Inguinal hernia repair is the most common operation in general surgery. Its main challenge is to achieve low recurrence rates. With the introduction of mesh implants, first in open and later in laparoscopic repair, recurrence rates have decreased substantially. Therefore, the focus has been shifted from clinical outcome, such as recurrence, towards patient-experienced endpoints, such as chronic pain. In order to compare the results of open and laparoscopic hernia repair, a randomised multicentre trial - the Swedish Multicentre trial of Inguinal hernia repair by Laparoscopy (SMIL) - was designed by a study group from 11 hospitals. Between November 1996 and August 2000, 1512 men aged 30-70 years with a primary inguinal hernia were randomised to either laparoscopic (TEP, Totally ExtraPeritoneal) or open (Lichtenstein) repair. The primary endpoint was recurrence at five years. Secondary endpoints were short-term results, frequency of chronic pain and a cost analysis including complications and recurrences up to five years after surgery. In total, 1370 patients, 665 in the TEP and 705 in the Lichtenstein group, underwent operation. With 94% of operated patients available for follow-up after 5.1 years, the recurrence rate was 3.5% in the TEP and 1.2% in the Lichtenstein group. Postoperative pain was lower in the TEP group up to 12 weeks after operation, resulting in five days less sick leave and 11 days shorter time to full recovery. Patients in the TEP group had a slightly increased risk of major complications. Chronic pain was reported by 9-11% of patients in the TEP and 19-25% in the Lichtenstein group at the different follow-up points. Hospital costs for TEP were higher than for Lichtenstein, while community costs were lower due to shorter sick leave. By avoiding disposable laparoscopic equipment, the cost for TEP would be almost equal compared with Lichtenstein. In conclusion, both TEP and Lichtenstein repair have advantages and disadvantages for the patient. Depending on local resources and expertise both methods can be used and recommended for primary inguinal hernia repair.

Zugl.: Tübingen, Univ., Diss., 2004

Made available in DSpace on 2013-08-07T18:46:39Z (GMT). No. of bitstreams: 1 000407451-Texto+Completo-0.pdf: 13227593 bytes, checksum: 15a14899eb816b5517bba59d740f0b15 (MD5) Previous issue date: 2008 / The present work discusses the images of Lichtenstein as communication. Such images are responsible for the generation of a proper visual language instituted by the contemporary visual communication, once there is identification of post-modern man with the artist style. The Deep Hermeneutics of John Thompson has been the methodology chosen to enable the development of this thesis. lnitially it is approached the history of visual communication and its transformations influenced by technologies. After that, it is treated the theoretical questions related to the image and imaginary. The vanguards are approached in what concerns Pop Art, artistic movement which Lichtenstein has participated and that anticipates the man visualization post-modern. The Lichtenstein Style is appropriate by the post-modern visual communication, because, between other factors, it is more easily employed through the new informatics technologies. In this way, the limitations inherent to previous periods related with creation, production and reproduction of images has been overcome. The modern images of the artist are analyzed and interpreted to subsequently provide contributions to the understanding of the post-modern appropriations. The images are easily interpreted by the contemporary man by the imaginary, because they are harmonized with the characteristics of today sociocultural configuration, the post-modern condition.His images involve the notions of design, of reproduction, of simplification, of direct communication (commercial communication), of work in group, of appropriation, of rereading and even the banality’s aesthetics. These notions permeate the contemporary visual communication, being Lichtenstein a revolutionary artist. It has noticed that the image is an important vector of socialization and that the exchange between areas such as art, publicity, design, and popular culture powers the visual communication. / O presente trabalho discute as imagens de Lichtenstein enquanto comunicação. Tais imagens são responsáveis pela geração de uma linguagem visual própria instituída pela comunicação visual contemporânea, uma vez que existe a identificação do homem pós-moderno com o estilo do artista. A hermenêutica de profundidade de John Thompson foi à metodologia escolhida para viabilizar o desenvolvimento desta tese. Inicialmente aborda-se a história da comunicação visual e suas transformações influenciadas pelas tecnologias. Apos tratam-se questões teóricas relacionadas com a imagem e o imaginário. As vanguardas são abordadas no que tangem a Pop Art, movimento artístico do qual participou Lichtenstein e que antecipa a visualidade pós-moderna. O estilo Lichtenstein é apropriado pela comunicação visual pós-moderna, pois, dentre outros fatores, é também mais facilmente empregado através das novas tecnologias da informática. Assim, as limitações inerentes a períodos anteriores relacionadas com a criação, a produção e a reprodução de imagens foram superadas. As imagens modernas do artista são analisadas e interpretadas para posteriormente fornecerem aporte ao entendimento das apropriações pós-modernas. As imagens são facilmente interpretadas pelo homem contemporâneo via imaginário, sendo condizentes com as características da configuração sócio-cultural da atualidade, a condição pós-moderna.Suas imagens envolvem as noções de projeto, de reprodução, de simplificação, de comunicação direta, de trabalho em equipe, de apropriação, de releitura e até mesmo da estética da banalidade. Essas noções permeiam a comunicação visual contemporânea, sendo Lichtenstein um artista revolucionário. Percebeu-se que a imagem é um importante vetor de socialização e que o intercâmbio entre áreas como arte, publicidade, design e cultura popular potencializa a comunicação visual.

Groin hernia is common, and each year 200 repairs per 100 000 adult inhabitants are performed in Sweden. Groin hernias are either inguinal or femoral (2-4%). Elective repair is not associated with an excess mortality, but adverse outcomes include recurrence and long-term pain. Emergency procedures have a 4% mortality rate with an increased risk for bowel resection and postoperative complications. The aim of this thesis was to identify risk factors for adverse outcomes and to propose measures to improve groin hernia treatment. Twenty-three per cent of female hernias were femoral. Thirty-six per cent of femoral hernias, and 5% of inguinal hernias, have emergency procedures. Females (OR 1.47) and patients above 65 years-of-age (OR 2.24) were at higher risk for emergency repair. Bowel resection was performed in 23% of emergency femoral repairs, and the 30-day mortality was 10 times that of an age- and gender-matched population. The majority of emergency patients were unaware of their hernia, and one third had previously had no groin symptoms. Femoral repairs were at larger risk for recurrence than inguinal repairs. The surgical techniques with least risk for recurrence were preperitoneal mesh repairs (open HR 0.28, and laparoscopic HR 0.31). Long-term pain was present in 24% of femoral hernia patients, of whom 5.5% described pain interfering with daily activities. The only factor predicting the risk for long-term pain was pain preoperatively. Pain decreased with time. In a randomized study on inguinal hernia, TEP resulted in less pain six weeks after surgery than Lichtenstein repair performed under local anesthesia (LLA). TEP patients were to a larger extent able to perform sporting activities. No difference was seen in intra-operative complications. Femoral hernias should be given high priority for repair and preperitoneal techniques should be used. Earlier diagnosis, in the elective setting, is probably difficult to attain. Heightened awareness in the emergency department is required. TEP is safe, and results in less pain than LLA six weeks after surgery. A widening of indications for TEP in primary inguinal hernia repair is justifiable.

Made available in DSpace on 2015-04-14T14:40:50Z (GMT). No. of bitstreams: 1 407451.pdf: 13227593 bytes, checksum: 15a14899eb816b5517bba59d740f0b15 (MD5) Previous issue date: 2008-10-31 / O presente trabalho discute as imagens de Lichtenstein enquanto comunica??o. Tais imagens s?o respons?veis pela gera??o de uma linguagem visual pr?pria institu?da pela comunica??o visual contempor?nea, uma vez que existe a identifica??o do homem p?s-moderno com o estilo do artista. A hermen?utica de profundidade de John Thompson foi ? metodologia escolhida para viabilizar o desenvolvimento desta tese. Inicialmente aborda-se a hist?ria da comunica??o visual e suas transforma??es influenciadas pelas tecnologias. Apos tratam-se quest?es te?ricas relacionadas com a imagem e o imagin?rio. As vanguardas s?o abordadas no que tangem a Pop Art, movimento art?stico do qual participou Lichtenstein e que antecipa a visualidade p?s-moderna. O estilo Lichtenstein ? apropriado pela comunica??o visual p?s-moderna, pois, dentre outros fatores, ? tamb?m mais facilmente empregado atrav?s das novas tecnologias da inform?tica. Assim, as limita??es inerentes a per?odos anteriores relacionadas com a cria??o, a produ??o e a reprodu??o de imagens foram superadas. As imagens modernas do artista s?o analisadas e interpretadas para posteriormente fornecerem aporte ao entendimento das apropria??es p?s-modernas. As imagens s?o facilmente interpretadas pelo homem contempor?neo via imagin?rio, sendo condizentes com as caracter?sticas da configura??o s?cio-cultural da atualidade, a condi??o p?s-moderna. Suas imagens envolvem as no??es de projeto, de reprodu??o, de simplifica??o, de comunica??o direta, de trabalho em equipe, de apropria??o, de releitura e at? mesmo da est?tica da banalidade. Essas no??es permeiam a comunica??o visual contempor?nea, sendo Lichtenstein um artista revolucion?rio. Percebeu-se que a imagem ? um importante vetor de socializa??o e que o interc?mbio entre ?reas como arte, publicidade, design e cultura popular potencializa a comunica??o visual

The master thesis concentrates on studying the relations between the Czech Republic and Liechtenstein from 2000 until 2015. The Czech Republic and the monarchy share a long common history, reaching all the way to the Middle Ages. The Liechtensteins constituted autonomous political power in the Czech lands for centuries and this power played a significant role not only on the regional but also on the continental level. Historical development in Czech territory in 20th century interrupted this continuous symbiosis, the Liechtensteins lost all their Czech property in a short period of time and decided to leave Czech land permanently. Due to the confiscation of property by the Czech state, long-lasting litigations between the two states were created. Even the establishment of the democratic Czech Republic did not bring any change. It was only in 2009 when diplomatic communication was re-established, but ownership issues of different properties remain a challenging issue of bilateral relations. The opening part of the thesis summarizes the historical development in 20th century. The second part analyses property disputes between the Czech Republic and Liechtenstein from the historical perspective. The third part concentrates on contemporary political and economic system of Liechtenstein. Specific...

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Between the years 1960 and 1970, New York gallerist Leo Castelli was closely involved with Milanese editor and publisher Bruno Alfieri's Metro magazine--an international review of contemporary art. By placing his artists in Metro, Castelli inserted them into the world of Italian art criticism and theory. This recontextualization familiarized the American artists of Castelli's gallery to a European audience and positioned them at the end of a succession of modern European styles. Specifically, Castelli's artists, each of whom engaged in a form of pictorial figuration, were seen as ending the dominance of the "pure" abstraction of the French informel style. This thesis uses the archive of correspondence between Bruno Alfieri and Leo Castelli to examine Castelli's contribution to Metro during the 1960s. Departing from this chronology, it also seeks to understand the unique brand of figuration that each of Castelli's artists brought to Metro, given cues from contemporary Italian theory and criticism--particularly that of Gillo Dorfles, who wrote on several of Castelli's artists. / text

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Die Lichtensteinhöhle ist eine Klufthöhle im Berg Lichtenstein in den Harzausläufern. Im anthropogenen Teil der Höhle wurden größere Mengen disoloziert vorliegender Menschenknochen gefunden. Über assoziierte archäologische Artefakte und 14C-Datierungen erfolgte eine Einordnung ins 10.–9. Jh. v. Chr.. Aufgrund eines Überzuges mit Gipssinter und konstant niedriger Temperaturen war ein herausragend guter Erhaltungszustand der Knochen und der enthaltenen aDNA gegeben. Dies ermöglichte umfangreiche anthropologische Forschungsarbeiten an den menschlichen Überresten aus der Lichtensteinhöhle. Eine zentrale Fragestellung zu Beginn der Forschungsarbeiten war, ob es sich um eine Opferstätte oder einen Bestattungsplatz handelt. Es konnte für die zunächst identifizierten 40 Individuen ein ausgewogenes Geschlechterverhältnis und eine Altersverteilung über alle Altersklassen hinweg nachgewiesen werden. Zudem konnten mittels molekulargenetischer Methoden verwandtschaftliche Beziehungen zwischen den Individuen aufgedeckt werden. Die Verwandtschaftsrekonstruktion ergab den Stammbaum eines Familienclans. Damit lagen eindeutige Hinweise für eine Nutzung als Bestattungsplatz vor. Während molekulargenetischer Reihenuntersuchungen verschiedener Skelettelemente und morphologischer Zuordnungen von Skelettelementen zu Individuen wurde deutlich, dass Knochen von mehr Individuen als den 40 bislang identifizierten vorhanden waren. Zudem deutete sich an, dass für nahezu alle Individuen nicht alle Knochen in der Höhle aufgefunden worden waren. Das Fehlen von Skelettelementen warf die Frage auf, ob es sich bei der Lichtensteinhöhle nicht um einen Primär- sondern um einen Sekundärbestattungsplatz handeln könnte. Im aktuell durchgeführten Forschungsprojekt wurden, unter Verwendung morphologischer und molekulargenetischer Methoden, die Zuordnungen der dislozierten Knochen zu Individuen zu Ende geführt. Die rekonstruierten Individuen wurden umfassend morphologisch und molekulargenetisch untersucht, mit dem Ziel, die demografische Struktur der Population zu erschließen und die Verwandtschaftsrekonstruktion auszuweiten. Zudem wurde den Fragen der Nutzungsdauer und der genauen Nutzungsart der Höhle nachgegangen. Es konnten 60 Individuen identifiziert werden. Nur für zwei der Individuen wurden alle bei den Zuordnungen berücksichtigten Skelettelemente vorgefunden. An den Knochen zeigten sich nur wenige Fälle degenerativer Veränderungen. Dies ließ darauf schließen, dass die in der Lichtensteinhöhle bestatteten Menschen nicht übermäßig harter körperlicher Belastung ausgesetzt waren. Spuren massiver Gewalteinwirkung fehlten vollständig. Dies macht es unwahrscheinlich, dass die bestattete Population in kriegerische Auseinandersetzungen involviert war. Einige wenige verheilte Frakturen an Rippen oder Schlüsselbein lassen sich problemlos auf Alltagsunfälle zurückführen. Spuren von Mangel- oder Stressphasen waren nur in Einzelfällen nachweisbar. Dies deutet darauf hin, dass die Bestatteten zu Lebzeiten kontinuierlichen Zugang zu ausreichenden Nahrungsressourcen hatten. Das Geschlechterverhältnis war ausgewogen und die Altersverteilung entsprach in den Grundzügen der für eine historische Population zu erwartenden. Eine fesgestellte Unterrepräsentanz von Individuen der Altersklasse Infans I könnte als Hinweis darauf interpretiert werden, dass tatsächlich Sekundärbestattungen praktiziert wurden und die sehr kleinen, fragilen Knochen der Infans I Individuen zum Zeitpunkt der Umbettungen bereits vergangen waren. In begleitenden Arbeiten durchgeführte statistischen Analysen verschiedener Merkmale, wie z.B. Unterschiede im Grad der DNA-Degradierung, lieferten weitere Hinweise in die Richtung, dass es sich bei der Lichtensteinhöhle um einen Sekundärbestattungsplatz handeln dürfte. Für alle neu identifizierten Inividuen wurden mittels molekulargenetischer Analysen die genetischen Fingerabdrücke sowie die mitochondraialen und Y-chromosomalen Haplotypen bestimmt. Die anschließende Verwandtschaftsrekonstruktion ergab einen erweiterten Stammbaum, in dem für 47 der 60 Individuen entweder direkte Verwandtschaft oder aber Verwandtschaft in mütterlicher oder väterlicher Familienlinie belegt ist. Der Stammbaum umfasst insgesamt sechs Generationen. Dies entspricht – bei einer angenommenen Generationendauer von 20 Jahren – einer Nutzungsdauer von 120 Jahren und passt somit gut zum archäologisch ermittelten Nutzungszeitraum. Die Auswertung der Diversität der mitochondrialen und Y-chromosomalen Haplotypen ergab Hinweise auf eine patrilokale Gesellschaftsform. In begleitenden Arbeiten wurden weitere genetische Marker – z.B. für die Augen- und Haarpigmentierung, die immungenetische Ausstattung oder auch für den Laktosetoleranzstatus – analysiert. Insgesamt zeigte sich, dass sich in vielerlei Hinsicht die genetische Ausstattung heutiger Populationen im Vergleich zu der vor 3.000 Jahren nicht grundlegend unterscheidet. Lediglich für die Frequenz des Laktosetoleranz verursachenden Allels war eine deutliche Zunahme seit der Bronzezeit zu verzeichnen.