La reconstruction trachéale autologue a pu être standardisée et optimisée grâce au développement d’untravail de recherche expérimentale. Ce travail a permis d’améliorer la technique chirurgicale et les résultatscliniques. C’est une solution thérapeutique qui permet de remplacer de façon reproductible plus de 50 % delongueur de trachée. Toutes les autres techniques de remplacement trachéal développées par denombreuses équipes, ainsi que leurs résultats expérimentaux et cliniques, ont été étudiés et classés enfonction du substitut utilisé.Après de nombreuses publications du Laboratoire de Recherche du Centre Chirurgical Marie Lannelonguesur ce sujet, nous nous sommes orientés vers l’utilisation des tissus autologues (lambeau libre et cartilagescostaux) en collaboration avec les chirurgiens plasticiens. Cela a permis grâce aux avancées techniques etnotamment de microchirurgie de réaliser un nouveau conduit trachéal. Ce substitut ne contient aucunmatériel prothétique et il peut donc résister aux infections. Malgré l’absence de renfort prothétique, il résisteaux pressions et surtout à la dépression respiratoire.Le développement de cette technique chirurgicale a été obtenu grace à ces travaux de recherche qui ontpermis d’optimiser la procédure, de l'améliorer et de la répéter.Le premier travail expérimental a été la création d'un modèle animal de remplacement trachéal autologuepar un lambeau pédiculé armé. Nous avons ainsi confirmé la résistance mécanique et la viabilité descartilages, ainsi que la durabilité de ce type de reconstruction.Les travaux suivants ont été réalisés en collaboration avec des équipes spécialisées en Ingénierie tissulaire.Le premier travail expérimental d’Ingénierie tissulaire a consisté en la réalisation d’anneaux de cartilage àpartir de cellules souches. L'objectif était d'obtenir des anneaux cartilagineux préformés, que l'on pourraitinsérer dans l'épaisseur du lambeau.Le deuxième travail a été de développer une technique permettant de transformer le revêtement cutané dulambeau en une muqueuse respiratoire. Quatre techniques d'ingénierie tissulaire ont été utilisées et testées :la greffe de péritoine, la greffe de muqueuse buccale expansée, l’ensemencement de cellules de lamuqueuse trachéale et la greffe de cellules épithéliales respiratoire de culture.Malgré les avancées technologiques, la culture de cellules cartilagineuses en trois dimensions sur desmoules en Silicone ne s’est pas avérée satisfaisante.Les différents procédés de remplacement du revêtement cutané ont confirmé la nécessité de réaliser desétapes supplémentaires au préalable de l'intervention chirurgicale. Parmi les techniques de remplacementde l'épithélium, la greffe de muqueuse buccale expansée et la greffe d’épithélium respiratoire de culture ontété les plus fiables.La reconstruction autologue est à ce jour la meilleure alternative pour le remplacement trachéal étendu enutilisant des tissus autologues. La poursuite d’une approche expérimentale est fondamentale pourl’amélioration de nos résultats. Ainsi, ces travaux vont être poursuivis par un travail expérimental sur leremplacement des anneaux de cartilages par des anneaux de Titane poreux sur un modèle animal. / Autologous tracheal reconstruction has been standardized and optimized in parallel with the development of experimental research and clinical practice. This is a therapeutic solution that replaces reproducibly more than 50% of tracheallength. All the other tracheal replacement techniques, developed by many teams and their experimental and clinical results, were studied and classified according to the substitute used.After an experimental study at the Laboratory of Surgical Research in the Marie Lannelongue, center, we started to work towards the use of autologous tissue (free flaps and costal cartilages). Thoses tissues were shaped using technical advances including microsurgery to create a new tracheal conduit.This tracheal substitute does not contain any prosthetic material. It may therefore resist to infection and it resists to respiratory pressures and especially respiratory depression.The development of this technique was conducted in parallel with research studies, that improved and optimized the surgical process and the results.The first experimental work was the creation of an animal model tracheal replacement using an armed autologous pedicle flap. We confirmed the strength and viability of the cartilage strip inserted between the dermal layers and the sustainability of this type of reconstruction.The following work was carried out in collaboration with two other teams specialized in Tissue Engineering.The first experimental work of tissue engineering tried to produce cartilage rings from stem cells. The objective was to obtain complete cartilaginous rings that could be inserted into the thickness of the flap.The next objective was to develop a technique to transform the superficial layer of the skin in a respiratory epithelium. Four tissue engineering techniques were used and tested: peritoneum of the graft, oral mucosa transplant, seeding cells from the tracheal mucosa and graft culture respiratory epithelial cells.Despite advances in technology, the culture of cartilage cells in three dimensions on Silicone mold were not viable and could not be used in clinical practice.The various alternative processes of skin covering highlighted the need for additional steps in advance of surgery.Among the techniques used to replace the epithelium with an expanded graft buccal mucosa, transplantation of culture respiratory epithelium is the most reliable.Autologous reconstruction is so far the best alternative for extended tracheal replacement using only autologous tissue. The pursuit of an experimental approach is fundamental to improve our results.Thus, this work will be pursued by an experimental work on the replacement of cartilage rings using porous titanium ring on an animal model.

Orientador: Paola Castro Moraes / Resumo: O escopo do presente trabalho visa a análise da reparação tecidual traqueal, viabilidade e biocompatibilidade de implante manufaturado tridimensionalmente por método de modelagem por fusão e deposição de co-poliamida associado a elastômero termoplástico aplicado por técnica de anastomose, em coelhos. Quinze animais foram divididos em três grupos homogêneos, referentes aos momentos das eutanásias programadas: sete, 15 e 30 dias. Sinais de caráter clinico e cirúrgico foram observados diariamente durante o tempo de sobrevida de cada grupo, indicando ausência de sinais respiratórios e complicações com a técnica de implantação. Avaliações macroscópicas foram realizadas, para verificar o comportamento tecidual perante a inserção do biomaterial por inspeção direta, assim como análise histopatológica em coloração hematoxilina-eosina para investigação das reações celulares locais. Os resultados dos estudos citado à cima foram aplicados ao teste Exato de Fisher, sob significância de 5% (p<0,05). Não houve deformidade traqueal, deiscência de sutura e luxação da prótese em nenhum animal do projeto. Processo inflamatório de padrão misto foi notado em todos os tempos explorados de forma decrescente, presença de crescimento tecidual sob implante conforme a reparação do organismo frente a prótese ocorreu de forma progressiva e houve escassez de células gigantes, comprovando ausência de reação tipo corpo estranho, revelando boa aceitação do implante e do material proposto na reparação de teci... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The scope of the present work aims at the analysis of the tracheal tissue repair, viability and biocompatibility of a three-dimensional manufactured implant by fusion molding and co-polyamide deposition associated with thermoplastic elastomer applied by anastomosis technique in rabbits. Fifteen animals were divided into three homogeneous groups, related to the euthanasia moments programmed: seven, 15 and 30 days. Signs of clinical and surgical character were observed daily during the survival time of each group, indicating absence of respiratory signs and complications with the implantation technique. Macroscopic evaluations were performed to verify the tissue behavior before insertion of the biomaterial by direct inspection, as well as histopathological analysis in hematoxylin-eosin staining to investigate the local cellular reactions. The results of the above-mentioned studies were applied to Fisher's exact test, in a significance of 5% (p <0.05). There was no tracheal deformity, suture dehiscence, and dislocation of the prosthesis in any animal of the project. Inflammatory process of mixed pattern was observed at all times explored decreasingly, presence of tissue growth under implant as the repair of the organism before the prosthesis occurred progressively and there was a shortage of giant cells, proving absence of foreign body type reaction, revealing good acceptance of the implant and of the proposed material in the repair of tracheal tissue. Thus, it is concluded that... (Complete abstract click electronic access below) / Mestre

The upper airways are a major site of pediatric airway obstruction with its accompanying morbidity and mortality. The simplest approach to provide a stable airway is to perform a tracheotomy but it is a long recovery with its own complications. Other surgical procedures to reconstruct the airway require significant experience. The long-term objectives of this project are to develop a greater understanding of congenital abnormalities of the larynx and trachea. The objective of this thesis is to create a process to automatically segment and measure the pediatric trachea from MR images. Using 3DSlicer and ITK and program was created to perform the measurements. The software tool was optimized to produce similar results to that of CT image measurements from Pulmonary Workstation. The program was tested on a pediatric population and showed a significant correlation between cross-sectional area and age or height of the individual.

Tez (Yüksek Lisans) - Süleyman Demirel Üniversitesi, Fen Bilimleri Enstitüsü, Biyoloji Anabilim Dalı, 2009. / Kaynakça var.

Thesis (M.Nurs.)--Edith Cowan University, 2009. / Submitted to the Faculty of Computing, Health and Science. Includes bibliographical references.

Thesis (M.S.) --University of Texas Graduate School of Biomedical Sciences at San Antonio, 2008. / Vita. Includes bibliographical references.

Thesis (M.S.) --University of Texas Graduate School of Biomedical Sciences at San Antonio, 2008. / Vita. Includes bibliographical references.

Um tema relevante de pesquisa em pneumologia atualmente é a contratilidade de via aérea, e como a mesma é modulada por estímulos mecânicos e farmacológicos. De modo a contribuir com este campo de pesquisa, este projeto tem por objetivo a execução de medições de grandezas associadas à mecânica respiratória de vias aéreas isoladas in vitro para avaliar sua resposta a estímulos externos como alterações de pressão transmural, estiramento, poluentes e drogas. Para tal finalidade, foi integrada uma nova instrumentação de processamento de imagens e condicionamento/estimulação de tecidos aos equipamentos já em uso em diversas pesquisas pelo Laboratório de Engenharia Biomédica da Escola Politécnica da Universidade de São Paulo. Este ambiente foi testado em corpos de prova; foi avaliado o efeito da pressão transmural na mecânica de traqueias e o ambiente foi utilizado na análise do efeito de bronco-constritores na mecânica respiratória de traqueias decelularizadas (utilizadas em transplante traqueal). Os testes em corpos de prova demonstraram a capacidade do ambiente em executar as medidas de interesse; os estudos com pressão transmural quantificaram a expansão das paredes da traqueia com o incremento da pressão interna e os estudos com traqueias decelularizadas mostram que as mesmas não respondem a broncoconstritores, ao contrário de traqueias normais que apresentaram indícios de contração. Desta forma, o ambiente foi capaz de realizar pesquisas de contratilidade de via aérea, demonstrando indícios da insensibilidade de traqueias decelularizadas a bronco-constritores. / Currently, a relevant field in the research of pulmonology is the contractibility of airways, and their modulation through mechanical and pharmacological stimuli. In order to contribute to this research, the goal of this project is to execute measurements of respiratory mechanic indicators to assess the behavior of isolated airways in vitro to external stimuli such as modifications in transmural pressure, dynamic stretching, pollution and drugs. For this purpose a new image processing and tissue conditioning/stimulation environment was integrated with the existing instrumentation already in use by the Biomedical Engineering Laboratory in the Escola Politécnica da Universidade de São Paulo. The environment was tested in tubular structures mimicking airways, the effect of transmural pressure in the respiratory mechanics of trachea was assessed and the environment was used in the research of the effect that bronchoconstrictor drugs have on the respiratory mechanics of decellularized tracheas (used in tracheal transplants). The tests in tubular structures proved the environments capacity to execute the desired measurements; the expansion of the tracheal walls with the rise of internal pressure was quantified and the experiments with decellularized tracheas show that they are not responsive to bronchoconstrictor durgs, opposite to normal tracheas that presented evidences of contraction. The environment succeeded in the execution of research of airway contractibility and demonstrated evidences of insensitivity of decellularized trachea to bronchoconstrictor drugs.

Na última década, o uso de sistemas microventilados (sistema VMA) em biotérios possibilitou alojar animais com melhor qualidade sanitária devido ao maior controle ambiental fornecido por esses sistemas. Contudo, ainda é necessária uma melhor avaliação, principalmente no que tange às respostas dos animais. Dessa forma, o objetivo deste trabalho foi avaliar a integridade do aparelho respiratório (pulmões e traquéia) de cobaias mantidas sob dois sistemas de ventilação diferentes: ventilação geral diluídora (VGD) ou ventilação para conforto e ventilação microambiental (VMA). Foram utilizados quatro grupos de animais que ficaram alojados por 180 dias no CREAL-UFRGS. Os animais foram acompanhados com exames radiológicos dos pulmões a cada 45 dias. A histopatologia foi realizada no último dia de acompanhamento dos animais.Os resultados da análise radiológica não demonstraram diferença significativa entre as lesões pulmonares de cobaias fêmeas e machos mantidas sob os dois sistemas de ventilação. A avaliação histopatológica evidenciou lesões descamativas e de metaplasia no epitélio da traquéia de animais de ambos os sexos e sistemas de ventilação. As lesões encontradas nos pulmões das cobaias machos e fêmeas de ambos os sistemas foram em sua maioria lesões inflamatórias, com intenso infiltrado de mononucleares. A presença e intensidade dessas lesões variaram de acordo com o sistema de ventilação sendo que no grupo VGD é que foram encontradas lesões mais severas. / During the last decade, the use of intracage ventilation systems (VMA) in animal facilities has improved the health status of animal by better environmental control supplied by these systems. Yet, here is little information upon use of VMA systems, mainly in that it referes to animal responses. Thus, the purpose in this investigation was to evaluate epithelial integrity in airways (trachea and lungs) of Guinea pigs kept in two different systems: general diluting ventilation system or comfort ventilation system (VGD) and intracage ventilation systems (VMA). Four groups of animals were kept for 180 days on CREAL- UFRGS. The animals were observed with radiological exam taked from lungs every 45 days. The histophatology was done in the last day of trial. The results show the radiological exams haven’t differences between lung injuries from males and females kept in two different ventilation systems. The histological examination showed lost and changes of trachea epithelium in both, male and female under two different ventilation. The injuries found in lung from Guinea pigs, male and female, under two different ventilation were in the most inflammatory injuries, predominantly mononuclear cells. Intensity of lesions varied according to the ventilation system wich animals were kept, the animals kept in VGD system have presented more intensity of injuries.

Introdução e Objetivos: A cirurgia traqueal experimental utiliza diversas técnicas para a realização de traqueoplastias. A variabilidade de técnicas pode determinar irregularidades nos resultados obtidos. Este estudo tem como objetivo apresentar um modelo de traqueoplastia em ratos, sob ventilação espontânea, utilizando um molde intraluminal para conferir qualidade e homogeneidade à sutura, mesmo com limitação de recursos. Essas características visam a oferecer substrato adequado para comparação de métodos diferentes propostos para cirurgia traqueal. Material e Métodos: Trinta ratos machos Wistar, com cerca de noventa dias de vida e peso variando entre 326 e 505 gramas foram recrutados para o experimento. Dez animais foram utilizados como pilotos sendo que a destreza técnica e os cuidados para com os animais foram estabelecidos. Os demais vinte animais foram operados para avaliação clínica da permeabilidade da via aérea e identificação de causas de falência do método.Os animais foram anestesiados, e a traquéia cervical foi abordada. Foi ressecado o quarto anel traqueal com preservação da porção membranosa e, a seguir, a traquéia foi entubada de maneira retrógrada para clearance da via aérea e moldagem para a confecção da sutura traqueal. Foi realizada uma traqueoplastia por sutura contínua e, o animal foi extubado. O fator analisado foi o padrão ventilatório tanto no período pós-operatório imediato como no pósoperatório tardio. Resultados: Apenas um animal apresentou insuficiência respiratória imediata após o procedimento e evoluiu a óbito. A causa da disfunção foi a migração do tubo traqueal que não atuou como suporte para a traqueoplastia. Os demais animais apresentaram evolução clínica sem eventos desfavoráveis. Conclusões: O modelo de traqueoplastia proposto, avaliado a partir de parâmetros clínicos, mostrouse viável e reprodutível, podendo ser utilizado para diversos fins em cirurgia traqueal experimental. / Introduction and objectives: This study has the objective to present a tracheoplasty model in rats, in spontaneous ventilation and using an intraluminal stent to secure quality and homogeneity to the suture. And this way offer an adequate substrate to compare different methods proposed to tracheal surgery. Material and methods: thirty male wistar rats, around 90 days of life were included in this study. Ten animals were used as pilots to the study. The last twenty animals were operated for clinical valuation and identification of collapse of the method. The fourth tracheal ring was removed with preservation of the membranous layer and after that the trachea was tubed by reversed way for modeling and confection of the tracheal suture. A tracheoplasty with running suture was accomplished and the tube was removed. The studied factor was the breathing pattern as post – operative period immediately as in the late it. Results: Only one animal had fatal respiratory failure immediately after the surgery. It was caused by the migration of the tracheal tube and this way, do not acting as a stent to the tracheoplasty. The other animals presented good clinical evolution. Conclusions: The proposed tracheoplasty model, evaluated by clinical parameters, presented viable and reproducible and can be used in several tracheal experiments.