Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed Oct. 13, 2008). Includes bibliographical references.

Uterine leiomyomas are benign tumors within the uterus, where patients present with symptoms such as abnormal bleeding, urinary retention, and pelvic pressure. The exact etiology of uterine leiomyomas is unknown, but numerous theories have been proposed, indicating a multifactorial mechanism, including lifestyle and steroid hormones. Uterine leiomyomas have become a public health concern due to the high cost of treatment as well as the high prevalence within African American communities. Currently, many treatment options exist, ranging from conservative treatments that address symptoms, to surgical intervention to remove the uterus. Research efforts thus far have determined the relationship between the role of estrogen in the growth of uterine leiomyomas (which has led to development of medications that target different approaches to estrogen synthesis) and its effects in the pathogenesis. Studies have shown that estrogen acts on estrogen receptor subtypes, ER and ER. This study examines the role of these two receptors in estrogenic effects, and how these effects relate to the development of uterine leiomyomas. Available research has shown that each receptor has its unique functions and impacts the growth of tumors differently. There is conflicting evidence in how the number of receptors and surrounding environment modulate leiomyomas, with some studies reporting that it is the corepressors and/or coactivators that ultimately determine the influence of estrogenic effects. However, the general consensus of such studies suggests that estrogen receptor-specific therapeutic intervention is a novel area with great potential. The primary benefit of estrogen receptor-specific treatment, such as selective estrogen receptor modulators, is the ability to regulate physiological processes that contribute to the growth of uterine leiomyomas. Future directions of research include confirming the exact roles of ER and ER and harnessing the effects of their differing functions to manage uterine leiomyomas.

The significance of ultrasound examination in the management of experimental uterine transplantation Abstract Uterine transplantation (UTx) represents a new experimental method of treatment of absolute uterine factor infertility (AUFI), which includes inability to conceive and deliver as a result of absence of the uterus. This can be congenital (Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS)) or acquired (after hysterectomy, severe congenital uterine malformations). For a woman affected this way is the uterine transplantation the only way to give birth to a child by herself. This is a very sophisticated and invasive procedure for the treatment of sterility with promising results, but the woman - recipient of the uterus - is burdened by at least three abdominal surgeries (transplantation, Caesarean section, explantation), in vitro fertilization and by the need to use immunosuppressive therapy. The dissertation summarizes current knowledge on this issue from the perspective of a gynecologist-obstetrician, who regularly examined by ultrasound or gynecologically participants in the Czech uterine transplant study in 2016-2019, which was carried out on the basis of a cooperation agreement between two Prague hospitals - IKEM and FN Motol. The set contains data on ten patients with a transplanted uterus, five from...

La maternité se définit de manière intuitive par le fait de porter un enfant et de le mettre au monde. Notion universelle, la maternité semble empreinte d’évidence et de certitude et à ce titre n’a guère suscité d’interrogation jusqu’à une époque récente. Pourtant, cette évidence supposée caractériser la maternité n’est bien qu’une évidence relative, tant du point de vue de la science que du droit. En effet, la maternité biologique peut désormais être divisée entre maternité utérine et génétique, elle n’est donc plus certaine. Ensuite, la notion juridique de maternité ne procède pas d’un pur décalque de la biologie. Au contraire, s’il s’appuie sur le fait biologique de la maternité, le droit en adopte une interprétation singulière, laissant découvrir l’existence d’un véritable concept juridique de maternité. Le contexte de la maternité apparaît en outre aujourd’hui profondément bouleversé, si bien que cette notion semble se restructurer autour de la seule volonté et subir un brouillage de sa distinction avec la paternité. Ainsi bouleversée, la maternité peut-elle alors être repensée ? S’il est nécessaire de prendre en compte les facteurs de bouleversement de la maternité, sa spécificité tirée de l’accouchement ne semble guère devoir être remise en cause. Une telle affirmation n’exclut toutefois pas d’admettre une réception conditionnée des formes nouvelles de maternité / Motherhood is intuitively defined by carrying a child and giving birth. Universal concept, motherhood seems to be evident and sure, and as such, has hardly raised questions until recently. Yet, this obviousness supposed to characterize motherhood is only relative from the point of view of both science and law. Indeed, biological maternity can now be divided between uterine maternity and genetics, so it is no longer certain. Next, the legal notion of motherhood does not come from a pure decal of biology. On the contrary, if it is based on the biological fact of maternity, the law adopts a singular interpretation, revealing the existence of a real legal concept of motherhood. The context of motherhood also seems to be deeply upset, so that this notion seems to be restructured around intention, and its distinction with paternity is blurred. So upset, can maternity be rethought? Although it is necessary to take into account factors of change in motherhood, its specificity derived from childbirth does not seem to be denied. However, this affirmation does not exclude a conditioned admission of new forms of maternity

Abnormal uterine bleeding (AUB) is one of the most common presenting complaints in our medical system with up to 30% of females affected by this condition. The current evaluation and management of AUB often requires multiple lengthy visits to both general practitioners and specialists. Advances in endoscopic technology have allowed clinicians to diagnose and treat women presenting with AUB in a single-visit within an outpatient uterine assessment and treatment unit (UATU). Unfortunately, the UATU is not the standard of care with very few locations in Canada providing this type of service. This thesis project aimed to synthesize data pertaining to efficacy and safety as well as to evaluate the cost-effectiveness of a UATU service model compared to usual care in diagnosing and treating AUB. To address the main aim for this thesis project, the first manuscript focuses on the hysteroscopic procedures that may be offered in a UATU. The manuscript includes a systematic review that synthesizes outcome measures surrounding efficacy, patient safety, and cost data of outpatient hysteroscopy compared to hysteroscopy performed in the operating room. The second manuscript is a cost-effectiveness modelling study that compares cost and effectiveness outcomes, including time to diagnosis and time to treatment of a UATU versus usual care for women who present with AUB. Data used to populate the cost-effectiveness model were obtained from a retrospective review of patient charts and the published literature. The systematic review found no statistically significant difference in the safety, efficacy, or patient tolerability between outpatient and intraoperative hysteroscopy procedures. This review helps provide further support for performing procedures outside of a traditional operating room without increasing patient harm or compromising efficacy. However, given the current available evidence and limited number of studies, findings should be interpreted with caution. The cost-effectiveness analysis found that a UATU is cost-effective when compared to usual care in diagnosing and treating patients who present with AUB. These two studies combined provide evidence to support that the UATU has the potential to improve gynecologic care by reducing wait-times to receiving diagnosis and treatment and to lower overall costs to the health care system.

Department of Obstetrics and Gynaecology University of the Witwatersrand Johannesburg February 2015 A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Masters in Medicine, in the branch of Obstetrics and Gynaecology. / HIV accelerates the development of cervical cancer by up to15 years. South Africa is currently in the midst of an HIV epidemic. With limited facilities for colposcopy it is vital to identify risk factors within the HIV positive population resulting in positive margins after Large Loop Excision of the Transformation Zone (LLETZ) and persistence of cytological abnormalities on follow-up Pap smears. Objective: The primary objective was to determine the patient risk factors, pre and during colposcopy and LLETZ biopsy, which resulted in the histological involvement of margins of the LLETZ biopsy and persistent cervical dysplasia on follow-up Pap smears. Secondary objectives included determining follow up rate of patients at the clinic as well as the correlation between the original Pap smear cytology grade and the histological grade found on histology of the LLETZ biopsy. Methods: A retrospective review of the files of HIV seropositive patients was done at the colposcopy clinic at Charlotte Maxeke Johannesburg Academic Hospital after the roll out of antiretroviral treatment for the period 1 April 2004 to 31 October 2012. Patients with abnormal pap smears during this time were referred to the colposcopy clinic where a colposcopy and LLETZ biopsies were done. Demographic and clinical data in regards to age, gravidity, contraception, CD4 count, antiretroviral usage, and referral time was collected. Data from the clinical description of the colposcopy and histology of the LLETZ biopsy was also collected. Patients followed up again after 6 months when a repeat pap smear was done. The results of these Pap smears were also collected. Data was then analysed and variate and multivariate logistical regression was used to find statistically significant correlations. Results: A total of 480 files were found to have complete clinical records. One hundred and sixty eight (42.71%) patients had both endo and ectocervical margins clear. Predictive factors for the involvement of endocervical margins was the doctor performing the procedure (p-value <0.01) cytology of the original Pap smear (p value <0.01) and the grade of histological abnormality found at time of LLETZ (p-value <0.01). The statistically significant predictive factors for ectocervical margin involvement was the visualization of the transformation zone at colposcopy (p-value <0.01), the size of lesion found at colposcopy (p-value <0.01), the use of combined oral contraceptive pill (OCP) (p-value 0.02) and the histological grade of abnormality found on the LLETZ biopsy. Age, parity, CD4 count, use of antiretroviral drugs, length of time from Pap smear to colposcopy and use of contraception other than OCP were not found to be statistically significant in our sample population for the involvement of either endo or ectocervical margins. Statistically significant risk factors for the recurrence of intraepithelial lesions on follow up Pap smear was having both endo and ectocervical margin involvement on histology (p-value 0.01) The Ectocervical margin alone was found to have a p-value of <0.01. Abnormal cytology on follow up Pap smear was found in 58.69% of patients. The follow up rate at the clinic was 46.04%. Correlation of cytological grade and histological grade of cervical intraepithelial neoplasm in our sample population was found to be adequate (p-value <0.01). Conclusion: Incomplete incision of the intraepithelial lesion was found to be a significant risk factor for the recurrence of cytological abnormality in patients undergoing LLETZ biopsy. Identifying patients at increased risk for recurrence is important to ensure close follow up in this patient population.

by Wai Ching Wa, Gina. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1990. / Bibliography: leaves 303-314. / Chapter 1. --- INTRODUCTION --- p.1 / Chapter 2. --- LITERATURE REVIEW ON CERVIX UTERI / Chapter 2.1 --- HISTOLOGY OF CERVIX UTERI --- p.4 / Chapter 2.2 --- CYTOLOGY OF CERVIX UTERI --- p.5 / Chapter 2.3 --- CERVICAL EPITHELIAL LESIONS / Chapter 2.3.1 --- Squamous Metaplasia --- p.7 / Chapter 2.3.2 --- Cervical Intraepithelial Neoplasia --- p.9 / Chapter 2.3.3 --- Viral Infections --- p.17 / Chapter 2.4 --- DIAGNOSTIC APPROACH TO CERVICAL LESIONS --- p.20 / Chapter 2.5 --- DIAGNOSTIC VARIABILITY OF CERVICAL LESIONS --- p.21 / Chapter 2.6 --- IMPORTANCE OF CERVICAL CARCINOMA IN HONG KONG --- p.21 / Chapter 3. --- LITERATURE REVIEW ON NASOPHARYNX / Chapter 3.1 --- HISTOLOGY OF NASOPHARYNX --- p.22 / Chapter 3.2 --- CYTOLOGY OF NASOPHARYNX --- p.24 / Chapter 3.3 --- NASOPHARYNGEAL EPITHELIAL LESIONS / Chapter 3.3.1 --- 'Squamous Metaplasia' --- p.25 / Chapter 3.3.2 --- Nasopharyngeal Intraepithelial Neoplasia --- p.26 / Chapter 3.3.3 --- Viral Infections --- p.27 / Chapter 3.4 --- DIAGNOSTIC APPROACH TO NASOPHARYNGEAL LESIONS --- p.28 / Chapter 3.5 --- IMPORTANCE OF NASOPHARYNGEAL CARCINOMA IN HONG KONG --- p.29 / Chapter 4. --- LITERATURE REVIEW ON MORPHOMETRY / Chapter 4.1 --- QUANTITATIVE ASSESSMENT OF CELL FEATURES --- p.30 / Chapter 4.2 --- TERMINOLOGY --- p.31 / Chapter 4.3 --- APPROACHES TO SAMPLING --- p.32 / Chapter 4.4 --- SOURCES OF VARIATION --- p.32 / Chapter 4.5 --- METHODOLOGY FOR MORPHOMETRY --- p.33 / Chapter 4.6 --- FEATURES FOR MORPHOMETRY IN INTRAEPITHELIAL NEOPLASIA --- p.35 / Chapter 4.7 --- PREVIOUS MORPHOMETRIC STUDIES ON INTRAEPITHELIAL NEOPLASIA --- p.36 / Chapter 5. --- MATERIALS AND METHODS / Chapter 5.1 --- MATERIALS / Chapter 5.1.1 --- Cervix Uteri --- p.41 / Chapter 5.1.2 --- Nasopharynx --- p.41 / Chapter 5.2 --- METHODS / Chapter 5.2.1 --- Equipment --- p.42 / Chapter 5.2.2 --- Pilot Study for Reproducibility --- p.43 / Chapter 5.2.3 --- Estimation of Minimum Sample Size --- p.43 / Chapter 5.2.4 --- Morphometric Procedures --- p.44 / Chapter 5.2.5 --- Statistical Analysis --- p.48 / Chapter 5.2.6 --- Comparison of Visual Diagnosis of Cervical smears and biopsies --- p.49 / Chapter 5.2.7 --- Survey of Subjective Assessment Criteria for Cervical Biopsies and Smears --- p.50 / Chapter 6. --- RESULTS / Chapter 6.1 --- PILOT STUDY / Chapter 6.1.1 --- Intraobserver Reproducibility --- p.52 / Chapter 6.1.2 --- Minimum Sample Size --- p.52 / Chapter 6.2 --- CERVIX / Chapter 6.2.1 --- Maturation Sequence of Cervical Epithelium --- p.53 / Chapter 6.2.2 --- Differences of Morphometric Means between various groups of Cervical Biopsies --- p.56 / Chapter 6.2.3 --- Discriminant Analysis of Cervical Biopsies --- p.58 / Chapter 6.2.4 --- Differences of Morphometric Means between various groups of Cervical Smears --- p.60 / Chapter 6.2.5 --- Discriminant Analysis of Cervical Smears --- p.61 / Chapter 6.2.6 --- Comparison of Cervical Smears and Biopsies --- p.62 / Chapter 6.2.7 --- Subjective Assessment Criteria for Cervical Biopsies and Smears --- p.63 / Chapter 6.3 --- NASOPHARYNX / Chapter 6.3.1 --- Maturation Sequence of Nasopharyngeal Epithelium --- p.65 / Chapter 6.3.2 --- Differences of Morphometric Means between various groups of Nasopharyngeal Biopsies --- p.68 / Chapter 6.3.3 --- Discriminant Analysis of Nasopharyngeal Biopsies --- p.70 / Chapter 6.4 --- COMPARISON OF CERVIX UTERI AND NASOPHARYNX --- p.71 / Chapter 7. --- DISCUSSION / Chapter 7.1 --- CERVIX UTERI / Chapter 7.1.1 --- Maturation Sequence --- p.73 / Chapter 7.1.2 --- Discrimination of different groups in Biopsies --- p.76 / Chapter 7.1.3 --- Discrimination of different groups in Smears --- p.77 / Chapter 7.1.4 --- Comparison of Smears and Biopsies --- p.78 / Chapter 7.1.5 --- Subjective Assessment Criteria --- p.80 / Chapter 7.1.6 --- Future directions --- p.81 / Chapter 7.2 --- NASOPHARYNX / Chapter 7.2.1 --- Maturation Sequence --- p.81 / Chapter 7.2.2 --- Discrimination of different groups --- p.84 / Chapter 7.2.3 --- Nasopharyngeal Cytology --- p.84 / Chapter 7.2.4 --- Future directions --- p.85 / Chapter 7.3. --- COMPARISON OF CERVIX UTERI AND NASOPHARYNX / Chapter 7.3.1 --- Morphometric data --- p.85 / Chapter 7.3.2 --- Discriminant Analysis --- p.87 / Chapter 8. --- CONCLUSIONS --- p.89 / Chapter APPENDIX A --- Survey of subjective assessment criteria for cervical biopsies and smears / Tables A1-A7 --- p.92 / Chapter APPENDIX B --- Results of pilot study / Tables B1-B6 --- p.100 / Chapter APPENDIX C --- Morphometric data and results of statistical tests for cervical biopsies / Fig. C1-C61 --- p.104 / Tables C1-C19 --- p.166 / Chapter APPENDIX D --- Morphometric data and results of statistical tests for cervical smears / Fig. D1-D2 6 --- p.179 / Tables D1-D3 --- p.206 / Chapter APPENDIX E --- Comparison of cervical smears and biopsies / Tables E1-E3 --- p.208 / Chapter APPENDIX F --- Morphometric data and results of statistical tests for nasopharyngeal biopsies / Fig. F1-F61 --- p.211 / Tables F1-F12 --- p.273 / Chapter APPENDIX G --- Comparison of nasopharyngeal and cervical biopsies / Tables G1-G15 --- p.282 / Chapter APPENDIX H --- Pictures of materials and equipment / Fig. H1-H21 --- p.291 / REFERENCES --- p.303

Orientador: Luis Otavio Zanatta Sarian / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-07T13:22:12Z (GMT). No. of bitstreams: 1 Oliveira_AntonioCarlosZulianide_D.pdf: 2312185 bytes, checksum: 6a45c1be8238c13c3a584fdc2ef426e4 (MD5) Previous issue date: 2013 / Resumo: Introdução: Ensaios clínicos das últimas duas décadas do século XX demonstraram a superioridade da radioterapia associada à quimioterapia na abordagem do carcinoma espinocelular do colo do útero (CEC). Contudo, tais estudos abordaram todos os estádios clínicos e para o subgrupo de mulheres com CEC estádio IIIB e os benefícios da quimioterapia não foram totalmente comprovados. Objetivos: Esta tese divide-se em dois estudos: 1) uma comparação histórica de sobrevida livre de doença (SLD), sobrevida total (ST) e toxicidade de tratamento em mulheres com CEC IIIB submetidas à braquiterapia de baixa taxa de dose (BBTD) versus braquiterapia de alta taxa de dose exclusiva (BATD) versus braquiterapia de alta taxa de dose associada à quimioterapia (BATD-QT) e 2) um ensaio clínico aleatorizado comparando esses mesmos parâmetros em mulheres submetidas à BATD versus BATD-QT. Métodos: Na comparação histórica de tratamentos, foram levantados os dados de evolução de pacientes admitidas entre 1985 e 2005 no CAISM-UNICAMP e seguidas até 2007, totalizando 230 pacientes com CEC IIIB que receberam BBTD (42 pacientes), BATD (155 pacientes) ou BATD-QT (33 pacientes). As SLD e ST das mulheres nos três grupos foram comparadas usando curvas de sobrevida tipo Kaplan-Meyer e testes de log-rank. Já o ensaio clínico aleatorizado foi realizado entre setembro de 2003 e julho de 2010. Foram incluídas no estudo 147 mulheres com CEC IIIB. Após aceitarem participar e assinarem o termo de consentimento, as mulheres foram randomizadas para BATD ou BATD-QT através de planilha de aleatorização criada pelo programa SAS e trazida ao conhecimento de pacientes e médicos através de envelopes opacos. Todas as mulheres receberam teleterapia com dose de 45Gy para a região pélvica em 25 frações, 14,4Gy de reforço no(s) paramétrio(s) comprometido(s) e BATD em quatro frações semanais de 7Gy, prescritos no ponto A. O grupo BATD-QT recebeu cisplatina concomitante semanal (40mg/m2) durante a teleterapia pélvica. O follow-up durou até janeiro de 2013, (72 pacientes do grupo com cisplatina e 75 no grupo-controle), com o seguimento médio de 54,9 meses (intervalo interquartil = 55,4 meses). Comparações de SLD e ST foram realizadas usando curvas de Kaplan-Meyer, testes de log-rank e modelos multivariados de Riscos Proporcionais de Cox, os quais englobaram características clínicas das mulheres como variáveis de controle. Resultados: Na comparação histórica, a SLD média para o grupo BATD foi de 60%, para BBTD 45% e para BATD-QT foi de 65% (p = 0,02). Já a ST foi de 65% para o grupo BATD, 49% para BBTD e a ST em dois anos para o grupo BATD-QT foi de 86% (p = 0,02). A toxicidade retal de grau II foi de 7% para o grupo que recebeu BBTD, de 4% para BATD e 7% para o grupo BATD-QT, que teve um caso de toxicidade retal grau IV. No ensaio clínico aleatorizado, mulheres alocadas no grupo BATD-QT tiveram SLD significativamente melhor (RR = 0,52, 95% CI 0,28-0,98, p = 0,04), porém não houve diferença em relação a ST (RR = 0,67, 95% CI 0,37-1,183, p = 0,16). Mulheres com Karnofsky <90 tiveram uma SLD significativamente pior (RR = 2,52, 95% CI 1,23-4,78, p = 0,01). O mesmo ocorreu para as mulheres com invasão parametrial bilateral até a parede óssea (RR = 2,93, 95% CI 1,21-7,13, p = 0,02), e a hemoglobina média durante o tratamento <10mg/dL (RR = 2,22, 95% CI 1,01-4,93, p = 0,04). A ST também foi menor em mulheres com Karnofsky <90 (RR = 2,75, 95% CI 1,29-5,87, p <0,01), e hemoglobina média durante o tratamento <10mg/dL (RR = 2,82, 95% CI 1,27-6,29, p = 0,01). Conclusões: Na revisão da série histórica, as pacientes que receberam braquiterapia de alta taxa de dose tiveram melhores SLD e ST, e as taxas de toxicidade não foram diferentes entre os três grupos. O ensaio clínico, que é o único estudo controlado randomizado comparando a BATD-QT e BATD para CEC IIIB, sugere que há um pequeno, mas significativo, benefício na SLD com a adição de cisplatina à BATD, com uma toxicidade aceitável / Abstract: Introduction: Clinical trials of the last two decades of the twentieth century demonstrated the superiority of radiotherapy combined with chemotherapy in the management of squamous cell carcinoma of the cervix (SCC). However, such studies have addressed all clinical stages and for the subgroup of women with stage IIIB SCC the benefits of chemotherapy have not been fully proven. Objectives: This thesis is divided into two studies: 1) a historical comparison of disease-free survival (DFS), overall survival (OS) and toxicity of treatment in women with SCC IIIB undergoing low-dose rate brachytherapy (LDR) brachytherapy versus high dose rate exclusive (HDR) brachytherapy versus high dose rate associated with chemotherapy (CHT) and 2) a randomized clinical trial comparing these parameters in women undergoing HDR versus CHT. Methods: In the historical comparison of treatments, data on the outcomes of patients admitted between 1985 and 2005 in CAISM-Unicamp and followed until 2007 were collected, totaling 230 patients with SCC stage IIIB who received either LDR (42 patients), HDR (155 patients) or CHT (33 patients). The DFS and OS of women in the three groups were compared using Kaplan-Meyer survival curves and the "log-rank" test. The randomized clinical trial was conducted between September 2003 and July 2010. A total of 147 with SCC stage IIIB were included. After accepting to participate and signing the consent form, women were randomized to HDR or CHT through a randomization spreadsheet created by SAS program and concealment allocation of patients through opaque envelopes. Patients of either the CHT or HDR groups received external-beam radiation (45 Gy) to the entire pelvic region in 25 fractions over a 5-week period. Compromised parametria were treated with 14.4 Gy boost. High-dose rate brachytherapy consisted of four weekly fractions of 7 Gy prescribed to point A. Patients in the CHT group also received concomitant weekly cisplatin (40mg/m2) during the pelvic external beam radiotherapy. The follow-up lasted until January 2013 (72 patients in the cisplatin group and 75 in the control group), with a mean follow-up of 54.9 months (interquartile range = 55.4 months). Comparisons of DFS and OS were performed using Kaplan-Meyer log-rank tests and multivariate models of Cox proportional hazards model, which encompassed the clinical characteristics of women as control variables. Results: In the historical comparison, the DFS for the group HDR was 60% , 45% for LDR and 65% for CHT (p = 0.02). The OS was 65% for the HDR group, 49% for LDR and 86% for CHT (p = 0.02). The Grade II rectal toxicity was 7% for LDR, 4% in HDR patients and 7% in CHT group, which had a case of rectal toxicity grade IV. In the randomized clinical trial, women in the CHT group had significantly better DFS (RR = 0.52, 95% CI from 0.28 to 0.98, p = 0.04), but there was no difference in OS (RR = 0.67, 95% CI 0.37 to 1.183, p = 0.16). Women with Karnofsky <90 had a significantly worse DFS (RR = 2.52, 95% CI 1.23 to 4.78, p = 0.01). The same was true for women with bilateral parametrial invasion to the bone wall (RR = 2.93, 95% CI 1.21 to 7.13, p = 0.02), and mean hemoglobin during treatment <10mg/dL (RR = 2.22, 95% CI 1.01 to 4.93, p = 0.04). The OS was also lower in women with Karnofsky <90 (RR = 2.75, 95% CI 1.29 to 5.87, p <0.01), and mean hemoglobin during treatment <10mg/dL (RR = 2, 82, 95% CI 1.27 to 6.29, p = 0.01). Conclusions: Patients who received HDR had better DFS and OS, and toxicity rates were not different among the three groups. The randomized trial, which is the only randomized controlled study comparing HDR and CHT for CEC IIIB, suggests that there is a small but significant DFS benefit with the addition of cisplatin to HDR, with acceptable toxicity / Doutorado / Oncologia Ginecológica e Mamária / Doutor em Ciências da Saúde

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A ideia de seguimento, na perspectiva de acompanhar de mulheres com diagnÃstico de CÃncer de Colo Uterino (CCU), identificar como estÃo sendo encaminhadas e tratadas no Sistema Ãnico de SaÃde (SUS), possibilita conhecer variÃveis, eventos e condiÃÃes que proporcionam uma avaliaÃÃo dessa Ãrea do cuidado e do sistema. à elevado o nÃmero de casos de CCU, que apesar de prevenÃveis e controlÃveis com os conhecimentos e as tecnologias existentes, apresenta taxas de morbidade e de mortalidade elevadas, sendo os aspectos associados ao acesso e à qualidade do seguimento fatores estreitamente relacionados a esse desfecho. Diante do exposto, o trabalho objetivou avaliar o seguimento de mulheres com CCU na perspectiva dos sistemas de informaÃÃo de saÃde e de mulheres que nÃo obtiveram registros de seguimento nestes sistemas. Trata-se de pesquisa documental, avaliativa e de campo, realizada em quatro etapas: listagem nominal de mulheres com diagnÃstico de CCU, residentes em Fortaleza-CE, registradas em 2008 no SISCOLO de Fortaleza; busca nominal de mulheres com diagnÃstico de CCU nas APAC-Onco, AIH e DeclaraÃÃo de Ãbito (DO); busca nominal de mulheres com diagnÃstico de CCU no prontuÃrio eletrÃnico das pacientes; e realizaÃÃo das entrevistas com mulheres nÃo identificadas na 2 e 3 etapas. As entrevistas foram realizadas por meio de visita domiciliÃria, de setembro a dezembro de 2010. Os resultados evidenciaram 80 casos de mulheres com diagnÃstico de CCU, residentes em Fortaleza-CE, em 2008. Destas, 2,6% encontravam-se abaixo de 25 anos, 61,2% na faixa de 25 a 59 anos e 36,2% apresentaram idade acima de 60 anos. O carcinoma epidermÃide invasivo acometeu 81,2% das mulheres, enquanto que o adenocarcinoma apresentou-se em 18,2% dos casos. A anÃlise nos sistemas de informaÃÃo SIA/SUS, SIH/SUS e SIM identificou procedimentos que caracterizaram seguimento de mulheres com diagnÃstico de CCU, em 50% das mulheres diagnosticadas. Da outra metade, 16,2% obtiveram seguimento identificado no prontuÃrio eletrÃnico; 33,7% nÃo apresentaram informaÃÃes de seguimento em nenhuma das fontes citadas, tendo estas sido selecionadas para entrevista. No entanto, destas, apenas 20% foram entrevistas, pois as demais nÃo ofereciam informaÃÃes suficientes para o acesso à pesquisadora. As entrevistas revelaram baixas condiÃÃes socioeconÃmicas destas mulheres. Os resultados de Papanicolaou foram entregues com cerca de um mÃs e na data agendada. Na identificaÃÃo de aspectos relacionados ao encaminhamento da paciente com CCU para outros nÃveis de referÃncia, 87,5% recebeu encaminhamento para algum tipo de instituiÃÃo com nÃvel de complexidade mais alto; quanto ao estado atual de seguimento, das mulheres entrevistadas, apesar da maioria ter realizado procedimentos que caracterizaram seguimento, ainda foi evidente a necessidade da educaÃÃo permanente para a qualificaÃÃo profissional, a fim de evitar iniquidades no atendimento à mulher acometida pelo CCU. Houve evidÃncia de subregistro no SIH. Confirmou-se a tese de que as informaÃÃes de seguimento das mulheres com CCU, em Fortaleza-CE, nÃo refletem a real magnitude de seguimento das mulheres que obtiveram diagnÃstico de CCU, uma vez que se constatou o acesso destas à realizaÃÃo dos procedimentos necessÃrios para o seguimento adequado.