Diss. Linköping : Univ., 2004.

Diss. (sammanfattning) Stockholm : Stockholms universitet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Ao tramar sentimentos contraditórios como resignação e indignação, que uma vez contextualizados histórica e socialmente são capazes de colocar em movimento atitudes permeadas de valores, de contraposição a valores hegemônicos negadores da humanização das relações sociais, políticas, econômicas e culturais, emerge o conceito de tema-gera-dor-de-dor.A pesquisa realizada por meio de entrevistas com sete ex-estudantes do curso de EJA-Ensino Médio, e a análise dos documentos da Escola Técnica Mesquita, permitiu ao pesquisador refletir sobre a importância de uma Proposta de Educação com intencionalidades pedagógicas, com base nos pressupostos metodológicos da Educação Popular. Os objetivos centrais desta dissertação foram entender como o conceito de experiência de Thompson contribuiria para transformar a escola em espaços de guerra de posição, e como este constituiria intelectuais orgânicos, já que as “experienci-ações” vivenciadas por educandos/as nas situações-limites, realizam-se inédito-viáveis nos quais os intelectuais orgânicos se constituem, rompendo / superando ideologias ao transitarem da experiência vivida para experiência percebida. Este processo se dá na escola pesquisada. / When plotting contradictory feelings as resignation and indignation, that once historically and socially contextualized, were able to put in motion actions permeated by values of contraposition to hegemonic values deniers of the humanization of the social, political, economic and cultural relations, emerges the concept of theme-generate-pain-of-pain. The research realized through interviews with seven people who were students from EJA-High School, and by analysis of documents of Technical School Mesquita, allowed to the researcher reflect about the value of a Education Proposed with pedagogical intentions based on the methodological assumptions of Popular Education. The objectives, centrals of this dissertation were understand how the concept of Thompson’s experience would help to transform the school into places of position’s war and how these would constitute organic intellectuals, since the “experienci-ações” lived by the students in the same limit situations, are realize inedited-viable in which the organic intellectuals would constitute breaking/overcoming ideologies to transmit lived experience to perceived experience. This is the process that happens in the researched school.

Ao tramar sentimentos contraditórios como resignação e indignação, que uma vez contextualizados histórica e socialmente são capazes de colocar em movimento atitudes permeadas de valores, de contraposição a valores hegemônicos negadores da humanização das relações sociais, políticas, econômicas e culturais, emerge o conceito de tema-gera-dor-de-dor.A pesquisa realizada por meio de entrevistas com sete ex-estudantes do curso de EJA-Ensino Médio, e a análise dos documentos da Escola Técnica Mesquita, permitiu ao pesquisador refletir sobre a importância de uma Proposta de Educação com intencionalidades pedagógicas, com base nos pressupostos metodológicos da Educação Popular. Os objetivos centrais desta dissertação foram entender como o conceito de experiência de Thompson contribuiria para transformar a escola em espaços de guerra de posição, e como este constituiria intelectuais orgânicos, já que as “experienci-ações” vivenciadas por educandos/as nas situações-limites, realizam-se inédito-viáveis nos quais os intelectuais orgânicos se constituem, rompendo / superando ideologias ao transitarem da experiência vivida para experiência percebida. Este processo se dá na escola pesquisada. / When plotting contradictory feelings as resignation and indignation, that once historically and socially contextualized, were able to put in motion actions permeated by values of contraposition to hegemonic values deniers of the humanization of the social, political, economic and cultural relations, emerges the concept of theme-generate-pain-of-pain. The research realized through interviews with seven people who were students from EJA-High School, and by analysis of documents of Technical School Mesquita, allowed to the researcher reflect about the value of a Education Proposed with pedagogical intentions based on the methodological assumptions of Popular Education. The objectives, centrals of this dissertation were understand how the concept of Thompson’s experience would help to transform the school into places of position’s war and how these would constitute organic intellectuals, since the “experienci-ações” lived by the students in the same limit situations, are realize inedited-viable in which the organic intellectuals would constitute breaking/overcoming ideologies to transmit lived experience to perceived experience. This is the process that happens in the researched school.

Ao tramar sentimentos contraditórios como resignação e indignação, que uma vez contextualizados histórica e socialmente são capazes de colocar em movimento atitudes permeadas de valores, de contraposição a valores hegemônicos negadores da humanização das relações sociais, políticas, econômicas e culturais, emerge o conceito de tema-gera-dor-de-dor.A pesquisa realizada por meio de entrevistas com sete ex-estudantes do curso de EJA-Ensino Médio, e a análise dos documentos da Escola Técnica Mesquita, permitiu ao pesquisador refletir sobre a importância de uma Proposta de Educação com intencionalidades pedagógicas, com base nos pressupostos metodológicos da Educação Popular. Os objetivos centrais desta dissertação foram entender como o conceito de experiência de Thompson contribuiria para transformar a escola em espaços de guerra de posição, e como este constituiria intelectuais orgânicos, já que as “experienci-ações” vivenciadas por educandos/as nas situações-limites, realizam-se inédito-viáveis nos quais os intelectuais orgânicos se constituem, rompendo / superando ideologias ao transitarem da experiência vivida para experiência percebida. Este processo se dá na escola pesquisada. / When plotting contradictory feelings as resignation and indignation, that once historically and socially contextualized, were able to put in motion actions permeated by values of contraposition to hegemonic values deniers of the humanization of the social, political, economic and cultural relations, emerges the concept of theme-generate-pain-of-pain. The research realized through interviews with seven people who were students from EJA-High School, and by analysis of documents of Technical School Mesquita, allowed to the researcher reflect about the value of a Education Proposed with pedagogical intentions based on the methodological assumptions of Popular Education. The objectives, centrals of this dissertation were understand how the concept of Thompson’s experience would help to transform the school into places of position’s war and how these would constitute organic intellectuals, since the “experienci-ações” lived by the students in the same limit situations, are realize inedited-viable in which the organic intellectuals would constitute breaking/overcoming ideologies to transmit lived experience to perceived experience. This is the process that happens in the researched school.

Background: Irritable bowel syndrome (IBS) is an extremely common condition affecting approximately 10-15% of the population. Lower abdominal pain is a common feature and, if the patient also has gynaecological symptoms such as heavy periods, they may be referred to a gynaecologist especially when the bowel symptoms are relatively mild. In this setting a laparoscopy is often undertaken and endometriosis commonly identified as this condition affects up to 10% of women. Consequently pain is frequently attributed to the endometriosis even when it is relatively mild. However it is a common observation amongst gynaecologists that women with mild endometriosis often have severe symptoms which do not seem to respond well to treatment. This raises the possibility that their pain may not actually be due to endometriosis or is being amplified by the visceral hypersensitivity which is a characteristic feature of irritable bowel syndrome.Methods: 20 patients with minimal-mild endometriosis, 20 with moderate-severe endometriosis, 20 healthy volunteers (HV) who have had laparoscopy for sterilisation, 20 IBS patients and 20 patients with pain who were found to have a normal pelvis (on laparoscopy) were studied. Gastrointestinal, gynaecological, and noncolonic symptoms were recorded as well as demography, quality of life and psychological status. Visceral sensitivity was assessed in all patients and abdominal distension was studied in a sub group of 26 endometriosis patients and 20 IBS patients.Results: 20 (100%) of IBS patients, 13 (65%) of minimal-mild endometriosis patients, 11 (55%) of moderate-severe endometriosis patients, 17 (85%) of laparoscopic negative pain patients and no healthy volunteers fulfilled ROME III criteria for IBS. Patients with endometriosis and IBS had similar levels of visceral sensitivity which were significantly lower than that observed in controls (p=0·002, p<0·001).In particular, both minimal-mild and moderate-severe endometriosis patients had significantly lower (mean-95% CI) pain thresholds in mmHg 28.1(24.5, 31.6) and 28.8(24.9, 32.6) respectively compared with controls 39·5 (36·0, 43·0) p=0.001and p=0.002. However, with few exceptions, there were no distinguishing features between patients in terms of demography, symptomatology and distension.Conclusion: Clinically, it is very difficult to distinguish between endometriosis and IBS. However, visceral hypersensitivity appears to be a major component of endometriosis and may explain the problem of excessive pain especially in patients with mild disease offering a potential new target for treatment

Acute and chronic pain conditions cause significant patient distress, interference with daily activities, and increased health care costs. It is important to evaluate analgesic interventions to improve pain relief, function, quality of life, and also to prevent persisting pain after surgery. This thesis is a combination of studies evaluating analgesic interventions in the setting of acute surgical pain; prevention of persistent post-surgical pain; and chronic low back pain. In part 1, we report our comparison of morphine and hydromorphone in 402 ambulatory surgery patients, for their ability to achieve satisfactory analgesia with minimal emesis using a design of multicentre randomized controlled trial. We observed no differences in their analgesic potential and common side effects and note that appearance of side effects is likely to be idiosyncratic. In part 2, we report our 2×2 factorial feasibility trial to prevent persistent post-surgical pain in patients having elective video-assisted thoracic surgery lobectomies, comparing N-methyl-D-aspartate antagonists versus placebo, and intravenous steroids versus placebo. As our feasibility outcomes were not met, we suggest appropriate considerations for protocol changes before embarking on a definitive larger trial. In part 3, we report on our systematic review and meta-analysis assessing the effectiveness and safety of gabapentinoids (gabapentin and pregabalin) in adult patients with chronic low back pain. We observed that the existing evidence is small and there is minimal improvement in pain and other outcomes with potential for adverse events. We suggest that the use of gabapentinoids for chronic low back pain merits caution and there is need for large high-quality trials. / Thesis / Doctor of Philosophy (PhD) / It is important to evaluate analgesic interventions to decrease pain, improve function, and lessen health care costs. In a randomized controlled trial of day surgery patients, we demonstrate that there are no differences between morphine and hydromorphone in achieving pain relief and common side effects. To prevent persistent post-surgical pain in patients having elective video-assisted thoracic surgery lobectomies, we performed a 2×2 factorial, feasibility randomized controlled trial, to compare N-methyl-D-aspartate antagonists versus placebo, and intravenous steroids versus placebo. We observe that appropriate protocol changes must be made before embarking on a larger trial. Finally, we report our systematic review and meta-analysis on the use of gabapentinoids in adult patients with chronic low back pain and observe that the existing evidence is small and not supportive, and the use of gabapentinoids for chronic low back pain merits caution.

<p>UVOD: Ingvinalna hernioplastika predstavlja najučestaliju operaciju u abdominalnoj hirurgiji. U istorijatu herniologije su se razvijale različite ideje, te iz njih nastale operativne metode, koje su imale za cilj formiranje kvalitetnog vezivnog tkiva na mestu kilnog defekta. Danas postoje brojne hirur&scaron;ke tehnike, bazirane na tenzionim ili beztenzionim principima, uz primenu hirur&scaron;kih mrežica, otvorenim pristupom, kao i laparoskopskim tehnikama. Zajednički cilj navedenih metoda je kreiranja idealne hernioplastike ingvinalnih kila. I pored postojanja ogromnog broja hirur&scaron;kih procedura i tehnika, jo&scaron; uvek ne postoji tzv. &raquo;prava hernioplastika&laquo; koja bi zadovoljila sve potrebne zahteve vezane za problem ingvinalnih hernija. CILJ I HIPOTEZA: Cilj rada je bio da se napravi uporedna analiza između dve različite hirur&scaron;ke tehnike otvorenim pristupom, konvencionalne tenzione suturne hernioplastike, te beztenzione tehnike, uz kori&scaron;ćenje hirur&scaron;kih mrežica ( mesh ). Kori&scaron;ćeni su sledeći parametri tokom istraživanja: određivanje nivoa postoperativnog bola prema numeričkoj skali, vizuelno-analognoj te kategorijskoj skali bola; određivanje samostalne fizičke aktivnosti; (savijanje nogu, naprezanje trbu&scaron;nih mi&scaron;ića, ustajanje) u neposrednom postoperativnom periodu; gradacija nivoa mi&scaron;ićne snage, određivanje vremenskog perioda kada se pacijenti uspevaju vratiti svojim svakodnevnim aktivnostima i radnim obavezama; određivanje stope postoperativnog morbiditeta i mortaliteta te određivanje stope ranog recidiva bolesti. RADNA HIPOTEZA: Beztenzionu ingvinalnu hernioplastiku karakteri&scaron;e znatno manja operativna trauma, &scaron;to ima za posledicu manji lokalni i generalizovani odgovor organizma na stres. Kod bolesnika operisanih beztenzionom metodom očekuje se manji intenzitet bola, kraće zadržavanje u hospitalnim uslovima, manji procenat postoperativnih komplikacija, brži povratak uobičajenim fizičkim i radnim aktivnostima i znatno manji stepen recidiva bolesti. Pretpostavlja se da beztenziona ingvinalna hernioplastika u poređenju sa konvencionalnom uzrokuje manju nelagodnost za pacijente, znatno manji postoperativni bol i bolju mi&scaron;ićnu aktivnost. Pobolj&scaron;anje mi&scaron;ićne aktivnosti ogleda se u lak&scaron;oj vertikalizaciji, kvalitetnijem kretanju uz manje bolan hod, bez povijanja tela na stranu operativne rane. MATERIJAL I METODE: Istraživanje je prospektivna, kliničko- statistička studija sa praćenjem parametara (preoperativnih, intraoperativnih i postoperativnih) kod svakog operisanog bolesnika. Studija je obuhvatila seriju od 200 pacijenata hospitalizovanih na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju Kliničkog centra Vojvodine, od decembra 2002. do avgusta 2007.godine, svrstanih u dve jednake grupe po 100 pacijenata, odabranih metodom slučajnog izbora. Prva, ispitivana grupa obuhvatila je pacijente operisane beztenzionim procedurama, druga, kontrolna grupa je obuhvatila pacijente operisane konvencionalnim, tenzionim tehnikama. Kori&scaron;ćeni metod rada je kliničko statistički sa praćenjem svih potrebnih fiziolo&scaron;kih parametara, a dobijeni rezultati su analizirani i međusobno upoređivani statističkim metodama multifaktorijalne analize. Pronađene vrednosti su međusobno upoređene parametrijskim i neparametrijskim testovima značajnosti na nivou p&lt;0.05. REZULTATI: komparacija između dve ispitivane grupe je vr&scaron;ena tokom preoperativnog, intraoperativnog i postoperativnog perioda, različitim statističkim parametrima. Konstatovana je, statističkom analizom, homogenost grupa u smislu starosne dobi i polne distribucije, kao i lokalnog preoperativnog nalaza vezanog za tip, veličinu i lokalizaciju kila, kao i spram klasifikacije hernija. U sledećim parametrima je ustanovljena statistički signifikantna razlika: postoperativni bol, gradacija mi&scaron;ićne snage, rana fizička aktivnost, količina utro&scaron;enih analgetika, dužina hospitalizacije, prisutnost obostranih kila, povratak radnim aktivnostima i obavezama, postoperativne komplikacije i recidiv bolesti. Dobijeni podaci su prikazani tabelarno, te delom u vidu grafikona i dijagrama. ZAKLJUČCI: 1. Kod pacijenata operisanih beztenzionom metodom evidentan je znatno manji postoperativni bol i brži oporavak i povratak uobičajnim dnevnim i radnim aktivnostima 2. Proceduru treba izvoditi u svim slučajevima sa prisutnim velikim defektima i razorenim zadnjim zidom ingvinalnog kanala 3 Beztenzionu hernioplastiku karakteri&scaron;e manji broj recidiva u poređenju sa otvorenim tenzionim hernioplastikama. 4. Pacijenti sa bilateralnim ingvinalnim i recidivnim hernijama imaju punu indikaciju za izvođenje beztenzione herioplastike sa ugradnjom mesh-a. 5. Preduslov za uspe&scaron;no obavljenu beztenzionu hernioplastiku je primena dovoljno velike proteze, odnosno mesh-a, dimenzija 15 x 10 cm.</p> / <p>INTRODUCTION: Inguinal hernioplasty is the most common surgical procedure in abdominal surgery. In the history of herniology have developed different ideas, and from them emerged operational methods, which are aimed at educating quality of connective tissue at the site of the hernia defect. Nowadays, there are numerous surgical techniques, based on the tensioned or tension-free principles, with the use of surgical mesh for open access as well as laparoscopic techniques. Common goal of these methods is creating ideal inguinal hernioplasty despite the existence of a huge number of surgical procedures and techniques, there is still no so-called &raquo;Proper hernioplasty &quot; that would satisfy all the necessary requirements related to the problem of inguinal hernia. AIM AND HYPOTHESIS: The aim of this study was to make a comparative analysis between two different open access surgical techniques conventional tension hernioplasty and tension-free techniques, with the use of surgical mesh .The following parameters were used during the research: determining the level of postoperative pain according to a numerical scale, visual analogue scale and categorical scale of pain; determining the initial independent physical activities: (bending the legs, straining abdominal muscles, getting up) in the immediate postoperative period; gradation levels of muscular strength, determination period when patients can return to their usual daily activities and work duties; determining the rate of postoperative morbidity and mortality and to determine rates of early recurrence of the disease. WORKING HYPOTHESIS: Tension-free inguinal hernioplasty characterized by significantly less operative trauma, which results in smaller local and generalized body&#39;s response to stress. In patients operated by the tension. free method is expected to lower the intensity of pain, a shorter stay in the hospital setting, a smaller percentage of postoperative complications, faster return to normal physical and occupational activities and much lower degree of disease recurrence. It is assumed that the tensional. free inguinal hernioplasty compared with conventional causes less discomfort for patients, significantly less postoperative pain and better muscle activity. Better muscle activity is reflected in a facilitated mobilization, quality of movement and less painful gait, without bending the body at the side of the surgical wound. MATHERIAL AND METHODS: The research was a prospective, clinical-statistical study of the monitoring parameters (preoperative, intraoperative and postoperative) in each of the operated patients. The study involved a series of 200 patients hospitalized at the Clinic for Abdominal, Endocrine and Transplantation Surgery, Clinical Center Vojvodine, from December 2002 to August 2007, divided into two groups of 100 patients, randomly chosen. First, the test group consisted of patients operated by the tension-free procedures, the other, the control group consisted of patients operated on conventional techniques. The method used is the work of clinical statistical tracking of all necessary physiological parameters, and the results were analyzed and compared with each other with multivariate statistical methods of analysis. Found values are compared with each other parametric and non-parametric tests of significance at p &lt;0.05. RESULTS: The comparison between the two study groups was performed during the preoperative, intraoperative and postoperative period, using various statistical parameters. It was noted using the statistical analysis, the homogenity of the groups in terms of age and sex distribution, as well as local preoperative findings related to the type, size and location pounds as well as towards the classification of hernias. In the following parameters is statistically significant difference: postoperative pain, graduations of muscle strength, healing of physical activity, the quantity of analgesics, length of hospitalization, the presence of bilateral hernias, the return of work activities and responsibilities, postoperative complications and recurrence. The data are presented in tables, and partly in the form of graphs and charts. CONCLUSIONS: 1. In patients operated by the tension-free obvious method is significantly less postoperative pain and faster recovery and return to usual daily and work activities 2. The procedure should be performed in all cases with the presence of large defects and lacerated back wall of the inguinal canal 3. Tension-free hernioplasty is characterized by a smaller number of recurrence compared with conventional hernioplasty 4. Patients with bilateral inguinal hernias and recurrent have a full indication of the performance of the tension-free hernioplasty with the installation of mesh. 5. A prerequisite for the successful work carried out tension-free hernioplasty application is large enough prosthesis ( mesh ), measuring 15 x 10 cm.</p>

At present, there are few clinically effective pain therapies available to treat chronic pain. One reason is due to a lack of understanding about how pain emerges in the brain. Excitingly, an emerging body of work suggests that the perfusion imaging technique, arterial spin labelling (ASL), is particularly well-suited to investigate this issue. The primary aim of this thesis is to develop and optimise a quantitative perfusion imaging approach to investigate the neural correlates of both experimental and pathological tonic pain. In Chapter 2, we explore different methods of inducing ongoing pain in healthy subjects. Results from this study show that mechanically induced pain is well suited for use in ASL FMRI experiments. In Chapter 3, we compare currently available ASL FMRI approaches for investigating tonic states, using a range of sensory paradigms. Results from these experiments support the use of an optimised version of Continuous ASL (CASL) FMRI to obtain whole-brain perfusion. Additionally, we discuss our decision to proceed with the newly acquired pseudo-continuous ASL (pCASL); a novel ASL technique that benefits from maximal signal-to-noise (SNR) across a whole-brain volume. In Chapter 4 we implement the pCASL FMRI approach to image the neural correlates of ongoing experimental pain. Results from the investigation of parametrically modulated ongoing mechanical pain show robust pain-related activation of key pain related regions that are monotonically active with an increase in stimulus intensity. Additionally, data from this experiment shows the presence of complex perfusion dynamics relative to pain worthy of further study. In Chapter 5, we optimised the pCASL sequence to obtain absolute perfusion changes across the whole-brain volume, using multi-inversion times, so that we could investigate the perfusion dynamics observed in Chapter 4. Results show that absolute perfusion changes during tonic pain are considerably less than for regions recruited during a non- pain task. Additionally, dynamic perfusion changes show complex stimulus responses across all active regions regardless of stimulus type. We conclude that while the technique is well suited to quantify absolute perfusion, the mechanisms underlying the dynamic changes in CBF (neuronal signal, neurovascular coupling) need further study. Finally, in Chapter 6, we implement the absolute perfusion approach developed in Chaper 5 to interrogate the neural correlates of the genetic pain disease, Erythromelalgia, and pleasurable relief. The results of this study show pain-related activation (and relief-induced reduction) of key pain-related regions. We conclude from these results that the ASL technique developed over the course of this thesis can be used to study a range of pain pathologies. Taken together, the results of this thesis document the development of a powerful perfusion imaging technique capable of quantifying absolute perfusion changes across a whole-brain volume. The data presented here from investigations of both experimental and pathological pain states supports the use of this technique in future tonic pain studies, as well as other neuroscience applications. We are confident that implementation of this imaging approach will provide integral insight into the mechanisms of ongoing pain states; and further the development of novel efficacious pain treatment options.