Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Transvaginal ultrasound-guided follicle aspiration is a non-invasive procedure for oocyte recovery from live animals. In equine medicine there are a few studies about this technique, so there is lack of information. Therefore, to evaluate the effect of follicular aspiration on subsequent fertility in mares, two experiments were conducted using an ultrasound with a setorial probe (5.0MHz). On the first experiment, fifteen Criollo mares were not aspirated and fifteen were assigned to one of three groups according to the diameter of the aspirated follicle: 25-29mm (n=4; Group 1); 30-34mm (n=6; Group 2) or > 35mm (n=5; Group 3), all of them in oestrus. On the second experiment, the follicular aspiration was performed in twenty five mares during dioestrus and thirty one were used as control mares. The number of follicles aspirated was between 4 and 8 and all visualized follicles were aspirated. Follicle aspiration was performed when at least four follicles (> 5mm) were present on both ovaries. In the Experiment I, the pregnancy rates were 75.0% (Group 1), 83.3% (Group 2), 60.0% (Group 3), and 73.3% (Group 4 - Control). In the Experiment II, pregnancy rates were 76.0% in aspirated group and 77.4% in control group. On both experiments, pregnancy rates were similar in treated and control mares (P>0.05). So far the study indicated that next cycle fertility was not affected by the follicular aspiration. / A aspiração folicular transvaginal é um método não invasivo de obter oócitos de animais vivos. Devido à quase inexistência de estudos relacionados à técnica, na espécie eqüina ainda não se conhece bem seus efeitos sobre a fertilidade. Para avaliar o efeito da aspiração folicular sobre a fertilidade de éguas no ciclo subseqüente, foram realizados dois experimentos utilizando um ultra-som de 5,0MHz com transdutor setorial. No primeiro experimento, quinze éguas Crioulas serviram como controle e não foram aspiradas e outras quinze foram distribuídas em três grupos, de acordo com o tamanho do folículo aspirado: 25-29mm (n=4; Grupo 1); 30-34mm (n=6; Grupo2) ou > 35mm (n=5; Grupo 3), todas na fase do estro. No segundo experimento, vinte e cinco éguas foram aspiradas durante o diestro e trinta e uma serviram como éguas-controle, não sendo aspiradas. O número de folículos aspirados por ovário variou de quatro a oito. Todos os folículos visualizados no monitor foram aspirados. A escolha do dia da aspiração foi determinada quando as éguas apresentaram acima de quatro folículos com diâmetro superior à 5mm em cada ovário. No primeiro experimento, as taxas de prenhez foram: 75,0% (Grupo 1), 83,3% (Grupo 2), 60,0% (Grupo 3) e 73,3% (Grupo 4 - Controle). No Experimento II, o grupo de éguas com folículos aspirados apresentou porcentagem de gestação de 76,0% e o grupo controle 77,4%. Nos dois experimentos, a taxa de prenhez das éguas controle e das que foram aspiradas foi similar (P>0,05). Esta pesquisa indica que a fertilidade das éguas no primeiro ciclo pós-aspiração não foi afetada pela técnica.

Orientador: Wilter Ricardo Russiano Vicente / Banca: Marcelo Emílio Beletti / Banca: José Octávio Jacomini / Banca: Maria Rita Pacheco / Banca: Paulo Henrique Franceschini / Resumo: O objetivo deste estudo foi avaliar histologicamente as biópsias testiculares de cães obtidas por punção aspirativa por agulhas fina (PAAF) e "tru cut". Foram utilizados 40 cães, adultos, hígidos, distribuídos em 2 grupos: G1 - punção biópsia aspirativa; e G2 - biópsia com agulha "tru-cut". Cada grupo foi dividido em quatro subgrupos (Ga, Gb, Gc e Gd) com cinco animais cada, sendo estes orquiectomizados 3, 7, 14 e 62 dias após as biópsias PAAF ou "Tru-cut". O material colhido pela PAAF foi submetido à avaliação citológica, e o proveniente da biópsia "tru-cut" e orquiectomia submetidos à histopatologia. Foram avaliados os espermiogramas e mensuração de comprimento e largura do escroto e colhido o soro para pesquisa de anticorpo antiespermatozóides. Referente ao espermiograma e a mensuração do escroto não foram observados diferenças (p>0,05) significativas. A amostra direcionada para citologia e histologia obtida pelas duas técnicas foi considerada de quantidade suficiente para diagnóstico. Na histopatologia a PAAF apresentou menor área de lesão e reação inflamatória comparada a "tru cut", no entanto esta última apresentou maior quantidade de material, preservando a arquitetura dos túbulos seminíferos e interstício. Não foi observado diferença (p>0,05) na produção de anticorpos anti-espermatozóides, após as biopsias. Concluímos que apesar das biópsias fornecerem material em qualidade e quantidade adequadas, e da PAAF ter se mostrado menos traumática, a escolha da técnica a ser empregada dependerá da finalidade para o qual o material se destina. / Abstract: The aim of this study it was evaluate hystologicaly the testicular biopsies in dogs obtained by aspirative puncture by fine needle and "tru-cut". Forty males dogs, adults, healthies were used, distributed in 2 groups: G1 - Fine Needle aspiration; and G2- biopsy by "Tru-cut". Each group were shared in four groups (Ga, Gb, Gc e Gd) with 5 animals each, and all of then were orchiectomized after 3, 7, 14, 62 days after the biopsies by FNA and "tru-cut" being performed. The samples collected by FNA were submitted to cytology evaluate, and the sample from tru-cut biopsy and orchiectomy submitted to histopathology. The spermiograms were evaluated, the testicular length and with were measure, and the animal's blood were collected to the anti-sperm antibody quantification. About the spermogram and measurement of scrotal bag any significative difference was observed (p>0,05). The sample to cytology and histology obtained from two techniques showed be in quantity enough to diagnostic. In histopathology, the biopsy FNA showed smaller damage area and inflammatory reaction compared to tru-cut, however this one showed biggest quantity of material, preserving the seminiferous tubules architeture and interstitium. It was not observed significative difference at anti-sperm antibodies production. We concluded that althought the biopsies provide material in quantity and quality appropriate, and the PAAF showed less traumatic, the choose of the technique to be used will depend the purpose for which the material is intended. / Doutor

Nódulos de tireoide são achados clínicos comuns e, atualmente, o método diagnóstico de escolha para diferenciar lesões benignas de lesões malignas é a análise citopatológica dos nódulos através de punção aspirativa por agulha fina (PAAF). Estudos prévios já indicaram que os níveis séricos de TSH podem estar associados ao risco de malignidade nodular. O objetivo deste estudo foi avaliar se o TSH sérico é um preditor de malignidade em nódulos de tireoide em pacientes submetidos à PAAF. A amostra contemplou 100 indivíduos puncionados consecutivamente no Centro de Pronto Diagnóstico Ambulatorial, CPDA, HCPA e que apresentavam níveis de TSH dentro da normalidade. Todos os pacientes foram submetidos à PAAF da tireoide com controle ultrassonográfico e tiveram, posteriormente, a análise citopatológica da PAAF e a avaliação histopatológica do bloco celular. A análise estatística baseou-se em dados de frequências e testes não-paramétricos foram utilizados para correlacionar as variáveis. A população de estudo foi composta por 100 pacientes, sendo 89 mulheres e 11 homens. A média de idade foi de 54,1 ± 14,2 anos e o tamanho médio dos nódulos foi de 2.53 ± 1.36 centímetros. Vinte e seis % destes pacientes apresentavam algum tipo de doença tireoidiana prévia. A média do nível de TSH sérico entre os 100 indivíduos foi de 1.81 ± 1.08 uUI/mL. De acordo com o diagnóstico citopatológico da PAAF complementado pelos achados do bloco celular foram classificados como malignos 8% dos nódulos, 70% benignos, 11% suspeitos/ indeterminados, 8% insuficientes e 3% lesões foliculares. A média de TSH para os grupos maligno, benigno, suspeito/indeterminado, insuficiente e lesão folicular foi de, respectivamente, 2.48, 1.59, 2.21, 2.35 e 2.20 uUI/ml (p>0.05). Não houve diferença estatística significante entre os grupos diagnósticos avaliados, apesar de haver uma variação entre os níveis de TSH entre os grupos refletindo, provavelmente, o pequeno tamanho da amostra. / Thyroid nodules are common and currently the first choice of investigation in distinguishing benign from malignant disease is the cytological analysis of fine needle aspiration biopsy (FNAB). Previous studies have indicated that serum TSH levels might be associated with the likelihood of malignancy. The aim of this study was to evaluate whether serum TSH is a predictor of malignancy of thyroid nodules in patients undergoing FNAB. One hundred consecutive patients, who underwent FNAB as part of clinical investigation of thyroid nodule in a multidisciplinary setting tertiary hospital, underwent ultrasonography followed by FNAB, cytology and cell block analysis. Independent-Samples Kruskal-Wallis test was used to compare the groups. The study population comprised of 89 female and 11 male patients. The mean age was 54.1 ± 14.2 years. 26% had previous thyroid disease. Mean TSH levels was 1.81 ± 1.08 uUI/mL and the mean nodule size was 2.53 ± 1.36cm. Final cytology/cell block diagnosis classified 8% as malignant, 70% as benign, 11% suspicious/indeterminate, 8% insufficient and 3% follicular lesion. The mean TSH values for malignant, benign, suspect, insufficient and follicular lesion group were as follows: 2.48, 1.59, 2.21, 2.35 and 2.20 uUI/ml, respectively. No statistical significance was detected between TSH levels and final cytology/cell block diagnosis, possibly reflecting the small sample size (P>0.05). We observed a variation between TSH levels among the groups covered in this study, but there was no statistically significant difference among them.

A infecção pelo Vírus da Língua Azul (VLA) ocorre em ruminantes domésticos e selvagens, preferencialmente, ovinos, bovinos e caprinos em regiões tropicais e temperadas onde há o vetor, mosquito do gênero Culicoides. O objetivo do trabalho é descrever os aspectos clínicos e anatomopatológicos de sete surtos de infecção pelo VLA em ovinos no Rio Grande do Sul, confirmados pelo isolamento viral e teste da RT-PCR. De janeiro a outubro de 2014 foram diagnosticados sete surtos de infecção pelo VLA em ovinos no estado do Rio Grande do Sul com histórico de mortalidade de ovinos nos municípios de Taquara (Propriedade A), Fazenda Vilanova (Propriedade B), Viamão (Propriedades C e F), Cachoeira do Sul (Propriedade D e E) e Venâncio Aires (Propriedade G). Os achados clínicos relacionavam-se com o sistema respiratório e locomotor. A taxa de mortalidade variou de 1,7 (4/230 ovinos) a 56% (28/50 ovinos). Realizou-se a necropsia de 10 ovinos e de um feto abortado por um dos ovinos submetidos à necropsia. As principais alterações observadas nos ovinos foram: hiperemia e conteúdo alimentar na cavidade nasal (7/10), pulmões aumentados de tamanho com intenso edema (6/10), consolidação pulmonar antero-ventral (5/10), hemorragias no coração (5/10), hemorragia da artéria pulmonar (4/10) e discreta dilatação e flacidez do esôfago (4/10). Os achados histológicos caracterizaram pneumonia aspirativa (3/10), rinite purulenta (1/10), necrose muscular do esôfago (8/10), hemorragias no coração (3/10), necrose de cardiomiócitos (2/10) e necrose do músculo serrátil cervical ventral (8/10). O feto não apresentou alterações macroscópicas e histológicas. Para confirmar a suspeita foram coletadas 20 amostras de sangue de ovinos doentes e recuperados, e de um bovino. A partir do teste da RT-PCR e isolamento viral confirmou-se o diagnóstico de infecção pelo vírus da língua azul nos sete surtos ocorridos em 2014 no Rio Grande do Sul. E, pela análise filogenética comprovou-se a participação do sorotipo 4 nas Propriedades D e B. / The infection by Bluetongue Virus (BTV) occurs in domestic and wild ruminants, including sheep, cattle and goats in the tropical and temperate regions where the vector is present Culicoides. The objective is describe the clinical and pathological aspects of seven outbreaks of infection by BTV in Rio Grande do Sul, confirmed by viral isolation and RT-PCR test. From January to October 2014 were diagnosed seven outbreaks of infection by BTV in sheep in the state of Rio Grande do Sul with a history of sheep mortality in the cities of Taquara (Propriedade A), FazendaVilanova (Propriedade B), Viamão (Propriedade C and F), Cachoeira do Sul (Propriedade D and E) and Venâncio Aires (Propriedade G). Clinical findings were related to the respiratory and locomotor system. The sheep mortality ranged from 1.7 to 56%. At necropsy the main changes observed in sheep were hyperemia and food content in the nasal cavity (7/10), increased lung size with marked edema (6/10), anterior-ventral pulmonary consolidation (5/10), bleeding heart (5 / 10), bleeding from the pulmonary artery (4/10) and mild swelling and sagging of the esophagus (4/10). Histological findings included aspiration pneumonia (3/10), purulent rhinitis (1/10), muscle necrosis of the esophagus (8/10), bleeding heart (3/10), cardiomyocyte necrosis (2/10) and cervical ventral serratus muscle necrosis (8/10). The fetus showed no macroscopic and histological changes. To confirm the suspicion were collected 20 blood samples from sick and recovered and sheep, and one cow. The RT-PCR test and virus isolation confirmed infection with bluetongue. For phylogenetic analysis of the virus serotype 4 was identified in the Propriedade B and D.

A infecção pelo Vírus da Língua Azul (VLA) ocorre em ruminantes domésticos e selvagens, preferencialmente, ovinos, bovinos e caprinos em regiões tropicais e temperadas onde há o vetor, mosquito do gênero Culicoides. O objetivo do trabalho é descrever os aspectos clínicos e anatomopatológicos de sete surtos de infecção pelo VLA em ovinos no Rio Grande do Sul, confirmados pelo isolamento viral e teste da RT-PCR. De janeiro a outubro de 2014 foram diagnosticados sete surtos de infecção pelo VLA em ovinos no estado do Rio Grande do Sul com histórico de mortalidade de ovinos nos municípios de Taquara (Propriedade A), Fazenda Vilanova (Propriedade B), Viamão (Propriedades C e F), Cachoeira do Sul (Propriedade D e E) e Venâncio Aires (Propriedade G). Os achados clínicos relacionavam-se com o sistema respiratório e locomotor. A taxa de mortalidade variou de 1,7 (4/230 ovinos) a 56% (28/50 ovinos). Realizou-se a necropsia de 10 ovinos e de um feto abortado por um dos ovinos submetidos à necropsia. As principais alterações observadas nos ovinos foram: hiperemia e conteúdo alimentar na cavidade nasal (7/10), pulmões aumentados de tamanho com intenso edema (6/10), consolidação pulmonar antero-ventral (5/10), hemorragias no coração (5/10), hemorragia da artéria pulmonar (4/10) e discreta dilatação e flacidez do esôfago (4/10). Os achados histológicos caracterizaram pneumonia aspirativa (3/10), rinite purulenta (1/10), necrose muscular do esôfago (8/10), hemorragias no coração (3/10), necrose de cardiomiócitos (2/10) e necrose do músculo serrátil cervical ventral (8/10). O feto não apresentou alterações macroscópicas e histológicas. Para confirmar a suspeita foram coletadas 20 amostras de sangue de ovinos doentes e recuperados, e de um bovino. A partir do teste da RT-PCR e isolamento viral confirmou-se o diagnóstico de infecção pelo vírus da língua azul nos sete surtos ocorridos em 2014 no Rio Grande do Sul. E, pela análise filogenética comprovou-se a participação do sorotipo 4 nas Propriedades D e B. / The infection by Bluetongue Virus (BTV) occurs in domestic and wild ruminants, including sheep, cattle and goats in the tropical and temperate regions where the vector is present Culicoides. The objective is describe the clinical and pathological aspects of seven outbreaks of infection by BTV in Rio Grande do Sul, confirmed by viral isolation and RT-PCR test. From January to October 2014 were diagnosed seven outbreaks of infection by BTV in sheep in the state of Rio Grande do Sul with a history of sheep mortality in the cities of Taquara (Propriedade A), FazendaVilanova (Propriedade B), Viamão (Propriedade C and F), Cachoeira do Sul (Propriedade D and E) and Venâncio Aires (Propriedade G). Clinical findings were related to the respiratory and locomotor system. The sheep mortality ranged from 1.7 to 56%. At necropsy the main changes observed in sheep were hyperemia and food content in the nasal cavity (7/10), increased lung size with marked edema (6/10), anterior-ventral pulmonary consolidation (5/10), bleeding heart (5 / 10), bleeding from the pulmonary artery (4/10) and mild swelling and sagging of the esophagus (4/10). Histological findings included aspiration pneumonia (3/10), purulent rhinitis (1/10), muscle necrosis of the esophagus (8/10), bleeding heart (3/10), cardiomyocyte necrosis (2/10) and cervical ventral serratus muscle necrosis (8/10). The fetus showed no macroscopic and histological changes. To confirm the suspicion were collected 20 blood samples from sick and recovered and sheep, and one cow. The RT-PCR test and virus isolation confirmed infection with bluetongue. For phylogenetic analysis of the virus serotype 4 was identified in the Propriedade B and D.

Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients. The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention. In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated. The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain. The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.

Abstract Patients with acute drug poisonings are common in emergency departments and hospitals. Patients typically ingest medical products, most commonly psychotropic drugs that lead to intoxication. The outcome is usually good and hospital stays are short, even among patients requiring intensive care. Complications such as aspiration pneumonia can prolong hospital stays. Acute mortality is low (usually less than 5%) but repetition of self-harm is common and long-term mortality is high. The aim of this study was to evaluate the outcome of drug poisoned patients and the factors associated with unfavourable outcome, including morbidity, length of intensive care unit (ICU) and hospital stays, repetition of drug poisonings, and mortality. The study population consisted of patients treated in Oulu University Hospital due to acute drug poisoning between 1985–2006 and drug poisoned patients in the data base of the Finnish Consortium intensive Care Data. In the first part of the study 276 hospitalised self-poisoned adolescents were examined retrospectively from the patient records for acute contributing risk factors before the intake. Patients with such risk factors had higher rates of depression, non-ethanol poisonings and repetition of self-poisoning within one year. The second part of the study included 257 acute drug-poisoned adult patients requiring intensive care. The factors associated to aspiration pneumonia were evaluated retrospectively. Of these, 28.4% had aspiration pneumonia. Pre-hospital intubation of the comatose patients was associated with lower number of aspiration pneumonias. The third study evaluated 2755 drug-poisoned patients requiring intensive care for risk factors for prolonged ICU length of stay (LOS) using national intensive care database. Factors associated with prolonged stay were respiratory failure, renal dysfunction and lowered platelet count on admission. The hospital mortality in these studies ranged from 0 to 1.6%. The fourth study evaluated the long-term mortality and causes of deaths of 3709 patients admitted to Oulu University Hospital due to acute drug poisoning between 1985 and 2000. The all-cause mortality was recorded at the end 2009 and patients were compared to age- and sex-matched controls. Mortality among the study population was 30.6% compared to 13.6% for the controls. In conclusion, patients admitted to hospital due to acute drug poisoning have good short-term outcomes. Factors associated with prolonged ICU LOS were aspiration pneumonia, respiratory failure on admission, lowered platelet count on admission and renal dysfunction on admission. Impulsive self-poisonings among adolescents are associated with psychopathology and repetitions. Patients with acute drug poisonings have high long-term mortality. / Tiivistelmä Myrkytyspotilaat ovat yleinen potilasryhmä päivystyksissä ja sairaaloissa. Sairaalahoitoisen, akuutin lääkeainemyrkytyksen ennuste on hyvä ja jopa tehohoitoa vaativat potilaat selviävät lyhyellä sairaalahoitojaksolla. Komplikaatiot, kuten mahan sisällön hengitysteihin joutumisesta aiheutuva keuhkokuume (aspiraatiokeuhkokuume) pitkittävät hoitoa. Kuolleisuus hoitojakson aikana on yleensä alle 5 %, mutta pitkäaikaiskuolleisuus näillä potilailla on merkittävä. Tutkimuksen tarkoituksena oli selvittää akuutin lääkeainemyrkytyspotilaan ennustetta ja ennusteeseen vaikuttavia tekijöitä. Ensimmäisessä osatyössä tutkittiin 276 nuoren myrkytyspotilaan myrkytystapahtumaan vaikuttaneita akuutteja riskitekijöitä. Potilaat, joilla oli riskitekijöitä, olivat useammin masentuneita ja heillä oli enemmän uusintakäyntejä myrkytysten vuoksi vuoden sisällä. Toisessa osatyössä selvitettiin aspiraatiokeuhkokuumeen yleisyyttä 257 tehohoitoa tarvinneella lääkemyrkytyspotilaalla. Potilaista 28,4 % sai aspiraatiokeuhkokuumeen. Ennen sairaalaan tuloa suoritettu hengitysteiden varmistaminen hengitysputkella (intubaatio) pienensi aspiraatiokeuhkokuumeen riskiä merkittävästi verrattuna niihin, jotka intuboitiin vasta sairaalassa. Kolmannessa osatyössä tutkittiin 2755 myrkytyspotilaan riskitekijöitä pitkittyneeseen tehohoitoon. Hengitysvajaus, munuaisten toiminnan vajaus ja matala veren verihiutalearvo sairaalaan tullessa olivat pitkittyneen hoidon riskitekijöitä. Kuolleisuus hoitojakson aikana oli näissä kolmessa tutkimuksessa 0–1.6 %. Neljännessä osatyössä tutkittiin 1985–2000 OYS:ssa hoidettujen myrkytyspotilaiden pitkäaikaisennustetta ja kuolinsyitä. Kuolleisuus vuoden 2009 loppuun mennessä oli 3709 potilaan joukossa 30,4 %, kun vastaava kuolleisuus ikä- ja sukupuolivakioitujen verrokkien keskuudessa oli 13,6 %. Kaikki kuolinsyyt olivat yleisempiä tutkimusjoukossa verrattuna verrokkeihin. Yhteenvetona voidaan todeta että akuuttien myrkytyspotilaiden ennuste on hyvä akuutissa vaiheessa. Aspiraatiokeuhkokuume on yleinen komplikaatio myrkytyspotilailla ja se on osittain vältettävissä hengitystien varhaisella varmistamisella. Impulsiivinen käytös nuorella myrkytyspotilaalla assosioituu psykopatologiaan ja uusintamyrkytyksiin. Myrkytyspotilaan pitkäaikaisennuste on huono. Kuolleisuus ennaltaehkäistäviin syihin, kuten itsemurhiin sekä sydän- ja verisuonitauteihin, on huomattava.

The work is focused on the composition of the atmosphere, the processes that take place in it, especially on the formation of atmospheric ions and the energy that must be supplied to ionize the gas. The work examines the influence of aerosol particles on the concentration of ions and also how air ions influence the human health. Last but not least, there is mentioned a comparison of the possibilities of artificial air ionization for interiors.

Background: Reported results for thyroid nodule fine-needle aspiration (FNA) cytology mainly originate from tertiary centers. However, thyroid nodule FNA cytology is mainly performed in primary care settings for which the distribution of FNA Bethesda categories and their respective malignancy rates are largely unknown. Therefore, this study investigated FNA cytology malignancy rates of a large primary care setting to determine to what extent current evidence-based strategies for the malignancy risk stratification of thyroid nodules are applied and applicable in such primary care settings. Methods: In a primary care setting, 9460 FNAs of thyroid nodules were retrospectively analyzed from 8380 patients evaluated by one cytologist (I.R.) during a period of two years. The 8380 FNA cytologies were performed by 64 physicians in different private practices throughout Germany in primary care settings. Results: The cytopathologic results were classified according to theBethesda Systemas non-diagnostic in 19%, cyst/ cystic nodule in 21%, benign (including thyroiditis) in 48%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 6%, follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) in 4%, suspicious for malignancy (SFM) in 1%, and malignant in 1%. The proportion of patients proceeding to surgery or with a follow-up of at least one year and the observed risks of malignancy were 22%/8% for AUS/FLUS, 69%/ 17% for FN/SFN, 78%/86% for SFM, and 71%/98% for malignant. For 112 cytologically suspicious and malignant FNAs, there were 102 true positives and 10 false positives, considering histology as gold standard. Conclusion: At variance with other data mostly originating from tertiary centers, these data demonstrate low percentages for malignant, SFM, FN/SFN, and AUS/FLUS, and high percentages for cysts/cystic nodules in this primary care setting in Germany. The risks of malignancy for malignant, SFM, AUS/FLUS, and FN/SFN FNA cytologies are according to Bethesda recommendations.:1 ABKÜRZUNGSVERZEICHNIS ............................................................................................................... 1 2 EINFÜHRUNG .......................................................................................................................................... 2 2.1 DAS ORGAN SCHILDDRÜSE ................................................................................................................................ 3 2.1.1 Anatomie der Schilddrüse ......................................................................................................................... 3 2.1.2 Funktion der Schilddrüse .......................................................................................................................... 3 2.2 SCHILDDRÜSENKNOTEN ..................................................................................................................................... 4 2.2.1 Epidemiologie der Schilddrüsenknoten .............................................................................................. 4 2.2.2 Ätiologie der Schilddrüsenknoten ......................................................................................................... 4 2.2.3 Jodversorgung in Deutschland ................................................................................................................ 5 2.2.4 Symptomatik der Schilddrüsenknoten ................................................................................................ 5 2.2.5 Diagnostik von Schilddrüsenknoten ..................................................................................................... 6 2.2.6 Die Feinnadelaspirationszytologie (FNA) ......................................................................................... 9 2.2.7 Therapeutisches Management ............................................................................................................ 11 2.3 DIE ABLEITUNG DER RATIONALE .................................................................................................................. 13 3 PUBLIKATIONSMANUSKRIPT ........................................................................................................ 14 4 ZUSAMMENFASSUNG ......................................................................................................................... 22 4.1 SCHLUSSFOLGERUNG ....................................................................................................................................... 26 5 LITERATURVERZEICHNIS ................................................................................................................ 28 6 ANLAGEN ............................................................................................................................................... 33 6.1 TABELLE 1: MALIGNITÄTSRISIKO NACH SONOGRAPHISCHEM ERSCHEINUNGSBILD UND FNA INDIKATION FÜR SCHILDDRÜSENKNOTEN (36) ........................................................................................................... 33 6.2 TABELLE 2: DAS BETHESDA SYSTEM FOR REPORTING THYROID CYTHOPATHOLOGY. DIAGNOSTISCHE KATEGORIEN UND MALIGNITÄTSRISIKEN (36) ........................................................................................................... 34 6.3 ABBILDUNG 1: ALGORITHMUS FÜR PATIENTEN MIT SCHILDDRÜSENKNOTEN NACH DER AMERICAN THYROID ASSOCIATION (36) .......................................................................................................................................... 35 6.4 DARSTELLUNG DES EIGENEN BEITRAGS AN DER PUBLIKATION ............................................................... 36 6.5 ERKLÄRUNG ÜBER DIE EIGENSTÄNDIGE ABFASSUNG DER ARBEIT .......................................................... 54 6.6 LEBENSLAUF ..................................................................................................................................................... 55 6.7 VERZEICHNIS WISSENSCHAFTLICHER VERÖFFENTLICHUNGEN ................................................................ 56 6.8 DANKSAGUNG ................................................................................................................................................... 57

In South Africa, the majority of youth entering emerging adulthood find themselves in a protracted struggle to access further education, training or to secure their first decent job. The purpose of this multi-case study is to deepen the understanding of how capability measurement approaches and tools can empower marginalized youth to better understand their aspirations and map their way through emerging adulthood and out of poverty. This research aims to deepen the understanding of youth's experience utilizing 'Poverty Stoplight'; a poverty measurement and capability building instrument that utilizes a self-assessment survey and mentorship methodology. The researcher utilized a youth-focused participatory approach in conducting focus groups and in-depth one-on-one interviews across five marginalized communities in the Western Cape to gain insight into their experience using the tool, their ability to envision their future selves and develop their aspirations. What emerged from the data were insights into the youth's aspirations, the perceived enabling factors and impediments towards their aspirations and their experiences utilizing Poverty Stoplight. This process enabled youth to genuinely reflect and assess their situation, and have the opportunity to define their aspirations. Overall the Poverty Stoplight programme was experienced as empowering by participants, with several implications for the programme pertaining to data accessibility, communication, mentorship and solution sharing, as well as the importance of youth-specific participatory approaches. Aligned to this, the findings yielded several recommendations pertaining to providing support and enabling opportunities for emerging adults to realise their aspirations. Despite the limitations of this research, this study is relevant for stakeholders in South Africa and globally as it examines the critical issue of youth development, with a focus on the ability of young people to attain their aspirations. Further, it analyses the capability measurement approach as a means to ensuring young people can better understand and plot their way out of poverty, making the most of their individual capabilities and attributes within the broader structural and systemic challenges they face. This exploration of practical tools and methodologies being developed and utilized by pioneering organisations in the South African context provides empirical evidence of the merit of such approaches, with recommendations on how tools and approaches can even better serve the needs of youth. Further, longitudinal research is merited into the use of such capability measurement approaches to empower youth and the further use of participatory methodologies.