Thesis (M.S.)--University of Wisconsin--Madison, 1990. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 54-58).

Thesis (M.S.)--University of Michigan, 1976.

München, Techn. Univ., Diss., 2004.

Orientadores: Ivan Felizardo Contrera Toro, Alfio Jose Tincani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T10:37:06Z (GMT). No. of bitstreams: 1 Vega_NelsondeAraujo_M.pdf: 4035476 bytes, checksum: 8e53d952a2d1dafb0e3094da655eed5a (MD5) Previous issue date: 2008 / Resumo: O manuseio tradicional dos drenos de tórax, após toracotomia, resume-se em um período inicial de aspiração contínua do frasco de drenagem, subseqüente a um intervalo de tempo com o selo de água. Essa estratégia foi desenvolvida, há muitos anos, para ser utilizada após grandes toracotomias. O aprendizado de novas técnicas cirúrgicas e o moderno desenvolvimento de instrumentais médicos propiciaram um menor trauma cirúrgico ao doente. Atualmente, o manejo dos drenos vem sendo modificado em algumas situações. O objetivo desse estudo é avaliar a drenagem pleural, por meio de válvula unidirecional de tórax (VUT), no pós-operatório de ressecção pulmonar eletiva. Foram realizadas 39 ressecções pulmonares, de forma prospectiva e não randomizada, em pacientes que utilizaram a VUT, como o método de drenagem pleural durante o período pós-operatório. Foram excluídos os pacientes com idade inferior a 12 anos, os submetidos à pneumectomia ou à operação de urgência e os que não completaram o seguimento do estudo. Observou-se a expansão pulmonar, o tempo de permanência com o sistema de drenagem, o período de internação e as complicações pós-operatórias. Foram incluídos e analisados 36 pacientes. A média de permanência com o sistema de drenagem pleural foi de 2,94 ± 1,6 dias. A radiografia de tórax, realizada após 30 dias do procedimento cirúrgico, foi considerada normal em 34 (94,18%) pacientes. Ocorreram oito (22,16%) casos de complicações pós-operatórias, sendo três (8,31%) relacionados à VUT. A utilização da VUT, no pós-operatório de ressecção pulmonar eletiva, foi eficiente e apresentou baixo índice de complicação, principalmente nas ressecções menores / Abstract: The traditional management of chest tubes after a lung resection involves a period of applied suction followed by water seal drainage. This strategy was developed over many years to be used after large thoracotomies. However, the learning of new surgical techniques associated with the current development of medical devices made possible minor surgical traumas in patients. Nowadays, this strategy has been modified in some situations. This study aim is to evaluate pleural drainage using a unidirectional thorax valve (UTV) after elective lung resection.Thirty-nine non randomized prospective lung resections were performed in patients that have been used UTV during a postoperative period. Exclusion criteria were patients below 12 years of age, those who underwent pneumonectomy or emergency surgery and those who were considered lost of follow-up. Pulmonary expansion, chest tube duration, hospital stay and postoperative complications were observed. This study comprised 36 patients. Mean duration of pleural drainage was 2,94 ± 1,6 days. Thirty-four (94,18%) patients showed normal findings on chest roentgenogram 30 days after surgical procedure. Postoperative complications occurred in 8 (22,16%) patients, being 3 (8,31%) related to drainage system. The use of UTV after elective lung resection was effective and showed a low rate of complications, especially in minor resection / Mestrado / Cirurgia / Mestre em Cirurgia

Cartas al Editor

Ein protektives Ileostoma reduziert die schweren klinischen Folgen einer Anastomoseninsuffizienz nach Darmresektion wie Abszess, Sepsis und Tod. Die Rückverlagerung des Ileostomas ist selbst mit einer nennenswerten Morbiditäts- (3-40%) und Mortalitätsrate (0-4%) verknüpft. Dennoch gilt die ISRV als Ausbildungseingriff junger chirurgischer Weiterbildungsassistenten. In dieser Arbeit wurden alle erwachsene Patienten (n = 558), die eine ISRV im Zeitraum zwischen September 2008 und Januar 2017 erhalten haben, anhand einer prospektiv gesammelten Datenbank ermittelt und retrospektiv anhand der Patientenakten ausgewertet. Dabei wurden neben den Basis-Charakteristika der Patienten (Alter, Krankenversicherung, ASA, BMI, Raucheranamnese, Immunsuppression) und operativen Daten (Verschlusstechnik, Operationsdauer, Rate der segmentalen Darmresektionen, Adhäsiolyse) erfasst. Die postoperativen Komplikationsraten, gemessen anhand der Clavien- Dindo-Klassifikation, und die Länge des postoperativen Krankenhausaufenthaltes, wurden in Bezug auf den Ausbildungsstand des Operateurs analysiert. In der Facharzt-Kohorte (355 Patienten) zeigte sich eine signifikant kürzere Operationsdauer. Unter Berücksichtigung möglicher Störfaktoren zeigte sich kein signifikanter Unterschied zwischen beiden Gruppen bezüglich Major- Komplikationen. Die Rate an Anastomoseninsuffizienzen betrug 3% und die Gesamt-Morbiditätsrate 11%. Da sich nur die Operationsdauer abhängig vom Ausbildungsstand des Chirurgen unterschiedlich zeigte, kann die ISRV als guter Ausbildungseingriff für junge chirurgische Assistenten in Weiterbildung gesehen werden. / Defunctioning ileostomies reduce the consequences of distal anastomotic leakage following bowel resections. Ileostomy reversal in itself, however, is associated with appreciable morbidity (3–40%) and mortality (0–4%). Despite being a common teaching procedure, there is limited information on the impact of surgical proficiency levels on postoperative outcome. Methods Adult patients undergoing closure of a defunctioning ileostomy between September 2008 and January 2017 were identified from a surgical administrative database that was collected prospectively (n = 558). Baseline characteristics (age, ASA score, BMI, health care insurance coverage) and closure techniques were recorded. Operation time, rate of bowel resection, postoperative complications ranked by Clavien-Dindo classification and length of stay were analysed with respect to proficiency levels (residents vs. consultants). Two hundred three ileostomy reversals were performed by residents; 355 ileostomies were closed by consultants. Operation time was considerably shorter in the consultant group (p < 0.001). Major postoperative complication rates however were not different among the groups when adjusted for possible confounders (p = 0.948). The rate of anastomotic leakage was 3% and the overall major morbidity rate was 11%. Operation time rather than surgical outcome and overall morbidity were affected by surgical proficiency levels. Therefore, ileostomy reversal can be considered an appropriate teaching operation for young general surgery trainees.

No description available.

The effectiveness of preoperative relaxation training and preparatory information, separately and in combination, on postoperative pain was examined with respect to surgical patients' coping style (avoidance-sensitization). Subjects were 64 patients undergoing elective cholecystectomy or hysterectomy (abdominal or vaginal) in a large private hospital. Experimenters were advanced clinical psychology graduate students and trained undergraduate research assistants. On the afternoon prior to surgery, patients were contacted, completed an interview that was used to assess their coping style in the surgical situation (Cohen & Lazarus, 1973), and completed the state anxiety portion of the State-Trait Anxiety Inventory. Patients also completed the Pain Rating Index and the Present Pain Index of the McGill Pain Questionnaire. At this point in the preoperative session, patients were presented with materials and/or information corresponding to the group to which they were assigned. Treatments consisted of training in the Benson relaxation technique, receiving information about procedures and specific sensations they would experience, or a combination of relaxation training and information-imparting. Controls talked briefly with the experimenter of feelings about surgery and experiences in the hospital. Patients in all groups were revisited on the second (counting the day after surgery as the first postoperative day) and fourth postoperative days, and again completed the pain measures and the state anxiety measure. Patients were also encouraged to practice the relaxation technique, instructed concerning procedures and sensations they had yet to experience, both, or neither, depending on the group to which they were assigned. After each patient was discharged, his/her medical records were examined and the number and type of analgesics administered during the postoperative period, from the day of surgery until discharge, was tabulated. Preoperative interviews were rated according to coping style and patients were divided into two groups, sensitizers and avoiders. Data were analyzed in a 2 x 4 analysis of covariance. Results indicated that there were no main effects for treatment. It is possible that the treatments provided in this study were too brief to provide an adequate test of their effectiveness for patients in general. There were no significant main effects for coping style, although sensitizers generally reported more pain and received more analgesics than avoiders. An avoidant method of coping appeared to be an adequate method of adjustment to elective surgery and did not result in poorer recovery, as previous authors have suggested. Significant effects on postoperative pain were primarily a function of the interaction between treatment and coping style. Sensitizers reported less pain with relaxation training alone than sensitizers in any of the other groups. This effect was apparently owing to the anxiety-reducing nature of the technique and the fact that it encourages redirection of attention, away from discomforts. Avoiders reported low levels of pain and anxiety with no treatment. However, of the treatments provided, relaxation plus information did reduce some indices of pain below that of avoider controls. Finally, information-imparting did not appear to be beneficial for either sensitizers or avoiders. It was suggested that specific information may contribute to further sensitization to discomforts for sensitizers and conflict with avoidant processes of coping in avoiders. It was also suggested that more extensive preoperative preparation of sensitizers may be necessary to promote habituation to the discomforts of surgery. / Ph. D.

No description available.

Trotz stetiger Weiterentwicklung und Verbesserungen in chirurgischen Anastomosetechniken treten postoperative Pankreasfisteln (POPF) in 20 - 25 % der Patienten und Patientinnen als Komplikation nach partieller Pankreatikoduodenektomie (PPD) auf. Kommt es zu einer kombinierten Leckage aus Gallen- und Pankreassekret, wurde in dieser Arbeit die Definition einer komplizierten POPF (CPPF) eingeführt, welche eine seltene, aber schwerwiegende und gefährliche postoperative Komplikation darstellt. Neben einer Relaparotomie kann eine Restpankreatektomie als ultima ratio zur Beherrschung dieser schweren Komplikation notwendig werden, welche mit einer Mortalität von 50 % verbunden ist. Die Internationale Studiengruppe der Pankreaschirurgie (ISGPS) entwickelte ein Klassifikationssystem für POPF, welches auf Abweichungen der üblichen postoperativen Behandlungsstrategie beruht. Jedoch wurden keine spezifischen Behandlungsalgorithmen bzw. Therapiekonzepte, insbesondere im Falle einer CPPF, vorgeschlagen. In dieser Arbeit soll die therapeutische Effektivität einer perkutanen transhepatischen Cholangiodrainage (PTCD) bei Patienten und Patientinnen mit einer CPPF evaluiert werden. Dazu wurde eine retrospektive Analyse an Patienten und Patientinnen durchgeführt, welche eine CPPF nach PPD entwickelten. Die Patienten und Patientinnen wurden hinsichtlich der gewählten Behandlungsstrategie, des Outcomes, postoperativer Komplikationen nach Clavien-Dindo-Klassifikation, des CCI (Comprehensive Complication Index), der 30- und 90-Tage-Mortalität sowie Restpankreatektomie, postoperativer Arrosionsblutungen und der Hospitalisierungsdauer nach Behandlung einer CPPF analysiert. Zwischen 2007 und 2018 entwickelten 56 (19,1 %) von insgesamt 293 Patienten und Patientinnen eine relevante POPF (ISGPS Grad B/C) nach einer Pankreaskopfresektion. Darunter wurden 17 Patienten und Patientinnen mit einer komplizierten POPF (CPPF) identifiziert. 11 Patienten und Patientinnen erhielten als Behandlung eine PTCD und sechs Patienten und Patientinnen erhielten eine chirurgisch eingebrachte transhepatische Cholangiodrainage (CTCD) im Rahmen eines Revisionseingriffes. Es wurde keine Restpankreatektomie oder Reoperation nach einer initialen PTCD Therapie notwendig. In 4 von 17 Fällen kam es zu postoperativen Blutungen nach Einbringen einer transhepatischen Cholangiodrainage, der mediane CCI lag bei 44 ± 17,3, die mediane Hospitalisierungsdauer betrug 36 ± 19,2 Tage, die 30-Tage-Mortalität war 0 % und die 90-Tage-Mortalität 17,7 %. Es wurde kein Sterbefall in Verbindung mit einer PTCD beobachtet. Mit Hilfe dieser Studie kann gezeigt werden, dass eine PTCD eine praktikable, sichere und effektive Behandlungsoption für Patienten und Patientinnen mit einer CPPF bietet. Die Separierung von Galle und Pankreassaft stellt eine neuartige Behandlungsoption in ausgewählten Patienten und Patientinnen mit ausreichend drainierter CPPF nach PPD dar. / Despite continuous advancements and improvements in surgical anastomosis techniques, postoperative pancreatic fistulas (POPF) occur as complications in 20-25 % of patients after partial pancreaticoduodenectomy (PPD). In cases of combined leakage of bile and pancreatic secretions, this work introduces the definition of a complicated POPF (CPPF), which is a rare but severe and dangerous postoperative complication. Besides a relaparotomy, a remaining pancreatectomy may be necessary as a last resort to control this severe complication, which is associated with a mortality rate of 50 %. The International Study Group of Pancreatic Surgery (ISGPS) developed a classification system for POPF based on deviations from the usual postoperative treatment strategy. However, no specific treatment algorithms or therapeutic concepts, especially in the case of a CPPF, have been proposed. This study aims to evaluate the therapeutic effectiveness of percutaneous transhepatic biliary drainage (PTCD) in patients with a CPPF. For this purpose, a retrospective analysis was conducted on patients who developed a CPPF after PPD. The patients were analyzed regarding the chosen treatment strategy, outcome, postoperative complications according to the Clavien-Dindo classification, the Comprehensive Complication Index (CCI), the 30- and 90-day mortality rates, as well as remaining pancreatectomy, postoperative erosive bleeding and hospitalization duration after treatment of a CPPF. Between 2007 and 2018, 56 (19.1%) out of a total of 293 patients developed a relevant POPF (ISGPS Grade B/C) after pancreatic head resection. Among them, 17 patients with a complicated POPF (CPPF) were identified. Eleven patients received PTCD as treatment, and six patients received surgically placed transhepatic biliary drainage (CTCD) as part of a revision procedure. No remaining pancreatectomy or reoperation was necessary after initial PTCD therapy. In 4 out of 17 cases, postoperative bleeding occurred after the introduction of a transhepatic biliary drainage; the median CCI was 44 ± 17.3, the median hospitalization duration was 36 ± 19.2 days, the 30-day mortality was 0%, and the 90-day mortality was 17.7%. No deaths associated with PTCD were observed. This study demonstrates that PTCD offers a feasible, safe and effective treatment option for patients with a CPPF. The separation of bile and pancreatic juice presents an innovative treatment option in selected patients with adequately drained CPPF after PPD.