Thesis (doctoral)--Umeå University, Sweden, 1995. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Orientadores: Luiz Paulo Kowalski, Oslei Paes de Almeida / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-09T14:07:50Z (GMT). No. of bitstreams: 1 Silva_KeniaRegina_M.pdf: 1402143 bytes, checksum: 385a4aeaced1369767478ecb4c8dd53b (MD5) Previous issue date: 2007 / Resumo: As neoplasias benignas e malignas que acometem glândulas salivares constituem cerca de 1 a 4% de todas as neoplasias do organismo humano. As glândulas parótidas são as mais frequentemente envolvidas, seguidas das glândulas salivares menores e submandibulares, sendo raramente acometidas as glândulas sublinguais. A presença de metástases regionais, extensão do tumor, dor na apresentação e idade maior que 55 anos têm sido considerados como indicadores de pior prognóstico. O objetivo deste estudo foi avaliar as características clínicas, histopatológicas e imunohistoquímicas de 293 tumores malignos das glândulas salivares tratados no Departamento de Cirurgia de Cabeça e Pescoço do Hospital A.C. Camargo, São Paulo, a fim de identificar fatores de riscos associados ao desenvolvimento de metástases linfonodais e sua importância prognóstica. Os dados clínicos dos pacientes foram obtidos por meio dos prontuários médicos e transferidos para uma ficha clínica padronizada especialmente para o estudo. Os diagnósticos histopatológicos foram confirmados, através da revisão dos preparados histológicos. As reações imunoistoquímicas foram feitas através da técnica da estreptavidina-biotina-peroxidase, utilizando-se anticorpos contra proteína p53, antígeno carcinoembrionário (CEA), Ki-67, c-erbB-2 e bcl-2. Dos pacientes que participaram do estudo, 150 eram homens (51,2%) e 143 (48,8%) mulheres, com idade média de 48 anos, variando de 5 a 91 anos. Cento e cinqüenta dois casos (51,9%) eram tumores primários das glândulas salivares maiores, sendo desses 120 em parótida. O tipo histológico mais comum foi Carcinoma Mucoepidermóide seguido pelo Carcinoma Adenóide Cístico, que juntos corresponderam a 70,3% dos casos. Cirurgia foi o tratamento mais realizado e 119 pacientes foram submetidos a esvaziamento cervical. Cento e quatro pacientes (35,5%) apresentaram recidivas locais, regionais e ou à distância. Metástases linfonodais foram observadas em 25% dos casos com idade superior a 65 anos (p=0,020) e em 23% dos pacientes que foram a óbito pela doença (p=0,004). A sobrevida global em 5 anos foi de 65,6% e em 10 anos 54,6%. Reações imunoistoquímica para p53, bcl-2, Ki-67, CEA, c-erbB-2 foram positivas em 31,2%, 46,6%, 27,1%, 19,2% e 41,0% respectivamente. Após a análise dos dados, observou-se que os fatores de riscos para presença de metástases linfonodais incluíam a idade maior que 40 anos, linfonodos clinicamente comprometidos, p53 positivo e C-erb-2 negativo. Os fatores prognósticos independentes para óbito foram idade acima dos 40 anos, linfonodos clinicamente comprometidos, diâmetro do tumor maior que 4 cm e tumores com marcação positiva para Ki-67. Conclusão: Metástases linfonodais estão associadas a idade, achado clinico de presença de metástases e imunoexpressão de p53 (positivo) e C-erbB-2 (negativo). A metástase linfonodal é um fator prognóstico independente em carcinomas de glândulas salivares / Abstract: Benign and malignant salivary gland neoplasias comprises 4¿10% of all the neoplasias affecting humans. The parotid glands are the most commonly affected, followed by minor salivary and submandibular glands. Regional metastasis, tumor extension, presence of pain, and age older than 55 years have been considered poor prognostic indicators. The aim of this study was to analyze the clinical, histological and immunohistochemical characteristics of malignant salivary gland tumors treated at the Department of Head and Neck Surgery, A.C. Camargo Hospital, São Paulo, and to identify the risk factors associated with lymph node metastasis and its prognostic relevance. Clinical data were obtained from the medical records. Histopathological slides were reviewed and immunohistochemical reactions against p53 protein, carcinoembryonic antigen (CEA), Ki-67, c-erbB-2 and bcl-2 performed using the streptavidin-biotin-peroxidase method. Results revealed that 150 patients were men (51.2%) and 143 women (48.8%), with a mean age of 48 years, varying from 5 to 91 years. Primary tumors involving the major salivary glands were observed in 152 cases (51.9%), 120 of which affected the parotid glands. Histological analysis revealed Mucoepidermoid Carcinoma (41.6%) followed by Adenoid Cystic Carcinoma (28.7%) totaling 70.3% of the cases. Surgery was needed in most of the cases and 119 patients were submitted to neck dissection. Recurrence was observed for 104 patients (35.5%). Survival rate was 65.6% at 5 years and 54.6% at 10 years. Immunohistochemical reactions for p53, bcl-2, Ki-67, CEA, c-erbB-2 were positive in 31.2%, 46.6%, 27.1%, 19.2% and 41.0% of the cases, respectively. Clinically affected lymph nodes, p53 positive and C-erb-2 negative tumor cells, and age older than 40 years were regarded as risk factors for lymph node metastasis. Clinically affected lymph nodes, tumors 4 cm or greater in diameter, tumors with Ki-67 positive cells, and age older than 40 years were considered independent prognostic factors for death. Conclusion: limph node metastasis are associated with age, clinical identification of metastatic limph nodes and immunoexpression of p53 (positive) and C-erbB-2 (negative). Limph node metastasis is a significant and independent prognostic factor in salivary gland carcinomas / Mestrado / Patologia / Mestre em Estomatopatologia

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Tumores malignos de origem nÃo epitelial sÃo considerados raros na regiÃo de cabeÃa e pescoÃo e podem apresentar grande morbidade e mortalidade. Este estudo teve o objetivo de fazer um levantamento dos casos de sarcomas e melanomas em regiÃo de cabeÃa e pescoÃo no perÃodo de 1999 a 2008, em trÃs centros especializados no MunicÃpio de Fortaleza, CearÃ. A coleta de dados foi feita com base nos livros de registros das cirurgias de cabeÃa e pescoÃo e dos prontuÃrios dos centros avaliados. Foram observados 54 casos, sendo 36 sarcomas e 18 melanomas. Quanto à avaliaÃÃo dos sarcomas, observamos que os indivÃduos mais acometidos foram homens adultos, da raÃa parda, na faixa etÃria de 20 a 59 anos, com idade mÃdia de 39,7. A relaÃÃo homem/mulher foi de 1,76:1. O tipo histolÃgico mais prevalente foi o rabdomiossarcoma, e as localizaÃÃes mais acometidas foram face e regiÃo cervical. Em relaÃÃo aos melanomas, homens adultos tambÃm foram predominantes, na faixa etÃria de 20 a 59 anos, com idade mÃdia de 54,6. Verificou-se igual acometimento nas raÃas parda e branca, com 33,3%, cada uma. A relaÃÃo homem/mulher foi de 1,25:1. O tipo histolÃgico mais prevalente foi o melanoma de disseminaÃÃo superficial, e a pele da face foi a localizaÃÃo mais frequente. Na avaliaÃÃo da procedÃncia, houve semelhanÃa em ambas as doenÃas, sendo aproximadamente metade dos pacientes da capital e metade do interior do estado. Quanto ao acompanhamento, a maior parte da amostra foi de pacientes vivos sem evidÃncia de doenÃa na Ãltima consulta, correspondendo a 41,6% nos sarcomas e 44,5% entre os melanomas. A variaÃÃo de terapia tambÃm foi observada em ambos os grupos, sendo os tipos mais comuns de tratamento a associaÃÃo de cirurgia, radioterapia e quimioterapia e cirurgia e radioterapia para sarcomas, e cirurgia, seguida da associaÃÃo de cirurgia e radioterapia para melanomas. Apesar de os tumores malignos de origem nÃo epitelial em cabeÃa e pescoÃo serem lesÃes raras, eles apresentam grande morbidade e mortalidade e dessa forma, necessita-se de que seus aspectos clinicopatolÃgicos sejam estudados e conhecidos, sempre com o objetivo de melhorar as formas de tratamento dessas lesÃes, garantindo assim maiores chances de cura e melhor qualidade de vida para os pacientes acometidos. / Malignant tumors of non-epithelial origin are considered rare in the head and neck region and they can show great morbidity and mortality. The aim of this study was to investigate the cases of sarcomas and melanomas in the head and neck region over the period from 1999 to 2008, in specialized centers located in the Municipality of Fortaleza. The data were collected from the register books of surgery of the head and neck and patient reports at the evaluated centers. Fifty-four cases were observed, being 36 sarcomas and 18 melanomas. As per the evaluation of the sarcomas, we have observed that the most assailed individuals were men with brown skin, ranging from 20 to 59 years old, with median age of 39.7. The relation man/woman was 1.7:1. The most prevailing histological type was the rhabdomyosarcoma, and the most attacked areas were the face and the cervical region. And as per the melanomas, adult men were also prevailing, ranging from 20 to 59 years old, with median age of 54.6. It has also been verified equal assailment in the brown and white races, with 33.3% in each one. The relation man/woman was 1.25:1. The most prevailing histological type was the superficial spreading melanoma, and the face skin was the most frequent location. In the evaluation of the origin, there was similarity in both diseases, being approximately half the patients in the capital city, and half in the stateÂs hinterland. As concerning the monitoring, the greatest part of the sample came from patients alive without evidence of the disease from the last consultation, corresponding to 41.6% in sarcomas and 44.5% in melanomas. The variation of therapy has also been observed in both groups, being the most common types of treatments, the association of surgery, radiotherapy and chemotherapy and surgery and radiotherapy for sarcomas and surgery, followed by surgery and radiotherapy for melanomas. Although malignant tumors of non-epithelial origin are rare in the head and neck region, they can show great morbidity and mortality and it is necessary the better understanding of their clinicalpatological aspects, in order to establish better treatment and life quality to these patients.

M.Tech. (Chiropractic) / The aim of this study was to determine the most effective treatment protocol for cervical spine facet syndrome, with regards to treatment frequency. Group one was treated three times weekly, and group two was treated once weekly. Both groups were treated with chiropractic manipulation of the cervical spine over a period of six treatments with a two week follow-up consultation. It was hypothesised that the group treated three times weekly would respond better compared to the once weekly treatment group. The study was a clinical trial involving two experimental groups of fifteen patients each (n=15), total sample size N=30. Volunteers responded to advertisements placed in the local press. Those who met the criteria, in other words suffered from cervical spine facet syndrome, were included in the study. Objective data was acquired using a goniometer to measure cervical spine range of motion. Subjective data was obtained by participants recording their progress on the Vemon-Miorneck pain and disability index and the Numerical pain rating scale. Data obtained from the range of motion testing showed that both groups responded with statistical significance to the treatment, but no statistically significant difference was obtained when the two respective groups were compared to each other. It was also noted that specifically rotation bilaterally for both groups, and left lateral flexion for group 1 (treated three times weekly), showed no statistically significant improvement at all. Statistical analysis of the data obtained from the questionnaires indicated that both groups responded with statistical significance to the treatment, but when group was compared to group 2, no statistically significant difference was noted between the two groups. This rejects the hypothesis that three times weekly chiropractic treatment is more beneficial to the patient, than once weekly chiropractic treatment. This study concluded that there was no statistical difference between the two above mentioned groups and no difference in response to different treatment frequencies. Therefore it shows that less frequent treatment is not to the detriment of the patients' progress and might be of benefit for achieving cost effectiveness.

M.Tech. (Chiropractic) / The aim of this study was to compare the effects of chiropractic manipulative therapy with and without stripping massage of the sternocleidomastoid, with regards to pain, disability, cervical range of motion and head repositioning accuracy in the treatment of chronic mechanical neck pain. The aim was determined by using the Vernon-Mior Neck Pain and Disability Index, Numerical Pain Rating Scale and the Cervical Range of Motion measuring instrument (CROM).The study consisted of thirty participants that had an equal male to female distribution. An age range was set and individuals had to be between eighteen and fourty. Participants were chosen according to inclusion and exclusion criteria that were set before the study commenced. Treatment received by the participants was dependent on which group they were allocated to. Group One received just chiropractic manipulative therapy to three restricted segments of the cervical spine. Group Two also received chiropractic manipulative therapy to three restricted cervical segments and had stripping massage of both sternocleidomastoid muscles.Treatment consisted of six treatments sessions and with the seventh visit only readings were taken. Treatments were carried out twice weekly so that the treatment time period fell over a three week study period. Participants were asked to complete the subjective data before the first, fourth and seventh visit. Subjective data was gathered by using the following: Numerical Pain Rating Scale and a Vernon-Mior Neck and Pain Disability Index Questionnaire. The objective data that was recorded by the researcher consisted of the cervical range of motion that was gathered by using the Cervical Range of Motion (CROM) machine and the head repositioning accuracy. Participants then received either chiropractic manipulative therapy to the restricted cervical spinal segments or a combination of stripping massage to the sternocleidomastoid muscles as well as chiropractic manipulative therapy, depending on their groupallocation. All data gathered by the researcher and then analysed by a statistician at the University of Johannesburg...

M.Tech. (Chiropractic) / Mechanical neck pain is the general term that refers to any type of pain within the cervical spine caused by placing abnormal stress and strain on muscles of the vertebral column. This is a very common musculo-skeletal disorder within the population, with 45% to 54% reporting neck pain at any given time of their lives (Martinez-Segura, Fernandez-de-las-Penas, Ruiz-Saez, Lopez-Jimenez and Rodriguez-Blanco, 2006). A vast majority of individuals do not experience a complete resolution of symptoms and as such often becomes a chronic pain (Cote, Cassidy, Carol and Kristman, 2004). Chronic pain by definition is one which is present for a period longer than six weeks (Segen, 2002). Accompanying the neck pain is often a limited or reduced range of motion within the cervical spine. Some studies suggest that hyper-tonicity and strain of the supporting muscles within this region due to an altered biomechanics also contributes to the pain and dysfunction (Armstrong, McNair and Williams, 2005 and Dall’Alba et al. 2001). One of the major muscle groups involved in this is the posterior cervical musculature. This is a general term used to describe the muscles located on the posterior aspect of the neck and includes longissimus capitis, semispinalis capitis, semispinalis cervicis, rotatores and multifidus (Dalley and Moore, 2006). Chiropractic adjustment therapy has been shown to have many effects of the body and especially the cervical spine including a decrease in pain perception and muscle hypertonicity (Kirkaldy-Willis and Cassidy, 1985), an increase in cervical range of motion (Bergmann, Peterson and Lawrence, 1993) as well as an increased skin pain tolerance level (Terrett and Vernon, 1984). Dry needling therapy has also been proven to have similar effects, including, a reduction in pain perception, an increase in range in motion of the specific linked biomechanical section, and most importantly a reduction of muscle tension (Travell and Simons, 1993). The purpose of this study was to see if a synergistic effect of the two above mentioned treatments would occur when combined under one treatment protocol. The aim of this study was to determine how effectively cervical adjustment therapy, dry needling of the posterior cervical muscles and a combination of the two treatments was in treating chronic mechanical neck pain with regards to pain, disability and cervical spine range of motion over a three week period. Participants were recruited from the University of Johannesburg Chiropractic Day Clinic. They were eligible to participate in the study once they met the inclusion and exclusion criteria. Participants were recruited by means of word of mouth as well as with the use of advertisements that were placed around the respective campuses of the University of Johannesburg. Thirty participants who presented with chronic mechanical neck pain, volunteered for this comparative study. This trial is a randomised controlled clinical trial which used convenience sampling. Group A received a combination treatment of dry needling and cervical manipulation. Group B received cervical adjustment only while group C received dry needling of the posterior cervical musculature alone. participants were treated for a total of 6 visits. Subjective and objective measurements were done at visits 1, 4 and a final visit 7 during which only measurements were taken. These effects are based on Vernon-Mior Pain and Disability Index, Numerical Pain Scale Rating, Pressure Algometer as well as Cervical Spine Range of Motion measuring instrument (CROM). The results of this trial indicated that all three treatments were effective in treating chronic mechanic neck pain. While one treatment was not statistically more effective than the other the dry needling and cervical manipulation alone produced a superior result. While combining these treatments was effective the synergistic effect one would expect was not as evident.

La cervicalgia es un problema de salud ocupacional en los odontólogos y está presente desde las prácticas del pregrado. Se realizó un estudio cuasi experimental para evaluar el efecto de un programa de gimnasia laboral en todos los estudiantes de cuarto año de un escuela de odontología de Lima para reducir la prevalencia de cervicalgia. El programa duró seis semanas, consistía en dos charlas para que realicen ejercicios de estiramiento de 5 minutos 3 veces por día y un recordatorio diario por mensaje de texto. 31 estudiantes fueron evaluados al inicio y final de la intervención, 13/31 manifestaron no haber realizado los ejercicios. Se encontró que la prevalencia de cervicalgia en las últimos 4 semanas se redujo de 90,3 % a 71,0 % (p=0,034) y la intensidad del dolor se redujo de 5,4 a 3,6 (p=0,009). El programa demostró reducir la cervicalgia, futuras intervenciones deben buscar alternativas para incrementar la adherencia. / The neck pain (Cervicalgia) is an occupational health problem in dentists and is present from the practices of undergraduate. A quasiexperimental study was conducted to evaluate the effect of a workplace gymnastics exercise program for all students in the fourth year of a dental school in Lima to reduce the prevalence of neck pain. The program lasted six weeks, consisted of two talks to perform stretching gymnastics exercises for 5 minutes 3 times per day and a daily reminder by text message. 31 students were assessed at the beginning and end of the intervention, 13/31 they said they had not done the exercises. It was found that the prevalence of neck in the previous 4 weeks was reduced from 90,3 % to 71,0 % (p = 0,034) and the intensity of pain was reduced from 5,4 to 3,6 (p = 0,009). The program was shown to reduce neck pain, future interventions should seek alternatives to increase adherence.

Abstract This study comprised three parts: a cross-sectional survey of 826 high school students, a 7-year follow-up survey of the same sample, and a MRI study of a subgroup (n=31) of the follow-up study population. Firstly, the aims of the study were to determine the prevalence and incidence of neck and shoulder pain (NSP) in populations 15-18 and 22-25 years old, and to evaluate sociodemographic factors, body size measurements, psychological factors and leisure time activities as possible associated and predictive factors of NSP. Secondly, the aim was to find out whether structural changes of the cervical spine detected by magnetic resonance imaging (MRI) were associated with NSP in young adults. The results showed the prevalence of self-reported weekly NSP in 15- to 18-year-old adolescents to be 17%, and in seven years, the prevalence of weekly NSP had increased to 28%. After seven years, the six-month incidence of occasional or weekly NSP was 59% among those asymptomatic at baseline. In the cross-sectional study, female gender, low physical activity, hobbies which statically load the upper extremities, low intensity of physical exercise, self-assessed moderate physical condition and psychosomatic symptoms and depressive mood were associated with a high prevalence of NSP, and sports which dynamically load the upper extremities were associated to a low prevalence of NSP. Symptoms in adolescence were associated with a high prevalence of NSP seven years later. Activity in sports, which dynamically load the upper extremities in adolescence, was associated with a low prevalence of NSP in adulthood. Of all variables in the study, psychosomatic symptoms were most congruently associated with a high prevalence of NSP, and psychosomatic symptoms in adolescence also predicted NSP in adulthood. In the MRI study, disc degeneration and anular tears of the cervical spine were common in asymptomatic and symptomatic subjects. Disc herniations were the only abnormal finding that was significantly more common in symptomatic subjects.

M.Tech. (Chiropractic) / Purpose: This study was undertaken in order to demonstrate the effects of static magnetic field therapy on acupuncture points in the treatment of those suffering from mechanical neck pain. Isolated spinal manipulative therapy of the cervical spine was compared to spinal manipulative therapy of the cervical spine in conjunction with magnetic field therapy on acupuncture points using both objective and subjective measurements. Before the execution of this study, it was hypothesised that both treatment protocols would be effective in the treatment of mechanical neck pain, although the combined therapy would be more effective. Method: Patients were recruited by way of advertisements placed in and around the University of Johannesburg, Doornfontein campus and their health clinic. Thirty patients with mechanical neck pain were recruited and randomly divided into two groups. Group one received manipulation to the affected joints of the cervical spine and group two received manipulation to the cervical spine combined with magnetic field therapy on acupuncture points. Procedure: Each patient in each group attended six treatment sessions; three in the first week and three in the second week. The Vernon Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale (subjective measurements) were completed by each patient and the Cervical Range of Motion instrument (objective measurements) was used to collect readings from each patient in both the control and experimental groups, subjective and objective measurements were taken before treatment one, three and six. Specific treatment protocols were then adhered to. Results: The results indicated that both treatment protocols were effective in reducing mechanical neck pain although not one group was more effective than the other. Both groups improved subjectively and objectively as they had cervical spinal manipulation directed at joint dysfunction. Conclusion: The experimental group who received spinal manipulative therapy to correct joint dysfunction in conjunction with magnetic field therapy on acupuncture points was not more effective than the control group who received spinal manipulation only, in the treatment of mechanical neck pain.

M. Tech. / Cervical Facet Syndrome is a condition characterised by neck pain and decreased mobility of the cervical spine (Bovim et al., 1994). It is essentially the dysfunction of the posterior joints in the neck where muscle hypertonicity causes the ligaments to shorten (Gatterman, 1995). There is a high prevalence of Cervical Facet Syndrome in industrialised countries leading to a loss in productivity and costly expenditure in terms of treatment (Jordan et al., 1998). The aim of this research study was to assess the efficacy of treatment with injectables of the Anthroposophical medicine Disci comp. cum Argento on the symptoms of Cervical Facet Syndrome. These symptoms include pain and a decrease in range of motion. Pain was assessed using two questionnaires, namely the Visual Analogue Scale for Pain (Annexure D) and the Vernon Mior Neck Pain Disability Index (Annexure E). Range of motion was measured using the Cervical Range of Motion Goniometer (Annexure F). This was a double-blind, placebo-controlled trial. Thirty participants, male and female between the ages of 18 and 40 who had been pre-diagnosed with Cervical Facet Syndrome were recruited to participate in the research study. The study was conducted over a period of three weeks. On day one, participants were requested to complete a Consent Form (Annexure B), a Participant Profile (Annexure C), and the two questionnaires used to assess pain. Range of motion was measured by the researcher. The group was then randomly divided into two groups with 15 participants per group. The experimental group received subcutaneous injections of Disci comp. cum Argento and the control group received subcutaneous injections of saline. These injections were administered by the researcher and repeated three times a week for two weeks so that each participant received a total of six injections. A final assessment without treatment was completed in the third week. The two questionnaires and range of motion measurements were repeated at the third, sixth and seventh or final assessment. . The results of this study indicated that although both the remedy and placebo groups showed improvements, there was no significant difference in these improvements between the groups for the results obtained for the Visual Analogue Scale for Pain, Vernon Mior Neck Pain Disability Index and measurements of flexion, left rotation and left lateral flexion. There was however, significant differences in improvement between the visits in favour of the remedy group for measurements of extension, right rotation and right lateral flexion.