Orientador: Hamilto Akihissa Yamamoto / Coorientador: Carlos Márcio da Nóbrega de Jesus / Banca: José Carlos Souza Trindade Filho / Banca: Victor Augusto Sanguinetti Scherrer Leitão / Banca: Reinaldo José Rafaelli / Banca: Fernandes Denardi / Resumo: Objetivo: Avaliar a utilidade do uso de 10,12 e 16 fragmentos em biópsias de próstata na positividade para câncer de próstata (CaP) bem como quanto o Antígeno Prostático Específico (PSA), volume prostático, escore de Gleason, detecção de Neoplasia Intraepitelial Prostática de Alto Grau (NIPAG) e Proliferação Atípica de Pequenos Ácinos (ASAP). Métodos: É um estudo prospectivo e controlado, realizado em uma amostra consecutiva de 354 pacientes com diferentes indicações para biópsia prostática que foram submetidos ao procedimento analisando a positividade de câncer de próstata com a coleta de 10 fragmentos (base, terço médio, ápice, face medial (zona de transição) e face látero-lateral, bilateralmente) comparando com 12 fragmentos (base, terço médio, ápice e nas regiões mais laterais da base, terço médio e ápice, bilateralmente) e o total global de 16 fragmentos. Também comparada a positividade com 10, 12 e 16 fragmentos quanto ao PSA, volume prostático, escore de Gleason, NIPAG e ASAP. Resultados: Entre os 351 pacientes selecionados para biópsia de próstata, a positividade para 10 fragmentos foi de 102 pacientes (29.06%), 12 fragmentos foi de 99 pacientes (28.21%) e 16 fragmentos foi de 107 pacientes (30.48%) (p = 0.79).Os protocolos de biópsia de próstata (10,12 e 16 fragmentos) foram comparados com o PSA estratificado, volume prostático estratificado, escore de Gleason, detecção de NIPAG e ASAP não havendo diferença entre os grupos aferidos. Conclusão: O protocolo com 10 fragmentos não apresentou diferença de positividade em relação aos protocolos de 12 e 16 fragmentos, demonstrando ser um bom método para realização de primeira biópsia / Abstract: Objective: To evaluate the utility of 10,12 and 16 fragments in prostate biopsies positive for the prostate cancer (PCa) as well as the Prostate Specific Antigen (PSA), prostate volume, Gleason score, Prostatic Intraepithelial Neoplasia Detection High Grade (NIPAG) and Atypical Small Acinar Proliferation (ASAP). Methods: It is a prospective controlled study performed with a sample of 354 consecutive patients with different indications for prostate biopsy who underwent the procedure analyzing the positivity of prostate cancer with the collection of 10 cores (base, middle third, apex, medial (transition zone) and latero-lateral, bilaterally) compared with 12 cores (base, middle third, apex and in areas more lateral to the base, middle third and apex, bilaterally) and the global total of 16 cores. It also was compared the positivity with 10, 12 and 16 cores, concerning the PSA, prostate volume, Gleason score, NIPAG and ASAP. Results: Among 351 patients screened for prostate biopsy positivity to 10 cores was 102 patients (29.06%), 12 cores of 99 patients (28.21%) and 16 cores of 107 patients (30.48%) (p = 0.798). The prostate biopsy protocols (10, 12 and 16 cores) were compared with the stratified PSA, stratified prostate volume,Gleason score, detection NIPAG and ASAP, there was no statistical difference. Conclusion: The protocol with 10 cores showed no difference in positivity in relation to 10 and 16 cores protocols, proving to be a good method for performing first biopsy / Doutor

Orientador: Ulisses Frederigue Júnior / Resumo: O grau nuclear é considerado um dos principais fatores prognósticos do carcinoma invasivo de ductos mamários, porém não é frequentemente utilizado em Punção aspirativa por agulha fina (PAAF) na rotina diária de muitos patologistas. Para avaliar a concordância citohistológica da graduação nuclear foi realizado estudo retrospectivo de 90 casos de carcinoma ductal invasivo da mama, inicialmente diagnosticados por PAAF e com subsequente confirmação histológica. As leituras dos preparados citológicos foram realizadas em esfregaços corados pela Hematoxilina-Eosina por dois patologistas independentemente, utilizandose a graduação nuclear de Black modificada por Fisher (BM) e simplificada por Cajulis (BS) e posteriormente confrontadas com a graduação de Bloom&Richardson na histologia. O índice de concordância com a histologia variou de 64,4% a 68,8% na classificação de BM e de 86,6% a 88,8% na classificação de BS. Na graduação pelo sistema de Black modificado, a reprodutibilidade intra-observador foi de 68,8%, enquanto que a reprodutibilidade inter-observador variou de 56,6% a 68,8%. No sistema de Black simplificado, a reprodutibilidade intraobservador foi de 93,3%, enquanto que a reprodutibilidade interobservador variou de 82,2% a 84,4%. Constatou-se que a graduação nuclear na PAAF utilizando o sistema de Black simplificado (BS) teve maior concordância... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Nuclear grading is one of the major prognostic factors of invasive ductal carcinoma of the breast. However, many pathologists do not routinely use it in fine-needle aspiration biopsy (FNAB). A retrospective study was performed on 90 cases of invasive breast ductal carcinoma, diagnosed by FNAB and confirmed by histology, to evaluate the cyto-histological agreement of nuclear grading. Cytological readings were made from smears stained with Hematoxilin-Eosin by two independent pathologists, using Black's nuclear grading a) modified by Fisher (BM) and b) simplified by Cajulis (BS). This was then compared with Bloom & Richardson's histological grade. The histological agreement rate was between 64.4% and 68.8% for BM classification and between 86.6% and 88.8% for BS. Grading using BM classification showed intraand inter-observer reproducibility rates of 68.8% and from 56.6% to 68.8% respectively, while BS showed 93.3% and from 82.2% to 84.4% respectively. Nuclear grading in FNAB using Black's simplified system (BS) gave... (Complete abstract click electronic access below) / Mestre

Magister Scientiae (Biodiversity and Conservation Biology) - MSc (Biodiv and Cons Biol) / Hard benthic reefs are increasingly known as highly diverse biodiversity ecosystems where sponges constitute a significant proportion of inhabitants. Nearly 60% of the seabed over the inner and outer shelf on the Agulhas Bank comprises hard substrata, and in combination with the convergence of the cold Benguela and the warm Agulhas Currents serves to create a nutrient rich zone supporting multiple fish nurseries. Here we provide the first information on hard benthic reef habitats on the subphotic zone of the Agulhas Bank complex marine protected area, which include Alphard Banks, 72 Mile Reef and 45 Mile Reef, as well as the shallow reefs which include 12 Mile Reef, 6 Mile Reef, 7 Mile Reef, Marthas Reef and inshore reefs within the Tsitsikamma marine protected area. The aim is to provide baseline data on the sponge fauna by identifying species and describing the biodiversity of these hard reefs between the depths 10–200 m on the south coast of South Africa. / 2024

Thesis (MSc (Geography and Environmental Studies))--University of Stellenbosch, 2007. / The Agulhas Plain, an area rich in fynbos, was monitored within six months after the February 2006 fire. The potential of using medium resolution imagery, specifically from the Moderate Resolution Imaging Spectroradiometer (MODIS) in determining the re-growth rates of indigenous and alien vegetation types after fire was explored. Pixels representing dense areas of each vegetation type were selected. There was a significant difference in the pixels selected for each vegetation type. A time series of Normalized Difference Vegetation Index (NDVI) data was derived and fitted to functions, such as Double Logistics and Asymmetric Gaussian as implemented in the TIMESAT software. The results show that alien vegetation grows faster after a fire occurrence than in its absence. Within the specified months of monitoring, it was observed that fynbos grew faster than the alien vegetation. Also, the re-growth rates of vegetation on the coastal soils were higher than those of vegetation on the inland soils. The determination of the re-growth rate was necessary to assist resource managers determine the appropriate time for follow-up of clearing invaded sites after fire.

Thesis (MScConsEcol (Conservation Ecology and Entomology))--University of Stellenbosch, 2010. / 134, 43 p. : ill. / ENGLISH ABSTRACT: The Agulhas Plain is a constituent of the Cape Floristic Region, internationally known as a global biodiversity hotspot. The species-rich Agulhas Plain consists mainly of fire-prone fynbos shrublands of which sandstone fynbos covers a significant surface area. This lowland region is characterised by mostly infertile soils yet has unique floristic complexity and contains a high amount of threatened lowland species. Natural vegetation on the Agulhas Plain has been prone to large scale land transformation activities, mainly attributed to the extent of alien plant invasions, urbanisation and agricultural expansion. Fynbos wildflower farming, specifically from natural vegetation, is an important economic activity and contributes to the region‟s agricultural sector. Farmers harvest large quantities of commercial fynbos species and supply these to the market in an attempt to sustain a livelihood. Certain wildflower farming practices (burning, ploughing and broadcast sowing) are applied to natural vegetation in an attempt to increase the abundance of commercial species (i.e. augmentation). Numerous farming practices are used in the industry and the application of these methods can be dynamic and divergent. Furthermore, the implementation of farming practices manifest as anthropogenically induced disturbance events and are a concern for conservation. Previous investigations suggest that farming practices could establish monocultures of commercial wildflower species by reducing species richness and plant diversity of wildflower vegetation. Although the impact of natural disturbance regimes (e.g. fire) and flower harvesting activities have been researched, the impact of farming practices on fynbos structure and composition remains largely unknown. This thesis reports on various aspects related to wildflower farming on the Agulhas Plain. Firstly, by administering a questionnaire, the extent and application of farming practices was investigated. Additionally, the opinion of wildflower farmers (referred to as landholders) about the impact of farming practices on wildflower populations was explored. Secondly, a vegetation survey aimed to assess the impact of farming practices on various structural (regeneration mode and growth form) and compositional attributes (plant family, dominant and rare species) of fynbos. Results from the questionnaire indicate that the application of farming methods are seasonally restricted, often used in varying combinations and relatively small in spatial extent. Furthermore, results show that wildflower farmers have an ecologically acceptable knowledge base and awareness of fynbos management and conservation. Secondly results, obtained from the vegetation survey, imply that natural vegetation subjected to particular farming practices differ from pristine fynbos vegetation by having both altered structural and compositional attributes. However, the impact of farming practices on rare species was less apparent. The conflict between commercial and conservation objectives are apparent from consultation with landholders. Nonetheless, landholders are optimistic about fynbos conservation and conservation can build upon these positive sentiments. Importantly, there is a need to communicate locally with landholders if a sustainable wildflower industry is a priority to stakeholders on the Agulhas Plain. Furthermore, fynbos ecosystems naturally entail complex ecological interactions. Wildflower farming practices reduce the ecological integrity (i.e. altered plant diversity, growth form and plant composition) of wildflower vegetation, at least at the local scale. These farming practices ultimately result both in distorted competitive interactions and disturbance regimes. Therefore, from a conservation perspective, the implementation of these farming practices (ploughing and broadcast sowing) should be cautioned against. / AFRIKAANSE OPSOMMING: Die Agulhas-vlakte vorm deel van die Kaapse Blommeryk; „n gebied wat internasionale bekendheid verwerf het as „n biodiversiteits-brandpunt. Die spesieryke Agulhas-vlakte bestaan hoofsaaklik uit fynbosstruiklande wat geneig is tot veldbrande. Sandsteenfynbos beslaan „n beduidende oppervlak van die gebied (Agulhas-vlakte). Hierdie laagliggende area (Agulhas-vlakte) word meestal deur onvrugbare grondtipes gekenmerk maar beskik nogtans oor unieke fynbos kompleksiteit wat „n aantal bedreigde laagland spesies insluit. Natuurlike plantegroei op die Agulhas-vlakte is onderworpe aan grootskaalse grondgebruik transformasie; hoofsaaklik toe te skryf aan indringer plantegroei, verstedeliking en uitbreiding van landbou. Fynbos veldblomboerdery, spesifiek van natuurlike plantegroei, is „n belangrike ekonomiese aktiwiteit en lewer „n bydrae tot die Agulhas-vlakte se landbou sektor. Boere oes en lewer groot hoeveelhede kommersiële fynbos spesies aan die mark. Sekere veldblom-boerderypraktyke (brand, ploeg en saadstrooi) word ingespan op fynbosveld ten einde die opbrengs en afwisseling van kommersiële spesies te verhoog. „n Verskeidenheid boerderypraktyke word gevolg en die toepassing van hierdie boerderypraktyke is dinamies en uiteenlopend. Voorts manifesteer die implementering van hierdie boerderypraktyke as mensgemaakte versteurings wat kommerwekkend is vanuit „n bewaringsperspektief. Vorige ondersoeke dui moontlik daarop dat boerderypraktyke monokulture van kommersiële veldblomspesies kan vestig deur die veelheid van spesies en diversiteit van veldblomplantegroei te verminder. Ten spyte daarvan dat die impak van natuurlike versteuringsregimes (bv. vuur) en veldblompluk-aktiwiteite reeds nagevors is, bly die impak van veldblomboerderypraktyke op fynbosstruktuur en -samestelling grotendeels onbekend. Hierdie tesis doen verslag oor verskeie aspekte van veldblomboerdery op die Agulhas-vlakte. Eerstens, deur middel van „n vraelys, is die omvang en aanwending van verskillende boerderypraktyke nagevors. Verder is die menings van veldblomboere (na wie verwys word as grondeienaars) ondersoek met die klem op die impak van boerderypraktyke op veldblombevolkings. Tweedens, is „n plantegroei-opname met die doelwit om die impak van landboupraktyke op verskeie strukturele- (regenerasiemodus en groeivorm) en samestellende eienskappe (plantfamilie, dominante- en seldsame spesies) van fynbos vas te stel gedoen. Die resultate van die vraelys dui daarop dat die aanwending van boerderypraktyke seisoenaal beperk word, dikwels in wisselende kombinasies gebruik word en in ruimtelike omvang redelik klein is. Boonop toon die resultate dat veldblomboere oor „n ekologies-aanvaarbare kennisgrondslag en bewustheid van fynbosbestuur en –bewaring beskik. Tweedens, impliseer die resultate, vanuit die plantegroei-opname, dat fynbosveld wat onderwerp word aan sekere boerderypraktyke van natuurlike fynbosplantegroei verskil deurdat dit gewysigde strukturele- sowel as samestellende eienskappe toon. Die impak van die boerderypraktyke op seldsame spesies was egter minder waarneembaar. Die botsing tussen kommersiële- en bewaringsoogmerke blyk duidelik uit konsultasie met grondeienaars. Nietemin is die grondeienaars optimisties oor fynbosbewaring en bewaring kan op hierdie positiewe sentimente staatmaak en voortbou. Dit is belangrik om daarop te let dat dit noodsaaklik is om plaaslik met grondeienaars oorleg te pleeg indien „n volhoubare veldblomindustrie „n prioriteit vir belanghebbendes op die Agulhas-vlakte is. Verder, aangesien fynbos ekosisteme natuurlik komplekse ekologiese wisselwerkings behels, verminder veldblom-boerderypraktyke die ekologiese integriteit (m.a.w. gewysigde plantdiversiteit, groeivorm en plantsamestelling) van fynbosveld, ten minste op kleinskaal (plaaslik). Hierdie landboupraktyke het uiteindelik beide verwronge kompeterende wisselwerkinge asook versteuringsregimes tot gevolg. Vanuit „n bewaringsperspektief moet daar dus teen hierdie boerderypraktyke gewaarsku word.

Thesis (MSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Invasive alien plants (IAPs) are known for their detrimental impacts on biodiversity and ecosystem goods and services. A substantial body of research has contributed to our understanding of their impacts on ecology. In comparison the socio-economic aspects of IAPs, are not well understood. Additionally, valuation practises have usually excluded the positive and the non-monetary impacts (benefits and uses) that IAPs hold for local livelihoods. Holistic valuation has been regarded as imperative for decision-making and managerial frameworks. A study was conducted in Elim on the southern Cape coast of the Agulhas Plain, South Africa, which aimed to explore the various impacts of IAPs on the livelihoods of rural land-users. Individual qualitative interviews were conducted face to face with landholders (referred to as farmers) (N = 12) and individuals from the economically marginalized community (referred to as marginalized community) (N = 12). The grounded theory approach to data analysis was used and results of the coding method used were displayed by means of superscripts. Results indicate that farmers were aware of broader uses of IAPs although they themselves did not utilise them as extensively as members of the marginalized communities. Invasive alien and problem plants that held value for both land-users were not perceived as being „invasive‟. Invasive alien plants were believed to have detrimental impacts on biodiversity and ecosystems goods and services which support people‟s livelihoods. Alien clearing programmes such as Working for Water (WfW) and LandCare have done much to alleviate the socio-economic burden of unemployment in this marginalized community. Aside from the social development aims set out by WfW (i.e. employment of low-income communities, poverty alleviation and skills training), knock-on social development benefits (e.g. feelings of pride, responsibility and awareness as well as conflict management skills) were also realised by individuals from the marginalized community that were previously employed by the programme. Farmers regarded alien clearing and management as a process that demands excessive time, energy and financial resources. On single occasions it was found that farmers employed methods other than the conventional clearing and management strategies (e.g. livestock that feed on IAPs and giving refuse IAP biomass from clearing and felling to neighbouring poor communities). No clear consensus was reached about regarding alien clearing and management but more support is desired from government. Working for Water relies on private landholders for alien clearing as it is required by law. This study emphasizes that stronger relationships between government and private landholders as well as more substantial incentives to clear IAPs on private land are prerequisites if required outcomes are to be achieved. Educating society at large about the detrimental impacts of IAPs is fundamental. Additionally, informing landholders on effective alien clearing methods and policies and legislation pertaining to it are key activities for the South African government. Finally, clearing and management programmes need to consider the benefits that local land-users obtain from IAPs when prioritising areas for the management of alien vegetation. / AFRIKAANSE OPSOMMING: Uitheemse indringerplante (UIPe) is bekend vir die nadelige gevolge wat hulle vir biodiversiteit en ekosisteem goedere en dienste inhou. ʼn Aansienlike liggaam van navorsing het bygedra tot ons begrip van die impak daarvan op ekologie. In teendeel, die sosio-ekonomiese aspekte van UIPe word egter nie goed verstaan nie. Daarbenewens, evalueringspraktyke het gewoonlik die positiewe en nie-monetêre impakte (voordele en gebruike) wat UIPe vir plaaslike lewensbestaan hou, uitgesluit. Holistiese evaluering word as noodsaaklik beskou vir besluitneming en bestuursraamwerke. ʼn Studie was uitgevoer in Elim op die Suid-Kaapse kus van die Agulhas-vlakte, Suid-Afrika. Die doel was om die verskillende aspekte van UIP impakte op die lewensbestaan van landelike grondgebruikers aan te spreek. Individuele kwalitatiewe onderhoude is van aangesig tot aangesig gevoer met grondeienaars (na wie verwys word as boere) (N = 12) en individue van die ekonomies gemarginaliseerde gemeenskap (na wie verwys word as gemarginaliseerde gemeenskap) (N = 12). Die gegronde teorie metode tot data analise was gebruik en die resultate van die kodering metode is vertoon deur middel van boskrifte. Resultate dui daarop dat boere bewus was van ʼn wyer reeks van gebruike van UIPe alhoewel hulle dit nie so ekstensief benut het soos die lede van die gemarginaliseerde gemeenskappe nie. Uitheemse en probleem plante wat waarde gehou het vir beide landgebruikers,was nie soseer beskou as „indringers‟ nie. Daar was geglo dat UIPe nadelige impakte het op biodiversiteit en ekosisteme goedere en dienste wat mense se lewensbestaan ondersteun. Programme soos Werk vir Water (WvW) en LandCare wat fokus op die uitroeiing van UIPe, het baie gedoen om die sosio-ekonomiese laste as ʼn gevolg van werkloosheid in hierdie gemarginaliseerde gemeenskap te verlig. Benewens die sosiale ontwikkelings doelwitte uiteengesit deur WvW (o.a. indiensneming van lae-inkomste gemeenskappe, armoedeverligting en vaardigheidsopleiding), is daar ook domino-voordele (bv. gevoelens van trots, verantwoordelikheid en bewustheid sowel as konflik bestuursvaardighede) aangaande sosiale ontwikkeling ervaar deur individue van die gemarginaliseerde gemeenskap wat voorheen in diens van die program was. Boere beskou die uitroeiing en bestuur van UIPe as ʼn proses wat oormatige tyd, energie en finansiële hulpbronne vereis. Op enkele geleenthede was dit gevind dat boere gebruik maak van metodes anders as die konvensionele skoonmaak-en bestuurs strategieë (bv. vee wat voed op UIPe en biomassa wat na afloop van skoonmaak aan die naburige arm gemeenskappe gegee word). Geen duidelike konsensus is bereik met betrekking tot die uitroeiing en bestuur van UIP nie, maar meer ondersteuning van die regering word verlang. Werk vir Water maak staat op private grondeienaars vir die uitroeiing van UIPe. Hierdie studie beklemtoon dat sterker verhoudings tussen die regering en private grondeienaars sowel as meer aansienlike aansporings om UIPe op private grond skoon te maak ʼn voorvereiste is as verwagte uitkomste bereik wil word. Opvoeding van die breër gemeenskap oor die nadelige impakte van UIPe is fundamenteel. Om grondeienaars in te lig oor effektiewe UIP verwyderingsmetodes asook beleide en wetgewing met betrekking daartoe, is belangrikste aktiwiteite vir die Suid-Afrikaanse regering. Ten slotte, skoonmaak- en bestuursprogramme moet oorweging skenk aan die voordele wat plaaslike landgebruikers put uit UIPe wanneer daar geprioritiseer word vir gebiede vir die bestuur van indringerplante.

Sandy beaches are often highly allochthonous, depending on external subsidies of carbon and nutrients. Despite this, sandy beach macrofaunal assemblages have received little attention regarding their response to enhanced primary productivity generated from coastal upwelling. This thesis investigates the influence of upwelling on macrofaunal assemblages over a variety of spatial and temporal scales. Spatially, four regions were examined across two biogeographic provinces to remove temperature as a confounding factor, and limit biogeography-specific effects. A nested hierarchical design enabled both large and small scales to be examined and generalities about upwelling effects across multiple areas to be considered. Sampling was conducted in two seasons, and over two years, to test the persistence of any effects. Biogeography and region had the strongest influences on macrofaunal biodiversity. Upwelling influenced macrofaunal assemblages in every region when analyses were conducted at the species level. However, the particular effect, positive or negative, differed among regions depending on local factors, and between the response variables, abundance and biomass. Coarser scales of taxonomy, feeding guild and developmental mode were investigated; however, the influence of upwelling generally became weaker and more varied, and occasionally disappeared. Seasonality was greater on the South Coast but was still important in some analyses on the West Coast. At the small-scale, variation within-beaches was lower than between beaches, assemblage structure remained stable over time, and consistent zonation was not present. The influence of temperature on filtration rate and oxygen consumption of Donax serra was investigated to test a driving mechanism for assemblage responses to upwelling. Feeding ability was significantly reduced at colder temperatures indicating an important factor which may be involved in determining assemblage structure. These results suggest that alterations to upwelling regimes predicted under climate change scenarios will impact sandy beach macrofauna, however the specific outcome will depend on multiple contextual factors.

Masters in Public Administration - MPA / The problems of the predispositions of municipal public officials and the professionalization of the public service have in the recent past come into the spotlight in service delivery protests involving poor people and unemployed youth. The criticism levelled at bureaucrats within the public service relates to administrative systems, bad policies as well as unresponsive attitudes among frontline staff. The existing perception is that South African street-level bureaucrats are lazy, uncaring, self-serving, unethical, and conceive of the poor in derogatory terms. They are generally only in public service because it is a means of employment or enrichment. Most recent literature on municipal water and free basic services focused on exposing the cost recovery drive of the state and its associated forms of oppressive neoliberal surveillance of the poor. The research sought to primarily understand the attitudes of street-level bureaucrats (SLB’s) within two B-category municipalities in the Western Cape, South Africa. This was done by identifying what motivates them to work in the public sector, how they see and interact with identified poor members of the public (usually defined as municipal indigents), what their value orientations are, and if and how principles of Batho Pele are understood by frontline workers. It explored how these principles are applied when interacting with indigent citizens in their everyday work environment. Additionally, the research explored how poor citizens view their experience of interacting with the state. A qualitative study, using semi-structured questionnaires, was conducted in the Cape Agulhas municipality which is the most southern municipality and the Matzikama municipality which is the most northern municipality of the WC on the west coast. Interviews with frontline municipal employees, senior bureaucrats and residents were conducted. The interviews were conducted, to obtain three different views on the problem, with a total of 71 participants. The participants comprised of 15 street-level bureaucrats, 8 senior staff, with a minimum of 5 years’ tenure, and a total of 43 indigent citizens. Given the sample size, composition and the demographics relating to these municipalities, the research is not generalizable. The public workers in the case studies, I found, cared deeply for the community and the community in turn are very appreciative of this. I also found that indigent citizens were not ashamed of their indigent status although there were those who outright denied being indigent and therefore were not interviewed.

Orientador: Athanase Billis / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-11-07T16:10:17Z (GMT). No. of bitstreams: 1 Worschech_Adriana_M.pdf: 2136837 bytes, checksum: e169d43b81c649e3dde44c36f7a96278 (MD5) Previous issue date: 2008 / Resumo: A atrofia parcial (AP) é uma lesão benigna que mais freqüentemente imita adenocarcinoma, particularmente a variante parcial. AP ocorre com maior freqüência no lobo posterior ou zona periférica e ganhou importância maior com o uso das biópsias por agulha na detecção do carcinoma prostático. A atrofia parcial e a hiperplasia pós-atrófica (atrofia hiperplásica) são as lesões benignas que mais freqüentemente são confundidas com adenocarcinoma. Uma das razões que contribuem para dificultar o diagnóstico da atrofia parcial está relacionada com a ausência de células basais em alguns ácinos. Mais recentemente a aplicação da molécula de AMACR (alfa-metilacil Co-enzima A racemase) como marcador de células neoplásicas através de imunoistoquímica tem auxiliado no diagnóstico diferencial com o adenocarcinoma. Entretanto, sua aplicação na rotina diagnóstica ainda não está estabelecida. A imunoexpressão da AMACR pode causar algumas dúvidas em sua interpretação. Na literatura existem poucos estudos que relatam a expressão da AMACR em atrofia parcial. Avaliamos através da imunoistoquímica a expressão da AMACR e do 34ßE12 (citoqueratina de alto peso molecular) através do coquetel P504S+34ßE12 em material proveniente de 74 biópsias por agulha de próstata correspondendo a 61 pacientes. Foram analisados um total de 1198 ácinos prostáticos (324 ácinos com adenocarcinoma, 213 ácinos normais, 190 ácinos com atrofia parcial, 298 ácinos com hiperplasia pós-atrófica, 139 ácinos com atrofia simples e 34 ácinos com atrofia esclerosante). Nos ácinos com adenocarcinoma a intensidade da marcação da AMACR foi forte em 251/324 (77.5%) e fraca 73/324 (22.5%). Não houveram casos negativos. Nos ácinos normais observou-se marcação para a AMACR forte em 13/213 (6.1%), fraca em 33/213 (15.5%) e negativa em 167/213 (78.4%). A atrofia parcial apresentou marcação para a AMACR fraca em 47/190 (24.7%) e negativa em 143/190 (75.3%). Não houve marcação forte em nenhum dos casos de atrofia parcial. Os ácinos normais mostraram expressão para AMACR negativo, fraco e forte onde os valores foram respectivamente 167/213 (78,4%), 33/213 (15,5%) e 13/213 (6,1%). A atrofia parcial mostrou-se negativa, e fraca para imunoexpressão da AMACR em 143/190 (75,3%) e 47/190 (24,7%) respectivamente. Não foi observada forte positividade em atrofia parcial, no entanto, a fraca positividade observada em cerca de 25% dos ácinos pode causar dificuldade para a interpretação correta no diagnóstico diferencial de câncer e atrofia parcial. A AMACR foi negativa em todos os ácinos da atrofia simples, hiperplásica (ou hiperplasia pós-atrófica) e esclerosante, por conseguinte, sem qualquer ajuda no diagnóstico diferencial de adenocar-cinoma. A distribuição das células basais, observadas na atrofia simples, hiperplásica e esclerosante foram descontínuas e as células do compartimento secretor mostraram imunoexpressão aberrante de 34ßE12 sugerindo um fenótipo intermédio. Analisando-se os estes resultados conclui-se que o diagnóstico diferencial do adenocarcinoma com atrofia parcial deve ser feito com cautela considerando-se que a expressão da AMACR, apesar de fraca em nosso estudo, pode ocorrer em cerca de 25% dos ácinos. Soma-se a este achado o fato de que em 23.2% dos ácinos de atrofia parcial as células basais estão ausentes. Estes dados impõem cautela no difícil diagnóstico diferencial de pequenos focos "suspeitos, mas não diagnósticos de adenocarcinoma da próstata", sendo que, em alguns casos, os critérios puramente morfológicos poderão ser os únicos na identificação da lesão. / Abstract: Prostatic atrophy (PA) is the benign lesion that most frequently mimicks adenocarcinoma particularly the partial variant. PA occurs more frequently in the peripheral zone and gained greater importance with the use of needle biopsies in detecting cancer of the prostate. Partial atrophy and post-atrophic hyperplasia (hyperplastic atrophy) are the benign lesions that most often are confused with adenocarcinoma. One of the reasons that contribute to make the diagnosis of partial atrophy difficult is related to the absence of basal cell in some acini. More recently the application of AMACR (alpha-metilacil Co-enzyme A racemase) as a marker of malignant cells through immunohistochemistry has helped in the differential diagnosis with prostate cancer. However, its application in routine diagnosis is not yet established. The immunoexpression of AMACR may cause some doubt in interpretation. In literature there are few studies that reported the expression of AMACR in partial atrophy. We evaluated by immunohistochemistry the expression of AMACR and 34ßE12 (cytokeratin high-molecular weight) using the cocktail P504S +34ßE12 in 74 needle prostatic biopsies corresponding to 61 patients. We analyzed a total of 1198 prostate acini (324 acini with adenocarcinoma, 213 normal acini, 190 acini with partial atrophy, 298 acini with post-atrophic hyperplasia, 139 acini with simple atrophy and 34 acini with sclerosing atrophy). In adenocarcinoma acini the staining of AMACR was strong in 251/324 (77.5%) and weak in 73/324 (22.5%). There were no negative acini. In normal acini AMACR was strong in 13/213 (6.1%), weak in 33/213 (15.5%) and negative in 167/213 (78.4%). In partial atrophy, acini showed weak AMACR in 47/190 (24.7%) and were negative in 143/190 (75.3%). There was no strong staining in partial atrophy. The immunoexpression of AMACR was negative in all variants of complete atrophy: simple atrophy, hyperplastic atrophy and sclerosing atrophy. Normal acini showed negative, weak, or strong expression in 167/213 (78.4%), 33/213 (15.5%), and 13/213 (6.1%) acini, respectively. Partial atrophy showed negative, and weak expression in 143/190 (75.3%), and 47/190(24.7%) acini, respectively. No strong positivity was seen in partial atrophy, however, the weak positivity seen in approximately 25% of the acini may be a pitfall for the correct interpretation in the differential diagnosis of cancer and partial atrophy. AMACR was negative in all acini of simple, postatrophic hyperplasia and sclerosing atrophy, therefore, with no help in the differential diagnosis of adenocarcinoma. The distribution of basal cells in simple, postatrophic hyperplasia and sclerotic atrophy was discontinuous and the cells of the secretory compartment showed aberrant expression of 34ßE12 suggesting an intermediate phenotype. Analyzing these results it is concluded that the differential diagnosis of prostate cancer with partial atrophy must be done carefully considering that the expression of AMACR, although weak in our study, can occur in about 25% of the acini. Furthermore, in 23.2% acini of partial atrophy the basal cells are absent. In some cases the microscopic identification of partial atrophy will rely only on morphologic criteria. / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Orientador: Noeme Sousa Rocha / RESUMO Os tumores de mama representam 50% de todas as neoplasias que acometem as cadelas, com freqüência de duas a três vezes maior que a observada na mulher. O objetivo deste trabalho foi diagnosticar as neoplasias mamárias malignas das cadelas pela citologia aspirativa e histopatologia, para o estagiamento dos tumores e prognóstico dos pacientes. Os cânceres de mama de 32 cadelas foram diagnosticados pela citologia aspirativa e histopatologia. Também foram realizadas colheita de dados epidemiológicos, classificação TNM e analise de sobrevida. Além disso, os resultados obtidos foram comparados com a literatura humana. Foram diagnosticados pela citopatologia e histopatologia; carcinoma complexo (15,63%); carcinoma sólido (15,63%); carcinoma epidermóide (9,37%), fibrossarcoma (9,37%), carcinomas papilares (15,62%), carcinoma de células fusiformes (6,25%), melanoma (6,25%), carcinoma anaplásico (6,25%); carcinossarcoma (3,13%) e carcinoma neuroendócrino (3,13%). A idade e o peso médio foram 9,5 anos e 13,8 kg respectivamente, predominaram os animais sem raça definida, de médio e pequeno porte, com dieta de comida caseira e ração e sem alterações reprodutivas. A classificação TNM revelou a maior parte da amostra como dos estágios III (43,75%) e IV (28,13%). A análise de sobrevida indicou tempo médio de 7,5 meses para o grupo IV e 25 meses para o II. As taxas de sobrevivência para os grupos II, III e IV aos 35 meses foram 67%, 50% e 11% respectivamente. A comparação com dados humanos revela haver correlação entre a morfologia e o comportamento biológico de alguns cânceres. A associação das técnicas diagnósticas utilizadas neste trabalho constituiu fator prognóstico efetivo para cadelas com câncer de mama. Palavras-chave: Câncer de mama; citopatologia: diagnóstico; histopatologia; TMN; prognóstico. / ABSTRACT Mammary gland tumors comprise 50% of all neoplasms in female dog which occur three times greater than the level reported in women. Tumor stagement and patient prognosis with cytopathologic and histopathologic diagnostic of female dog breast cancer were the aims of this paper. 32 malignant breast tumors were both fine-needle aspiration and histopathologicaly diagnosed. More over, the TNM system was applied and epidemiological data was compiled. Human breast tumor information was compared with our results. Complex carcinoma (15.63%), solid carcinoma (15.63%), squamous cell carcinoma (9.37%), fibrosarcoma (9.37%), papillary carcinoma (15.62%), spindle cell carcinoma (6.25%), malignant melanoma (6.25%), anaplastic carcinoma (6.25%), carcinossarcoma (3.13%) and neuroendocrine carcinoma (3.13%) were all diagnosed by cytological and histopathological exams. 9.5 years and 13.8 kg were respectively the average age and weight. The predominant status of the bitches was of small and medium size animals, mongrel breed, fed with pet food and other kinds of food and with normal reproductive functions. The TNM system showed that the major part of the females was in stages III (43.75%) and IV (28.13%). The mean time of survival were 7.5 months to stage IV and 25 months to stage II. The survival rate to stages II, III and IV at 35 months were 67%, 50% and 11% respectively. The results compared to human breast data reveal similar biological behavior and morphology to some tumors in both species. In conclusion effective prognostic factors to breast cancer in female dog were established by the association of the diagnostic techniques used. Key words: Breast cancer; cytopathology; diagnosis; histopathology; TMN; prognostic. / Doutor