Orientadores: Luiz Carlos Zeferino, Joana Fróes Bragança Bastos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T05:47:30Z (GMT). No. of bitstreams: 1 Yoneda_JulianaYoko_M.pdf: 1509037 bytes, checksum: 64a492fd2dcabf75db665898f34f50aa (MD5) Previous issue date: 2014 / Resumo: Objetivos: Avaliar fatores patológicos em mulheres submetidas à histerectomia radical e linfadenectomia pélvica bilateral para tratamento de câncer do colo do útero estádio IA1 com invasão angiolinfática e IA2, correlacionando achados na peça de conização e de histerectomia radical, para identificação de um grupo de pacientes candidatas a tratamento cirúrgico menos radical. Métodos: Avaliação de mulheres com câncer do colo do útero estádio IA1 com invasão angiolinfática e IA2, diagnosticadas por LEEP ou conização a frio, tratadas com histerectomia radical e linfadenectomia pélvica bilateral, no período de Janeiro de 1999 à Dezembro de 2011. Resultados: Foram avaliadas 50 pacientes, 40 estádio IA2 e 10 estádio IA1 com invasão angiolinfática. A média de idade foi de 43 anos (30-67). Todas as pacientes foram submetidas à conização prévia, sendo 45 LEEP (90%) e cinco cones a frio (10%). A análise de histologia revelou carcinoma epidermóide em 44 pacientes (88%), adenocarcinoma em quatro pacientes (8%) e carcinoma adenoescamoso em duas pacientes (4%). Invasão angiolinfática foi detectada em 15 pacientes (30 %), dez estádio IA1 e cinco estádio IA2. Margens estiveram comprometidas em 35 pacientes, e em quatro casos não foram avaliadas por artefato de fulguração. Linfonodos estiveram comprometidos em dois casos. Não foi identificado nenhum caso de comprometimento parametrial. Doença residual foi detectada em 22 pacientes (44%) e margens comprometidas no produto de conização foram preditoras de doença residual na peça cirúrgica de histerectomia radical (p=0,04). O tempo médio de seguimento foi de 51 meses, não sendo observado nenhum óbito relacionado à doença. Conclusões: Pacientes com margens comprometidas na peça de conização apresentam risco aumentado de doença residual na peça cirúrgica de histerectomia radical, necessitando de avaliação cautelosa previamente à cirurgia conservadora. Avaliação de linfonodos pélvicos é essencial devido ao risco de envolvimento mesmo em estádios iniciais. A ausência de comprometimento parametrial no presente estudo reforça que esse seleto grupo de pacientes com carcinomas microinvasores estádios IA1 com invasão angiolinfática e IA2 apresentam baixo risco de comprometimento parametrial, podendo ser considerada a realização de tratamento cirúrgico menos radical / Abstract: Aims: To evaluate pathological features in women treated with radical hysterectomy and pelvic lymphadenectomy for stages IA1 with lymph-vascular space invasion and IA2 cervical cancer by correlating findings on conization and hysterectomy specimens identifying a group of patients that could be candidate for less radical surgical treatment. Methods: Analysis of women with cervical cancer stages IA1 with lymph-vascular space invasion and IA2, diagnosed by LEEP or cold knife conization, treated with radical hysterectomy and pelvic lymphadenectomy, from January 1999 to December 2011. Results: Fifty patients were enrolled, 40 stage IA2 and 10 IA1 with lymph-vascular space invasion. Median age was 43 years (30-67). All patients underwent cervical conization, 45 LEEP (90%) and five cold knife (10%). Histology revealed squamous cell carcinoma in 44 patients (88%), adenocarcinoma in four patients (8%) and adenosquamous carcinoma in two patients (4%). Lymph-vascular space invasion was detected in 15 patients (30%), 10 stage IA1 and 5 stage IA2. Cone biopsy margins were positive in 35 patients and unavailable in 4 patients. There were two cases of positive pelvic nodes. No parametrial involvement was detected in the entire cohort. Residual disease was detected in 22 patients (44%). Positive margins predicted residual disease at radical hysterectomy (p= 0,04). Medium follow up time was 51 months and there were no disease- related deaths. Conclusions: Patients with positive margins at cone biopsy specimens have increased risk of residual disease at radical hysterectomy, and need careful evaluation prior to conservative surgery. Pelvic lymph-nodes evaluation is essential due to the risk of involvement even on early stages. The lack of parametrial involvement in the present study reinforce that this select group of patients with microinvasive cervical carcinoma stages IA1 LVSI, and IA2 have a very low risk of parametrial infiltration and less radical surgery could be considered / Mestrado / Oncologia Ginecológica e Mamária / Mestra em Ciências da Saúde

A incidência do câncer cervical permanece elevada em nosso país, provavelmente devido ao rastreamento ser realizado principalmente em áreas urbanas e haver áreas menos favorecidas onde os programas de rastreamento não são efetivos. É bem sabido que a mortalidade pelo câncer raramente é devida ao tumor primário, mas à disseminação metastática das células tumorais em órgãos distantes. A via linfática é considerada a preferencial para disseminação metastática nos tumores ginecológicos. E o estágio clínico e os linfonodos regionais são considerados os fatores prognósticos mais potentes no carcinoma de colo útero. A compreensão da linfangiogênese pode ser considerada uma importante chave na elucidação dos mecanismos usados pelas células tumorais na sua disseminação. Os objetivos do presente estudo são avaliar as características clínico-patológicas do câncer do colo do útero e sua associação com o comprometimento linfonodal e o desfecho; avaliar a linfangiogênese intratumoral pela análise quantitativa da microdensidade vascular linfática (MDVL), usando o método imunoistoquímico para marcação dos vasos linfáticos e três métodos morfométricos para a quantificação; determinar a associação entre a MDVL, características clínico-patológicas de apresentação, comprometimento linfonodal, desfecho e a expressão de podoplanina em células neoplásicas e a expressão da podoplanina em células fibroblásticas do estroma intratumoral. Os estudos sobre a MLVD em câncer de colo de útero são raros e controversos. Nossos resultados demonstraram que a MLVD foi mais acentuada nos tumores de menor tamanho (<2 cm), nos estádios iniciais (IB1), com menos infiltrações, sem comprometimento vascular e sem comprometimento linfonodal, provavelmente porque a indução da linfangiogênese pode ser um evento inicial na progressão do câncer, quando ainda nem todos os vasos neoformados estão funcionantes ou patentes. Isto explicaria a elevada MLVD nos tumores iniciais quando os linfonodos estavam frequentemente negativos. Observou-se que não não houve associação significativa entre expressão de podoplanina em células neoplásicas e comprometimento vascular, comprometimento dos linfonodos ou desfecho. A expressão de podoplanina em fibroblastos do estroma intratumoral no câncer precoce de colo de útero está associada a melhor prognóstico. Até o presente, acreditase que este seja o primeiro estudo a investigar o papel da expressão da podoplanina no estroma intratumoral de carcinoma precoce do colo do útero, relacionando-a com MLVD, comprometimento dos linfonodos e o desfecho / Cervix carcinoma incidence remains still high in our country, probably as the screening occurrence is carried out mainly in the urban areas and there are less favored areas where the screening programs are not effective. It is well known that the cancer mortality is rarely caused by the primary tumor, but it is caused by the metastatic spread of tumor cells in distant organs. The lymphatic route is considered the choice for the metastatic dissemination in the gynecological tumors. And the clinical stage and the regional lymphonodes are considered the most powerful prognostic factors in the uterine cervix cancer. The understanding of the lymphangiogenesis can be considered an important key for the elucidation of the mechanisms used in the tumor cells dissemination. The current study objectives are to evaluate the clinic-pathological characteristics of the uterine cervix carcinoma and its association with the lymphnodal involvement and outcome; to evaluate the intratumoral lymphangiogenesis by the quantitative analysis of the lymphatic vessel micro density (LVMD), using the immunoistochemical method for marking the lymphatic vessels and three morphometric methods for the quantification. To determine the association between the LVMD, the clinicpathological characteristics, the lymphonodal involvement and outcome and the podoplanin expression in neoplasic cells and in fibroblastic cells of the intratumoral stroma. Studies about the LVDM in uterine cervical cancer are rare and controversial. Our results demonstrated that the LVDM was more remarkable in the smaller tumors(<2cm), in the initial stages (IB1), with less infiltrations, with no vascular involvement and no lymphnodal involvement. Probably because the induction of lymphangiogenesis may be an early event in cancer progression, while still not all the newly formed vessels are functioning or patent. This would explain the high LVMD in the initial tumors while the lymphonodes were frequently negative. It was noted that there were no significant association between podoplanin expression in neoplasic cells and vessel involvement, lymphonodes involvement or outcome. Podoplanin expression in fibroblasts of the intratumoral stroma in early cervix carcinoma was associated to better prognosis. To date, it is believed that this is the first study to investigate the role of podoplanin expression in intratumoral stroma of cervix carcinoma, relating it to LVMD, lymph node involvement and outcome

Made available in DSpace on 2016-04-28T20:39:55Z (GMT). No. of bitstreams: 1 Karoline Sa Ferreira.pdf: 2918129 bytes, checksum: d13ab5ddb583f1609e5f0335e3df5cf5 (MD5) Previous issue date: 2008-11-14 / This research is the result of the master's dissertation in Clinical Psychology at the Hospital Psychology and Psycossomatic Nucleus of PUC-SP. The research aimed to check the body image of hysterectomy patients and their relation with the sense of fertility in a psychosomatic perspective. The study took place in Goiânia GO, with 09 women, who had their uteruses surgically removed in ages between 35 and 45 years. The instruments used in data collection were; i) socio-demographic questionnaire (to identify socio-cultural characteristics of women studied), ii) semi-directed interview (to identify characteristics about the subjectivity of participants in relation to their surgery, sense of fertility, their body and how she relates with the world), and iii) the draw a person test (based on studies of Karen Machover and evaluated by examining aspects of body image). The qualitative study of the data showed that each patient with her particular history has a different reaction to the same fact. The conclusion of the results shows that every experience causes a change, whether visible or not, but the body, the thought and the feeling produce and leave marks of this experience. The way that each woman experiences her body image is unique and singular, and it can be seen in the drawings made by the participants / Esta pesquisa é resultado da dissertação de mestrado em Psicologia Clínica no Núcleo de Psicossomática e Psicologia Hospitalar da PUC-SP. A pesquisa teve como objetivo verificar a imagem corporal de pacientes histerectomizadas e suas relações com o sentido de fertilidade numa perspectiva psicossomática. O estudo foi realizado em Goiânia-GO, com 09 mulheres que retiraram o útero em idades entre 35 e 45 anos. Os instrumentos utilizados na coleta de dados foram: i) questionário sócio-demográfico (para identificar características sócio-culturais das mulheres estudadas), ii) entrevista semi-dirigida (para identificar características a respeito da subjetividade da participante em relação à cirurgia, ao sentido da fertilidade, ao seu corpo e como este se relaciona com o mundo), e iii) o desenho da figura humana (baseado nos estudos de Karen Machover e avaliado segundo aspectos relacionados à imagem corporal). O estudo qualitativo dos dados mostrou que cada paciente, com sua história particular, tem uma reação diferente diante do mesmo fato. A conclusão dos resultados demonstra que toda experiência vivida causa uma mudança, seja ela visível ou não; mas o corpo, o pensamento e o sentimento elaboram e deixam marcas desta experiência. A maneira como cada mulher vivencia sua imagem corporal é única e singular, podendo ser vista nos desenhos realizados

A incidência do câncer cervical permanece elevada em nosso país, provavelmente devido ao rastreamento ser realizado principalmente em áreas urbanas e haver áreas menos favorecidas onde os programas de rastreamento não são efetivos. É bem sabido que a mortalidade pelo câncer raramente é devida ao tumor primário, mas à disseminação metastática das células tumorais em órgãos distantes. A via linfática é considerada a preferencial para disseminação metastática nos tumores ginecológicos. E o estágio clínico e os linfonodos regionais são considerados os fatores prognósticos mais potentes no carcinoma de colo útero. A compreensão da linfangiogênese pode ser considerada uma importante chave na elucidação dos mecanismos usados pelas células tumorais na sua disseminação. Os objetivos do presente estudo são avaliar as características clínico-patológicas do câncer do colo do útero e sua associação com o comprometimento linfonodal e o desfecho; avaliar a linfangiogênese intratumoral pela análise quantitativa da microdensidade vascular linfática (MDVL), usando o método imunoistoquímico para marcação dos vasos linfáticos e três métodos morfométricos para a quantificação; determinar a associação entre a MDVL, características clínico-patológicas de apresentação, comprometimento linfonodal, desfecho e a expressão de podoplanina em células neoplásicas e a expressão da podoplanina em células fibroblásticas do estroma intratumoral. Os estudos sobre a MLVD em câncer de colo de útero são raros e controversos. Nossos resultados demonstraram que a MLVD foi mais acentuada nos tumores de menor tamanho (<2 cm), nos estádios iniciais (IB1), com menos infiltrações, sem comprometimento vascular e sem comprometimento linfonodal, provavelmente porque a indução da linfangiogênese pode ser um evento inicial na progressão do câncer, quando ainda nem todos os vasos neoformados estão funcionantes ou patentes. Isto explicaria a elevada MLVD nos tumores iniciais quando os linfonodos estavam frequentemente negativos. Observou-se que não não houve associação significativa entre expressão de podoplanina em células neoplásicas e comprometimento vascular, comprometimento dos linfonodos ou desfecho. A expressão de podoplanina em fibroblastos do estroma intratumoral no câncer precoce de colo de útero está associada a melhor prognóstico. Até o presente, acreditase que este seja o primeiro estudo a investigar o papel da expressão da podoplanina no estroma intratumoral de carcinoma precoce do colo do útero, relacionando-a com MLVD, comprometimento dos linfonodos e o desfecho / Cervix carcinoma incidence remains still high in our country, probably as the screening occurrence is carried out mainly in the urban areas and there are less favored areas where the screening programs are not effective. It is well known that the cancer mortality is rarely caused by the primary tumor, but it is caused by the metastatic spread of tumor cells in distant organs. The lymphatic route is considered the choice for the metastatic dissemination in the gynecological tumors. And the clinical stage and the regional lymphonodes are considered the most powerful prognostic factors in the uterine cervix cancer. The understanding of the lymphangiogenesis can be considered an important key for the elucidation of the mechanisms used in the tumor cells dissemination. The current study objectives are to evaluate the clinic-pathological characteristics of the uterine cervix carcinoma and its association with the lymphnodal involvement and outcome; to evaluate the intratumoral lymphangiogenesis by the quantitative analysis of the lymphatic vessel micro density (LVMD), using the immunoistochemical method for marking the lymphatic vessels and three morphometric methods for the quantification. To determine the association between the LVMD, the clinicpathological characteristics, the lymphonodal involvement and outcome and the podoplanin expression in neoplasic cells and in fibroblastic cells of the intratumoral stroma. Studies about the LVDM in uterine cervical cancer are rare and controversial. Our results demonstrated that the LVDM was more remarkable in the smaller tumors(<2cm), in the initial stages (IB1), with less infiltrations, with no vascular involvement and no lymphnodal involvement. Probably because the induction of lymphangiogenesis may be an early event in cancer progression, while still not all the newly formed vessels are functioning or patent. This would explain the high LVMD in the initial tumors while the lymphonodes were frequently negative. It was noted that there were no significant association between podoplanin expression in neoplasic cells and vessel involvement, lymphonodes involvement or outcome. Podoplanin expression in fibroblasts of the intratumoral stroma in early cervix carcinoma was associated to better prognosis. To date, it is believed that this is the first study to investigate the role of podoplanin expression in intratumoral stroma of cervix carcinoma, relating it to LVMD, lymph node involvement and outcome

Theories are tools with which we critically analyze society‟s structure and understand experiences that are not our own. When theories no longer describe the narratives that they claim, we must update them. This thesis proposes to do just that. The trans theories of J. Halberstam and Jay Prosser will be analyzed using ten autobiographies written by self-identified FTM transsexuals and transmen. Prosser and Halberstam are two well-known theorists in the field of trans theory. J. Halberstam approaches FTM transsexuality from the perspective of a lesbian feminist, who has an understanding of transgender butch individuals. Jay Prosser writes from the perspective of being a FTM transsexual himself. I chose publications by these theorists because they had sections that focused specifically on FTM narratives, and they both used at least two of the autobiographies I use and they were published the same year. Therefore, I found them to be two theoretical frameworks that could be compared on several different levels. The publication dates of the ten narratives range from the 1970s to the early 2000s. Applicability of the theories will be measured by comparing them to what the autobiographers say about their lives. The tool of analysis will be five focus areas that are represented, to some degree, in each narrative. They are: Trying to fit into female roll/body/world; Discovering one is Trans/Coming Out; Acquiring Hormones and Sexual Reassignment Surgery; Trying to Establish/Re-establish a Confident Identity; and Romantic/Sexual Relationships.. I will discuss how helpful each theory is in accordance with these narratives. The aim of this thesis is to assess how well each theorist addresses the issue of transsexual identity. The field of transsexual research is still new and developing, there are many interesting parts of these narratives that can be delved into further. I will conclude by proposing a new trans theoretical view point that would better help one to understand the process of female-to-male transition. What one should take away from this thesis is that despite differences in sex and gender formation, these people are, like the rest of the world, trying to create an identity that they not only feel comfortable with as a representation of themselves, but also one that they can be proud of.

Tyrimo tikslas: nustatyti diafragmos, skersinio pilvo ir dubens dugno raumenų funkcinius ryšius ir jų kaitą moterims po gimdos šalinimo operacijos. Tyrimo uždaviniai: 1. Įvertinti skersinio pilvo raumens aktyvumą ir ištvermę prieš ir po gimdos šalinimo operacijos kontrolinėje ir skersinio pilvo raumens lavinimo grupėje ir tarp jų. 2. Įvertinti diafragmos aktyvumą prieš ir po gimdos šalinimo operacijos kontrolinėje ir skersinio pilvo raumens lavinimo grupėje ir tarp jų; 3. Įvertinti dubens dugno raumenų jėgą ir ištvermę prieš ir po gimdos šalinimo operacijos kontrolinėje ir skersinio pilvo raumens lavinimo grupėje ir tarp jų. Tyrimo kontingentas ir metodai. Tyrime dalyvavo savanorės moterys, kurioms planuota gimdos šalinimo operacija. Jos atsitiktine tvarka buvo suskirstytos į dvi grupes: kontrolinę grupę (n=17), kurioje poveikis netaikytas, ir skersinio pilvo raumens lavinimo grupę (n=15), kurioje skirti skersinio pilvo raumens lavinimo pratimai. Diafragmos aktyvumas tirtas kvėpavimo slėgio matuokliu “MicroRPM“, dubens dugno raumenų jėga ir ištvermė – „Peritron 9300“ aparatu, o skersinio pilvo raumens aktyvumas ir ištvermė – Stabilizer“ prietaisu dieną prieš gimdos šalinimo operaciją ir praėjus šešioms savaitėms bei trims mėnesiams po jos. Išvados: 1. Po gimdos šalinimo operacijos, nelavinant skersinio pilvo raumens, jo aktyvumas ir ištvermė mažėja ir didžiausias mažėjimas stebimas šeštą savaitę po operacijos. Lavinant skersinį pilvo raumenį, jo jėga didėja tolygiai visu... [toliau žr. visą tekstą] / Research aim: To evaluate functional relations and their changes between diaphragm, transversus abdominis and pelvic floor muscles after hysterectomy. Objectives of study: 1.To evaluate an activity, endurance of transversus abdominis muscle in control group, transversus abdominis muscle training group and between these groups before and after hysterectomy. 2.To evaluate an activity of diaphragm muscle in control group, transversus abdominis muscle training group and between these groups before and after hysterectomy. 3.To evaluate strength and endurance of pelvic floor muscles in control group, transversus abdominis muscle training group and between these groups before and after hysterectomy. Contingent and methods of the study: All investigative women were divided randomly into two training groups: control (n=17), and transversus abdominis muscle (n=15). The strength of diaphragm was estimated with “MicroRPM“, pelvic floor muscles strength and endurance – „Peritron 9300“ device, and the activity and strength of transversus abdominis muscles was assessed with „Stabilizer“ one day before the operation of hysterectomy, six weeks and three months after it. Conclusions: 1.If there is no training of transversus abdominis muscle after uterus removal surgery, its activity and endurance decreases and the largest decrease is observed in the sixth week after surgery. While the transversus abdominis muscle is trained, its strength increases progressively all postoperative period and... [to full text]

Introduction: Hysterectomy is the most common major gynecological operation in the Western World and approximately 5000 benign hysterectomies are performed in Sweden every year. Consequently it is a surgical procedure that affects many women. The procedure comprises challenges concerning perioperative health care, perceived postoperative symptoms, quality of life aspects and health economics. The concept of fast track is a multimodal strategy to reduce hormonal surgical stress response and achieve an enhanced postoperative recovery and is today considered to be evidence based in relation to colorectal surgery. Spinal anesthesia, as an important part of fast track, provides benefits of extended effect on analgesia and reduced postoperative morbidity. It is reasonable to believe that employing the strategies of fast track including spinal anesthesia could also provide substantial benefits for women requiring surgical removal of the uterus. Aims: To determine whether duration of hospital stay, presence and intensity of postoperative symptoms, duration of sick leave and cost-effectiveness differ between women undergoing benign fast track abdominal hysterectomy in spinal anesthesia with intrathecal morphine (SA) and in standard general anesthesia (GA). Material &amp; Methods: 180 women participated in this open randomized multicenter study with five participating hospitals in the southeast region of Sweden. One hundred and sixty two completed the study; 82 women were randomized to SA and 80 to GA. A fast track model comprising premedication without sedatives, intravenous fluid regulation, analgesics based on non-opioids, pre-emptive antiemetic therapy, early enteral nutrition and mobilization and standard criteria for discharge were used. End points were duration of hospital stay, use of analgesics, perceived postoperative symptoms, occurrence of postoperative complications, duration of sick leave and health economic evaluations. Results: Duration of hospital stay did not differ between the two modes of anesthesia. Vomiting and pruritus occurred significantly more often after SA. Complication rates did not differ between groups. Women with SA experienced less overall discomfort and had a reduced need for opioids postoperatively. Abdominal pain, drowsiness and fatigue occurred less often and with lower intensity among the women in the SA group. Health related quality of life improved faster and the duration of sick leave was shorter in women after SA. Total costs (hospital costs plus costs for productivity loss) were lower for the SA group. Within the first 29 days after hysterectomy the women in the SA group gained more QALYs than women in the GA group. Conclusions: The duration of hospitalisation after fast track abdominal hysterectomy was less than 50 hours and mode of anesthesia did not influence this. SA displayed considerable advantages regarding postoperative symptoms and recovery. SA was considered cost-effective in comparison with GA due to lower total costs and more QALYs gained. Our study indicates that SA should be recommended as the first choice of anesthesia in benign abdominal hysterectomy.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.