Made available in DSpace on 2015-04-14T13:35:34Z (GMT). No. of bitstreams: 1 440859.pdf: 1769440 bytes, checksum: 1b3b990746636f5c1f4b9a971b320293 (MD5) Previous issue date: 2012-03-26 / Introduction: As a chronic disease which is highly prevalent, epilepsy has an important impact on the affected person's psychic/cognitive functioning and their family and social relationships. Among refractory epilepsies, epilepsy of the temporal lobe (ETL) is the most frequent in adults. Studies about lesions on the hippocampus and their effects found that patients with ETL presented verbal and visual memory deficits, depending on the affected hemisphere. Refractoriness to clinical treatment leads to the recommendation of surgery when it is seen that up to that point there have not been any other therapeutic alternatives available. In this context, there is a glimpse of a new treatment possibility for refractory epilepsies, using stem cells. These present a large capacity for proliferation and auto-renovation and the capacity to respond to external stimuli and give rise to different, more specialized cell lines. Objectives: To evaluate the effect of autologous stem cell transplants of bone marrow on the memory functions of patients with refractory epilepsy of the mesial temporal lobe. Patients and Methods: The selection of patients was done at the Outpatient Center for Clinical Epilepsy Research at PUCRS S?o Lucas Hospital [Ambulat?rio de Pesquisa Cl?nica em Epilepsia do Hospital S?o Lucas da PUCRS]. The 13 patients submitted themselves to therapy, and they were evaluated before and after the stem cell treatment (3 and 6 months after). The tests utilized for neuropsychological evaluation (pre and post-therapy) include the Wechsler Memory Scale revised (WMS-R), the Rey Auditory Verbal Learning Test (RAVLT) and the Taylor Complex Figure. Results and Conclusions: The results indicate a significant increase in the neuropsychological scores over time. In six out of seven utilized tests, the increase of average score obtained was significant. In only one test (visual reproduction I WMS R), the increase showed limitrofe statistical significance (between 5% and 10%). Given the favorable evolution of those patients analyzed, the stem cell transplant showed itself to be feasible, safe and with important perspectives for rehabilitation as well as psychosocial and professional reinsertion. / Introdu??o: A epilepsia, enquanto condi??o cr?nica de alta preval?ncia tem impacto importante no funcionamento ps?quico/cognitivo e nas rela??es familiares e sociais da pessoa acometida. Entre as epilepsias refrat?rias, a epilepsia do lobo temporal (ELT) ? a mais freq?ente em adultos. Estudos sobre les?es no hipocampo e seus efeitos, constataram que pacientes com ELT apresentam d?ficits de mem?ria verbal e visual, dependendo do hemisf?rio acometido. A refratariedade ao tratamento cl?nico, leva ? indica??o cir?rgica, visto que at? o momento, n?o est?o dispon?veis outras alternativas terap?uticas. Neste contexto, se vislumbra uma nova possibilidade de tratamento para as epilepsias refrat?rias, utilizando-se c?lulas-tronco (CT). Estas apresentam grande capacidade de prolifera??o e auto-renova??o e capacidade de responder a est?mulos externos dando origem a diferentes linhagens celulares mais especializadas. Objetivos: Avaliar o efeito do transplante aut?logo de c?lulas-tronco da medula ?ssea (CTMO) nas fun??es de mem?ria de pacientes com epilepsia refrat?ria do lobo temporal mesial. Pacientes e M?todos: A sele??o dos pacientes foi realizada no Ambulat?rio de Pesquisa Cl?nica em Epilepsia do Hospital S?o Lucas da PUCRS. Os 13 pacientes que se submeteram ? terapia, foram avaliados antes e ap?s o tratamento com c?lulas-tronco (3 meses e 6 meses depois). Os testes utilizados para avalia??o neuropsicol?gica: Escala de Mem?ria Wechsler-revisada (WMS-R), Teste de Aprendizado de Mem?ria Verbal de Rey (RAVLT) e Figura Complexa de Taylor. Resultados e Conclus?es: Os resultados indicam um aumento significativo nos escores neuropsicol?gicos ao longo do tempo. Em seis dos sete testes utilizados, o acr?scimo no escore m?dio obtido foi significativo e, em apenas um teste (WMS R visual imediato), o acr?scimo apresentou signific?ncia estat?stica lim?trofe (entre 5% e 10%). Dada a evolu??o favor?vel dos pacientes analisados, o transplante de CTMO mostrou-se fact?vel, seguro e com perspectivas importantes para a reabilita??o e reinser??o psicossocial e profissional.

Made available in DSpace on 2015-04-14T13:35:34Z (GMT). No. of bitstreams: 1 441495.pdf: 393716 bytes, checksum: 44d5110d0dc89507b042452bde0134c9 (MD5) Previous issue date: 2012-08-29 / Objective: The aim of this study was to evaluate the relationship between body weight gain and small solute transport by the peritoneum Methods: A retrospective review was conducted of the records from 50 patients over the age of 18 years, all of whom had undergone peritoneal dialysis for at least one year. Weight changes were recorded at quarterly intervals until completion of one year of therapy and were subsequently compared with the categories of peritoneal transport. Biochemical markers including glucose, albumin and lipid profile were evaluated at the beginning of therapy and again one year later. Results: A significant effect of time on the mean body weight of the study participants was detected, as shown by the Repeated Measures Analysis of Variance. The final BMI mean was significantly higher than the initial. A significant reduction in serum albumin also occurred. However, no significant difference was found when comparing the weight change over the first year of treatment to the categories from the peritoneal equilibration test. Conclusion: This study was unable to demonstrate the existence of an association between the initial peritoneal membrane small solute transport with weight changes in patients undergoing peritoneal dialysis. The acknowledged multifactorial nature of obesity may be a possible explanation for our findings. The glucose uptake rate by the peritoneum does not seem to be responsible, therefore, it is necessary to search for factors linked to peritoneal dialysis that would have a greater influence on the observed alterations in nutritional status / Objetivo: o objetivo do presente estudo foi avaliar a rela??o entre aumento do peso corp?reo dos pacientes em di?lise peritoneal e a fun??o de transporte de solutos pelo perit?nio. M?todos: os registros de 50 pacientes maiores de 18 anos, que realizavam di?lise peritoneal h? no m?nimo de um ano, foram revisados retrospectivamente. As altera??es de peso foram registradas em intervalos trimestrais at? completarem um ano de terapia e, posteriormente, foram comparados com as categorias de transporte peritoneal avaliadas pelo teste de equil?brio peritoneal ?s quais pertenciam os pacientes. Marcadores bioqu?micos inclu?ram glicose, albumina e perfil lip?dico avaliados no inicio e ap?s um ano de terapia. Resultados: Foi detectado um efeito significativo do tempo em di?lise na m?dia de peso dos investigados, quanto realizada a an?lise de vari?ncia para medidas repetidas. A m?dia final do ?ndice de massa corporal (IMC) mostrou-se significativamente maior que a inicial. Tamb?m ocorreu uma redu??o significativa da albumina s?rica. A varia??o do peso ao longo do primeiro ano de tratamento n?o foi significativamente diferente entre as categorias do teste de equil?brio peritoneal. Conclus?es: o presente estudo n?o demonstrou a exist?ncia de uma associa??o entre as caracter?sticas do transporte de membrana peritoneal e absor??o de glicose, com as altera??es de peso em pacientes em di?lise peritoneal. A reconhecida natureza multifatorial da obesidade pode ser uma poss?vel explica??o para nossos achados. Entretanto, mais estudos s?o necess?rios a fim de identificar quais destes fatores ligados a di?lise peritoneal teriam uma maior influ?ncia sobre as altera??es no estado nutricional e na composi??o corporal desta popula??o de pacientes

Made available in DSpace on 2015-04-14T13:35:35Z (GMT). No. of bitstreams: 1 443018.pdf: 1116136 bytes, checksum: 690ba226b9d2b8f98e9eb79de327b98e (MD5) Previous issue date: 2012-08-28 / INTRODUCTION: The prevalence of fatty liver increased concomitantly with the growth of the global obesity epidemic has become. Steatosis affects most patients with morbid obesity and may progress to more severe forms of liver disease nonalcoholic fatty, such as nonalcoholic steatohepatitis and cirrhosis. The aim of this study is to evaluate the body fat of bariatric patients followed at the Center for Obesity and Metabolic Syndrome of PUCRS and analyze its relationship with hepatic hepatic steatosis. METHODS: This is a historical cohort study that compares the disease of nonalcoholic fatty liver for liver biopsies and the percentage of fat by bioimpedance preoperatively segmented and in these same patients 1 year after surgery. The degree of hepatic steatosis and body fat percentage, was analyzed by relating them to the body mass index, waist-hip ratio, weigth loss, blood glucose and other comparative data regarding age and gender. RESULTS: Of 25 patients undergoing gastrointestinal bypass surgery will be included in the study met all inclusion criteria and 5 were male and 20 female with mean age of 37,6?12,6 years. In this study, the difference in the percentage of fat in preoperatively and postoperative period in an average of 25,9?10,2. Of the 12 (48%) individuals who regressed 2 degrees of the disease, had a percentage difference of 14,3?4,2 in the amount of body fat, 5 (20%) patients regressed 3 degrees with a mean of 11,4?9,0 and 3 (12%) subjects regressed 4 degrees with an average of 11,0?2,4 percentage of difference of body fat in relation to preoperative and one year after surgery. CONCLUSION: Of 25 patients analyzed %, showed improvement in hepatic steatosis. However, the patients who showed a smaller loss in percentage fat, were the patients who regressed more in steatosis or nonalcoholic steatohepatitis after one year of bariatric surgery. / INTRODU??O: A preval?ncia da esteatose hep?tica aumentou concomitante ao crescimento da epidemia global que a obesidade se tornou. A esteatose acomete grande parte dos pacientes obesos m?rbidos e pode evoluir para formas mais graves de doen?a hep?tica gordurosa n?o-alco?lica, como a esteatohepatite n?o-alco?lica e a cirrose. O objetivo deste estudo ? avaliar o percentual de gordura corporal em rela??o ? esteatose hep?tica no p?s-operat?rio de pacientes bari?tricos acompanhados no Centro de Obesidade e S?ndrome Metab?lica da PUCRS. M?TODOS: Trata-se de um estudo de coorte hist?rica que compara as doen?as do f?gado gorduroso n?o-alco?lico por bi?psias hep?ticas e o percentual de gordura por bioimped?ncia no pr?-operat?rio e, nesses mesmos pacientes, 1 ano ap?s a cirurgia. O grau de esteatose hep?tica e o percentual de gordura corporal, foram analisados relacionando-os com o ?ndice de massa corporal, rela??o cintura-quadril, perda de peso, glicemia e outros dados comparados em rela??o ? idade e g?nero. RESULTADOS: Dos 25 pacientes submetidos ? cirurgia por bypass gastrointestinal inclu?dos no estudo por preencherem todos os crit?rios de inclus?o, 5 s?o homens e 20 s?o mulheres com idade m?dia de 37,6?12,6 anos. Neste estudo, a diferen?a do percentual de gordura no pr? e no p?s-operat?rio teve resultado significativo quanto sua rela??o com a regress?o da esteatose hep?tica e esteatohepatite (P= 0,023). Dos 25 pacientes, apenas 1(4%) manteve-se no mesmo grau de esteatose, 4 (8%) pacientes regrediram apenas 1 grau da doen?a hep?tica e tiveram uma diferen?a de percentual de gordura no p?s-operat?rio em uma m?dia de 25,9?10,2. Dos 12 (48%) indiv?duos que regrediram 2 graus da doen?a, obtiveram uma diferen?a percentual de 14,3?4,2 na quantidade de gordura corporal, 5 (20%) pacientes regrediram 3 graus com uma m?dia de 11,4?9,0 e 3 (12%) indiv?duos regrediram 4 graus com uma m?dia percentual de 11,0?2,4 de diferen?a de gordura corporal em rela??o ao pr?-operat?rio e ap?s 1 ano de procedimento cir?rgico. CONCLUS?O: De25 pacientes analisados96%, obtiveram melhora na esteatose hep?tica. No entanto, os que apresentaram uma perda menor no percentual de gordura, foram os pacientes que mais regrediram a esteatose ou esteatohepatite n?o-alco?lica no per?odo de 1 ano ap?s cirurgia bari?trica.

Made available in DSpace on 2015-04-14T13:35:35Z (GMT). No. of bitstreams: 1 443569.pdf: 1818330 bytes, checksum: 440d1a0ec56c8d386d2ce13eb489f265 (MD5) Previous issue date: 2012-08-28 / Introduction: Although temporal lobe epilepsy is associated with high rates of psychiatric comorbidities, investigations about the temperament of these patients have been neglected. Previous studies have suggested that epileptiform and clinical variables may have a role in this context. Objectives: The present study characterized, through a reliable instrument, the temperament of patients with mesial temporal lobe epilepsy, compared them to controls and established relationships with disease-related variables. Methods: Temperament was assessed in 42 (forty-two) adult patients with unilateral mesial temporal lobe epilepsy and 84 (eighty-four) control, through the questionnaire AFECTS (Affective and Emotional Composite Temperament Scale). Among patients, variables related to epilepsy were collected prospectively as well as the scales of the BDI and BAI. Results: Statistically significant correlations were observed between disease duration and higher BDI against temperaments "Depressive" and "Anxious" and the emotional dimension of temperament "Fear." The number of antiepileptic drugs correlated inversely with the temperament "Obsessive." Regarding laterality, patients with lesion in the left lobe had lower average in the emotional dimension "Sensitivity". Discussion: Even though some findings, such as higher BDI scores in patients with temperament "Depressive" and "Anxious" could be justified by the bigger prevalence of psychiatric disorders in patients with mesial temporal lobe epilepsy, statistically significant correlations were found between affective dimensions and variables, independently. Lower means of "Sensitivity" in patients with left itcal focus were consistent with recent data about neurobiological basis of temperament. Conclusion: While they should be interpreted with caution, the results suggest a possible role of mesial temporal lobe epilepsy, directly and through lesion, as one of the determinants of temperament in these patients. / Introdu??o: Embora a epilepsia do lobo temporal esteja associada a altas taxas de comorbidades psiqui?tricas, investiga??es acerca do temperamento destes pacientes t?m sido negligenciadas. Estudos pr?vios t?m sugerido que vari?veis cl?nicas e epileptiformes possam exercer um papel fundamental neste contexto. Objetivos: O presente estudo caracterizou, atrav?s de instrumento confi?vel, o temperamento de pacientes com epilepsia temporal mesial, comparando-os a controles e estabelecendo rela??es com vari?veis associadas ? doen?a. M?todos: O temperamento foi analisado em 42 adultos, portadores de epilepsia mesial temporal unilateral e 84 controles, atrav?s do question?rio AFECTS (Affective and Emotional Composite Temperament Scale). Entre os pacientes, as vari?veis relacionadas ? epilepsia foram coletadas prospectivamente, assim como as escalas de BDI e BAI. Resultados: Correla??es estatisticamente significativa foram observadas entre dura??o da doen?a e altos ?ndices no BDI aos temperamentos Depressivo e Ansioso e ? dimens?o emocional do temperamento Medo. O n?mero de drogas antiepil?pticas correlacionou-se inversamente ao temperamento Obsessivo. Quanto ? lateralidade, pacientes com les?o ? esquerda apresentaram m?dias menores na dimens?o emocional Sensibilidade. Discuss?o: Mesmo que alguns achados, como os elevados ?ndices no BDI em pacientes com temperamento Depressivo e Ansioso possam ser justificados pela maior preval?ncia de dist?rbios psiqui?tricos em indiv?duos com epilepsia temporal mesial, correla??es estatisticamente significativas encontradas entre dimens?es afetivas e vari?veis epileptiformes foram independentes. Menores m?dias de Sensibilidade em pacientes com foco itcal ? esquerda foram condizentes com dados recentes sobre as bases neurobiol?gicas do temperamento. Conclus?o: Embora devam ser interpretados com cautela, os resultados sugerem um poss?vel papel da epilepsia mesial temporal, de maneira direta e lesional, como um dos determinantes do temperamento nestes pacientes.

Made available in DSpace on 2015-04-14T13:35:36Z (GMT). No. of bitstreams: 1 443764.pdf: 1879751 bytes, checksum: a84345f48429752c882a6b33df97af04 (MD5) Previous issue date: 2012-08-28 / Objective: To evaluate the association of maternal serum uric acid (UA) and proteinuria with clinical and demographic data of pregnant women with preeclampsia syndrome (PES) complicated by HELLP syndrome. Methods: One hundred and nine pregnant women were divided into two groups: group 1 - HELLP pregnant women with PES complicated by HELLP syndrome (n=64); group 2 PES pregnant women with PES but no HELLP syndrome (n=105). Results: Age, ethnicity, parity, delivery mode and perinatal mortality were not statistically different between groups. Systolic and diastolic blood pressure, protein to creatinine (P/C) ratio, uric acid, creatinine and maternal complications were statistically different between groups; values were higher and events, more frequent among pregnant women with HELLP syndrome. The newborns of pregnant women with HELLP syndrome were more premature, had a lower birth weight and a lower APGAR score. Conclusion: Uric acid equal to or higher than 6.0 gm/dL and P/C ratio equal to or higher than 5 were more frequent in gestations with HELLP syndrome, which suggests that elevated proteinuria and uric acid levels in pregnant women with PES may increase the chances of developing HELLP syndrome / Objetivo: Avaliar a associa??o dos n?veis maternos de ?cido ?rico s?rico (AU) e protein?ria e os dados cl?nicos e demogr?ficos em gesta??es complicadas por s?ndrome de pr?-ecl?mpsia (SPE), com s?ndrome de HELLP. M?todos: Cento e sessenta e nove gestantes foram divididas em dois grupos: Grupo 1 - HELLP gestantes com SPE complicada pela s?ndrome de HELLP (n=64); Grupo 2 SPE gestantes com SPE sem s?ndrome de HELLP (n=105). Resultados: N?o ocorreram diferen?as estatisticamente significativas quanto ?s vari?veis idade, cor, paridade, via de parto e mortalidade perinatal entre os grupos. Press?o arterial sist?lica, press?o arterial diast?lica, ?ndice protein?ria/creatinin?ria (P/C), ?cido ?rico, creatinina e complica??es maternas apresentaram diferen?a estatisticamente significativa entre os dois grupos, sendo mais elevados e mais frequentes nas gestantes com s?ndrome de HELLP. Observou-se que os RN de gestantes com s?ndrome de HELLP foram mais prematuros, apresentaram menor peso ao nascimento e menor ?ndice de APGAR. Conclus?o: ?cido ?rico igual ou maior do que 6,0 mg/dL e ?ndice P/C igual ou maior do que 5 foram mais frequentes nas gesta??es com s?ndrome de HELLP, o que permite supor que maiores valores de ?cido ?rico e de protein?ria em gestantes com SPE aumentam a chance de desenvolvimento de s?ndrome de HELLP.

Made available in DSpace on 2015-04-14T13:35:36Z (GMT). No. of bitstreams: 1 444379.pdf: 796253 bytes, checksum: 4373f9d99666d84dec56318b0fe505a4 (MD5) Previous issue date: 2012-09-14 / Introduction: Lesions hypoxic-ischemic pathologies can cause a higher or lesser degree, depending on when they occur. In postnatal insults, is the common occurrence of scarring, characterizing ulegyria and/or cysts porencephalic (U/PC).Objectives: To associate the location, extent and severity of brain injury in the spectrum U/PC, with characteristics of epilepsy, motor abnormalities and their impact on activities of daily living (ADLs).Methods: We evaluated 21 patients (15 men and 6 women, aged between 15 and 39 years, mean 25.66 SD 7.12) with epilepsy and brain injury by U/PC attending the epilepsy clinic of the Neurology Service S?o Lucas Hospital of the Catholic University of RS. All patients underwent MRI, EEG, motor and functional assessment.Results: Fifteen patients (71%) presented U, 2 (9.8%) PC and 4 (19.2%) U + PC. All EEGs were abnormal, with a predominance of slowing multilobar (66.6%) and multilobar discharges (71%). The vast number of patients (47.6%) had a combination of simple partial seizures (SPS), complex (CPS), evolving to secondarily generalized (GTS). Decreased balance and difficulty in performing activities of daily living were common to 21 patients.Conclusion: motor abnormalities resulting from brain damage, coupled with the occurrence of seizures impact the functional capacity of patients with U/PC / Introdu??o: Les?es hip?xico-isqu?micos (HI) podem causar patologias em maior ou menor grau, dependendo do momento em que estes ocorrem. Em insultos p?s-natais, ? comum a ocorr?ncia de les?es cicatriciais, caracterizando ulegiria e/ou cistos porencef?licos (U/CP).Objetivos: associar a localiza??o, extens?o e gravidade da les?o cerebral no espectro U/CP, com caracter?sticas da epilepsia, das altera??es motoras e do impacto destas em atividades de vida di?ria (AVD).M?todos: Foram avaliados 21 pacientes (15 homens e 6 mulheres, com idades entre 15 e 39 anos, m?dia de 25,66; DP = 7,12) com epilepsia e les?o cerebral por U/CP que frequentavam o ambulat?rio de epilepsia do Servi?o de Neurologia do Hospital S?o Lucas da Pontif?cia Universidade Cat?lica do RS (PUCRS). Todos realizaram RNM, EEG, avalia??o motora e funcional.Resultados: Quinze pacientes (71%) apresentaram U, dois (9,8%) CP e quatro (19,2%) U + CP. Todos os EEGs estavam alterados, com predom?nio de lentifica??o multilobar (66,6%) e descargas multilobares (71%). A maioria dos pacientes (47,6%) apresentou combina??o de crise parcial simples (CPS) e complexa (CPC), evoluindo para secundariamente generalizada (CSG). Equil?brio diminu?do e dificuldades na realiza??o de atividades de vida di?ria foram comuns aos 21 pacientes.Conclus?o: altera??es motoras, advindas de les?es cerebrais, somadas a ocorr?ncia de crises epil?pticas impactam na capacidade funcional de pacientes com U/CP

Made available in DSpace on 2015-04-14T13:35:36Z (GMT). No. of bitstreams: 1 444693.pdf: 339452 bytes, checksum: ef9dfaf2d55534b68964afd3bb92e166 (MD5) Previous issue date: 2012-08-28 / The aim of this study was to check if there is a predictive relationship of measured serum levels of anti-Mullerian hormone (AMH), antral follicle count (AFC) and ovarian volume with the results of IVF. We conducted a prospective study between January 2010 and March 2012 with women aged 35 or more who underwent IVF. The levels of AMH, AFC and ovarian volume were correlated with response to ovarian hyperstimulation, with rates of fertilization, with embryo quality and pregnancy rates. We evaluated 40 patients with a median age of 39 years old. There was a significant direct correlation between the levels of AMH and the number of follicles larger than 14 mm (rS = 0.81 and P < 0.001). The same happened to the AFC (rS = 0.69 and P < 0.001). This correlation was not significant when evaluated the ovarian volume. AMH, AFC and ovarian volume did not show a statistically significant correlation with rates of fertilization, with embryo quality or with pregnancy rates. In predicting good or poor response, AMH and AFC showed a high positive predictive value (100% for the AMH and 87% for AFC, using a cutoff of 0.9 ng/ml and 7 follicles respectively, values established by ROC curve). We conclude from this study that AMH and AFC can be used as predictors of response to ovarian hyperstimulation in IVF, but they are not related to embryo quality, fertilization rates or pregnancy. / O objetivo deste estudo foi verificar se existe rela??o preditiva da medida do n?vel s?rico do horm?nio antim?lleriano (HAM), da contagem de fol?culos antrais (CFA) e do volume ovariano com os resultados de FIV. Realizou-se um estudo prospectivo no per?odo de janeiro de 2010 a mar?o de 2012 com mulheres de 35 anos ou mais que realizaram FIV. Os n?veis do HAM, CFA e volume ovariano foram correlacionados com resposta ? hiperestimula??o ovariana, com as taxas de fertiliza??o, com a qualidade dos embri?es e com os ?ndices de gesta??o. Foram avaliadas 40 pacientes com uma mediana de idade de 39 anos. Observou-se uma correla??o direta significativa entre os n?veis do HAM e o n?mero de fol?culos maiores de 14 mm (rS = 0,81 e P < 0,001), ocorrendo o mesmo com a CFA (rS = 0,69 e P < 0,001). Tal correla??o n?o foi significativa quando avaliado o volume ovariano. HAM, CFA e volume ovariano n?o apresentaram uma correla??o estatisticamente significativa com as taxas de fertiliza??o, com a qualidade embrion?ria, nem com os ?ndices gesta??o. Na predi??o de boa ou m? resposta, HAM e CFA apresentaram um alto valor preditivo positivo (100% para o HAM e 87% para a CFA, usando um ponto de corte de 0,9 ng/ml e 7 fol?culos respectivamente, valores estabelecidos pela curva ROC). Conclu?mos, com o estudo, que HAM e CFA podem ser utilizados como preditores da resposta ? hiperestimula??o ovariana em FIV; por?m, n?o est?o relacionados ? qualidade embrion?ria, taxas de fertiliza??o ou gesta??o.

Made available in DSpace on 2015-04-14T13:35:37Z (GMT). No. of bitstreams: 1 444782.pdf: 1327290 bytes, checksum: 51c0bcf62b76809d6ed98fd7aca7d6b9 (MD5) Previous issue date: 2011-03-15 / The Wilms Tumors (WT) is the most frequent renal tumors of children, and although curable, fatal outcomes may occur. A number a genetic alterations have been suggested as associated factors but still, the exact pathogenesis of WT remains to be fully characterized. Tissue factor (TF) is a glycoprotein which happens to be a key receptor for factor VII/VIIa and is the primary initiator of blood coagulation. Also important, TF has been associated with processes that lead to angiogenesis. It is widely expressed among cells and tissues and recent evidences pointed out an important role for TF in cancer progression and metastasis. Recent evidences suggested that TF may have a role in WT since its immunodetection was associated with poor prognosis. In the present investigation the differential expression of TF was assessed in WT using real-time PCR of RNA retrieved from paraffin sections using microdissection. Different histological components of WT - (blastema, epithelial and stromal) were analysed and the results revealed that TF in blastema and epithelial components was upregulated (14.38 and 16.02-fold respectively, P<0.001). Stroma and control non neoplasic tissues expressed similar levels of expression (P>0.05). TF expression in metastatic lesions from WT was also singificantly upregulated compared to non metastatic lesions. Microvessel density was positively correlated with TF expression (r=0.721). As described for other tumors, TF seems to play a role in malignancy or WT. Further investigations are warranted to better understand the pathways by which TF exerts its effects on tumor progression. Noteworthy, pharmacological strategies that aim at controlling angiogenesis through regulation of TF may be very promising / Esta pesqusisa teve como objetivo demonstrar a express?o diferencial do fator tecidual (FT) em tumor de Wilms (TW), atrav?s de um estudo do tipo transversal. O TW ? a neoplasia renal maligna mais comum na inf?ncia. Os estudos sobre angiog?nese em neoplasias malignas pedi?tricas apresentam poss?veis vias de terapias antiangiog?nicas, com menor agressividade e melhor especificidade tumoral. E, entre os fatores angiog?nicos poss?veis, foi estudo o Fator Tecidual (FT), prote?na transmebrana com sua principal fun??o no processo de hemostasia, mas que demonstra ter importante papel nos processos patol?gicos de tumorig?nese, angiog?nese e microambiente tumoral favor?vel ? dissemina??o neopl?sica. Sua express?o vem sendo associada ?s met?stases e piora no progn?stico. Contuto, s? a partir da pesquisa de Maciel et al (1) que a associa??o do FT com TW foi observada, onde se encontrou, utilizando imunoistoqu?mica, a correla??o positiva entre a express?o do FT, recidiva tumoral e ?bito. Ent?o, a partir desses dados iniciais, a presente pesquisa analisou uma amostra com 27 esp?cimes fixadas em parafina de TW e 26 controles (?rea sem TW), para demonstrar a express?o diferencial do FT em TW, atrav?s da t?cnica de quantifica??o de ?cidos nucl?icos (RNAm) por Rea??o Cadeia de DNA Polimerase em Tempo Real (RT-PCR), avaliar a express?o do FT em diferentes componentes tumorais, com a densidade microvascular (DMV) do TW e a ocorr?ncia de met?stases. Foi observado aumento da express?o diferencial do FT no TW, sua maior varia??o do FT foi encontrada nos componentes blastematoso e epitelial, enquanto no componente estromal apresentou varia??o m?nima em rela??o ao tecido n?o tumoral, em les?es metast?ticas o FT se mostrou significativamente mais elevado, sugerindo um papel importante para essa prote?na no processo de dissemina??o dessas c?lulas malignas, o aumento da DMV apresentou associa??o positiva com a express?o do FT. Os resultados apresentados corroboram os achados de Maciel et al (1) de forma mais concisa e quantitativa, enfatizando a import?ncia do FT na biologia do TW

Made available in DSpace on 2015-04-14T13:35:37Z (GMT). No. of bitstreams: 1 445040.pdf: 2039522 bytes, checksum: 2f433c611b99e5b28cbd56ef7aed5bb1 (MD5) Previous issue date: 2010-09-30 / Rationale: Comorbidity between difficult-to-treat epilepsies and ADHD is high, but because of concerns with the use of stimulants in this population, there is no data on the possible impact of such treatment.Objective: We studied the effect of methylphenidate in the quality of life of children and adolescents with DSM-IV criteria for ADHD and difficult-to-treat epilepsies.Methods: Open label, non-controlled trial, with intention-to-treat analysis following 30 patients for 6 months. Subjects received methylphenidate following 3 months of baseline, during which antiepileptic drugs (AEDs) were adjusted and epilepsy, ADHD and quality of life variables were assessed. Multivariate regression analysis identified the main variables correlated with outcome.Results: Only one patient withdrew because of seizure worsening. Following methylphenidate introduction, reaching doses of 0.40 - 0.50 mg/kg/day, a marked improvement in quality of life scores and a significant reduction in seizure frequency and severity were observed. Female sex, reduction of core ADHD symptom burden and tolerability to adequate doses of methylphenidate correlated with quality of life scores.Conclusion: These preliminary data suggest that methylphenidate treatment is safe and effective to patients with ADHD and difficult-to-treat epilepsies and has a positive impact on quality of life scores / Fundamentos - A associa??o entre epilepsia e TDAH ? altamente prevalente comprometendo a Qualidade de Vida de crian?as e adolescentes com crises epil?pticas. Metilfenidato Ritalina(R) - ? o medicamento de uso consagrado para o Transtorno de D?ficit de Aten??o/Hiperatividade com 80% de efic?cia em crian?as com TDAH com ou sem epilepsia. Questiona-se a possibilidade do MFD diminuir o limiar convulsivo dos pacientes epil?pticos.Objetivos - Avaliar a influ?ncia do uso de Metilfenidato sobre a Qualidade de Vida e o perfil das crises epil?pticas em crian?as e adolescentes com epilepsias de dif?cil controle.Pacientes e M?todos - Foi realizado um ensaio cl?nico aberto, n?o randomizado, com 30 crian?as e adolescentes do Ambulat?rio de Neuro-Epilepsias Graves apresentando crises de dif?cil controle e TDAH. Foram avaliadas quanto ? Qualidade de Vida, sintomas de TDAH e perfil das crises antes e ap?s o uso de MFD. Houve um ajuste/troca de FAE somente no tempo -3 (baseline). Metilfenidato foi iniciado ap?s estes 3 meses (T 0) sem outras modifica??es nos FAE com avalia??es 1 m?s e 3 meses ap?s. Foram avaliados tamb?m eventos adversos ao uso do MFD.Resultados - Ocorreu melhora da QV em todos os momentos avaliados: T -3 (baseline) a T0, T0 a T+1 e T+1 a T+3. A melhora ocorrida entre T-3 e T0, momento em que foi realizado o ajuste de FAE, n?o foi estatisticamente significativa. Nos tempos subseq?entes, com o uso de MFD, as varia??es de QV ocorridas apresentaram signific?ncia estat?stica. Ocorreu melhora da qualidade de vida com signific?ncia estat?stica em indiv?duos do sexo feminino, os que apresentaram in?cio mais tardio da doen?a e naqueles em houve maior diminui??o dos escores de d?ficit de aten??o. Os pacientes com crises generalizadas apresentaram piores ?ndices de QV. N?o houve associa??o estatisticamente significativa entre a varia??o da QV com a freq??ncia e/ou gravidade das crises, idade, dura??o da doen?a, QI, ocorr?ncia de eventos adversos.Conclus?es - Houve melhora da QV de pacientes epil?pticos de dif?cil controle tratados com MFD sem que houvesse piora na freq??ncia ou gravidade das crises. Condizente com a literatura tamb?m n?o verificamos a presen?a de efeitos colaterais de gravidade significativa ao MFD. Estes dados preliminares sugerem a possibilidade da utiliza??o deste f?rmaco no tratamento de crian?as e adolescentes com crises epil?pticas de dif?cil controle com a conseq?ente melhora de QV destes pacientes.

Made available in DSpace on 2015-04-14T13:35:38Z (GMT). No. of bitstreams: 1 445402.pdf: 4168826 bytes, checksum: 12e5afbd895c8db20632ed4bc6ddacbf (MD5) Previous issue date: 2012-12-20 / Background: Erythropoietin (EPO) and granulocyte colony stimulating factor (GCSF) have generated interest as novel therapies after myocardial infarction (MI), but the effect of combination therapy has not been studied in the large animal model.Objetives: We investigated the impact of prolonged combination therapy with EPO and GCSF on cardiac function, infarct size, and vascular density after MI in a porcine model.Methods: MI was induced in pigs by a 90 min balloon occlusion of the left anterior descending coronary artery. 16 animals were treated with EPO+GCSF, or saline (control group). Cardiac function was assessed by echocardiography and pressure-volume measurements at baseline, 1 and 6 weeks post-MI. Histopathology was performed 6 weeks post-MI.Results: At week 6, EPO+GCSF therapy stabilized left ventricular ejection fraction, (41?1% vs. 33?1%, p<0.01) and improved diastolic function compared to the control group. Histopathology revealed increased areas of viable myocardium and vascular density in the EPO+GCSF therapy, compared to the control. Despite these encouraging results, in a historical analysis comparing combination therapy with monotherapy with EPO or GCSF, there were no significant additive benefits in the LVEF and volumes overtime using the combination therapy.Conclusion: Our findings indicate that EPO+GCSF combination therapy promotes stabilization of cardiac function after acute MI. However, combination therapy does not seem to be superior to monotherapy with either EPO or GCSF / Introdu??o: Recentemente, a eritropoetina (EPO) e o fator estimulante de col?nia de granul?citos (GCSF) surgiram como potenciais terapias no tratamento do infarto agudo do mioc?rdio (IAM). Contudo, os efeitos da terapia combinada ainda est?o por ser investigados.Objetivo: Investigar a efic?cia e seguran?a da terapia combinada com EPO e GCSF p?s-IAM em um modelo porcino.M?todos: IAM foi induzido em porcos dom?sticos atrav?s da oclus?o por 90 minutos da coron?ria descendente anterior esquerda. Dezesseis animais foram tratados com an?logo de longa a??o da EPO a GCSF ou solu??o salina (grupo controle). Fun??o card?aca foi avaliada via ecocardiografia e medidas de press?o-volume no inicio do estudo, uma e seis semanas ap?s o IM. Histologia foi realizada seis semanas ap?s o IAM.Resultados: Seis semanas ap?s o IAM, a terapia combinada com EPO e GCSF demonstrou estabilizar a fra??o de eje??o ventricular esquerda (41?1% vs. 33?1%, p<0.01) e melhorar a fun??o diast?lica quando comparada com o grupo controle. Avalia??o histopatol?gica revelou aumento de ?reas de mioc?rdio vi?vel e de densidade vascular no grupo tratado com EPO e GCSF quando comparada com o grupo controle. Apesar dos resultados encorajadores, em uma avalia??o hist?rica comparando a terapia combinada com a monoterapia com EPO ou GCSF, a terapia combinada n?o demonstrou ter beneficio adicional na preserva??o da fra??o de eje??o ou volumes ventriculares ao longo do per?odo em estudo.Conclus?o: Os presentes achados sugerem que a terapia combinada com EPO e GCSF promove a estabiliza??o da fun??o card?aca ap?s o IAM. Contudo, a terapia combinada n?o aprece ser superior a monoterapia com EPO ou GCSF