This investigation was undertaken to determine the relative importance of bladder neck prolapse and neuromuscular damage in the aetiology of stress incontinence of urine and to identify any tissue change in the pubocervical fascia associated with prolapse. Sixty women with stress incontinence and no previous surgery and twenty women with normal urinary control were studied. Bladderneck prolapse was assessed radiologically. Measurement of urethral closure pressure was made at rest and during stress. Neurophysiological assessment of the urethra and pelvic floor was made by single fibre electromyography and pudendal nerve terminal motor latency measurements. At operation biopsies of the pubocervical fascia were taken and studied histologically using Massons trichrome and acetylcholinesterase staining. Collagen was assessed using autofluorescence, hydroxy-proline assay and pyridinium link analysis. All stress incontinent women had reduced urethral closure pressures and neuromuscular damage to the pelvic floor. This damage was greatest in those stress incontinent women without prolapse. Histologically the same connective tissue elements were present in the pubocervical fascia of both groups of stress incontinent women, but there was greater smooth muscle denervation in those without prolapse. There was no difference in collagen content but there was a marked difference in the nature of collagen in women with stress incontinence and prolapse, compared to those women with stress incontinence alone.

Στόχος της παρούσας εργασίας είναι η ακινητοποίηση λιποσωμάτων με εγκλωβισμένη Tobramycin σε επιχρυσωμένες μεταλλικές επιφάνειες, με σκοπό την παρασκευή αντιμικροβιακών ενδοπροθέσεων του ουροποιητικού, που αποδεσμεύουν φάρμακο με ελεγχόμενο ρυθμό. / The aim of this study is to covalently link liposomes on metallic surfaces, as a method to prepare antimicrobial controlled (release) drug-eluting stents, using Tobramycin (TOB) as an anti-microbial drug. As a preliminary step for immobilization of TOB, different types of liposomes were constructed and evaluated for TOB loading efficiency, size distribution and ζ-potential. TOB concentrations were measured by a chemiluminescence immunoassay (ADVIA Centaur, Siemens), after modulating the technique as required for the specific samples. Results show that extruded DRV liposomes with similar sizes (mean diameter) with that of SUV liposomes (~95 nm), have 4 times higher drug loading efficiency.

Introdução: as neoplasias renais sempre foram desafiadoras devido à história natural pouco previsível e pelo incessante acréscimo de conhecimentos que rapidamente se desenvolvem com o passar das últimas décadas. Como resultado, o anseio pela busca do conhecimento relacionado ao carcinoma de células renais (CCR) gerou grande opulência de novos tratamentos e melhor conhecimento de sua fisiopatologia. Seguindo essa mesma direção, surgiram inúmeros novos fatores prognósticos que, então, foram transformados em ferramentas de predição, destacando-se os nomogramas. Nomogramas buscam estimativas para sobrevida e recorrência baseados nos parâmetros clínicos e anatomopatológicos. Contudo, pelo grande número de variáveis e populações, não existe um padrão utilizado mundialmente pela comunidade urológica. Assim, o objetivo deste estudo é criar um nomograma brasileiro baseado nas características clínicas e patológicas dos pacientes com CCR tratados pela nossa instituição. Pacientes e Métodos: duzentos e sessenta pacientes foram divididos em dois grupos, separados por diagnóstico de tumor incidental ou sintomático, sendo distribuídos conforme os dados anatomopatológicos, relacionando o grau de Fuhrman, invasão microvascular, tamanho do tumor e degeneração sarcomatosa. Foram realizadas análises univariada e multivariada, discriminando os fatores mais importantes para a criação deste nomograma. Resultados: nos tumores incidentais <7cm, não-sarcomatoso, de baixo grau e ausência de invasão microvascular, a expectativa de vida é de 97-98%, todavia, caso se mude o tamanho do tumor para >7cm, sarcomatoso, alto grau, presença de invasão microvascular, a expectativa de vida será de 70-82%. Nos tumores sintomáticos, <7cm, não-sarcomatosos, baixo grau e ausência de invasão microvascular, a expectativa de vida é de 87-93%, se o tumor for sintomático >7cm, sarcomatoso, de alto grau, ou com invasão microvascular, a expectativa de vida será de 18-40%. Conclusão: foi possível a confecção de um nomograma para predição prognóstica em pacientes brasileiros com CCR. A presença de sintomas controla as variáveis patológicas clássicas, tamanho tumoral, grau de Fuhrman, invasão microvascular e degeneração sarcomatosa, fornecendo uma importante ferramenta para avaliação do risco de progressão do carcinoma de células renais após o tratamento cirúrgico. / Introduction: Renal neoplasms have been challenging because of its unpredictable natural history and incessant improvements of knowledge developed in the recent decades. Nomograms predict survival and recurrence based on clinical and pathological parameters, however there is no spread gold standard around the world. The main goal of this study is to build a Brazilian nomogram including RCC clinical and pathological data from our institution records and experience. Patients and Method: patients were divided in two groups based on presence or absence of symptoms. These two groups were classified by patient pathological data and Fuhrman grade, microvascular invasion, tumor size and sarcomatous degeneration. Statistic analyses were performed in order to recognize the most important risk factors, allocated to nomogram construction. Results: The incidental group with tumour size <7cm, low grade, non-sarcomatous tumors without microvascular invasion has recidive-free survival of 97-98%. The same incidental group with patients presenting a tumor size > 7cm, high grade, sarcomatous tumor, with microvascular invasion has recidive-free survival rate of 70% to 82%. In the symptomatic patients group with tumour size <7cm, low grade, non-sarcomatous tumors without microvascular invasion the survival rate is 87%-95%, while symptomatics patients with tumor size >7cm, high grade, sarcomatous tumor with microvascular invasion have recidive-free survival of 18% to 40%..Conclusion: a Brazilian nomogram has been developed for predicting prognostic outcome in patients with RCC The presence of symptoms ruled classical risk variables as Fuhrman grade, tumor size, sarcomatous degeneration. The study of those variables provided an important stride for RCC recidive prediction.

Introdução: as neoplasias renais sempre foram desafiadoras devido à história natural pouco previsível e pelo incessante acréscimo de conhecimentos que rapidamente se desenvolvem com o passar das últimas décadas. Como resultado, o anseio pela busca do conhecimento relacionado ao carcinoma de células renais (CCR) gerou grande opulência de novos tratamentos e melhor conhecimento de sua fisiopatologia. Seguindo essa mesma direção, surgiram inúmeros novos fatores prognósticos que, então, foram transformados em ferramentas de predição, destacando-se os nomogramas. Nomogramas buscam estimativas para sobrevida e recorrência baseados nos parâmetros clínicos e anatomopatológicos. Contudo, pelo grande número de variáveis e populações, não existe um padrão utilizado mundialmente pela comunidade urológica. Assim, o objetivo deste estudo é criar um nomograma brasileiro baseado nas características clínicas e patológicas dos pacientes com CCR tratados pela nossa instituição. Pacientes e Métodos: duzentos e sessenta pacientes foram divididos em dois grupos, separados por diagnóstico de tumor incidental ou sintomático, sendo distribuídos conforme os dados anatomopatológicos, relacionando o grau de Fuhrman, invasão microvascular, tamanho do tumor e degeneração sarcomatosa. Foram realizadas análises univariada e multivariada, discriminando os fatores mais importantes para a criação deste nomograma. Resultados: nos tumores incidentais <7cm, não-sarcomatoso, de baixo grau e ausência de invasão microvascular, a expectativa de vida é de 97-98%, todavia, caso se mude o tamanho do tumor para >7cm, sarcomatoso, alto grau, presença de invasão microvascular, a expectativa de vida será de 70-82%. Nos tumores sintomáticos, <7cm, não-sarcomatosos, baixo grau e ausência de invasão microvascular, a expectativa de vida é de 87-93%, se o tumor for sintomático >7cm, sarcomatoso, de alto grau, ou com invasão microvascular, a expectativa de vida será de 18-40%. Conclusão: foi possível a confecção de um nomograma para predição prognóstica em pacientes brasileiros com CCR. A presença de sintomas controla as variáveis patológicas clássicas, tamanho tumoral, grau de Fuhrman, invasão microvascular e degeneração sarcomatosa, fornecendo uma importante ferramenta para avaliação do risco de progressão do carcinoma de células renais após o tratamento cirúrgico. / Introduction: Renal neoplasms have been challenging because of its unpredictable natural history and incessant improvements of knowledge developed in the recent decades. Nomograms predict survival and recurrence based on clinical and pathological parameters, however there is no spread gold standard around the world. The main goal of this study is to build a Brazilian nomogram including RCC clinical and pathological data from our institution records and experience. Patients and Method: patients were divided in two groups based on presence or absence of symptoms. These two groups were classified by patient pathological data and Fuhrman grade, microvascular invasion, tumor size and sarcomatous degeneration. Statistic analyses were performed in order to recognize the most important risk factors, allocated to nomogram construction. Results: The incidental group with tumour size <7cm, low grade, non-sarcomatous tumors without microvascular invasion has recidive-free survival of 97-98%. The same incidental group with patients presenting a tumor size > 7cm, high grade, sarcomatous tumor, with microvascular invasion has recidive-free survival rate of 70% to 82%. In the symptomatic patients group with tumour size <7cm, low grade, non-sarcomatous tumors without microvascular invasion the survival rate is 87%-95%, while symptomatics patients with tumor size >7cm, high grade, sarcomatous tumor with microvascular invasion have recidive-free survival of 18% to 40%..Conclusion: a Brazilian nomogram has been developed for predicting prognostic outcome in patients with RCC The presence of symptoms ruled classical risk variables as Fuhrman grade, tumor size, sarcomatous degeneration. The study of those variables provided an important stride for RCC recidive prediction.

The type 1 insulin-like growth factor receptor (IGF-1R) is a receptor tyrosine kinase that mediates diverse cellular functions including growth, differentiation, migration and apoptosis protection. IGF-1R signalling has been implicated in tumorigenesis in a variety of cancers, and IGF-1R inhibitory drugs are currently undergoing clinical evaluation. Previous work in our laboratory has shown IGF-1R over-expression in urological cancers at both the mRNA and protein level, thus making it a potential therapeutic target. The first aim of this project was to develop a protocol for IGF-1R immunohistochemistry, investigate the expression and cellular distribution of the IGF-1R receptor in clear cell renal cell carcinomas (ccRCC), and assess correlation with clinical parameters. In tissue microarray analysis, IGF-1R was detected in ~90% of 195 ccRCCs, with signal in the plasma membrane, cytoplasm and also in the nucleus. The presence of nuclear IGF-1R in up to 50% of ccRCCs and its association with adverse prognosis was a novel finding, and suggests that nuclear IGF-1R may influence ccRCC biology. Further investigations will clarify its role in the nucleus and its potential as a prognostic biomarker. The second aim was to investigate effects of IGF-1R inhibition on radiosensitivity and DNA repair, following previous work in our laboratory showing that IGF-1R depletion enhances chemo- and radio-sensitivity, delays double strand break (DSB) resolution, and may play a role in the homologous recombination (HR) pathway of DNA DSB repair. However, the repair defect seen in these early experiments was larger than could be entirely explained by a defect in HR. The current project used a small molecule IGF-1R tyrosine kinase inhibitor AZ12253801 (AstraZeneca), which blocked IGF-1 induced IGF-1R activation and inhibited cell survival. AZ12253801 enhanced the radiosensitivity of prostate cancer cells, which appeared to be independent of effects of IGF-1R inhibition on cell cycle distribution and apoptosis induction. IGF-1R inhibition delayed the resolution of γH2AX foci, supporting a potential role for the IGF-1R in DSB repair. This delay in focus resolution was apparent at early time-points (less than 4 hr), and was epistatic with DNA dependent protein kinase (DNAPK) inhibition in prostate cancer cells and DNAPK deficiency in glioblastoma cells. These results suggest a role for the IGF-1R in the non-homologous end-joining (NHEJ) pathway of DNA DSB repair. A cell-based reporter assay in HEK-293 cells confirmed that IGF-1R inhibition suppressed DSB repair by NHEJ, helping to explain the radiosensitization demonstrated upon IGF-1R inhibition. There was lack of support for a transcriptional effect, with no significant change observed in gene expression on microarray analysis. Although the mechanism of this effect remains unclear, the observed inhibition of NHEJ has implications for the use of IGF-1R inhibitors in combination with DNA damaging agents in cancer treatment.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı, 2004. / Bibliyografya var.

The purpose of the study was to investigate the perception of given information at discharge from a urological ward at Akademiska sjukhuset, and to investigate whether the patients had searched for information themselves after discharge.   The study is an empirical cross -sectional study with descriptive design. All the patients inscribed as urologic patients, discharged to their home during month of March 2009, were asked to participate in the study (in total 82 patients), which led to 57 participants. The data collection method was an interview over the phone, with 20 structured questions. The interview form was sent by mail to the patients after the discharge from the ward, the authors thereafter called the participants at home and performed the interview within 10-20 days after discharge.   The most common concerns for surgical patients after discharge are wound care, pain management, daily activity, the detection of complications, handling symptoms, elimination and quality of life. This study shows that 72 % of the participants considered the given information as sufficient for handling their self-care at home. The lack of information experienced by the participants concerned daily activity, eventual complications that may occur and pain management. The majority of the discharge information was given in the patient room.   Postoperative complications that occur after discharge can be expensive for the society and is a cause of unnecessary suffering for the patient, therefore the patient need to understand what to be observant of after discharge. This requires that both doctors and nurses provide relevant information for each individual patient. / Syftet var att undersöka patienters uppfattning av information given vid utskrivning från en urologisk vårdavdelning på Akademiska sjukhuset samt att undersöka om patienterna själva sökt information efter utskrivningen.   Studien är en empirisk tvärsnittstudie med deskriptiv design. Alla patienter inskrivna som urologpatienter, som skrevs ut till hemmet från en urologisk vårdavdelning under mars månad 2009 tillfrågades att delta (sammanlagt 82 patienter), 57 patienter deltog. Som datainsamlingsmetod användes en telefonintervju med 20 strukturerade frågor. Frågorna skickades hem till patienterna efter hemgång och författarna ringde sedan upp patienterna i hemmet och genomförde intervjun.   De områden som kirurgiska patienter upplever störst bekymmer för efter utskrivning från sjukhuset är sårvård, smärthantering, daglig aktivitet, att upptäcka komplikationer, symtomhantering, elimination och livskvalitet. Studien visar att 72 % av deltagarna tyckte att den information de fått var tillräcklig för att sköta sin egenvård. Den information som saknats har varit inom områdena daglig aktivitet, eventuella komplikationer som kan uppstå och smärtlindring. Majoriteten av utskrivningssamtalen ägde rum på patientsalen.   Postoperativa komplikationer som uppträder efter utskrivning kan bli kostsamma för samhället och är källa till onödigt lidande för patienten, patienten behöver därför förstå vad denne skall vara uppmärksam på efter hemgång. Detta ställer krav på både läkare och sjuksköterskor att ge information som är relevant för varje individuell patient.

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-07-04T12:59:07Z No. of bitstreams: 1 julianacristinapdasilva_dissert.pdf: 6143362 bytes, checksum: 40d299f2c23885568637781644986d64 (MD5) / Made available in DSpace on 2017-07-04T12:59:07Z (GMT). No. of bitstreams: 1 julianacristinapdasilva_dissert.pdf: 6143362 bytes, checksum: 40d299f2c23885568637781644986d64 (MD5) Previous issue date: 2016-02-19 / Introduction: Urinary Incontinence (UI) is a common symptom at some stages of a woman's life. It has an important negative impact on women's daily activities and can adversely affect their quality of life. Objective: To investigate the profile of women with urinary incontinence (UI) seen at an urological treatment center, according to the type of UI present. Methods: This descriptive, exploratory, quantitative study was conducted with 150 women with UI who had undergone urodynamic study at an urological treatment center in Sao Jose do Rio Preto, SP, Brazil. The research methodology followed for this research was based on the collection of primary and secondary data, which were analyzed using univariate and multivariate analysis of variance. Results: Most women were white (119-79.33%), overweight (68-45.33%), homemakers (58-38.7%), and menopausal (80-53.3%); drank coffee (124-82.67%); did not perform any physical activity (98-65.33%); and had urethral hypermobility (UH) ((91-60.67%). One hundred and forty-two women had gone through childbirth. There were 331 deliveries, of which 54.98% were cesarean sections. We found a statistically significant association between weight change and type of UI (p = 0.024); menopause (p=0.001) and intrinsic sphincter deficiency (ISD) and detrusor instability (DI); gynecological surgery and ISD and DI (p = 0.014); hysterectomy and all types of UI (p = 0.040); and performance of physical activity and mixed UI (p = 0.014). Conclusion: The obtained data suggest that the prevention and control of UI include measures such as weight loss (decrease in BMI), exercise, pelvic floor-strengthening exercises and improved care at primary healthcare level. This subject offers a fertile field for investigation regarding diagnosis, treatment and new inter-and multiprofessional care delivery models that improve the quality of life of women with UI. / Introdução: A Incontinência Urinária (IU) é um sintoma comum em algumas fases da vida da mulher, com impacto negativo em suas atividades diárias e também comprometendo sua qualidade de vida. Objetivo: Analisar o perfil de mulheres com incontinência urinária (IU) atendidas em um serviço de urodinâmica, segundo o tipo de IU que apresentam. Método Estudo descritivo, exploratório, quantitativo, realizado por meio de coleta de dados primários e secundários de 150 mulheres que realizaram elucidação da IU por meio de estudo urodinâmico em Centro de Diagnóstico e Tratamento Urológico da cidade de São José do Rio Preto SP. Os dados foram analisados por meio de técnicas de estatística uni e multivariada. Resultados: Entre as mulheres avaliadas, a maioria era: branca (119 – 79,33%), com sobrepeso (68 – 45,33%), do lar (58 – 38,67%), na menopausa (80 – 53,33%), ingeriam café (124 – 82,67%), não faziam atividade física (98 – 65,33%) e apresentavam hipermobilidade uretral (HU) (91 – 60,67%), Encontrou-se associação estatística significante entre mudança de peso e HU(p=0,024), menopausa e deficiência esfincteriana intrínseca (DEI) e instabilidade detrusora (ID) (P=0,001); ocorrência de cirurgia ginecológica com DEI e ID (p=0,014), histerectomia e todos os tipos de IU (p=0,040) e realização de atividade física com IU mista (p=0,014). Os dados sobre antecedentes obstétricos mostraram que 142 mulheres passaram pelo processo da parturição, resultando em 331 partos, a maioria cesarianas (54,98%), Conclusão: O perfil analisado sugere que as medidas de prevenção e controle da IU urinária seria uma diminuição do IMC, a prática de atividade física, o desenvolvimento de exercícios para o fortalecimento do assoalho pélvico e maior cuidado em nível de atenção básica de saúde. Também que é um amplo campo de investigação nos aspectos de diagnóstico, terapêutica e outras diretrizes assistenciais multi e interprofissionais, que contribuam para a melhoria da qualidade de vida das mulheres afetadas.

Objective: In this study, 22 cases of locally recurrent urological malignant fibrous histiocytoma were reviewed considering therapeutic options, follow-up and prognosis. Patients and Methods: In the available literature on this topic we identified 19 cases of locally recurrent genitourinary malignant fibrous histiocytoma. Three additional cases are discussed, primarily arising from the kidney, the bladder and the paratesticular region. Results: The prognosis of locally recurrent urological malignant fibrous histiocytoma was found to be extraordinarily poor. Only 2 of 22 patients have survived for longer than 3.5 years. One of them reported herein is still alive 10 years after extensive lymphatic spread accompanying the first local recurrence. In this case, late local recurrence occurred after an 8-year interval free of disease. Conclusion: Malignant fibrous histiocytoma is an unusual urological malignancy with a high rate of local recurrence. The latter is frequently accompanied by metastatic disease and unrelenting progression. Despite the poor prognosis early detection of local failure and aggressive salvage therapy might offer the chance of long-term survival in selected cases. Close and life-long follow-up is advisable for patients once treated for recurrent urological malignant fibrous histiocytoma. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Introdução: As moléculas de adesão celular (MAC) participam da interação entre o epitélio e a matriz extracelular (MEC) que são importantes para o desenvolvimento normal da célula. Alguns estudos têm revelado que alterações na expressão das MAC têm implicações no processo de carcinogênese. Nosso objetivo foi estudar a influencia da expressão da E-caderina e cateninas por imuno-histoquímica (IH) na previsão prognóstica de pacientes com carcinoma urotelial do trato urinário superior submetidos à cirurgia. Material e métodos: Avaliamos os espécimes de 20 pacientes com carcinoma urotelial da pelve renal e ureter tratados com nefroureterectomia ou ureterectomia com intenção curativa entre junho de 1997 e janeiro de 2007, todas realizadas pelo mesmo cirurgião (MS). A expressão das MAC foi avaliada através de IH pela técnica de microarranjo tecidual ou tissue microarray (TMA), e correlacionada com as características anatomopatológicas do tumor e sobrevida dos pacientes Resultados: Observamos uma relação entre a expressão de E-caderina com a recidiva da doença. Dos tumores com expressão forte de E-caderina, 85,7% sofreram recidiva contra 50,0% daqueles com moderada expressão (p=0,014). Também houve diferença na sobrevida livre de doença, sendo que aqueles com expressão forte evidenciaram media de sobrevida livre de doença de 49,1 meses, enquanto aqueles com expressão moderada ou ausente sofreram média de 83,9 meses (p=0,011). A ausência de expressão de -catenina se relacionou com maior frequência de tumores com mais de 3cm (p=0,003). Conclusões: Demonstramos que a imuno-expressão da E-caderina e - catenina estão relacionadas com recidiva e tamanho tumoral no carcinoma urotelial do trato urinário alto, podendo constituir novos marcadores prognósticos nessa neoplasia / Introduction: The cell adhesion molecules (CAM) participating in the interaction between epithelium and extracellular matrix (ECM) that are important for normal development of the cell. Some studies have shown that changes in the expression of CAM have implications in the process of carcinogenesis. We studied the E-cadherin and catenins expression profile by immunohistochemistry in patients with urothelial carcinoma of upper urinary tract underwent surgery. Materials and Methods: We evaluated specimens from 20 patients with urothelial carcinoma of renal pelvis and ureter treated with nephroureterectomy or ureterectomy between June 1997 and January 2007, all performed by one surgeon (MS). The expression of CAM was evaluated by tissue microarray technique (TMA). Results: We observed a relation between E-cadherin expression with disease recurrence. Tumors with strong expression of E-cadherin, 85.7% recurrence compared to 50.0% of those with moderate expression and 0.0% with weak expression (p = 0.014). There was also a difference in disease-free survival, and those with strong expression recurrence a median time of 49.1 months while those with moderate expression recurrence a median time of 83.9 months (p = 0.011). The absence of -catenin expression was associated with tumors larger than 3 cm (p = 0.003). Conclusions: We demonstrate that the immuno-expression of E-cadherin and -catenin are related to recurrence and tumor size in urothelial carcinoma of upper urinary tract, may be new prognostic markers in these disease