Bakgrund: Normaltryckshydrocefalus (NPH) är ett neurologiskt tillstånd som innefattar psykiska funktionsnedsättningar, demenssymtom, inkontinens samt problem med gång. Behandlingen för detta är via shuntoperation. Gångförmågan undersöks via gångtester innan och efter ett tapptest, som sedan ligger till grund för att diagnos ska kunna ställas.   Syfte: Syftet med arbetet var att undersöka gångförmågan hos patienter med NPH genom att jämföra gångtesters resultat mätt i sekunder innan tapptest och shuntoperation med resultat efter shuntoperation, samt jämföra skillnader mellan män och kvinnor.    Metod: För studien valdes en kvantitativ metod med en deskriptiv komparativ design. Data som bearbetats i den aktuella studien kommer från ett pågående forskningsprojekt på ett universitetssjukhus där det samlats in resultat av tre gångtester innan shuntoperation och tre månader efter. Totalt var det 161 patienter med NPH i forskningsstudien varav 129 inkluderades i den aktuella studien. Av dessa var 65 stycken män och 64 stycken kvinnor. Gångtesterna som jämförs är Timed up and go (TUG), 10 meter walk test (10 MWT) och 3 meter backwards walk (3 MBW).   Resultat: Resultatet visade på en signifikant förbättring i alla gångtester tre månader efter shuntoperation jämfört med innan operation, samt att det inte förelåg någon signifikant skillnad mellan män och kvinnor. TUG förbättrades med 5 sekunder, 10 MWT förbättrades med 4 sekunder samt att 3 MBW förbättrades med 4 sekunder.   Konklusion: Resultaten visar på att det sker en signifikant förbättring i gångtester för patienter med NPH som genomgått en shuntoperation. Vidare forskning krävs för att säkerställa att gångtesterna är relevanta för personer med NPH, samt för att uppnå ett standardiserat testbatteri som går att applicera över hela populationen. / Background: Normal pressure hydrocephalus (NPH) is a neurological condition that causes cognitive symptoms, dementia, incontinence and difficulties with walking. The treatment for this is shunt surgery. The ability to walk is examined with walking tests before and after a tap test, which then forms the basis for a diagnosis.   Purpose: The purpose of the study was to examine patients with NPH ability to walk through comparison of the results of walking tests measured in seconds before lumbar puncture test and shunt surgery with the results three months after shunt surgery, as well as comparing differences between men and women.   Method: A quantitative method with a descriptive and comparative design was chosen for this study. Data in the current study comes from an ongoing research project at a university hospital that has c ollected data of results of three walking tests before and three months after shunt surgery. In total data from 161 patients with NPH was collected of which 129 patients was included in the current study. Of these were 65 men and 64 women. The walking tests compared are Timed up and go (TUG), 10 meter walk test (10MWT) and 3 meter backwards walk (3MBW)  Results: The results showed a significant improvement in all walking tests before compared to three months after shunt surgery and that there was no significant difference between men and women. The results of TUG improved by 5 seconds, 10MWT by 4 seconds and 3MBW by 4 seconds.  Conclusion: The results show that there is a significant improvement in walking tests for patients with NPH who have undergone shunt surgery. Further research is required to ensure that the walking tests are relevant for people with NPH, as well as to achieve a standardized test battery that can be applied to the entire population.

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal. cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation.

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No. of bitstreams: 1 delianevileladeoliveira.pdf: 2301067 bytes, checksum: f01e829116b34f9daf190e8d706de303 (MD5) Previous issue date: 2013-07-11 / Resumo: Pesquisa quantiqualitativa cuja trajetória metodológica visou analisar as representações sociais da punção venosa entre indivíduos adultos que vivenciaram a experiência com o processo de punção de vasos periféricos. Adotou-se múltiplos métodos e técnicas. Na abordagem quantitativa foi realizado um survey e no delineamento qualitativo foram utilizadas entrevistas individuais com aplicação das técnicas de “recorte e colagem de gibi” e “evocação livre”. A aplicação destas técnicas visou captar as variáveis intervenientes sobre o processo de punção de vasos periféricos e subsidiar a identificação dos elementos e caracterizar a relevância da representação social sobre tal processo. Dados obtidos no período de outubro/2012 a fevereiro/2013, por meio de entrevistas individuais gravadas e registro cursivo em diário de campo, realizados numa instituição hospitalar (setor de internação convencional) e num serviço de terapia renal substitutiva. Amostra de seleção completa. Após a aplicação dos critérios de elegibilidade e exclusão, foram realizadas 365 abordagens de coleta de dados, tendo participado 235 pessoas na fase do survey, das quais 120 estavam internadas, 75 estavam em hemodiálise e 40 coletaram sangue. Houve abordagem individualizada do questionário com auxílio para preenchimento. Técnica de evocação aplicada a partir de entrevista com participação de 90 pessoas, sendo 30 delas internadas, em coleta de sangue ou em tratamento hemodialítico. Foram obtidas 444 palavras/expressões evocadas para cinco das solicitadas. Na aplicação da técnica de “recorte e colagem de gibi” e gravação do discurso explicativo participaram 60 pessoas, sendo 20 em cada situação abordada. Foi oferecido o mesmo material de figuras para os participantes desta etapa. Um mesmo participante integrou uma ou mais técnicas. Os dados do survey foram tratados em software Statistical Package for the Social Sciences (SPSS) versão 20 com análise descritiva. Os dados provenientes da evocação formaram o corpus, sendo consolidados no software EVOC versão 2000 com análise pela técnica do quadro de quatro casas. E os conteúdos obtidos pela técnica de recorte e colagem de gibi foram consolidados no software NVivo versão 10 e analisados segundo similitude de expressões. Todas as informações foram abordadas com padrões de anonimato, utilizando nomes de flores, pedras ou cores. Foram atendidos todos os requisitos éticos e legais de pesquisa envolvendo seres humanos. No perfil dos participantes da fase survey predominou a participação de mulheres na coleta de sangue e de homens internados ou em tratamento hemodialítico; com idade mais nova entre mulheres que coletavam sangue; predomínio de pele declarada como branca (40%), menos de nove anos de escolaridade (65%), união estável (55%) e filhos. Sendo o processo de punção de vasos um procedimento técnico/científico, os usuários, porém, se apropriam do mesmo de forma particular, havendo destaque de algumas etapas em detrimento de outras. Foi possível identificar as variáveis intervenientes (exposição às diferentes situações e ocasiões de ocorrência do processo de punção de vasos) comparando-as com as variáveis de desfecho, ou seja, com os sentimentos, percepções e comportamentos dos participantes diante do processo de punção de vasos sanguíneos. Houve modificação de percepções, de sentimentos e de comportamentos ao longo das etapas do processo de punção dos vasos. No período que antecedeu a introdução da agulha no interior do vaso houve predomínio de sentimentos de medo, desconforto, ansiedade, indiferença e normalidade e foram adotados comportamentos de silêncio, colaboração, normalidade e de "acostumado", embora xx acompanhados pelo nervosismo das pessoas que fizeram hemodiálise. O período de introdução da agulha foi vivenciado com sentimentos de dor e desconforto e comportamentos de colaboração, silêncio e nervosismo, com ocasional desvio do olhar para não acompanhar o procedimento técnico realizado. Manter a agulha no interior do vaso gerou predomínio de sentimentos de limitação de movimento e desconforto quando o período foi prolongado e houve comportamento de colaboração. O sentimento de alívio e a sensação de ardência foram aqueles que predominantemente emergiram por ocasião da remoção do cateter do interior do vaso e os participantes mencionaram adotar comportamentos de colaboração e de indiferença frente à remoção. No período pós-remoção predominaram os sentimentos de indiferença, alívio, normalidade e nada e comportamentos de silêncio e colaboração, caracterizando a não percepção deste momento como uma etapa do processo, exceção feita às pessoas que realizaram hemodiálise. Os resultados evidenciaram que a estrutura das representações sociais do processo de punção de vasos foi composta pelos elementos centrais de dor e medo. Como elementos periféricos apareceram a insegurança, quem punciona, habilidade profissional, resultado, repuncionar e sangrar, configurando uma abordagem negativa ou neutra expressa em diferentes situações de punções que se apoiaram em experiências, informações, julgamento de valores, concepção de sua finalidade e percepção sensorial, o que foi reafirmado pela técnica de recorte e colagem. Captar as representações sociais através dos sentimentos e comportamentos, bem como, conhecimentos, valores e experiências das pessoas que possuem seus vasos puncionados para fins de coleta de sangue, terapêutica farmacológica ou hemodialítica durante o processo de punção possibilitou fazer uma releitura da punção de vasos. Enquanto atividade processual, evidenciaram-se demandas de cuidado para as quais o enfermeiro dispõe de oportunidades para imprimir ao cuidado orientações educacionais, ações terapêuticas e gerenciais e captar/utilizar evidências a partir da investigação. Foram caracterizadas respostas dos indivíduos para as quais o enfermeiro é capaz de minimizar sentimentos e comportamentos negativos e favorecer formas positivas de enfrentamento. Ao propor-se uma abordagem quantiqualitativa, utilizando múltiplos métodos e técnicas a partir de um recorte conceitual e metodológico, a presente investigação mostrou-se enriquecedora e criativa e trouxe como limite a não comparação entre os participantes enquanto grupos que possuem vivências peculiares no processo de punção de vasos sanguíneos. / Abstract: Quanti-qualitative research whose methodological route intended to analyze the social representations of venipuncture among adults who have experienced the peripheral vessels puncture. Multiple methods and techniques were adopted. During the quantitative approach a survey research was conducted, while in the qualitative approach individual interviews were taken, applying the techniques of "cutting and pasting of comics" and "free recall". The application of these techniques aimed to capture intervening variables on the process of puncturing peripheral vessels and support the identification of elements and characterize the relevance of the social representation of this process. Data obtained from October 2012 to February 2013 through individually recorded interviews and field diary, both conducted in a hospital (regular hospitalization area) and in a program of renal replacement therapy. Sample selection complete. After applying the eligibility and exclusion criteria, there were 365 approaches for data collection, 235 people participated in the phase of the survey, of whom 120 were hospitalized, 75 were on hemodialysis and 40 collected blood samples. There was individualized approach and help to fill the questionnaire. Evocation technique applied in the interviews, with participation of 90 people, 30 of them hospitalized for blood collection or hemodialysis. With the inductive term appointed (process of vessel puncture). We obtained 444 words/expressions evoked to five of the requested. In applying the technique of "cutting and pasting of comics" and recording the explanatory discourse 60 people participated, 20 in each situation addressed. The same comics were shown to the participants of this step. A participant joined one or more techniques. For the treatment of the survey data, with descriptive analysis, was used the Statistical Package for Social Sciences (SPSS) version 20. Evocation data formed the corpus, consolidated in EVOC 2000 version, and were analyzed through the fourhouse board technique. The contents obtained by the technique of cutting and pasting the comics were consolidated into NVivo software version 10 and analyzed according to similarity of expressions. All information has been addressed with patterns of anonymity, using names of flowers, stones or colors. We met all ethical and legal requirements for research involving humans. In the survey phase participants profile predominated the participation of women in blood sample collection and men hospitalized or undergoing hemodialysis, with younger age among women who collected blood; predominance of skin declared as white (40%), less than nine years of education (65%), marital stability (55%) and children. As the process of vessel puncture is a technical/scientific procedure, users, however, interpret it in a particular way, featuring some steps over others. It was possible to identify the intervening variables (exposure to different situations and times of occurrence of vessels puncture processes) compared with the outcome variables, i.e., the feelings, perceptions and behaviors of the participants before the process of puncturing blood vessels. There was a modification of perceptions, feelings and behaviors throughout the stages of the process of vessels puncturing. In the period preceding the introduction of the needle inside the vessel there was a predominance of feelings of fear, discomfort, anxiety, indifference and normality and behaviors of xxii silence, collaboration, normality and "being used to" were adopted, although accompanied by the nervousness of those people in hemodialysis. The length of the needle insertion was experienced with feelings of pain and discomfort and behaviors of collaboration, silence and nervousness, with occasional gaze deviation, not to follow the technical procedure performed. Maintaining the needle in the vessel predominantly generated feelings of limitation of movement and discomfort when the period was extended. There was also the behavior of collaboration. The feeling of relief and burning sensation were predominantly those who emerged during the removal of the catheter inside the vessel and the participants mentioned to adopt behaviors of collaboration and indifference to the removal. In the post-removal time predominated feelings of indifference, relief, normality and nothing and behaviors of silence and collaboration, showing the non-perception of this moment as a step of the process, except to people who underwent hemodialysis. The results showed that the structure of social representations of vessel puncture was composed by the central elements of pain and fear. The peripheral elements appeared insecurity, who punctures, professional skill, result, repuncturing and bleed, setting a neutral or negative approach expressed in different puncture situations that relied on experience, information, value judgment, conception of its purpose and sensory perception, what was reaffirmed by the technique of cutting and pasting. To capture the social representations through the feelings and behaviors, as well as knowledge, values, experiences of people own their vessels punctured for the purpose of blood collection, drug therapy or hemodialysis during puncture, allowed to reread the puncture of vessels. While a procedural activity, care demands showed up for which the nurse has opportunities to print educational guidelines, therapeutic and management actions and to capture/use evidences from the investigation. Answers of individuals were characterized for which the nurse is able to minimize negative feelings and behaviors and to encourage positive ways of coping. In proposing a quanti-qualitative approach, using multiple methods and techniques from a conceptual and methodological framework, this research proved to be enriching and creative and brought as its limitation the not comparison of the participants while groups that have peculiar experiences in the process of blood vessels puncturing.

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal. cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation.

Despite decades of research of normal pressure hydrocephalus (NPH), a clear pathophysiological mechanism of the disease is sill unknown. This results in the absence of a unambiguous diagnostic biomarker. Moreover, NPH in contrast to similar neurodegenerative diseases is curable by insertion of a ventrikulo-peritoneal shunt. Now the diagnostics is based on invasive functional testing, on the contrary, imaging methods play only a supporting role. This work is processed with an effort to find a sufficiently sensitive and specific biomarker of MRI imaging using advanced analytical methods. For this reason, the structural volumetry and the phase contrast method were tested. The individual partial results of both of these modalities have already been described in the literature, but the conclusions were controversial. The main contribution of this work is the range of tested parameters and their to date untested advanced analysis - accurate automatic segmentation in volumetric study and machine learning algorithms in phase contrast study. In a volumetric study, we segmented a total of 26 structures in 74 patients (29 with diagnosed NPH, 45 without NPH). In the case of preoperative examination, we demonstrated statistically significant differences in the size of the left hippocampus, corpus callosum, left...