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Orientador: Gabriel Hessel / Tese (mestrado - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-24T05:12:49Z (GMT). No. of bitstreams: 1 Antunes_MargaridaMariadeCastro_M.pdf: 2516292 bytes, checksum: c31c0bdd4525951708e4bfc8965866c9 (MD5) Previous issue date: 1998 / Resumo: O objetivo desse trabalho foi determinar a acurácia da ultra-sonografia em identificar episódios de refluxo gastro-esofágico (RGE) e o valor da medida ultra -sonográfica do esôfago intra -abdominal em crianças portadoras da doença do refluxo gastro-esofágico (DRGE). Participaram do estudo 20 pacientes que foram submetidos a exames simultâneos de ultra-sonografia e registro do pH esofágico no período de 15 minutos após ingestão de suco de laranja. Foi observada a presença de episódios de RGE e efetuada a medida do esôfago intra abdominal. Os episódios de RGE visualizados à ultra-sonografia foram comparados com os episódios registrados à pHmetria quanto à presença e número por paciente, além de coincidência temporal. para essas comparações foram empregados os testes de Wilcoxon e de McNemar. As medidas do esôfago intra-abdominal foram comparadas com o índice de refluxo da pHmetria prolongada e com os resultados da avaliação endoscópica e histopatológica da mucosa esofágica. Para essas variáveis foi utilizado o teste de Fisher. episódios de RGE foram visualizados ao ultra-som e 24 episódios registrados pela pHmetria. Um paciente apresentou 23 episódios de RGE visualizados pelo ultra-som e apenas 4 na pHmetria e foi excluído da análise estatística global e estudado em separado. Foi encontrada coincidência temporal dos episódios de refluxo .em 100% do tempo de observação do ultra-som com o registro da pHmetria em 15 pacientes, em 75% do tempo em 2 pacientes, em 50% do tempo em 1 paciente e nenhuma coincidência em 2 pacientes. A coincidência temporal da pHmetria em relação ao ultra-som foi de 100% em 16 pacientes, 75% em-1 paciente, 50% em 1 paciente e nenhuma coincidência em 2 pacientes. A USG observou RGE em 10 pacientes, desses, 9 apresentaram RGE nos 15 minutos à pHmetria. A pHmetria (15 min) apresentou episódios de RGE em 10 pacientes, desses 9 apresentaram RGE ao ultra-som.- As medidas do esôfago intraabdominal estavam diminuídas em 7 crianças e nessas o índice de refluxo foi maior em comparação com o grupo de pacientes que apresentaram medidas normais do esôfago intra-abdominal. A endoscopia digestiva alta foi realizada em 15 pacientes, com o diagnóstico de esofagite por macroscopia em 7 e por microscopia em 10. Todos os pacientes com endoscopia digestiva e biópsia esofágica normais apresentavam esôfago intra-abdominal de tamanho normal e todos os pacientes com esôfago intra-abdominal diminuído e que fizeram endoscopia apresentavam diagnóstico de esofagite na avaliação macroscópica e microscópica. Conclusões: 1. Houve coincidência quanto à presença e número de episódios de RGE por paciente nos exames simultâneos de pHmetria e ultra-sonografia; 2. foi observada coincidência entre o período de observação do ultra-som e o registro da pHmetria e a mesma relação foi encontrada entre a pHmetria com o ultra som; 3. as crianças com medida do esôfago intra-abdominal diminuída para a idade apresentaram índice de refluxo maior do que as com esôfago normal; 4. o achado de um esôfago intra-abdominal diminuído ao ultra-som corresponde à presença de esofagite tanto à avaliação macroscópica quanto à biópsia da mucosa esofágica / Abstract: The aim of this study was to determine the accuracy of the ultrasound in order to identify the episodes of gastroesophageal reflux (GER) and the value of the ultrasound measurement of the esophageal abdominal segment (EAS) in children with gastroesophageal reflux disease (GERD). Twenty patients participated on this study who were submitted to simultaneous examination of ultrasound and esophagic pH records during a period of 15 minutes after the ingestion of orange juice. It was observed the presence of episodes of GER and it was also made the measurement of the EAS. The episodes of GER at the ultrasound were compared to the episodes recorded on the pH measurement about the presence and the number of patients and also the ,time coincidence. Wilcoxon and McNemar's tests were used to make these comparisons. The measurements of the EAS were compared to the reflux index of the prolonged pH measurement and with the results of the endoscopic and histopatologic evaluation of the esophageal mucosa. The Fisher's test was used to these changes. Fourty episodes of GER were seen at the ultrasound and 24 were recorded by the pH measurement. One patient has shown 23 episodes of reflux by the ultrasound and on1y 4 episodes by pH measurement and this patient was exc1uded from this study and was studied separately. A time coincidence was found on the episodes of the reflux of about 100% of the observation time of the ultrasound with the measurement record of pH in' 15 patients, 75% in 2 patients, 50% in one patient and no coincidence in 2 patients. The time coincidence of the pH measuremeÍ1t in relation to the ultrasound wa,s of about 100% in 16 patients, 75% in one patient, 50% in one patient ando no coincidence in 2 patients. The ultrasonography has observed GER in 10 patients; nine of these have shown GER during the period of 15 minutes in the .pH measurement. The pH measurement (15 minutes) has demonstrated episodes of GER in 10 pacients, nine of these haveshovm GER at the ultrasound. The measurement of the EAS were reduced in 7 children and in these, the reflux index was greater when compared -to the group of the patients who had presented normal measurements of the EAS. The upper digestive endoscopy was performed in 15 patients, giving the diagnosis of esophagitis by macroscopy in 7 patients and by microscopy in 10 patients. All the patients with normal digestive endoscopy and esophageal biopsy have shown EAS of normal size and all the patients with reduced EAS and that they had already urdergone endoscopy have shown a diagnosis of esophagitis at the macroscopy and microscopy evaluation. Conclusions: 1. There had been coincidence about the presence and number of episodes of GER by patients at the ultrasound ultrasonography, simultaneously examination of pH measurement and 2. A coincidence was observed between the observation period of the ultrasound and record of the pH measurement and also it was observed the same relationship between the pH measurement by the ultrasound. 3. The children which had the measurenient of the EAS reduced considering their ages have shown a greater reflux index than the others with normal esophagus. 4. The fmdings of a reduced esophageal abdominal segment by the ultrasound correspond with the presence of esophagitis in the macroscopy evaluation as well as at the microscopy evaluation of the esophageal mucosa / Mestrado / Mestre em Pediatria

Tese de mestrado integrado. Engenharia Informátca e Computação. Faculdade de Engenharia. Universidade do Porto. 2008

Tese de Doutoramento. Engenharia Electrotécnica e de Computadores. Faculdade de Engenharia. Universidade do Porto. 2005

No description available.

Background: Intestinal fibrosis is a serious complication of IBD, with more than a third of Crohn’s disease (CD) patients developing a fibrostenosing phenotype with formation of strictures that will require surgical intervention. Remarkably, SAMP1/YitFc (SAMP) mice, a spontaneous model of CD, develop gut fibrosis; similar to IBD patients, the pathophysiology of SAMP fibrosis is unknown. IL-33 is a member of the IL-1 cytokine family and increased expression is associated with IBD. Emerging evidence suggests its potential role in liver and cutaneous fibrosis, as well as myofibroblast-associated colonic ulcerations . Aim: The aim of this study was to evaluate the role of IL-33 as a potential mediator of profibrotic events leading to intestinal fibrosis and possible stricture formation. Methods: A detailed histologic time course study, with collagen-specific Masson trichrome staining and IHC for ST2 (IL-33 receptor), was performed on SAMP and control AKR (parental strain) mice. qRT-PCR was done on full-thickness ilea for the profibrogenic genes, collagen (coll)-1, coll-3, connective tissue growth factor (CTGF) and insulin-like growth factor 1 (IGF-1). Exogenous IL-33 (33 μg/kg, i.p.) or vehicle was administered daily for 7d to SAMP and AKR mice (N=6/exp group), and ileal tissues evaluated as above. Finally, microarray analysis was performed on full-thickness ilea from SAMP and AKR mice, and IL-33 stimulated subepithelial myofibroblasts (SEMFs). Results: SAMP mice displayed ileal skip lesions with randomly distributed strictures, preceded by typical pre-stricture dilations of the ileum. Ileal wall was visibly thickened with hypertrophy of the serosa, muscularis mucosa, muscularis propria, within which intense collagen deposition was observed, and inflammatory infiltrates in segments showing strictures. Interestingly, intense ST2 staining was present within the inflamed lamina propria of SAMP, notably localized to SEMFs. Fibrosis was first observed at 20 wks, and reached its peak by 50 wks of age. mRNA expression of coll-1 (4.74±0.69-fold; P=0.001), coll-3 (4.92±1.05-fold; P=0.01), IGF1 (12.9±3.45; P=0.006), and CTGF (3.29±0.69; P=0.004) was dramatically elevated in SAMP vs. AKR ilea. IL-33 treatment of AKR mice induced a marked increase in muscle fiber/myofibroblast cellularity and hypertrophy of the muscularis propria (4.13±0.74-fold; P<0.0001), and mRNA expression of coll-1 (5.16±0.89-fold; P=0.0009), coll-3 (1.97±0.14-fold; P=0.01), IGF-1 (9.32±2.27-fold; P=0.004), and CTGF (1.43±0.31-fold; P=0.006) vs. vehicle controls. Microarray data from SAMP ilea and IL-33-treated SEMFs confirmed these trends, displaying a global increase in profibrogenic gene expression. Conclusion: These data suggest an important role for IL-33 in intestinal fibrosis, and may represent a potential target for the treatment of IBD-associated fibrosis and stricture formation.

Introdução e objetivos: a patogênese da hepatopatia alcoólica envolve três mecanismos patogênicos. O primeiro corresponde à agressão direta do álcool e de seus resíduos metabólicos sobre os hepatócitos, o segundo é devido ao aporte de endotoxinas provenientes da circulação portal o que desencadeia uma resposta inflamatória inata, e o terceiro, uma provável resposta imunológica adquirida contra neoantígenos. Considerando a possibilidade deste último mecanismo patogênico ser similar ao da hepatite crônica, estudamos explantes de pacientes com cirrose alcoólica em abstinência e comparamos suas características imunoistoquímicas com cirróticos de etiologia viral C. Materiais e métodos: foram estudados imunoistoquimicamente o infiltrado linfocitário septal e perisseptal de 34 explantes de cirróticos alcoólicos e 40 explantes de cirróticos virais C. Resultados: na avaliação das colorações de HE, não houve diferença significativa entre os dois grupos. As alterações estatisticamente significativas encontradas foram: (a) nas C-VHC o componente T-CD8+ intenso tanto na hepatite de interface como no infiltrado septal, neste último acompanhado pelos T-CD4+; (b) nas C-HA intenso componente linfocitário B-CD20+ com presença de folículos linfóides nos septos fibrosos e, componente igualmente intenso, na hepatite de interface. Conclusões: a hepatite de interface também ocorre nas C-HA e não difere, nas preparações histológicas habituais, daquela encontrada na C-VHC. O infiltrado linfocitário septal e perisseptal T-CD4+ e T-CD8+ tende a ser mais difuso e intenso nas C-VHC e mais focal nas C-HA que apresenta um componente mais significativo de B-CD20+. O modelo por nós estudado, na medida em que afasta a ação direta do álcool e a da resposta inflamatória inata constitui um modelo promissor para o estudo da resposta inflamatória adquirida na patogênese da hepatopatia alcoólica. / Introduction and objectives: the pathogenesis of alcoholic liver injury involves different cell types of the liver and leucocytes present in the innate immune response. Two different pathways are known: mitochondrial direct injury and damage related to endotoxins proceeding from the portal circulation. An immune adaptive response as a third mechanism of alcoholic liver injury was suggested by Thiele et. al. Considering this possibility, a similar mechanism usually seen in chronic hepatitis may be present. We studied the main immunohistochemical features on explants livers from C-HA patients in abstinence and compared them with explants from C-HCV patients. Materials and Methods: an immunohistochemical study was achieved on 34 explants of the C-HA group of patients and on 40 explants of the C-HCV group. We focused our study on the septal lymphocyte inflammatory infiltrate and on interface hepatitis. Results: the C-HCV group presented a diffuse septal lymphocyte inflammatory infiltrate, and lymphocytes focally positive for T-CD4, T-CD8 and B-C D20. An interface hepatitis was seen in 90% of the samples and lymphocytes were strongly positive for T-CD8, weakly positive for T-CD4 and negative for B-CD20(55,6%) The C-HA group also presented a diffuse septal lymphocyte inflammatory infiltrate and lymphocytes focally positive for T-CD4, TCD8 and B-CD20. In a great number of samples (88,2 %) lymphoid follicles were identified. An interface hepatitis was seen in 70,6% of the explants and these lymphocytes were strongly positive for T-CD8 and B-CD20 and weakly positive for T-CD4. Conclusion: an interface hepatitis may also occur in C-HA. By removing the effects of direct alcoholic injury and those of the innate inflammatory response we strongly recommend this model to study the immune adaptive response in the pathogenesis of alcoholic liver disease.

Made available in DSpace on 2015-12-06T23:05:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2004 / Introdução: Para pacientes que desenvolveram doenças físicas relacionadas ao consumo de álcool, a abstinência de bebidas alcoólicas pode oferecer a melhor chance de sobrevivência. Entretanto, se alguns subestimarem a severidade dos problemas, ou não acreditarem que o comportamento de beber possa exacerbar sua condição, terão maior dificuldade em manter a abstinência. Um levantamento inicial realizado no Hospital São Paulo da Universidade Federal de São Paulo com 394 pacientes internados, mediu a frequência do consumo nocivo de álcool e encontrou 22 por cento dos homens internados e 3 por cento das mulheres com escore positivo no AUDIT (The Alcohol Use Disorders ldentification Test). A prevalência mais alta foi na enfermaria de gastroenterologia (26 por cento). Esse dado contribuiu para o estudo da motivação para a modificação do comportamento de beber nos pacientes portadores de doenças gástricas. Objetivos: 1. investigar a motivação para tratamento em dois grupos de dependentes de álcool, sendo 151 pacientes do ambulatório de gastroenterologia e 175 do ambulatório especializado no tratamento para alcoolismo; 2. estudar as propriedades psicométricas dos instrumentos que medem a motivação para tratamento do alcoolismo pela análise confirmatória fatorial. Métodos: A entrevista foi conduzida nos ambulatorios na primeira consulta ao serviço em hospital escola da Universidade Federal de S?o Paulo e consistiu em uma seção com dados demográficos e as escalas a seguir: Short Form Health Survey (SF-36); Alcohol Dependence Data Questionnaire (SADD); Fagerstr?m Test for Nicotine Dependence (FTND); Padr?o de consumo de alcool e drogas; University of Rhode Island Change Assessment Scale (URICA); The Stages Readiness and Treatment Eagerness Scale (SOCRATES); The Drinker lnventory of Consequences (Drlnc). Resultados: A análise fatorial confirmatória da SOCRATES mostrou a existência de dois fatores correlacionado que melhor exploram o modelo (ambivalência/reconhecimento e ac?o). A mesma analise com a URICA sugeriu que a versão estudada mediu os fatores proposto: (pre-contemplac?o, contemplação, ação e manutenção), incorporando uma estrutura correlacional dos fatores, sendo constatada evidencia de validade concorrente com a severidade da dependência alcoólica. Ambos instrumento apresentaram boa consistência interna, com exceção da subescala de manutenção da URICA. Os resultados comparativos sugeriram que os paciente do ambulatório de gastroenterologia eram menos dependentes do álcool, sofriam menos as consequências relacionadas ao consumo de bebidas alcoólicas e possuíam menos problemas mentais e emocionais quando comparados com os pacientes do ambulatório para tratamento do alcoolismo. Quanto aos estágios de mudança, os pacientes da gastroenterologia apresentaram maiores escores na pré-contemplação no inicio do tratamento e, os pacientes do ambulatório especializado escores maiores em contemplação, ação e manutenção Conclusões: Os dados desse estudo sugerem que os sintomas físicos da doença gástrica pode ser uma razão para a abstinência temporária de álcool no: pacientes do ambulatório de gastrenterologia, uma vez que os mesmos exibiram menor motivação para a modificação do comportamento de beber. As versões brasileiras da SOCRATES e URICA mostraram ser parâmetros validos confiáveis na avaliação da motivação de dependentes de álcool / Introduction: For some patients who have developed significant alcohol-related physical diseases, total abstinence from alcohol may offer the best chance of survival. However, if such patients underestimate the severity of their drinking problem or do not believe that their drinking behaviour exacerbates their health problems, they will found higher difficulties to remain alcohol free. A first survey undertaken at the Hospital São Paulo of the Universidade Federal de São Paulo used the AUDIT (The Alcohol Use Disorders Identification Test) to measure the frequency of alcohol misuse in a general hospital and found that 22% of male inpatients 3% of female inpatients scored positive. The highest prevalence was on the gastroenterology wards (26%). This data contributed to the study about the motivations to change the drink behaviour in outpatients with gastric disease. Objectives: The mainly aims of this cross-sectional study were: 1. To investigate motivational issues for treatment in two different groups of people with alcohol dependence: 151 outpatients from the gastroenterology clinic and 175 from an alcohol treatment service. 2. To study the psychometrics properties of the scales that measures the motivation to alcohol treatment through the confirmatory factor analysis. Methods: The interviews were conducted at the outpatient clinics, during the patients’ first appointment, at the teaching hospital of the Universidade Federal de São Paulo and consisted of a demographic section with the use of the following scales: Short Form Health Survey (SF-36), Alcohol Dependence Data Questionnaire (SADD), Fagerström Test for Nicotine Dependence, pattern of alcohol and drug consumption, University of Rhode Island Change Assessment Scale (URICA), Readiness and Treatment Eagerness Scale (SOCRATES) and Drinker Inventory of Consequences (DrInc 2-L). Results: The confirmatory factor analysis of SOCRATES showed that two correlated factors (ambivalence / recognition and action) provided the best fit for the data. The same analysis with URICA suggested that the studied version measured the proposed factors (precontemplation, contemplation, action and maintenance), incorporating a correlational structure of the factors with evidence of concurrent validity with severity of alcohol dependence and stages of change. The both questionnaires showed good internal consistency with exception the maintenance scale in URICA. The comparative results suggested that outpatients from the gastroenterology clinic were less dependent on alcohol, had suffered fewer consequences from alcohol, and had less emotional and mental health problems when compared with the outpatients from the alcohol treatment service. In relation to their stages of change, the gastroenterology outpatients presented with high pre-contemplation stages at the beginning of treatment; while outpatients of alcohol treatment service showed higher scores in contemplation, action and maintenance. Conclusions: The data of this study suggested that the physical symptoms of the gastric diseases may be a reason for the temporary alcohol abstinence behaviour to the outpatients from gastric diseases because this group showed low motivation to change the drinking behaviour. The Brazilian versions of the SOCRATES e URICA were valid and reliable to measure motivation in alcohol dependents. / BV UNIFESP: Teses e dissertações