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The role of nuclear factor-kappaB in the laryngeal cancer cell death induced by Pteris semipinnata L extract.January 2008 (has links)
Lo, Chun Shan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 71-80). / Abstracts in English and Chinese. / Abstract --- p.i / Chinese abstract --- p.iii / Acknowledgements --- p.iv / List of figures --- p.vi / Abbreviations --- p.vii / Contents --- p.viii / Chapter Chapter One --- General Introduction --- p.Page / Chapter 1.1 --- Background --- p.1 / Chapter 1.2 --- Human papillomavirus infection at the larynx --- p.2 / Chapter 1.2.1 --- Biology of human papillomavirus --- p.4 / Chapter 1.2.2 --- HPV E6 protein --- p.5 / Chapter 1.2.3 --- HPV E7 protein --- p.7 / Chapter 1.3 --- Apoptosis --- p.9 / Chapter 1.3.1 --- Apoptosis signaling pathways --- p.11 / Chapter 1.4 --- Transcription factor: Nuclear factor -kB --- p.14 / Chapter 1.4.1 --- Overview of the NF-kB signaling pathway --- p.14 / Chapter 1.4.2 --- Regulation of NF-kB signaling --- p.16 / Chapter 1.4.3 --- Roles of NF-kB in cancers --- p.19 / Chapter 1.5 --- Pteris semipinnata L extract: ent-11 -hydroxy-15-oxo-kaur-16-en-19-oic-acid (5F) --- p.21 / Chapter 1.6 --- Objectives --- p.22 / Chapter Chapter Two --- Materials and Methods / Chapter 2.1 --- Cell culture --- p.24 / Chapter 2.2 --- Cell proliferation analysis --- p.24 / Chapter 2.3 --- Western Blotting --- p.26 / Chapter 2.3.1 --- Total protein extraction --- p.26 / Chapter 2.3.2 --- Nuclear and cytoplasmic protein extraction --- p.26 / Chapter 2.3.3 --- Quantification of protein concentration --- p.27 / Chapter 2.3.4 --- Sodium dodecyl sulfate - polyacylamide gel electrophoresis (SDS-PAGE) and protein transfer --- p.28 / Chapter 2.3.5 --- Immunoblotting --- p.29 / Chapter 2.4 --- NF-kB Luciferase Assay --- p.29 / Chapter 2.5 --- Annexin V apoptosis assay --- p.31 / Chapter 2.6 --- mRNA expression analyses --- p.33 / Chapter 2.6.1 --- RNA extraction --- p.33 / Chapter 2.6.2 --- Reverse Transcription --- p.33 / Chapter 2.6.3 --- Polymerase Chain Reaction --- p.34 / Chapter 2.7 --- Antibodies --- p.35 / Chapter Chapter Three --- Results / Chapter 3.1 --- "Anti-proliferation effect of 5F on laryngeal cancer cells UMSCC11A, UMSCC12 and HEp-2 cells" --- p.36 / Chapter 3.2 --- Suppression by 5F in HEp-2 of mRNA and protein expression levels in HPV18 E7 while the expression level of HPV18 E6 was not altered --- p.38 / Chapter 3.3 --- Quantification of 5F-induced apoptosis in laryngeal cancer cells by Annexin V assay --- p.40 / Chapter 3.4 --- Morphological changes in laryngeal cancer cells induced by 5F --- p.41 / Chapter 3.5 --- "Cleavage of poly (ADP-ribose) polymerase (PARP) and pro-caspase-3 induced by 5F in UMSCC11 A, UMSCC12 and HEp-2 cell lines" --- p.47 / Chapter 3.6 --- "Down-regulation of TNF-α-induced NF-kB subunit p65 and p50 nuclear translocations in UMSCC11 A, UMSCC12 and HEp-2 by 5F" --- p.47 / Chapter 3.7 --- Dose-dependent inhibition of 5F on NF-kB transcriptional activity measured by luciferase assay --- p.53 / Chapter 3.8 --- Partial inhibition of TNF-α induced kBα degradation by 5F in UMSCC11A but not in UMSCC12 and HEp-2 --- p.56 / Chapter 3.9 --- Cell proliferation inhibition and apoptosis induction by Bay (11-7082) in laryngeal cancer cells --- p.56 / Chapter 3.10 --- Differential basal nuclear translocation of p65 and p50 in laryngeal cancer cell lines --- p.57 / Chapter 3.11 --- 5F regulated NF-kB target gene expression --- p.58 / Chapter Chapter Four --- Discussions --- p.64 / Reference --- p.71 / Appendix / Appendix 1 Map of pLuc- NF-kB plasmid --- p.81
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Estudo do perfilamento gênico tumoral e de marcadores de doença residual mínima (CK19 e c-ErbB-2) através de RT-PCR quantitativo na fração mononuclear do sangue periférico em pacientes com câncer de mama durante o tratamento / Study of tumor gene profiling and minimal residual disease markers (CK19 and c-ErbB-2) by quantitative RT-PCR in peripheral blood mononuclear fraction in patients with breast cancer during chemotherapyKuniyoshi, Renata Kelly 13 November 2013 (has links)
INTRODUÇÃO: De acordo com a estimativa de 2012 do INCA, eram esperados 52.680 novos casos de câncer de mama no Brasil, com um risco estimado de 52 casos a cada 100 mil mulheres. Estes dados mostram a necessidade da identificação de biomarcadores efetivos para rastreamento precoce e seguimento destas mulheres durante seu tratamento. Neste trabalho, para a avaliação de potenciais biomarcadores desta doença, foi idealizado um modelo laboratorial específico que avalie tanto a capacidade de um dado biomarcador rastrear um tumor inicial de mama, bem como testar o seu potencial valor para o seguimento de mulheres já diagnosticadas durante seu tratamento. Este modelo baseia-se na avaliação de células tumorais circulantes e perfilamento gênico tumoral. MÉTODOS: Amostras biológicas (sangue periférico e tumor) de 167 pacientes diagnosticadas com carcinoma mamário estadios I, II e III com indicação de quimioterapia adjuvante para: a) avaliação da presença de células tumorais circulantes através da expressão de CK19 e HER2 na Fração Mononuclear do Sangue Periférico (FMNSP) por RT-PCR quantitativo e b) perfilamento gênico tumoral através da análise da expressão de 21 genes relacionados a importantes processos de carcinogênese mamária em amostras de tecido parafinado por ensaio multiplex de RT-PCR quantitativo utilizando o sistema Plexor®. RESULTADOS: Foi observada uma correlação significativa entre CK19 e HER2 na primeira coleta e queda da concentração de HER2 no SP durante o tratamento; porém, não foi percebida queda significativa do CK19 ao longo do estudo. A expressão de HER2 na segunda coleta de pacientes positivas para HER2 na primeira coleta tendeu a se correlacionar significativamente com um pior Intervalo Livre de Doença (ILD). Através da padronização da pontuação em quartis das análises realizadas em multiplex pelo sistema Plexor, foi percebido que o quartil superior apresentava ILD significativa pior do que a de pacientes nos demais quartis. Também foi observada uma estratificação do estadio clínico II em pior ou melhor prognóstico de acordo com o quartil de pontuação do teste de perfilamento proposto neste estudo; além disso, verificou-se que pacientes submetidas a tratamento neoadjuvante com pontuações inferiores tenderam a responder melhor à quimioterapia. CONCLUSÃO: Pelas características do comportamento evolutivo no presente estudo, HER2 parece ser melhor como possível biomarcador de células tumorais circulantes do que o CK-19. Até o presente momento do seguimento das pacientes incluídas neste estudo, não foi possível criar um modelo com diversas variáveis para prever o prognóstico de pacientes com câncer de mama. Isto ocorreu principalmente pelas características preditivas prognósticas superiores do perfilamento genético do tumor que desloca fatores de prognóstico tais como células circulantes e estadio clínico, expressão hormonal do tumor e idade de um modelo multivariado. Por outro lado, foi padronizada uma tecnologia genômica complexa que poderá viabilizar seu uso para a população se estudos posteriores confirmarem seu valor em outras coortes de pacientes com câncer de mama / BACKGROUND: According to the estimate of 2012 INCA, were expected 52,680 cases of breast cancer in Brazil, with an estimated risk of 52 cases per 100 000 women. These data show the need for effective identification of biomarkers for early screening and follow-up of these women during their treatment. In this work, for the evaluation of potential biomarkers of this disease, a model laboratory was designed to evaluate both the specific capacity of a given biomarker trace an initial breast tumor, as well as test its potential value for the follow-up of women already diagnosed during their treatment. This model was based on the evaluation of circulating tumor cells and tumor gene profiling. METHODS: Biological samples (peripheral blood and tumor) of 167 patients diagnosed with breast cancer stages I, II and III with an indication for adjuvant chemotherapy: a) to evaluate the presence of circulating tumor cells through the expression of HER2 and CK19 in Peripheral Blood Mononuclear fraction (PBMN) by quantitative RT-PCR and b) tumor profiling gene by analyzing the expression of 21 genes related to important processes of mammary carcinogenesis in paraffinized tissue samples by multiplex assay for quantitative RT-PCR using the Plexor ® System. RESULTS: Was observed a significant correlation between HER2 and CK19 in the first collection and decrease in concentration of HER2 in PB during the treatment, but were not perceived significant decrease of CK19 along the study. The expression of HER2 in the second collection of patients positive for HER2 in the first test tended to correlate with a significantly worse disease-free interval (DFI). Through standardization of the scores in quartiles of the analyzes performed at multiplex Plexor system was seen that the upper quartile ILD had significantly worse than patients in the other quartiles. Also stratification was observed in clinical stage II in better or worse prognosis according to quartiles of test score profiling proposed in this study, in addition, it was found that patients submitted to neoadjuvant treatment with lower scores tended to better respond to chemotherapy. CONCLUSION: HER2 seems to be better as possible biomarker of circulating tumor cells than the CK-19. So far the monitoring of patients included in this study, it was not possible to create a model with multiple variables to predict the prognosis of patients with breast cancer. This occurred primarily due to the characteristics predictive prognostic upper genetic profiling of tumor that displaces prognostic factors such as circulating cells and clinical stage, tumor hormone expression and age in a multivariate model. In the other hand, was standardized complex genomic technology that may enable their use for the population if further studies confirm its value in other cohorts of patients with breast cancer
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Estudo crítico dos resultados obtidos no tratamento dos hemangiomas cutâneos cervicofaciais / Critical evaluation of results obtained in the management of cutaneous cervicofacial hemangiomas.Goldenberg, Dov Charles 09 January 2003 (has links)
O hemangioma é o tumor vascular mais comum e a neoplasia benigna mais freqüente da infância. Devido ao potencial de involução espontânea, o tratamento de hemangiomas cutâneos com indicação relativa de tratamento permanece controverso, em oposição a situações específicas, como obstrução do eixo visual ou comprometimento de vias aéreas, onde tratamento ativo deve ser instituído imediatamente. O objetivo do presente estudo foi avaliar epidemiologicamente a amostra estudada e verificar os resultados obtidos no tratamento dos hemangiomas, utilizando-se um protocolo de condutas pré-estabelecido e um questionário de avaliação objetivo. No período de março de 1996 a abril de 2001, foram selecionados 38 pacientes portadores de hemangiomas cutâneos da região cervicofacial com indicação relativa de tratamento e com período de evolução suficiente para avaliação do tratamento realizado. Os pacientes, submetidos a tratamento por observação, tratamento clínico com corticosteróide oral ou tratamento cirúrgico, foram avaliados por três cirurgiões plásticos não envolvidos com o atendimento aos pacientes. Os quesitos contorno facial, volume da lesão, comprometimento funcional, qualidade da pele, simetria facial e aspecto geral da face foram utilizados, atribuindo-se notas e comparando-se as avaliações ao início e final do período de seguimento. Um índice de melhora evolutiva foi utilizado para verificar se houve benefício com o tratamento proposto e qual tipo de tratamento apresentou a melhor evolução. A avaliação epidemiológica mostrou resultados semelhantes aos dados da literatura mundial. O método de avaliação utilizado mostrou-se eficaz, permitindo uma visão crítica e objetiva dos resultados. Em todos os casos houve melhora evolutiva dos parâmetros avaliados. Os pacientes submetidos a tratamento cirúrgico apresentaram média das notas pós-tratamento semelhantes aos pacientes tratados por observação e superiores aos pacientes submetidos a tratamento clínico. Os índices de melhora evolutiva dos pacientes submetidos a tratamento cirúrgico foram estatisticamente superiores aos demais pacientes, exceto para o quesito comprometimento funcional, permitindo indicar o tratamento cirúrgico como opção ao tratamento por observação, na abordagem aos pacientes portadores de hemangiomas cervicofaciais, considerando-se os critérios protocolados e utilizados na indicação de tratamento. / Hemangioma is the most common vascular tumor and the most frequent benign neoplasm of infancy. The potential for spontaneous involution makes active treatment of non-life-threatening lesions controversial, in opposition to specific situation, as visual axis obstruction or airway compromise, which need immediate approach. The purposes of the present study were to perform an epidemiological assessment of patients and a critical evaluation of hemangioma management, based on an objective survey. From March 1996 to April 2001, 38 selected patients with cervicofacial non-life-threatening hemangiomas were evaluated. All patients had an adequate period of follow-up to guarantee a reliable assessment. Patients underwent expectant, clinical or surgical treatment. Three senior plastic surgeons not involved with patients? treatment answer evaluation forms, in order to verify the status of facial contour, volume of the lesions, functional impairment, skin quality, facial symmetry and global aspect of the face, giving scores and comparing pre and post follow-up photographs. An evolutive improvement index was created in order to verify the benefits of treatment modalities and which treatment option presented the best performance. Epidemiological evaluation showed results comparable to the literature. A critical and objective evaluation was possible using the evaluation method. All patients improved during the follow-up period. Patients submitted to surgical management had better scores in comparison to patients submitted to clinical approach and similar scores when compared to patients followed by observation, in the post-treatment period. The evolutive improvement index of surgical patients was statistically superior to other patients, except for functional impairment. In the management of non-life-threatening hemangiomas, surgical treatment can be considered an alternative option to observation, considering a systematic treatment protocol.
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The role of informational support in relation to health care service use among individuals newly diagnosed with cancer /Dubois, Sylvie. January 2008 (has links)
Background: The relationship between informational support and use of health care services among individuals newly diagnosed with cancer remains little documented despite its importance for optimal care delivery. Aim: To document the role of informational support in light of patterns of health services used by women and men newly diagnosed with cancer. Method: A sequential mixed methods approach (i.e., quantitative-qualitative) was conducted among women and men newly diagnosed with either breast or prostate cancer. First, an existing quantitative database was used to determine whether an intervention relying on multimedia tool as a complement to the provision of usual cancer informational support to patients (N = 250) would modify subsequent health care service use. A follow-up qualitative inquiry with distinct individuals also newly diagnosed (N = 20) was conducted to explore this relationship further. Next, the resulting quantitative and qualitative findings were merged and reanalyzed using a quantitative-hierarchical approach to enhance our understanding of the phenomenon. Findings: Several personal and contextual factors were found to qualify the relationship between cancer informational support and health service use. Although quantitative analyses showed no significant differences in terms of overall reliance on health care services among participants who received more intense cancer informational support as opposed to those who received care as usual, several sex differences were noted in terms of number of visits to health care professionals, time spent with nurses and satisfaction with cancer information received. Qualitative findings revealed that participants reported a variety of experiences pertaining to cancer information received (e.g., positive, unsupportive or mixed) as well as several processes at play (e.g., cancer information seen as enabling, confirming, or conflicting). These differences in informational support, in turn, influenced their subsequent service utilization (e.g., more phone calls made to health professionals, reduction in face-to-face visits, reluctance to use cancer-related services). The mixed data analysis clarified further the findings allowing a broader perspective to emerge. Conclusion: Findings underscore that the relationship between cancer information and use of services is not as straightforward as initially anticipated. These findings provide initial insights that may inform future research on the topic and assist health care providers in optimizing their cancer informational interventions to guide patients in their reliance on health care services.
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Estudo do perfilamento gênico tumoral e de marcadores de doença residual mínima (CK19 e c-ErbB-2) através de RT-PCR quantitativo na fração mononuclear do sangue periférico em pacientes com câncer de mama durante o tratamento / Study of tumor gene profiling and minimal residual disease markers (CK19 and c-ErbB-2) by quantitative RT-PCR in peripheral blood mononuclear fraction in patients with breast cancer during chemotherapyRenata Kelly Kuniyoshi 13 November 2013 (has links)
INTRODUÇÃO: De acordo com a estimativa de 2012 do INCA, eram esperados 52.680 novos casos de câncer de mama no Brasil, com um risco estimado de 52 casos a cada 100 mil mulheres. Estes dados mostram a necessidade da identificação de biomarcadores efetivos para rastreamento precoce e seguimento destas mulheres durante seu tratamento. Neste trabalho, para a avaliação de potenciais biomarcadores desta doença, foi idealizado um modelo laboratorial específico que avalie tanto a capacidade de um dado biomarcador rastrear um tumor inicial de mama, bem como testar o seu potencial valor para o seguimento de mulheres já diagnosticadas durante seu tratamento. Este modelo baseia-se na avaliação de células tumorais circulantes e perfilamento gênico tumoral. MÉTODOS: Amostras biológicas (sangue periférico e tumor) de 167 pacientes diagnosticadas com carcinoma mamário estadios I, II e III com indicação de quimioterapia adjuvante para: a) avaliação da presença de células tumorais circulantes através da expressão de CK19 e HER2 na Fração Mononuclear do Sangue Periférico (FMNSP) por RT-PCR quantitativo e b) perfilamento gênico tumoral através da análise da expressão de 21 genes relacionados a importantes processos de carcinogênese mamária em amostras de tecido parafinado por ensaio multiplex de RT-PCR quantitativo utilizando o sistema Plexor®. RESULTADOS: Foi observada uma correlação significativa entre CK19 e HER2 na primeira coleta e queda da concentração de HER2 no SP durante o tratamento; porém, não foi percebida queda significativa do CK19 ao longo do estudo. A expressão de HER2 na segunda coleta de pacientes positivas para HER2 na primeira coleta tendeu a se correlacionar significativamente com um pior Intervalo Livre de Doença (ILD). Através da padronização da pontuação em quartis das análises realizadas em multiplex pelo sistema Plexor, foi percebido que o quartil superior apresentava ILD significativa pior do que a de pacientes nos demais quartis. Também foi observada uma estratificação do estadio clínico II em pior ou melhor prognóstico de acordo com o quartil de pontuação do teste de perfilamento proposto neste estudo; além disso, verificou-se que pacientes submetidas a tratamento neoadjuvante com pontuações inferiores tenderam a responder melhor à quimioterapia. CONCLUSÃO: Pelas características do comportamento evolutivo no presente estudo, HER2 parece ser melhor como possível biomarcador de células tumorais circulantes do que o CK-19. Até o presente momento do seguimento das pacientes incluídas neste estudo, não foi possível criar um modelo com diversas variáveis para prever o prognóstico de pacientes com câncer de mama. Isto ocorreu principalmente pelas características preditivas prognósticas superiores do perfilamento genético do tumor que desloca fatores de prognóstico tais como células circulantes e estadio clínico, expressão hormonal do tumor e idade de um modelo multivariado. Por outro lado, foi padronizada uma tecnologia genômica complexa que poderá viabilizar seu uso para a população se estudos posteriores confirmarem seu valor em outras coortes de pacientes com câncer de mama / BACKGROUND: According to the estimate of 2012 INCA, were expected 52,680 cases of breast cancer in Brazil, with an estimated risk of 52 cases per 100 000 women. These data show the need for effective identification of biomarkers for early screening and follow-up of these women during their treatment. In this work, for the evaluation of potential biomarkers of this disease, a model laboratory was designed to evaluate both the specific capacity of a given biomarker trace an initial breast tumor, as well as test its potential value for the follow-up of women already diagnosed during their treatment. This model was based on the evaluation of circulating tumor cells and tumor gene profiling. METHODS: Biological samples (peripheral blood and tumor) of 167 patients diagnosed with breast cancer stages I, II and III with an indication for adjuvant chemotherapy: a) to evaluate the presence of circulating tumor cells through the expression of HER2 and CK19 in Peripheral Blood Mononuclear fraction (PBMN) by quantitative RT-PCR and b) tumor profiling gene by analyzing the expression of 21 genes related to important processes of mammary carcinogenesis in paraffinized tissue samples by multiplex assay for quantitative RT-PCR using the Plexor ® System. RESULTS: Was observed a significant correlation between HER2 and CK19 in the first collection and decrease in concentration of HER2 in PB during the treatment, but were not perceived significant decrease of CK19 along the study. The expression of HER2 in the second collection of patients positive for HER2 in the first test tended to correlate with a significantly worse disease-free interval (DFI). Through standardization of the scores in quartiles of the analyzes performed at multiplex Plexor system was seen that the upper quartile ILD had significantly worse than patients in the other quartiles. Also stratification was observed in clinical stage II in better or worse prognosis according to quartiles of test score profiling proposed in this study, in addition, it was found that patients submitted to neoadjuvant treatment with lower scores tended to better respond to chemotherapy. CONCLUSION: HER2 seems to be better as possible biomarker of circulating tumor cells than the CK-19. So far the monitoring of patients included in this study, it was not possible to create a model with multiple variables to predict the prognosis of patients with breast cancer. This occurred primarily due to the characteristics predictive prognostic upper genetic profiling of tumor that displaces prognostic factors such as circulating cells and clinical stage, tumor hormone expression and age in a multivariate model. In the other hand, was standardized complex genomic technology that may enable their use for the population if further studies confirm its value in other cohorts of patients with breast cancer
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Estudo crítico dos resultados obtidos no tratamento dos hemangiomas cutâneos cervicofaciais / Critical evaluation of results obtained in the management of cutaneous cervicofacial hemangiomas.Dov Charles Goldenberg 09 January 2003 (has links)
O hemangioma é o tumor vascular mais comum e a neoplasia benigna mais freqüente da infância. Devido ao potencial de involução espontânea, o tratamento de hemangiomas cutâneos com indicação relativa de tratamento permanece controverso, em oposição a situações específicas, como obstrução do eixo visual ou comprometimento de vias aéreas, onde tratamento ativo deve ser instituído imediatamente. O objetivo do presente estudo foi avaliar epidemiologicamente a amostra estudada e verificar os resultados obtidos no tratamento dos hemangiomas, utilizando-se um protocolo de condutas pré-estabelecido e um questionário de avaliação objetivo. No período de março de 1996 a abril de 2001, foram selecionados 38 pacientes portadores de hemangiomas cutâneos da região cervicofacial com indicação relativa de tratamento e com período de evolução suficiente para avaliação do tratamento realizado. Os pacientes, submetidos a tratamento por observação, tratamento clínico com corticosteróide oral ou tratamento cirúrgico, foram avaliados por três cirurgiões plásticos não envolvidos com o atendimento aos pacientes. Os quesitos contorno facial, volume da lesão, comprometimento funcional, qualidade da pele, simetria facial e aspecto geral da face foram utilizados, atribuindo-se notas e comparando-se as avaliações ao início e final do período de seguimento. Um índice de melhora evolutiva foi utilizado para verificar se houve benefício com o tratamento proposto e qual tipo de tratamento apresentou a melhor evolução. A avaliação epidemiológica mostrou resultados semelhantes aos dados da literatura mundial. O método de avaliação utilizado mostrou-se eficaz, permitindo uma visão crítica e objetiva dos resultados. Em todos os casos houve melhora evolutiva dos parâmetros avaliados. Os pacientes submetidos a tratamento cirúrgico apresentaram média das notas pós-tratamento semelhantes aos pacientes tratados por observação e superiores aos pacientes submetidos a tratamento clínico. Os índices de melhora evolutiva dos pacientes submetidos a tratamento cirúrgico foram estatisticamente superiores aos demais pacientes, exceto para o quesito comprometimento funcional, permitindo indicar o tratamento cirúrgico como opção ao tratamento por observação, na abordagem aos pacientes portadores de hemangiomas cervicofaciais, considerando-se os critérios protocolados e utilizados na indicação de tratamento. / Hemangioma is the most common vascular tumor and the most frequent benign neoplasm of infancy. The potential for spontaneous involution makes active treatment of non-life-threatening lesions controversial, in opposition to specific situation, as visual axis obstruction or airway compromise, which need immediate approach. The purposes of the present study were to perform an epidemiological assessment of patients and a critical evaluation of hemangioma management, based on an objective survey. From March 1996 to April 2001, 38 selected patients with cervicofacial non-life-threatening hemangiomas were evaluated. All patients had an adequate period of follow-up to guarantee a reliable assessment. Patients underwent expectant, clinical or surgical treatment. Three senior plastic surgeons not involved with patients? treatment answer evaluation forms, in order to verify the status of facial contour, volume of the lesions, functional impairment, skin quality, facial symmetry and global aspect of the face, giving scores and comparing pre and post follow-up photographs. An evolutive improvement index was created in order to verify the benefits of treatment modalities and which treatment option presented the best performance. Epidemiological evaluation showed results comparable to the literature. A critical and objective evaluation was possible using the evaluation method. All patients improved during the follow-up period. Patients submitted to surgical management had better scores in comparison to patients submitted to clinical approach and similar scores when compared to patients followed by observation, in the post-treatment period. The evolutive improvement index of surgical patients was statistically superior to other patients, except for functional impairment. In the management of non-life-threatening hemangiomas, surgical treatment can be considered an alternative option to observation, considering a systematic treatment protocol.
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The role of informational support in relation to health care service use among individuals newly diagnosed with cancer /Dubois, Sylvie. January 2008 (has links)
No description available.
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