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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Comment on Charlier et al., 2019 "The Mandible of Saint-Louis (1270 AD): Retrospective diagnosis and circumstances of death"

Snoddy, A.M.E., Beaumont, Julia, Buckley, H.R., Colombo, A., Halcrow, S.E., Kinaston, R.L., Vlok, M. 13 January 2020 (has links)
Yes / We read with interest the recent article by Charlier and colleagues entitled “The Mandible of Saint-Louis (1270 AD): Retrospective diagnosis and circumstances of death” [1]. This work, which consisted of macroscopic examination of a mandible purported to belong to the Crusader King of France and a review of historical accounts pertaining to his death, generated a good deal of press coverage and stimulated public interest in the fascinating field of palaeopathology. However, as researchers engaged in studying dental and nutritional disease in archaeological human remains we have some concerns with the methodology employed by the authors and the conclusions reached from the data they have collected. These include issues of provenance, lesion description, diagnostic methodology employed, and problems with historical references.
2

Cardiac Troponin T and myocardial damage

Stubbs, Peter John January 1995 (has links)
No description available.
3

Improving differential diagnosis of vocal cord dysfunction

Bernstein, Sarah Mae 12 September 2014 (has links)
Purpose: The purpose of this study was to assess whether the factors historically presented in the literature to differentiate vocal cord dysfunction (VCD) from breathing difficulties of other etiologies accurately predict and identify patients who have VCD. The researchers were also interested in whether patients with VCD have a higher risk of misdiagnosis than patients with breathing difficulties of other etiologies. Finally, the present study investigated whether patients with VCD were more likely to have their symptoms attributed to psychological factors than patients with breathing difficulties of other etiologies. Method: A survey comprised of 23 questions regarding the participants’ previous and current diagnoses, triggers that precede breathing difficulty, and whether or not the participants have ever been misdiagnosed was posted to internet support groups, websites, blogs, and forums. The final participant pool included 20 participants with VCD and 25 participants with asthma. Results: None of the factors investigated accurately differentiated participants with asthma from participants with VCD one hundred percent of the time. However, participants with VCD were more likely to report throat tightness during an attack, association of an attack with symptoms of acid reflux, and rapid resolution of symptoms without treatment. Conversely, participants with asthma were more likely to report expiratory stridor and chest tightness, full resolution of symptoms with use of asthma medications, nocturnal symptoms or symptoms just after waking, and symptoms that seemed to be triggered by environmental agents or allergens. Preliminary findings from the present study suggest that patients with VCD are both more likely to receive a misdiagnosis and have their symptoms attributed to psychological factors than participants with asthma. Conclusion: A diagnosis of VCD must be made very carefully, ideally with instrumental evaluation of the vocal mechanism during an acute “attack” of breathing difficulty. The factors identified in the literature to differentially diagnose patients with asthma from patients with VCD do not accurately differentiate these populations. These findings suggest that continued education about the nature of VCD and differential diagnosis should be paramount to medical professionals. / text
4

Development and assessment issues in the diagnosis of early-onset bipolar disorder

George, Carrie Anne 01 November 2005 (has links)
Psychologists face challenges on a daily basis. Among the challenges they face are making diagnostic decisions. Recently, bipolar disorder has shown an increase in diagnosis in children and adolescents. Once felt to be an adult disorder, journals are describing the use of the diagnosis with children and adolescents. While the diagnosis has been considered as relevant, no psychological measures have been developed to make an accurate diagnosis. Developing a new psychological measure for bipolar disorder in children is critical. Due to the lack of data on what constitutes normal behavior as well as the absence of an accurate measurement of early-onset bipolar disorder, it is necessary to develop such a measure. The purpose of this study was to evaluate a newly developed measure based on the literature on bipolar disorder in children. The measure was developed through a review of the current literature, DSMIV-TR criteria for bipolar disorder, and ideas developed within a bipolar disorder research team at Texas A&M University. Because of the item content, the new measure is entitled the Mania Assessment Scale for Children (MASC). The first steps in understanding a new measure for early-onset bipolar disorder is to determine the factor structure of the scale as well as the reliability and validity. Results indicated that the MASC is best understood as a measure with a single score, or factor. Once the underlying structure of the MASC was determined, the study evaluated which behaviors of typically developing children may be misconstrued as indicative of bipolar disorder. Group differences on the measure are also evaluated. Results from statistical analysis showed that there were significant group differences between age groups, but not gender and ethnic groups. In addition, there was a statistically significant difference between clinical and non-clinical groups. To conclude, a discussion of the findings and recommendations for future research is presented. Overall, it is hoped that the study will help psychologists better understand the complexity of behaviors associated with the diagnosis of bipolar disorder in children and adolescents.
5

DiagnÃstico laboratorial de dengue e leptospirose em pacientes com sÃndrome febril aguda / Laboratory diagnosis of dengue and leptospirosis in patients with acute febrile syndrome

Laiane Fernanda de Melo Brezerra 31 January 2012 (has links)
FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / Dentre as arboviroses, a dengue apresenta-se como a mais importante, constituindo um grave problema de saÃde pÃblica a nÃvel mundial. As regiÃes tropicais e subtropicais sÃo as mais afetadas, ocorrendo aproximadamente 100 milhÃes de infecÃÃes por ano. Os principais sintomas que caracterizam a infecÃÃo sÃo febre, cefalÃia, dor retro-orbitÃria, mialgia, artralgia, prostraÃÃo e exantema. No entanto, outras infecÃÃes apresentam sintomas bastante semelhantes com a dengue, como a leptospirose. Ambas, dengue e leptospirose, podem causar surtos durante as estaÃÃes chuvosas, visto que à o melhor perÃodo para a disseminaÃÃo do mosquito Aedes aegypti e a contaminaÃÃo de Ãreas alagadas pela bactÃria Leptospira sp.. Dessa forma, este estudo teve como objetivo empregar diferentes mÃtodos para o diagnÃstico laboratorial de dengue e leptospirose em pacientes com sÃndrome febril. Oitenta e seis amostras de 86 pacientes com suspeita de dengue foram analisadas por meio do teste imunocromatogrÃfico NS1, ELISA-NS1, teste imunocromatogrÃfico de captura de IgM e IgG, ELISA-IgM e RT-PCR. Dentre os 86 pacientes avaliados, 48 (55,8%) foram positivos para pelo menos um dos testes diagnÃsticos realizados. ApÃs testados para dengue, 68 pacientes foram avaliados pelo teste imunocromatogrÃfico de captura de IgM e pelo teste de ELISA-IgM, ambos para identificaÃÃo de anticorpos anti-Leptospira. Cinco (7,3%) foram positivos para esta infecÃÃo. à de grande importÃncia pesquisar outras causas infeciosas, como a leptospirose, que tambÃm à uma doenÃa febril, em pacientes com suspeita clÃnica de dengue, pois o controle das doenÃas mais prevalentes sà se torna possÃvel quando conhecemos os agentes infecciosos responsÃveis por elas. Portanto, faz-se necessÃrio o uso de diagnÃsticos especÃficos para cada infecÃÃo, permitindo com que os programas de controle epidemiolÃgicos sejam realizados. / Among the arboviruses, dengue is the most important, constituting a serious public health problem worldwide. The tropical and subtropical regions are most affected, occurring approximately 100 million infections per year. The main symptoms that characterize the infection are fever, headache, retro-orbital pain, myalgia, arthralgia, prostration and rash. However, other infections have very similar symptoms to dengue, such as leptospirosis. Both dengue and leptospirosis, can cause outbreaks during the rainy seasons, since it is the best period for the dissemination of Aedes aegypti and contamination of wetlands by Leptospira sp.. This study aimed to employ different methods for the laboratory diagnosis of dengue and leptospirosis in patients with febrile syndrome. Eighty-six samples of 86 patients suspected of being infected with dengue were analyzed by NS1 immunoassay, NS1-ELISA, immunoassay IgM and IgG capture, IgM-ELISA and RT-PCR. Among the 86 patients evaluated, 48 (55.8%) were positive for at least one of diagnostic tests. After tested for dengue, 68 patients were evaluated by immunoassay IgM capture and by ELISA-IgM, both for identification of anti-Leptospira. Five (7.3%) were positive for this infection. It is very important to search for other infectious causes, such as leptospirosis, which is also a febrile illness, in patients with clinical suspicion of dengue, since the control of diseases prevalent only becomes possible when we know the infectious agents responsible for them. Therefore, it is necessary to use specific diagnoses for each infection, allowing epidemiological control programs can be carried out.
6

IdentificaÃÃo etiolÃgica de quadros dengue-sÃmile no CearÃ, no ando de 2008. / Etiology of dengue-like infections in Cearà State, Brazil, 2008.

Augusto CÃsar AragÃo Oliveira 30 May 2011 (has links)
Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / A dengue à a arbovirose mais importante no mundo, causando mais de 100 milhÃes de casos de dengue clÃssico (DC) e mais de 250 mil casos de febre hemorrÃgica da dengue (FHD), anualmente. A infecÃÃo com o vÃrus dengue (DENV), famÃlia Flaviviridae, causa um amplo espectro de manifestaÃÃes clÃnicas que variam desde formas assintomÃticas a quadros graves, potencialmente fatais, como os casos hemorrÃgicos e/ou de choque hipovolÃmico. Na maioria das vezes, a doenÃa se apresenta com sintomas inespecÃficos. Dessa forma, torna-se difÃcil diferenciar a dengue de outros casos febris de natureza infecciosa como leptospirose, febre amarela e outras arboviroses, apenas com base nas manifestaÃÃes clÃnicas iniciais. Diante disso, o objetivo deste estudo foi identificar a etiologia de 82 pacientes com quadro clÃnico semelhante ao de dengue e com resultado negativo no isolamento viral (IV) para o DENV. O IV foi realizado pelo LaboratÃrio Central de SaÃde PÃblica do Cearà (LACEN-CE), em 2008. Neste estudo, as amostras desses pacientes foram avaliadas para dengue por meio da detecÃÃo de anticorpos especÃficos contra o vÃrus pela tÃcnica de IgM-ELISA (PanBio DiagnosticsÂ) e pela reaÃÃo em cadeia da polimerase apÃs transcriÃÃo reversa (RT-PCR). As amostras negativas para dengue foram testadas para a detecÃÃo de anticorpos IgM especÃficos contra bactÃrias do gÃnero Leptospira por ELISA (PanBio DiagnosticsÂ). Foram testadas tambÃm amostras de 73 pacientes quanto a infecÃÃo por hantavirus, atravÃs da detecÃÃo de anticorpos especÃficos (IgM e IgG) contra antÃgenos de hantavÃrus e RT-PCR. Trinta e cinco pacientes (35/82; 42,68%) foram positivos para dengue, sendo que destes, todos foram positivos no IgM-ELISA e 4 foram positivos tambÃm no RT-PCR. Das 47 amostras dengue-negativas, apenas 43 foram testadas para infecÃÃo por Leptospira devido ao volume insuficiente das amostras. Seis pacientes (6/82; 7,32%) foram positivos IgM-ELISA para leptospirose. TrÃs pacientes foram positivos para hantavÃrus, entretanto apenas 1 (1/82; 1,22%) foi positivo no IgM-ELISA e 2, no IgG-ELISA. A infecÃÃo dos 35 (42,68%) pacientes negativos em todos os testes de detecÃÃo de infecÃÃo aguda foi classficada como sÃndrome febril indiferenciada (SFI). Esta à a primeira evidÃncia de infecÃÃo por hantavÃrus no Estado do CearÃ. Essas doenÃas podem causar infecÃÃo clinicamente indistinguÃvel da dengue e, portanto, deveriam ser incluÃdas no diagnÃstico diferencial no contexto dessas sÃndromes febris. / Dengue is the most important arborvirosis in the world, causing approximately 100 millions cases of classical dengue fever (DF) and more than 250.000 of dengue hemorrhagic fever (DHF), annually. The dengue virus (DENV) belongs to the Flaviviridae family and its infection causes a wide clinical spectrum ranging from assymptomatic forms to severe manifestations, potentially fatal, as in hemorrhagic forms or dengue shock syndrome (DSS). Most of times the disease presents inespecific symptoms. Thus, DF is difficult to distinguish from other acute febrile illnesses, including arboviral ones and leptospirosis, based only on clinical criteria. Given this, the aim of this study was to identify the etiology of 82 patients with clinical picture of dengue-like illness, negative in DENV isolation. The virus isolation was done in Laboratorio Central de SaÃde PÃblica do Cearà (LACEN-CE), Brazil, in 2008. In the present study, the serum samples from these patients were evaluated for dengue infection by IgM-ELISA (PanBio DiagnosticsÂ) and RT-PCR, following Lanciotti et alli protocol (1992). Negative samples to dengue infection were tested to leptospirosis by IgM-ELISA (PanBio DiagnosticsÂ). Seventy-three patients were also tested for hantavirus infection by IgM and IgG by ELISA and RT-PCR. Dengue infection was diagnosed in 35 patients (35/82; 42.68%) of which all were positive in IgM-ELISA, and 4 were also positive in RT-PCR. Of 47 (47/82; 57.32%) DENV-negative samples, only 43 were tested to evaluate lesptospiral infection because of insufficient sample volume. Six patients (6/82; 7,32%) were positive to leptospirosis in the IgM-ELISA. Three patients were positives to hantavirus infection, but only 1 (1/82; 1,22%) was positive in the IgM-ELISA and the two others, in the IgG-ELISA. Thirty and five patients (35/82; 42,68%) remained negative em all tests. They were classified as having other febril illness (OFI). To the best of our knowledge, this is the first evidence of hantavirus infection in humans in the state of CearÃ, Brazil. These diseases, including leptospirosis, may cause infection clinically indistinguishable from DF and therefore should be included in the differential diagnosis of febrile illnesses in this setting.
7

Monogenic Diseases Masquerading as Multiple Sclerosis: A Systematic Review

Marino, Meghan J. January 2011 (has links)
No description available.
8

Identificação das variações do espectro do autismo / Variants autism spectrum identification

Barbosa, Milene Rossi Pereira 31 October 2013 (has links)
O termo \"Distúrbio do Espectro do Autismo\" reflete uma tendência a valorizar a grande variedade clínica observada na prática diária e a possibilidade de existirem outros subtipos da patologia. A natureza clínica dos critérios de diagnóstico e a falta de instrumentos definidos e acessíveis para esse processo, em conjunto com a preocupação em não \"rotular\" a criança, contribuem para o atraso no diagnóstico. Para presente pesquisa, dividida em três estudos, foi utilizado o instrumento Differential Assessment of Autism and Other Developmental Disorders (DAADD) e traz como objetivos identificar as variações do Espectro do Autismo das crianças e adolescentes em atendimento no Laboratório de Investigação Fonoaudiológica nos Distúrbios do Espectro do Autismo da Faculdade de Medicina da Universidade de São Paulo, identificar os comportamentos das variações do Espectro do Autismo o instrumento com o Autism Behavior Checklist e por fim a partir dele, propor um instrumento reduzido. As análises permitem dizer que, quanto mais nova a criança, mais fácil se dá a diferenciação entre estar incluída no Espectro do Autismo e não estar, e quanto maior a idade da criança mais o DAADD identifica o diagnóstico diferencial dentro dos Distúrbios do Espectro do Autismo. O instrumento mostrou-se eficiente para o diagnóstico no espectro do autismo na comparação dos resultados apresentados no Autism Behavior Checklist pelo mesmo grupo de sujeitos, uma vez que o diagnóstico de Autismo foi o mais prevalente na classificação \"alta probabilidade\" do ABC para as idades de 4 a 8 anos. Outros estudos, com outros distúrbios do desenvolvimento (como Retardo Mental e Paralisia Cerebral) podem confirmar a utilidade e a especificidade do DAADD e de sua versão reduzida / The term \"autism spectrum disorder\" reflects a larger clinical variability observed in daily practice and the possibility of other subtypes of the disease. The clinical diagnostic criteria and the lack of accessible and defined instruments with the concern to not \"label\" the child, contribute to the delay in diagnosis. To this study, divided into three studies, we used the instrument Differential Assessment of Autism and Other Developmental Disorders (DAADD) and has as objective to identify variations Autism Spectrum children and adolescents in care at the Laboratory of Speech Spectrum Disorders Autism, Faculty of Medicine, University of São Paulo, identify behaviors variations Autism Spectrum instrument with the Autism Behavior Checklist (ABC) and finally, propose an instrument reduced. Analyses showed that for the younger children was easier to differentiate between being included in the Autism Spectrum and not being, and as the age increases the DAADD is more effective to give the differential diagnosis in the Autism Spectrum Disorders . The instrument proved to be efficient for the diagnosis on the autism spectrum in comparing the results presented in the ABC by the same group of subjects, once the diagnosis of autism was more prevalent in ranking \'high probability\' ABC for ages 4-8 years. Other studies with other developmental disorders (such as mental retardation and cerebral paralysis) may confirm the use and specificity of DAADD and its reduced version
9

Identification cases of leptospirosis and hantaviruses in patients with clinical suspected of dengue in Cearà / IdentificaÃÃo de casos de leptospirose e hantavirose em pacientes com suspeita clÃnica de dengue no CearÃ

RaÃssa Matos Fontes 01 April 2014 (has links)
CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Dengue is considered the most important arbovirus in the world in terms of morbidity and mortality, causing 50-270,000,000 infections per year, of which 2,000,000 cases progress to more severe forms and 21,000 result in death. Clinical manifestations range from asymptomatic and undifferentiated febrile syndrome to severe hemorrhagic. Considering that dengue has a wide range and nonspecific clinical spectrum, it is difficult to distinguish it from other diseases, using only clinical and epidemiological criteria. There is a high prevalence of patients with a non-laboratory confirmed dengue in epidemics, there is a need to investigate other possible etiologic agents responsible for these cases in order to take early and effective therapeutic measures. This study aimed to identify cases of leptospirosis and hantavirosis in patients with dengue-like syndrome. Therefore, we evaluated 93 patients, with clinical suspicion of dengue, recruited during January-September in 2012, in the State of CearÃ. The samples were tested for dengue through NS1 immunochromatographic, ELISA-IgM and RT-PCR. Dengue negative samples were tested for leptospirosis, through ELISA-IgM and PCR, and for hantaviruses, through RT-PCR. All the samples from this study were tested for hantavirus by ELISA-IgM and ELISA-IgG. Of the 93 patients evaluated for dengue, 48 (51,6%) were positive for at least one of the tests. Of the remaining 45 patients with negative results for dengue, 13 (28,8%) patients were positive for leptospirosis, 5 by ELISA-IgM and 8 by PCR. One (1,07%) patient was positive for hantavirus by ELISA IgM and 30 (31,6%) were positive by ELISA-IgG. Thirty two (32,2%) patients remained negative in tests for dengue, leptospirosis and hantavirus, not having revealed its etiology. Thus, in epidemics of dengue, leptospirosis and hantaviruses cases were underdiagnosed and confused with dengue, leading to inappropriate treatment. Besides these, other etiologic agents should be involved, requiring further investigation to define its etiology and the actual prevalence of these pathologies in State. / A dengue à considerada a mais importante arbovirose no mundo em termos de morbi-mortalidade, causando 50 a 270.000.000 de infecÃÃes por ano, dos quais 2.000.000 de casos evoluem para as formas mais graves e 21.000 resultam em morte. As manifestaÃÃes clÃnicas variam desde formas assintomÃticas e sÃndrome febril indiferenciada a quadros hemorrÃgicos graves. Considerando-se que a dengue possui um amplo e inespecÃfico espectro clÃnico, torna-se difÃcil distingui-la de outras doenÃas, utilizando apenas critÃrios clÃnicos e epidemiolÃgicos. Hà uma grande prevalÃncia de pacientes com quadro de dengue nÃo confirmado laboratorialmente em epidemias, havendo necessidade de pesquisar outros possÃveis agentes etiolÃgicos responsÃveis por estes casos a fim de se adotar medidas terapÃuticas precoces e efetivas. O presente estudo apresentou como objetivo identificar casos de leptospirose e hantavirose nos pacientes com quadro dengue-sÃmile. Foram avaliados 93 pacientes, com quadro clÃnico de dengue, atendidos em hospital de referÃncia no Estado do CearÃ, no perÃodo de janeiro a setembro de 2012. As amostras foram avaliadas para dengue atravÃs do teste imunocromatogrÃfico NS1, ELISA-IgM e RT-PCR. As amostras negativas para dengue foram testadas para leptospirose, atravÃs de ELISA-IgM e PCR, e para hantavirose, atravÃs da reaÃÃo de RT-PCR. Todas as amostras do estudo foram testadas para hantavÃrus atravÃs de ELISA-IgM e ELISA-IgG. Dos 93 pacientes avaliados para dengue, 48 (51,6%) foram positivos por pelo menos um dos testes utilizados. Dos 45 pacientes com resultados negativos para dengue, 13 (28,8%) foram positivos para leptospirose, sendo 5 por ELISA IgM e 8 por PCR. Um (1,07%) paciente foi positivo para hantavÃrus, atravÃs de ELISA IgM e 30 (31,6%) foram positivos pelo ELISA-IgG. Trinta e dois (32,2%) pacientes permaneceram negativos nos testes realizados para dengue, leptospirose e hantavÃrus, nÃo tendo sua etiologia revelada. Desta forma, em epidemias de dengue, os casos de leptospirose e hantavirose podem estar sendo subdiagnosticados e confundidos com a dengue, levando a tratamentos inadequados. AlÃm destes, outros agentes etiolÃgicos devem estar envolvidos, sendo necessÃrias maiores investigaÃÃes para se definir suas etiologias e as reais prevalÃncias dessas patologias no Estado.
10

Contribuição da analise de textura do nucleo celular para o diagnostico diferencial de lesões foliculares da tireoide : comparação com marcadores imunoistoquimicos / Contribution of the cellular nucleus texture analyses for the differential diagnosis of follicular thyroid lesions: comparison with imunohistochemical

Ferreira, Rita de Cassia 02 September 2007 (has links)
Orientadores: Patricia Sabino de Matos, Konradin Metze / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T07:31:38Z (GMT). No. of bitstreams: 1 Ferreira_RitadeCassia_D.pdf: 3204202 bytes, checksum: 19b68934360416ff1710b9848a450ced (MD5) Previous issue date: 2007 / Resumo: O diagnóstico diferencial entre algumas lesões da tireóide é, muitas vezes, difícil de ser determinado, mesmo diante de diversas amostras de tecido. O propósito deste estudo foi o de investigar até que ponto a análise de textura da cromatina em cortes histológicos de rotina contribui para o diagnóstico diferencial entre lesões foliculares da glândula tireóide. Entraram no estudo cortes histológicos corados com hematoxilina-eosina de 12 nódulos adenomatosos hiperplásicos (NA), 18 adenomas foliculares (AF), 24 carcinomas foliculares mínimamente invasores (CFMI) e 22 variantes foliculares do carcinoma papilífero (VFCP). As amostras de tecido utilizadas foram analisadas morfologicamente por meio de estudo histológico e estudo imunoistoquímico pela expressão de diferentes proteínas ou marcadores. Os marcadores utilizados foram HBME-1, CK-19 e galectina-3. Em cada caso 100 núcleos foram aleatoriamente escolhidos, digitalizados e segmentados. A estrutura dos núcleos foi descrita por morfometria, densitometria e por variáveis derivadas da matriz de co-ocorrência. Sexo, idade do paciente e metástases foram informações pesquisadas. Os resultados da análise de imagem computadorizada foram comparados com aqueles obtidos por meio de estudo imunoistoquímico, na distinção das lesões foliculares benignas e malignas da tireóide. Os dados foram comparados por análise de variância (nível de significância p<0,05). As amostras sugerem que o HBME-1 foi um marcador mais sensível quanto à malignidade. Entretanto, o uso dos três marcadores, num painel, pode ser útil em casos específicos, como por exemplo, na diferenciação de lesões foliculares, com referência especial à variante folicular do carcinoma papilífero. Dados descritos como fatores prognósticos, nas lesões foliculares malignas, não se mostraram significantes para discriminar o carcinoma folicular da variante folicular do carcinoma papilífero. As variáveis de morfometria não apresentaram grande valor discriminante, exceto, pelo P5FF4 (quinto percentil do fator de forma) que estabeleceu diferenças significantes entre AF e VFCP e entre CFMI e VFCP. Variáveis densitométricas demonstraram diferenças significantes entre NA e AF, NA e CFMI, AF e VFCP, AF e CFMI e entre CFMI e VFCP. Variáveis derivadas da matriz de co-ocorrência demonstraram diferenças entre os subgrupos, mas somente o P5Energy (quinto percentil da variável ?energia?), demonstrou diferença entre AF e CFMI. Ainda a variável r2Mink (grau de aproximação da dimensão fractal de Minkowski) diferenciou lesões benignas de malignas (NA e CFMI, NA e VFCP, AF e CFMI, AF e VFCP). A análise de textura pôde auxiliar na discriminação entre lesões benignas e malignas da tireóide principalmente quando se tratava da discriminação entre NA ou AF e VFCP, na qual a análise histológica, baseada em características nucleares pode trazer grandes dificuldades. Por outro lado, o diagnóstico entre AF e CFMI é difícil e não se baseia em características nucleares, mas no achado de invasão capsular ou vascular. Entretanto, nestes casos, as variáveis 'energia' e r2Mink, contribuíram para o diagnóstico diferencial. Portanto, a análise de imagem computadorizada pode ser considerada como uma ferramenta que auxilia no diagnóstico diferencial de lesões foliculares da tireóide, somando-se à interpretação morfológica e imunoistoquímica / Abstract: The differential diagnosis between some thyroid lesions is often difficult to determine, even with permanent sections. The purpose of this study was to find out if chromatin texture analysis contributes to the differential diagnosis of thyroid follicular lesions. We selected slides stained with H-E (hematoxilin-eosin) of 12 hyperplastic adenomatous nodules (AN), 18 follicular adenomas (FA), 24 minimally invasive follicular carcinomas (MIFC) and 22 follicular variants of papillary carcinomas (FVPC). A total of 100 nuclei of each case were digitalized and segmented. The utility of a combination of immunostaining including galectin-3, HBME-1 and CK-19 in the routine differentiation of the histologies of thyroid malignancies was evaluated. The nuclei structure was described by morfometry, densitometry and by variables derived by co-occurrence matrix. Sex, age of the patient and metastasis were clinical and morphologic parameters searched in this study. These data, described as prognostic factors for follicular malignant tumors, were compared by variance analysis (significance value p<0,05) and did not differentiate significantly among the groups. The best marker, in terms of sensitivity and specificity, was HBME-1. The combination CK-19, HBME-1 and galectin-3, in a panel, may be useful in specific cases, for example, for differentiate folicullar lesions, with special reference for folicullar variant of papillary carcinoma. Morphometric variables did not show significant discriminant value, except, the P5FF4 (5th percentile of the form factor) which demonstrated significant differences between FA and FVPC and between MIFC and FVPC. Densitometric variables demonstrated significant differences between AN and FA, AN and MIFC, FA and FVPC, FA and MIFC and even between MIFC and FVPC. The variables derived from co-occurrence matrix demonstrated differences among the sub- groups, but only P5 Energy (fifth percent of energy variable) showed significant differences between FA and MIFC. Also, the variable r2Mink (Goodnesss of fit of the Minkowski - fractal dimension) was able to differentiate benign and malignant lesions such as: AN and MIFC, AN and FVPC, FA and MIFC, FA and FVPC. Texture analysis may help to differentiate benign and malignant follicular lesions of the thyroid, specially when one is trying to differentiate AN or FA and FVPC. In this situation the histological analysis based on nuclear characteristics may not be definitive; owing to the fact that all the nuclear criteria may not be always present in most cases. On the other hand, the differential diagnosis of FA and MIFC is difficult and it is not based on nuclear characteristics, but on the finding of capsular or vascular invasion. However, in these cases, the variables energy and r2Mink contributed to the differential diagnosis. Therefore, the computerized image analysis may be considered as a tool that helps the differential diagnosis of follicular thyroid lesions, added to the morphological and immunohistochemical analysis / Doutorado / Anatomia Patologica / Doutor em Ciências Médicas

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