Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment for the degree Master of Medicine (Surgery) / Aim: The aim of this research report is to assess which local epidemiological and clinical factors determine impact on the morbidity and mortality of intussusception, expressed as defined clinical outcomes. Methods: A retrospective hospital record review of paediatric intussusception admitted to Chris Hani Baragwanath (CHBH) and Charlotte Maxeke Johannesburg Academic Hospitals (CMJAH) for the period of January 2007 to April 2010 was undertaken. The four determining factors evaluated are: Duration of symptoms, weight, palpable rectal intussusceptum, admission serum C-­‐reactive protein, against seven possible clinical outcomes: Failed pneumatic reduction, perforation during attempted pneumatic reduction, intestinal resection, ileostomy, relook laparotomy, intensive care unit admission and mortality. A total of 108 cases were found of which 11 were excluded from data analysis. Results: Sixty eight percent of cases were from CHBH and a total of 57% of cases were referred from surrounding medical facilities. 62 of 97 cases had an attempted pneumatic reduction with a 51.6% (32/62) success rate and an overall success rate of 32/97, 33%. Seven cases developed pneumoperitoneum during pneumatic reduction. A total of 65 cases underwent surgical management. Of those 81.5% (53/65) underwent intestinal resection. Ileostomy diversion was necessary in 13.8% (9/65) of operative cases and 11% (7/65) needed a second surgical procedure during the initial presenting admission. An overall mortality rate of 9.3% (9/97) is noted. Conclusion: Intussusception in Johannesburg is associated with significant morbidity and mortality. Duration of symptoms and C -­‐ reactive protein levels are predictive for clinical outcomes in paediatric intussusception.

Habilitationsschrift--Heidelberg. / At head of title: Aus dem physiologischen Institut zu Heidelberg. Includes bibliographical foot-notes.

INTRODUCCIÓ: Hi ha molt poca informació a la literatura mèdica que suggereix que existeix una alta prevalença de la infecció pel virus hepatitis B (VHB) i C (VHC) en malalts amb malaltia inflamatòria intestinal (MII). El seu coneixement és important per la possibilitat de reactivació viral relacionada amb el tractament immunosupressor. HIPÒTESI: La infecció per VHB i C és més freqüent en la MII que en la població general de referència. El tractament immunosupressor pot reactivar la infecció per VHB i C. OBJECTIUS: Avaluar: 1) La prevalença d'infecció per VHB i C en pacients amb MII de diferents àrees geogràfiques d'Espanya. 2) L'efecte del tractament immunosupressor i els fàrmacs biològics sobre l'evolució de la infecció per VHB i C. METODOLOGIA: Estudi 1: inclusió de 2076 pacients amb MII, als quals s'avalua l'existència d'infecció per VHB i C mitjançant tècniques analítiques estàndard (ELISA i PCR). Es van registrar els factors relacionats amb la MII i la infecció. Estudi 2: Inclusió de 162 pacients amb MII i infecció per VHB i / o C i que van rebre tractament immunosupressor per la MII. Es van registrar variables clíniques i analítiques relacionades amb la reactivació. Tots dos són estudis multicèntrics amb registre electrònic (www.repentina.com). Per a l’anàlisi de resultats es van utilitzar tests univariants (2 i test de t Student) i multivariants (regressió logística i model de risc proporcional de Cox). RESULTATS: Estudi 1: El 9.7% de pacients amb colitis ulcerosa (CU) i malaltia de Crohn (MC) van presentar positivitat de marcadors d'infecció pel VHB i C actual o passada (CU: HBsAg 0.8 % , anti-HBc 8 % , anti-VHC 1.3 % ; MC: HBsAg 0.6 % , anti-HBc 7.1 % , anti-VHC 2.3 % ). El 12% de pacients amb MII van presentar marcadors de vacunació eficaç. En l’anàlisi multivariant, l'edat, la història familiar d'hepatitis i la MII moderada-greu, es van relacionar de manera significativa amb el VHB, mentre que les transfusions i l'ús d'antibiòtics ho van fer amb el VHC. Estudi 2: Un 36% de pacients van presentar disfunció hepàtica (DH) relacionada amb el VHB, un 66% dels quals van presentar insuficiència hepàtica. L’anàlisi multivariant va demostrar que l’únic factor relacionat amb la DH per VHB va ser l'ús simultani de 2 o més immunosupressors. En canvi només un 15.7% dels pacients amb VHC van presentar DH. CONCLUSIONS:Estudi 1: El pacients amb MII presenten una prevalença d’infecció pels VHB i VHC similar a la de la població general de referència, i aquesta és més baixa del que prèviament s’havia publicat. L’escassa relació de la infecció pel VHC i VHB amb els procediments invasius i ingressos hospitalaris suggereix que aquestes infeccions rarament s’adquireixen en l’àmbit hospitalari al nostre país. Es detecta un baix percentatge de vacunació eficaç pel VHB, el que obliga a intensificar els programes de vacunació en aquests pacients. Estudi 2: La DH en pacients amb MII tractats amb immunosupressors, és més freqüent i greu en els pacients amb infecció pel VHB que en el pacients amb infecció pel VHC. La immunosupressió combinada va ser l’únic factor predictiu independent de reactivació pel VHB. / Background: Limited information suggests the existence of a high prevalence of hepatitis B (HBV) and C virus (HCV) in inflammatory bowel disease (IBD). Hypothesis: HBV and HCV infection is more common in IBD than in the general population. Immunosuppressants can reactivate these infections.Objectives: To asses: 1) the prevalence of HBV and HCV in IBD, in a nationwide study, and to evaluate associated risk factors. 2) the influence of immunosuppressants on the course of HBV and HCV in IBD.Methods: Study 1: inclusion of 2076 IBD patients, which evaluates the existence of HBV and HCV using ELISA and PCR. Factors related to IBD and to infection were registered. Study 2: Inclusion of 162 IBD patients with HBV and HCV infection and immunosuppressants. Registration of clinical and laboratory variables related to reactivation. Both are multicentre studies with electronic data base (www.repentina.com). The results are analyzed by univariate and multivariate analysis. Results: Study 1: Present and / or past HBV and HCV infection was found in 9.7 % of IBD patients (HBsAg 0,6-0,8% / antiHBc 7-8% / anti-HCV 1.3-2.3%). Effective vaccination was present in 12 % of patients. In multivariate analysis, age, family history of hepatitis and moderate-to-severe IBD were significantly associated with HBV, whereas transfusions and antibiotics were significantly associated with HCV. Study 2: Liver dysfunction (LD) was observed in 36% HBsAg positive patients, 66% of whom developed hepatic failure. In contrast LD in HCV was observed in 15.7% of HCV-RNA positive patients. Treatment with ≥2 immunosuppressants was an independent predictor of HBV reactivation.Conclusions: Study 1: Prevalence of HBV and HCV infection in IBD is similar to that of the general population and lower than that in previously published series. This fact, in addition to the lack of association with invasive procedures, suggests the existence of adequate preventive measures in centres attending to these patients. The low percentage of effective vaccination makes it mandatory to intensify B virus vaccination in IBD. Study 2: LD in patients with IBD treated with immunosuppressants is more frequent and severe in those with HBV than in HCV carriers and is associated with combined immunosuppression.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Made available in DSpace on 2014-06-11T19:31:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-12Bitstream added on 2014-06-13T20:02:03Z : No. of bitstreams: 1 vieira_na_dr_botfm.pdf: 811081 bytes, checksum: 2278982cab7496707fe49b900b22418d (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / O ecossistema gastrintestinal é caracterizado por interações recíprocas e dinâmicas entre o epitélio gastrintestinal, células do sistema imunológico e sua microbiota intestinal (MI), a qual desempenha atividades metabólicas importantes locais (mucosa intestinal) e sistêmicas. Avaliar a MI de crianças com malformação craniofacial atendidas em um hospital especializado e verificar a influência da antibioticoprofilaxia com cefazolina em palatoplastia foi o objetivo desse trabalho. Foram isoladas e quantificadas as bactérias anaeróbias intestinais dos gêneros Bacteroides sp, Bifidobacterium sp e Lactobacillus sp nas fezes de 11 crianças sem fissura de palato (C) e de 50, com fissura de palato (FP), no período compreendido entre maio de 2007 a setembro de 2008. Foi avaliada a MI de 18 crianças com fissura de palato após 24 horas de tratamento, em dose única na indução anestésica, com cefazolina para palatoplastia. Observou-se que a frequência de Bacteroides sp foi maior no grupo FP (p < 0,001). Para Lactobacillus sp, houve tendência a maior quantidade (p = 0,086) no grupo FP. Não houve diferença na frequência de Bifidobacterium sp entre os dois grupos de crianças (p = 0,495). Houve diminuição do número de UFCs de Bacteróides sp (p = 0,031) e Lactobacillus sp (p = 0,004) em crianças com fissura tratadas com cefazolina em cirurgia de palato. Para o gênero Bifidobacterium sp, houve tendência à diminuição nas UFCs (p = 0,063). A dificuldade de ingestão de nutrientes, aleitamento materno insuficiente, otites recorrentes, entre outras ocorrem com frequência em indivíduos com malformação craniofacial, o que pode ter influenciado na composição da MI. A associação da palatoplastia e o uso de antibiótico... / The gastrointestinal ecossystem is characterized by reciprocal and dynamic interactions between the host and the intestinal microbiota (IM), which performs local important metabolic (intestinal mucosa) and systemic activities. The purposes of this study are the assessment of the IM in children with craniofacial malformation attended at a specialized hospital and the verification of the influence of the antibiotic prophylaxis with cefazolin on palatoplasty. The intestinal anaerobic bacteria Bacteroides sp, Bifidobacterium sp and Lactobacillus sp were isolated and quantified in the feces of 11 non-cleft children (NC) and 50 cleft children (CP), from May 2007 to September 2008. After a 24-hour treatment, the IM in 18 cleft children was evaluated – in a single dose – by means of anesthetic induction with cefazolin, in palatoplasty. It was observed that the Bacteroides sp occurred more often in the CP group (p < 0.001). Regarding the Lactobacillus sp, the largest quantity (p = 0.086) tended towards the CP group. There was no frequency difference for the Bifidobacterium sp between the two groups of children (p = 0.495). There was a reduction in the number of Colony-Forming Units (CFUs) for the Bacteroides sp (p = 0.031) and the Lactobacillus sp (p = 0.004) in cleft children treated with cefazolin, in palate surgeries. Regarding the Bifidobacterium sp, there was a reduction tendency in the CFUs (p = 0.063). The difficulty to ingest nutrients, the insufficient breastfeeding, the recurrent otitis – among other things – are frequent in individuals with craniofacial malformation, which may have influenced the IM composition. The association between palatoplasty and the use of antibiotics has intensified the IM changes. New investigations must be performed in order to verify which factors related to the craniofacial malformation, the surgical treatment and the use of antimicrobians would... (Complete abstract click electronic access below)

Orientador: Paulo Câmara Marques Pereira / Banca: Jussara Marcondes Machado / Banca: Hilton Coimbra Borgo / Banca: Manoel Armando Azevedo dos Santos / Banca: Sergio Aparecido Torres / Resumo: O ecossistema gastrintestinal é caracterizado por interações recíprocas e dinâmicas entre o epitélio gastrintestinal, células do sistema imunológico e sua microbiota intestinal (MI), a qual desempenha atividades metabólicas importantes locais (mucosa intestinal) e sistêmicas. Avaliar a MI de crianças com malformação craniofacial atendidas em um hospital especializado e verificar a influência da antibioticoprofilaxia com cefazolina em palatoplastia foi o objetivo desse trabalho. Foram isoladas e quantificadas as bactérias anaeróbias intestinais dos gêneros Bacteroides sp, Bifidobacterium sp e Lactobacillus sp nas fezes de 11 crianças sem fissura de palato (C) e de 50, com fissura de palato (FP), no período compreendido entre maio de 2007 a setembro de 2008. Foi avaliada a MI de 18 crianças com fissura de palato após 24 horas de tratamento, em dose única na indução anestésica, com cefazolina para palatoplastia. Observou-se que a frequência de Bacteroides sp foi maior no grupo FP (p < 0,001). Para Lactobacillus sp, houve tendência a maior quantidade (p = 0,086) no grupo FP. Não houve diferença na frequência de Bifidobacterium sp entre os dois grupos de crianças (p = 0,495). Houve diminuição do número de UFCs de Bacteróides sp (p = 0,031) e Lactobacillus sp (p = 0,004) em crianças com fissura tratadas com cefazolina em cirurgia de palato. Para o gênero Bifidobacterium sp, houve tendência à diminuição nas UFCs (p = 0,063). A dificuldade de ingestão de nutrientes, aleitamento materno insuficiente, otites recorrentes, entre outras ocorrem com frequência em indivíduos com malformação craniofacial, o que pode ter influenciado na composição da MI. A associação da palatoplastia e o uso de antibiótico... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The gastrointestinal ecossystem is characterized by reciprocal and dynamic interactions between the host and the intestinal microbiota (IM), which performs local important metabolic (intestinal mucosa) and systemic activities. The purposes of this study are the assessment of the IM in children with craniofacial malformation attended at a specialized hospital and the verification of the influence of the antibiotic prophylaxis with cefazolin on palatoplasty. The intestinal anaerobic bacteria Bacteroides sp, Bifidobacterium sp and Lactobacillus sp were isolated and quantified in the feces of 11 non-cleft children (NC) and 50 cleft children (CP), from May 2007 to September 2008. After a 24-hour treatment, the IM in 18 cleft children was evaluated - in a single dose - by means of anesthetic induction with cefazolin, in palatoplasty. It was observed that the Bacteroides sp occurred more often in the CP group (p < 0.001). Regarding the Lactobacillus sp, the largest quantity (p = 0.086) tended towards the CP group. There was no frequency difference for the Bifidobacterium sp between the two groups of children (p = 0.495). There was a reduction in the number of Colony-Forming Units (CFUs) for the Bacteroides sp (p = 0.031) and the Lactobacillus sp (p = 0.004) in cleft children treated with cefazolin, in palate surgeries. Regarding the Bifidobacterium sp, there was a reduction tendency in the CFUs (p = 0.063). The difficulty to ingest nutrients, the insufficient breastfeeding, the recurrent otitis - among other things - are frequent in individuals with craniofacial malformation, which may have influenced the IM composition. The association between palatoplasty and the use of antibiotics has intensified the IM changes. New investigations must be performed in order to verify which factors related to the craniofacial malformation, the surgical treatment and the use of antimicrobians would... (Complete abstract click electronic access below) / Doutor

The gastrointestinal tract has a large functional reserve. This is particularly true of the small intestine, and early studies by Flint in 1912, showed that dogs could withstand 50%-70% small intestinal resection, returning to normal health after an initial period of weight loss and malabsorption. No doubt, this reserve is in part due to the very high rate of epithelial proliferation in small bowel mucosa. Intestinal adaptation is the result of morphological and functional changes, and while these parameters can be accurately appreciated, the mechanisms by which these changes take place, are still under active investigation. This section summarises the changes, both structural and functional, in the adaptive process, and this is followed by a review of the background work done on the possible mechanism of adaptation. The normal anatomy of intestinal mucosa is however, considered first. Most of the work done to date in the field of intestinal adaptation, involves the small bowel, and this part of the gut will be discussed predominantly, but data available on colonic growth will be mentioned.