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Orientadores: Adriano Fregonesi, André Deeke Sasse / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T02:08:25Z (GMT). No. of bitstreams: 1 Borges_ClaudioFerreira_M.pdf: 4164710 bytes, checksum: 9f518f9bfaf2ebc75a3dd5241d26cdcf (MD5) Previous issue date: 2010 / Resumo: Propósito: Comparar a segurança e efetividade da realização de nefrolitotripsia percutânea (NPC) com e sem a inserção de nefrostomia, através de revisão sistemática e metanálise de estudos Materiais e métodos: Uma revisão sistemática da literatura foi realizada. Foi feita busca nos bancos de dados PUBMED, EMBASE, LILACS e Cochrane para identificação de estudos clínicos prospectivos randomizados que compararam a NPC com e sem inserção de nefrostomia. Os desfechos avaliados foram os índices de remoção total de cálculos, dor pós-operatória, necessidades de analgésicos, tempo cirúrgico, tempo de internação, perda de sangue e complicações. Resultados: Um total de dez estudos clínicos prospectivos randomizados (ECR) foram identificados somando 621 pacientes. Sete estudos analisaram os índices de remoção total de cálculos. A metanálise dos dados resultou em ausência de diferença entre os grupos de NPC sem nefrostomia e convencional. Quando avaliados o tempo cirúrgico, transfusão sanguínea, queda de hemoglobina e febre pós-operatória não houve diferença entre os grupos. A metanálise do tempo de internação hospitalar e da drenagem prolongada de urina pela região lombar favoreceu o grupo de NPC sem o uso de nefrostomia. Conclusão: Em pacientes selecionados, a NPC sem nefrostomia é um procedimento seguro e eficaz com taxas de remoção total de cálculo comparáveis a NPC convencional. A NPC sem nefrostomia apresentou um menor tempo de internação hospitalar e menos casos de drenagem prolongada de urina. Não foi possível realização de metanálise na avaliação da redução da dor pós-operatória e minimização das necessidades analgésicas. Entretanto, a maioria do estudos avaliados apresentaram benefícios nestes parâmetros para o grupo de NPC sem nefrostomia / Abstract: Purpose: We performed a systemic review with meta-analysis to compare tubeless versus conventional percutaneous nephrolithotripsy and assess the effectiveness and safety of this innovative procedure. Material and Methods: A systematic review of PUBMED, EMBASE, LILACS and Cochrane Library was done to identify all randomized controlled trials comparing tubeless PCNL versus conventional PCNL. The outcomes analyzed were stone free rate, pain assessment, analgesic medication requirements, operative time, hospitalization time, blood loss, stone-free rates and complications. Results: A total of 10 RCT were identified reporting 621 patients. Seven studies analyzed stone free rates. Meta-analysis of the data resulted in no difference between tubeless and conventional PCNL. Operative time, blood transfusion, hemoglobin drop and postoperative fever did not differ between the groups. Meta-analysis of length of hospitalization and prolonged urinary drainage was analyzed and favoured the tubeless PCNL group. Conclusions: Tubeless PCNL is a safe and effective procedure with a stone free rate compared to conventional PCNL. Tubeless PCNL presented a shorter hospital stay and less postoperative urinary leakage. Pain reduction and minimization of analgesic requirements also were demonstrated / Mestrado / Cirurgia / Mestre em Cirurgia

The need for tissue and organ replacements cannot be satisfied by autograft and allografts alone. The purpose of this study was to investigate the feasibility of electrospinning a blend of polydioxanone and fibrinogen to produce an engineered tissue scaffold. Fiber diameter and pore size of blends were characterized, as well as mechanical strength. Cell proliferation assays for 1 and 7 day cultures were preformed, and a histological evaluation was performed to determine how favorable the various blends were to cell infiltration and proliferation. Some ratios of blends were identified that contained both acceptable mechanical properties and properties that facilitated cell infiltration. These findings pave the way for future refinement and use of these scaffolds for a variety of tissue engineered targets.

Interaction of drugs used in gynecology and urology and their management Author: Kupka Vojtěch Tutor: PharmDr. Martin Doseděl Ph.D., Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Introduction: Drug interactions represent a serious health problem and they cause adverse drug effects and toxicity of drugs. Objectives: The goal of the thesis was to create an overview of possible drug interactions with drugs used in gynecological and urological practice. Methodology: From a theroretical introduction was selected registred drugs to 1 st January 2015 by State Institute for Drug Controle. Information about drug interactions were collected and collated from databases Vademecum Infopharm and Micromedex. From database Micromedex, the drug interactions were selected with quality of documentation "excellent" or "good". Pubmed database (www.pubmed.gov) with entering key words "basic drug", "drug interaction" and "interactive drug" was applied to create a current information. To complement the information was also gathered from magazines Practical Pharmacy and Clinical Pharmacology and Pharmacy. In case of not finding relevant information was drawn from the summary information of medicine (SPC). Results: The results were categorized into a research...

Lei, Man Cheong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 79-80). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgement --- p.iii / Table of Contents --- p.iv / Chapter 1. --- Introduction --- p.1 / Chapter 2. --- Introduction to Ureteroscope --- p.3 / Chapter 2.1. --- Ureteroscope --- p.3 / Chapter 2.2. --- Configuration of flexible ureteroscope --- p.5 / Chapter 2.2.1. --- The optical system --- p.5 / Chapter 2.2.2. --- Deflection mechanism --- p.6 / Chapter 2.2.3. --- Control wires (Guidewires) --- p.9 / Chapter 2.2.4. --- Working channel --- p.10 / Chapter 2.3. --- Problems of the existing products --- p.10 / Chapter 2.4. --- Designs of the bending section --- p.11 / Chapter 2.4.1. --- Pin-joint bending section --- p.12 / Chapter 2.4.2. --- Wire-connected bending section --- p.15 / Chapter 2.5. --- CAD Modeling of the bending section --- p.16 / Chapter 2.5.1. --- Different designs of components --- p.16 / Chapter 2.5.2. --- Configuration of the bending section --- p.17 / Chapter 3. --- Wire-Driven Deflection Mechanism --- p.19 / Chapter 3.1. --- Literature review --- p.19 / Chapter 3.2. --- Geometry modeling of the bending section --- p.21 / Chapter 3.2.1. --- Description of formulation --- p.21 / Chapter 3.2.2. --- Assumption --- p.21 / Chapter 3.2.3. --- Notation --- p.22 / Chapter 3.2.4. --- Geometric analysis --- p.22 / Chapter 3.3. --- Simulations of the motion of the deflection mechanism --- p.26 / Chapter 3.3.1. --- Construction of the simulation --- p.26 / Chapter 3.3.2. --- Controlled by a pair of wires --- p.28 / Chapter 3.3.2.1. --- For bending section composed by identical parts --- p.28 / Chapter 3.3.2.2. --- For bending section composed by two sub-sections --- p.29 / Chapter 3.3.3. --- Controlled by two pairs of wires --- p.30 / Chapter 3.3.3.1. --- Deflecting in the same direction --- p.30 / Chapter 3.3.3.2. --- Deflecting in opposite direction --- p.31 / Chapter 3.4. --- Trajectory of the distal end --- p.32 / Chapter 3.4.1. --- Bending section composing by identical parts --- p.32 / Chapter 3.4.2. --- Bending section composing by two sub-sections --- p.40 / Chapter 3.4.2.1. --- Controlled by a single pair of wires --- p.43 / Chapter 3.4.2.2. --- Controlled by two pairs of wires --- p.46 / Chapter 3.5. --- Static analysis of the deflection mechanism --- p.57 / Chapter 4. --- Application: Design of Ureteroscope --- p.64 / Chapter 4.1. --- Design of the bending section --- p.64 / Chapter 4.2. --- Design of the control body --- p.67 / Chapter 4.2.1. --- Parts introduction and major assembling --- p.68 / Chapter 4.2.2. --- Control mechanism --- p.72 / Chapter 5. --- Conclusion and Future Work --- p.75 / Chapter 6. --- Bibliography --- p.79 / Chapter Appendix A: --- List of Publication --- p.81 / Chapter Appendix B: --- MATLAB Programs V --- p.83

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Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser.

La curiethérapie constitue 25% à 30% des opérations de traitement utilisées sur les 40.000 cas de cancer de prostate par an en France. Elle consiste à mettre manuellement une trentaine d'aiguilles creuses dans la prostate, à travers le périnée, en utilisant des images échographiques pour localiser la prostate et les aiguilles. Au moyen de ces aiguilles, des grains radioactifs sont insérés dans la prostate à des endroits précis pré-planifiés grâce à l'imagerie. Le succès de l'opération est étroitement lié à la répartition et l'homogénéité de la dose radioactive répartie dans la prostate, donc à la précision avec laquelle les grains y sont placés. Cette précision est affectée par plusieurs facteurs. Premièrement, la prostate bouge et se déforme pendant l'insertion des aiguilles et lors des déplacements de la sonde échographique pour les acquisitions d'images. Deuxièmement, la taille de la prostate est susceptible d'augmenter pendant l'opération à cause des saignements occasionnés. Enfin, les aiguilles sont très minces et susceptibles de se courber pendant leur insertion.Le laboratoire TIMC-IMAG (équipe GMCAO) a mis au point un système robotisé d'insertion d'aiguilles transpérinéale, guidé par échographie 3D avec le but d'améliorer la précision, la fiabilité et l'efficacité de la pose des grains. Ces travaux ont montré une première faisabilité globale de l'approche avec un premier prototype de laboratoire. Cependant l'approche actuelle permet de corriger seulement en partie les bougés et déformations de la prostate en cours de geste grâce au couplage avec des méthodes d'imagerie 3D. La correction ne tire pas parti des informations très riches issues de l'imagerie : seule la profondeur d'insertion est modifiée pendant le geste. Le LIRMM (équipe DEXTER) a développé récemment une approche de planification adaptative pour le guidage d'aiguille flexible lors de leur insertion dans des procédures percutanées. La technique proposée permet la mise à jour du chemin suivi par l'aiguille en intégrant des informations obtenues en ligne par un retour visuel. Cette stratégie de planification et de contrôle est définie dans une architecture en boucle fermée et permet ainsi de compenser les incertitudes du système et les perturbations (déformations des organes, inhomogénéité des tissus, etc) auxquelles il est soumis.Le but de ces travaux de thèse est donc de coupler les savoir-faire de chacun des deux laboratoires afin d’apporter une solution de guidage d’aiguilles flexibles pour la curiethérapie de prostate. La réalisation de cet objectif passe, dans un premier temps, par l’élaboration d’un algorithme de suivi d’aiguille sous échographie 3D. Cet algorithme est confronté à la faible visibilité des aiguilles offerte par cette modalité d’imagerie, associée à diverses sources de bruit. Ces conditions rendent très difficile la détection de l’aiguille. Dans le but d’améliorer la robustesse de cet algorithme, la zone de recherche de l’aiguille dans le volume est déterminée par un modèle prédictif, qui constitue une première contribution de ce manuscrit. Le contrôle de l’aiguille par planification en boucle fermée a été adapté aux spécificités de l’imagerie échographique 3D ainsi qu’à celles du robot développé précédemment. Ce contrôle est couplé au retour visuel de l’aiguille donné par l’algorithme de détection. Ce dispositif a, par la suite, été testé sur fantômes puis sur pièce anatomique afin de déterminer la viabilité et la pertinence du système proposé.Ce travail constitue donc une première étape vers une future application clinique du guidage d’aiguilles flexibles. Si voir un système robotique insérer seul une aiguille flexible en clinique est encore un rêve lointain, l’idée d’un système d’assistance à l’insertion d’aiguille, où le clinicien et le robot travaillent de pairs, est une solution envisageable dès maintenant. / In France, 25% to 30% of the 40,000 prostate cancer cases per year are treated with brachytherapy. During this procedure, about thirty needles are manually inserted into the prostate through the perineum using ultrasound images to locate the prostate and needles. Radioactive seeds are then inserted into the prostate specific pre-planned locations using needle cannula. The success of the operation is closely related to the distribution and homogeneity of the radioactive dose distribution in the prostate, therefore the precision with which the seeds are positioned. This accuracy is affected by many factors. Firstly, the prostate moves and deforms due to the insertion of the needles and to the movements of the ultrasonic probe. Secondly, the size of the prostate increases due to tissue inflammation and bleeding. Finally, the needles are very thin and could bend during insertion.The TIMC-IMAG laboratory (CAMI team) has developed a robotic system for transperineal needle insertion. This system is guided by 3D ultrasound to improve the precision, reliability and efficiency of the radioactive source positioning. These works showed a first proof of concept using a laboratory prototype. However the current approach can only partially correct prostate movements and deformations using 3D imaging methods. The correction does not take advantage of the rich information of this imaging modality: only the insertion depth is changed during the gesture. LIRMM (DEXTER team) recently developed an adaptive planning approach to guide a flexible needle during its insertion in percutaneous procedures. The proposed technique allows to update the path followed by the needle using online information from the visual feedback. This planning and control approach forms a closed-loop architecture and allows to compensate system disturbances (organ deformities, tissue inhomogeneity, etc.).The purpose of this thesis is to combine the expertise of the two laboratories to provide a flexible needle steering system for prostate brachytherapy purposes. This objective is achieved first by developing a needle tracking algorithm in 3D ultrasound. This algorithm deals with low visibility of the needles offered by this imaging modality, combined with various noises. These conditions complicate the detection of the needle. In order to improve the robustness of our algorithm, a search area is defined to detect the needle in the volume. This area is then determined by a predictive model, which is a first contribution of this manuscript. Control of the closed-loop planning needle is adapted to the specifications of the 3D ultrasound imaging system as well as those of the previously developed robot. This control is coupled to the needle visual feedback given by the detection algorithm. This device is tested on phantoms then on anatomical specimen to assess the viability and relevance of the proposed system.This work is therefore a first step towards a future clinical application of flexible needle steering. The entirely automatic insertion of flexible needle in clinic is a distant dream. However, the idea of an assistance system for needle insertion, where the clinician and the robot work together, is reachable from now.