No description available.

Aim of the study: The aim of this study was to measure the effects of a specific technique used when assisting vaginal delivery and intended to decrease anal sphincter ruptures. After measuring the effects, the direct costs of a rupture were calculated and finally the cost impact of the intervention was evaluated. Data and model: Data from deliveries before the intervention, from 2004, and after the intervention, from 2008, were used and a pre-test – post-test evaluation design was applied. The dependent variable was the presence or absence of a rupture and because the variable is binary a logit model was used. The independent variables consisted of twelve different factors considered to affect the number of ruptures. When only accounting for ruptures alone 123 of 2900 deliveries resulted in a sphincter ruptures which equals 4.24% of the total amount of deliveries. Results: When not controlling for any of the independent variables, the risk of getting a rupture decreased by 3.8 percentage points when using the method while assisting a delivery. On the other hand, when controlling for all of the independent variables and the use of the method, the risk of getting a rupture decreased by 2.5 percentage points, from 4.24% to 1.74%. Two different models were tested, one with the variable weeks and one without the same variable, due to the presence of correlation in the model. The total cost of ruptures for a year was calculated as $84,429,254 without the implementation of the method and $34,647,854 with the implementation. Total cost savings for society with the implementation of the method would then be $49,677,045. Conclusions: Implementation of the method is highly recommendable for both society and the women involved. Not only does the number of ruptures decrease due to the method but also the costs for society decreases dramatically.

No description available.

Thesis (Ph.D.) -- Flinders University, Dept. of General and Digestive Surgery, School of Medicine. / Typescript (bound). Includes bibliographical references (leaves 254 - 270). Also available online.

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline. / Bakgrund: Sfinkterskada är en allvarlig komplikation i samband med vaginal förlossning. Önskan om att undvika vaginal förlossning igen ses hos kvinnor som tidigare drabbats av sfinkterskada. Syfte: Syftet med studien var att ta reda på om det fanns riktlinjer gällande sfinkterskada i samband med förlossning vid Sveriges förlossningskliniker samt sammanställa och granska innehållet i riktlinjerna. Metod: Innehållsanalys med en kombination av deduktiv och induktiv ansats. Resultat: Av de 39 kliniker som svarade hade 31 riktlinjer gällande sfinkterskada. I riktlinjerna beskrevs vanligast förekommande riskfaktorer samt prevention med hjälp av perinealskydd. Läkaren ställde diagnos och utförde reparation av sfinkterskadan på operationsavdelningen. Komplikationer som samlagssmärta och anal inkontinens fanns beskrivet i riktlinjerna. Paracetamol och diklofenak var den vanligast förekommande smärtlindringen. Profylax som antibiotikabehandling och laxantia gavs av de flesta förlossningskliniker. Information till den nyförlösta kvinnan beskrevs. Uppföljning hos läkare, barnmorska och sjukgymnast rekommenderades efter fyra veckor till sex månader. Vid kommande graviditet och förlossning föredrogs kejsarsnitt. Slutsats: Riktlinjerna var uppbyggda på samma sätt och hade till stor del liknande innehåll. Författarna till föreliggande fördjupningsarbete efterfrågar en nationell riktlinje.

The sphincter of Oddi (SO) is a neuromuscular structure located at the junction of the bile and pancreatic ducts with the duodenum. The primary functions of the SO are to regulate the delivery of bile and pancreatic juice into the duodenum, and to prevent reflux of duodenal contents into the biliary and pancreatic systems. Neural, hormonal or functional disturbances of biliary motility can lead to painful and sometimes life threatening clinical conditions, such as SO dysfunction and acute pancreatitis. Clearly understanding the regulation of biliary and duodenal motility patterns is necessary and may provide useful pharmacological sites for drug development to aid in the treatment of these diseases. Spontaneous activity of the SO is regulated by complex interactions between the enteric nervous system, hormones, possibly interstitial cells of Cajal and other bioactive agents, together with modulation via neural reflexes between the duodenum, common bile duct/gallbladder, and stomach. Purines are one group of neurotransmitters/regulatory agents that have been shown to effect gastrointestinal motility, however their functions in the regulation of SO motility have not been elucidated. The studies described in this thesis used in vitro organ bath techniques and in vivo preparations to determine the effects of exogenous purines on possum SO and duodenal motility. The possum SO has been extensively characterized and is an excellent model for motility studies. In vitro, exogenous adenosine was found to decrease spontaneous activity in both the SO and duodenum. In contrast exogenous ATP induced both excitatory and inhibitory responses in the SO and duodenum. Interestingly, the adenosine and ATP-induced effects were predominantly exhibited by the proximal portion of the SO (proximal-SO), with no or little effect observed in the distal portion of the SO (distal-SO). These data support the hypothesis that the SO is comprised of different functional components that can act differently in response to certain stimuli, and highlights the importance of studying each of the SO components. Agonists and antagonists, together with immunohistochemical studies, were used in an attempt to identify the P1 and P2 receptor sub-types responsible for mediating the adenosine- and ATP-induced responses. In the duodenum the adenosine-induced decrease in spontaneous activity was likely to be mediated by A2A and A3 receptors, but the receptors mediating the proximal-SO response could not be identified. In the duodenum ATP induced a complex non-neural response consisting of a P2X1, and P2Y2 and/or P2Y4 mediated immediate inhibition. This was followed by a return to baseline activity or small excitation. The response concluded with a late inhibitory response, likely to be mediated by P2Y1 receptors, but the effects of other P2Y receptors could not be excluded. In contrast, ATP application to the proximal-SO evoked a partially neurally mediated early excitation, likely via P2X receptors, followed by an inhibition of activity, likely via activation of non-neural P2Y2 and/or P2Y4 receptors. In vivo studies with exogenous application of adenosine and ATP to the SO activated neural pathways to produce increased motor activity. Characterisation of these neural pathways found ATP and/or adenosine to activate excitatory cholinergic motor neurons. ATP also activated an inhibitory nicotinic/nitrergic pathway. This is the first comprehensive investigation of the possible involvement of purines in the regulation of SO motility. These studies demonstrate that exogenous purines influence SO and duodenal motility, inducing complex neural and non-neural responses, acting via multiple P1 and P2 receptors. It now remains to be determined if endogenously released purines induce similar responses, together with elucidation and location of the receptor sub-types involved.

Thesis (Ph. D.)--University of Nevada, Reno, 2002. / Includes bibliographical references. Online version available on the World Wide Web.

Orientador: Maria Aparecida Coelho de Arruda Henry / Resumo: Em 40 coelhos machos foram realizados estudos eletromanométricos do esôfago segundo a técnica de puxada intermitente da sonda e infusão contínua dos catéteres com água destilada. Estes estudos permitiram a análise de dois parâmetros: amplitude da pressão no EIE (mmHg) e comprimento do EIE em condições basais (momento 1). Neste momento foi também realizada avaliação do peso corpóreo dos animais. Os 40 animais foram divididos em quatro grupo de 10, na dependência do procedimento cirúrgico realizado: Grupo 1: Fundoplicatura total laparotômica Grupo2 : Laparotomia mediana e dissecção da transição gastroesofágica Grupo 3: Fundoplicatura total laparoscópica Grupo 4: Pneumoperitôneo e dissecção da transição gastroesofágica No momento 2 (uma semana após os procedimentos cirúrgicos) foram realizados estudos eletromanométricos do esôfago e avaliação ponderal em todos os animais. Nos animais do grupo 1 (fundoplicatura laparotômica) foi observado aumento da amplitude da pressão e do comprimento do EIE (p<0,05). Naqueles do grupo 2 não foi observada alteração da amplitude e do comprimento do EIE (p>0,05). Nos coelhos do grupo 3 houve aumento da amplitude da pressão e do comprimento do EIE (p<0,05). Nos animais do grupo 4 não foi observada alteração dos parâmetros acima citados (p>0,01). Com relação ao peso corpóreo, foi observada redução do mesmo (p<0,05) apenas nos coelhos submetidos a fundoplicatura laparotômica (Grupo 1). Nos demais animais (Grupos 2, 3 e 4) não houve qualquer alteração do peso corpóreo na avaliação realizada uma semana após os procedimentos cirúrgicos (momento 2) / Abstract: Electromanometric studies of the esophagus were registered in 40 male rabbits, through the pull through technique and continuous infusion of the catheters with distilled water. These exams allowed us to measure the pressure width (mmHg) and the length (cm) of the lower esophageal sphincter (LES) in basal conditions (moment 1). The 40 animals were divided into four groups of 10, according to surgical procedure: Group 1: open total fundoplication Group 2: Median laparotomy and dissection of the gastroesophageal junction Group 3: laparoscopic total fundoplication Group 4: pneumoperitonium and dissection of the gastroesophageal junction. In moment two (one week after surgery) electromanometric studies of the esophagus and weight evaluation were performed in every animals. In group 1 (open fundoplication) an increase of pressure width and of LES was observed (p<0,05). In group 2, the pressure width and length of LES didn't present any alteration (p>0,05). In group 3 an increase of pressure width and length of LES was observed (p<0,05). In group 4, the pressure width and length LES didn't present any alteration (p>0,05). In respect to the weight evaluation, a decrease was observed in rabbits submitted to open fundoplication (p<0,05). In other animals (groups 2, 3 and 4) the weight didn't present any alteration in evaluation performed one week after surgery (moment 2) / Mestre

Made available in DSpace on 2014-06-11T19:23:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T20:30:33Z : No. of bitstreams: 1 motta_dcp_me_botfm.pdf: 1151223 bytes, checksum: 1d7fefba88005a4773d3d06cae669504 (MD5) / Em 40 coelhos machos foram realizados estudos eletromanométricos do esôfago segundo a técnica de puxada intermitente da sonda e infusão contínua dos catéteres com água destilada. Estes estudos permitiram a análise de dois parâmetros: amplitude da pressão no EIE (mmHg) e comprimento do EIE em condições basais (momento 1). Neste momento foi também realizada avaliação do peso corpóreo dos animais. Os 40 animais foram divididos em quatro grupo de 10, na dependência do procedimento cirúrgico realizado: Grupo 1: Fundoplicatura total laparotômica Grupo2 : Laparotomia mediana e dissecção da transição gastroesofágica Grupo 3: Fundoplicatura total laparoscópica Grupo 4: Pneumoperitôneo e dissecção da transição gastroesofágica No momento 2 (uma semana após os procedimentos cirúrgicos) foram realizados estudos eletromanométricos do esôfago e avaliação ponderal em todos os animais. Nos animais do grupo 1 (fundoplicatura laparotômica) foi observado aumento da amplitude da pressão e do comprimento do EIE (p<0,05). Naqueles do grupo 2 não foi observada alteração da amplitude e do comprimento do EIE (p>0,05). Nos coelhos do grupo 3 houve aumento da amplitude da pressão e do comprimento do EIE (p<0,05). Nos animais do grupo 4 não foi observada alteração dos parâmetros acima citados (p>0,01). Com relação ao peso corpóreo, foi observada redução do mesmo (p<0,05) apenas nos coelhos submetidos a fundoplicatura laparotômica (Grupo 1). Nos demais animais (Grupos 2, 3 e 4) não houve qualquer alteração do peso corpóreo na avaliação realizada uma semana após os procedimentos cirúrgicos (momento 2) / Electromanometric studies of the esophagus were registered in 40 male rabbits, through the pull through technique and continuous infusion of the catheters with distilled water. These exams allowed us to measure the pressure width (mmHg) and the length (cm) of the lower esophageal sphincter (LES) in basal conditions (moment 1). The 40 animals were divided into four groups of 10, according to surgical procedure: Group 1: open total fundoplication Group 2: Median laparotomy and dissection of the gastroesophageal junction Group 3: laparoscopic total fundoplication Group 4: pneumoperitonium and dissection of the gastroesophageal junction. In moment two (one week after surgery) electromanometric studies of the esophagus and weight evaluation were performed in every animals. In group 1 (open fundoplication) an increase of pressure width and of LES was observed (p<0,05). In group 2, the pressure width and length of LES didn’t present any alteration (p>0,05). In group 3 an increase of pressure width and length of LES was observed (p<0,05). In group 4, the pressure width and length LES didn’t present any alteration (p>0,05). In respect to the weight evaluation, a decrease was observed in rabbits submitted to open fundoplication (p<0,05). In other animals (groups 2, 3 and 4) the weight didn’t present any alteration in evaluation performed one week after surgery (moment 2)

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20800号 / 医博第4300号 / 新制||医||1025(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 福原 俊一, 教授 福田 和彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM