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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
11

Modelo suino de aneurisma de aorta abdominal com bolsa de pericárdio bovino / The aortic pericardium sac: new model of abdominal aortic aneurysm in pigs

Perini, Sílvio César January 2008 (has links)
Introdução: A correção do aneurisma pela técnica endovascular ganha mais espaço com o aprimoramento do material utilizado, buscando-se um sistema ideal. Os estudos com esses dispositivos necessitam de modelos experimentais que devem apresentar características anatômicas e fisiopatológicas similares aos aneurismas em humanos. Apresentamos um novo modelo com bolsa de pericárdio bovino em suínos, com abordagem cirúrgica por via retroperitonial. Materiais e métodos: Estudo prospectivo, de coorte, avaliado pelo comitê de bioética, utilizando 11 suínos de raça Large White e do sexo feminino, com idade de 12 semanas, dividido em duas fases. A fase I consistiu na confecção do aneurisma, abordando a aorta retroperitonial com anestesia geral; na fase II, após 15 dias, realizou-se a arteriografia, eutanásia e retirada da peça para estudo anatomopatológico. Resultados: Em todos os animais, observou-se formação de trombos murais, como ocorre em aneurismas verdadeiros que comprometem de 30 a 90% da luz. À microscopia foram observadas calcificações na região do trombo em 82% dos animais. Havia infiltrado linfoplasmocitário no enxerto e região perienxerto, com fibrose em nove animais. Em três suínos havia espessamento miointimal considerável, e em oito, microcalcificações. A mortalidade foi nula, sem complicações cirúrgicas locais, isquêmicas e de ruptura. Conclusão: O modelo corresponde ao objetivo inicial de manter a aorta, seus ramos colaterais e terminais pérvios, com achados estruturais semelhantes aos de aneurismas encontrados em humanos: reação inflamatória parietal, periadvencial, trombo e calcificações da parede. As técnicas anestésica e operatória desenvolvidas foram satisfatórias e de morbimortalidade nula no período avaliado. / Background: The correction of an aneurysm using endovascular techniques has gained importance with the improvement of materials. The study of endovascular prostheses requires experimental models that reproduce anatomic and physiopathologic characteristics of human aneurysms. This study describes a new swine model that used bovine pericardium and a retroperitoneal surgical approach. Material and methods: This prospective cohort study used eleven Large White female pigs with a mean age of 12 weeks in the two study phases. In phase I, the aneurysm was produced and surgery using a retroperitoneal approach to the aorta under general anesthesia was performed; and in phase II, 15 days later, the animals underwent arteriography and were later killed, and specimens were removed for histological analysis Results: The formation of parietal thrombus, which is also found in true aneurysms that involve 30 to 90% of the lumen, was observed in all animals. Microscopic analysis showed calcifications in the area of thrombus in 82% of the animals. There was lymphoplasmocytic infiltration in the graft and adjacent area, with fibrosis in nine animals. Three pigs had substantial myointimal thickening, and eight had microcalcifications. Mortality was zero, and there were no ruptures, ischemia or surgery site. Conclusion: The aorta and its collateral and terminal branches remained healthy, and structural findings were similar to those observed in human aneurysms: wall inflammation, periadventitial thrombus and wall calcification. The anesthetic and operatory techniques were satisfactory, and there was no morbidity or mortality during the study.
12

Modelo suino de aneurisma de aorta abdominal com bolsa de pericárdio bovino / The aortic pericardium sac: new model of abdominal aortic aneurysm in pigs

Perini, Sílvio César January 2008 (has links)
Introdução: A correção do aneurisma pela técnica endovascular ganha mais espaço com o aprimoramento do material utilizado, buscando-se um sistema ideal. Os estudos com esses dispositivos necessitam de modelos experimentais que devem apresentar características anatômicas e fisiopatológicas similares aos aneurismas em humanos. Apresentamos um novo modelo com bolsa de pericárdio bovino em suínos, com abordagem cirúrgica por via retroperitonial. Materiais e métodos: Estudo prospectivo, de coorte, avaliado pelo comitê de bioética, utilizando 11 suínos de raça Large White e do sexo feminino, com idade de 12 semanas, dividido em duas fases. A fase I consistiu na confecção do aneurisma, abordando a aorta retroperitonial com anestesia geral; na fase II, após 15 dias, realizou-se a arteriografia, eutanásia e retirada da peça para estudo anatomopatológico. Resultados: Em todos os animais, observou-se formação de trombos murais, como ocorre em aneurismas verdadeiros que comprometem de 30 a 90% da luz. À microscopia foram observadas calcificações na região do trombo em 82% dos animais. Havia infiltrado linfoplasmocitário no enxerto e região perienxerto, com fibrose em nove animais. Em três suínos havia espessamento miointimal considerável, e em oito, microcalcificações. A mortalidade foi nula, sem complicações cirúrgicas locais, isquêmicas e de ruptura. Conclusão: O modelo corresponde ao objetivo inicial de manter a aorta, seus ramos colaterais e terminais pérvios, com achados estruturais semelhantes aos de aneurismas encontrados em humanos: reação inflamatória parietal, periadvencial, trombo e calcificações da parede. As técnicas anestésica e operatória desenvolvidas foram satisfatórias e de morbimortalidade nula no período avaliado. / Background: The correction of an aneurysm using endovascular techniques has gained importance with the improvement of materials. The study of endovascular prostheses requires experimental models that reproduce anatomic and physiopathologic characteristics of human aneurysms. This study describes a new swine model that used bovine pericardium and a retroperitoneal surgical approach. Material and methods: This prospective cohort study used eleven Large White female pigs with a mean age of 12 weeks in the two study phases. In phase I, the aneurysm was produced and surgery using a retroperitoneal approach to the aorta under general anesthesia was performed; and in phase II, 15 days later, the animals underwent arteriography and were later killed, and specimens were removed for histological analysis Results: The formation of parietal thrombus, which is also found in true aneurysms that involve 30 to 90% of the lumen, was observed in all animals. Microscopic analysis showed calcifications in the area of thrombus in 82% of the animals. There was lymphoplasmocytic infiltration in the graft and adjacent area, with fibrosis in nine animals. Three pigs had substantial myointimal thickening, and eight had microcalcifications. Mortality was zero, and there were no ruptures, ischemia or surgery site. Conclusion: The aorta and its collateral and terminal branches remained healthy, and structural findings were similar to those observed in human aneurysms: wall inflammation, periadventitial thrombus and wall calcification. The anesthetic and operatory techniques were satisfactory, and there was no morbidity or mortality during the study.
13

Modelo suino de aneurisma de aorta abdominal com bolsa de pericárdio bovino / The aortic pericardium sac: new model of abdominal aortic aneurysm in pigs

Perini, Sílvio César January 2008 (has links)
Introdução: A correção do aneurisma pela técnica endovascular ganha mais espaço com o aprimoramento do material utilizado, buscando-se um sistema ideal. Os estudos com esses dispositivos necessitam de modelos experimentais que devem apresentar características anatômicas e fisiopatológicas similares aos aneurismas em humanos. Apresentamos um novo modelo com bolsa de pericárdio bovino em suínos, com abordagem cirúrgica por via retroperitonial. Materiais e métodos: Estudo prospectivo, de coorte, avaliado pelo comitê de bioética, utilizando 11 suínos de raça Large White e do sexo feminino, com idade de 12 semanas, dividido em duas fases. A fase I consistiu na confecção do aneurisma, abordando a aorta retroperitonial com anestesia geral; na fase II, após 15 dias, realizou-se a arteriografia, eutanásia e retirada da peça para estudo anatomopatológico. Resultados: Em todos os animais, observou-se formação de trombos murais, como ocorre em aneurismas verdadeiros que comprometem de 30 a 90% da luz. À microscopia foram observadas calcificações na região do trombo em 82% dos animais. Havia infiltrado linfoplasmocitário no enxerto e região perienxerto, com fibrose em nove animais. Em três suínos havia espessamento miointimal considerável, e em oito, microcalcificações. A mortalidade foi nula, sem complicações cirúrgicas locais, isquêmicas e de ruptura. Conclusão: O modelo corresponde ao objetivo inicial de manter a aorta, seus ramos colaterais e terminais pérvios, com achados estruturais semelhantes aos de aneurismas encontrados em humanos: reação inflamatória parietal, periadvencial, trombo e calcificações da parede. As técnicas anestésica e operatória desenvolvidas foram satisfatórias e de morbimortalidade nula no período avaliado. / Background: The correction of an aneurysm using endovascular techniques has gained importance with the improvement of materials. The study of endovascular prostheses requires experimental models that reproduce anatomic and physiopathologic characteristics of human aneurysms. This study describes a new swine model that used bovine pericardium and a retroperitoneal surgical approach. Material and methods: This prospective cohort study used eleven Large White female pigs with a mean age of 12 weeks in the two study phases. In phase I, the aneurysm was produced and surgery using a retroperitoneal approach to the aorta under general anesthesia was performed; and in phase II, 15 days later, the animals underwent arteriography and were later killed, and specimens were removed for histological analysis Results: The formation of parietal thrombus, which is also found in true aneurysms that involve 30 to 90% of the lumen, was observed in all animals. Microscopic analysis showed calcifications in the area of thrombus in 82% of the animals. There was lymphoplasmocytic infiltration in the graft and adjacent area, with fibrosis in nine animals. Three pigs had substantial myointimal thickening, and eight had microcalcifications. Mortality was zero, and there were no ruptures, ischemia or surgery site. Conclusion: The aorta and its collateral and terminal branches remained healthy, and structural findings were similar to those observed in human aneurysms: wall inflammation, periadventitial thrombus and wall calcification. The anesthetic and operatory techniques were satisfactory, and there was no morbidity or mortality during the study.
14

O volume celular do adipócito contribui para a heterogeneidade funcional do tecido adiposo branco / The adipocyte size contributes to the functional heterogeneity of white adipose tissue

Natalie Carolina de Castro 29 April 2010 (has links)
O tecido adiposo já foi considerado um tecido metabolicamente pouco ativo, no entanto, os mais recentes avanços mostram que ele desempenha uma função importante no controle da homeostase energética. Baseado neste conceito, este trabalho objetivou caracterizar o perfil morfológico e metabólico de adipócitos isolados de três diferentes coxins adiposos, subcutâneo, peri-epididimal, retro-peritoneal (SC, PE e RP respectivamente). Os adipócitos dos diferentes coxins foram coletados e submetidos a análise morfológica, aos ensaios metabólicos e análise da expressão de enzimas envolvidas no metabolismo lipídico e glicídico. Os resultados mostraram diferença estatisticamente significativa no volume dos adipócitos das três regiões entre si (p<0,05), maior capacidade lipogênica dos adipócitos RP. Paralelamente, o tecido SC, mostrou maior expressão de enzimas envolvidas na via lipogênica (p< 0,05; SC vs PE e RP). / The adipose tissue was considered to be a little active metabolic tissue, however, the most recent advances show that it plays an important function in the control of the energy homostasis. Based on this concept, this work aimed to characterize the morphology and metabolism of isolated adipocytes of three different depots, like: subcutaneous, periepididymal, retroperitoneal (SC, PE and RP) . The adipocytes of the different depots had been collected and submitted to morphologic analysis, metabolic assays and to analysis of the enzymes expressions involved on lipids and glucose metabolism. The results showed statistical significant difference on volume of the adipocytes among the three different depots (p< 0, 05), high lipogenic capacity of RP adipocytes and higher expression of proteins involved in lipogenic patways of SC adipocytes (p<0, 05).
15

Contribution to the physiopathology, symptomatology and treatment of deep infiltrating endometriosis

Anaf, Vincent 15 December 2004 (has links)
L’endométriose est définie comme la présence de tissu endométrial et de stroma en dehors de la cavité utérine. Ses localisations les plus fréquentes sont le péritoine pelvien et les ovaires. L’endométriose infiltrante est classiquement décrite comme la présence de tissu endométriotique plus de cinq millimètres sous le péritoine pelvien ou la séreuse d’un organe. Histologiquement il s’agit d’une lésion endométriotique mais qui contrairement aux lésions ovariennes ou péritonéales contient significativement plus de muscle lisse et de fibrose et est davantage associée à la douleur. Les lésions infiltrantes peuvent être responsables de dysménorrhée, dyspareunie profonde et douleurs pelviennes chroniques sévères ayant un charactère hyperalgique tel qu’on peut le retrouver dans les douleurs neuropathiques. Ces douleurs nécessitent souvent la prise de quantités importantes d’antalgiques et ont des répercussions importantes sur la vie professionnelle, quotidienne et sexuelle des femmes atteintes. L’endométriose infiltrante présente un rapport histologique étroit avec les structures nerveuses du rétropéritoine ou les nerfs des organes atteints. Dans sa localisation rectovaginale il existe une relation histologique étroite entre les lésions d’endométriose et les nerfs ainsi qu’une correlation entre l’intensité de la douleur et le nombre de structures nerveuses envahies par l’endometriose ou engaînées dans la fibrose. Ces lésions infiltrantes expriment le «nerve growth factor» (NGF), une neurotrophine qui joue un rôle clé dans la genèse de l’hyperalgie et de la douleur. Les structures nerveuses du rétropéritoine pelvien expriment quant à elles le récepteur spécifique pour la neurotrophine NGF. Le système «NGF-récepteur spécifique» peut être responsable d’un chimiotactisme tissulaire entre les tissus sécrétant du NGF et les nerfs qui expriment le récepteur pour le NGF. Le système «NGF- récepteur spécifique» au sein de la relation endométriose-nerfs pourrait rendre compte du caractère hyperalgique des lésions endométriotiques infiltrantes ainsi, qu’expliquer pourquoi les lésions nodulaires n’apparaissent que dans les sites anatomiques richement innervés (ligaments utérosacrés, lame rectovaginale, paroi du rectum ou du côlon…) et pas ailleurs. Le traitement de première intention est chirurgical. Il convient d’être suffisamment agressif sur les lésions tout en engendrant le moins de séquelles postopératoires possibles sachant que nombre de ces femmes sont stériles. En cas d’atteinte digestive basse, les modalités de l’intervention sont dictées par l’extension et le degré d’infiltration de la paroi digestive. Dans le but de réaliser dans la majorité des cas une chirurgie minimalement invasive (laparoscopique) avec des cicatrices de petites tailles, nous avons développé une stratégie de traitement basée sur le degré d’infiltration de la paroi digestive. Dans ce cadre nous avons développé une technique laparo-assistée de résection colique segmentaire et de résection antérieure du rectum. / Doctorat en sciences médicales / info:eu-repo/semantics/nonPublished
16

Les voies nerveuses périphériques autonomes et somatiques lien avec les dysfonctions génito-urinaires / Autonomic and Somatic Peripheral Nervous Pathways Link with Genitourinary Dysfunction

Zaitouna, Mazen 07 December 2017 (has links)
Introduction: Parmi les structures anatomiques impliquées dans les fonctions génitales et urinaires, l’innervation autonome et somatique du rétro-péritoine, du pelvis et du périnée a un rôle contrôle déterminant. Cette innervation reste incomplètement systématisée et elle apparaît vulnérable lors d’interventions chirurgicales ou au cours de maladies neurologiques. Classiquement, deux voies nerveuses se situent de part et d’autre du muscle élévateur de l’anus (MEA) : la voie autonome est supra-lévatorienne ; la voie somatique est infra-lévatorienne. Les nerfs autonomes viennent du plexus hypogastrique supérieur (PHS) (fibres sympathiques) qui se divise en deux nerfs hypogastriques (NHs) s’engageant dans le pelvis. Les NHs reçoivent des nerfs splanchniques pelviens (fibres parasympathiques) qui forment le plexus hypogastrique inférieur (PHI). Les voies somatiques proviennent des nerfs pudendaux. Ces notions établies par la dissection conventionnelle peuvent aujourd’hui être complétées par l’analyse de marqueurs nerveux en Dissection Anatomique Assisté par Ordinateur (DAAO). Celle-ci est susceptible de préciser les connaissances anatomiques et d’éclairer la compréhension des dysfonctions génito-urinaires.Objectifs: L’objectif était de décrire le système nerveux autonome rétro-péritonéal et pelvi-périnéal dans ses aspects morphologiques (origine, topographie, trajet, rapports) et fonctionnels (nature des fibres, terminaisons viscérales) pour mettre en perspective les implications potentielles dans les dysfonctions génito-urinaires.Matériel et méthodes: Des coupes histologiques sériées de 5 µm d’épaisseur ont été effectuées dans les régions lombaire et pelvienne de onze fœtus humains âgés de 14 à 31 semaines de gestation, et au niveau pénien chez cinq sujets anatomiques adultes masculins. Pour chaque niveau de coupe, des lames ont été colorées puis traitées en immunohistochimie pour détecter : l’ensemble des fibres nerveuses (anticorps anti-protéine S100), les fibres nerveuses somatiques (anti-PMP 22), les fibres autonomes adrénergiques (anti-TH), les fibres autonomes cholinergiques (anti-VAChT), les fibres autonomes nitrergiques (anti-nNOS), et les fibres musculaires lisses (anti-actine lisse). Les coupes ont ensuite été numérisées par un scanner de haute résolution optique et les images ont été reconstruites en 3D avec le logiciel Winsurf®.Résultats: Au niveau rétro-péritonéal, le PHS est formé de fibres adrénergiques, cholinergiques et nitrergiques. Ses fibres proviennent à la fois du plexus mésentérique inférieur, des ganglions sympathiques voisins et des nerfs splanchniques lombaires. Au niveau pelvien, le PHI se systématise en : une portion supérieure recevant ses fibres du PHS et innervant détrusor, uretères et vésicales séminales ; une portion inférieure recevant ses fibres des nerfs splanchniques pelviens et innervant trigone, prostate et corps érectiles. La jonction uretéro-vésicale est une zone richement innervée par des fibres adrénergiques, cholinergiques et nitrergiques provenant du PHI et des NHs. En outre, le PHI fournit un contingent nerveux autonome au MEA par voie supra-lévatorienne, tandis que le nerf pudendal (NP) lui fournit un contingent somatique par voie infra-lévatorienne. Au niveau pénien, la composante autonome prédomine dans les 2 tiers proximaux quand, en distalité, l’innervation est presque exclusivement somatique. Trois niveaux de communication entre les voies autonome et somatique ont été observés : pré- trans- et post-lévatorien.Conclusion: L’intrication des voies autonomes et somatiques rétropéritonéo-pelvi-périnéales, la diversité de leurs origines, leurs communications et répartition depuis les plexus jusqu’aux viscères s’établissent par DAAO. Ces voies méritent d’être au mieux préservées au cours d’interventions chirurgicales ou instrumentales. Elles représentent de potentielles voies de modulation, de plasticité ou de régénération à explorer. / Introduction: The autonomous and somatic innervations of the retro-peritoneum, the pelvis and the perineum have a determining control role among the anatomical structures involved in the genital and urinary functions. The innervations remain incompletely systematized and appear vulnerable during surgical procedures or during neurological diseases. Normally, two nerve pathways are located on both side of levator ani muscle (LAM): the autonomic pathway is supra-levatorian and the somatic pathway is infra-Levatorian. The autonomic nerves come from the superior hypogastric plexus (SHP) (sympathetic fibers) which divides into two hypogastric nerves (HNs) engaging in the pelvis. The HNs receive pelvic splanchnic nerves (parasympathetic fibers) which form the inferior hypogastric plexus (IHP). The somatic pathways come from the pudendal nerves. These notions which are established by conventional dissection can now be supplemented by the analysis of nerve markers in computer-assisted anatomic dissection (CAAD). This is likely to clarify anatomical knowledge and illuminate the understanding of genitourinary dysfunction.Objectives: The objective of this study was to describe the retro peritoneal and pelvic -perineal autonomic nervous system, its morphological (origin, topography, path and relationships) and functional (nature of fibers, visceral endings) aspects and to put into perspective the potential implications on genitourinary dysfunction.Materials and methods: Serial histological sections of 5 μm of thickness were performed in the lumbar and pelvic regions of eleven human fetuses aged 14 to 31 weeks of gestation and at the penile level in five male adult anatomical subjects. For each level, slides were stained and then treated in immunohistochemistry to detect: general nerve fibers (anti-protein S100), somatic nerve fibers (anti-peripheral myelin protein 22), autonomic adrenergic fibers (anti-tyrosine hydroxylase), autonomic cholinergic fibers (anti-VAChT), autonomic nitrergic fibers (anti-nNOS), and smooth muscle fibers (anti-actin). The slides were then digitized by a high-resolution optical scanner and the images were reconstructed in 3D using the Winsurf® software.Results: At the retroperitoneal level, the SHP is composed of adrenergic, cholinergic and nitrergic fibers. Its fibers come from inferior mesenteric plexus, the adjacent ganglions and the lumbar splanchnic nerves. At the pelvic level, the IHP is systematized into: a superior portion receiving its fibers of the SHP and innervating detrusor, ureters and seminal vesicles, a inferior portion receiving its fibers from the pelvic splanchnic nerves and innervating trigone of bladder, prostate and erectile bodies. The ureterovesical junction is an area richly innervated by adrenergic, cholinergic and nitrergic fibers from the IHP and the HNs. In addition, the IHP provides an autonomic nervous to the LAM via the supra-levatorian route, while the pudendal nerve provides a infra-levatorian somatic nervous. At the penile level, the autonomic component predominately innervates in the proximal two thirds where, in distal third, the innervation is almost exclusively somatic. Three levels of communications between the autonomic and somatic pathways were observed: pre- trans- and post-levatorian.Conclusions: The interaction of the autonomic and somatic retroperitoneo-pelvic-perineal pathways, the diversity of their origins, their communications and distribution from the plexus to the viscera are established by CAAD. These pathways deserve to be best preserved during surgical or instrumental procedures. They represent potential pathways of modulation, plasticity or regeneration to be explored in future studies.

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