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Thesis (doctoral)--Chirurgisch-Medicinische Akademie zu Dresden. / Praeses ascribed to Burkhard W. Seiler by Gesamtvereichnis des deutschsprachigen Schrifttums (GV) 1700-1910. Half title, p. [17]: De cura herniae radicali per ligaturam. Imprint date in roman numerals. Includes bibliographical references.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 9, 2009). Includes bibliographical references (p. 92-115).

Orientadores: Silvia Regina Brandalise, Alejandro Enzo Cassone / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T19:12:23Z (GMT). No. of bitstreams: 1 Mendonca_SandraMariaHolandade_M.pdf: 1479631 bytes, checksum: 5ee76bf19344482d5af7b11bf4c31770 (MD5) Previous issue date: 2007 / Resumo: Introdução: O Osteossarcoma e o Sarcoma de Ewing são as principais neoplasias malignas primárias ósseas, que acometem indivíduos menores de 15 anos de idade. A cirurgia com preservação do membro faz parte do tratamento atual. O objetivo do estudo foi comparar retrospectivamente, os resultados funcionais dos pacientes submetidos à ressecção do fêmur distal e reconstrução com endoprótese não convencional parcial ou total do joelho. Material e Método: Foram analisados 26 pacientes portadores de sarcomas ósseos da extremidade distal do fêmur, admitidos no Centro Infantil Boldrini, no período de janeiro de 1990 a dezembro de 2003. Vinte e quatro pacientes eram portadores de Osteossarcoma e 2 de Sarcoma de Ewing. Quinze pacientes foram reconstruídos com endoprótese total de joelho e 11 com endoprótese parcial de joelho. Foram considerados as variáveis idade, gênero, tipo de reconstrução do membro, dor, aceitação emocional, estabilidade, movimento, deformidade, força e atividade funcional. O sistema de avaliação foi o proposto por Enneking (1987) e preconizado pela Musculoskeletal Tumor Society. Para a comparação das médias entre cada critério e, também, entre os escores finais, utilizou-se o teste de Wilcoxon, com erro alfa de 5%. Resultados: A idade variou de 5 a 21 anos, mediana=11,9 anos. A predominância foi no sexo feminino (61,5%). Na avaliação funcional, a comparação entre as médias de cada critério, foi encontrada diferença estatisticamente significativa somente relacionada ao critério estabilidade (p=0,0037). Nos demais critérios avaliados, não foi observado diferença estatisticamente significativa: movimento (p=0,7546), dor (p=0,4848), deformidade (p=0,8695), força (p=1,0000), atividade funcional (p=0,9127) e aceitação emocional (p=0,5866). Conclusão: O escore final da avaliação funcional global não apresentou diferença estatisticamente significativa (p=0,6027). O tipo de reconstrução com endoprótese distal do fêmur não interferiu nos resultados funcionais dos pacientes / Abstract: Introduction: Osteosarcoma and Ewing¿s Sarcoma are the two most common malignant primary bone neoplasms in individuals under the age of 15 years. Limb sparing surgery is a recent method of treatment. The purpose of the study is to compare functional results of patients who underwent distal femur resection and reconstruction with a hemi or total knee endoprosthesis. Methods: Were reviewed 26 patients with bone sarcomas of the distal femur admitted at Boldrini¿s Children Center between January 1990 and December 2003. Twenty-four patients presented an Osteosarcoma and the other two ones an Ewing¿s sarcoma. Fifteen patients were submitted to a total endoprosthesis and eleven to a partial one. Variables as age, sex, type of reconstruction, pain, emotional acceptance, stability, movement, deformity, strength and functional activities were studied. The evaluation system has been proposed by Enneking (1987) and preconized by The Musculoskeletal Tumor Society. For the statistical analysis among criteria and final scores the Wilcoxon test was used, with an alpha error of 5%. Results: The age ranged from 5 to 21 years, mean 11.9 years; 61.5% were female. The only statistically significant difference found in this study was related to stability (p=0.0037). No statistical significance was found on any other criteria like movement (p=0.7546), pain (p=0.4848), deformity (p=0.8695), strength (p=1.0000), functional activities (p=0.9127) and emotional acceptance (p=0.5866). Conclusion: The final score between both types of endoprosthesis did not present a statistically significant difference (p=0.6027). The type of implant for limb reconstruction did not affect the patient¿s functional results / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

At present, there is no cure for bone metastasis. The current goals in patient care are to palliate pain, prevent pathological bone fracture and increase the strength and function of bone, so as to extend the life expectancy and maintain a good quality of life. Bisphosphonate treatment is the currently standard therapy of bone metastasis and is commonly used by physicians; it alleviates the tumour-induced hypercalcemia in 90% of patients and reduces the metastatic bone pain in 50% of patients. Moreover, it also prevents the pathological fracture of the affected bones. However, while effective, bisphosphonate injections are very costly, though its oral formulation is less expensive it is also less efficacious, and causes gastrointestinal discomfort. Furthermore, prolonged use of bisphosphonate treatment may lead to certain adverse effects, including hypocalcemia. These factors will prohibit the longterm use of such medication as it can negatively affect the treatment outcome. / Based on enormous medical potentials illustrated by the aforementioned findings, BBYNG deserves wider clinical application, large-scale clinical study on its preventive effect against bone metastasis and detailed investigation of its mode(s) of action in the body. / Based on the above-described understanding of Chinese medicine and bone metastasis, supplementing the kidney and strengthening bone could be the basic principle for the treatment of bone metastasis using Chinese medicine. In view of this theory, and in addition to the clinical observation and a thorough search of the available literature, we selected relevant kidney-tonifying Chinese herbs, namely (Fructus Ligustri Lucidi), (Rhizoma Drynariae), (Herba Epimedii), (Psoralea Corylifolia) and wide-spectrum anticancer herbs (Herba Hedyotidis Diffusae) for the preparation of a combined formula--BBYNG. / Chinese medicine has long been used to treat cancers. Its advantages reside in its holistic properties, which bring palliative, corrective and convalescing functions against damage caused by radiotherapy, chemotherapy and surgery. These features position Chinese medicines as the adjuvant to orthodox cancer treatment. During the late stage of tumour development, when standard therapy is no longer effective, Chinese medicine plays a critical role as an integrated therapy. Searching for a safe, inexpensive and effective Chinese medicine preparation suitable for prolonged use as adjunct therapy in late cancer cases is of paramount importance. / Clinical results. Both Chinese medicine and Western medicine treated patients showed no significant change in their blood parameters or liver and kidney examinations before and after drug administration; Male subjects on BBYNG, their bone mass density remained stable after 6 months treatment and the subjects on OSTAC showed slightly decreased In females, subjects on BBYNG remained stable, but subjects on OSTAC slightly increased. / Clinical study. The study was designed as a randomized, parallel-group comparison between BBYNG formula and Bisphosphonate. The patients who meet the inclusion/exclusion criteria were randomly assigned to receive either BBYNG granules, which was prepared by a GMP manufacturer, or Clodronic acid. The treatment period was 6 months (24 weeks). For both groups, various clinical parameters such as body functions, blood examinations, bone density (BMD) assessment, X-ray examinations, pain intensity and quality of life were evaluated and compared. / Conclusions. (1) As an adjuvant to patients with bone metastases, BBYNG is effective in relieving the metastatic bone pain, improving the quality of life. (2) In the animal model, BBYNG reduced the metastatic bone damage, prolonged the survival and enhanced the T lymphocyte immunity in the tumour-bearing mice. (3) In vitro study on the breast and lung cancer cell lines showed that BYYNG could induce apoptosis and prevent tumour cell invasion. It suggests that BYYNG may restrict tumour growth and development, thus reducing the occurrence of bone metastasis. / In accordance with Chinese medicine, bone metastasis can be categorized into "bone tumour" "bone erosion" "bone wilting" "bone necrosis" and "bone impediment". The main cause of bone metastasis is twofold: cancer toxicity, and in Chinese medicine theory, the kidney governs the bone marrow, if the kidney is not functioning in balance, then the bone will become weak. Cancer toxicity is the "pathogenic cause" to skeletal metastases, while kidney weakness decreases the body defence against the cancer. A vicious cycle ensues when cancer and kidney deficiency and bone weakness occurs simultaneously coincidently and worsens the conditions. / In vitro study on tumour cell lines. The anticancer effects of different concentrations of BBYNG formula and various single components against human breast cancer and lung cancer cell lines were evaluated by cell viability test (MTT assay), cell apoptosis test and invasion suppression test. / In vitro study results. BBYNG and the aqueous extracts of its component herbs at very low drug concentrations stimulated the growth of three tumour cell lines tested. When the concentrations were slightly increased, they showed an inhibitory effect on cancer cell proliferation. As the drug concentrations further increased, the extracts showed cytotoxic effects on these tumor cells. At the noncytotoxic dose, the extracts could trigger apoptosis and enhance the caspase-3 activity in all three tumour cell lines. In addition, at this "non toxic" concentration, the extracts markedly inhibited the in vitro invasive property of the 4T1 breast cancer cell lines in our Matrigel invasion model. Thus these in vitro results suggested that BBYNG possess anticancer, invasion-inhibitory and anti-metastatic activities. / In vivo animal study results. (Tumour growth was slower in the BBYNG treatment group when compared to the OSTAC and control groups, but this was not significantly difference) BBYNG significantly delayed tumour growth in tumour bearing mice, but it did not minimize the tumour size markedly. Moreover, BBNYG did minimize the mobility restriction caused by tumours, reduce the damage to bones, prolong the survival time and enhanced the T lymphocyte immunity. / In vivo animal study. A well-established animal model for breast cancer was used to evaluate and compare the pharmacological effects of BBYNG formula and Clodronic acid, as shown by different indicators such as tumour progression, animal's mobility, survival time, bone metastasis-induced fracture intensity and the immunological status of the tumour-bearing mice. / Malignant tumour is characterized by early metastasis. Among them 37 to 80 (depending on which type of cancer) patients show tendency of bone metastasis. Bone metastasis is usually accompanied by various complications, such as severe pain, pathological bone fracture, hypercalcemia, and bone marrow suppression, which can substantially affect the quality of life of the patients. Thus, the prevention and treatment of bone metastasis in cancer is an issue worth pursuing. / Malignant tumours leading to high mortality and morbidity are a serious threat to human health. It is the leading cause of death in China. In Hong Kong, there are over 20 thousand new cancer cases and more than 1100 people die due to cancers every year. / Study objectives. To elucidate the efficacy and some pharmacological aspects of BBYNG in regard to the treatment of bone metastasis through clinical observation and different laboratory experiments. This study would be of significant reference value to the disease-oriented drug formulation and application, mechanistic study and research methodology of the treatment of bone metastasis using Chinese medicines. / The clinical and laboratory experimental results are summarized as below: / The research study is composed of three parts, the clinical study, in vivo animal study and in vitro study on tumour cell lines. The research methods used are as follows: / Those on BBYNG treatment showed more a stable and satisfactory quality of life than those in the Western medicine-treated group. For the Clodronic acid treatment group, patients generally showed worsened symptoms and quality of life deteriorated. The ECOG index of the BBYNG group was statistically better than that of the Clodronic acid group. Within the 72-week clinical observational period, the mortality of Clodronic acid group is significantly higher that of the BBYNG group. The effects of BBYNG group as presented in relieving the pain-induced influence on patients' emotion, interpersonal relationship and entertainment was more pronounced than that in the Clodronic acid group. / Wu Ka. / 論文(哲學博士)--香港中文大學, 2006. / 參考文獻(p. 299-324). / Adviser: Leung Ping Chung. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1570. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / School code: 1307. / Lun wen (zhe xue bo shi)--Xianggang Zhong wen da xue, 2006. / Can kao wen xian (p. 299-324). / Wu Ka.

A ressecção ampla do trajeto de biópsia junto ao tumor faz parte da técnica cirúrgica oncológica para evitar os riscos de implante de células tumorais e recidiva local e/ou sistêmica da doença. O objetivo deste estudo foi verificar se havia risco de contaminação por células neoplásicas no trajeto da biópsia. Realizou-se um estudo prospectivo dos trajetos de biópsias de pacientes operados por tumores musculoesqueléticos malignos no Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo no período de abril de 2006 a abril de 2007. Foram estudados por histopatologia 25 casos. Houve implante de células neoplásicas em 32% dos trajetos. Quando foram correlacionados os resultados dos estudos dos trajetos e o uso de quimioterapia neo-adjuvante (p=0,19) não houve significância, mostrando que mesmo com esse tratamento o risco de implante existe. As alterações histológicas mais comuns foram: fibrose acentuada, componente inflamatório leve e neovascularização acentuada. Sugerimos a ressecção tradicional oncológica do trajeto junto com a peça / Wide resection of biopsy tracts to tumors forms part of oncological surgical techniques because of the risk of tumor cell implantation and local and/or systemic disease recurrence. The aim of this study was to investigate the risk of seeding by neoplastic cells along biopsy tracts. This was a prospective histopathological study on biopsy tracts in 25 patients who underwent operations due to malignant musculoskeletal tumors, at the Institute of Orthopedics and Traumatology, School of Medicine of the University of São Paulo, between April 2006 and April 2007. Neoplastic cells were found implanted in 32% of the tracts. Correlation of the results from studying the tracts with the use of neoadjuvant chemotherapy did not present significant findings. This shows that, even with chemotherapy, the risk of implantation exists. The most common histological abnormalities in positive cases were classified as severe fibrosis, mild inflammatory component and severe neovascularization. We suggest that oncological resection of the tract should be carried out together with excision of the specimen

A partir de células de osteossarcoma humano (MG-63) que tem características de osteoblastos imaturos produzimos anticorpos monoclonais (Mabs) nomeados PSP 4-5, PSP 42-22 e PSP 85-9. Esses anticorpos reconhecem antígenos de 100, 26 e 20 kDa respectivamente. Avaliamos a especificidade dos mesmos, testando suas expressões em cortes congelados de tecidos oriundos da mesma célula mesenquimal, ou seja, osso, cartilagem, músculo cardíaco e tecido adiposo. Os anticorpos marcaram o periósteo, com distintos padrões de expressão, porém o PSP 42-22 foi o mais específico marcando a camada osteogênica do periósteo. Os anticorpos marcaram também células ósseas. Diante desses resultados nosso objetivo, no presente estudo, foi identificar os antígenos reconhecidos por esses anticorpos usando clonagem e sequenciamento dos genes em biblioteca de cDNA com capacidade de expressão proteica. Outro objetivo foi testar os anticorpos, pela técnica de imunohistoquímica (IHQ), em tumores ósseos primários visando estabelecer os padrões de marcação e se diferenciavam os diferentes tipos de tumores. Os antígenos reconhecidos pelos anticorpos PSP 42-22 e PSP 85-9 foram isolados, purificados e sequenciados. Devido ao elevado peso molecular do PSP 4-5 necessitaremos de outras técnicas para isolar o clone que codifica seu antígeno. O sequenciamento do clone isolado pelo PSP 42-22, mostrou uma sequência com 99% de homologia descrita no \"Homo sapiens\" como sendo \"serologically defined colon cancer antigen 3 (SDCCAG3), transcript variant 3\". A proteína SDCCAG3 foi descrita pela primeira vez em 1998 como um antígeno de câncer de cólon reconhecido por anticorpo autólogo. Vale lembrar que antígeno reconhecido pelo nosso anticorpo tem um peso molecular de aproximadamente 26 kDa, inferior ao da proteína SDCCAG3. Essa diferença poderia ocorrer devido a uma diferença no local da tradução do mRNA das células MG-63, produzindo uma proteína menor (isoforma), ou no clone isolado (3B2-3-1), poderia ocorrer uma mutação produzindo uma proteína mais curta que se expressaria na membrana celular ao contrário de uma proteína mais longa. Já o alinhamento das sequências obtidas dos clones isolados utilizando o PSP 85-9, mostrou uma sequência com 100% de concordância descrita com a porção não codante da proteína \"Homo sapiens microtubule associated protein, RP/EB family, member 1 (MAPRE1)\" portanto um falso positivo; já o clone 1A5-1-3, mostrou uma sequência de 99% de homologia com a proteína \"Homo sapiens Yip1 interacting factor homolog B (S. cerevisiae) (YIF1B), transcript variant 8\". Trata-se de uma proteína de membrana, com 6 isoformas diferentes que pode interagir com o receptor de serotonina. O resultado da IHQ nos tumores ósseos testados mostrou que o PSP 4-5 se expressou predominantemente no citoplasma de osteossarcoma, condrossarcoma e leiomiossarcoma e no núcleo de osteoblastoma. O anticorpo PSP 42-22 não reconheceu nenhum antígeno nos tumores avaliados. Quanto ao anticorpo PSP 85-9 nos condrossarcomas e leiomiossarcomas a expressão foi predominante citoplasmática e nos osteossarcomas e osteoblastoma foi nuclear. Em conclusão, identificamos os antígenos de dois dos anticorpos estudados que apresentam potencial diagnóstico diferencial em tumores ósseos primários / From human osteosarcoma cells (MG-63), which have characteristics of immature osteoblasts, we produced monoclonal antibodies (Mabs) named PSP 4-5, PSP 42-22 and PSP 85-9. These antibodies recognize antigens with 100, 26 and 20 kDa, respectively. We evaluated their specificity by testing their expression in frozen tissue sections from the same mesenchymal cells, that is, bone, cartilage, cardiac muscle and adipose tissue. The antibodies stained the periosteum, with distinct patterns of expression, but PSP 42-22 was the most specific, scoring the osteogenic layer of the periosteum. The antibodies also marked bone cells. With these results, our goal in this study was to identify the antigens recognized by these antibodies using cloning and sequencing of the genes in the cDNA library with capacity of protein expression. Another objective was to test the antibodies by immunohistochemistry (IHC) in primary bone tumors to establish standards for marking and whether they set apart different types of tumors. The antigens recognized by the PSP 42-22 and PSP 85-9 antibodies were isolated, purified and sequenced. Due to the high molecular weight of PSP 4-5 we will need other techniques to recognize its antigen. Sequencing of the clone isolated using the PSP 42-22 showed a sequence with 99% homology described in \"Homo sapiens\" as being \"serologically defined colon cancer antigen 3 (SDCCAG3), transcript variant 3\". The SDCCAG3 protein was first described in 1998 as a colon cancer antigen recognized by autologous antibody. It is worth remembering that the antigen recognized by our antibody has a molecular weight of approximately 26 kDa, lower than the SDCCAG3 protein. This difference could be due to a difference in mRNA translation site of MG-63 cells producing a lower protein; or on the isolated clone (3B2-3-1) a mutation could occur producing a shorter protein that expresses in the cell membrane instead of a longer protein. The alignment of the sequences obtained from isolated clones using the PSP 85-9 showed a sequence with 100% of homology described with the non-coding protein portion \"Homo sapiens microtubule associated protein, RP/EB family, member 1 (MAPRE1), mRNA\" therefore, a false positive; 1A5-1-3 clone showed a 99% homology sequence with the protein \"Homo sapiens Yip1 interacting factor homolog B (S. cerevisiae) (YIF1B), transcript variant 8, mRNA\". It is a membrane protein with 6 different isoforms which can interact with the serotonin receptor. The result of IHC in bone tumors tested showed that PSP 4-5 expressed predominantly in the cytoplasm of osteosarcoma, chondrosarcoma, leiomyosarcoma and osteoblastoma in was in nucleus. The PSP 42-22 antibody did not recognize any antigen in the tumors examined. As for the PSP 85-9 antibody in chondrosarcoma and leiomyosarcoma, the expression was predominantly cytoplasmic and the osteoblastoma was nuclear in osteosarcomas. In conclusion, we have identified the antigens of two of the antibodies studied which have potential differential diagnosis in primary bone tumors

Objetivo: Este estudo foi realizado com objetivo de traduzir para o português do Brasil e validar a ferramenta Musculoskeletal Tumor Society Rating Scale (MSTS) para avaliação da função em pacientes com sarcomas ósseos dos membros inferiores. Método: A ferramenta MSTS foi traduzida da língua inglesa para o português do Brasil. As versões traduzidas foram sintetizadas em uma versão de consenso que foi retrotraduzida para o inglês e analisada por um comitê multidisciplinar para posterior aplicação da ferramenta. O questionário foi aplicado em 67 pacientes operados por tumores musculoesqueléticos ósseos malignos de membros inferiores com cirurgia preservadora de membro ou amputação. Este grupo também preencheu uma versão validada em Português do Toronto Extremity Salvage Score (TESS). Foram realizadas as análises de confiabilidade do teste e reteste, confiabilidade interobservador, consistência interna, validação do instrumento e correlação com o TESS. Resultados: A confiabilidade do teste e reteste e interobservadores foi feita através da análise dos coeficientes de correlação intraclasse (ICC) com valores de 0,92 e 0,98 respectivamente (intervalo de confiança de 95%). Na análise da consistência interna, o valor do coeficiente alfa de Cronbach foi de 0,84. A correlação entre as ferramentas MSTS e TESS foi moderada. Conclusão: A ferramenta MSTS foi traduzida e validada para o Português do Brasil e mostrou ser confiável para aplicação em pacientes com sarcomas ósseos de membros inferiores. Isto possibilitará a avaliação funcional dos pacientes brasileiros e comparação com resultados de estudos multicêntricos / Objective: This study was designed to translate and validate the Brazilian version of the Musculoskeletal Tumor Society Rating Scale (MSTS) for functional evaluation in patients with lower extremity bone sarcomas. Method: The MSTS was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English and reviewed by a multidisciplinary committee for further implementation. The questionnaire was administered to 67 patients treated for malignant lower extremity bone tumors who were submitted to limb salvage surgery or amputation. They also completed a Brazilian version of the Toronto Extremity Salvage Score (TESS). Scale reliability and validity were evaluated. Results: Testretest reliability and interobserver analysis were performed using the intraclass correlation coefficients (ICC) with values of 0,92 and 0,98 respectively (confidence interval 95%). Cronbach\'s alpha was used to estimate internal consistency (0,84). There was mild correlation between MSTS and TESS. Conclusion: The Brazilian version of the MSTS was translated and validated. It is a reliable tool to assess functional outcome in patients with lower extremity bone sarcomas. It can be used for functional evaluation of Brazilian patients and cross-cultural comparisons

Dissertation (Ph.D.)--University of South Florida, 2007. / Includes vita. Includes bibliographical references. Also available online.

Thesis--Copenhagen. / Summary in Danish. Includes bibliographical references (p. 202-221) and index.