Background: The use of stapling equipment for intestinal surgery in cats is rarely reported, and appropriate staple sizes for cat intestine are unknown. Objective: To determine staple cartridge sizes for thoracoabdominal (TA) and endoscopic gastrointestinal anastomosis (EndoGIA) that will simultaneously prevent leakage of small intestinal contents while also allowing for sufficient vascular permeability past the staple lines for intestinal healing. Methods: Two sizes of EndoGIA cartridges (2.0/2.5/3.0mm and 3.0/3.5/4.0mm) and two sizes of TA cartridges (2.5mm and 3.5mm), applied in a transverse manner across fresh cadaveric cat jejunum, were evaluated via intestinal burst pressure testing for maximum intraluminal pressure prior to leaking, and via infusion of an intravascular dye at normal arterial pressures to determine percentage of vascular patency past the staple lines. Vascular patency was compared not only from pre-and post-staple segments of the same intestinal sample, but also EndoGIA vascular patency was evaluated against TA vascular patency. Results: Two cats met study criteria. All samples had intraluminal burst pressures over twice the chosen minimum (of 30mmHg). Vascular patency post- staple line ranged from 0-90.8%, with the most consistently high numbers noted with the TA 3.5mm cartridges. No EndoGIA cartridge had a post- staple line vascular patency higher than 31.1%, and no intravascular dye was noted in any post- staple line sample in the EndoGIA 2.0/2.5/3.0mm group. Conclusions: While statistical analysis of the dataset was unable to be performed due to low numbers of samples for comparison, both intestinal intraluminal burst pressure trends and intravascular dye patterns suggested both the TA 3.5mm cartridge and (to a lesser extent) the 3.0/3.5/4.0mm EndoGIA cartridge could provide the ideal combination of intraluminal seal without restriction of vascular access for healing. The intravascular dye infusion technique, developed during this research, shows promise as a future instrument to determine vascular patterns around intestinal implants in cadaveric cat specimens. / Master of Science / Despite the regularity of feline small intestinal surgery, few reports exist of stapled anastomoses in cats, in part due to stapler size limitations. However, the recently developed endoscopic gastrointestinal anastomosis (EndoGIA) stapler shows promise as a future surgical tool for cats because it fits into cat intestine. In dogs, 3.5mm staples are often chosen for intestinal surgery; however, dog intestine is considerably thicker than cat intestine. The study goal was to evaluate not only intestinal burst pressures (the pressure at which repaired intestine leaks), but also the ability of fluids to flow through blood vessels that cross the staple lines of four stapler cartridge types from two staple lineages (EndoGIA 2.0/2.5/3.0mm, EndoGIA 3.0/3.5/4.0mm, TA 2.5mm, and TA 3.5mm). The central hypothesis was twofold. First, smaller stapler cartridge sizes (the EndoGIA 2.0/2.5/3.0mm and TA 2.5mm) would have higher intraluminal burst pressures when compared to the larger sizes (the EndoGIA 3.0/3.5/4.0mm). Second, larger stapler cartridges (the EndoGIA 3.0/3.5/4.0mm and the TA 3.5mm) would allow for increased flow of fluids in blood vessels past the stapler lines compared to the smaller cartridges (the EndoGIA 2.0/2.5/3.0mm and the TA 2.5mm). Two cats were included in the study. Trends in the data suggested that all components of the hypothesis might be proven with further data. However, due to the low number of cats acquired during the study period, the hypotheses could not be verified with statistics. The dye infusion technique to evaluate flow of fluids in blood vessels, developed during this research, shows promise as a future instrument to determine vascular patterns around intestinal implants. Future research should focus on acquiring more cats to have the ability able to perform statistical analyses (and prove the hypothesis), before proceeding with additional related studies.

Introdução: A DPOC caracteriza-se pela limitação ao fluxo aéreo associada à resposta inflamatória anormal dos pulmões a partículas ou gases nocivos. As alterações mecânicas decorrentes da DPOC estão relacionadas com a disfunção mecânica das fibras do diafragma, já observadas nas fases iniciais da doença. Alguns estudos têm demonstrado o elevado potencial da Técnica de Oscilações Forçadas (FOT) na detecção das alterações mecânicas da DPOC. Contudo, tais aplicações da FOT não permitiam a análise em tempo real das alterações do sistema respiratório, bem como da mobilidade toracoabdominal destes indivíduos. Desta forma, os objetivos desta pesquisa foram analisar, em tempo real, as alterações de impedância do sistema respiratório nas distintas fases do ciclo em portadores de DPOC, assim como avaliar a movimentação toracoabdominal destes indivíduos. Metodologia: Trata-se de um estudo observacional controlado, prospectivo onde foram analisados 48 indivíduos, 23 indivíduos controles e 25 portadores de DPOC com grau de obstrução acentuado. Os indivíduos realizaram exames de FOT para análise da impedância do sistema respiratório e mobilidade toracoabdominal, simultaneamente. Posteriormente aos exames da FOT os indivíduos foram submetidos à Espirometria. Resultados: Os resultados demonstraram aumento da impedância do sistema respiratório nos indivíduos com DPOC em comparação ao grupo controle, em nos parâmetros estudados (Zt, Zi, Ze, Zii, Zie, Zrs e Zpp) (p<0,0001). Em relação às distintas fases do ciclo, os indivíduos deste estudo apresentaram impedâncias maiores na fase inspiratória quando comparadas à fase expiratória (p<0,004). Somente 10% dos portadores de DPOC apresentaram assincronia toracoabdominal (&#966; &#8805; 45), sendo que os valores médios não apresentaram diferença estatística quando comparados ao grupo controle. Discussão: A impedância total do sistema respiratório (Zt) aumentada nos portadores de DPOC confirma o aumento da carga mecânica do sistema respiratório destes indivíduos. Essas alterações são coerentes com o processo fisiopatológico, evidenciado pela obstrução ao fluxo aéreo e destruição do parênquima pulmonar. O aumento da impedância na fase inspiratória quando comparada à fase expiratória, sugere um aumento no trabalho resistivo e elástico. Não foram evidenciados sinais de assincronia na mobilidade toracoabdominal na maior parte dos indivíduos, sugerindo que alguns mecanismos adaptativos atuam na tentativa de evitar a fadiga do músculo respiratório. Conclusões: A DPOC resulta no aumento da carga mecânica do sistema respiratório, alterações identificadas pelo aumento da impedância do sistema respiratório, medida pela FOT em tempo real. Este aumento foi mais evidente durante a fase inspiratória. A mobilidade toracoabdominal não se mostrou alterada na maior parte dos indivíduos com DPOC. Estes resultados são consistentes com publicações prévias e fundamentos fisiopatológicos, confirmando o potencial da FOT monofreqüência na avaliação das modificações relacionadas à DPOC. / Introduction: COPD is carachterized by airflow limitation associated abnormal inflammatory response of the lung to noxious particles or gases. The mechanical alterations associated with COPD have been related with dysfunction of the diaphragm, observed since the initial phases of the disease. Several studies have confirmed the high potential of FOT in the assessment of the mechanics modifications related to COPD. However, such studies did not allow a real-time analysis of the changes in the respiratory system, and the thoracoabdominal mobility of these individuals. Thus, the goals of the present study were to analyze, in real-time, the impedance alterations of the respiratory system in different phases of the respiratory cycle of COPD patients. Methodology: This research consists of a controlled observational study where 48 individuals were analyzed, 23 controls and 25 individuals with COPD and severe airway obstruction. Firstly, they performed simultaneous analysis of impedance of the respiratory system and thoracoabdominal motion. In subsequent examinations, these subjects were submitted to spirometry. Results: The results demonstrated an increase of the respiratory system impedance in individuals with COPD compared with the control group in all of the studied parameters (Zt, Zi, Ze, Zii, Zie, &#916;Zrs e Zpp) (p<0.0001). Considering the different phases of the respiratory cycle, higher impedances were observed in the inspiratory phase (p<0.004). Only 10% of individuals with COPD showed thoracoabdominal asynchrony (&#966;&#8805; 45), and the mean values showed no statistical difference when compared to the control group. Discussions: The total impedance of the respiratory system increased in individuals with COPD, which describes the increase of the mechanic load of the respiratory system in these individuals. These alterations are coherent with the physiopathology of COPD, associated with airflow obstruction and lung parenchyma destruction. The increase of the impedance in the inspiratory phase suggests an increase of the resistive and elastic work. There were not signals of thoracoabdominal asynchrony in the major part of the studied individuals, suggesting that some adaptation mechanisms act to compensate respiratory muscle fatigue. Conclusion: The COPD results in the increase of the mechanic load of the respiratory system. These alterations were identified by the increase of the respiratory system impedance, which was more evidence in the inspiratory phase. The thoracoabdominal asynchrony was not usual in individuals with COPD. Those results are consistent with previously published data and physiopathological fundamentals, confirming the potential of monofrequency FOT in the assessment of the modifications related to COPD.

Introdução: A DPOC caracteriza-se pela limitação ao fluxo aéreo associada à resposta inflamatória anormal dos pulmões a partículas ou gases nocivos. As alterações mecânicas decorrentes da DPOC estão relacionadas com a disfunção mecânica das fibras do diafragma, já observadas nas fases iniciais da doença. Alguns estudos têm demonstrado o elevado potencial da Técnica de Oscilações Forçadas (FOT) na detecção das alterações mecânicas da DPOC. Contudo, tais aplicações da FOT não permitiam a análise em tempo real das alterações do sistema respiratório, bem como da mobilidade toracoabdominal destes indivíduos. Desta forma, os objetivos desta pesquisa foram analisar, em tempo real, as alterações de impedância do sistema respiratório nas distintas fases do ciclo em portadores de DPOC, assim como avaliar a movimentação toracoabdominal destes indivíduos. Metodologia: Trata-se de um estudo observacional controlado, prospectivo onde foram analisados 48 indivíduos, 23 indivíduos controles e 25 portadores de DPOC com grau de obstrução acentuado. Os indivíduos realizaram exames de FOT para análise da impedância do sistema respiratório e mobilidade toracoabdominal, simultaneamente. Posteriormente aos exames da FOT os indivíduos foram submetidos à Espirometria. Resultados: Os resultados demonstraram aumento da impedância do sistema respiratório nos indivíduos com DPOC em comparação ao grupo controle, em nos parâmetros estudados (Zt, Zi, Ze, Zii, Zie, Zrs e Zpp) (p<0,0001). Em relação às distintas fases do ciclo, os indivíduos deste estudo apresentaram impedâncias maiores na fase inspiratória quando comparadas à fase expiratória (p<0,004). Somente 10% dos portadores de DPOC apresentaram assincronia toracoabdominal (&#966; &#8805; 45), sendo que os valores médios não apresentaram diferença estatística quando comparados ao grupo controle. Discussão: A impedância total do sistema respiratório (Zt) aumentada nos portadores de DPOC confirma o aumento da carga mecânica do sistema respiratório destes indivíduos. Essas alterações são coerentes com o processo fisiopatológico, evidenciado pela obstrução ao fluxo aéreo e destruição do parênquima pulmonar. O aumento da impedância na fase inspiratória quando comparada à fase expiratória, sugere um aumento no trabalho resistivo e elástico. Não foram evidenciados sinais de assincronia na mobilidade toracoabdominal na maior parte dos indivíduos, sugerindo que alguns mecanismos adaptativos atuam na tentativa de evitar a fadiga do músculo respiratório. Conclusões: A DPOC resulta no aumento da carga mecânica do sistema respiratório, alterações identificadas pelo aumento da impedância do sistema respiratório, medida pela FOT em tempo real. Este aumento foi mais evidente durante a fase inspiratória. A mobilidade toracoabdominal não se mostrou alterada na maior parte dos indivíduos com DPOC. Estes resultados são consistentes com publicações prévias e fundamentos fisiopatológicos, confirmando o potencial da FOT monofreqüência na avaliação das modificações relacionadas à DPOC. / Introduction: COPD is carachterized by airflow limitation associated abnormal inflammatory response of the lung to noxious particles or gases. The mechanical alterations associated with COPD have been related with dysfunction of the diaphragm, observed since the initial phases of the disease. Several studies have confirmed the high potential of FOT in the assessment of the mechanics modifications related to COPD. However, such studies did not allow a real-time analysis of the changes in the respiratory system, and the thoracoabdominal mobility of these individuals. Thus, the goals of the present study were to analyze, in real-time, the impedance alterations of the respiratory system in different phases of the respiratory cycle of COPD patients. Methodology: This research consists of a controlled observational study where 48 individuals were analyzed, 23 controls and 25 individuals with COPD and severe airway obstruction. Firstly, they performed simultaneous analysis of impedance of the respiratory system and thoracoabdominal motion. In subsequent examinations, these subjects were submitted to spirometry. Results: The results demonstrated an increase of the respiratory system impedance in individuals with COPD compared with the control group in all of the studied parameters (Zt, Zi, Ze, Zii, Zie, &#916;Zrs e Zpp) (p<0.0001). Considering the different phases of the respiratory cycle, higher impedances were observed in the inspiratory phase (p<0.004). Only 10% of individuals with COPD showed thoracoabdominal asynchrony (&#966;&#8805; 45), and the mean values showed no statistical difference when compared to the control group. Discussions: The total impedance of the respiratory system increased in individuals with COPD, which describes the increase of the mechanic load of the respiratory system in these individuals. These alterations are coherent with the physiopathology of COPD, associated with airflow obstruction and lung parenchyma destruction. The increase of the impedance in the inspiratory phase suggests an increase of the resistive and elastic work. There were not signals of thoracoabdominal asynchrony in the major part of the studied individuals, suggesting that some adaptation mechanisms act to compensate respiratory muscle fatigue. Conclusion: The COPD results in the increase of the mechanic load of the respiratory system. These alterations were identified by the increase of the respiratory system impedance, which was more evidence in the inspiratory phase. The thoracoabdominal asynchrony was not usual in individuals with COPD. Those results are consistent with previously published data and physiopathological fundamentals, confirming the potential of monofrequency FOT in the assessment of the modifications related to COPD.

Detection of early pathophysiological changes of breathing in children with chronic respiratory disease MD. Vaclav Koucky - Ph.D. thesis Abstract Introduction: Currently, there are different methods for infant pulmonary function testing (iPFT) and morphological assessment of microscopic changes in endobronchial biopsy samples (EBB). In research setting, they allow detection of early pathophysiological changes of breathing in small children with chronic respiratory disease, respectively in risk of its development. Their clinical significance, however, is not fully acknowledged. The aim of this thesis is to evaluate the safety, feasibility and clinical significance of iPFT and EBB in infants younger than 2 years of age. In addition, the relationship between functional and morphological changes of respiratory tract and the function of peripheral chemoreceptors was studied in selected patients' subgroups. Methods: Fifty-five infants with cystic fibrosis (CF), 35 physician-confirmed recurrent wheezers (AB), 9 infants with congenital diaphragmatic hernia, 7 with interstitial lung disease (chILD) and 3 with primary ciliary dyskinesia (PCD) were enrolled. All infants underwent iPFT and relevant clinical history data were recorded. Based on patients' age, CF group was divided into CFmalí (< 6 months) and CFvelcí (>...