A esteato-hepatite não alcoólica (EHNA) consiste em esteatose e inflamação lobular hepática, em indivíduos não alcoolistas. Ocorre associada a obesidade, hiperlipidemia, diabetes mellitus, sexo feminino, medicamentos e ‘bypass’ jejunoileal. Recentemente, a sobrecarga de ferro, secundária a mutações no gene HFE da hemocromatose hereditária, também vem sendo evidenciada nos pacientes com EHNA do sexo masculino, não obesos e não diabéticos. O presente estudo, envolvendo pacientes com EHNA do Ambulatório de Gastroenterologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, teve como objetivos traçar seu perfil clínico, laboratorial e histopatológico, pesquisar a presença de mutações do gene HFE, buscar associações entre esses resultados e rever a literatura a respeito. Trinta e dois indivíduos foram caracterizados quanto a 14 aspectos clínicos, 12 parâmetros laboratoriais e 11 variáveis histopatológicas. Em 31 destes pesquisaram-se as mutações C282Y e H63D pela técnica de PCR-RFLP, utilizando-se as enzimas de restrição SnaB I e Bcl I, respectivamente. As idades variaram entre 32 e 76 anos, com média de 49,2 anos. Sexo feminino (59%), obesidade (50%), hiperlipidemia (53%) e diabetes mellitus (31%) ocorreram em taxas inferiores às das primeiras séries publicadas. Outras condições encontradas foram uso de amiodarona e prednisona, inalação de substâncias químicas industriais e enterectomia extensa. As etnias branca (72%) e asiática (12%) ocorreram em percentagens maiores que da população geral; ao contrário, a negra (ausente) e mulatos (12%), em menores. A fibrose perivenular ocorreu em todos os casos, proporcional ao grau de atividade necroinflamatória. Os hialinos de Mallory foram identificados em 78% dos casos, mas a siderose em apenas 9%. Cerca de dois terços da casuística não apresentou queixas relacionadas ao aparelho digestivo. Dentre as enzimas hepáticas, a ALT foi a que se alterou com maior freqüência e magnitude, e a relação AST/ALT foi menor que dois em todos os casos. As incidências das mutações pesquisadas corresponderam às da população geral. A sobrecarga de ferro em sangue periférico não se correlacionou estatisticamente com a agressão histológica, nem com a presença das mutações. EHNA é um diagnóstico que engloba múltiplas condições, mas, na população estudada, não houve associação com a sobrecarga de ferro hepático, tampouco com as mutações conhecidas do gene HFE. / Non-alcoholic steatohepatitis (NASH) consists of steatosis and hepatic lobular inflammation in non-alcoholic individuals. It occurs in association to obesity, hyperlipidemia, diabetes mellitus, female sex, drug therapy and jejunoileal bypass. Recently, iron overload, secondary to mutations in the HFE gene in hereditary hemochromatosis has also been evidenced in nonobese, non-diabetic male patients with NASH. This study involves patients with NASH from the outpatient clinic of Hospital das Clinicas of the University of São Paulo School of Medicine, and its objective was to define patients’ clinical, laboratory and histological profiles and search for mutations in the HFE gene, compare results for associations and review the literature. Thirtytwo individuals were characterized for 14 clinical features, 12 laboratory parameters and 11 histopathological variables. The C282Y and H63D mutations in 31 of these individuals were searched using PCR-RFLP techniques, using restriction enzymes SnaB I and BcI I, respectively. Age varied from 32 to 76 yrs old, with an average of 49,2 yrs. Female sex (59%), obesity (50%), hyperlipidemia (53%) and diabetes mellitus (31%) had a lower incidence than those in the first series in the literature. Other features observed were amiodarone and prednisone use, inhalation of industrial chemical substances and extensive enterectomy. Its incidence was higher among Caucasians (72%) and Asians (12%) than in the general population, contrary to other ethnic types such as Black (absent) and Mulattos (12%) which presented lower incidences. Perivenular fibrosis was present in all cases, proportional to the degree of necroinflammatory activity. Mallory’s hyalines were identified in 78% of the cases, but hepatic siderosis was identified in only 9%. Around two-thirds of the casuistic did not have abdominal complaints. Among the hepatic enzymes, ALT was the most frequently altered with the highest magnitude and the AST/ALT ratio was < 2 in all cases. The incidence of the mutations studied was similar to those found in the general population. The iron overload in peripheral blood was neither statistically correlated to the histological aggression, nor to the presence of mutations. NASH diagnosis depends on multiple features, but in the population studied, there was no association with hepatic iron overload as well as with the known mutations in the HFE gene.

OBJETIVO: A restauração de dentes tratados endodonticamente é um desafio para a Odontologia. A fratura do remanescente radicular é comum neste tratamento. São três os métodos utilizados para estudar as fraturas: a análise por elementos finitos, os que utilizam dentes naturais e aqueles que utilizam dentes artificiais. O uso de dentes naturais apresenta alguns inconvenientes, como as variações anatômicas e de histórico de exposição a esforços (que aumentam a variabilidade da amostra e dificultam as conclusões), além da pequena disponibilidade de espécimes. Este estudo propõe-se avaliar a viabilidade de usar compósito para a construção de raízes artificiais e a aplicação dessas réplicas em estudos sobre a essas fraturas. MÉTODOS: Na primeira etapa foram utilizadas 50 raízes unirradiculares de 2º pré-molar superior e 50 réplicas. As raízes naturais foram selecionadas por terem características anatômicas semelhantes. As réplicas foram confeccionadas a partir de um molde de resina acrílica que copiou uma raiz natural com proporções dentro da média. O compósito foi escolhido pelas propriedades mecânicas mais próximas das propriedades mecânicas da dentina. Todas as raízes e as réplicas foram submetidas a forças compressivas de uma ponta metálica cônica (simulação do pino intrarradicular), até a fratura. A velocidade de avanço da ponta foi de 5mm/min. Na segunda etapa, foram confeccionadas 30 réplicas, divididas em 3 grupos (n=10). Todas foram restauradas com pinos metálicos fundidos e coroas metálicas. No grupo FZ os pinos foram cimentados com fosfato de zinco; no grupo CRD foi aplicada uma camada de vaselina sólida no conduto radicular e os pinos foram cimentados com cimento resinoso dual; no grupo CRC foi feita aplicação de um agente de união no conduto radicular e os pinos foram cimentados com cimento resinoso dual. Os espécimes foram submetidas a ciclagem mecânica de 130.000 ciclos sob pressão de 5bar. Duas raízes de cada grupo foram utilizadas para testar os parâmetros do ensaio de resistência à fratura. Em seguida, as outras raízes (n=8) foram submetidas ao teste de resistência sob forças compressivas até a ruptura. A carga foi aplicada com inclinação de 20º e velocidade de 5mm/min. RESULTADOS: Na comparação entre a resistência das raízes naturais e artificiais à penetração de pino no conduto radicular, houve diferença estatística entre os dois grupos. As raízes artificiais apresentam maior resistência à fratura (115,4MPa) do que as raízes naturais (75,4MPa). O coeficiente de variação das réplicas (21%) é menor que o das raízes naturais (36,3%), o que indica uma menor variabilidade da amostra das réplicas. Mesmo com valores diferentes, há semelhança na direção do traço de fratura e no local onde ocorrem. Esse resultado indica que a concentração de tensões e a propagação da fratura é semelhante em dentina e compósito. Quanto às réplicas restauradas com pinos, não houve diferença estatística entre os grupos. CONCLUSÃO: As raízes artificiais quando comparadas as raízes naturais, apresentam maior resistência à fratura, menor variação dos resultados individuais em torno da média e modo de fratura semelhante às raízes naturais. Desta maneira, é viável a utilização das réplicas nos estudos sobre mecânica da fratura. / OBJECTIVE: The restoration of endodontically treated teeth is a challenge for dentistry. The fracture of the remaining root is common in this treatment. There are three methods used to study fractures: a finite element analysis, using the natural teeth and those who use artificial teeth. The use of natural teeth has some disadvantages, such as anatomical variations and a history of exposure to stresses (which increase the variability of the sample and the findings difficult), beyond the limited availability of specimens. This study aims to evaluate the feasibility of using composite for the construction of artificial roots and application of these replicas in studies of these fractures. METHODS: In the first stage were used 50 single-rooted roots of 2nd premolar and 50 replicas. The natural roots were selected for having similar anatomical features. The replicas were made from an acrylic resin such that a natural root copied with ratios in the average. The composite was selected by the mechanical properties closer to the mechanical properties of the dentin. All the roots and the replicas were subjected to compressive forces of a conical metal tip (simulation post) until failure. The feed rate was tip of 5mm/min. In the second step, 30 replicas were prepared, divided into 3 groups (n = 10). All were filled with molten metal pins and metal crowns. In group A the posts were cemented with zinc phosphate, group B was applied to a solid layer of vaseline in the root canal and the posts were cemented with dual resin cement, in group C was made applying a bonding agent in the root canal and the posts were cemented with dual resin cement. The specimens were subjected to mechanical loading of 130,000 cycles under a pressure of 5bar. Two roots from each group were used to test the parameters of fracture toughness test. Then the other root (n = 8) were subjected to endurance test under compressive forces until failure. The load was applied with an inclination of 20° and speed 5mm/min. RESULTS: Comparing the resistance of natural and artificial root penetration of the pin in the root canal, was no statistical difference between the two groups. The artificial roots showed higher fracture strength (115.4 MPa) than the natural roots (75.4 MPa). The coefficient of variation of the replicas (21%) is less than the natural root (36.3%), indicating a lower variability of the replicas of the sample. Even with different values, there are similarities in the direction of the fracture site and where they occur. This result indicates that the stress concentration and fracture propagation is similar in dentin and composite. As for replicas restored with posts, no statistical difference between groups was found. CONCLUSION: The artificial roots showed greater resistance to fracture when compared to natural roots, less variation of individual results around the mean and mode of fracture similar to the natural roots. Thus, it is feasible to use in studies of replicas of fracture mechanics.

As lesões cervicais não cariosas (LCNCs) são caracterizadas pela perda de estrutura dental no terço cervical dos dentes, que se origina a partir de mecanismos não relacionados com o processo de cárie. Este trabalho buscou investigar a correlação das LCNCs (severidade e acometimento), com os seguintes fatores: idade, sexo, dieta, hábitos parafuncionais, hábitos de higiene dental, distúrbios gástricos e aspectos oclusais. Foram estudados cinquenta pacientes (36 mulheres e 14 homens), com idades entre 20 e 62 anos (média de 40.9 anos). A avaliação consistiu na aplicação de questionários e exame clínico intraoral. Um índice de desgaste dental foi utilizado para classificação da severidade das LCNCs e do desgaste da borda incisal/face oclusal. Os resultados mostraram que os primeiros pré-molares (20,5%), segundos pré-molares (19,5%), caninos (14%), primeiros molares (13,9%) e segundos molares (11,6%) foram os dentes mais acometidos pelas LCNCs. Foi constatada correlação positiva entre idade e o percentual de dentes acometidos, ou seja, quanto maior a idade do paciente, maior foi o percentual de dentes acometidos com LCNC (p=0,003). Foi constatado que os pacientes com ingestão diária de alimentos e bebidas ácidas apresentaram relação significante com a severidade das LCNCs (p=0,038) e também apresentaram maior percentual de dentes acometidos pelas LCNCs (p=0,014). Não foi verificada relação significante entre as LCNCs (severidade e percentual de dentes acometidos) com o sexo dos pacientes, número de escovações diárias, apertamento dental, bruxismo, distúrbios gástricos, força durante a escovação e tipo de cerdas da escova. Quanto aos aspectos relacionados à oclusão, foi observada pequena correlação (r=0,079) entre o desgaste cervical e o desgaste da borda incisal/face oclusal. Em nenhum caso foi observada diferença estatística significante da severidade das LCNCs entre dentes que participam ou não do movimento de lateralidade. / Noncarious cervical lesions (NCCL) are characterized by loss of tooth structure in the cervical area, and originated by mechanisms unrelated to dental caries process. This study investigated the correlation of NCCL (severity and involvement) with the following factors: age, gender, diet, parafunctional habits, dental hygiene, gastric disorders and occlusal aspects. Fifty patients (36 female and 14 male) aged between 20 and 62 years (mean age of 40.9 years) were evaluated. The evaluation consisted of questionnaires and intraoral clinical examination. A Tooth Wear Index was used to classify the severity of NCCL and wear of the incisal/ occlusal surface. Results indicate that first premolars (20,5%), second premolars (19,5%), canine (14%), first molars (13,9%) and second molars (11,6%) were the teeth most affected by NCCL. There was correlation between the age of patients and the percentage of teeth affected, meaning that the older the patient, the higher the percentage of teeth affected with NCCL (p=0,003). Patients with daily intake of acidic foods and beverages presented a significant relationship with the severity of NCCL (p=0,038) and also a higher percentage of teeth affected by NCCL (p=0,014). There was no significant relationship between NCCL (severity and percentage of affected teeth) and gender of patients, number of daily brushings, teeth clenching, bruxism, gastric disorders, force applied during toothbrushing and characteristics of the toothbrushes. There was a small correlation (r=0,079) between NCCL and the wear of incisal/occlusal surface. Regarding the severity of NCCL, no significant statistical differences were observed between the teeth involved or not in the lateral excursive movement.

The vertebrate eye lens functions to focus light onto the retina to produce vision. The lens is composed of an anterior monolayer of cuboidal epithelial cells that overlie a core of organelle free fiber cells. The lens develops and grows throughout life by the successive layering of lens fiber cells via their differentiation from lens epithelial cells. Lens developmental defect and damage to the lens are associated with cataract formation, an opacity of the lens that is a leading cause of visual impairment worldwide. The only treatment to date for cataract is by surgery. Elucidating those molecules and mechanisms that regulate the development and lifelong protection of the lens is critical toward the development of future therapies to prevent or treat cataract. To determine those molecules and mechanisms that may be important for these lens requirements we employed high-throughput RNA sequencing of microdissected differentiation statespecific lens cells to identify an extensive range of transcripts encoding proteins expressed by these functionally distinct cell types. Using this data, we identified differentiation state-specific molecules that regulate mitochondrial populations between lens epithelial cells that require the maintenance of a functional population of mitochondria and lens fiber cells that must eliminate their mitochondria for their maturation. In addition, we discovered a novel mechanism for how lens epithelial cells clear apoptotic cell debris that could arise from damage to the lens and found that UVlight likely compromises this system. Moreover, the data herein provide a framework to determine novel lens cell differentiation state-specific mechanisms. Future studies are required to determine the requirements of the identified molecules and mechanisms during lens development, lens defense against damage, and cataract formation. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

Metastasis is the primary cause of mortality in women with breast cancer. Recently, elevated serum levels of a glycoprotein known as chitinase-3 likeprotein- 1 (CHI3L1) has been correlated with poor prognosis and shorter survival of patients with cancer and inflammatory diseases. The biological and physiological functions of CHI3L1 in tumor progression have not yet been elucidated. In this document, we describe the role of CHI3L1 in tumor growth and metastasis and its relationship with inflammation. Using well-established models of breast cancer, we show that CHI3L1 is increased in the serum of tumor bearing mice. We found that CHI3L1 levels are increased at both the “pre-metastatic” and “metastatic stage” and that tumor cells, splenic, alveolar and interstitial macrophages; and myeloid derived population produce CHI3L1. Furthermore, we demonstrated that CHI3L1 has an inhibitory role on the expression of interferon-gamma (IFN γ) by T cells, while enhancing the production of pro-inflammatory mediators by macrophages such as Cchemokine ligand 2 (CCL2/MCP-1), Chemokine CX motif ligand 2 (CXCL2/IL-8) and matrix metalloproteinase-9 (MMP-9), all of which promote tumor growth and metastasis. We demonstrated that in vivo treatment of tumor-bearing mice with chitin microparticles, a TH1 adjuvant and a substrate for CHI3L1, promoted immune effector functions with increased production of IFN-γ but decreased CCL2/MCP-1, CXCL2/IL-8 and MMP-9 expression by splenic and pulmonary macrophages. Significantly, in vivo administration of chitin microparticles decreased tumor growth and pulmonary metastasis in mammary tumor bearing mice. These results suggest that CHI3L1 may play a role in tumor progression. Inflammation plays a pivotal role during tumor progression and metastasis by promoting the production of pro-inflammatory molecules such as CHI3L1. However, little is known about how CHI3L1 expression can affect secondary sites to enhance metastasis. In these studies, we demonstrated that CHI3L1 alters the cellular composition and inflammatory mediators that aid in the establishment of a metastatic niche for the support of infiltrating tumor cells leading to accelerated tumor progression. Since previous studies showed that CHI3L1 modulates inflammation, we determined the role of CHI3L1 in the context of pre-existing inflammation and metastasis. We found that CHI3L1 deficient mice with preexisting inflammation had decreased pro-inflammatory mediators, and significant reduction in tumor volume and metastasis compared to wild type controls. Preexisting inflammation and CHI3L1 may be driving the establishment of a premetastatic milieu in the lungs and aiding in the establishment of metastasis. Understanding the role of CHI3L1 in inflammation during tumor progression could result in the design of targeted therapies for breast cancer patients. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

A doença renal policística autossômica dominante (DRPAD) constitui-se na enfermidade humana monogênica com risco de óbito mais frequente, responsabilizando-se por 4,4 a 10,0% dos casos de doença renal terminal em diferentes populações. Na quase totalidade dos pacientes, a doença é causada por mutação em um de dois genes: PKD1 (polycystic kidney disease 1) ou PKD2 (polycystic kidney disease 2). Tais genes codificam, respectivamente, as proteínas policistina-1 (PC1) e policistina-2 (PC2). Mutações em PKD1, por sua vez, respondem pela ampla maioria dos casos de DRPAD. Camundongos haploinsuficientes para Pkd1 (Pkd1+/-), o gene ortólogo a PKD1 neste animal, consistem num modelo não cístico de deficiência de atividade deste gene. Em um estudo anterior, mostramos que animais Pkd1+/- apresentam lesão renal mais severa que camundongos selvagens (Pkd1+/+) quando submetidos a isquemia/reperfusão (I/R) renal. Esse estudo sugeriu, portanto, que a capacidade de regeneração renal pós-I/R esteja prejudicada em camundongos Pkd1+/- e em pacientes com DRPAD. O insulto por I/R constitui-se em uma causa importante de indução de estresse de retículo endoplasmático (ER), podendo ativar as vias UPR (unfolded protein response) e ERAD (ER-associated degradation). Além disso, a ativação de vias envolvidas no ER determinado por I/R exerce um efeito de agravamento da lesão decorrente deste insulto. O ER pode, ainda, ativar e ser induzido pela resposta inflamatória. Estudos prévios revelaram que as policistinas também se relacionam com este processo. A expressão de PC2 pode ser superregulada pela ativação de um dos braços da via UPR, enquanto a ativação da via ERAD estimula sua degradação. A superexpressão de XBP1, por sua vez, atenua o fenótipo cístico em camundongos deficientes em Pkd1, revelando que a ativação da via UPR pode mitigar a formação cística. Para analisar a relação entre ER e suscetibilidade aumentada a I/R na deficiência de Pkd1, avaliamos diferentes marcadores de ER em camundongos Pkd1+/- e Pkd1+/+ submetidos a um insulto leve por I/R renal associado a 32 min de isquemia. A razão de expressão renal dos mRNAs Xbp1s/Xbp1u mostrou-se menor em camundongos Pkd1+/- que Pkd1 +/+ 48 h após I/R, enquanto a expressão proteica de XBP1s foi maior em rins Pkd1+/- comparados a Pkd1+/+ após o insulto. Não detectamos diferença na expressão renal do gene Hspa5 e de seu produto BIP/GRP78, assim como na expressão de Ddit3, gene que codifica CHOP, após intervenção sham e após I/R. Também não observamos diferenças entre os níveis renais e séricos de IL1beta, IL6, IL10, TNFalfa e RANTES entre camundongos Pkd1+/- e Pkd1+/+ pós-procedimento sham e pós-I/R, embora tendências não significantes de elevação de MCP1 tenham sido detectadas nos rins submetidos ao insulto para ambos os genótipos. As variações em sentidos opostos de XBP1s e Xbp1s/Xbp1u determinadas por I/R em rins Pkd1+/- são consistentes com uma maior suscetibilidade destes animais à indução de ER. Esses achados sugerem que a indução de ER em resposta a um insulto leve por I/R possa aumentar a atividade de PC1 e exercer um efeito de atenuação sobre a maior suscetibilidade de camundongos deficientes em Pkd1 a I/R renal / Autosomal dominant polycystic kidney disease (ADPKD) is the most common life-threatening monogenic disease in humans, accounting for 4.4 to 10.0% of the end-stage kidney disease cases in different populations. In almost all patients, this disorder is caused by a mutation in one of two genes: PKD1 (polycystic kidney disease 1) or PKD2 (polycystic kidney disease 2). These genes encode, respectively, the proteins polycystin-1 (PC1) and polycystin-2 (PC2). Mutations in PKD1, in turn, are responsible for the large majority of ADPKD cases. Pkd1- haploinsufficient mice (Pkd1+/-), the gene orthologous to PKD1 in this animal, constitute a noncystic model of this gene\'s deficiency. In a previous study, we showed that Pkd1+/- animals develop a more severe renal injury than wild-type mice (Pkd1+/+) when submitted to renal ischemia/reperfusion (I/R). This study suggested, therefore, that the capacity of renal regeneration following I/R is impaired in Pkd1+/- mice and in ADPKD patients. The I/R insult is an important cause of endoplasmic reticulum stress (RS) induction, potentially leading to activation of the UPR (unfolded protein response) and ERAD (ER-associated degradation) pathways. The activation of pathways involved in RS determined by I/R exerts an aggravating effect on the injury resulting from the insult. In addition, RS can activate and be induced by the inflammatory response. Previous studies revealed that polycystins also relate to this process. PC2 expression can be upregulated by the activation of one of the UPR pathway branches, while activation of the ERAD pathway stimulates its degradation. XBP1 overexpression, in turn, attenuates the cystic phenotype in Pkd1-deficient mice, revealing that activation of UPR can mitigate cyst formation. To analyze the relationship between RS and the increased susceptibility to I/R associated to Pkd1 deficiency, we evaluated different RS markers in Pkd1+/- and Pkd1+/+ mice submitted to a mild I/R insult determined by 32-min ischemia. The renal expression ratio of mRNA Xbp1s/Xbp1u was lower in Pkd1+/- than Pkd1+/+ mice 48 h after I/R, while the XBP1s protein expression was higher in Pkd1+/- compared to Pkd1+/+ kidneys after the insult. We have not detected differences in renal expression of the Hspa5 gene and its product BIP/GRP78, as well as in Ddit3 expression, the gene that encodes CHOP, postsham intervention and post-I/R. We have also not observed differences in the renal and serum levels of IL1beta, IL6, IL10, TNFalfa and RANTES between Pkd1+/- e Pkd1+/+ mice post-sham procedure and post-I/R, although non-significant trends of MCP1 increase have been detected in kidneys submitted to the insult for both genotypes. The variations in different directions of XBP1s and Xbp1s/Xbp1u induced by I/R in Pkd1+/- kidneys are consistent with a higher susceptibility of these animals to RS induction. These findings suggest that the RS induction in response to a mild I/R insult can increase PC1 activity and exert an attenuating effect on the increased susceptibility of Pkd1-deficient mice to renal I/R

A doença de Chagas compromete o cólon em torno de 10% dos pacientes soro positivos, levando ao megacólon adquirido. O tratamento é cirúrgico, sendo a operação de Duhamel-Haddad a mais utilizada no Estado de Goiás, cuja execução pode levar a alterações do plexo nervoso vesical durante a dissecção do espaço retro-retal, ou ainda, a retirada do segmento colônico dilatado, levar a possíveis modificações da função miccional. O objetivo deste estudo foi avaliar através da urodinâmica se ocorrem alterações funcionais da bexiga no pós-operatório da cirurgia de Duhamel- Haddad, tendo como controle o próprio paciente, avaliado no pré-operatório. Foram estudados prospectivamente 16 pacientes (7 homens e 9 mulheres) no período de 2001 a 2002, cuja idade variou entre 30 e 71 anos. Para a realização deste exame, utilizou-se o aparelho Urosystem DS-5600 com cateter uretral de duas vias - 7 French e sonda retal com balão. A perfusão foi realizada com água destilada à temperatura ambiente e velocidade de 50 ml/min. Os parâmetros observados foram a fluxometria livre, cistometria e estudo miccional, utilizando-se os testes t-student e a regra de sinais de Descartes para a análise estatística. Os resultados deste estudo foram divididos em três grupos: 1- masculino e feminino; 2- feminino; 3- masculino. No primeiro grupo observou-se diminuição na pressão detrusora máxima. No segundo grupo, diminuição da pressão detrusora no fluxo máximo. No terceiro grupo, evidenciou-se aumento do fluxo urinário máximo e médio, diminuição do tempo de micção e pressão de abertura vesical (P < 0,05) / Acquired megacolon caused by Chagas disease is found in around 10% of chronic infected patients. Chagasic megacolon evolves with constipation and the advocated treatment is surgical. Duhamel-Haddad procedure has been one of the most used techniques in many centers. The necessity of rectal dissection and excision of the rectossigmoid dilated part may cause urinary malfunction. This study addressed urodynamic outcomes in patients submitted to surgical treatment of chagasic megacolon by the Duhamel-Haddad procedure. Sixteen patients (9 females), aged between 30 to 71 years old, were evaluated by urodynamic study in the pre and post operative period. Uroflowmetry, cystometry and pressure flow studies were analyzed. Statistical analysis was carried out applying the Student t-test. Each patient was considered his own control. There was an overall decrease of the maximum detrusor pressure. A decrease of the maximum urinary flow was found in the female group while in the male group an increase of the maximum urinary flow and a decrease of urinary flow time and opening pressure were observed (P < 0.05)

A deficiência auditiva constitui uma importante categoria de defeitos congênitos que podem se manifestar isoladamente ou fazer parte do espectro fenotípico de várias síndromes. O presente trabalho refere-se ao estudo genéticoclínico de pacientes portadores de deficiência auditiva não sindrômica, com os objetivos de estabelecer a razão sexual, tipo, grau, simetria, lateralidade e progressão da deficiência auditiva; determinar diagnósticos etiológicos prováveis da deficiência auditiva, estabelecendo, quando possível, o padrão de herança genética e fornecer meios para o aconselhamento genético. Foram avaliados 306 pacientes no serviço de Genética Clínica do Centro de Atendimento aos Distúrbios da Audição, Linguagem e Visão do Hospital de Reabilitação de Anomalias Craniofaciais-USP, no período de dezoito meses. Dos 306 pacientes avaliados, 278 eram portadores de deficiência auditiva, 27 portadores de distúrbio de linguagem e 1 portador de deficiência visual. De acordo com o critério estabelecido (presença de deficiência auditiva isolada), 144 pacientes foram selecionados para este estudo, através da história clínica, história familial, dados pré, peri e pós-natais e audiometria (dados de prontuário). A análise estatística não mostrou associação significativa entre a ocorrência de deficiência auditiva não sindrômica e o sexo dos propósitos. Dos 144 pacientes estudados, 95.8% dos casos tinham etiologia genética e 4.2% etiologia ambiental. Nos portadores de deficiência auditiva de etiologia genética, o padrão de herança indefinido (53.6%) foi o mais freqüente, seguido o de herança autossômica recessiva (23.9%) e autossômica dominante (22.5%); as anomalias maiores e menores associadas à deficiência auditiva não estavam relacionadas com esta deficiência. O tipo de perda auditiva predominante foi o neurossensorial (99.3%) e deficiência auditiva severa a profunda foi a mais freqüente (34.8%). Da amostra, 68.1% dos casos apresentaram perda auditiva pré-lingüística, 54.9% apresentaram perda auditiva assimétrica, 95.8% perda auditiva bilateral e 95.1% perda auditiva não progressiva. O estudo permitiu concluir que história clínica e familial são informações importantes no diagnóstico etiológico da deficiência auditiva; que as configurações da curva audiométrica são avaliações de apoio ao esclarecimento diagnóstico da deficiência auditiva; que o aconselhamento genético é dificultado nos casos com padrão de herança indefinido e que análises moleculares são dados subsidiários à definição etiológica da deficiência auditiva. / Hearing loss constitutes an important category of congenital defects that can be expressed isolately or making part of the phenotypical spectrum of several syndromes. The aim of this study is to establish the sex-ratio, type, degree, symmetry, laterality, progression , and to find out the etiology of non syndromic hearing loss, establishing, when possible, the inheritance pattern providing ways to genetic couseling. During 18 months, 306 patients were evaluated at Centro de Atendimento aos Distúrbios da Audição, Linguagem e Visão of the Hospital de Reabilitação de Anomalias Craniofaciais-USP. Nonsyndromic hearing loss was observed in 144 of them; syndromic hearing loss in 134; only speech impairment in 27, and only visual impairment in 1. According criteria only the 144 patients with nonsyndromic were selected for this study. There were 83 females (57.6%) and 61males (42.4%); genetic etiology was found in 95.8% of the sample and environmental etiology in 4.2%; major and minor associated anomalies were not related with hearing loss. Sensorineural hearing loss was found in 99.3% and severeprofound hearing loss was the most frequent (34.8%). Others results were: asymmetrical hearing loss in 54.9%, bilateral hearing loss in 95.8%, and non progressive in 95.1%. This study allow to conclude that the familial and clinical data were important to define etiological diagnosis; the shape of audiograms were evaluations that help to clarify, but not define, the diagnosis. Genetic counseling is difficult when the pattern of inheritance is unknown; and molecular studies are important subsidiary test to define the etiology of the hearing loss.

Objetivo: Descrever os aspectos clínicos, etiológicos e terapêuticos da candidíase sistêmica em recém-nascidos. Casuística e Métodos: Estudo observacional, em 60 neonatos com candidíase sistêmica, durante 10 anos. Resultados: Freqüência global = 1,8%;sintomas: alterações respiratórias, febre, hipotermia, letargia, hepatomegalia. A C. albicans ocorreu em 83,3% dos casos. Conclusão: A freqüência global da candidíase foi alta, os fatores de risco observados concordam com os citados na literatura, os sinais e sintomas mais freqüentes foram alterações respiratórias, a espécie mais freqüentemente identificada foi C.albicans (83,3%). A mortalidade foi elevada (33,3%), a sobrevida foi maior nos neonatos tratados com formulação lipídica da anfotericina / Objetives: To describe the clinical, etiologic and therapeutical aspects of systemic candidiasis in newborns. Casuistic and methods: Observacional study in 60 neonates with systemic candidiasis during 10 years. Results: Global frequency = 1,8%,symptoms: respiratory alterations, fever, hipotermia, lethargy, hepatomegalia. The C.albicans occurred in 83,3% of the cases. Conclusions: The global frequency of candidiasis was high, the observed fators of risk agrees to the cited ones to literature, the signal and more frequent symptoms had been respiratory alterations, the species more frequently identified were C.albicans(83,3%).The mortality was high (33,3%), the survival was highest in neonates treated with lipid formulation of amphotericin

Chow Yuet-ming. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 254-262). / Abstracts in English and Chinese, appendix in Chinese. / Abstract --- p.i / Acknowledgement --- p.iv / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1 --- Rationale for Selecting this Research Topic --- p.1 / Chapter 1.2 --- Research Objectives --- p.4 / Chapter 1.3 --- Research Questions --- p.5 / Chapter 1.4 --- Overview of the Present Thesis --- p.5 / Chapter Chapter 2: --- Literature review --- p.7 / Chapter 2.1 --- Anorexia Nervosa in Western Countries --- p.7 / Chapter 2.1.1 --- Historical Perspective --- p.8 / Chapter 2.1.2 --- Biomedical Perspective --- p.10 / Chapter 2.1.2.1 --- Physiological manifestation of anorexia nervosa patients --- p.10 / Chapter 2.1.2.2 --- Behavioral manifestation of anorexia nervosa patients --- p.12 / Chapter 2.1.3 --- Psychological Models --- p.14 / Chapter 2.1.3.1 --- Bruch ´ةs view --- p.14 / Chapter 2.1.3.2 --- Minuchin´ةs view --- p.16 / Chapter 2.1.3.3 --- Palazzoli 's view --- p.17 / Chapter 2.1.4 --- Sociological Perspective --- p.24 / Chapter 2.1.5 --- Summary of Part I (2.1) --- p.30 / Chapter 2.2 --- Psychology of Self-development --- p.33 / Chapter 2.2.1 --- "Erikson ,s identity formation" --- p.33 / Chapter 2.2.2 --- Women self-development --- p.38 / Chapter 2.2.3 --- Bowen's differentiation of self --- p.42 / Chapter 2.2.4 --- Summary of Part II (2.2) --- p.46 / Chapter 2.3 --- Anorexia Nervosa in Hong Kong Context --- p.48 / Chapter 2.3.1 --- The notion of self in traditional Chinese family --- p.49 / Chapter 2.3.2 --- Women position in Hong Kong --- p.55 / Chapter 2.3.3 --- Related research in Hong Kong --- p.62 / Chapter 2.3.4 --- Summary of Part III (2.3) --- p.69 / Chapter Chapter 3: --- Theoretical framework --- p.71 / Chapter 3.1 --- Theoretical Framework as Summarized from the Literature Review --- p.71 / Chapter 3.2 --- Definition of Terms --- p.77 / Chapter 3.2.1 --- Anorexia nervosa --- p.77 / Chapter 3.2.2 --- Family --- p.78 / Chapter 3.2.3 --- Family interaction --- p.79 / Chapter 3.2.4 --- Family rule --- p.79 / Chapter 3.2.5 --- Family myths --- p.80 / Chapter 3.2.6 --- Family myths as quest for meaning --- p.80 / Chapter 3.2.7 --- Meaning --- p.80 / Chapter 3.2.8 --- Power --- p.81 / Chapter 3.2.9 --- Power struggle --- p.81 / Chapter 3.2.10 --- Differentiation of self --- p.81 / Chapter Chapter 4: --- Research Methodology --- p.83 / Chapter 4.1 --- General Overview --- p.83 / Chapter 4.2 --- Research Methodology of this Study --- p.88 / Chapter 4.2.1 --- Rationale in Selecting Qualitative Method --- p.88 / Chapter 4.2.2 --- Research Design --- p.89 / Chapter 4.2.3 --- Unit of Analysis --- p.90 / Chapter 4.2.4 --- Sampling --- p.90 / Chapter 4.2.5 --- Methods of Data Collection --- p.92 / Chapter 4.2.5.1 --- Direct Observation of the Family Interviews of AN families --- p.92 / Chapter 4.2.5.2 --- Participant Observation in an AN Mutual Support Group --- p.94 / Chapter 4.2.5.3 --- Summary of the Case Study Protocol of this Study --- p.96 / Chapter 4.2.6 --- Time Frame for Data Collection --- p.96 / Chapter 4.2.7 --- Method of Analysis --- p.97 / Chapter 4.2.8 --- Validity and Reliability of this Study --- p.97 / Chapter 4.2.9 --- Summary of Chapter --- p.98 / Chapter Chapter 5: --- Results of the Study :Data Gathered from Family Interview Sessions --- p.100 / Chapter 5.1 --- Case History --- p.100 / Chapter 5.2 --- Results Gathered from Family Interview Sessions --- p.104 / Chapter 5.2.1 --- Having difficulties in differentiating from the family and self- starvation as a means of asserting the personal boundariesin the families --- p.104 / Chapter 5.2.2 --- Being triangulated in the parents' marital discords and self- starvation as a means of diluting their conflicts --- p.122 / Chapter 5.2.3 --- Self-sacrificing for the family interest --- p.131 / Chapter 5.2.4 --- "Being helpless and powerless in the families, self-starvation as a means of empowering the mothers in the families " --- p.134 / Chapter Chapter 6: --- Results of the Study:Data Gathered from Mutual Support Group Sessions --- p.138 / Chapter 6.1 --- Case History --- p.138 / Chapter 6.2 --- Results Gathered from Mutual Support Group sessions --- p.140 / Chapter 6.2.1 --- Having difficulties in handling peer relationship --- p.140 / Chapter 6.2.2 --- Having difficulties in resisting their mothers intrusiveness to their personal boundaries and self-starvation as a means of exerting their personal boundaries --- p.143 / Chapter 6.2.3 --- Being triangulated in their parents marital discords and self- starvation as a means of diluting the marital conflicts --- p.149 / Chapter 6.2.4 --- Acting for their mothers in the families --- p.149 / Chapter 6.3 --- Cross-checking of findings with group members and worker --- p.161 / Chapter Chapter 7: --- Discussions and Conclusion --- p.163 / Chapter 7.1 --- Research Findings of this Study --- p.163 / Chapter 7.2 --- Contributions of this Study --- p.173 / Chapter 7.3 --- Limitations of this Study --- p.174 / Chapter 7.4 --- Recommendation --- p.175 / Chapter 7.4.1 --- Future Research --- p.175 / Chapter 7.4.1.1 --- Proposed Theoretical Framework for Future Study --- p.175 / Chapter 7.4.1.2 --- Proposed Methodology --- p.179 / Chapter 7.4.2 --- Management of AN patients --- p.179 / Chapter 7.4.3 --- Prevention of AN --- p.181 / Appendix I: The Chinese verbatim of family interview sessions --- p.183 / Appendix II: The Chinese verbatim of mutual support group sessions --- p.234 / List of Figures: / Figure 1: Summary of the framework from western literature --- p.75 / "Figure 2: Interplay among individual, family and society " --- p.76 / Figure 3: Socio-demographic characteristics of the AN patients and their families of the family interview sessions --- p.91 / Figure 4: Socio-demographic characteristics of the AN patients and their families of the mutual support group --- p.92 / Figure 5: Summary of the proposed theoretical framework of Understanding self-starvation in Hong Kong --- p.178 / Bibliography --- p.254