No description available.

No description available.

L’expérience avec des familles issues de la migration et leurs adolescents en souffrance identitaire, que nous recevons dans notre dispositif de la clinique de la multiplicité alors que l’expression symptomatologique de leur mal être est au maximum nous a incités à ouvrir la question de la greffe, de l’adoption et de l’héritage psychiques. L’adoption, pensée comme l’aboutissement d’un processus réciproque de reconnaissance, demande à ce que soit interrogée la mise en place du rapport familier/étranger entre l’adolescent, l’enfant et ses parents. Pouvoir interroger la préhistoire psychique et les appartenances aussi bien chez les parents que chez l’adolescent/l’enfant c’est permettre de faire émerger les éléments sources, éléments constitutifs de l’identité issus de la transmission qui inscrivent dans les liens et les appartenances. C’est également permettre un traitement des restes ; ces restes qui agitent, qui poussent au clivage et à la destructivité. C’est aussi pouvoir pointer ce qui a fait défaut, ce qui a entravé ce processus. Ce travail d’archéologie psychique peut permettre de constituer ou de restaurer une membrane interne, une interface qui absorbe, filtre et transforme les éléments issus des échanges entre le dehors et le dedans ; entre l’enfant et ses parents ; un brassage d’informations qui s’imbriquent, se lient, qui fabrique la multiplicité, une multiplicité fonctionnelle qui enrichit l’identité. La métaphore de la greffe, du rejet, de corps étranger, de transplantation vont nous permettre de penser le concept de la greffe psychique pour pouvoir redéfinir le processus d’adoption, de reconnaissance réciproque et d’héritage ; processus qui dépasse le processus de transmission. En effet, au-delà de la position de « fils de », c’est ici la question du devenir « héritier » qui est posée et travaillée pour ces adolescents en souffrance et pourrait faciliter la redéfinition symbolique de leur acte de naissance. / Experience with migrant families and their adolescents in distress regarding their identity we receive in our setting: “La Clinique de la Multiplicité”, encourage us to open the issue of transplantation, of adoption and psychic inheritance. Adoption, thought as the culmination of a reciprocal process off recognition, led as to question the organization of the familiar/foreign relationship between the adolescent, the child and his parents.Questionning the psychic prehistory and the affiliations of both parents and adolescents / children, enables to reveal the source elements, the significant elements of identity as a result of , transmission, which inscribe the patient within links and affiliations.It allows, as well treatment of the remains; these remains that trouble the patient, pushing him towards dissociation and destructiveness. It also highlights what is lacking, what has hampered this process.This work of psychic archaeology can enable to constitute or to restore an inner membrane, an interface which absorbs, filters and transforms the elements issued from the exchange between the outside and inside ; between the child and his parents; a composition of information that fits together, that binds manufacturing the multiplicité, a functional multiplicité that enriches the identity.The metaphor of the transplantation, of the rejection of a foreign transplant will enable us to consider the concept of the psychic transplantation in order to redefine the process of adoption, of reciprocal recognition and inheritance; a process that exceeds the transmission process. Indeed, beyond being “son of”, the question of becoming heir is here relevant for these adolescents in suffering, a question that could facilitate the symbolic redefinition of their birth certificate.

Nutritional support for bone marrow transplant recipients is recognized as vital, yet little research has occured to determine the best method. This study was designed to survey existing food and nutrition services in bone marrow transplant centers in the U.S. in order to determine similarities in the services provided among centers from which a model protocol could be established for such centers. A survey instrument was developed and sent to all chief dietitians associated with BMT centers in the U.S, listed the International Bone Marrow registry, 1982. Items on the questionnaire included: background information on size and organization, nature of foodservice, and nutrition support services. The research suggested that there was a trend away from sterile food service. Problems encountered in establishing the food and nutrition services included: availability of single-serve sterile foods, standardization of recipes, and palatability of autoclaved foods. Four centers switched from sterile diets to either low bacteria diets or modified house diets at some point in their operation. Patient related services of the registered dietitian were most concentrated on admission and during critical care monitoring. Near all respondents indicated a desire to form a network for developing standards for services provided. Many differences between centers still remain which prevent the development of a model center.

BACKGROUND: Organ transplantation is one of the best modalities for treating fatal organ failure. Despite the success of this procedure, an increasing incidence of cancer in this population has drawn the attention of public health officials in recent years. OBJECTIVES: The overall objective of this study is to conduct a detailed examination of adverse health outcomes among Canadian organ transplant recipients, with an emphasis on cancer incidence and mortality. METHODS: This project employed a retrospective cohort follow-up study design, whereby Canadian Organ Replacement Registry records were linked to the Canadian Mortality Database and the Canadian Cancer Registry Database. The study population consisted of more than 16,000 solid organ transplant recipients registered between January 1, 1981 and December 31, 1998. This study was designed to assess the risks of developing cancer, overall and site-specific, in transplant recipients in comparison to the general Canadian population using Standardized Incidence Ratios (SIR), Standardized Mortality Ratios (SMR), and Proportionate Mortality Ratios (PMR). In addition, Cox and logistic models were used to assess the effects of various risk factors on cancer incidence and mortality in transplant sub-populations, while cumulative incidence was used to study the patient survival pattern. Lastly, Population Attributable Risk (PAR) was used to quantify the impact of organ transplantation on cancer incidence and mortality. RESULTS: Among major causes of death, the highest PMRs are due to genitourinary diseases, followed by endocrine, nutritional and metabolic diseases, and infectious diseases. SIRs indicate that cancer incidence and mortality were relatively lower than that observed for other major causes of death, and slightly higher than that observed in the general Canadian population. Lastly, logistic regression results indicate that age, year of surgery, and smoking status were significant risk factors in mortality due to all causes, while the Cox regression model shows that age, sex and year of surgery were significant risk factors for cancer incidence. Overall, the PAR in this cohort was very minimal, indicating that the risk in mortality and cancer incidence due to organ transplantation is negligible. CONCLUSION: Life threatening diseases such as those of the genitourinary system, as well as endocrine, nutritional and metabolic diseases and infectious diseases are leading causes of death. Future research should be directed at ways of reducing incidence and subsequent mortality due to these causes.

Ph.D. (Psychology) / In this study the illness behavior of people with a life threatening illness was described and the relationship between stress, affect and illness behavior investigated. An overview of the literature shows that the illness behavior patients exhibit is and should be an important consideration in the diagnosis of illness and treatment of patients. This is evident in reports of a high amount of ill people who do not receive treatment and the high amount of patients who seek treatment for minor ailments. It is further evident in the light of findings that illness behavior does not always accurately represent the physical disfunction and that it may even be present in :t- the absence of a physical disfunction. The paucity of research on the illness behavior of specific patient groups, and of information on the relative effects of physical versus psychological factors on illness behavior, indicate a void in the literature. The present study investigates this relationship in a group of patients with a life threatening illness. In the first phase of the study 15 kidney transplant patients were compared to themselves, under normal conditions and conditions of stress, regarding affect, the experiencing of stress and the reporting of physical symptoms. In the second phase of the study 15 kidney transplant patients were compared to 15 patients with acute but minor ailments regarding the reporting of physical symptoms, affect, the experiencing of stress and the psychosocial impact of the illness.

Orientador: Marcelo Silva Monnazzi / Resumo: As reconstruções maxilofaciais, cada vez mais utilizadas para o reparo das deficiências dos tecidos ósseos na face ou nos maxilares, são cirurgias demasiadamente importantes. Elas não devolvem apenas a função local, mas também, em muitos casos, restabelecem a autoestima do paciente, e assim, melhoram sua qualidade de vida. Para as grandes reconstruções ósseas, a quantidade de tecido ósseo necessário como substrato para a realização do enxerto, muitas vezes é um fator limitante. Este estudo observacional foi planejado, para avaliar a anatomia e a quantidade óssea do processo coronóide da mandíbula, do mento e da crista ilíaca anterior. Quinhentas e dez mandíbulas secas foram analisadas e medidas em pontos pré-determinados, por meio de um paquímetro digital. Após as medidas, foi estabelecida a média da espessura e das medidas lineares do processo coronóide; a media de espessura de pontos do mento e a média de espessura de pontos da crista ilíaca anterior, bem como uma estimativa de volume para este último. Observou-se que a crista ilíaca anterior apresentou uma estimativa média de volume ósseo de 21.347,19 mm3 e 21.125,56 mm3 para o lado esquerdo e direito, respectivamente. O processo coronóide apresentou menor espessura (2,11 mm) e tamanho linear (5,77 mm) em sua porção mais superior e maior espessura (3,63 mm) e tamanho linear (14,51 mm) na sua base, em média. No mento, foi observada maior média de espessura na linha média (12,90 mm), além disso, essa espessura foi 1,57 mm ma... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Maxillofacial reconstructions, used for the repair of boneless areas of the face or jaw, are extremely important surgeries. They restore the local function and in many cases, also restore the patient's self-esteem, and thus, improve their quality of life. For extensive maxillary reconstructions, the amount of bone tissue required as a substrate for grafting is often a limiting factor. This observational study was designed to evaluate the anatomy and the amount of bone found in the coronoid process, chin and anterior iliac crest. Five hundred and ten dry mandibles were analyzed and measured at predetermined points by a digital calypter. After the measurements, the mean thickness and linear measurements of the coronoid process were established; the mean thickness of points of the chin and the mean thickness of points of the anterior iliac crest, as well as an estimate of volume of the iliac crest. It was observed that the anterior iliac crest had an average bone volume estimate of 21,347.19 mm3 and 21.125,56 mm3 for the left and right sides, respectively. The coronoid process had a smaller thickness (2.11 mm) and linear (5.77 mm) in its uppermost portion and greater thickness (3.63 mm) and linear (14.51 mm) in its base, on average. At the chin, a greater mean thickness was observed in the midline (12.90 mm), in addition, this thickness was 1.57 mm greater in males. The anterior iliac crest provides a large amount of bone volume, compared to intra-oral areas. The knowledge of th... (Complete abstract click electronic access below) / Mestre

O objetivo deste estudo foi avaliar o efeito do laser de baixa intensidade (LBI), na regeneração de defeitos de tamanho críticos preenchidos com osso autógeno ou Bio-Oss® associados à membrana colágena. O estudo foi conduzido em 120 defeitos críticos (5 mm) em calvárias de ratos machos (Rattus norvegicus, albinus, Wistar), pesando entre 250 a 300g, divididos em 12 grupos experimentais (n=10): 1) Grupo C (Controle coágulo sanguíneo); 2) Grupo M (membrana colágena- BioGide®); 3) L (laser de baixa intensidade, GaAlAs, 808 nm, 100 mW, 6J, 210 J/cm2); 4) Grupo OA (osso autógeno); 5) Grupo OA/L (osso autógeno + LBI) 6) Grupo OA/M (osso autógeno + membrana colágena); 7) Grupo L/M (LBI + membrana colágena); 8) Grupo OA/L/M (osso autógeno + LBI + membrana colágena); 9) Grupo BO (Bio-Oss®); 10) Grupo BO/M ( Bio-Oss® + membrana colágena) 11) Grupo BO/L (Bio-Oss®+ LBI); 12) Grupo BO/L/M (Bio-Oss® + LBI + membrana colágena). Aos 30 dias pós-operatórios os animais foram sacrificados e após o processamento tecidual, foram realizadas análises histológica, histométrica e estatística. Os dados foram submetidos ao teste paramétrico ANOVA, seguido pelo teste de Tukey (p<0,05). As variáveis analisadas foram: área de osso neoformado (AON) e área de partículas residuais (APR). Todos os grupos apresentaram maiores quantidades de AON quando comparados ao grupo C (9,96% ± 4,49%). Quando o LBI foi associado aos biomateriais apresentou diferença estatística signicativa somente no grupo BO/L (48,57% ± 28,22%, p < 0,05). Menor APR foi encontrada nos grupos irradiados pelo LBI, com diferença estatística significativa para o grupo BO/L (16,74% ± 15,25%, p < 0,05). O LBI possui efeito positivo na regeneração óssea de DTC, e embora na análise estatística tenha apresentado diferença significante somente quando aplicado sobre o Bio-Oss®, na análise histomorfométrica foi possível observar formação óssea em extensões variadas nos demais grupos. / The purpose of the study was to evaluate the effect of low-level laser therapy (LLLT) on guided bone regeneration of critical size defects filled with autogenous bone or Bio- Oss® associated with the collagen membrane. The study was conducted in 120 critical size defects (5mm) in male rats (Rattus norvegicus, albinus, Wistar),weighing between 250 and 300g, divided into 12 experimental groups (n = 10): 1) Group C (control only blood clot); 2) Group M (collagen membrane- BioGide®); 3) Group LLLT (low-level laser therapy, GaAlAs, 808 nm, 100 mW, 6J, 210 J/cm2); 4) Group AB (autogenous bone); 5) Group AB/LLLT (autogenous bone + LLLT); 6) Group AB/M (autogenous bone + collagen membrane); 7); Group LLLT/M (LLLT + collagen membrane) 8) Group AB/LLLT/M (autogenous bone + LLLT + collagen membrane); 9) Group BO (Bio-Oss®); 10) Group BO/M (Bio-Oss® + collagen membrane) 11) Group BO/LLLT (Bio-Oss® + LLLT), 12) Group BO/LLLT/M Bio- Oss® + LLLT + collagen membrane). The animals were killed 30 days postoperatively. After tissue processing, bone regeneration was evaluated by histomorphometric and statistical analysis was performed (Tukey test, p<0,05). The variables analyzed were the area of newly formed bone (NFB) and residual particle area (RPA). All groups presented greater amounts of AON when compared to group C (9,96% ± 4,49%). When LBI was associated with biomaterials, it showed a significant statistical difference only in the BO/L group (48,57% ± 28,22%, p<0,05). Smaller APR was found in the groups irradiated by LBI, with a significant statistical difference for BO/L group (16,74% ± 15,25%, p<0,05). LBI has a positive effect on bone regeneration of DTC, and although in the statistical analysis it presented significant difference only when applied on Bio-Oss®, in the histomorphometric analysis it was possible to observe bone formation in varied extensions in the other groups.

Introduktion/Bakgrund: Transplantation är en livräddande behandling som erbjuds när ingen annan behandling leder till förbättrat tillstånd. Organbristen är idag större än utbudet som finns för organ. Väntelistan för att få ett nytt organ är lång och som konsekvens av detta kan individer avlida innan transplantation. Det finns levande och avlidna donatorer, där levande donatorer behöver öka i antal för att utveckla möjligheten till fler organtransplantationer. Det är angeläget att sjuksköterskan tillgodoser andliga, existentiella, sociala och psykiska behov i lika stor utsträckning som fysiska behov avseende omvårdnadsinterventioner. Syfte: Undersöka hur individer beskriver väntan på en organtransplantation. Metod: Litteraturstudien har framställts genom Polit och Beck’s (2017) nio steg och är systematiskt utformad genom datainsamling från databaserna Cinahl, PubMed och PsycINFO. Resultatet inkluderar elva vetenskapliga artiklar, varav nio kvalitativa och två kvantitativa studier. Resultat: I litteraturstudien identifierades fyra kategorier; en evig kamp, brist på frihet, det okända och livet med andra som beskriver väntan. Slutsats: Litteraturstudiens resultat beskriver upplevelser av både negativ och positiv karaktär. Begränsningar i livet är främst vad som påverkar välbefinnandet hos individer och bidrar även till psykologiska utmaningar. Väntetiden är en individuell upplevelse där information och stöttning från sjuksköterskan är angeläget för att förebygga ohälsa.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21960号 / 医博第4502号 / 新制||医||1037(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 平井 豊博, 教授 松原 和夫, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM