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.

The purpose of this descriptive study was to evaluate, through clinical testing, the interrater reliability and concurrent validity of the Interchange of Gases Assessment Tool (IGAST) for monitoring the respiratory status of patients in the Postanesthesia Care Unit. The IGAST was used to assess the respiratory status of 20 patients over three time periods (60 data samples). Findings indicated that interrater reliability of the IGAST was acceptable for clinical use in the PACU. The IGAST received a mean interrater reliability rating of 98% in the PACU setting. Results of the mean dimension scores supported the patients' readiness for discharge. Chart audit revealed that the IGAST had concurrent validity since charted information and rated IGAST items were congruent. Further findings suggested that nurses using the IGAST document the respiratory status of patients more completely and more consistently than nurses using narrative documentation.