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Jury, Vanessa. "Transferts couplés masse chaleur d'une matrice alvéolée : application à la décongélation-cuisson du pain précuit surgelé." Nantes, 2007. http://www.theses.fr/2007NANT2149.
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Cette thèse concerne l'étude des transferts couplés de masse et de chaleur au sein d'une matrice poreuse. Le pain précuit a été pris comme matrice d'étude avec comme objectif final une meilleure compréhension des phénomènes de transfert de masse et de chaleur prenant place lors de l'opération finale de décongélation – cuisson de ces produits. Les propriétés thermophysiques du pain précuit congelé ont été mesurées et modélisées. Un système de mesure de la conductivité thermique en continu lors de la décongélation-cuisson a été mis au point. La conductivité thermique a été modélisée avec un modèle parallèle prenant en compte le phénomène d'évaporation-condensation. L'étude des transferts de masse a pris en compte les transferts générés par un gradient de concentration (diffusivité) et ceux générés par un gradient de pression (perméabilité). Ces deux propriétés ont été reliées aux paramètres de structure (tortuosité, porosité et surface spécifique dynamique) de la matrice poreuse. Les résultats obtenus mettent en évidence la complexité des phénomènes physiques impliqués dans le transfert couplé de masse et de chaleur. La modélisation des transferts couplés masse-chaleur a été réalisée en géométrie cylindrique après avoir caractérisé l'activité de l'eau et mesuré le coefficient de convection. Le modèle prend en compte les phénomènes de transfert de masse liés au gradient de concentration mais aussi au gradient de pression. Les profils de température et de la teneur en eau ont été validés par comparaison avec l'expérienceThis PhD dissertation concerns a study on coupled mass and heat transfer in porous media. Partially baked bread has been considered as a case study with the final objective a better understanding of the mass transfer and heat transfer phenomena taking place during the combined thawing – baking unit operation of such products. The thermophysical properties of partially baked bread have been measured an model has been used. An experimental set up has been designed to measure the thermal conductivity during the combined thawing baking operation. The thermal conductivity has been modelled with a parallel model taking into account the evaporation – condensation phenomenon. The study of the mass transfer has accommodated the mass transfer induced by a concentration gradient (mass diffusivity) and the mean related to structure parameters (tortuosity, porosity, specific surface) of the porous matrix. The results obtained stress out the complexity ot the phenomena involved in coupled heat and mass transfer. The modeling of the coupled heat and mass transfer has been done considering a cyclindrical geometry. Water activity and convective heat transfer have been determined previously. The model accommodates the mass transfer linked to the concentration gradient and also to the partial pressure gradient. Calculated temperature and water content profiles have been compared to experimental data
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Leinot, Alain. "Propriétés gélifiantes des protéines myofibrillaires (surimi) de sardines en fonction de la saison de pêche et de la durée d'entreposage réfrigéré ou congelé des poissons." Montpellier 2, 1991. http://www.theses.fr/1991MON20025.
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La valorisation d'un poisson gras pelagique, la sardine de mediterranee (sardina pilchardus), a ete etudiee en utilisant la technologie japonaise de preparation de surimi (concentre de proteines myofibrillaires). Les proprietes gelifiantes de ces proteines ont ete evaluees en mesurant la texture des gels de surimi prepares par incubation en presence de nacl, et par cuisson. L'alteration progressive des proprietes gelifiantes des proteines myofibrillaires a ete systematiquement etudiee en fonction de la temperature et de la duree d'entreposage refrigere ou congele des sardines. La vitesse d'alteration est toujours plus elevee avec les sardines pechees en periode de reproduction (mars ou juin 89) qu'avec celles pechees a d'autres periodes de l'annee (octobre ou decembre 88 ou 89). Les mecanismes biochimiques responsables de l'alteration des proprietes gelifiantes des proteines myofibrillaires ont ete etudies par mesures de solubilite a diverses forces ioniques, par electrophorese, et par calorimetrie differentielle a balayage
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Lejeune, Maxime. "Optimisation du couplage entre froid statique et inertie thermique. Application à un véhicule de livraison à domicile de produits surgelés." Electronic Thesis or Diss., Paris 6, 2016. http://www.theses.fr/2016PA066754.
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Dans le domaine du transport de denrées périssables à température dirigée, on distingue un type de livraison à domicile de produits surgelés qui utilise des petits véhicules réfrigérés à plaques eutectiques et à portes latérales. Leur concept se base sur un stockage de froid à forte inertie thermique permis par l’utilisation de Matériaux à Changement de Phase (MCP). Aujourd’hui, les objectifs de protection environnementale et les contraintes qui en découlent pour les industriels conduisent à devoir optimiser ces systèmes et à repenser leur conception. Dans cette étude une démarche expérimentale et numérique a été adoptée dans le but de mieux comprendre le comportement thermique de ce type de véhicule à froid statique, et de prévoir l’évolution en température des produits transportés afin de garantir le respect de la chaine du froid. Des essais ont été réalisés en conditions simulées de fonctionnement (véhicule à l’arrêt) ainsi qu’en conditions réelles de fonctionnement (en livraison). La conception de deux prototypes a également été engagée, un premier qui contient une masse réduite de MCP et un deuxième qui n’en contient plus. En parallèle une modélisation semi-empirique de type nodale nous a permis de simuler différents systèmes caractérisés par des échanges thermiques par convection naturelle. Finalement une analyse multicritères des performances de trois concepts de véhicules a été menée selon un cahier des charges établi auprès d’un professionnel de la livraison à domicile de produits surgelésA type of frozen food home delivery vehicles consist of light commercial vehicles made of eutectic plates and multiple lateral doors. Their concept is based on the high thermal inertia of a cold storage made of a phase change material (PCM). Nowadays sustainability concern and consequences create opportunities and challenges to proof new concepts for this type of refrigerated vehicles and to optimize existing system design. In this study an experimental and numerical approach has enabled to better understand the thermal behavior of such static cold systems as well as to predict the temperature evolution in transported goods for the cold chain continuity. Two prototypes with a new design have been built, one containing a reduced masse of PCM and another one without any PCM. Tests under controlled conditions and field tests have been performed. Meanwhile, a semi-empirical nodal modeling has been developed and used to simulate these different systems dominated by natural convection. Finally, a multi criteria performance analysis has been made regarding the requirement of a frozen food delivery vehicle user
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Marlard, Sylvain. "Différenciation de filets de poisson frais de filets congelés/décongelés sur le modèle du bar (Dicentrarchus labrax)." Thesis, Littoral, 2013. http://www.theses.fr/2013DUNK0411.
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En alimentation humaine, le poisson représente non seulement une source importante de protéines mais il apporte aussi des acides gras essentiels et des minéraux. Actuellement, en France, il est majoritairement consommé sous forme fraîche et préparé en filets sans peau. Cependant, face à la diminution des captures, à l'augmentation de la demande et à l'évolution des modes de consommation, l'importation de produits de la mer est de plus en plus importante dans notre pays. Or, depuis quelques années, les importateurs suspectent des fraudes consistant à vendre des filets de poisson décongelés sous la dénomination "frais". Ces produits entrent ainsi en concurrence directe avec les produits de la pêche française. L'objectif de la thèse consiste à mettre au point et à optimiser des méthodes de différenciation des filets de poisson frais de filets décongelés. La technique de l'électrophorèse bidimensionnelle comparative couplée à la spectrométrie de masse nous a permis d'identifier la parvalbumine comme marqueur de différenciation frais/décongelé à partir des exsudats de filets de bar (Dicentrarchus labrax). Nous avons utilisé la composition des exsudats comme source potentielle d'autres indicateurs pour différencier les filets frais des filets décongelés. Nous nous sommes ainsi intéressés à différents paramètres tels que l'activité de l'α-glucosidase lysosomique (marqueur historique), le dosage du calcium libre et le dosage des nucléotides et de leurs dérivés, des protéines et des parvalbumines. Nous avons procédé à une analyse statistique par Classification Hiérarchique Ascendante (CHA) et nous avons ainsi mis en évidence trois groupes dissimilaires : les indicateurs de lyse cellulaire, les indicateurs d'altération des nucléotides et les indicateurs d'altération des protéines. Nous disposons ainsi d'outils de différenciation frais/décongelé complémentaires, rapides et peu onéreux susceptibles de répondre aux attentes des industriels de la filièreInhuman diet, seafood is an important source of proteins, essential fatty acids and minerals. Nowadays, in France, fresh fish is mainly consumed as skinless fillets. Due to the decrease of the fishing and the increase and evolution of fish consumption, the importation of fish becomes more significant in our country. Since several years, the importers suspect fraudulent pratices consisting in selling thawed fish fillets labeled as fresh ones. These products are directly in competition with the national fish market. The main aim of this thesis consisted in developing and improving methods to differentiate fresh versus frozen/thawed fish fillets. A comparative two-dimensional electrophoresis and tandem mass spectrometry proteins identification strategy, performed on fish fillet exudates of European sea bass (Dicentrarchus labrax) allowed us to identify parvalbumin as a protein marker for differentiation. Further analysis of exudates composition could be a good way to find other indicators. The lysosomal alpha-glucosodase activity is already used to differentiate fresh versus frozen/thawed fillets. Two new indicators were studied : concentration of the nucleotides and their derivatives and free calcium concentration. The total protein and the parvalbumin concentrations were also measured. An Ascendant Hierarchical Clustering (AHC) was done to aggregate the variables into three dissimular clusters : the cellular lysis indicators, the proteins damages indicators and the nucleotides alteration
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Magampa, Ramanare. "Surgeon directed transcranial motor evoked potential spinal cord monitoring in spinal deformity surgery: A review of viability, safety and efficacy." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32793.
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Aims Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury facilitating early intervention which has a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon directed intra-operative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon directed TcMEP is presented in terms of viability, safety and efficacy. Methods A retrospective review was performed on a single surgeon's prospectively maintained database from 2010 to 2017 where TcMEP monitoring was utilised. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude of the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analysed. Results Of the 299 cases were reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No case with normal traces had a post-operative clinical neurological deficit. True alerts occurred in 20 (6.7%) cases. The alert group diagnoses included adolescent idiopathic scoliosis 9 (45%) and congenital scoliosis 6 (30%). The incidence of deterioration based on diagnosis AIS was 9/153 (6%), congenital 6/30 (20%) and TB spine 2/16 (12.5%). Deterioration in congenital is much more common (p=0.02) when compared to AIS. 65% of alerts occurred during rod instrumentation and 15% during decompression of the internal apex in vertebral column resection surgery. 4 (20%) alert cases awoke with clinically detectable neurological compromise Conclusion Surgeon directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress and immediate intervention. In resource constrained environments, surgeon directed TcMEP is a viable and effective method of intra-operative spinal cord monitoring. Clinical relevance • Surgeon directed TcMEP monitoring has a 100% negative predictive value. • In resource constrained environments, surgeon directed TcMEP is viable and effective • Level 3 evidence
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Zolotaryova, A. "Plastic surgery." Thesis, Сумський державний університет, 2013. http://essuir.sumdu.edu.ua/handle/123456789/33929.
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Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand surgery, microsurgery, and the treatment of burns.
When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/33929
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Morkvin, Y., R. Kremeznoy, Наталія Ігорівна Муліна, Наталия Игоревна Мулина, and Nataliia Ihorivna Mulina. "Robotic surgery." Thesis, Сумський державний університет, 2013. http://essuir.sumdu.edu.ua/handle/123456789/31098.
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Surgery is a field of study that deals mainly with lives especially that of the human life. A lot of activities take place in the theatre, as surgeons and other medical personnel are usually faced with problem of saving human live via surgical operations. Sometimes, errors occur in course of operating on delicate parts of the body, which might result to severe injury and sometimes death due to inaccuracy on the side of surgeons. This is the reason why it is imperative that the issue of error should be corrected using a well developed machine called ROBOT to perform delicate surgical operations as they can only do that which they have been programmed for.
When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/31098
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Shen, Jun. "Framework for ultrasonography-based augmented reality in robotic surgery : application to transoral surgery and gastrointestinal surgery." Thesis, Rennes 1, 2019. http://www.theses.fr/2019REN1S078.
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Cette thèse porte sur le développement d’une solution de réalité augmentée dans le cadre de la chirurgie robotisée et plus particulièrement pour la chirurgie transorale des tumeurs de la base de langue et la chirurgie laparoscopique des cancers du bas rectum. Une des problématiques pour les chirurgiens est de repérer sur la vue endoscopique les limites de la tumeur et les marges de résections. Celles-ci sont en effet non visibles directement. L’échographie peropératoire est largement utilisée pour repérer les tumeurs lors des interventions. Nous proposons donc une solution de réalité augmentée dans laquelle l’information extraite de l’échographie est reprojetée sur la vision binoculaire de la station de chirurgie robotisée afin de guider le chirurgien dans la résection de la tumeur. Plusieurs verrous de cette chaîne de traitement ont été repérés et étudiés. Nous avons ainsi proposé une nouvelle méthode pour la calibration de sondes d’échographie. Nous avons démontré que cette méthode était plus facile à mettre en œuvre, plus rapide et plus précise que les méthodes proposées dans la littérature. Cette sonde calibrée, associée à des outils de localisation et de calibration de la sonde endoscopique nous a permis de proposer une solution de réalité augmentée qui permettait de reprojeter l’information acquise sur l’image sur la vue endoscopique avec des erreurs inférieures à 1 mm. Nous avons alors établi la preuve de concept de l’application de cette chaîne de réalité augmentée dans deux expérimentations, l’une sur un fantôme physique en silicone du rectum et l’autre sur une langue de mouton en ex-vivo. Les résultats expérimentaux ont montré que l’information augmentée avait permis au chirurgien de percevoir avec précision les marges de résections des tumeurs simulées et d’accomplir le geste opératoire à l’aide de cette perceptionThe medical context of this thesis is transoral robotic surgery for base of tongue cancer and robot-assisted laparoscopic surgery for low-rectal cancer. One of the main challenges for surgeons to perform these two surgical procedures is to identify the tumor resection margins accurately, because tumors are often concealed in base of tongues or rectal walls and there is lack of efficient intraoperative guidance systems. However, ultrasonography is widely used to image soft-tissue tumors, which motivates our proposition of an augmented reality framework based on intraoperative ultrasonography images for tumor resection guidance. The framework, proposed, with clinical partners, consists to adapt to the surgical workflow of robot-assisted surgery for treating base of tongue cancer and low-rectal cancer. For this purpose, we developed a fast and accurate 3D ultrasound probe calibration method to track the probe and facilitate its intraoperative use. Moreover, we evaluated the performance of the proposed framework augmenting an intraoperative endoscopic camera with ultrasound information, which shows less than 1mm error. Furthermore, we designed experimental protocols using a silicone rectum phantom and an ex-vivo lamb tongue, that simulate the integration of the implemented framework into the current surgical workflow. The experimental results show that, according to the augmented endoscopic views provided by the proposed framework, a surgeon is able to accurately identify the resection margins of the simulated tumors in these phantoms
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Hauck, Robert. "Virtual surgery and orthopaedic surgery : towards training using haptic technology." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/38530/.
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Medical education and practical training in surgery is changing, by shifting from an on the job learning paradigm, which possesses problems such as that it is unpredictable, dependent on clinical needs and that patient safety may be jeopardised, to an evidence-based surgical skills training driven by curricular needs, and acquiring basic surgical skills prior to assisting in the operating theatre and thus reducing operation duration. Towards achieving this goal, virtual reality (VR) simulators are used in minimally invasive surgery for technical skills training at the beginning of the learning curve, but have not yet been adapted for open surgery due to its complexity for simulation. This thesis investigated the potential of using a VR simulator for training in orthopaedic hand surgery, with an emphasis on providing a meaningful, effective and motivating addition to current training methods for surgical procedures. A review of literature, preliminary research projects and currently available surgical systems revealed limited results on whether a VR simulation of orthopaedic hand surgery could be created, fulfilling the needs of medical experts. Therefore, a study investigating the current state of medical education and to understand the expectations on such a simulator was carried out, which resulted in the identification of promising medical scenarios for simulation (such as carpal tunnel release, distal radius fracture treatment or surgical incision) and in requirements for its development. Different software frameworks have been evaluated for their ability for use by analysing five developed demonstrators, with the result that a custom implementation of a six-degrees-of-freedom haptic algorithm was required. By following a human-centred design approach, a VR surgical simulator with inbuilt objective measures of assessment has been developed, allowing applying a plate, drilling holes, measuring their lengths, inserting screws and taking virtual X-rays, supported by haptic feedback for increased realism and teaching aspects not possible by common computer-based simulators, such as feeling the resistance when drilling through the cortical bone. By close collaboration with medical experts and following user interface design principles, a carried out medical evaluation of the simulator showed that the simulator was well-received by the targeted young doctors and medical students, that relevant aspects of the implemented medical scenario are taught and that the users’ performance can be assessed. The findings of this work showed that it is possible to create an interactive VR simulator aimed at early stages to learn basic orthopaedic principles of open surgery using the example of the treatment of distal radius fractures in a meaningful manner. It addresses issues in the current medical education and enables learning educational objectives repeatedly in reusable medical scenarios and in a safe and controlled environment, without the risk of harming patients, and thus contributing to improved quality and patient safety when proceeding to the operating theatre.
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Streletskyi, Ye S., and S. S. Strizhak. "Robotics serving surgery." Thesis, Sumy State University, 2017. http://essuir.sumdu.edu.ua/handle/123456789/62810.
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Resch, Sylvia. "Hallux valgus surgery." Lund, Sweden : Dept. of Orthopedics, University Hospital, 1995. http://catalog.hathitrust.org/api/volumes/oclc/37990161.html.
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Rhodes, Andrew. "Outcomes from surgery." Thesis, St George's, University of London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.604015.
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This thesis explores the utility of critical care following surgery. In particular, it assesses whether there are differences in how countries provide for critical ca re following surgery and whether these impact on outcomes. A meta-analysis of pre-emptive haemodynamic interventions in surgery was shown to reduce complications and mortality. Many of these interventions required the use of critical care which limited their utility. An analysis of a quality Austrian critical ca re database enabled an understanding of the group of patients admitted to critical care following surgery and the factors that are important in determining outcome. By utilizing these factors in a hierarchical logistic regression model, I demonstrated that outcomes are improving. Unfortunately, the provision of healthcare is not the same throughout Europe. Extrapolating data from Austria to the United Kingdom is therefore difficult. A further study was completed to identify differences in critical care provision between European countries. This study was hampered by inconsistent definitions of what an intensive care bed is, although did find a worryingly wide difference in beds per head of population. This must have implications for the case mix of patients admitted (or refused) to critical ca re and therefore surgical outcomes. A final study was performed to assess whether there were differences in outcomes at a national level. In this large observational study, critical care utilization varied following surgery and mortality rates were higher than expected with significant differences found between individual countries. In conclusion, critical care is a vital part of the surgical pathway for a select group of patients. Unless this group can be understood and quantified, then healthcare providers will be unable to develop systems that are able to cope with the likely demand. Only by matching this demand will optimal ca re be delivered.
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Nguyen, Nga Quynh. "Surgery on frames." [College Station, Tex. : Texas A&M University, 2008. http://hdl.handle.net/1969.1/ETD-TAMU-2994.
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Avcil, Tuba [Verfasser], and Arkadiusz [Akademischer Betreuer] Miernik. "Single‑incision transumbilical surgery (SITUS) versus single‑port laparoscopic surgery (SPLS) versus conventional laparoscopic surgery (CLS) im Trainingslabor." Freiburg : Universität, 2019. http://d-nb.info/1206537043/34.
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Schmitt, Robin L. "BARIATRIC SURGERY: WHAT IS THE RELATIONSHIP BETWEEN BARIATRIC SURGERY PATIENTS AND THEIR SELF-EFFICACY TOWARD THE RECOMMENDATIONS OF BARIATRIC SURGERY?" Columbus, Ohio : Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1243907012.
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Watson, David Ian. "Improving outcomes following surgery for gastro-oesophageal reflux disease : laparoscopic antireflux surgery /." Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phw338.pdf.
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Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1998.Copies of the just first page of author's previously published articles inserted. Includes bibliographical references (leaves 227-254).
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Miyake, Makoto. "Early Surgery vs. Surgery After Watchful Waiting for Asymptomatic Severe Aortic Stenosis." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/264637.
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D'Urso, Paul Steven. "Stereolithographic biomodelling in surgery /." [St. Lucia, Qld.], 1998. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17881.pdf.
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de, Lorenzi Francesca. "Refinements in microvascular surgery." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 2003. http://arno.unimaas.nl/show.cgi?fid=6025.
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Bringman, Sven. "Minimally invasive hernia surgery /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-466-6/.
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Schuurman, Peter Richard. "Thalamic surgery for tremor." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2002. http://dare.uva.nl/document/65876.
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Tarazi, Kamal. "Computer assisted orthopaedic surgery." Thesis, Imperial College London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321608.
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Rowsell, Anthony Richard. "Intra-uterine foetal surgery." Thesis, University of Oxford, 1988. http://ora.ox.ac.uk/objects/uuid:5a97d2ca-ea8a-441a-890a-1a529b6897c3.
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Uppal, G. S. "Surgery for macular disease." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1333992/.
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The MD will primarily examine the role of surgery in the management of the wet form of age related macular degeneration (AMD) and secondarily for specific inherited macular dystrophies. It is postulated that in the early stages of wet AMD and other sub-foveal disorders involving choroidal neovascular membranes (CNV), photoreceptor loss is relatively limited with the disease confined to the sub-foveal layers, namely the choriocapilliaris-Bruch membrane-retinal pigment epithelium (RPE) interface. At this stage the retina is affected functionally and reversibly but with time the damage becomes permanent and irreversible. As such a critical window of opportunity exists to: 1. Salvage function from the existing photoreceptor pool before fibrovascular proliferation causes marked ‘irreversible’ photoreceptor loss 2. Treat any visual loss that may be due to secondary and potentially ‘reversible’ factors such as sub-foveal fluid and haemorrhage and 3. Mechanically restore normal anatomy. Previous attempts at sub-macular surgery have been associated with the loss of RPE in the area of the CNV during removal that secondarily causes degeneration of photoreceptors. Consequently, different innovative surgical approaches, including 360-degree macular translocation and full thickness autologous RPE transplantation, are under investigation for the management of sub-foveal CNV. The rationale of surgery in both techniques is to effectively restore the choriocapilliaris-Bruch’s-RPE interface beneath the foveal photoreceptors and rescue function before fibrovascular proliferation causes marked ‘irreversible’ photoreceptor loss. Pilot studies have been established to: 1. Examine the surgical feasibility and the anatomical and functional outcomes for each procedure 2. Investigate the pathophysiology of the underlying disease processes. In addition, a number of parameters will be investigated to evaluate the quality of recovery of vision. This will include assessing fixation stability, reading ability, histopathological studies and electrophysiological correlates.
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Mohamed, Bragheeth Mohamed Abd El-Naby. "Lamellar corneal refractive surgery." Thesis, University of Nottingham, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403907.
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Laidlaw, David Alistair Hunter. "Second eye cataract surgery." Thesis, University of Bristol, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322548.
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Perttunen, Kristiina. "Pain after thoracic surgery." Helsinki : University of Helsinki, 2003. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/perttunen/.
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Ashby, Elizabeth. "Morbidity following orthopaedic surgery." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10054431/.
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Morbidity following hip and knee arthroplasty has previously been poorly recorded. This is the first time the Post-Operative Morbidity Survey (POMS) has been used for this purpose. The POMS identifies clinically significant morbidity using indicators of organ system dysfunction rather than traditional diagnostic categories. The most common types of morbidity following hip and knee arthroplasty are infection and renal morbidity. Pulmonary, pain and gastro-intestinal morbidity are less common. Cardiovascular, wound, neurological and haematological morbidity are least common. Many arthroplasty patients remain in hospital without morbidity. The POMS identifies these patients and thus has potential as a prospective bed utilisation tool. To be used for this purpose, the POMS must identify all clinically significant morbidity. Mobility is an important factor for safe discharge of arthroplasty patients. Addition of a ‘mobility’ domain could improve the utility of POMS as a bed utilisation tool following orthopaedic surgery. This study showed no association between post-operative morbidity defined by the POMS and longer-term patient-reported outcome measures (PROMs). This study does not support the POMS as an early surrogate marker of long-term PROMs in orthopaedic patients. The wound domain of the POMS has a high specificity, reasonable sensitivity, high negative predictive value and low positive predictive value compared to the inpatient ASEPSIS (Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, inpatient Stay over 14 days) score. The wound domain of POMS could be replaced with a validated definition of wound infection such as ASEPSIS. On the same series of orthopaedic patients, surgical site infection (SSI) rate according to the Centres for Disease Control (CDC) definition was 15.45%, according to the Nosocomial Infection National Surveillance Scheme (NINSS) definition was 11.32% and according to the ASEPSIS definition was 8.79%. This highlights the need for a consistent definition of SSI.
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Hendry, Paul. "Enhanced recovery after surgery." Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/29151.
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The Enhanced Recovery After Surgery model of perioperative care targets the obstacles to recovery following major abdominal surgery: pain, gastrointestinal dysfunction and immobility. This model of care combines elements that have individually been shown to attenuate the surgical stress response, reduce postoperative analgesia requirement or maintain perioperative nutrition. Through combining these elements it has been possible to improve early postoperative function and reduce the requirement for hospital stay with an unaltered or even reduced complication rate. Within the available ERAS studies subjective postoperative outcomes are employed and it is difficult to assess the true contribution of many of the individual protocol elements to postoperative recovery. The reduction in length of stay, in itself, may represent more efficient use of inpatient care rather than an improved rate of functional recovery. Further refinement and validation of the ERAS model will be achieved by establishing randomised controlled trials that test its feasibility and effectiveness within other surgical specialties, establish objective, reproducible outcome measures and examine the specific contribution of individual protocol elements within the ERAS protocol. It is expected that further improvement in postoperative recovery may specifically rely on reducing gut dysfunction in the early postoperative period. The establishment of randomised controlled trials and objective endpoints will facilitate testing individual element that target gastrointestinal recovery. This thesis demonstrates that the application of an ERAS model of care to hepatic surgery is feasible and results in a reduction in postoperative stay similar to that seen in colorectal surgery. This suggests that the ERAS programme of care may be extrapolated to other surgical specialties. The present thesis also demonstrates that activity meters and stable isotope gastric empting breath tests can be employed in the early postoperative period to provide objective measures of postoperative recovery. Most significantly this thesis demonstrates through a randomised controlled trial that within an ERAS protocol early routine administration of laxatives can improve postoperative rate of gastrointestinal recovery following hepatic resection.
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Moonesinghe, S. R. "Risk in major surgery." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1418539/.
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A qualitative systematic review was conducted to assess the performance of tools which have been validated for the prediction of morbidity and/or mortality, in heterogeneous cohorts of surgical (non-cardiac, non-neurological) patients. The Portsmouth- Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) and the Surgical Risk Scale (SRS) were found to be the most widely validated and accurate risk stratification tools. The POSSUM, P-POSSUM and SRS were then validated in a population of patients who had major non-cardiac surgery in a metropolitan UK hospital. Their accuracy (discrimination) was compared against two novel predictors - the additive POSSUM score and the POSSUM physiology score. P-POSSUM and the additive POSSUM score predicted short-term mortality with high-moderate accuracy. The POSSUM Physiology score was moderately accurate and therefore worthy of further evaluation. Both POSSUM and P-POSSUM were poorly calibrated for this population. The relationships between perioperative risk, postoperative morbidity (measured using the Post Operative Morbidity Survey, POMS), postoperative length of hospital stay, and short-term mortality, were explored in a series of univariate analyses. There were differences in short-term mortality, and the patterns and prevalence of POMS-defined morbidity between surgical specialities. Cox Proportional Hazards Modelling, using time-dependent covariates, was undertaken to explore the independent relationship between perioperative risk, postoperative morbidity and long-term survival. POMS-defined neurological morbidity (prevalence 2.9%) was independently associated with reduced long-term survival. Prolonged postoperative morbidity, defined as the presence of POMS-defined morbidity on Day 15 post-surgery (prevalence 15.6%), conferred a relative hazard for death in the first 12 months post surgery of 3.52 (p<0.001; 95% C.I. 2.23-5.43) and for the next two years of 2.33 (p<0.001; 95% C.I. 1.56-3.50). Postoperative morbidity is a significant public health issue and poses a risk to longer-term survival; it would be an important measure of the quality of perioperative healthcare.
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Ali, Omair. "Outcomes of refractive surgery." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12262.
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Thesis (M.A.)--Boston UniversityProcedures to reshape the cornea to correct refractive errors have been a longstanding and fast-evolving area of interest for centuries. As recent advances in excimer laser technology allow keratorefractive treatments to deliver precise treatments with fewer associated risks and complications, the popularity of modern refractive procedures continues to grow at unprecedented rates. For this reason, it is imperative to continue correlating patient characteristics to outcomes so that refractive surgeons can more accurately foresee the results of the selected procedure. This study examined the outcomes of refractive surgeries at a full-scope ophthalmology clinic from January 2011 to November 2011. The main objectives of th is study were to determine the differences between the outcomes of LASIK vs. LASEK, Custom vs. Traditional treatment plans, myopic vs. hyperopic patients and MMC exposure vs. no MMC exposure (LASEK only). More importantly, the data was scrutinized to determine whether or not any of these treatments and/or patient characteristics correlated with poor visual outcomes or the need for an enhancement. Of the 590 myopic eyes treated with Custom LASIK, 90.85% (n=536 eyes) had UDVA of 20/20 or better, 96.10% (n=567 eyes) had UDVA of 20/25 or better and 99.32% (n=586 eyes) had UDVA of 20/40 or better. Of the 170 myopic eyes treated with Custom LASEK, 70.59% (n=120 eyes) had a UDVA of 20/20 or better, 82.94% (n=141 eyes) had a UDVA of 20/25 or better and 96.47% (n=164 eyes) had a UDVA of 20/40 or better. Of the 45 hyperopic eyes that were treated with Traditional LASIK, 44.44% (n=20 eyes) had postoperative UDVA of 20/20 or better, 62.22% (n=28 eyes) had postoperative UDVA of 20/25 or better and 82.22% (n=37 eyes) had postoperative UDVA of 20/40 or better. Of the 536 eyes receiving LASIK, 91.42% (n=490 eyes) had an UDVA of 20/20 or better, 96.46% (n=517 eyes) had an UDVA of 20/25 or better and 99.44% (n=533 eyes) had an UDVA of 20/40 or better. Of the 146 low or moderately myopic eyes receiving Custom LASEK, 74.65% (n=106 eyes) had an UDVA of 20/20 or better, 86.62% (n=123 eyes) had an UDVA of 20/25 or better and 96.48% (n=137 eyes) had an UDVA of 20/40 or better. Of the 54 highly myopic eyes treated with Custom LASIK, 85.19% (n=46 eyes) had an UDVA of 20/20 or better, 92.59% (n=50 eyes) had an UDVA of 20/25 or better, and 98.15% (n=53 eyes) had an UDVA of 20/40 or better. Of the 28 highly myopic eyes treated with Custom LASEK, 53.57% (n=15 eyes) had an UDVA of 20/20 or better, 64.29% (n=18 eyes) had an UDVA of 20/25 or better, and 96.43% (n=27 eyes) had an UDVA of 20/40 or better. An analysis of these data yields significantly greater percentages of myopic (low, moderate and high) eyes achieving 20/20 or better after treatment by Custom LASIK versus Custom LASEK. The data suggested no correlations between poor visual outcomes and/or the need for an enhancement treatment and intraoperative complications, magnitude of ametropia, pupil size, age, treatment type, and treatment plan. All of the LASEK patients who underwent an enhancement treatment were exposed to MMC during their original procedure. Hyperopic patients displayed significantly reduced visual outcomes than comparable myopic treatments. Future studies should investigate similar preoperative characteristics and attempt to correlate them to results to improve predictability and, thus, visual outcomes.
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Decadt, Bart. "Evidence-based laparoscopic surgery." Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268504.
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Zhang, Xingru. "Topics on Dehn surgery." Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/32117.
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Cyclic surgery on satellite knots in S³ is classified and a necessary condition is given for a knot in S³ to admit a nontrivial cyclic surgery with slope m/l, \m\ > 1. A complete classification
of cyclic group actions on the Poincaré sphere with 1-dimensional fixed point sets is obtained. It is proved that the following knots have property I, i.e. the fundamental group of the manifold obtained by Dehn surgery on such a knot cannot be the binary icosahedral group I₁₂₀, the fundamental group of the Poincaré homology 3-sphere: nontrefoil torus knots, satellite knots, nontrefoil generalized double knots, periodic knots with some possible specific exceptions, amphicheiral strongly invertible knots, certain families of pretzel knots. Further the Poincaré sphere cannot be obtained by Dehn surgery on slice knots and a certain family of knots formed by band-connect sums. It is proved that if a nonsufficiently large hyperbolic knot in S³ admits two nontrivial cyclic Dehn surgeries then there is at least one nonintegral boundary slope for the knot. There are examples of such knots. Thus nonintegral boundary slopes exist.Science, Faculty of
Mathematics, Department of
Graduate
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Almoudaris, Alex. "High performance in surgery." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/25511.
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The national identification of high performing providers in surgery is of prime importance to patients, surgeons and commissioners of healthcare. This thesis explores how high performance is identified, defined and measured nationally and attempts to identify the factors that underlie high performance in colorectal cancer surgery during the peri-operative period. An introduction into the determinants of high performance in surgery as well as defining quality as it pertains to surgery is then undertaken. Identification of available national data sources and metrics for national performance are then identified. Comparison is made between voluntary and compulsory reporting systems highlighting greater capture of peri-operative mortality in compulsory reporting datasets. A novel marker that reflects outcome following complication management is developed. This marker is based on re-operations and is derived from compulsory reporting datasets. The use of non-operative re-interventions is then assessed in oesophago-gastric cancer resections as proof of concept. An appraisal of all colorectal cancer units in England is then undertaken using a panel of metrics demonstrating that analysis on a single marker alone may be too simplistic. Identifying factors that pertain to high performance beyond those available from routinely available datasets using a novel methodological approach called HiPer (High Performance) is performed. The interview based methodology identified rich qualitative factors in a group of colorectal cancer units worldwide that may be causal in their performance status. Finally, results from the interview study were related to hard outcome data from each unit which demonstrated some correlation between the HiPer methodology and the outcome data in the final section of the feasibility study. The implications of this may be that a dual approach of analysing routinely collected data with a more qualitative HiPer style methodology may help us better understand how high performing units achieve their results.
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Мадяр, Володимир Васильович, Владимир Васильевич Мадяр, Volodymyr Vasylovych Madiar, and A. Magyfwa. "Surgery in pulmonary tuberculosis." Thesis, Видавництво СумДУ, 2011. http://essuir.sumdu.edu.ua/handle/123456789/15964.
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Aksenchuk, R. I. "Developent of the surgery." Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/25980.
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Salleh, Rosli. "Minimally invasive surgery training and tele-surgery system using VR and haptic techniques." Thesis, University of Salford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365996.
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Muallem, Jumana [Verfasser]. "Upper abdominal surgery in advanced epithelial ovarian cancer diaphragm surgery in focus / Jumana Muallem." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2019. http://d-nb.info/1202042821/34.
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Dinkelbach, Jonathan. "Equivariant Ricci-Flow with Surgery." Diss., lmu, 2008. http://nbn-resolving.de/urn:nbn:de:bvb:19-91361.
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Ribenis, Aksels. "Epilepsy surgery around language cortex." Diss., lmu, 2009. http://nbn-resolving.de/urn:nbn:de:bvb:19-98318.
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Nazaikinskii, Vladimir, and Boris Sternin. "On surgery in elliptic theory." Universität Potsdam, 2000. http://opus.kobv.de/ubp/volltexte/2008/2587/.
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We prove a general theorem on the behavior of the relative index under surgery for a wide class of Fredholm operators, including relative index theorems for elliptic operators due to Gromov-Lawson, Anghel, Teleman, Booß-Bavnbek-Wojciechowski, et al. as special cases. In conjunction with additional conditions (like symmetry conditions), this theorem permits one to compute the analytical index of a given operator. In particular, we obtain new index formulas for elliptic pseudodifferential operators and quantized canonical transformations on manifolds with conical singularities.
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Afilalo, Jonathan. "Frailty assessment before cardiac surgery." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=92222.
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Background: Frailty is a geriatric syndrome of impaired resistance to stressors which has been implicated in the pathogenesis and prognosis of cardiovascular disease. Our objective was to systematically explore the role of frailty in patients with cardiovascular disease, and determine the incremental prognostic value of frailty (as measured by gait speed) for predicting adverse events in elderly patients with cardiovascular disease undergoing cardiac surgery.Methods: After performing a systematic review of the literature, a multi-center prospective cohort of elderly patients undergoing cardiac surgery was assembled. Patients were evaluated with a questionnaire and timed 5-meter gait speed test, with frailty defined as a time taken to walk 5 meters ≥6 seconds. The composite endpoint was postoperative mortality or major morbidity.
Results: Based on nine previous studies, the prevalence of frailty was found to be 2-4 fold greater in patients with cardiovascular disease. Two studies suggested that frailty was a risk factor for mortality, although none specifically addressed frailty as a risk factor for adverse events in response to a cardiac surgery. Our cohort consisted of 131 patients undergoing cardiac surgery with a mean age of 75.8±4.4 years and 34% females. Thirty patients experienced the composite endpoint and frailty (slow gait speed) was an independent predictor (odds ratio 3.05, 95% confidence interval 1.23, 7.54). Addition of frailty to traditional risk assessment models resulted in notable improvements in model performance.
Conclusion: The prevalence of frailty is increased in patients with cardiovascular disease. Frailty, as measured by 5-meter gait speed, is a simple and effective test to identify a subset of vulnerable elders who have an incrementally higher risk of adverse events after cardiac surgery. Further studies are needed to validate the optimal cut-off for slow gait speed.
Objectif: La fragilité est un syndrome gériatrique qui signifie une diminution de la résistance au stress physiologique impliquée dans la pathogénèse et le pronostique des maladies cardiovasculaires. Notre objectif était de revoir de façon systématique le rôle de la fragilité dans les maladies cardiovasculaires et de déterminer la valeur incrémentielle de la fragilité (telle que mesurée par la vitesse de marche) pour prédire la mortalité et la morbidité chez les sujets âgés atteints de maladie cardiovasculaire subissant une chirurgie cardiaque.
Méthodes: Après avoir revu la littérature systématiquement, une cohorte multicentrique prospective de sujets âgés subissant une chirurgie cardiaque a été assemblée. Les sujets ont été évalués à l'aide d'un questionnaire et du test de vitesse de marche sur 5 mètres avec la fragilité définie comme étant un temps ≥6 secondes pour marcher 5 mètres. L'issue primaire étant un composé de la mortalité postopératoire et des complications majeures.
Résultats: Neuf études précédentes ont démontré que la prévalence de la fragilité était 2-4 fois plus élevée chez les patients avec une maladie cardiovasculaire. Deux études ont démontré que la fragilité était un facteur de risque pour la mortalité, cependant, aucune étude n'avait précisément adressé la fragilité comme facteur de risque après une chirurgie cardiaque. Notre cohorte incluait 131 sujets subissant une chirurgie cardiaque dont l'âge moyen était de 75.8±4.4 ans et 34% étaient des femmes. Trente patients ont développé l'issue primaire et la fragilité (faible vitesse de marche) était un prédicteur indépendant (odds ratio 3.05, 95% confidence interval 1.23, 7.54). L'inclusion de la fragilité au modèle de prédiction traditionnel a eu comme résultat une nette amélioration des performances du modèle.
Conclusion: La prévalence de fragilité est plus élevée chez les sujets âgés atteints de maladie cardiovasculaire. La vitesse de marche est un test simple et efficace pour identifier une sous-population de patients vulnérables ayant un risque plus élevé de mortalité et morbidité après une chirurgie cardiaque. D'autres études sont nécessaires pour valider la valeur seuil optimale de vitesse de marche.
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Harfmann-Ludwig, Susanne. "Bowel habits after bariatric surgery /." [S.l.] : [s.n.], 2009. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Warnock, Fay F. "Children's recovery from day surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq21271.pdf.
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Lundin, Anders. "Corticosteroids in Lumbar Disc Surgery." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6126.
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Jersenius, Ulf. "New techniques in liver surgery /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-596-8/.
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Widman, Jan. "Blood saving in orthopaedic surgery /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-220-5.
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Bjessmo, Staffan. "Surgery for acute coronary syndromes /." Stockholm, 2000.
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Otto, Gregory M. "Gustatory sweating after parotid surgery /." Title page, contents and abstract only, 1987. http://web4.library.adelaide.edu.au/theses/09MS/09ms091.pdf.
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Hoffman, Anton. "The surgeon´s third hand." Thesis, Umeå universitet, Designhögskolan vid Umeå universitet, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-110711.
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The biggest technical development within the field of surgery is focused on minimal invasive procedures. With new robot assisted solutions can the surgeons work more precise with a great level of flexibility. The work is nevertheless connected to a long set-up time and big costs. This project, based on pure user studies and in-depth surgery observations, discovers a possibility to, in a cost efficient way, offer robot benefits to an open surgery scenario. With a minimal effort can the surgeon merge the suggested product concept into their regular workflow and enhance the stability in their movements, get improved vision and aid in holding tissue in static positions.