Objectiu principal d’avaluar l’eficàcia de la col•locaciçó d’una malla en la prevenció d’una eventració quan es realitza una laparotomia mitjana en cirurgia electiva. Material i mètodes: estudi controlat, prospectiu, aleatoritzat i a cec simple. Es defineixen dos grups, al grup A es tanca la paret abdominal amb sutura continua i malla supraaponeuròtica. Al grup B es tanca la paret abdominal de forma convencional sense la malla. Resultats: En el Grup A s’han diagnosticat eventracions en 2/80 pacients i en el grup B 30/80. L’anàlisi de Kaplan-Meier mostra que la probabilitat d’eventració als 12 mesos en el grup A (malla) és de 1,5% i en el grup B (control) és de 35,9%, amb significació estadística (p<0,0001). Són factors relacionats amb l’aparició d’eventració: edat >75 anys, IMC>30 i albumina ≤3g/dL Conclusions: la col•locació d’una malla supraaponeuròtica profilàctica prevé l’hèrnia incisional independentment d’altres factors. / Objective: to evaluate the prevention of incisional hernia during the postoperative period of a midline laparotomy during elective surgery. Material and methods: a controlled, prospective, randomized and blind study was carried out. The patients in group A (mesh) were fitted with a polypropylene mesh, to reinforce the standard abdominal wall closure. The patients in group B (non- mesh) were given a standard abdominal wall closure and were not fitted with the mesh. Results: In group A 2/80 incisional hernias were diagnosed, whereas in group B the number was 30/80. The Kaplan-Meier survival curves show that the likelihood of incisional hernia at 12 months is 1.5% in group A compared to 35.9% in group B (p<0.0001), which means that the differences are statistically significant. The risk factotrs for incisional hernia are age>75 years old, BMI>30 and albumine <3g/dL. Conclusion: fitting a prophylactic supra-aponeurotic mesh prevents incisional hernia independently of other factors.

Bei kongenitalen Zwerchfelldefekten kommt es zu einer Herniation von abdominellen Organen in den Thorax. Es resultieren eine Lungenhypoplasie und eine pulmonale Hypertonie, die die hohe Mortalität und Morbidität bestimmen. In dieser Studie wurden prä-, peri- und postnatale Parameter von Patienten mit kongenitalen Zwerchfelldefekten retrospektiv betrachtet und auf eine mögliche Prädiktion für das Outcome sowie auf therapeutische Qualitätsänderungen überprüft. Im prospektiven Teil wurde die weitere Entwicklung der Kinder nach dem stationären Aufenthalt eruiert. Statistisch signifikante Unterschiede zeigten sich für einen höheren 1’ APGAR, eine seltenere Anwendung von NO und ein selteneres Vorkommen von assoziierten Anomalien bei den überlebenden verglichen mit den verstorbenen Patienten. Die Überlebenden hatten niedrigere Beatmungsfrequenzen, inspiratorische Spitzendrücke, Sauerstoffkonzentration sowie Mitteldrücke bei Beatmung und höhere arterieller Mitteldrücke. Als negativ für das Outcome erwiesen sich ein Polyhydramnion, eine Leberherniation oder die Notwendigkeit einer HFOV. Im zeitlichen Verlauf zeigten sich ein höherer 5’ APGAR, eine zeitigere Diagnosestellung in der Schwangerschaft, eine spätere Durchführung der Operationen und seltenere Rezidive. Die Kinder wurden mit niedrigeren Beatmungsdrücken und niedrigerem Sauerstoffgehalt beatmet, ohne dass sich das Outcome verschlechterte. Bezüglich der späteren Entwicklung gab es orthopädische und neurologische Folgen. Die Kinder hatten nur wenige Einschränkungen im Alltag. Dennoch zeigte sich das potentielle Auftreten einer Minderung der kognitiven Fähigkeiten.

published_or_final_version / abstract / toc / Surgery / Master / Master of Surgery

BACKGROUND: We compared hernia recurrence rates in patients undergoing primary elective inguinal hernia repair at general hospitals with the Shouldice Hospital in Ontario, Canada. METHODS: We conducted an administrative data analysis of persons who underwent inguinal hernia repair in Ontario, Canada from 1993-2007. Risk of recurrent hernia repair was estimated according to hospital type and volume, using Cox proportional-hazards regression models. RESULTS: Recurrence risk in the lowest volume quartile was 5.7%, compared to 3.9% at high volume general hospitals and 1.1% at the Shouldice hospital. Compared to persons who had surgery at the lowest volume hospitals, hernia recurrence among Shouldice Hospital patients was substantially lower after adjustment for confounding variables (hazard ratio 0.18, CI (0.16 to 0.19), P <0.001). CONCLUSIONS: Persons who had elective primary inguinal hernia repair at the Shouldice Hospital had a substantially lower risk of recurrence than those treated at general hospitals, including high volume general hospitals.

BACKGROUND: We compared hernia recurrence rates in patients undergoing primary elective inguinal hernia repair at general hospitals with the Shouldice Hospital in Ontario, Canada. METHODS: We conducted an administrative data analysis of persons who underwent inguinal hernia repair in Ontario, Canada from 1993-2007. Risk of recurrent hernia repair was estimated according to hospital type and volume, using Cox proportional-hazards regression models. RESULTS: Recurrence risk in the lowest volume quartile was 5.7%, compared to 3.9% at high volume general hospitals and 1.1% at the Shouldice hospital. Compared to persons who had surgery at the lowest volume hospitals, hernia recurrence among Shouldice Hospital patients was substantially lower after adjustment for confounding variables (hazard ratio 0.18, CI (0.16 to 0.19), P <0.001). CONCLUSIONS: Persons who had elective primary inguinal hernia repair at the Shouldice Hospital had a substantially lower risk of recurrence than those treated at general hospitals, including high volume general hospitals.

Thesis (M.S.)--University of Hong Kong, 2002. / Title from title frame. Includes bibliographical references (leaves 133-151).

Proefschrift Universiteit Maastricht. / Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.

Made available in DSpace on 2014-06-11T19:25:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-07-04Bitstream added on 2014-06-13T18:29:09Z : No. of bitstreams: 1 000737976.pdf: 485647 bytes, checksum: 9639675857b2f1dccc09e4c061e226ab (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / HMGB1 protein may act by promoting an inflammatory response. Thus, the goals of this study were to quantify plasma and peritoneal fluid concentrations of HMGB1 in calves with or without congenital umbilical hernia before and after surgery, as well as assess their levels during serial paracentesis used as an auxiliary diagnostic tool for assessing the inflammatory response in the abdominal cavity. The presence of a congenital umbilical hernia caused increased values of HMGB1 in plasma and peritoneal fluid. The herniorraphy was not a stimulus intense enough to increase the concentration of this protein in the peripheral blood. However, in the peritoneal fluid, HMGB1 levels were increasead from 7 to 15 days after surgery, in response to the inflammatory process established in the abdominal cavity postoperatively. Serial paracentesis caused an increase of HMGB1 levels in the peritoneal fluid only, showing a mild inflammatory process, returning to baseline values after a longer interval between punctures. Thus, the presence of congenital umbilical hernias in calves cause local and systemic changes in HMGB1 levels both in plasma and in the peritoneal fluid while herniorraphy and serial paracentesis cause later changes in HMGB1 levels only in the peritoneal fluid / FAPESP: 12/00334-3 / FAPESP: 12/08114-2

Tese (livre-docencia) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-14T07:43:16Z (GMT). No. of bitstreams: 1 Facure_JoseJorge_LD.pdf: 1342743 bytes, checksum: e144ff79ee9f2cfdb3a383d2b7d064b4 (MD5) Previous issue date: 1984 / Resumo: Não informado / Abstract: Not informed / Tese (livre-docencia) - Univer / Livre docente em Neurociencias

Herniation of the intervertebral disc is a pathological condition characterized by protrusion of the tissue posterio-laterally, often impinging on the spinal chord or nerve roots. The disease is accompanied by a reduction in the average molecular weight and viscosity of the disc proteoglycans, in excess of that which normally occurs with increasing age. The proteoglycans of disc however have not been examined in terms of the modern concepts of cartilage matrix structure. Bovine nasal cartilage, has been shown to contain proteoglycan aggregates, trapped in the intersticess of a collagen network, which can be dissociated with 4M guanidine hydrochloride into diffusible proteoglycan subunits and a multicomponent "linking" fraction. A similar system was thought to occur in the intervertebral disc. It seemed possible that, if such a system was present in the disc, the reduction in the molecular weight and viscosity of the proteoglycans with increasing age and herniation could be due to a decrease in proteoglycan aggregation. The present study showed that proteoglycan aggregates similar to those of bovine nasal cartilage are found in the human intervertebral disc, but that they only represent 5% of the total proteoglycans in the tissue. In contrast, bovine nasal cartilage contained 70% of the proteoglycans in the aggregated form. A novel modification of the extraction procedure was devised by which it was possible to assess the degree of proteoglycan aggregation. Sequential extraction of the tissue with a weak and strong electrolyte (0.4 M and 4M guanidine hydrochloride) selectively removed non-aggregated and aggregated proteoglycans respectively. This procedure provides a new and rapid method for assessing the degree of proteoglycan aggregation in a variety of connective tissues. The small proportion of aggregate in the disc was almost exclusively located in the annulus fibrosus. Re-aggregation studies suggested that both disc and cartilage contain two proteoglycans, only one of which is capable of forming aggregates. Examination of the proteoglycans in a limited number of discs suggested that the degree of aggregation did not change with increasing age. Since, in addition, aggregates represent only a small proportion of the disc proteoglycans, it appeared unlikely that a decrease in the degree of aggregation could account for the decrease in molecular weight and viscosity of the disc proteoglycans observed with increasing age and/or degenerative disc disease. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate