Malignome des Peritoneums (peritoneal surface malignancies, PSMs) treten als Mesotheliome oder Metastasen auf. Ihre Diagnose bedeutet häufig eine schlechtere Prognose als bei anderen Fernmetastasen. Die Standardtherapie in palliativer Intention ist in der Regel eine systemische Chemotherapie (sCHT). Intraperitoneale Druck-Aerosol-Chemotherapie (Pressurized intraperitoneal aerosol chemotherapy, PIPAC) ist eine neue, palliative Behandlungsmöglichkeit für ausgewählte Personen mit PSMs. Das Prinzip der laparoskopischen Vernebelung von Chemotherapeutika soll die Bioverfügbarkeit im Vergleich zu und anderen intraabdominellen Applikationen erhöhen. Sie wird meist in Kombination mit sCHT eingesetzt und zielt darauf ab, die Symptom- und Asziteslast der Behandelten zu reduzieren. Diese monozentrische, prospektive Registerstudie untersucht die Sicherheit, Durchführbarkeit und Wirksamkeit der PIPAC. Einschlusskriterien waren ein histologisch gesichertes PSM und eine positive Tumorboard-Entscheidung. Ausschlusskriterien waren extraperitoneale Fernmetastasen und ein Eastern Cooperative Oncology Group (ECOG) Performance Status größer als 2. Vor jeder PIPAC wurde eine strukturierte Anamnese, eine körperliche Untersuchung, sowie eine ausführliche chirurgische und onkologische Aufklärung durchgeführt. Die PIPAC-Prozeduren wurden laparoskopisch in Allgemeinanästhesie gemäß interner Standard Operating Procedure durchgeführt. Zunächst wurde Aszites aspiriert und quantifiziert. Anschließend wurde eine diagnostische Laparoskopie durchgeführt, der Zugang zum Abdomen als „access“ oder „non access“ beschrieben, sowie der peritoneale Adhäsionsindex (peritoneal adhesion index, PAI) nach Coccolini und der peritoneale Krebsindex (peritoneal cancer index, PCI) nach Sugarbaker erhoben. Sechs Peritonealbiopsien wurden standardisiert entnommen. Nach Präparation und Färbung mit Hämatoxylin und Eosin wurde die relative Tumormenge bestimmt. Nacheinander wurden Cisplatin und Doxorubicin in einer an die Körperoberfläche angepassten Dosierung appliziert. Die Chemotherapeutika wurden mit einer Injektionspumpe bei 200 psi und mit einer Flussrate von 0,5 ml/min über einen Hochdruckschlauch zum Vernebler gefördert. Dieser wurde auf dem 12 mm Trokar befestigt und verteilte die Medikamente im Abdomen. Währenddessen befand sich das gesamte Operationspersonal im separaten Einleitungsraum. Die Applikation wurde über einen Fußschalter gesteuert und durch ein Sichtfenster überwacht. Über den Druck im Kapnoperitoneum konnte freiwerdendes Aerosol detektiert werden. Nach 30 min wurde das Aerosol analog zu Narkosegasen in die Krankenhausentlüftung abgeleitet. Anschließend wurden die Behandelten für einige Stunden im Aufwachraum überwacht und dann auf die Normalstation gebracht. Postoperative Komplikationen wurden nach der Clavien Dindo Klassifikation (CDC) dokumentiert. Insgesamt wurden 108 Patient:innen (n = 55 Frauen, n = 53 Männer) mit einem medianen Alter von 60 Jahren (Interquartilsabstand [IQA] 53–‍69 Jahre) eingeschlossen. Sie wiesen Primärtumore verschiedener Entitätsgruppen auf: n = 41 (38 %) gastral, n = 26 (24 %) kolorektal, n = 9 (8 %) gynäkologisch und n = 15 (14 %) weitere (n = 7 Mesotheliome, n = 3 Pseudomyxoma peritonei, n = 5 Krebserkrankungen mit unbekanntem Primärtumor). Im Median wurden zwei PIPAC-Prozeduren pro Patient:in durchgeführt (IQA 1–‍3). Bei 12 Patient:innen wurde zuvor eine zytoreduktive Chirurgie (CRS) mit hyperthermer intraperitonealer Chemoperfusion (HIPEC) durchgeführt. Von 230 geplanten PIPAC-Prozeduren konnten 189 durchgeführt werden. 41 Prozeduren mussten abgebrochen oder storniert werden: 9 Patient:innen zeigten bei der Aufnahmeuntersuchung einen verschlechterten Allgemeinzustand (z. B. neue Fernmetastasen im Computertomogramm). 3 Patient:innen aspirierten während der Narkoseeinleitung. Bei 7 Laparoskopien war makroskopisch kein PSM mehr nachweisbar. In 22 Fällen war das Abdomen nicht zugänglich (non-access) und/oder es kam zu Darmläsionen. Bei der Aufnahmeuntersuchung vor jeder PIPAC-Prozedur wiesen die Patient:innen in den meisten Fällen keine der spezifisch erhobenen Symptome auf. 55 (24 %) klagten über Bauchschmerzen, 47 (21 %) über Übelkeit oder Erbrechen, 16 (7 %) über Obstipation und 4 (2 %) über Dysphagie (mehrere Symptome gleichzeitig möglich). Die folgenden prä- und perioperativ erhobenen Werte änderten sich nicht signifikant mit aufeinanderfolgenden PIPAC-Prozeduren pro Patient:in (Varianzanalyse [analysis of variance, ANOVA], p > 0,1): ECOG Performance Status (Median 1, IQA 0–‍1), American Society of Anesthesiologists Klassifikation (Median 3, IQA 2–‍3), nutritional risk screening (NRS) (Median 2, IQA 2–‍3), global health status der European Organization for Research and Treatment of Cancer (EORTC) (Median 50, IQA 33–‍67), Operationsdauer (Mittelwert 104 min, Standardfehler des Mittelwertes 1,5 min), PCI (Median 15, IQA 6–‍24), PAI (Median 4, IQA 0–‍12) und maximaler histologischer Tumoranteil (Median 24 %, IQA 5–‍60 %). Die ersten drei konsekutiven PIPAC-Prozeduren zeigten eine signifikante Reduktion des Aszitesvolumens (ANOVA, p = 0,016). Die mediane postoperative Liegedauer betrug 4 Tage (IQA 3 4 Tage). Bei 31 von 213 PIPAC-Prozeduren (14,6 %), bei denen die Patient:innen in den Operationstrakt gebracht worden waren, traten postoperative Komplikationen auf (10,8 % Grad II, 2,4 % Grad IV, 1,4 % Grad V nach CDC). Insgesamt wurden 21 non access-Fälle (9,9 % der 213 PIPAC-Prozeduren, bei denen die Patient:innen in den Operationstrakt gebracht worden waren) und 14 intraoperative Komplikationen (6,6 %) dokumentiert. In den 21 non access-Situationen traten 8 Darmläsionen auf (n = 4 Serosaläsionen, n = 4 transmurale Perforationen). Postoperativ kam es bei den non access Fällen zu 4 Komplikationen Grad II nach CDC und keinen höhergradigen Komplikationen. Bei 3 weiteren Prozeduren traten Darmläsionen ohne non access auf (n = 1 Serosa, n = 2 transmural). Ein:e Patient:in verstarb nach Darmläsion mit nachfolgender Nahtinsuffizienz, Peritonitis und Sepsis. Bei 3 Narkoseeinleitungen aspirierten die Patient:innen und entwickelten daraufhin eine Pneumonie. Auf der Intensivstation wurde sofort eine kalkulierte Antibiotikatherapie eingeleitet. Dennoch verstarben 2 von 3 Patient:innen nach 3 bzw. 4 Tagen. Ein:e Patient:in konnte erfolgreich behandelt und nach 15 Tagen entlassen werden. Aufgrund der hohen Inzidenz von non access und Darmläsionen wurde nach prädiktiven Markern gesucht. Patient:innen mit einer CRS mit HIPEC in der Vorgeschichte hatten ein signifikant erhöhtes Risiko für non access (Odds Ratio [OR] 5,9, χ², p < 0,01) und Darmläsionen (OR 6,4, χ², p < 0,01). Patient:innen mit mehr als zwei Voroperationen im Bauchraum wiesen ebenso ein signifikant erhöhtes Risiko für non-access (OR 4,9, χ², p < 0,01) und Darmläsionen (OR 4,9, χ², p = 0,01) auf. Am Ende des Studienzeitraums befanden sich noch 6 Patient:innen in Therapie. Bei den Übrigen (bei denen mindestens eine PIPAC-Prozedur durchgeführt wurde) gab es unterschiedliche Gründe für die Beendigung der Therapie: n = 26 (34 %) verstorben, n = 20 (26 %) Progression der Grunderkrankung, n = 12 (16 %) Regression der Grunderkrankung (n = 7 ohne weitere Therapie, n = 5 anschließend CRS mit HIPEC), n = 6 (8 %) non-access, n = 5 (6 %) Patient:innenwunsch, n = 8 (10 %) kein Grund dokumentiert. Das mediane Gesamtüberleben ab der ersten geplanten PIPAC-Prozedur betrug 264 Tage (IQA 108–‍586). Insgesamt stellt die PIPAC eine neuartige off-label-Therapie für Patient:innen mit PSMs dar, deren Wirksamkeit und Sicherheit untersucht werden muss. Sie sollte daher nur im Rahmen klinischer Studien durchgeführt werden. Die vorliegende Studie liefert eine genaue Dokumentation von Symptomen, Komplikationen und unerwünschten Ereignissen im Zusammenhang mit PIPAC. In Zusammenschau der vorhandenen Studien scheint die PIPAC gut geeignet zu sein, PSMs und Lebensqualität zu stabilisieren. Zum Nachweis eines kausalen Effekts sind jedoch randomisierte, kontrollierte Studien nötig.:Einführung 1 Epidemiologie 1 Magenkarzinom 1 Kolorektales Karzinom 1 Ovarialkarzinom 1 Pankreaskarzinom 2 Mesotheliom 2 Pseudomyxoma peritonei 2 Pathophysiologie 2 Ablösung vitaler Krebszellen 2 Intraperitonealer Transport 3 Adhäsion und Invasion 3 Wachstum und Metastasierung 3 Symptome/Klinik 3 Diagnostik 3 Bildgebende Verfahren 3 Peritonealer Krebsindex 5 Peritonealer Adhäsionsindex 5 Therapie 5 Systemische Therapie 6 Zytoreduktive Chirurgie 6 Hypertherme intraperitoneale Chemoperfusion 6 Intraperitoneale Druck-Aerosol-Chemotherapie 7 Weitere Therapieoptionen 8 Zielsetzung 8 Publikation 9 Zusammenfassung 21 Literaturverzeichnis 24

Peritoneal adhesions occur in up to 93% of adults after peritoneal trauma during surgery. Most adhesions are asymptomatic but can cause female infertility, small bowel obstruction (SBO) and chronic abdominal pain. Adhesion prophylaxis is needed to reduce the significant morbidity and increased health care costs resulting from peritoneal adhesions. This thesis aims to establish a relevant and reproducible experimental adhesion model to simultaneously study the healing processs and adhesion formation and later to examine whether carbazate-activated polyvinyl alcohol (PVAC), an aldehyde-carbonyl scavenger, can reduce adhesion formation or not; and, in a long-term follow-up, to investigate the incidence of and identify risk factors for adhesive SBO requiring surgical treatment after laparotomy during infancy and to survey the prevalence of self-reported chronic abdominal pain and female infertility. Male Sprague-Dawley rats were subjected to laparotomy, cecal abrasion, and construction of a small bowel anastomosis and examined at various time points after surgery. Early elevation of IL-6, IL-1β and TNF-α concentrations in peritoneal fluid but not in plasma correlate to adhesion formation in this rodent adhesion model, indicating that anti-adhesion treatment should be early, local and not systemic. The animals were treated with either peritoneal instillation of PVAC, or the anastomosis was sutured with PVAC-impregnated resorbable polyglactin sutures. At day 7, bursting pressure of the anastomosis was measured and adhesions were blindly evaluated using Kennedy- and Nair scoring systems. PVAC-impregnated sutures reduced adhesion formation without reducing bursting pressure. Infants who underwent laparotomy between 1976 and 2011 were identified (n=1185) and 898 patients were included with a median follow-up time of 14.7 (range 0.0-36.0) years. The median age at first laparotomy was 6 (range 1.0-365.0) days. There were 113 patients (12.6%) with adhesive SBO, with the highest incidence found in patients with Hirschsprung’s disease (19 of 65, 29%), malrotation (13 of 45, 29%), intestinal atresia (11 of 40, 28%) and necrotizing enterocolitis (16 of 64, 25%). Lengthy duration of surgery (hazard ratio (HR) 1.25, 95% CI, 1.07 to 1.45), stoma formation (HR 1.72, 1.15 to 2.56) and postoperative complications (HR 1.81, 1.12 to 2.92) were independent risk factors. Chronic abdominal pain was reported in 180 (24.0%) of 750 patients, and 17 (13.8%) of 123 women reported infertility. The morbidity after laparotomy in neonates and infants is high. Awareness of the risk factors may promote changes in surgical practice.

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Mental Health / Master / Master of Social Sciences

Grâce au progrès de la chimiothérapie systémique, la prise en charge de la carcinose péritonéale a connu une révolution avec le développement de la chirurgie de cytoréduction. L'association d'une chirurgie de cytoréduction à une chimiothérapie systémique et intra-péritonéale a permis de proposer à certains patients sélectionnés un traitement à visée curative et représente le traitement de référence pour la plupart des carcinoses d'origine non gynécologique. Toutes les carcinoses et tous les patients sont différents, c'est pourquoi de nombreux travaux ont permis de préciser les facteurs permettant la sélection des patients pouvant bénéficier d'un tel traitement. Le principal facteur pour proposer un traitement curatif d'une carcinose péritonéale est la possibilité de réaliser une résection complète. Malgré ces progrès dans le traitement et la sélection des patients, les résultats restent insuffisants et trop peu de patients présentent une maladie résécable accessible à un traitement curatif. L'apparition des biothérapies et notamment les anti-VEGF offre une nouvelle voie de recherche. Le bevacizumab, anticorps anti-VEGF, a montré une efficacité significative dans le traitement des maladies métastatiques. Il augmente l'efficacité du traitement par chimiothérapie systémique. Le VEGF semble également présenter un rôle important dans le développement et l'agressivité des carcinoses péritonéales. Pour permettre d'augmenter l'efficacité du traitement curatif des carcinoses péritonéales, se discute d'associer du bevacizumab. Cependant, administré par voie systémique il peut majorer la morbidité faisant contre-indiquer son association avec une chirurgie abdominale lourde déjà grevée d'une morbidité importante. L'hypothèse qui a justifié ce travail est que l'administration intra-péritonéale de bevacizumab pourrait augmenter la résécablité et la survie des patients atteints par une carcinose péritonéale d'origine non gynécologique en limitant la morbidité. Le but de ce travail est au travers d'études cliniques et expérimentales d'évaluer la faisabilité et l'efficacité d'un traitement par bevacizumab intra-péritonéale en association au traitement chirurgical de référence pour la prise en charge des CP d'origine non gynécologique / Advances in systemic chemotherapy permitted revolution in the management of peritoneal carcinomatosis with the development of cytoreductive surgery. The combination of cytoreductive surgery with systemic and intraperitoneal chemotherapy offer to selected patients a hope of cure and is considered as the treatment of choice for most carcinomatosis of non-gynecological origin. All carcinomatosis and all patients are different and numerous studies tried to determine factors for selecting patients eligible for such treatment. The mains prognostic factor for curative treatment is the ability to perform a complete cytoreduction. Despite these advances in the treatment and selection of patients, the results are still insufficient and few patients have resectable disease accessible to a cure. The development of biotherapies including anti -VEGF provides a new way of research. Bevacizumab, anti - VEGF antibody, showed significant efficacy in the treatment of metastatic diseases. It increases the efficiency of treatment by systemic chemotherapy. VEGF appears to have an important role in the development and aggressiveness of peritoneal carcinomatosis. To increase the effectiveness of curative treatment of peritoneal carcinomatosis, the combination of bevacizumab to the current standard treatment can be proposed. The bevacizumab administered intravenously may increase morbidity prohibiting its association with major abdominal surgery already burdened with significant morbidity. The hypothesis of this work is that the intraperitoneal administration of bevacizumab may increase resectability and survival of patients with peritoneal carcinomatosis of non- gynecologic origin and limit the morbidity. The aim is through clinical and experimental studies to evaluate the feasibility and the efficacy of treatment with intraperitoneal bevacizumab in combination with standard surgical treatment of peritoneal surface malignancy

Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-08-02T13:38:03Z No. of bitstreams: 1 DIS_SORAIA_LEMOS_DE_SIQUEIRA_COMPLETO.pdf: 1770308 bytes, checksum: 4220afcfa71b4f29b7880a79649bc375 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-08-02T13:38:32Z (GMT) No. of bitstreams: 1 DIS_SORAIA_LEMOS_DE_SIQUEIRA_COMPLETO.pdf: 1770308 bytes, checksum: 4220afcfa71b4f29b7880a79649bc375 (MD5) / Made available in DSpace on 2017-08-02T13:39:14Z (GMT). No. of bitstreams: 1 DIS_SORAIA_LEMOS_DE_SIQUEIRA_COMPLETO.pdf: 1770308 bytes, checksum: 4220afcfa71b4f29b7880a79649bc375 (MD5) Previous issue date: 2012-08-29 / Hand hygiene is an important procedure in preventing peritoneal dialysis-related infections. OBJECTIVE: To compare the effectiveness of two distinct techniques for hand hygiene in reducing the number of colony-forming units in patients on peritoneal dialysis. PATIENTS AND METHOD: Observational study. Twenty-two patients underwent two collections of microbiological flora from the hands in two different instances: after hand washing with non-antimicrobial soap and water followed by rubbing with 70% ethyl alcohol, gel presentation, after application of 70% ethyl alcohol, presentation gel. Cultures were obtained by applying the fingers surface directly on agar-blood plates. RESULTS: The comparison between groups showed a significant difference (p <0.01) in colony-forming units in the right hands and left hands, mean 59.6 ? 43.1 in the group not antimicrobial soap and water, proved higher than in group 70% ethyl alcohol, presentation gel (31.8 ? 39.9). This difference is characterized by the presence of colonies of Staphylococcus coagulase-negative, and this was predominant in the seed crops. CONCLUSION: Hand rubbing with gel-alcohol was more effective in reducing the number of colonies recovered than the other methods. / INTRODU??O: A higieniza??o das m?os ? um importante procedimento para a preven??o de infec??es relacionadas a di?lise peritoneal. OBJETIVO: comparar a efic?cia de duas t?cnicas de higieniza??o das m?os, na redu??o do n?mero de unidades formadoras de col?nia em pacientes em programa de di?lise peritoneal. MATERIAIS E M?TODO: Estudo observacional, transversal. Vinte e dois indiv?duos submetidos a duas coletas da flora microbiol?gica das m?os, em dois momentos distintos: ap?s higieniza??o das m?os com ?gua e sab?o n?o antimicrobiano seguida de fric??o com ?lcool et?lico 70%, apresenta??o gel; ap?s aplica??o de ?lcool et?lico 70%, apresenta??o gel. Culturas obtidas da superf?cie dos dedos das m?os, diretamente em placas de Agar Sangue de Carneiro. RESULTADOS: A compara??o entre grupos mostrou uma diferen?a significativa (p<0,01), nas unidades formadoras de col?nia nas m?os direitas e m?os esquerdas, a m?dia 59,6?43,1 do grupo ?gua e sab?o n?o antimicrobiano; mostrou-se mais elevada que no grupo ?lcool et?lico 70%, apresenta??o gel (31,8?39,9). Esta diferen?a ? caracterizada pela presen?a de col?nias de Staphyloccocus coagulasenegativa, sendo que este foi o germe prevalente nas culturas. CONCLUS?O: A higieniza??o com ?lcool et?lico 70%, apresenta??o gel produziu maior redu??o no n?mero de unidades formadoras de col?nia.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2017-08-24T12:57:55Z No. of bitstreams: 1 ADRIANA_CONTI_DIS.pdf: 1862760 bytes, checksum: d04417c4b0e9dd7ce859909035772034 (MD5) / Rejected by Caroline Xavier (caroline.xavier@pucrs.br), reason: Devolvido devido ? falta de capa institucional no arquivo PDF. on 2017-08-25T18:09:08Z (GMT) / Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2017-08-29T11:31:27Z No. of bitstreams: 1 ADRIANA_CONTI_DIS.pdf: 1902344 bytes, checksum: 5866bfc2071b034ae6ff6dedc003d26f (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-09-08T17:28:07Z (GMT) No. of bitstreams: 1 ADRIANA_CONTI_DIS.pdf: 1902344 bytes, checksum: 5866bfc2071b034ae6ff6dedc003d26f (MD5) / Made available in DSpace on 2017-09-11T11:26:00Z (GMT). No. of bitstreams: 1 ADRIANA_CONTI_DIS.pdf: 1902344 bytes, checksum: 5866bfc2071b034ae6ff6dedc003d26f (MD5) Previous issue date: 2017-03-20 / Introduction: Peritonitis remains a major complication in peritoneal dialysis patients, with the predominant infectious agent being coagulase-negative Staphylococcus (CNS). Intraperitoneal administration of antibiotics is the required treatment, however, no consensus exists on the appropriate disinfection of the medication port (MP). Objective: To compare different disinfection techniques for the peritoneal dialysis bag MP. Methods: An experimental study was conducted testing different cleaning agents (70% alcohol vs 2% chlorhexidine) and time periods (5, 10 and 60seconds) for disinfection of the MP. Four microorganisms (S. aureus, E.coli, A. baumannii and C.parapsilosis) were prepared for use as contaminants of the MP. MP were incubated in Tryptic soybroth at 36?C for 24 h, after which, they were seeded on a Biom?rieux? blood agar plate and incubated for 24 h at 36?C. Results: A total of 240 PD bags were contaminated with four different microorganisms. Two positive cultures (E. coli and S. aureus) were identified, both after disinfection with alcohol after 5 and 10 seconds of friction, and none in the chlorhexidine group. Conclusion: although there was no statistical difference between the antiseptics used and the cleaning time, the use of chlorhexidine for 1 minute was the only one in which there was no bacterial growth, therefore we considered this recommendation. / Introdu??o: A Di?lise Peritoneal utiliza a membrana peritoneal para realizar trocas entre o sangue e a solu??o de di?lise. Peritonite ? a maior complica??o, e o germe predominante ? o Staphylococcus coagulase negativa (SCN). O tratamento para peritonite ? realizado com a administra??o de antibi?tico intraperitoneal. Durante o treinamento, o paciente e/ou familiar s?o capacitados a administrar antibi?tico via intraperitoneal, se necess?rio. No entanto, n?o existe consenso quanto ? maneira mais apropriada para a desinfec??o do tubo entrada de medica??o (TEM). Empresas que comercializam o material de DP recomendam que, para a administra??o de antibi?ticos e outros medicamentos, o TEM deve ser limpo durante cinco minutos com ?lcool a 70%, iodo povidine alc?olico ou clorexidina alco?lica. Objetivo: Comparar a efic?cia das t?cnicas e produtos de desinfec??o do TEM da bolsa de di?lise peritoneal. M?todo: Foi realizado um estudo experimental com diferentes agentes de limpeza (?lcool x clorexidina 2%) e per?odos de tempo (5, 10, 60 segundos) para a desinfec??o do TEM. Foram preparados quatro micro-organismos (S. aureus, E. coli, A. baumanni e C. parapsilosis) para utiliza??o como contaminantes e foram incubados em Caldo de Soja Tripticase?na a 36? C durante 24 horas, ap?s foram semeados por deple??o em placas de ?gar sangue (AS) e incubados durante 24 horas a 36? C. Resultados: No total, 240 bolsas PD foram contaminadas com quatro micro-organismos diferentes. Foram identificadas duas culturas positivas (E. coli e S. aureus), ambas ap?s desinfec??o com ?lcool 70% com o tempo de 5 e 10 segundos de atrito. Conclus?o: Embora sem diferen?a estat?stica entre os antiss?pticos utilizados e o tempo de limpeza, o uso de clorexidine por 1 minuto foi o ?nico em que n?o houve crescimento bacteriano, portanto achamos pertinente esta recomenda??o.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2016-09-26T13:36:50Z No. of bitstreams: 1 jandira.pdf: 4878166 bytes, checksum: 9781aa90d57d48a213df7f97e1acf583 (MD5) / Made available in DSpace on 2016-09-26T13:36:50Z (GMT). No. of bitstreams: 1 jandira.pdf: 4878166 bytes, checksum: 9781aa90d57d48a213df7f97e1acf583 (MD5) Previous issue date: 2016-03-31 / By questioning the quality of life of ostomy patients in the municipality of Capão do Leão, the present study was proposed, which has the general objective to identify the profile and quality of life of users of Care Program to ostomy in the city of Capão do Leão, RS. The population consisted of all 14 registered ostomy patients in the Care Program to ostomy patients until the month of November 2015. We conducted a descriptive exploratory study of qualitative - quantitative nature. For data collection were used 4 methodological processes, each of them being a questionnaire specifically designed for the study, document analysis, field diary and the instrument developed by WHO WHOQOL BREF. As main results of this study, was found out that the subjects have better quality of life in the areas of social and environmental relationships, and worse quality of life in physical and psychological domains. There were also identified and analyzed factors such as gender, age, marital status, education, and other characteristics relevant to the study such as self-care, pathology which led to the stoma, stoma time. The results of this investigation point to the need for closer nurse monitoring of the stoma subjects and their families / caregivers, in order to minimize the negative impact resulting from the ostomy presence and to promote self-care and social reintegration of the individual. / Ao questionar a qualidade de vida dos pacientes estomizados do município do Capão de Leão, surgiu a proposta do presente estudo. O objetivo geral foi identificar o perfil e a qualidade de vida dos usuários do Programa de Atenção aos Estomizados no município de Capão do Leão-RS. A população foi composta por todos os 14 pacientes estomizados cadastrados no Programa de Atenção ao Estomizado até o mês de novembro de 2015. Realizou-se um estudo exploratório descritivo, de natureza quali- quantitativa. Para a coleta dos dados foram utilizados quatro processos metodológicos sendo eles um questionário elaborado especificamente para o estudo, análise documental, diário de campo e o instrumento WHOQOL bref, desenvolvido pela OMS. Como resultados principais, temos que os indivíduos do estudo apresentaram melhor qualidade de vida nos domínios relações sociais e meio ambiente, e pior qualidade de vida nos domínios físico e psicológico. Foram identificados e analisados também fatores como sexo, idade, estado civil, escolaridade, além de outras características pertinentes ao estudo, como o autocuidado, patologia que levou ao estoma, tempo de estomia. Os resultados desta investigação apontam para a necessidade de um estreito acompanhamento de enfermagem à pessoa estomizada e de seus familiares/cuidadores, de forma a minimizar o impacto negativo resultante da presença da ostomia e promover o autocuidado e a reinserção social do indivíduo.

by Tong Lai Wah, Christina. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 101-112). / Abstracts in English and Chinese. / Title Page --- p.i / Authorization Page --- p.ii / Signature Page --- p.iii / Acknowledgements --- p.iv / Table of Contents --- p.v-viii / List of Figures --- p.ix / List of Tables --- p.x / List of Append --- p.ix xi / Title Page --- p.xii / Abstract --- p.xiii / Chapter 1 --- Introduction --- p.14-15 / Chapter 2 --- Literature Review --- p.16-24 / Chapter 2.1 --- Introduction / Chapter 2.2 --- End-stage renal disease / Chapter 2.3 --- Continuous ambulatory peritoneal dialysis / Chapter 2.4 --- Patient participation / Chapter 2.4.1 --- Definition of participation / Chapter 2.4.2 --- Benefits of participation / Chapter 2.4.3 --- Problems of patient participation / Chapter 2.4.4 --- Application of patient participation / Chapter 2.5 --- Conclusion / Chapter 3 --- Methodology --- p.25-43 / Chapter 3.1 --- Introduction / Chapter 3.2 --- Overview of grounded theory / Chapter 3.3 --- Procedures / Chapter 3.3.1 --- Data generation / Chapter - --- Sampling / Chapter - --- Data gathering / Chapter - --- Data recording / Chapter 3.3.2 --- Data analysis / Chapter - --- Open coding / Chapter - --- Constant comparative analysis / Chapter - --- Categorization / Chapter - --- Axial coding / Chapter - --- Theoretical sensitivity / Chapter - --- Memoing / Chapter 3.3.3 --- Theory construction / Chapter - --- Core category / Chapter 3.4 --- Method application / Chapter 3.4.1 --- Data collection / Chapter - --- Sampling / Chapter - --- Interview / Chapter - --- Recording / Chapter 3.4.2 --- Data analysis / Chapter - --- Open coding / Chapter - --- Constant comparative analysis / Chapter - --- Categorization and Axial coding / Chapter - --- Theoretical sensitivity / Chapter - --- Memoing / Chapter 3.4.3 --- Theoretical construction / Chapter - --- Concept formation / Chapter - --- Concept development / Chapter 3.5 --- Credibility & Trustworthiness / Chapter 3.6 --- Conclusion / Chapter 4 --- Findings --- p.44-72 / Chapter 4.1 --- Introduction / Chapter 4.2 --- Core category: Integrative Restructuring / Chapter 4.3 --- Emotional Labour / Chapter 4.3.1 --- Entering the active zone / Chapter (a) --- Conditions to go into active zone / Chapter (b) --- Outcomes of emotional labour / Chapter (c) --- Strategies used for emotional labour / Chapter - --- Letting go of emotions / Chapter - --- Aligning cognitive consistency / Chapter - --- Maximizing ego / Chapter - --- Locating self / Chapter - --- Boosting power / Chapter i. --- Active control / Chapter ii. --- Building positive expectancies / Chapter iii. --- Covariance to positive expectancies / Chapter 4.3.2 --- Retreating into comfort zone / Chapter (a) --- Contexts of comfort zone / Chapter (b) --- Conditions to build comfort zone / Chapter (c) --- Strategies used within comfort zone / Chapter - --- Defending / Chapter - --- Relinquishing / Chapter - --- Anchoring / Chapter 4.3.3 --- Migrating between the two zones / Chapter (a) --- Conditions to initiate the move / Chapter (b) --- Covariance to the movement / Chapter (c) --- Strategies to make progress / Chapter 4.4 --- Conclusion / Chapter 5 --- Discussion --- p.73-92 / Chapter 5.1 --- Introduction / Chapter 5.2 --- Theoretical framework / Chapter 5.3 --- Core category: Integrative Restructuring / Chapter 5.4 --- Variables affecting the move to active zone / Chapter 5.4.1 --- Preparations / Chapter 5.4.2 --- Support / Chapter (a) --- Source of support / Chapter (b) --- Context of support / Chapter (c) --- Effects of support / Chapter (i) --- Effects upon support-seekers / Chapter (ii) --- Supporter's reaction to support-giving relationship / Chapter 5.4.3 --- Commitment / Chapter (a) --- Perception of the situation / Chapter (b) --- Cultural influences / Chapter 5.4.4 --- Control / Chapter 5.5 --- Conclusion / Chapter 6 --- Concluding Chapter --- p.93-100 / Chapter 6.1 --- Limitations / Chapter 6.2 --- Implications / Chapter 6.2.1 --- Practice / Chapter 6.2.2 --- Research / Chapter 6.2.3 --- Teaching / Chapter 6.2.4 --- Policy Making / Chapter 6.2.5 --- Summary / Chapter 6.3 --- Future research / Chapter 6.4 --- Reflections upon the study / Chapter 6.5 --- Conclusion / References --- p.101-112

Made available in DSpace on 2015-04-14T13:34:59Z (GMT). No. of bitstreams: 1 424905.pdf: 1635393 bytes, checksum: 130e114aa7e9842c1d462f5f400791c9 (MD5) Previous issue date: 2010-03-31 / Introdu??o: A cont?nua exposi??o da membrana peritoneal ?s solu??es de di?lise peritoneal convencionais, consideradas n?o fisiol?gicas, ? um dos fatores de risco para o desenvolvimento de altera??es morfol?gicas e funcionais do perit?nio. Objetivo: Comparar a viabilidade celular in vitro de fibroblastos de camundongos NIH/3T3 expostos a diferentes solu??es de di?lise peritoneal. Materiais e M?todos: Estudo experimental; onde foram realizadas culturas de fibroblastos empregando meios de cultura contendo diferentes solu??es de di?lise (padr?o e pH-neutro) nas 3 concentra??es de glicose dispon?veis. A viabilidade celular foi avaliada pelo m?todo do sal de tetraz?lio. Resultados: A viabilidade celular foi significativamente superior na solu??o com pH neutro em compara??o a solu??o controle, nas tr?s concentra??es de glicose (Densidade ?ptica-m?dia ? dp: 1.5%controle 0,295?0,047 vs 1,5%pH neutro 0,372?0,042 P<0,001; 2,3%controle 0,270?0,036 vs 2,3% pH neutro 0,337?0,051 P<0,001; 4,25%controle 0,284?0,037 vs 4,25%pH neutro 0,332 ? 0,032 P<0,001). N?o ocorreu diferen?a significativa na viabilidade celular entre as tr?s concentra??es de glicose quando se usou a solu??o de di?lise peritoneal padr?o (ANOVA P=0,218), embora a viabilidade celular foi maior ap?s a exposi??o ? solu??o com pH neutro na concentra??o de glicose de 1,5% em compara??o com 2,3 e 4,25% (ANOVA P=0,008: Bonferroni 1,5% vs 2,3% P=0,033, 1,5% vs 4,25% P=0,014, 2,3% vs 4,25% P=1,00). Conclus?o: A viabilidade celular foi maior nos fibroblastos expostos a solu??o de di?lise peritoneal com pH neutro, especialmente nas menores concentra??es de glicose. ? poss?vel que o pH mais fisiol?gico e a menor quantidade de produtos de degrada??o da glicose possam ser respons?veis pelos resultados.