A lacuna existente na compreensão das repercussões do câncer de mama feminino para casais que vivenciaram esse processo motivou a realização deste estudo, que objetivou compreender os sentidos para o câncer de mama feminino entre casais que permaneceram unidos na vivência dessa enfermidade, por meio do referencial teórico do construcionismo social. Os dados foram coletados numa amostra de sete casais entrevistados separadamente, em entrevistas semi-estruturadas com a utilização do diário de campo. A partir disso, foram identificadas três grandes temáticas referentes aos sentidos do câncer e da conjugalidade. Os sentidos do câncer foram agrupados no item vivência da doença, que contém os temas: confirmação da doença e fase do tratamento, esta subdividida nos seguintes sub-temas: a) ficando mais em casa; b) conversando omitindo a doença; c) transportando as esposas; d) cuidado fornecido por outras mulheres; e) realização do serviço doméstico: terceirizado; f) sexualidade: afastamento. E os sentidos da conjugalidade foram agrupados na temática ser marido e ser esposa. Essas temáticas emergiram dos discursos dos entrevistados ancorados na história do câncer e na moral do modelo de conjugalidade tradicional. O câncer foi associado a uma doença com sentidos de provação e morte, que despertou nos participantes sentimentos de revolta e ansiedade e a relação com Deus. Além disso, o compromisso assumido no casamento e a não revelação dos sentimentos mais íntimos experimentados por eles em relação ao câncer de mama, possibilitou a manutenção do laço conjugal em meio à experiência dolorosa da doença. Diante disso, sugere-se a relevância da assistência interdisciplinar com o intuito de desconstruir a negatividade associada ao câncer, bem como a reflexão sobre a relevância do discurso religioso como ferramenta do cuidado assistencial a essa população. / The existent gap in the comprehension of repercussions of the feminine breast cancer for couples that lived this process motivated the accomplishment of this study, which aimed to understand the meanings for the feminine breast cancer among couples that stayed united in living of this illness, through the social construction theory. The data were collected in a sample of seven couples interviewed separately, in semi-structured interviews with the use of field notes. From this, were identified three thematic related to the meanings of cancer and related to couples\' life. The meanings of cancer were gathered in disease living item that has these themes: disease confirmation and phase of treatment. The phase of treatment was subdivided in the following sub-themes: a) staying more at home; b) talking omitting the disease; c) transporting the wives; d) care supplied by other women; e) accomplishment of the domestic service: servant; f) sexuality: stand back. And the meanings of couples\' life were gathered at the thematic to be husband and to be wife. These thematic emerged of the interviewees\' speeches anchored in the history of cancer and in the moral of traditional couples\' life model. The cancer was associated it a disease with meanings of probation and death, that emerged in the participants feelings of revolt and anxiety in relation with God. Besides, the commitment assumed in the marriage and the non revelation of the most intimate feelings experienced by them in relation to breast cancer, it made possible the maintenance of the matrimonial bow amid the painful experience of the disease. Before this, it is suggested the importance of interdisciplinary assistance with the intention to construct different meanings than negativity of cancer, as well as the reflection of the importance of the religious discourse as a tool in the care of this population.

A avaliação da presença de destruição óssea provocada por neoplasias malignas de boca e orofaringe é um fator de fundamental importância no estabelecimento da terapêutica adequada para o caso, como também, para a determinação do prognóstico do paciente. O presente estudo teve por objetivo determinar os aspectos clínicos (localização, forma de apresentação e estadiamento) que podem estar associadas com o potencial de infiltração do osso subjacente a lesão, como também determinar a sensibilidade e especificidade do exame físico. A população de estudo consistio de vinte e cinco pacientes (17 homens e 8 mulheres, média de idade de 57,88 anos) portadores de neoplasias malignas de boca e orofaringe atendidos no Ambulatório de Semiologia da Faculdade de Odontologia da Universidade de São Paulo – campus São Paulo, no período de agosto de 2003 a agosto de 2004, os quais foram submetidos ao exame clínico e a tomografia computadorizada (TC). A TC foi considerada o padrão ouro para a avaliação da presença de destruição óssea. Foi observada a presença de infiltração neoplásica para o tecido ósseo adjacente em 68% dos casos (17 pacientes). O exame físico dos pacientes revelou uma sensibilidade de 80% e especificidade de 87,50% na análise de comprometimento do osso, além de uma acurácia de 84%. As lesões que se apresentavam clinicamente como uma úlcera do tipo infiltrativa e lesões do tipo nodulares, não ulceradas, foram as que apresentaram maior potencial de infiltrar-se para o osso, 68,75% e 100% respectivamente. A localização do tumor em determinados sítios, também influenciou diretamente na presença de invasão óssea,principalmente lesões localizadas em região de gengiva, trígono retromolar, palato duro e orofaringe. O estadiamento das lesões revelou relação existente entre o tamanho do tumor e a presença de metástases à distância com a presença de infiltração da neoplasia para o tecido ósseo. Concluindo, observou-se que a identificação de determinados parâmetros clínicos como localização, forma de apresentação clinica, tamanho da lesão e a presença de metástases à distância, associado a um criterioso exame físico regional podem servir como valiosas ferramentas para a análise de envolvimento ósseo por neoplasias malignas de boca e orofaringe. / The assessment of bone destruction by oral and oropharynx malignant neoplasms is a critical factor in the therapeutic planning and to determine the patient prognostic. The aim of this study was to determine the clinical aspects (localization, clinical manifestation and stage) that can be associated with the potential of bone infiltration, and also determine the physical exam sensibility and specificity. The study population consisted of twenty five patients (17 men and 8 women, mean age 57.88 years-old), with malignant neoplasms of the mouth and oropharynx, of the Stomatology Clinic of the College of Dentistry at the Sao Paulo University - campus Sao Paulo, in the period of august 2003 to august 2004, who were submitted to a clinical and computed tomography (CT) examinations. CT was considered the gold standard to evaluate the presence of bone involvement. The presence of bone destruction by the tumor was observed in 68% of the cases (17 patients). The physical examination of the patients revealed 82% of sensibility, 87.50% of specificity, and 84% of accuracy in the assessment of bone invasion by these diseases. The lesions that were clinical considered to be infiltrative ulcer and nodular lesions, non-ulcerated, presented the highest potential to cause bone destruction, 68.75% and 100% respectively. The tumor localization in specific sites also influenced the presence of bone invasion, meanly with the lesions localized in the gingival, retromolar trigone, hard palate and oropharynx. The stage of the lesions revealed a relation between the size and the presence of distant metastasis, with the presence of invasion by the neoplasm. In conclusion, it was determined that the identification of some clinical parameters such localization, clinical presentation, lesion size and the presence of distant metastasis, associated with a perceptive regional physical exam must be use as a value tool is the assessment of bone destruction by oral and oropharynx malignant neoplasms.

by Hon-wing Tsui. / Thesis (M.Ph.)--Chinese University of Hong Kong, 1988. / Bibliography: leaves 151-203.

by Shik Yuen Lo. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 102-124). / Abstract / List of Illustrations / List of Tables / Acknowledgements / Chapter 1. --- Introduction --- p.1 / Chapter 2. --- Literature Review / Chapter 2.1 --- Anatomy of the Human Nasopharynx --- p.4 / Chapter 2.2 --- Histology of the Human Nasopharynx --- p.6 / Chapter 2.3 --- Intra-epithelial Lesions of the Nasopharyngeal Epithelium --- p.10 / Chapter A. --- Hyperplasia / Chapter B. --- Metaplasia / Chapter C. --- Koilocytes / Chapter D. --- Nasopharyngeal intra-epithelial neoplasia / Chapter 2.4 --- Nasopharyngeal Carcinoma --- p.19 / Chapter A. --- Histopathological classification of NPG / Chapter B. --- Epidemiology / Chapter C. --- Etiological factors / Chapter 2.5 --- Epstein-Barr Virus and Nasopharyngeal Carcinoma --- p.27 / Chapter A. --- Serological / Chapter B. --- EBV genome in NPC / Chapter C. --- EBV encoded latent gene products / Chapter 2.6 --- Cancer Genes in Nasopharyngeal Carcinoma --- p.28 / Chapter A. --- "Tumours suppressor Gene, p53" / Chapter B. --- "Oncogenes, c-myc, ras and bcl-2" / Chapter 2.7 --- Immunohistochemical methods --- p.33 / Chapter A. --- Avidin-Biotin Complex method (ABC) / Chapter B. --- Alkaline phosphotase Anti-alkaline phosphotase method (APAAP) / Chapter C. --- Unmasking of antigens / Chapter 2.8 --- Techniques in ISH --- p.40 / Chapter 3. --- Material and Methods --- p.42 / Chapter 3.1 --- Tissue Samples --- p.42 / Chapter A. --- "Samples for ras, c-myc and p53 studies" / Chapter B. --- Samples for LMP-1 study / Chapter C. --- Samples for bcl-2 study / Chapter D. --- Samples for EBER-RNAs study / Chapter 3.2 --- Monoclonal Antibodies --- p.47 / Chapter 3.3 --- Tissue Processing --- p.49 / Chapter A. --- Tissue processing for formalin fixed tissue / Chapter B. --- Tissue processing for frozen section / Chapter 3.4 --- IHC Techniques --- p.50 / Chapter A. --- Pretreatment of Laboratory Wares / Chapter B. --- Determination of optimum dilution and incubation time for p53antibody / Chapter C. --- Determination of optimum dilution and incubation time for bcl-2 and LMP-1 antibodies / Chapter D. --- Determination of optimum dilution and incubation time for c-myc and ras / Chapter E. --- "Detection of p53, c-myc and ras by ABC method" / Chapter F. --- Detection of bcl-2 and LMP-1 by APAAP method / Chapter 3.6 --- ISH --- p.57 / Chapter A. --- Pretreatment of laboratory wares / Chapter B. --- FITC conjugated EBER oligonucleotide probe / Chapter C. --- Determination of PK dilution for paraffin section / Chapter D. --- Determination of PK dilution for frozen section / Chapter E. --- Determination of the choice of fixative for frozen section / Chapter F. --- Detection of EBER-RNAs by ISH method / Chapter 3.7 --- Statistical analysis --- p.62 / Chapter A. --- p53 / Chapter B. --- c-myc and ras / Chapter 4. --- Results --- p.63 / Chapter A. --- ras / Chapter B. --- c-myc / Chapter C. --- p53 / Chapter D. --- LMP-1 / Chapter E. --- Bcl-2 / Chapter F. --- EBER-RNAs / Chapter 5. --- Discussion --- p.86 / Chapter 6. --- Conclusion and Summary --- p.97 / Appendix --- p.99 / Reference --- p.102

by Sze Shun Fai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references (leaves 132-139). / Abstract --- p.1 / Chapter Chapter 1 --- General Introduction / Chapter 1.1 --- The pineal gland --- p.5 / Chapter 1.2 --- Discovery of melatonin --- p.5 / Chapter 1.3 --- Synthesis of melatonin --- p.5 / Chapter 1.4 --- Physiology of melatonin and its derivatives --- p.6 / Chapter 1.5 --- In vitro tumor biology of melatonin and its derivatives --- p.7 / Chapter 1.6 --- In vivo tumor biology of melatonin --- p.10 / Chapter 1.7 --- Macrophages --- p.11 / Chapter 1.8 --- Lymphocytes --- p.14 / Chapter Chapter 2 --- Toxicity of pineal indoles on tumor cell lines / Chapter 2.1 --- General introduction --- p.17 / Chapter 2.2 --- Material and methods --- p.18 / Chapter 2.3 --- Results --- p.22 / Chapter 2.4 --- Discussion --- p.23 / Chapter Chapter 3 --- Activation of murine peritoneal macrophages by melatonin and methoxytryptamine / Chapter 3.1 --- General introduction --- p.37 / Chapter 3.2 --- Material and methods --- p.38 / Chapter 3.3 --- Results --- p.55 / Chapter 3.4 --- Discussion --- p.61 / Chapter Chapter 4 --- Activation of murine splenocytes by melatonin and methoxytryptamine / Chapter 4.1 --- General introduction --- p.81 / Chapter 4.2 --- Material and methods --- p.82 / Chapter 4.3 --- Results --- p.91 / Chapter 4.4 --- Discussion --- p.128 / Chapter Chapter 5 --- General discussion --- p.132 / References

by Chen Paul. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 141-150). / Chapter 1. --- INTRODUCTION --- p.1 / Chapter 1.1 --- Immunomodulation --- p.1 / Chapter 1.2 --- Effector cells mediating anti-tumour immunity --- p.1 / Chapter 1.2.1 --- Cytotoxic T Lymphocytes --- p.3 / Chapter 1.2.2 --- Macrophages --- p.4 / Chapter 1.2.3 --- Natural Killer Cells --- p.5 / Chapter 1.2.4 --- Lymphokine-activated Killer (LAK) --- p.6 / Chapter 1.3 --- Cytokines as immunomodulators in cancer therapy --- p.7 / Chapter 1.3.1 --- Tumour Necrosis Factor-α (TNF-α) --- p.7 / Chapter 1.3.2 --- Interleukin-1 (IL-1) --- p.9 / Chapter 1.3.3 --- Interleukin-2 (IL-2) --- p.9 / Chapter 1.3.4 --- Granulocytes/Macrophages Colony-Stimulating Factors --- p.10 / Chapter 1.4 --- Polysaccharides as potential immunostimulating agents --- p.11 / Chapter 1.5 --- General properties of Klebsiella pneumoniae --- p.12 / Chapter 2. --- AIM AND SCOPE OF THIS DISSERTATION --- p.16 / Chapter 3. --- MATERIALS AND METHODS --- p.18 / Chapter 3.1 --- Materials --- p.18 / Chapter 3.1.1 --- Animals --- p.18 / Chapter 3.1.2 --- Klebsiella pneumoniae K24 --- p.18 / Chapter 3.1.3 --- Cell lines --- p.18 / Chapter 3.1.4 --- "Buffer, Culture media and Chemicals" --- p.19 / Chapter 3.2 --- Methods --- p.27 / Chapter 3.2.1 --- Extraction and Characterization of Klebsiella pneumoniae K24 Capsular Polysaccharide (K24 CPS) --- p.27 / Chapter 3.2.2 --- Assays of Immunomodulatory Activities of K24 CPS on Lymphocytes --- p.30 / Chapter 3.2.3 --- Assays of Immunomodulatory Effect of K24 CPS on Macrophages --- p.34 / Chapter 3.2.4 --- Assays of Anti-Tumour Activities of K24 CPS --- p.39 / Chapter 3.2.5 --- Assays of the Effects of K24 CPS on the Proliferation and Differentiation of Murine Bone Marrow Cells --- p.54 / Chapter 3.2.6 --- Assays of the Immunorestorative Activities of K24 CPS --- p.56 / Chapter 4. --- EXTRACTION AND CHARACTERIZATION OF KLEBSIELLA PNEUMONIAE K24 CAPSULAR POLYSACCHARIDE (K24 CPS) --- p.59 / Chapter 4.1 --- Preparation of Klebsiella pneumoniae K24 CPS Capsular Polysaccharide (K24 CPS) --- p.59 / Chapter 4.2 --- Acetic Acid Treatment of K24 CPS --- p.59 / Chapter 4.3 --- Gel Filtration --- p.59 / Chapter 4.4 --- Carbohydrate and Protein contents of K24 CPS --- p.61 / Chapter 4.5 --- Cytotoxicity Assay using Artemia franciscana (Brine Shrimp) --- p.61 / Chapter 5. --- IMMUNOMODULATORY EFFECTS OF K24 CPS --- p.68 / Chapter 5.1 --- The Effect of K24 CPS in vitro Mitogenic Assay of K24 CPS using Murine Splenocytes --- p.68 / Chapter 5.2 --- The in vivo Mitogenic Effect of K24 CPS on Murine Splenic Lymphocytes --- p.73 / Chapter 5.3 --- The Effect of K24 CPS on the Production of Interleukin-2 (IL-2)-like substance by Murine Splenocytes --- p.73 / Chapter 5.4 --- The effect of K24 CPS on the in vitro Stimulation of Murine Macrophage Nitric Oxide (NO) Production --- p.73 / Chapter 5.5 --- The effect of K24 CPS on the in vitro Stimulation of Macrophage Interleukin-1-like Production --- p.77 / Chapter 5.6 --- The effect of K24 CPS on in vivo Migration of Macrophage --- p.82 / Chapter 5.7 --- The effect of K24 CPS in vitro Stimulation of Macrophage Tumour Necrosis Factor- a (TNF-a) Production --- p.82 / Chapter 6. --- IN VITRO ANTI-TUMOUR EFFECT OF K24 CPS --- p.89 / Chapter 6.1 --- The in vitro Cytostatic effect of K24 CPS on the Suppression of EAT growth --- p.89 / Chapter 6.2 --- The effect of K24 CPS on cell cycle of EAT cells --- p.89 / Chapter 6.3 --- Study of the cytostatic effect of K24 CPS on EAT cells using Western Analysis --- p.93 / Chapter 6.3.1 --- Pattern of Phosphotyrosine Proteins --- p.93 / Chapter 6.3.2 --- Pattern of Phosphoserine Proteins --- p.96 / Chapter 6.3.3 --- Pattern of Phosphothreonine Proteins --- p.96 / Chapter 6.3.4 --- Level of c-fos --- p.99 / Chapter 6.3.5 --- Level of c-jun --- p.99 / Chapter 6.3.6 --- Level of c-myc --- p.102 / Chapter 7. --- THE IN VIVO ANTI-TUMOUR ACTIVITIES OF K24 CPS --- p.103 / Chapter 7.1 --- The effect of K24 CPS on the In vivo Suppression of EAT growth --- p.103 / Chapter 7.2 --- The effect of K24 CPS on the survival of EAT-bearing mice --- p.103 / Chapter 7.3 --- The effect of K24 CPS on the in vivo induction of Natural Killer (NK) Cell Cytotoxicity --- p.111 / Chapter 7.4 --- The effect of K24 CPS in vitro induction of Lymphokine-activated Killer (LAK) Cell Cytotoxicity --- p.111 / Chapter 7.5 --- The effect of K24 CPS on the in vivo Induction of Lymphokine-activated Killer (LAK) Cell Cytotoxicity --- p.114 / Chapter 7.6 --- The effect of K24 CPS on the endogenous production of TNF-α --- p.114 / Chapter 7.7 --- The effect of K24 CPS on the endogenous TNF-α production and EAT growthin vivo --- p.117 / Chapter 8. --- THE IMMUNORESTORATIVE ACTIVITIES OF K24 CPS --- p.122 / Chapter 8.1 --- The in vivo Immunorestorative Activities of K24 CPS in EAT-bearing Mice --- p.122 / Chapter 8.2 --- The in vitro Immunorestorative Activities of K24 CPS in Mice bearing 10-day-old- EAT --- p.122 / Chapter 9. --- THE EFFECT OF K24 CPS IN VITRO INDUCTION OF MURINE BONE MARROW CELLS PROLIFERATION AND DIFFERENTIATION --- p.126 / Chapter 9.1 --- The effect of K24 CPS in vitro induction of Murine Bone Marrow Cells Proliferation --- p.126 / Chapter 9.2 --- The effect of K24 CPS in vitro induction of Murine Bone Marrow Cells Differentiation --- p.126 / Chapter 10. --- CONCLUSIONS AND FUTURE PERSPECTIVES --- p.135 / Chapter 11. --- BIBLIOGRAPHY --- p.141

INTRODUÇÃO: Rabdomiossarcoma (RMS) representa o sarcoma de partes moles mais freqüente da infância, havendo poucas informações a seu respeito em países em desenvolvimento. OBJETIVOS: Estudar o perfil demográfico, social, clínico, biológico e patológico de pacientes portadores de rabdomiossarcoma tratados em uma instituição brasileira. Estimar a probabilidade acumulada de sobrevida global (SG) e de sobrevida livre de eventos (SLE) em 60 meses, assim como identificar fatores prognósticos. CASUÍSTICA E MÉTODOS: Foram analisados retrospectivamente 163 pacientes, no período de 1986 a 2004, que receberam tratamento multimodal seguindo orientações do protocolo Intergrupo para RMS III e IV. O estudo do percentual de positividade nuclear da miogenina foi realizado em 85 casos. RESULTADOS: As localizações da doença mais freqüentes foram cabeça e pescoço em 73 (44,7%), extremidade em 28 (17,2%), trato geniturinário em 25 (15,3%) e retroperitônio em 14 (8,6%) pacientes. O subtipo histológico foi embrionário em 99 (60,75%) pacientes e alveolar/sarcoma indiferenciado em 65 (38,7%). Foi observada positividade nuclear da imunoistoquímica com miogenina (> 75% das células) em 80% dos casos com RMS alveolar. O tamanho tumoral foi > 5 cm em 89%, com invasividade (T2) em 80,4% e comprometimento de linfonodos regionais em 45 (27,6%) pacientes. A maioria dos pacientes encontrava-se nos grupos clínicos III (49,1%) e IV (39,3%). O estado nutricional foi avaliado com o percentil do índice de massa corporal (IMC), sendo encontrado baixo peso (< 10º percentil) em 49 (30%) pacientes. Com tempo mediano de seguimento de 32 meses, as probabilidades acumuladas de SG e SLE para o grupo todo foram 48,6% e 42,2%, respectivamente. Nos pacientes com GC I + II a SLE foi de 73,3%; naqueles com GC III foi 57,5% e nos com GC IV foi 14,9% (p = 0,001). Na análise univariada, a SG em 60 meses foi influenciada negativamente por idade < 1 ano e maior ou igual a 10 anos, cor da pele preta, doença metastática (GC IV), um ou dois e mais sítios de metástases, local do tumor primário em extremidade, linfonodo N1 ou NX, invasividade e subtipo histológico alveolar. Na análise multivariada, foram fatores prognósticos Resumo independentes para SG: idade < 1 ano (p = 0,022) e maior ou igual a 10 anos (p = 0,069), um ou dois e mais sítios de metástase (p < 0,001) e percentil do IMC menor ou igual a 10 (p = 0,027); para SLE, IMC menor ou igaul a 10º percentil (p = 0,036) e presença de linfondo regional N1 e NX (p < 0,001); para SLE nos pacientes sem metástases, IMC menor ou igual a 10º percentil (p = 0,003) e presença de linfondo regional N1 (p = 0,003) e NX (p = 0,002). O tamanho tumoral, apesar de não ter entrado no modelo multivariado, foi um dos fatores prognósticos mais importantes. O estudo da positividade da miogenina não teve significado prognóstico. CONCLUSÕES: Esses resultados sugerem que além das características da doença, fatores nutricionais e socioeconômicos devem ser considerados no planejamento do tratamento e na análise de fatores prognósticos. Doença metastática está associada a prognóstico reservado. Investir no diagnóstico precoce é fundamental. / INTRODUCTION: Rhabdomyosarcoma (RMS) represents the most frequent soft tissue tumor in childhood. There are few reports on this disease in developing countries. PURPOSE: To analyze demographic, socio-economic, clinical, biological and pathological variables at a Brazilian institution. To estimate overall survival (OS) and event-free survival (EFS) in 60 months and identify prognostic factors. CASUISTICS AND METHODS: One hundred and sixty-three patients with rhabdomyosarcoma who had received multimodal treatment according to Intergroup protocols for rhabdomyosarcoma - IRS III and IV -were retrospectively analyzed from 1986 to 2004. The nutritional status was evaluated with the body mass index (BMI) percentile and less than 10 was considered low weight. Immunohistochemistry with myogenin was performed in 85 patients for the percentage of nuclear positivity. RESULTS: The frequent primary sites in patients were head and neck in 73 (44.7%), extremity in 28 (17.2%), genitourinary tract in 25 (15.3%) and retroperitoneum in 14 (8.6%). The histological subtype was embryonal in 99 (60.75%) and alveolar in 65 (38.7%) patients. Nuclear positivity for myogenin (> 75%), was observed in 80% of alveolar RMS patients. Tumor size > 5 cm was seen in 89%, invasivity (T2) in 80.4% and regional lymph node involvement in 45 (27.6%) patients. Most patients were in clinical groups (CG) III (49.1%) and IV (39.3%). The BMI was below the 10th percentile in 49 (30%) patients. With a median follow-up of 32 months, estimated OS and EFS for the whole group were 48.6% and 42.2%, respectively. The EFS for patients in CG I + II, III and IV was 73.3%, 57.5% and 14.9%, respectively (p = 0.001). Univariate analysis showed that OS in 60 months was adversely influenced by age < 1 year and maior ou igual a 10 year, black skin, metastatic disease, one or two and more metastatic sites, extremity as primary site, lymph node N1 or NX, invasivity, and histological subtype alveolar. Multivariate analysis showed that independent prognostic factors for OS were age < 1 year (p = 0.022) and maior ou igual a 10 years (p = 0.069), one or two and more metastatic sites (p < 0.001), BMI percentile menor ou igual 10 (p = 0.027); independent prognostic factors for EFS were BMI < 10th percentile (p = 0.036) and the presence of regional lymph node N1 e NX (p < 0.001); for EFS in Summary non-metastatic patients, BMI < 10th percentile (p = 0.003) and the presence of regional lymph nodes N1 (p = 0.003) and NX (p = 0.002). Tumor size was one of the most important factors, although not selected for the multivariate model. The positivity of myogenin had no prognostic significance. CONCLUSIONS: The results of this study suggest that besides disease characteristics, nutritional and socio-economic factors should be considered in planning treatment and in the analysis of prognostic factors. Metastatic disease is associated with bad prognosis. All efforts should be taken to provide early diagnosis.

INTRODUÇÃO: Rabdomiossarcoma (RMS) representa o sarcoma de partes moles mais freqüente da infância, havendo poucas informações a seu respeito em países em desenvolvimento. OBJETIVOS: Estudar o perfil demográfico, social, clínico, biológico e patológico de pacientes portadores de rabdomiossarcoma tratados em uma instituição brasileira. Estimar a probabilidade acumulada de sobrevida global (SG) e de sobrevida livre de eventos (SLE) em 60 meses, assim como identificar fatores prognósticos. CASUÍSTICA E MÉTODOS: Foram analisados retrospectivamente 163 pacientes, no período de 1986 a 2004, que receberam tratamento multimodal seguindo orientações do protocolo Intergrupo para RMS III e IV. O estudo do percentual de positividade nuclear da miogenina foi realizado em 85 casos. RESULTADOS: As localizações da doença mais freqüentes foram cabeça e pescoço em 73 (44,7%), extremidade em 28 (17,2%), trato geniturinário em 25 (15,3%) e retroperitônio em 14 (8,6%) pacientes. O subtipo histológico foi embrionário em 99 (60,75%) pacientes e alveolar/sarcoma indiferenciado em 65 (38,7%). Foi observada positividade nuclear da imunoistoquímica com miogenina (> 75% das células) em 80% dos casos com RMS alveolar. O tamanho tumoral foi > 5 cm em 89%, com invasividade (T2) em 80,4% e comprometimento de linfonodos regionais em 45 (27,6%) pacientes. A maioria dos pacientes encontrava-se nos grupos clínicos III (49,1%) e IV (39,3%). O estado nutricional foi avaliado com o percentil do índice de massa corporal (IMC), sendo encontrado baixo peso (< 10º percentil) em 49 (30%) pacientes. Com tempo mediano de seguimento de 32 meses, as probabilidades acumuladas de SG e SLE para o grupo todo foram 48,6% e 42,2%, respectivamente. Nos pacientes com GC I + II a SLE foi de 73,3%; naqueles com GC III foi 57,5% e nos com GC IV foi 14,9% (p = 0,001). Na análise univariada, a SG em 60 meses foi influenciada negativamente por idade < 1 ano e maior ou igual a 10 anos, cor da pele preta, doença metastática (GC IV), um ou dois e mais sítios de metástases, local do tumor primário em extremidade, linfonodo N1 ou NX, invasividade e subtipo histológico alveolar. Na análise multivariada, foram fatores prognósticos Resumo independentes para SG: idade < 1 ano (p = 0,022) e maior ou igual a 10 anos (p = 0,069), um ou dois e mais sítios de metástase (p < 0,001) e percentil do IMC menor ou igual a 10 (p = 0,027); para SLE, IMC menor ou igaul a 10º percentil (p = 0,036) e presença de linfondo regional N1 e NX (p < 0,001); para SLE nos pacientes sem metástases, IMC menor ou igual a 10º percentil (p = 0,003) e presença de linfondo regional N1 (p = 0,003) e NX (p = 0,002). O tamanho tumoral, apesar de não ter entrado no modelo multivariado, foi um dos fatores prognósticos mais importantes. O estudo da positividade da miogenina não teve significado prognóstico. CONCLUSÕES: Esses resultados sugerem que além das características da doença, fatores nutricionais e socioeconômicos devem ser considerados no planejamento do tratamento e na análise de fatores prognósticos. Doença metastática está associada a prognóstico reservado. Investir no diagnóstico precoce é fundamental. / INTRODUCTION: Rhabdomyosarcoma (RMS) represents the most frequent soft tissue tumor in childhood. There are few reports on this disease in developing countries. PURPOSE: To analyze demographic, socio-economic, clinical, biological and pathological variables at a Brazilian institution. To estimate overall survival (OS) and event-free survival (EFS) in 60 months and identify prognostic factors. CASUISTICS AND METHODS: One hundred and sixty-three patients with rhabdomyosarcoma who had received multimodal treatment according to Intergroup protocols for rhabdomyosarcoma - IRS III and IV -were retrospectively analyzed from 1986 to 2004. The nutritional status was evaluated with the body mass index (BMI) percentile and less than 10 was considered low weight. Immunohistochemistry with myogenin was performed in 85 patients for the percentage of nuclear positivity. RESULTS: The frequent primary sites in patients were head and neck in 73 (44.7%), extremity in 28 (17.2%), genitourinary tract in 25 (15.3%) and retroperitoneum in 14 (8.6%). The histological subtype was embryonal in 99 (60.75%) and alveolar in 65 (38.7%) patients. Nuclear positivity for myogenin (> 75%), was observed in 80% of alveolar RMS patients. Tumor size > 5 cm was seen in 89%, invasivity (T2) in 80.4% and regional lymph node involvement in 45 (27.6%) patients. Most patients were in clinical groups (CG) III (49.1%) and IV (39.3%). The BMI was below the 10th percentile in 49 (30%) patients. With a median follow-up of 32 months, estimated OS and EFS for the whole group were 48.6% and 42.2%, respectively. The EFS for patients in CG I + II, III and IV was 73.3%, 57.5% and 14.9%, respectively (p = 0.001). Univariate analysis showed that OS in 60 months was adversely influenced by age < 1 year and maior ou igual a 10 year, black skin, metastatic disease, one or two and more metastatic sites, extremity as primary site, lymph node N1 or NX, invasivity, and histological subtype alveolar. Multivariate analysis showed that independent prognostic factors for OS were age < 1 year (p = 0.022) and maior ou igual a 10 years (p = 0.069), one or two and more metastatic sites (p < 0.001), BMI percentile menor ou igual 10 (p = 0.027); independent prognostic factors for EFS were BMI < 10th percentile (p = 0.036) and the presence of regional lymph node N1 e NX (p < 0.001); for EFS in Summary non-metastatic patients, BMI < 10th percentile (p = 0.003) and the presence of regional lymph nodes N1 (p = 0.003) and NX (p = 0.002). Tumor size was one of the most important factors, although not selected for the multivariate model. The positivity of myogenin had no prognostic significance. CONCLUSIONS: The results of this study suggest that besides disease characteristics, nutritional and socio-economic factors should be considered in planning treatment and in the analysis of prognostic factors. Metastatic disease is associated with bad prognosis. All efforts should be taken to provide early diagnosis.

A brain tumor diagnosis is traumatic and has a devastating impact upon the caregiver and the family unit. The effects of the tumor growth and treatment often cause significant neurologic injury and dramatically affect the quality of life (QOL) for the patient and their entire family unit. Caregivers are constantly challenged to provide care, yet they feel untrained and underprepared as they struggle to adjust to new roles and responsibilities. The purpose of this study is to gain an understanding of the lived experiences of caregivers of individuals with primary benign brain tumor (PBBT). An interpretive phenomenological analysis approach was used to explore the experiences of 10 caregivers. Bowen's family systems theory provided an understanding of how families respond to changes in their family system resulting from a member of the family having a PBBT. A nonprobability sampling technique was used to recruit participants from 2 virtual support groups. Data were collected through semistructured interviews guided by an interview template. Interviews were transcribed and analyzed following the Smith tradition of inquiry until data saturation was reached. Three major themes emerged from the data: experiencing new challenges, responding to initial diagnosis, and facing challenges with family and friends. Caregivers experience a wide variety of responsibilities that are physically and psychologically challenging, which can negatively affect the QOL for the caregiver and the patient. These findings can be used by healthcare providers to identify resources to alleviate the unanticipated demands caregivers experience. Future studies are needed to explore how best to decrease challenges experienced by caregivers of individuals with PBBT.

Hypoxia is one of the hallmarks of cancer. It was first postulated to occur in solid tumours by Thomlinson and Gray in 1955.1 The presence of hypoxia has been demonstrated in different types of solid tumours.2 Intratumoral hypoxia is caused by the lack of functional blood vessels in proliferating tumour tissue, resulting in low intratumoral oxygen concentrations. If hypoxia is severe or prolonged, cell death occurs.3 Malignant cells can undergo genetic and adaptive changes that allow them to escape from dying of oxygen deprivation. These changes are associated with a more aggressive malignant phenotype 4,5 conferring resistance to radiation 6,7 and chemotherapeutic agents.3,8,9 Hence hypoxia is known to be a key factor responsible for tumour resistance in humans. / Invasive polarographic oxygen sensor measurements have demonstrated hypoxia in solid tumours and it is generally defined to occur at an oxygen tension less than ten mmHg.10 Perhaps of more importance is that hypoxia has been demonstrated to be a prognostic indicator for local control after treatment with radiotherapy in glioma, head and neck and cervical cancers.11-13 It has also been able to predict for survival and the presence of distant metastases in soft tissue sarcomas.14 Finally, the significance of hypoxia in the activation and induction of functional molecules such as hypoxia inducible factors (HIFs) and VEGF, the modulation of gene expression (e.g. carbonic anhydrase IX), increased proto-oncogene levels, activation of nuclear factors and accumulation of other proteins (e.g. TP53) although progressing, is yet to be defined.15,16 / Thus, it is of clinical interest to understand the levels of hypoxia and numbers of hypoxic cell populations in tumours, particularly those resistant to radiation and chemotherapy. In doing so clinicians and researchers may formulate more accurate prognostic information and develop treatments targeting hypoxic cells. Renal cell carcinoma (RCC) is a tumour resistant to radiation and chemotherapy that is yet to have its oxygen status investigated. / Although the “gold standard” of oxygen tension measurement is the Polarographic Oxygen Sensor (POS or Eppendorf pO2 histograph), non-invasive means of measuring oxygen status via imaging, immunohistochemistry or serum tumour markers are more practical. As highlighted by Menon and Fraker, it is imperative that reliable, globally usable, and technically simplistic methods be developed to yield a consistent, comprehensive, and reliable profile of tumour oxygenation. Until newer more reliable techniques are developed, existing independent techniques or appropriate combinations of techniques should be optimized and validated using known endpoints in tumour oxygenation status and/or treatment outcomes.17 / Hanahan and Weinberg 18 surmised that the field of cancer research has largely been guided by a reductionist focus on cancer cells and the genes within them- a focus that has produced an extraordinary body of knowledge. Looking forward in time, they believe that progress in cancer research would come from regarding tumours as complex tissues in which mutant cancer cells have conscripted and subverted normal cell types (endothelial cells, immune cells, fibroblasts) to serve as active collaborators in their neoplastic agenda. The interactions between the genetically altered malignant cells and these supporting coconspirators will prove critical to understanding cancer pathogenesis and to the development of novel, effective therapies.18 / Essentially, the background outlined here not only highlights the core aim of this thesis: to better understand the oxygen status of renal cell carcinoma and the relationship of this to angiogenesis so that better targeted therapies may be pursued in the future; but it also places this research in the context of the future proposed by Hanahan and Weinberg,18 by clearly focusing on collaborators in the neoplastic agenda, rather than just tumour cells themselves, to better understand RCC.