Orientador: Jose Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T20:46:57Z (GMT). No. of bitstreams: 1 Barbieri_Cristiane_M.pdf: 3185188 bytes, checksum: b566f66bd024181e78245a8dd5211fe7 (MD5) Previous issue date: 2007 / Resumo: Introdução: mais recentemente, demonstrou-se que o diâmetro do cordão umbilical pode se modificar nos casos de diabetes mellitus, pré-eclâmpsia, restrição de crescimento intra-uterino e baixo peso ao nascimento, podendo talvez ser utilizado como um marcador para detecção precoce destas condições. Objetivo: obter intervalos de referência das medidas ultra-sonográficas da área do cordão umbilical, dos diâmetros de seus vasos e da área da superfície da Geléia de Wharton da secção transversa do cordão umbilical em função da idade gestacional em gestações de baixo risco, entre 12 e 40 semanas, avaliar a variabilidade inter- e intra-observador destas medidas e investigar sua correlação com o peso fetal estimado. Método: foram avaliadas 2310 gestantes no período entre junho de 2005 e dezembro de 2006, seguindo critérios de inclusão e exclusão pré-estabelecidos. Em uma sub-amostra destas gestantes foi avaliada a variabilidade inter- e intraobservador, estimando-se o coeficiente de correlação de Spearman, o coeficiente de correlação intra-classe e o alfa de Crombach. Para cada idade gestacional, foi avaliado um número mínimo de 59 casos, calculando-se a média e seu respectivo desvio-padrão e os percentis 10, 50 e 90 de cada uma das medidas. Para a análise estatística foram utilizados os testes t de Student, Anova e Wilcoxon para amostras independentes. Os intervalos de referência foram estimados por regressão polinomial de terceiro grau. Foi avaliado também o desempenho da área da secção transversa do cordão umbilical, do diâmetro do cordão umbilical e da área de geléia de Wharton do cordão umbilical em predizer alterações do peso fetal estimado (PFE) nestas gestações, estimando-se sua sensibilidade, especificidade, valor preditivo positivo e negativo. Resultados: Foram obtidas elevadas correlação, reprodutibilidade e confiabilidade na avaliação da variabilidade inter e intra-observador das medidas do cordão umbilical e de seus vasos. Os intervalos de referência apresentaram valores crescentes até cerca de 32 semanas e depois estabilizaram-se. As medidas avaliadas apresentaram baixa sensibilidade para predição de alterações do PFE. Portanto, elas não devem ser utilizadas para rastreamento com esta finalidade. Conclusões: os valores normais padronizados para essas medidas em todas as idades gestacionais, para gestações de baixo risco na população de referência, foram determinados, havendo a necessidade de que sejam posteriormente validados como preditores de situações perinatais adversas / Abstract: Introduction: recently it has been demonstrated that the diameter of the umbilical cord may be modifyed in the case of diabetes, preeclampsia, intrauterine growth restriction and low birthweight. In this way it could perhaps be used as a marker for early detection of these conditions. Objective: to obtain reference ranges for the ultrasonographic measurements of the umbilical cord area, the diameters of its vessels and the area of the Wharton Jelly surface from a cross sectional plan of the umbilical cord according to gestational age in low risk pregnancies between 12 and 40 weeks; to evaluate the inter- and intra-observer variability of these measurements; and to investigate their correlation with the estimated fetal weight. Method: a total of 2310 pregnant women were evaluated in the period from June 2005 and December 2006, following previously stablished inclusion and exclusion criteria. Inter and intra-observer variability were evaluated in a sub sample of these pregnant women, with the estimation of Spearman correlation coefficient, the intraclass correlation coefficient and alfa of Crombach. For each gestational age a minimum number of 59 cases were evaluated. For statistical analysis mean and standard deviation and the percentiles 10, 50 and 90 for each one of the measurements were estimated. Student t, Anova and Wilcoxon tests for independent samples were used. The reference ranges were estimated by third degree polynomial regression. The performance of the area of the transverse section of umbilical cord, its diameter and the area of the Wharton Jelly in predicting deviations of the estimated fetal weight (EFW) was also estimated among these pregnancies, with their sensitivity, specificity, positive and negative predictive values. Results: High correlation, reproductibility and feasibility were obtained when evaluating the inter- and intra-observer variability of the measurements of umbilical cord and its vessels. The reference intervals presented increasing values up to around 32 weeks, and afterwards they estabilized. The measurements evaluated showed very low sensitivity for predicting deviations of the EFW. Therefore they should not be used for screening with this purpose. Conclusions: the normal standardized values for these measurements in all gestational ages, for low risk pregnancies in the reference population, were determined. There is still the need of them being validated as predictors of adverse perinatal conditions / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成4年7月20日 淺田義正氏の博士論文として提出された

Einführung - Periphere Blutmonozyten spielen eine Rolle in der Pathogenese der Arteriosklerose. Bei spontan hypertensiven Ratten wurden im Vergleich zu normotonen Wistar-Kyoto-Ratten signifikant erhöhte Zahlen aktivierter Monozyten beobachtet [Liu 1996]. Wir untersuchten Monozyten von Patienten mit essentieller Hypertonie und von gesunden Probanden hinsichtlich möglicher Unterschiede in der Aktivierung anhand ihrer Adhäsion an von uns kultivierte (HAEC) und isolierte (HSVEC, HUVEC, HUAEC) humane Endothelzellen. Wir bestimmten die Adhäsionsmoleküle ICAM-1, VCAM-1 sowie E-Selektin und analysierten die Superoxidfreisetzung von humanem Endothel und Monozyten. Methoden - Humane periphere Blutmonozyten wurden mittels Dichtegradienten-zentrifugation und Plastikadhärenz isoliert und mit LPS, Angiotensin II (Ang II), und Ang II nach Vorinkubation mit dem AT1-Antagonisten Eprosartan stimuliert. Die Monozyten wurden auf einschichtigem Endothel ausgesät und die Adhäsion als Prozentsatz der initial gesäten Zellen erfasst. Die durch PMA induzierte Superoxidfreisetzung des Endothels oder der Monozyten wurde mittels Chemilumineszenz bestimmt. Ergebnisse - Monozyten von Patienten mit essentieller Hypertonie hefteten sich im Vergleich zu gesunden Probanden spontan und nach Stimulation mit Ang II signifikant verstärkt an HAEC und HUVEC-Monolayer an. Die Spiegel von ICAM-1 und VCAM-1 waren bei Patienten mit arterieller Hypertonie im Vergleich zu den gesunden Kontrollpersonen signifikant erhöht. Die Chemilumineszenzaktivität postkonfluenter Endothelzellen erhöhte sich nach Stimulation mit Ang II im Vergleich zur Messung ohne vorherige Stimulierung. Nach Stimulation mit PMA oder mit Ang II wurden bei Hypertonikern signifikant höhere Werte für die Chemilumineszenzaktivität der Monozyten gemessen als bei gesunden Kontrollpersonen. Schluss - Mit diesen Versuchen an humanen Monozyten und Endothelzellen wurde ein weiterer Beweis für die Aktivierung der Monozyten von Patienten mit essentieller Hypertonie erbracht. Meine Ergebnisse unterstützen die Sicht einer Monozytenbeteiligung an der Pathogenese atherosklerotischer Läsionen, die mit arterieller Hypertonie in Zusammenhang stehen. / Introduction - Peripheral blood monocytes are involved in the pathogenesis of atherosclerosis. Significantly elevated numbers of activated monocytes were observed in spontaneously hypertensive rats compared to those in normotensive Wistar-Kyoto rats [Liu 1996]. We isolated and cultivated human endothelial cells and examined monocytes from patients with arterial hypertension and healthy volunteers to identify possible differences in their adhesion behavior to human endothelial cells (HAEC, HSVEC, HUVEC, HUAEC). We determined the levels of ICAM-1, VCAM-1 and E-selectin, and we analyzed superoxide release by human endothelium and human monocytes. Methods - Peripheral blood monocytes were isolated by density gradient centrifugation and plastic adherence. Subsets of the samples were stimulated with LPS, Angiotensin II, Angiotensin II following preincubation with the AT1-antagonist eprosartan or left without a stimulant. After incubation, monocytes were seeded onto confluent monolayers of human aortic endothelial cells and the adhesion was determined as the percentage of the initially seeded cells. Oxygen species release induced by PMA was analyzed for endothelium and monocytes in suspension by chemiluminescence. Results - Peripheral blood monocytes of patients with essential hypertension performed a significantly increased spontaneous adhesion and adhesion following stimulation with Angiotensin II to HAEC- and HUVEC-monolayers. Levels of human soluble adhesion molecules ICAM-1 and VCAM-1 were significantly raised in hypertensive patients. Chemiluminescence activity of post confluent endothelial cells was increased after stimulation with Angiotensin II compared to the measurement before stimulation. Following stimulation with PMA or Angiotensin II, significantly higher chem-iluminescence levels were measured in hypertensive patients compared to healthy volunteers. Conclusion - These data indicate that monocytes of patients with essential hypertension may be preactivated. My results support the view of a monocyte involvement in the pathogenesis of atherosclerotic lesions that are related to arterial hypertension.