 years; median weight 70 kg; males 68.5%; preoperative radiotherapy 28.6%; preoperative chemotherapy 17.1%; smoking 42.8%; hypertension 25.7%; diabetes mellitus 5.7%; atherosclerotic coronary artery disease 2.8%; asthma 2.8%; chronic renal failure 2.8%; gastroesophageal reflux 2.8%; lung metastasis 11.4%; and depression 5.7%. General anesthesia combined with regional anesthesia was employed in 31 (88,57%) patients. Intraoperative data: 23 (65.7%) patients presented hemodynamic instability and vasopressor agents were required in 12 (34.2%); 6 (17.1%) had coagulation disorders. The crystalloid infusion median was 3500 mL and colloids administration was between 500 - 1500 mL. Twenty patients (57.1%) received packed red blood cells and 4 (1.4%) of them required other blood products. Thirty-three (94.2%) patients were extubated in the operating room. Postoperative data: intense acute pain in 31.4% of cases; 40% developed chronic pain. Seventeen patients (48.5%) were transfused. One patient (2.8%) developed acute renal failure, 2 (5.7%) presented neurological disorders, 1 (2.8%) had arrhythmias and 9 (25.7%) had operative wound complications. Median length of hospital stay after surgery was 6 days. Mean survival after surgery was 30.5±4.9 months. In the bivariate analysis, only advanced stage of the disease had significance as an independent predictor of death (p=0.001, HR=6.0, 95% CI for HR=2.03-17.6). In the multivariate analysis at the level of 5%, only advanced stage of the disease (3 and 4) was an independent risk factor for reduced survival rate. Conclusions: Operation time, fluid and blood transfusion volumes and length of hospital stay before discharge were smaller than previous reports. External hemipelvectomy was more predominant and presented shorter survival than internal hemipelvectomy. Advanced disease stage was significant predictor for reduced survival after hemipelvectomy