Made available in DSpace on 2015-04-14T13:35:53Z (GMT). No. of bitstreams: 1 457548.pdf: 766828 bytes, checksum: 22a981e2f27dd96bd986b29478dc3ae1 (MD5) Previous issue date: 2013-03-25 / Metabolic Surgery for the treatment of type 2 Diabetes Mellitus (T2DM) in patients not morbidly obese (BMI <35 kg/m2) has been widely studied. Taking into account that approximately 12% of pancreas transplants are performed in T2DM patients, we tought to evaluate the impact of the metabolic surgery in the management of obese T2DM on the waiting lists for pancreas transplant. We performed a Roux-en-Y gastrointestinal bypass in 5 insulin-dependent T2DM patients, candidates for pancreas after kidney transplant, with BMI <35 kg/m2. Three patients became insulin independent by the end of the first year while the other two have reduced insulin requirements by 70%. Furthermore, all patients achieved improved control on lipids levels. We conclude the surgery is effective in controlling blood glucose and lipids metabolism in obese T2DM kidney transplant recipients. In this population, a pancreas transplant, along with its associated morbidity, may be avoided. / A cirurgia metab?lica para tratamento do Diabetes Mellitus tipo 2 (DM2) em pacientes sem obesidade m?rbida (IMC <35 kg/m2) vem sendo amplamente estudada. Levando em conta que aproximadamente 12% dos transplantes de p?ncreas s?o realizados em pacientes com DM2, pensamos em avaliar o impacto da cirurgia metab?lica no manejo de obesos, diab?ticos tipo 2, em lista de espera para transplante de p?ncreas. Realizamos o bypass gastrointestinal em Y de Roux em 5 pacientes diab?ticos tipo 2, insuino-dependentes, candidatos ao transplante de p?ncreas ap?s rim, com IMC<35 kg/m2. Tr?s pacientes tornaram-se insulino independentes ao final do primeiro ano, enquanto os outros dois reduziram sua necessidade insulinica em torno de 70%. Al?m disto, todos os pacientes obtiveram melhora no controle dos lip?dios. Conclu?mos que a cirurgia ? efetiva no controle da glicemia e no metabolismo dos lip?deos em pacientes obesos, transplantados renais, com DM2. Nesta popula??o de pacientes, o transplante de p?ncreas, com suas co-morbidades associadas, pode ser evitado.

Made available in DSpace on 2015-04-14T13:35:53Z (GMT). No. of bitstreams: 1 457561.pdf: 511212 bytes, checksum: a1a63d3229f283b583a6b5e9517ed0a7 (MD5) Previous issue date: 2014-03-31 / Objective: Omentin is an adipokine expressed in visceral adipose tissue that has been associated with positive effects on metabolism. The objective of this study was to assess whether changes occur in circulating omentin levels and cardiovascular risk factors after abdominal subcutaneous liposuction with or without abdominoplasty. Materials and methods: Serum omentin levels and cardiovascular risk factors (blood pressure, lipid profile, and waist circumference) were assessed in 21 women at baseline and 8 to 12 weeks after abdominal liposuction with or without abdominoplasty. Weight, blood glucose levels, insulin levels, and the homeostasis model assessment (HOMA) index were also evaluated. Results: At 12-week follow-up, circulating omentin levels had not changed significantly from baseline (P = 0.11; effect size - ES = 0.37). Waist circumference was significantly decreased (P < 0.001; ES = -1.38). Blood pressure, lipid profile, blood glucose levels, insulin levels, and HOMA index were statistically unchanged. Conclusion: Abdominal subcutaneous liposuction, whether alone or with abdominoplasty, was not associated with significant changes in circulating omentin levels or cardiovascular risk factors / Objetivo: Omentina ? uma adipocina expressada no tecido adiposo visceral e associada a efeitos positivos sobre o metabolismo. Nosso objetivo foi avaliar se ocorre altera??o nos n?veis circulantes de omentina e em fatores de risco cardiovascular ap?s lipoaspira??o subcut?nea abdominal associada ou n?o ? abdominoplastia. Materiais e m?todos: N?veis s?ricos de omentina e fatores de risco cardiovascular, tais como: press?o arterial, perfil lip?dico e circunfer?ncia abdominal, foram avaliados em 21 mulheres antes e 8 a 12 semanas ap?s lipoaspira??o abdominal associada ou n?o ? abdominoplastia; peso, glicemia, insulina e ?ndice HOMA tamb?m foram estudados. Resultados: N?veis circulantes de omentina n?o se alteraram significativamente 12 semanas ap?s (P = 0,11; tamanho de efeito - E/S = 0,37); circunfer?ncia abdominal alterou significativamente (P<0,001; E/S = -1,38), enquanto outros fatores de risco cardiovascular, como press?o arterial e perfil lip?dico, n?o alteraram significativamente; glicemia, insulina e ?ndice HOMA tamb?m n?o alteraram significativamente. Conclus?o: Lipoaspira??o subcut?nea abdominal isolada, ou associada ? abdominoplastia, n?o levou a altera??es significativas nos n?veis de omentina nem em fatores associados ao aumento de risco cardiovascular

Made available in DSpace on 2015-04-14T13:35:54Z (GMT). No. of bitstreams: 1 457569.pdf: 482302 bytes, checksum: 7d0e339871cad4e249f766e39fa5ae38 (MD5) Previous issue date: 2003-03-26 / Objective : The study attempted to estimate the prevalence of metabolic syndrome (MS) in seniors presenting at the Geriatrics Outpatient Service and analyze the association of metabolic syndrome with morbidity and mortality after a five-year follow-up. Method : A historic cohort study was carried out with patients attending the outpatient service from January through December 1998, at age 60 or older. In the first stage, patient charts were extensively reviewed, identifying patients with metabolic syndrome (MS), morbidity and lifestyle. At the second stage, the patients and/or their families were called for death reports in the period and its possible cause. A descriptive, comparative and multivariate analysis was conducted, and the survival curve was calculated as established by Cox and Kaplan-Meier. Results : Of a total of 383 old patients that attended the outpatient clinic in the period investigated, 283 (73.9%) were contacted. The comparison between the contacted sample and the missing one didn t show differences, suggesting the missing group wouldn t imply bias in the sample.The main results included the observation of: (1) 26.5% (75) MS prevalence; (2) 5.3% (15) mortality in the follow-up period among the seniors investigated, with only one MS patient dying in the period; (3) in the group affected, in addition to morbidities associated to the diagnosis (hypertension, diabetes, obesity, and dyslipidemia), the following disorders were significantly associated to MS: acute myocardial infarction and stable angina. Unlike other morbidities, osteoporosis was inversely associated to MS; (4) given the reduced number of individuals that died, no association between MS and mortality was observed in the study period. Conclusion : In spite of no association with mortality, most results related to MS are in agreement with literature and suggest that this disease is of great impact on geriatric practice. / Objetivo : o estudo realizado buscou estimar a preval?ncia de s?ndrome metab?lica em idosos que freq?entavam um Servi?o Ambulatorial de Geriatria e analisar a associa??o de s?ndrome metab?lica com morbidades e mortalidade ap?s cinco anos de seguimento. Metodologia : um estudo de coorte hist?rica foi realizado com pacientes que freq?entaram o servi?o ambulatorial no per?odo de janeiro a dezembro de 1998, com idade > 60 anos. Na primeira etapa, o prontu?rio dos referidos pacientes foi extensamente revisado, identificando-se pacientes com s?ndrome metab?lica (SM), morbidades e estilo de vida. Na segunda etapa, foi realizado contato telef?nico com os pacientes e/ou seus familiares para a obten??o da informa??o de ocorr?ncia de ?bito no per?odo, e sua poss?vel causa. An?lise estat?stica descritiva, comparativa e multivariada foi realizada, bem como foi calculada a curva de sobreviv?ncia calculada por Cox e Kaplan-Meier. Resultados : de um total de 383 pacientes idosos que freq?entaram o ambulat?rio no per?odo investigado, foram contatados 283 (73,9%). Compara??o entre a amostra contatada e a perdida n?o mostrou diferen?as entre as mesmas, sugerindo-se que tal perda n?o implicaria em um vi?s na amostra. Os principais resultados obtidos incluiram a observa??o de: (1) uma preval?ncia de SM de 26,5% (75); (2) uma mortalidade no per?odo de seguimento de 5,3% (15) dos idosos investigados, sendo que apenas um idosos com SM faleceu no per?odo; (3) no grupo afetado al?m das morbidades associadas ao diagn?stico (hipertens?o, diabetes, obesidade e dislipidemia) as seguintes outras doen?as foram significativamente associadas a SM: infarto agudo do mioc?rdio e angina est?vel. Ao contr?rio das outras morbidades, osteoporose foi inversamente associada a SM; (4) dado o n?mero reduzido de indiv?duos que foram a ?bito, n?o foi observada associa??o entre SM e mortalidade no per?odo investigado. Conclus?o : Apesar da n?o associa??o com mortalidade, a maioria dos resultados obtidos em rela??o a SM est?o em concord?ncia com a literatura e sugerem ser tal doen?a de grande impacto na cl?nica geri?trica.

Made available in DSpace on 2015-04-14T13:35:55Z (GMT). No. of bitstreams: 1 457609.pdf: 908457 bytes, checksum: 4face2ee7aed14459bb47a89ca31f82a (MD5) Previous issue date: 2013-11-29 / Background: The current study aims to test and a vancomycin protocol based on the initial hemodialysis patients weight and to describe drug peak and through serum levels. Methods: A study enrolling 16 ESRD adult patients cohort undergoing hemodialysis received a uniform vancomycin administration schedule: 20 mg/kg initial dose, infused during the last dialysis hour; blood sample collection 30 minutes post-dialysis and, subsequently, before every dialysis session. Additionally, a fixed schedule to adjust every new dose was used. Anthropometric, clinical and laboratory variables were collected. Descriptive statistics was used; Spearman correlation coefficient was used to verify associations. Results: No significant correlation between vancomycin peak serum level and trough levels and the initial dose, nor any trough level and the following doses were uncovered. However, total serum protein strong and positively correlated with the initial Vancomycin dose and the first trough serum level (rs = 0.608, P = 0.016 and rs= 0.641; P = 0.010, respectively). Initial dose positively correlated with albumin too (rs= 0.572, P = 0.02). A strong correlation between the first and second trough levels was also found (rs = 0.608; P = 0.021). Conclusion: As applied, the vancomycin administration protocol was ineffective in reaching and maintaining therapeutic peak and trough levels. It is possible that a significant loss of vancomycin free-fraction by dialysis accounted for such a finding. Correlation of vancomycin serum levels between total serum proteins should be further investigated. / Objetivo Descrever os n?veis s?ricos de vancomicina em amostras coletadas nos vales em pacientes em hemodi?lise, a partir de um protocolo de administra??o deste antimicrobiano com dose inicial de 20mg/kg seguida de 10mg/kg e ajustes nas doses subsequentes, conforme a faixa de vancocinemia obtida e correlacionar com par?metros fisiol?gicos para verificar poss?veis associa??es. M?todos Estudo de coorte onde foram inclu?dos pacientes em hemodi?lise ambulatorial, com idade igual ou superior a 18 anos que realizaram tratamento com vancomicina, emp?rico ou com germe isolado. O medicamento foi administrado por infus?o intravenosa numa concentra??o de 10mg/mL na ?ltima hora da sess?o de hemodi?lise. O protocolo proposto baseia-se em doses administradas a cada sess?o de di?lise, realizadas tr?s vezes na semana, considerando o peso do paciente, uma dose inicial e define ajustes de dose a cada vancocinemia, com o objetivo de mant?-la nos n?veis terap?uticos estabelecidos de 10 a 20mg/L. Resultados: N?o houve correla??o significativa entre as concentra??es de vancomicina s?rica no pico e vales com as doses definidas pelo protocolo. Entretanto, o primeiro vale e as prote?nas plasm?ticas apresentaram forte correla??o positiva (rs = 0.608, P = 0.01), al?m da dose inicial tamb?m se correlacionar positivamente com as prote?nas plasm?ticas e albumina (rs = 0.641, P = 0.01 e rs= 0.572, P = 0.02). Os n?veis s?ricos de vancomicina entre o primeiro e o segundo vales apresentam forte correla??o positiva (rs = 0.608, P = 0.02) e o volume de distribui??o apresenta forte correla??o inversa ao valor de pico de vancomicina (rs = - 0.990; P < 0.001). Conclus?o Embora o estudo n?o tenha sido capaz de determinar um protocolo, identificamos uma variabilidade muito grande entre os resultados de vancocinemia. Doses mesmo ajustadas pelo peso seco do paciente e n?veis s?ricos de vancomicina n?o foram suficientes para manter os n?veis terap?uticos de vancomicina. ? poss?vel que haja perda significativa de vancomicina durante a hemodi?lise. A correla??o com as prote?nas plasm?ticas pode ser sugestiva quanto ? prote??o na remo??o durante a di?lise, por?m necessita ser investigada.

Made available in DSpace on 2015-04-14T13:35:55Z (GMT). No. of bitstreams: 1 457603.pdf: 4114697 bytes, checksum: 30488d5fc2e6e62e5cc39c6a00ca84ff (MD5) Previous issue date: 2014-02-21 / Objective: To evaluate the association of leptin levels in the maternal plasma, umbilical cord plasma and placental tissue of normotensive and preeclamptic (PE) pregnant women. Patients and methods: Leptin levels were analysed in the maternal plasma, umbilical cord plasma and placental tissue of 50 women with preeclampsia and 67 normotensive pregnant women. Plasma and placental leptin were measured using the MagPlexTH-C microspheres system. Results: Leptin levels were 40 times higher in the maternal plasma and 82 times higher in the placental tissue of patients with preeclampsia in comparison to the controls. The geometric means found were 19.59 ng/mL and 163.31 mg/g in the PE group, and 13.96 ng/mL and 89.95 mg/g in the normotensive group, respectively. Analysis of the umbilical cord plasma showed no significant difference between the groups. The mean ratios found after adjustment for maternal age, BMI and gestational age were: maternal plasma (MR=1.40; 95% CI: 1.00 - 1.97, p=0.049), fetal plasma (MR=1.33; 95% CI: 0.85- 2.09, p=0.216) and placenta (MR=1.82; 95% CI: 1.11 - 2.98, p=0.019). Conclusion: Leptin values found in patients with preeclampsia are significantly increased in maternal plasma and placental tissue in comparison to the control. The extremely high levels in the placenta are believed to have resulted from studies that specifically aimed to evaluate biomarkers. / Objetivo: Avaliar a associa??o dos n?veis de leptina no plasma materno, plasma do cord?o umbilical e tecido placent?rio de gestantes normotensas e com pr?-ecl?mpsia (PE). Pacientes e m?todos: Foram analisados os n?veis de leptina no plasma materno, plasma do cord?o umbilical e tecido placent?rio de 50 gestantes com pr?-ecl?mpsia e 67 gestantes normotensas. A leptina foi mensurada em plasma e placenta utilizando o Sistema MagPlexTH-C - ensaio de microesferas.Resultados: Os n?veis de leptina foram 40 vezes maiores no plasma materno e 82 vezes maiores no tecido placent?rio das pacientes pr?-ecl?mpticas em compara??o aos controles. No grupo Pr?-ecl?mpsia encontramos as m?dias geom?tricas de 19.59 ng/mL e 163.31 mg/g e nas normotensas 13.96 ng/mL e 89.95 mg/g respectivamente. A an?lise do plasma do cord?o umbilical n?o mostrou diferen?a significativa entre os grupos. As raz?es das m?dias encontradas ap?s ajuste para idade materna, ?ndice de massa corporal e idade gestacional, foram no plasma materno (rm=1.40; IC 95%: 1.00 - 1,97, p=0.049), no plasma fetal (rm=1.33; IC 95%: 0.85- 2.09, p=0.216) e na placenta (rm=1.82; IC 95%: 1.11 - 2,98, p=0.019). Conclus?o: Os valores de leptina encontrados nas pacientes com pr?-ecl?mpsia quando comparados ao controle s?o significativamente maiores no plasma da m?e e no tecido placent?rio. Os n?veis extremamente elevados na placenta s?o sugestivos de estudos com desenho espec?fico para investiga??o de biomarcador.

Made available in DSpace on 2015-04-14T13:35:56Z (GMT). No. of bitstreams: 1 458595.pdf: 638415 bytes, checksum: 8d362a4b9f0ad71a38d9d181d7bd32fe (MD5) Previous issue date: 2014-02-21 / Background: Several studies indicate increases of psychiatric symptoms in obese patients however there is no consensus on evolution of these symptoms after bariatric surgery. Objective: Our study analyzed changes in psychiatric symptoms in obese patients at Center Obesity and Metabolic Syndrome (COMPUCRS) after surgery treatment. Methods: This cohort prospectively followed obese patients who underwent bariatric treatment. We applied standard psychiatric scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Binge Eating Scale (BES) and Symptom Check List- 90-R in baseline, 6-months and 1-year after Roux-en-Y gastric bypass (RYGB). Changes in scores are evaluated and associated with clinical and socio demographic status. Results: In our cohort, 289 patients are white (93.1%), 75.8% are woman with 37.65 ? 10.31 years old, entered to National Health System-SUS (57.4%) and 56.7% make use psychiatric medications. The mean body mass index (BMI) was 46.8 ? 7.6; 33.9 ? 6.2 and 29.9 ? 5.4 kg/m2 in baseline, 6-months and 1-year respectively (p<0.001). After surgery, all psychiatric symptoms showed a significant decline in scores of standard scales during follow-up. Beck Depression Inventory: 8.9 (7.8 to 0.1) vs 3.2 (2.7 to 3.7) and 2.4 (1.9 to 2.9); Beck Anxiety Inventory: 5.9 (5.1 to 6.8) vs 2.2 (1.8 to 2.6) and 1.8 (1.5 to 2.3); Binge Eaten Scale: 6.7 (5.8 to 8.0) vs 2.0 (1.6 to 2.5) and 1.4 (1.1 to 1.9) (p<0.001). All subscales of Symptom Check List 90-R showed a significant decline following 1-year after bariatric surgery (p<0.001). Conclusion: In one year, a significant reduction was observed in all scores of the assessment of psychiatric symptoms and substantial weight loss in obese patients after RYGB. / Introdu??o: V?rios estudos indicam que pacientes obesos t?m aumentada sintomatologia psiqui?trica, mas a literatura ? divergente sobre a evolu??o destes sintomas ap?s a cirurgia bari?trica. Este estudo investiga as altera??es de sintomatologia psiqui?trica em pacientes obesos que buscam tratamento para emagrecer no Centro de Obesidade Metab?lica (COMPUCRS). Objetivos: Foram analisadas as altera??es dos escores das escalas psiqui?tricas aplicadas ao longo do tempo nestes pacientes e comparadas com as vari?veis cl?nicas e s?cio demogr?ficas. M?todos: Este estudo acompanhou prospectivamente uma coorte de 289 pacientes obesos que se submeteram ao procedimento cir?rgico bypass g?strico em Y de Roux (RYGB), com avalia??o inicial datada em 06 de junho de 2011 ? 06 de junho de 2012 no Hospital S?o Lucas da PUCRS. Foram aplicadas escalas psicol?gicas padronizadas: Invent?rio Beck de Depress?o (BDI), Invent?rio Beck de Ansiedade (BAI), Escala de Compuls?o Alimentar Peri?dica (BES) e Escala de Avalia??o de Sintomas (SCL-90-R) em tr?s per?odos estipulados, pr?-operat?rio, 6 meses e 12 meses ap?s a cirurgia e avaliadas as mudan?as em seus escores m?dios e sua associa??o com as vari?veis cl?nicas e s?cio-demogr?ficas. Resultados: 75,8% s?o mulheres, com idade m?dia de 37,65 ? 10,31 anos, 93,1% s?o brancas, realizaram tratamento cir?rgico pelo Sistema ?nico de Sa?de- SUS (57,4%) e 56.7% realizam tratamento psiqui?trico medicamentoso O ?ndice pr?operat?rio de massa corporal (IMC) foi de 46,8 ? 7,6 vs 33,9 Kg/m2 ? 6,2 Kg/m2 em 6 meses e de 29,9 ? 5,4 kg/m2 em 1 ano de follow-up (p<0,001). Ap?s RYGB, todas as escalas psiqui?tricas utilizadas neste estudo mostraram um decl?nio significativo em suas m?dias geom?tricas em at? um ano. BDI: 8,9 (7,8 a 0,1) vs 3,2 (2,7 a 3,7) e 2,4 (1,9 a 2,9); BAI: 5,9 (5,1 a 6,8) vs 2,2 (1,8 a 2,6) e 1,8 (1,5 a 2,3); BES : 6,7 (5,8 a 8,0) vs 2,0 (1,6 a 2,5) e 1,4 (1,1 a 1,9) (p<0,001). Todas as dimens?es do teste SCL-90-R mostraram um significativo decl?nio (p<0,001) ap?s a cirurgia bari?trica em at? um ano. Conclus?o: Em um ano, foi observada uma redu??o significativa em todos os escores das escalas de avalia??o de sintomas psiqui?tricos, assim como uma substancial perda de peso em pacientes obesos ap?s RYGB.

Made available in DSpace on 2015-04-14T13:35:56Z (GMT). No. of bitstreams: 1 458596.pdf: 1378457 bytes, checksum: a9dd142726a70a37208a48023c45293e (MD5) Previous issue date: 2014-02-27 / The pathogenesis of nonalcoholic fatty liver disease (NAFLD) is not completely elucidated. There is increasing evidence that oxidative stress is involved in this process. The objective of the present study was to evaluate the role of plasma markers of oxidative stress in morbidly obese patients with NAFLD. Forty-three morbidly obese patients were subjected to Roux-en-Y gastric bypass with a liver biopsy obtained during surgery. Plasma oxidative stress was measured by thiobarbituric acid reactive substances (TBARS) and superoxide dismutase (SOD) assays. Histologic analysis showed NASH in 65.1% of patients and simple steatosis in 34.9%. The plasma TBARS levels were significantly greater in the patients with NASH when compared to those with simple steatosis [1.65 (1.43-1.82) nM/ml vs 1.12 (1.04-1.42) nM/ml; P=0.002]. There was a correlation of TBARS with NAS score (rs = 0.470; P = 0.001). Among the patients with NASH and simple steatosis, there was no difference in plasma antioxidant status measured by SOD. Our findings suggest that plasma lipid peroxidation is associated with the severity of NAFLD in the morbidly obese patients / A patog?nese da doen?a hep?tica gordurosa n?o alco?lica (DHGNA) n?o est? completamente esclarecida. Existem evid?ncias cada vez maiores de que o estresse oxidativo participa desse processo. O objetivo do presente estudo ? avaliar o papel de marcadores plasm?ticos de estresse oxidativo em obesos m?rbidos com DHGNA. Foram inclu?dos 43 obesos m?rbidos submetidos ao bypass g?strico em Y-de-Roux, com bi?psia hep?tica obtida durante a cirurgia. O estresse oxidativo plasm?tico foi mensurado por meio das subst?ncias que reagem ao ?cido tiobarbit?rico (TBARS) e ao super?xido dismutase (SOD). A an?lise histol?gica evidenciou NASH em 65,1% dos pacientes e esteatose simples em 34,9%. Os n?veis plasm?ticos de TBARS foram significativamente maiores nos pacientes com NASH, quando comparados aos com esteatose simples [1,65 (1,43-1,82) nM/ml vs 1,12 (1,04-1,42) nM/ml; P=0,002]. Houve correla??o da TBARS com o NAS score (rs= 0,470; P=0,001). Entre os pacientes com NASH e esteatose simples, n?o houve diferen?a no status antioxidante plasm?tico medido pela SOD. Nossos achados sugerem que a lipoperoxida??o plasm?tica est? associada com a gravidade da DHGNA em obesos m?rbidos

Made available in DSpace on 2015-04-14T13:35:57Z (GMT). No. of bitstreams: 1 458592.pdf: 13592524 bytes, checksum: 0f4861417438fcd80d410bc2aaf21c00 (MD5) Previous issue date: 2014-02-24 / Purpose: Increased expression of tissue factor (TF) was correlated with worse prognosis and survival in various malignant neoplasms. In urologic tumors, it was studied in prostate, bladder and kidney cancers. The present study evaluates the immunohistochemical expression of TF in human penile cancer, correlating it with prognostic factors and survival. Materials and Methods: A total of 34 patients were treated by partial or total penectomy for penile carcinoma at our institution from January 1998 to December 2012. The immunohistochemical expression of TF was determined by a quantitative methodology in formalin-fixed paraffin-embedded tissue samples and correlated with age, clinical stage, pathologic stage, lymph node metastases, tumor grade and survival. Results: Immunohistochemical expression of TF was observed in 26/34 (76.4%) specimens. The mean area of TF expression in the samples was 27.82 &#956;m2 [95% CI 20.0 35.6, SD 22.4]. Mean age was significantly lower among patients with increased TF expression in comparison to those with lower TF expression [57.6 (SD 9,9) vs. 67.3 years (SD 16,4); p = 0.047). Mean postoperative follow-up was 28.3 months (from 1 to 139.6 months). There were eight deaths (23.5%), four in each group, all related to the penile cancer. In multivariate analyses, there was no statistically significant correlation between TF expression and the study variables. Conclusions: TF was expressed in most samples of penile cancers. There was no statistically significant correlation between TF expression, prognostic factors and survival. / Embasamento: O aumento da express?o do fator tecidual (FT) foi correlacionado com pior progn?stico e sobrevida em v?rias neoplasias malignas. Em tumores urol?gicos, foi estudado na pr?stata, bexiga e rim. No presente estudo avaliamos a express?o imunoistoqu?mica do FT em esp?cimes de c?ncer de p?nis, correlacionando com fatores progn?sticos e sobrevida. Materiais e M?todos: Um total de 34 pacientes tratados com penectomia parcial ou total por c?ncer de p?nis no Hospital S?o Lucas da PUCRS no per?odo entre janeiro de 1998 a dezembro de 2012 foram inclu?dos no estudo. A express?o do FT foi determinada com metodologia quantitativa em amostras de tecido em parafina e correlacionada com idade, estadiamento cl?nico, estadiamento patol?gico, envolvimento linfonodal, grau de diferencia??o histol?gico e sobrevida. Resultados: A express?o do FT foi observada em 26 esp?cimes (76,4%). A m?dia da express?o na amostra foi de 27,8 &#956;m2 [IC 95% 20,0 35,6, DP 22,4]. Houve diferen?a significativa em rela??o a idade entre os grupos com express?o alta e baixa [57,6 anos (DP 9,9) contra 67,3 anos (DP 16,4), p = 0,047]. O seguimento m?dio foi de 28,3 meses (intervalo de 1 a 139,6 meses). Durante o acompanhamento houve 8 ?bitos (76,5%), 4 em cada grupo, todos relacionados a neoplasia. Na an?lise multivariada, n?o houve correla??o entre a express?o do FT e as vari?veis em estudo. Conclus?es: O FT foi expresso na maioria das amostras de c?ncer de p?nis. N?o houve correla??o entre n?vel de express?o do FT, fatores progn?sticos e sobrevida.

Made available in DSpace on 2015-04-14T13:35:58Z (GMT). No. of bitstreams: 1 458574.pdf: 1042465 bytes, checksum: a18a5566a2871bef1b665750abadef8e (MD5) Previous issue date: 2014-02-24 / OBJECTIVE: To evaluate blood pressure (BP), heart rate (HR), albuminuria (AL), and glomerular filtration rate (GFR) of patients undergoing ovarian stimulation to in vitro fertilization (IVF). METHODS: From March to September 2013 this quasi-experimental design analyzed the variation of baseline and after BP levels, HR, AL, and GFR from 75 subjects, before embryo transfer. Blood pressure was measured after a five minutes at rest. Glomerular filtration was estimated by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Follicular growth was assessed using serial ultrasound scans. RESULTS: Median patient age was 36,89 years. Thirty-three (44%) women got pregnant, and 9 (12%) cycles were complicated by ovarian hyperstimulation. No statistically significant associations were found between systolic BP levels (P=0,945), diastolic BP levels (P=0,802), and GFR (P=0,301) before and after ovarian stimulation. However, this study found a statistically significant correlation of HR (P=0,012) and AL (P=0,002) with ovarian stimulation. There was no statistically significant difference in the modification of variables before and after stimulation between patients who got pregnant from those who did not pregnant, as well as the group who developed ovarian hyperstimulation compared with group that developed the expected number of follicles. Three patients developed acute kidney injury. CONCLUSION: Ovarian stimulation to IVF does not change the BP levels, and GFR of patients undergoing it. There is statistically significant increasing of HR and AL, but without clinical relevance. Pregnancy and ovarian hyperstimulation does not alter the pattern of the study variables. / OBJETIVO: Avaliar press?o arterial, frequ?ncia card?aca, albumin?ria e filtra??o glomerular estimada de pacientes submetidas ? estimula??o ovariana para fertiliza??o in vitro. MATERIAIS E M?TODO: De mar?o a setembro de 2013, este quase experimento intra-grupos analisou a varia??o da press?o arterial (PA), frequ?ncia card?aca (FC), albumin?ria (AL) e filtra??o glomerular estimada (FGE) basais e ap?s estimula??o ovariana de 75 pacientes para fertiliza??o in vitro (FIV), ainda antes da transfer?ncia embrion?ria. A PA foi verificada ap?s repouso de cinco minutos, em duas medidas, sendo registrada a segunda. A filtra??o glomerular foi estimada pela f?rmula CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). O crescimento folicular foi avaliado por ecografias transvaginais seriadas. RESULTADOS: a m?dia de idade foi 36,89 anos. Trinta e tr?s mulheres (44%) gestaram e 9 (12%) desenvolveram hiperestimula??o ovariana. N?o foi identificada diferen?a estatisticamente significativa entre os n?veis de PA sist?lica (P=0,945) e diast?lica (P=0,802) e da FGE (P=0,301) antes e ap?s a estimula??o, por?m houve diferen?a estat?stica no que concerne ? FC (P=0,012) e ? AL(P=0,002). N?o houve diferen?a estatisticamente significativa na modifica??o das vari?veis antes e ap?s a estimula??o entre gestantes e n?o gestantes, bem como em rela??o ao grupo que desenvolveu hiperestimula??o ovariana em rela??o ao grupo com estimula??o normal. Tr?s pacientes desenvolveram perda aguda de fun??o renal. CONCLUS?ES: Estimula??o ovariana n?o altera significativamente press?o arterial e FGE das pacientes submetidas ? fertiliza??o in vitro. A signific?ncia estat?stica do aumento no que concerne ? FC e ? AL n?o apresentou significado cl?nico. Gesta??o e hiperestimula??o ovariana n?o alteraram o padr?o das vari?veis do estudo.

Made available in DSpace on 2015-04-14T13:35:58Z (GMT). No. of bitstreams: 1 458593.pdf: 1436191 bytes, checksum: b126309dee58688d2fe23cb45be67db7 (MD5) Previous issue date: 2014-02-21 / The purinergic system can induce proliferation, differentiation and death on tumor cells. Different P2 purinergic receptors are involved in preventing the growth of these cells. Although the mechanisms are not completely known, they may represent interesting therapeutic targets to control tumors. The RT4 and T24 human tumor bladder cell lines have been used as low and high cancer malignancy phenotype models, respectively. Our research group has demonstrated that quercetin increases the ADP hydrolysis and inhibits ecto-5'-nucleotidase/ CD73, exerting an anti-proliferative effect on T24 cell lines. We also demonstrate that T24 cell lines expresses the purinergic enzymes CD39L4 and ecto-5'-nucleotidase / CD73, and have low hydrolytic activity of ATPase and ADPase in contrast to a high activity AMPase. These data suggest the involvement of the enzymes and purinergic receptors on progression the tumor of the bladder, as well as other tumor types. The objective of the present study was characterize the purinergic receptors P2X (1-7) expression profile on human bladder tumor cell lines and biopsies; and investigate the inflammatory genes that are up-regulated on high-grade human tumor bladder cells compared to low grade tumor bladder cells. Human bladder cells RT4 and T24 were obtained from the ATCC. Cells were cultured in DMEN and RPMI, respectively, supplemented with 10% of fetal bovine serum (FBS), under ideal conditions of cultivation Data were analyzed by one-way analysis of variance (ANOVA), followed by Tukey Kramer test. To confirm the relevance of P2X (1-7) receptors in bladder cancer, we have also assessed their expression in human biopsies. For this purpose, upon approval by the local ethics committee, specimens of bladder tumors and normal tissues were obtained from the same patients, who have been undergone surgical resection at the Hospital S?o Lucas/PUCRS. All samples were collected and rapidly frozen in -80?C with RNA holder. Tissue specimens were ground and then sonicated in a TRIzol kit. The mRNA level was analyzed using RT-PCR analysis. Real-time PCR revealed that the mRNA expression of P2X purinergic receptors, particulary P2X4R was significantly up-regulated on both T24 and RT4 cell lines. Data from human bladder tumor biopsies comparing to bladder normal tissue, showed that P2X6 and P2X7 receptors appeared to be most often up-regulated on tumor tissues. Twelve inflammation related genes, CCL2, CCR2, TNF-&#945;, MAPK3, IL-1&#946;, IL-6, ADORA1, CD200, CD4, CHRNA4, EDNRA e ITGB2 were significantly up-regulated on the grade III bladder tumor cell line T24 when compared to grade I bladder tumor cell line RT4. Our results indicate that the inflammation genes overexpressed may play an important role in regulating urinary bladder cancer. We can conclude that P2X purinoreceptors and inflammation genes are differentially distributed among normal bladder, low and high tumor bladder, which could contribute to the different characteristics of these different types of cells. / O sistema purin?rgico pode induzir a prolifera??o, diferencia??o e morte em c?lulas tumorais. Diferentes receptores purin?rgicos P2, est?o envolvidos na inibi??o do crescimento tumoral. Embora os mecanismos n?o sejam completamente conhecidos, estes receptores podem representar alvos terap?uticos interessantes no tumor de bexiga. As linhagens celulares derivadas de tumor de bexiga humano RT4 e T24 t?m sido usadas como modelo de baixa e alta malignidade de tumor, respectivamente. Estudos realizados pelo nosso grupo de pesquisa t?m demonstrado o envolvimento do sistema purin?rgico no tumor de bexiga. A quercetina aumenta a hidr?lise do ADP e inibe a ecto - 5' - nucleotidase / CD73, exercendo um efeito anti - proliferativo sobre as c?lulas T24. Tamb?m demonstramos que as linhagens de c?lulas T24 expressam enzimas CD39L4 e ecto - 5' - nucleotidase / CD73, e t?m baixa atividade hidrol?tica de ATPase e ADP?sica com uma elevada atividade AMP?sica. Estes dados sugerem o envolvimento das enzimas e receptores purin?rgicos na progress?o do tumor de bexiga, bem como em outros tipos de tumor. O objetivo do estudo ? caracterizar a express?o dos receptores purin?rgicos P2X (1-7) em bi?psias de c?ncer de bexiga e linhagens celulares de tumor de bexiga humano, relacionado com o perfil de genes inflamat?rios mais expressos nestas amostras. Metodologia: As linhagens celulares de bexiga humanas RT4 e T24 foram obtidas a partir da ATCC. As c?lulas foram cultivadas em meio RPMI e DMEN, respectivamente, suplementado com 10 % de soro fetal bovino (SFB), sob condi??es ideais de cultivo. Para confirmar a relev?ncia dos receptores P2X (1-7) no tumor de bexiga, avaliou-se a express?o em bi?psias humanas. Para isso, ap?s aprova??o pelo comit? de ?tica local, amostras de tecidos normais e tumorais de bexiga foram obtidas dos mesmos pacientes, submetidos ? ressec??o cir?rgica no Hospital S?o Lucas / PUCRS. O RNA total dos tecidos foi isolado utilizando kit TRIzol . O n?vel de mRNA foi analisado utilizando an?lise RT - PCR . Resultados: O PCR em tempo real revelou que a express?o de mRNA de receptores purin?rgicos P2X, particularmente P2X4R foi significativamente up- regulada em ambas linhagens RT4 e T24. Dados a partir de bi?psias de tumores de bexiga humanos que comparam os resultados de express?o do tecido tumoral em rela??o ao tecido normal de bexiga, demonstrou que os receptores de P2X6 e P2X7 est?o superexpressos em tecidos tumorais. Doze genes relacionados com a inflama??o, CCL2, CCR2, TNF-&#945;, MAPK3, IL-1&#946;, IL-6, ADORA1, CD200, CD4, CHRNA4, EDNRA e ITGB2 foram significativamente superexpressos em c?lulas T24 derivadas de tumor de grau III quando comparadas com as c?lulas RT4 derivadas de tumor de grau I. Nossos resultados indicam que os genes superexpressos de inflama??o podem desempenhar um papel importante na regula??o do tumor de bexiga urin?ria. Conclus?o: Podemos concluir que purinoreceptores P2X e os genes inflamat?rios s?o diferencialmente distribu?dos entre bexiga normal e tumoral, o que pode contribuir para as diferentes caracter?sticas destes diferentes tipos de tumores.