Made available in DSpace on 2017-07-10T17:48:28Z (GMT). No. of bitstreams: 1 Aparecida_Oliveira.PDF: 706572 bytes, checksum: eaf8729b462e450590ef79f29daf8d4f (MD5) Previous issue date: 2012-02-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This work aimed to study the electrolyte balance of diets on the metabolism of nitrogen balance, blood parameters, urinary pH and physiological response of barrows in the initial phase, in condition of stress and thermal comfort.. For the experiment were used 32 barrows in the early stages, with initial mean body mass of 18.5 ± 0.73. Distributed in experimental design of randomized blocks in a 2x4 factorial design with four replicates of 32 experimental units. The treatments consisted of four isonitrogenous diets with CP: 19.24% BE ration with 168 mEq/kg, R2: BE ration with 212 mEq/kg; R3: BE diet with 256 mEq/kg; R4: ration with EB 300 mEq/kg and two thermal conditions (comfort and stress). The parameters studied were nitrogen ingested, excreted in feces, urine excreted, absorbed, retained, retained/ingested, retained/absorbed, total excretion, protein intake (PBC), excreted in the feces (PBF) and urine (PBU) crude protein retained (PBR), net protein utilization (ULP), glucose, chloride, urea, creatinine, sodium (Na) and potassium (K) in blood plasma, urine pH, environmental conditions of the room, respiratory rate and temperature rectal cancer. The use of feed containing levels of EB between 168 and 300 mEq/kg did not influenced nitrogen balance, protein metabolism and blood parameters of pigs. Pigs exposed to 21 °C have higher consumption, fecal excretion of nitrogen, protein, sodium and potassium plasma than pigs reared under average temperature of 30 °C. Nitrogen retained: intake (%), net protein utilization (%), had higher creatinine values in the condition of thermal stress. The rations containing levels of EB between 168 and 300 mEq/kg to promote linear increase urine pH. The hours of daily observations promoted a positive linear effect (p <0.05) on the physiological parameter (rectal temperature and respiratory rate). The rise in rectal temperature was directly proportional to temperature. The respiratory rate showed an increase (57% above normal) in the heat stress condition / Este trabalho teve por objetivo estudar o balanço eletrolítico de rações sobre o metabolismo do balanço de nitrogênio, parâmetros sanguíneos, pH urinário e resposta fisiológica de suínos machos castrados na fase inicial, em condição de estresse e conforto térmico. Para o experimento foram utilizados 32 suínos machos castrados em fase inicial, com massa corporal média inicial de 18,5 ± 0,73. Distribuídos em delineamento experimental de blocos ao acaso em esquema fatorial 2x4 com quatro repetições totalizando 32 unidades experimentais. Os tratamentos foram constituídos de quatro rações isoprotéicas com 19,24% PB: R1: ração com BE 168 meq/kg; R2: ração com BE 212 meq/kg; R3: ração com BE 256 meq/kg; R4: ração com BE 300 meq/kg e duas condições térmica (conforto e estresse). Os parâmetros analisados foram Nitrogênio ingerido, excretado nas fezes, excretado na urina, absorvido, retido, retido/ingerido, retido/absorvido, excreção total, proteína bruta consumida (PBC), excretada nas fezes (PBF) e na urina (PBU), proteína bruta retida (PBR), utilização líquida de proteína (ULP), glicose, cloretos, uréia, creatinina, sódio (Na) e potássio (K), no plasma sanguíneo, pH da urina, condições ambientais da sala, frequência respiratória e temperatura retal. O uso de rações contendo níveis de BE entre 168 e 300 mEq/kg não influenciou o balanço de nitrogênio, metabolismo protéico e os parâmetros sanguíneos dos suínos. Os suínos expostos à temperatura de 21°C apresentam maiores consumo, excreção fecal de nitrogênio, proteína bruta, sódio e potássio plasmático do que suínos criados sob temperatura média de 30°C. O nitrogênio retido:ingerido (%), utilização líquida da proteína (%), Creatinina apresentaram maiores valores na condição de estresse térmico. As rações contendo níveis de BE entre 168 e 300 mEq/kg promovem aumento linear para o pH da urina. Os horários de observações diárias promoveram efeito linear positivo (p<0,05) sobre os parâmetros fisiológicos avaliados (temperatura retal e frequência respiratória). A elevação da temperatura retal foi diretamente proporcional a temperatura do ambiente. A frequência respiratória apresentou aumento (57% acima do considerado normal) na condição de estresse térmico

Made available in DSpace on 2017-07-10T17:48:33Z (GMT). No. of bitstreams: 1 Debora_Cristiane_Freitag.pdf: 951246 bytes, checksum: 2fcc6daede28dcf8dac6f7f4dc54f30d (MD5) Previous issue date: 2012-08-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aimed to evaluate the reduction of crude protein ration on nitrogen balance, blood parameters, and physiological urinary pH of barrows in the initial phase in stress condition (28,77 ˚C) and thermal comfort (18,13 ˚C). For the experiment we used 32 barrows in the initial phase, with initial mean body mass of 18,5 ± 0,73 kg. The animals were divided into two experiments in two environmental conditions (stress and thermal comfort) in a randomized complete block with four decreasing levels of crude protein (20,5; 19,4; 18,3 and 17,2%) with four replications, totaling 16 plots in each experiment. Each plot consisted of an animal, totaling 32 animals. The parameters analyzed were ingested nitrogen, excreted in feces and urine, absorbed, retained, retained/absorbed, total excretion, net protein utilization (ULP), cholesterol, triglycerides, glucose, urea, creatinine in blood plasma, urine pH, respiratory rate, rectal temperature and body. In heat stress condition, reducing the crude protein content of the diet decreased the nitrogen excreted in the urine, the total excretion and plasma triglyceride in growing pigs. For thermal comfort condition in growing pigs had higher nitrogen ingested, absorbed, retained and, of plasma urea. The response surface for rectal temperature, body temperature and respiratory rate increased, in function to ITGU and different times of observation, being more evident in thermal comfort condition / Este trabalho teve por objetivo estudar a redução da proteína bruta de rações sobre o balanço de nitrogênio, parâmetros sanguíneos, fisiológicos e pH urinário de suínos machos castrados na fase inicial, em condição de estresse (28,77˚C) e conforto térmico (18,13˚C). Para o experimento foram utilizados 32 suínos machos castrados em fase inicial, com massa corporal média inicial de 18,5 ± 0,73kg. Os animais foram distribuídos em dois experimentos em duas condições de ambiente (estresse e conforto térmico) em um delineamento experimental de blocos com quatro níveis decrescentes de proteína bruta (20,5, 19,4, 18,3 e 17,2%) com quatro repetições, totalizando 16 parcelas em cada experimento. Cada parcela experimental constou de um animal, totalizando 32 animais. Os parâmetros analisados foram nitrogênio ingerido, excretado nas fezes e na urina, absorvido, retido, retido/absorvido, excreção total, utilização líquida de proteína (ULP), colesterol, triglicerídeos, glicose, uréia, creatinina no plasma sanguíneo, pH da urina, frequência respiratória, temperatura retal e corporal. Em condição de estresse térmico, a redução do teor de proteína bruta da ração diminuiu o nitrogênio excretado na urina, a excreção total e o triglicerídeo plasmático de suínos em crescimento. Para condição de conforto térmico os suínos em crescimento apresentaram maiores valores de nitrogênio ingerido, absorvido, retido, bem como, de uréia plasmática. A superfície de resposta para temperatura retal, temperatura corporal e frequência respiratória aumentaram em função do ITGU e diferentes horários de observação, sendo mais evidente em condição de conforto térmico

Introdução: De acordo com a União Internacional Contra o Câncer um mínimo de 12 linfonodos (LN) deve ser obtido no espécime cirúrgico para o estadiamento do câncer colorretal (CCR). Estudos recentes reportaram que o uso da quimioirradioterapia neoadjuvante (QRN) pode resultar na não obtenção do número mínimo de LN na peça em 30-52% dos pacientes. Objetivo: Identificar os fatores relacionados à redução do número de LN ressecados em pacientes submetidos à neoadjuvancia e a excisão total do mesorreto. Pacientes e métodos: De janeiro de 2012 a março de 2013, 160 pacientes com câncer de reto foram submetidos à QRN (5-FU e 5040 Gys) seguida de excisão total de mesorreto com ligadura dos vasos mesentéricos inferiores nas suas raízes. Foram incluídos pacientes com estadiamento T3, T4 e/ou N+ que distavam até 10cm da borda anal e T2N0 que distavam até 7 cm da borda anal. Foram excluídos pacientes cujo tratamento com quimiorradioterapia neoadjuvante foi incompleto, ou que tiveram atrasos significativos para re-estadiamento e/ou realização da cirurgia. Todos foram estadiados através de toque retal, colonoscopia, TC de tórax e de abdome, e RM de pelve e igualmente re-estadiados 8 semanas após o término da neoadjuvância, operados e submetidos a excisão total do mesorreto. Os pacientes foram divididos em 2 grupos: A) menos de 12 LN, e B) 12 ou mais LN. Foram estudadas as possíveis variáveis relacionadas ao número de LN obtidos: sexo, idade, presença de LN acometidos, tamanho do tumor, localização da altura do tumor no reto, comprimento da peça, preservação esfincteriana, via de acesso, estadiamento inicial, grau de resposta tumoral e resposta patológica à quimiorrradioterapia neoadjuvante. Resultados: Noventa e cinco pacientes (60 masculinos) preencheram os critérios de inclusão e conseguiram ser tratados, re-estadiados e operados dentro das datas pré-estabelecidas. A média de LN ressecados foi 23,2 (3-67). Resposta patológica completa foi obtida em 18 pacientes (19%). Um mínimo de 12 LN foram obtidos em 81 pacientes (85%). Dentre os 14 doentes que obtiveram menos de 12 LN, 7 (50%) eram respostas patológicas completas. De todas as variáveis estudadas apenas resposta patológica completa na peça foi fator associado à não obtenção do número mínimo de 12 LN (p=0,002). Conclusões: Em pacientes submetidos à QRN e ETM, a resposta patológica completa foi o único fator associado a não obtenção de um mínimo de 12 de LN na peça / INTRODUCTION: According to the International Union against Cancer a minimum of 12 lymph nodes (LN) must be obtained from the surgical specimen for staging colorrectal cancer. However, recent studies reported that neoadjuvant chemoradiation may result in failure to obtain a minimum number of LN in 30-52 % of patients. OBJECTIVE: To identify factors associated with decreased number of LN resected in patients undergoing neoadjuvant therapy followed by total mesorectal excision (TEM). METHODS: From January/2012 to March/2013, 160 patients with rectal cancer underwent CRT (5 - FU and Gys 5040) followed by TEM and ligation of inferior mesenteric vessels in the roots. Patients with stage T3, T4 and/or N + within 10cm from anal verge were included. Patients with T2N0 located within 7cm from the anal verge were also included. Patients who were not able to complete the chemoradiation treatment or who presented significant delay on restaging and/or surgery were excluded from analyses. All patients were staged by digital rectal examination, colonoscopy, CT of the abdomen and chest, and MRI of the pelvis. Patients were re-staged 8 weeks after completion of neoadjuvant therapy, and submitted to total mesorectal excision right after that. Patients were stratified according to LN retrieval in two groups: A) less than 12 LN, B) 12 or more LN. Possible factors associated with the decreased number of LN were evaluated: gender, age, presence of metastatic LN, tumor size, tumor location, and length of the specimen, sphincter preservation, surgical access, initial staging, tumor regression grade and pathological response to chemoradiation. RESULTS: Ninety-five patients (60 male) met the inclusion criteria and were able to be treated, re-staged and operated within the pre-established intervals. The mean number of resected LN was 23.2 (3-67). Pathological complete response was achieved in 18 patients (19%). A minimum of 12 LN were obtained from 81 patients (85%). Half of the 14 patients with less than 12 LN presented pathologic complete response. Of all the variables studied only pathologic complete response was associated with less than 12 LN yield (p = 0.002). CONCLUSIONS: In patients submitted to chemoradiation followed by TME the complete pathological response was the only factor associated with failure to obtain a minimum of 12 LN in the specimen

Background: In an aging society, the incidence and relevance of rectal cancer as one of the most frequent gastrointestinal cancers gains in importance. Excellent surgery and up-to-date multimodal treatments are essential for adequate oncological results and good quality of life. Summary: In this review, we describe modern developments in rectal cancer surgery and its embedment in modern multimodal therapy concepts. Key Message: Distinguished interdisciplinary cooperation combined with an outstanding surgical expertise is the basic requirement for an optimal treatment of rectal cancer. Thus, high standards of oncological outcome and patient’s quality of life can be achieved. Due to its localization within the rectum, rectal cancers are divided into tumors of the lower (0–6 cm), middle (6–12 cm), and upper (12–16 cm) third, assessed by rigid rectoscopy measured from the anal verge to the lower tumor margin. This classification is essential for the surgical strategy [2].

No description available.

Perineural spread of pelvic tumors mechanism and diagnosis Abstract Neoplastic lumbosacral plexopathies are infrequent affections of the lumbosacral plexus. Cases with minimal or non-specific finding on imaging can be particularly puzzling to diagnose. We describe a series of patients with perineural spread from the site of the primary tumor along the visceral autonomous nerves to the lumbosacral plexus and further proximally to the spinal nerves and even intradurally and also distally to the sciatic nerve. On series of 17 patients diagnosed with perineural spread of pelvic malignancy we describe characteristic clinical presentation and imaging finding. In many of these cases a tissue biopsy is necessary to finalize the diagnosis. We describe operative technique of targeted fascicular biopsy of the sciatic nerve and our experience with this procedure. On series of 117 patients, we report the outcome and complication: diagnostic yield was 84.8% and complication rate was 2.7 %. If a tissue sample is needed to conclude the diagnosis, targeted fascicular biopsy does increase the yield at an acceptable complication rate. Perineural spread of pelvic cancer is a new clinical-pathological entity with an unknown natural history or ideal treatment strategy. Based on the imaging finding in this group we present a...

Personalized treatment strategies for oncological patient management can improve outcomes of patient populations with heterogeneous treatment response. The implementation of such a concept requires the identification of biomarkers that can precisely predict treatment outcome. In the context of this thesis, we develop and validate biomarkers from multimodal imaging data for the outcome prediction after treatment in patients with locally advanced rectal cancer (LARC) and in patients with newly diagnosed glioblastoma multiforme (GBM), using conventional feature-based radiomics and deep-learning (DL) based radiomics. For LARC patients, we identify promising radiomics signatures combining computed tomography (CT) and T2-weighted (T2-w) magnetic resonance imaging (MRI) with clinical parameters to predict tumour response to neoadjuvant chemoradiotherapy (nCRT). Further, the analyses of externally available radiomics models for LARC reveal a lack of reproducibility and the need for standardization of the radiomics process. For patients with GBM, we use postoperative [11C] methionine positron emission tomography (MET-PET) and gadolinium-enhanced T1-w MRI for the detection of the residual tumour status and to prognosticate time-to-recurrence (TTR) and overall survival (OS). We show that DL models built on MET-PET have an improved diagnostic and prognostic value as compared to MRI.

Background: Early efficacy outcome measures in rectal cancer after total neoadjuvant treatment are increasingly investigated. We examined the prognostic role of pathological complete response (pCR), tumor regression grading (TRG) and neoadjuvant rectal (NAR) score for disease-free survival (DFS) in patients with rectal carcinoma treated within the CAO/ARO/AIO-12 randomized phase 2 trial. Methods: Distribution of pCR, TRG and NAR score was analyzed using the Pearson’s chi-squared test. Univariable analyses were performed using the log-rank test, stratified by treatment arm. Discrimination ability of non-pCR for DFS was assessed by analyzing the ROC curve as a function of time. Results: Of the 311 patients enrolled, 306 patients were evaluable (Arm A:156, ArmB:150). After a median follow-up of 43 months, the 3-year DFS was 73% in both groups (HR, 0.95, 95% CI, 0.63–1.45, p = 0.82). pCR tended to be higher in Arm B (17% vs. 25%, p = 0.086). In both treatment arms, pCR, TRG and NAR were significant prognostic factors for DFS, whereas survival in subgroups defined by pCR, TRG or NAR did not significantly differ between the treatment arms. The discrimination ability of non-pCR for DFS remained constant over time (C-Index 0.58) but was slightly better in Arm B (0.61 vs. 0.56). Conclusion: Although pCR, TRG and NAR were strong prognostic factors for DFS in the CAO/ARO/AIO-12 trial, their value in selecting one TNT approach over another could not be confirmed. Hence, the conclusion of a long-term survival benefit of one treatment arm based on early surrogate endpoints should be stated with caution.

<p>Focus of Thesis This thesis focuses on the initial stages of developing the Ontario Decision Aid in Rectal Cancer for Stage II and III patients (ODARC). The ODARC is a DA meant to facilitate relevant information exchange among physicians and patients. Such a tool should enhance patient knowledge and accuracy of treatment expectations by effectively conveying to patients relevant information on treatment options and associated benefits and risks. The ODARC is designed for use during a physician-patient consultation. The ODARC prototype development was guided by a workbook on developing & evaluating patient DAs published by O’Connor & Jacobsen (for efficiency we will call this the Workbook).24 This latter document provides detailed instructions for a 7-step DA development process including: 1) assess patient and provider need 2) assess DA feasibility 3) define objectives of the DA 4) identify the framework to guide DA development 5) select tailored methods of decision support to be used in the DA 6) select the designs and measures to evaluate the aid and, 7) plan dissemination.24 In this thesis we have created a prototype ODARC as informed by Steps 1 to 5 of the Workbook. The last two steps covering evaluation and dissemination are beyond the scope and available resources of this current research effort, and can be considered as future research endeavours. This will be reviewed in the final chapter.</p> / Master of Science (MSc)

Si les connaissances anatomiques supportent l’élaboration des techniqueschirurgicales, peu d’informations étaient disponibles sur l’anatomie et la physiologie del’innervation pelvi-périnéale. La détermination précise de l’origine, du trajet péri-viscéral, desrapports anatomiques avec les organes et les vaisseaux de voisinage et de la terminaison deces nerfs au niveau d’organes dont ils commandent la fonction était jusqu’alors peu accessibleaux techniques anatomiques classiques de dissection macroscopique sur sujet cadavérique.Dans le domaine de la chirurgie pelvienne pour cancer, l’amélioration de la qualité de vie desmalades passe par la préservation de ces structures nerveuses, la dimension fonctionnelle étantdésormais indissociable des impératifs carcinologiques. En effet, l’intégrité de ces nerfs estindispensable aux fonctions de continence sphinctérienne et de sexualité. Par ailleurs, lamajorité des travaux s’intéressant aux séquelles fonctionnelles postopératoires sont réaliséschez l’homme et très peu de travaux concernent exclusivement les femmes dont les troublessexuels sont plus difficiles à identifier. La réduction de ces troubles fonctionnelspostopératoires passe donc par une meilleure compréhension de l’anatomie nerveuse pelvipérinéale,qui peut être éclaircie par de nouvelles techniques d’étude / Anatomical knowledge is required for the development of surgical techniques,but little is known about the anatomy and physiology of innervation in the pelvic/perinealarea. The origin, perivisceral trajectory, anatomical relationships to organs and neighbouringvessels and of the endings of these nerves in the organs they control has not, to date, beeneasy to determine precisely by classical anatomical techniques based on the macroscopicdissection of cadavers. In the domain of pelvic cancer surgery, improvements in the quality oflife of patients are dependent on the preservation of these nervous system structures; themaintenance of function cannot be dissociated from oncological imperatives. Indeed, theintegrity of these nerves is essential for sphincter continence and sexual functions. Moststudies have focused on the functional sequelae of surgery in men. Very few studies havefocused exclusively on women, in whom sexual problems are more difficult to identify. Thereduction of such postsurgical functional problems thus requires a more completeunderstanding of the anatomy of the pelvic/perineal nervous system. This may be possiblethrough the use of new investigative techniques