Thesis (doctoral)--Ludwig Maximilians-Universität zu München, 1979.

A research report submitted to the Faculty of Medicine, University of the Witwatersrand, in partial fulfillment of the requirements for the Degree of Master of Medicine in the division of Plastic and Reconstructive Surgery. Johannesburg 2014 / With 67% of the world’s human immunodeficiency virus (HIV) infected population existing in Sub-Saharan Africa and recent access to highly active antiretroviral therapy (HAART); demand for plastic surgical intervention in addressing HIV-associated lipodystrophy has expanded dramatically. This study assessed the prevalence of lipodystrophy in a random clinic cohort, the demand for surgical correction, and risk of treatment non-compliance A questionnaire and database cross-sectional review of 554 patients was performed over a three-month period at the Themba Lethu Clinic, Johannesburg, South Africa. A total of 479 patients completed the questionnaire, 83% were female. Nearly 90% of patients were currently being treated, or had been treated with stavudine (d4T). The prevalence of lipodystrophy was 11.7%. Nearly 5.9% of patients had considered stopping treatment due to changes in body morphology following the onset of HAART, 47% of patients interviewed would consider surgery to correct unwanted physical changes following treatment with HAART. Male patients were satisfied by physical changes in their body habitus following treatment (pre-treatment satisfaction 38% vs. post-treatment satisfaction of 94%). Female patients had 6.5 times more breast hypertrophy related symptoms than in their pretreatment state. This study identified a prevalence of 11.7% of patients with HIV-associated lipodystrophy. A total of 3.8% of all patients would consider non-compliance on the basis of this side effect alone. The demand for surgical correction is significant, extends beyond patients diagnosed with HIV-associated lipodystrophy, and needs to be addressed.

Main findings A case is presented of a Leydig cell neoplasm in a 25 year-old male patient with no classic risk factors with an atypical outcome. The tumour mass was histologically analysed and was found to have features compatible with a germ cell neoplasm. A right orchiectomy was performed, followed by chemotherapy. After treatment, pulmonary metastasis, lymph nodes, and peri-hepatic hydronephrosis were found. The patient died two months after his last hospital admission. Case hypothesis Leydig cell tumours account for 1% to 3% of all testicular tumours. They occur at any age, especially in children, and between the third and sixth decade of life. Around 90% are benign, and 10% are malignant; these latter usually occurring between 50 and 60 years old, and are associated with sizes larger than 5 cm and gynecomastia. Finally, it is difficult to predict the development of the disease based on histopathological observations. Promising future implications Although non-germ cell tumours are rare, it is important to consider them in the differential diagnosis of testicular tumours, particularly in those of non-seminoma origin. Immunohistochemistry is useful for the differentiation of testicular tumours in those cases when conventional histology shows no conclusive findings. / Hallazgos principales Reportamos un caso de neoplasia de células de Leydig en un paciente varón de 25 años, sin factores de riesgo clásicos con evolución tórpida. Se analizó la histopatología de la masa tumoral y se encontró malignidad por lo que se decide realizar orquiectomía derecha, seguida de quimioterapia. Luego del tratamiento se halla metástasis pulmonar, adenopatías perihepáticas e hidronefrosis, falleciendo 2 meses después de su último ingreso hospitalario. Hipótesis del caso El tumor de células de Leydig representa entre el 1-3% de todos los tumores testiculares. Se presentan a cualquier edad; sobre todo en la infancia y en la 3.a-6.a década de la vida. Aproximadamente el 90% son de curso benigno y el 10% son malignos, presentándose sobre todo entre la 5.a y la 6.a década de la vida, y están asociados con un tamaño > 5 cm y ginecomastia. Finalmente, es difícil predecir el comportamiento en términos histológicos. Repercusiones a futuro A pesar que los tumores de células no germinales son poco frecuentes, es importante considerarlos como diagnóstico para brindar el tratamiento óptimo y evitar resultados desafortunados.

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Made available in DSpace on 2015-12-06T23:03:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2004 / A ginecomastia incide em ate 60 por cento dos adolescentes, causando dor e transtornos na auto-imagem do paciente, levando a problemas de ordem emocional e fisica (COLOMBO-BENKMAN, 1999), que podem ser revertidos com o tratamento. Este trabalho avaliou o tratamento cirurgico da ginecomastia el sua interferencia, na, qualidade de vida e auto-estima) do paciente. Casuistica: Foram incluidos 33 pacientes de 18 a 50 anos, com ginecomastia de 2 a 21 anos de evolucao, de etiologia puberal na maioria 90,1 por cento). Metodo: Foi feita adenectomia conforme a classificacao de Letterman & Schuster (1969). Os dados do infra e 90º pos-operatorio (PO) foram avaliados. Os pacientes responderam no pre e PO de seis meses as versoes brasileiras dos questionarios de Rosenberg para auto-estima e Short-Form 36 para qualidade de vida. Resultados: Houve melhora estatisticamente significante para os dominios Estado Geral de Saúde, Capacidade Funcional, Aspectos Sociais, Vitalidade e Saúde Mental. Conclusao: O emprego dos questionarios de Rosenberg-EPM e Short-Form 36 permitiu demonstrar que o tratamento cirurgico da ginecomastia promoveu mudancas positivas na qualidade de vida e na auto-estima dos pacientes / Gynecomastia has above a 60% incidence in adolescents, leading to pain and self-image disturbs, with emotional and physical problems (COLOMBO-BENKMAN, 1999), that can be solved with the threatening. This study has evaluated the patients’ self-esteem and health related quality of life before and after the surgical treatment of gynecomastia. Sample: 33 patients within 18 to 50 years old were included, with confirmed gynecomastia from 2 to 21 years of evolution, puberal etiology was the main cause (90.1%). Methods: There were performed adenectomy regarding Letterman & Schurter’s (1969) classification. Before and six month post-operatory (PO) data was evaluated. The patients answered at these moments to the brazilian versions of the Rosenberg self-esteem and Short Form-36 questionnaires. Results:There were improve, statisticaly significant, to Short Form-36 General Health State, Functional Capacity, Social Aspects, Vitality and Mental Health. Conclusion: Using the Rosenberg ́s and Short-Form 36 question naires could demonstrate increase to the quality of life and self-esteem due to the gynecomastia surgical treatment. / BV UNIFESP: Teses e dissertações