Introdução: A técnica de criopreservação de tecido ovariano tem sido vista como tratamento promissor e se apresenta como a principal maneira de preservar a fertilidade em pacientes pré-púberes e em mulheres que necessitam de tratamento do câncer de imediato. Contudo, atualmente, ainda existem obstáculos em relação ao autotransplante de tecido ovariano criopreservado, devido a fatores como lesão isquêmica, assim como danos causados pelo processo durante o congelamento, bem como a escolha do melhor local para o enxerto. Objetivo: Verificar a possível restauração da função ovariana, analisando a histologia do ovário transplantado em ratas adultas estéreis, após transplante autólogo de tecido ovariano criopreservado em fase pré-púbere. Métodos: Foram utilizadas 45 ratas Wistar com 30 dias de idade, que foram divididas aleatoriamente em três grupos: Grupo Controle (n = 15), férteis normais; Sham (n = 15), submetidas à ooforectomia bilateral; Transplante (n = 15), submetidas à ooforectomia bilateral, seguida de transplante autólogo na região dorsal entre as escápulas. A partir do d35, foram realizadas observações quanto à maturidade sexual, através da análise da abertura vaginal e de esfregaços vaginais, para avaliação do ciclo estral. Após observação da fase do ciclo estral, os animais foram eutanasiados. E, amostras de tecidos foram coletadas e processadas para avaliação histológica dos implantes ovarianos; considerando: organização estrutural do tecido transplantado e adjacente, bem como o desenvolvimento folicular. Resultados: Quanto às avaliações de maturidade sexual, através das análises de abertura vaginal e da análise microscópica do material obtido dos esfregaços vaginais, foi possível observar que os animais do Grupo Controle, que eram férteis ciclaram normalmente. As ratas do Grupo Sham e Transplante não apresentaram ciclo regular, permanecendo em diestro. As avaliações histológicas das amostras de tecido de ovário pré-púbere, implantados em fêmeas adulto jovens, evidenciaram degeneração ovariana; uma vez que estes apresentaram fibrose e áreas de necrose, o que provavelmente impossibilitou o desenvolvimento folicular, nas ratas que receberam o transplante. Conclusão: A técnica de transplante de tecido ovariano em ratas é uma técnica relativamente simples de ser executada, e se mostrou eficaz na manutenção do massa corporal dos animais durante o período observado. Este achado sugere que houve produção hormonal, oriunda do ovário transplantado, fato este que encoraja as pesquisas neste sentido, a fim de se obter uma técnica que restaure a produção de folículos viáveis em pacientes estéreis. Apesar de ter apresentando indícios de falência do enxerto e isquemia no tecido transplantado, os resultados preliminares desta investigação precisam ser complementados com estudos adicionais, a fim de buscar as melhores condições para a obtenção de maior eficácia dos transplantes autólogos de tecido ovarianos criopreservados. / Introduction: Ovarian tissue cryopreservation is a promising treatment and it is presented as the main way to preserve fertility in prepubertal patients and women who need cancer treatment immediately. However still remain obstacles related to the ovarian tissue cryopreserved autograft due to ischemic injury, damage caused by the freezing process and selecting the best location for the graft. Objective: Investigate a possible restoration of the ovarian function by analyzing the histology of the ovary transplanted into sterile adult rats after autologous transplantation of ovarian tissue cryopreserved in prepubertal phase. Methods: 45 Wistar rats, 30 days old,which were randomly divided into three groups: control group (n = 15), normal fertile; Sham group (n = 15), underwent bilateral oophorectomy; Transplantation group (n = 15), underwent bilateral oophorectomy followed by autologous transplantation in the scapular area. From the d35, sexual maturity was observed by examining the vaginal opening and vaginal smears, for evaluation of the estrous cycle. After observing the phase of the estrous cycle, the animals were euthanized. The tissue samples were collected and processed for histological evaluation of ovarian implants; where structural organization of the transplanted tissue and adjacent as well as follicular development were analyzed. Results: Regarding sexual maturity evaluations, observed by vaginal opening analysis and microscopic analysis of material obtained from vaginal swabs, we could observe that the animals in the control group cycled normally. The rats of Sham and Transplant Group showed no regular cycle, staying in diestrus phase. The histological assessments of prepubertal ovarian tissue samples implanted in young adult females showed ovarian degeneration, since they had areas of necrosis and fibrosis, which probably impeded the follicular development in these rats. Conclusion: The ovarian tissue transplantation technique in rats is a relatively simple technique, and is effective in body mass maintenance of animals during the observed period. This finding suggests that there were hormone production originated from the transplanted ovaries, and this, encourages research in order to obtain a technique to restore the production of viable follicles in sterile patients. Despite presenting evidence of graft failure and ischemia in the transplanted tissue, the preliminary results of this investigation need to be supplemented with additional studies in order to get the best conditions for achieving greater effectiveness of autologous transplantation of cryopreserved ovarian tissue.

La reconstruction trachéale autologue a pu être standardisée et optimisée grâce au développement d’untravail de recherche expérimentale. Ce travail a permis d’améliorer la technique chirurgicale et les résultatscliniques. C’est une solution thérapeutique qui permet de remplacer de façon reproductible plus de 50 % delongueur de trachée. Toutes les autres techniques de remplacement trachéal développées par denombreuses équipes, ainsi que leurs résultats expérimentaux et cliniques, ont été étudiés et classés enfonction du substitut utilisé.Après de nombreuses publications du Laboratoire de Recherche du Centre Chirurgical Marie Lannelonguesur ce sujet, nous nous sommes orientés vers l’utilisation des tissus autologues (lambeau libre et cartilagescostaux) en collaboration avec les chirurgiens plasticiens. Cela a permis grâce aux avancées techniques etnotamment de microchirurgie de réaliser un nouveau conduit trachéal. Ce substitut ne contient aucunmatériel prothétique et il peut donc résister aux infections. Malgré l’absence de renfort prothétique, il résisteaux pressions et surtout à la dépression respiratoire.Le développement de cette technique chirurgicale a été obtenu grace à ces travaux de recherche qui ontpermis d’optimiser la procédure, de l'améliorer et de la répéter.Le premier travail expérimental a été la création d'un modèle animal de remplacement trachéal autologuepar un lambeau pédiculé armé. Nous avons ainsi confirmé la résistance mécanique et la viabilité descartilages, ainsi que la durabilité de ce type de reconstruction.Les travaux suivants ont été réalisés en collaboration avec des équipes spécialisées en Ingénierie tissulaire.Le premier travail expérimental d’Ingénierie tissulaire a consisté en la réalisation d’anneaux de cartilage àpartir de cellules souches. L'objectif était d'obtenir des anneaux cartilagineux préformés, que l'on pourraitinsérer dans l'épaisseur du lambeau.Le deuxième travail a été de développer une technique permettant de transformer le revêtement cutané dulambeau en une muqueuse respiratoire. Quatre techniques d'ingénierie tissulaire ont été utilisées et testées :la greffe de péritoine, la greffe de muqueuse buccale expansée, l’ensemencement de cellules de lamuqueuse trachéale et la greffe de cellules épithéliales respiratoire de culture.Malgré les avancées technologiques, la culture de cellules cartilagineuses en trois dimensions sur desmoules en Silicone ne s’est pas avérée satisfaisante.Les différents procédés de remplacement du revêtement cutané ont confirmé la nécessité de réaliser desétapes supplémentaires au préalable de l'intervention chirurgicale. Parmi les techniques de remplacementde l'épithélium, la greffe de muqueuse buccale expansée et la greffe d’épithélium respiratoire de culture ontété les plus fiables.La reconstruction autologue est à ce jour la meilleure alternative pour le remplacement trachéal étendu enutilisant des tissus autologues. La poursuite d’une approche expérimentale est fondamentale pourl’amélioration de nos résultats. Ainsi, ces travaux vont être poursuivis par un travail expérimental sur leremplacement des anneaux de cartilages par des anneaux de Titane poreux sur un modèle animal. / Autologous tracheal reconstruction has been standardized and optimized in parallel with the development of experimental research and clinical practice. This is a therapeutic solution that replaces reproducibly more than 50% of tracheallength. All the other tracheal replacement techniques, developed by many teams and their experimental and clinical results, were studied and classified according to the substitute used.After an experimental study at the Laboratory of Surgical Research in the Marie Lannelongue, center, we started to work towards the use of autologous tissue (free flaps and costal cartilages). Thoses tissues were shaped using technical advances including microsurgery to create a new tracheal conduit.This tracheal substitute does not contain any prosthetic material. It may therefore resist to infection and it resists to respiratory pressures and especially respiratory depression.The development of this technique was conducted in parallel with research studies, that improved and optimized the surgical process and the results.The first experimental work was the creation of an animal model tracheal replacement using an armed autologous pedicle flap. We confirmed the strength and viability of the cartilage strip inserted between the dermal layers and the sustainability of this type of reconstruction.The following work was carried out in collaboration with two other teams specialized in Tissue Engineering.The first experimental work of tissue engineering tried to produce cartilage rings from stem cells. The objective was to obtain complete cartilaginous rings that could be inserted into the thickness of the flap.The next objective was to develop a technique to transform the superficial layer of the skin in a respiratory epithelium. Four tissue engineering techniques were used and tested: peritoneum of the graft, oral mucosa transplant, seeding cells from the tracheal mucosa and graft culture respiratory epithelial cells.Despite advances in technology, the culture of cartilage cells in three dimensions on Silicone mold were not viable and could not be used in clinical practice.The various alternative processes of skin covering highlighted the need for additional steps in advance of surgery.Among the techniques used to replace the epithelium with an expanded graft buccal mucosa, transplantation of culture respiratory epithelium is the most reliable.Autologous reconstruction is so far the best alternative for extended tracheal replacement using only autologous tissue. The pursuit of an experimental approach is fundamental to improve our results.Thus, this work will be pursued by an experimental work on the replacement of cartilage rings using porous titanium ring on an animal model.

Foram analisados 106 pacientes portadores de Linfoma de Hodgkin (LH) com recidiva da doença ou refratários ao tratamento inicial que foram submetidos ao transplante autólogo de células tronco hematopoiéticas (TCTH), na ordem consecutiva de sua realização, entre o mês de abril de 1993 a dezembro de 2007 em um único Centro Brasileiro: o Serviço de Transplante de Medula Óssea da FMUSP. O grupo teve a mediana etária de 28 anos, 55 pacientes (51,9%) eram do sexo masculino e houve predomínio da raça branca (87,6%). A mediana de seguimento clínico foi de 56,4 meses. Todos pacientes foram submetidos no pré TCTH a protocolos de tratamento convencionais, sendo que o uso dos protocolos MOPP, ABVD e sua associação foram utilizados em 97 pacientes (91,5%). Os pacientes foram classificados, de acordo com a resposta ao tratamento utilizado antes do TCTH, sendo 38,1% considerados refratários e 61,9% responsivos. Dos responsivos, 54 pacientes estavam em segunda remissão completa (85%). Tratamento com quimioterapia em alta dose pré TCTH foi feito em 45 (42,4%) dos pacientes (salvamento). A mobilização das células tronco hematopoiéticas foi realizada com ciclofosfamida 120 mg/kg dividida em dois dias seguido de fator estimulador de colônias de granulócitos (G-CSF) na dose de 6 a 17 mcg/kg em 83 (78%) pacientes. Em 25 pacientes (22%) houve falha de mobilização e a coleta foi realizada por múltiplas punções da medula óssea em centro cirúrgico. O valor mediano de células CD 34 coletadas foi de 2,6 x 106 células CD34/Kg de peso do paciente. Os condicionamentos mais utilizados foram BEAM e CVB, e não se encontrou diferença na sobrevida em relação ao regime empregado (p=0,17). A mediana de enxertia das células transplantadas foi de 12 dias. A sobrevida global após o TCTH pelo método de Kaplan-Meier foi, respectivamente, de 86% e 70% aos 5 e 10 anos. Não influenciaram a sobrevida na análise univariada o sexo, o estadio da doença e a presença de massa tumoral extensa. O principal fator preditivo de melhor sobrevida foi a presença de resposta a quimioterapia pré TCTH (p=0,0095) e hemoglobina maior que 10g/dL ao diagnóstico (p=0,0229). A mortalidade relacionada ao procedimento até o centésimo dia após o TCTH foi de 3,74%, e a principal causa de mortalidade tardia após TCTH foi a recidiva da doença / The study enrolled 106 patients with classic Hodgkin disease (HD) refractory or relapsed after initial treatment who underwent to autologous hematopoietic stem cell transplantation (HSCT) between April 1993 and December 2007. Median age was 28 years and 55 (51,9%) patients were male. Ninety three (87,6%) of patients were white. All patients underwent to conventional chemotherapy protocols prior HSCT. The use of MOPP, ABVD protocols and their associations were used in 97 (91,5%) of the patients. Disease classification was done according to the response to initial treatment and comprised 38,1% refractory and 61,9% responsive patients. In the group of responsive, 54 (85%) patients were in second complete remission. High dose chemotherapy prior HSCT was done as salvage in 45 (42,4%) patients. Stem cell mobilization was done after cyclophosphamide 120mg/kg divided in two days. Granulocyte-colony stimulating factor (G-CSF) 617 mcg/kg was given after cyclophosphamide in 83 (78%) patients. Twenty five (22%) patients failed the mobilization and stem cell harvest was done by bone marrow aspirations. The median number of CD34 collected was 2.6 x 106/L. Preparative regimen mostly used comprised BEAM and CVB and no differences was observed in overall survival (p=0.17). Median time to engraftment was 12 days. Median time of follow-up was 56.4 months. The overall survival (OS) was calculated by the Kaplan-Meier method and was 86% and 70% at 5 and 10 years, respectively. In the univariate analysis, response to initial treatment (p=0.009) and hemoglobin greater than 10g/dL at the time of diagnosis (p=0.02) were factors that influenced better OS. The gender, stage of disease and presence of bulky disease were not significant regarding OS in the univariate analysis. Treatment-related mortality (TRM) in 100-days was 3.74%. The major cause of late mortality was relapse of the disease

Introdução: Os enxertos de gordura autóloga (lipoenxertia) são utilizados há muito tempo como material de preenchimento para correção de defeitos de tecido mole, sendo inicialmente utilizados para correção de defeitos faciais. Nos últimos anos, houve um crescente interesse no uso da lipoenxertia em mamas, tanto como método de reconstrução em pacientes submetidas a cirurgias por câncer de mama quanto em procedimentos estéticos. A gordura é considerada um material de preenchimento ideal em decorrência da facilidade de obtenção e da baixa reação imunogênica e alérgica, além de se tratar de material autólogo. Os principais problemas da lipoenxertia são as taxas de reabsorção imprevisíveis do material enxertado (40-60%), a preocupação quanto a sua segurança, principalmente pela hipótese de a gordura estimular o crescimento de células cancerígenas e o fato da necrose do material enxertado poder produzir fibrose, calcificações ou cistos oleosos na mama, os quais poderiam interferir na interpretação das imagens mamográficas. A partir da técnica desenvolvida por Coleman, diversos estudos surgiram mostrando a eficácia e a segurança da lipoenxertia, já que a mesma não parece interferir nas imagens radiológicas, demonstrando que alterações mamográficas após a lipoenxertia são facilmente interpretadas como alterações benignas por radiologistas experientes. Objetivo: Analisar se a lipoenxertia realizada durante a cirurgia conservadora por câncer de mama e posteriormente seguida de radioterapia causa modificações mamográficas. Método: Foi realizado seguimento de 171 pacientes com diagnóstico de câncer inicial submetidas a tratamento conservador e radioterapia no Hospital de Clínicas de Porto Alegre, no período de junho de 2010 a junho de 2013. Trinta e oito dessas pacientes foram submetidas a reconstrução imediata com lipoenxerto segundo a técnica de Coleman. Resultados: A média da idade das pacientes foi de 58,9 anos para as pacientes sem lipoenxerto e 52,5 anos para as com lipoenxerto, e a média do volume enxertado foi de 125 mL. Foram analisadas as alterações mamográficas dessas pacientes 6, 12, 18 e 24 meses após a radioterapia. Constatou-se uma maior incidência de alterações benignas, como cistos oleosos e esteatonecrose, nas pacientes submetidas a lipoenxertia. Não se detectou no presente estudo diferenças quanto a frequência de nódulos, achados suspeitos ou na classificação BI-RADS entre as pacientes com e sem lipoenxerto. Conclusão: Conclui-se, portanto, que a lipoenxertia causa alterações mamográficas facilmente percebidas como benignas, sem elevar a incidência de achados inconclusivos ou suspeitos. Trata-se de um estudo inédito, pois a reconstrução mamária com gordura é realizada no momento da cirurgia conservadora. / Background: Fat grafts have been used for a long time as a filling material for correction of soft tissue defects. There is growing interest in the use of fat grafting as a method of breast reconstruction in patients undergoing surgery for breast cancer. Fat is considered an ideal filler material due to its easy availability and low immunogenic and allergic reaction and because it is an autologous material. However, fat grafts often have high rates of reabsorption and replacement by fibrous scar tissue, calcifications or oily cysts, which can generate sequels and difficulties in the interpretation of radiological images of the breast. Based on the technique developed by Coleman, several studies have emerged showing the efficacy of fat grafting and that it does not seem to interfere with the early diagnosis of breast cancer. Studies have shown that the incidence of mammographic changes after fat grafting does not differ from other surgical procedures of the breast and that they are easily interpreted as benign changes by experienced radiologists in breast imaging. Aim: Analyze mammographic changes in fat grafting performed during conservative surgery for breast cancer and subsequently followed by radiotherapy. Methods: A total of 171 patients diagnosed with early-stage cancer who received conservative treatment and radiotherapy at the Hospital de Clínicas de Porto Alegre from June 2010 to July 2013 were followed in the present study. Thirty-eight of these also underwent immediate reconstruction with fat grafting, as described by Coleman. Results: Mean patient age was 58.9 years for those not exposed to lipomodeling, and 52.5 years in the remainder of the sample. The mean graft volume was 125 ml. In the present study, oncological follow-ups at 6, 12, 18 and 24 months revealed a higher incidence of benign mammographic findings, such as oil cysts and steatonecrosis, in women who had undergone lipomodeling. However, no between-group differences were identified on any other radiological parameter, including scarring, nodules, suspicious findings and BI-RADS categories. Conclusion: These findings suggest that the mammography alterations caused by lipomodeling are easily identified as benign, and that this procedure is not associated with an increased incidence of inconclusive or suspicious findings. This is a unique study because breast reconstruction with fat is conducted at the time of conservative surgery.

Foram analisados 106 pacientes portadores de Linfoma de Hodgkin (LH) com recidiva da doença ou refratários ao tratamento inicial que foram submetidos ao transplante autólogo de células tronco hematopoiéticas (TCTH), na ordem consecutiva de sua realização, entre o mês de abril de 1993 a dezembro de 2007 em um único Centro Brasileiro: o Serviço de Transplante de Medula Óssea da FMUSP. O grupo teve a mediana etária de 28 anos, 55 pacientes (51,9%) eram do sexo masculino e houve predomínio da raça branca (87,6%). A mediana de seguimento clínico foi de 56,4 meses. Todos pacientes foram submetidos no pré TCTH a protocolos de tratamento convencionais, sendo que o uso dos protocolos MOPP, ABVD e sua associação foram utilizados em 97 pacientes (91,5%). Os pacientes foram classificados, de acordo com a resposta ao tratamento utilizado antes do TCTH, sendo 38,1% considerados refratários e 61,9% responsivos. Dos responsivos, 54 pacientes estavam em segunda remissão completa (85%). Tratamento com quimioterapia em alta dose pré TCTH foi feito em 45 (42,4%) dos pacientes (salvamento). A mobilização das células tronco hematopoiéticas foi realizada com ciclofosfamida 120 mg/kg dividida em dois dias seguido de fator estimulador de colônias de granulócitos (G-CSF) na dose de 6 a 17 mcg/kg em 83 (78%) pacientes. Em 25 pacientes (22%) houve falha de mobilização e a coleta foi realizada por múltiplas punções da medula óssea em centro cirúrgico. O valor mediano de células CD 34 coletadas foi de 2,6 x 106 células CD34/Kg de peso do paciente. Os condicionamentos mais utilizados foram BEAM e CVB, e não se encontrou diferença na sobrevida em relação ao regime empregado (p=0,17). A mediana de enxertia das células transplantadas foi de 12 dias. A sobrevida global após o TCTH pelo método de Kaplan-Meier foi, respectivamente, de 86% e 70% aos 5 e 10 anos. Não influenciaram a sobrevida na análise univariada o sexo, o estadio da doença e a presença de massa tumoral extensa. O principal fator preditivo de melhor sobrevida foi a presença de resposta a quimioterapia pré TCTH (p=0,0095) e hemoglobina maior que 10g/dL ao diagnóstico (p=0,0229). A mortalidade relacionada ao procedimento até o centésimo dia após o TCTH foi de 3,74%, e a principal causa de mortalidade tardia após TCTH foi a recidiva da doença / The study enrolled 106 patients with classic Hodgkin disease (HD) refractory or relapsed after initial treatment who underwent to autologous hematopoietic stem cell transplantation (HSCT) between April 1993 and December 2007. Median age was 28 years and 55 (51,9%) patients were male. Ninety three (87,6%) of patients were white. All patients underwent to conventional chemotherapy protocols prior HSCT. The use of MOPP, ABVD protocols and their associations were used in 97 (91,5%) of the patients. Disease classification was done according to the response to initial treatment and comprised 38,1% refractory and 61,9% responsive patients. In the group of responsive, 54 (85%) patients were in second complete remission. High dose chemotherapy prior HSCT was done as salvage in 45 (42,4%) patients. Stem cell mobilization was done after cyclophosphamide 120mg/kg divided in two days. Granulocyte-colony stimulating factor (G-CSF) 617 mcg/kg was given after cyclophosphamide in 83 (78%) patients. Twenty five (22%) patients failed the mobilization and stem cell harvest was done by bone marrow aspirations. The median number of CD34 collected was 2.6 x 106/L. Preparative regimen mostly used comprised BEAM and CVB and no differences was observed in overall survival (p=0.17). Median time to engraftment was 12 days. Median time of follow-up was 56.4 months. The overall survival (OS) was calculated by the Kaplan-Meier method and was 86% and 70% at 5 and 10 years, respectively. In the univariate analysis, response to initial treatment (p=0.009) and hemoglobin greater than 10g/dL at the time of diagnosis (p=0.02) were factors that influenced better OS. The gender, stage of disease and presence of bulky disease were not significant regarding OS in the univariate analysis. Treatment-related mortality (TRM) in 100-days was 3.74%. The major cause of late mortality was relapse of the disease

INTRODUÇÃO: O método padrão de reparo de falhas ósseas é o transplante do osso autólogo. No entanto, novas técnicas de bioengenharia de tecido ósseo poderão substituir o método padrão. A construção de uma técnica em bioengenharia de tecido ósseo é feita pela associação entre fatores ou células indutoras de osso e biomateriais carreadores. O objetivo do presente trabalho foi mensurar a neoformação óssea em falha óssea alveolar de modelo animal após o reparo com fontes diferentes de bioengenharia de tecido ósseo e compará-las com o reparo com o osso autólogo transplantado da região craniana. MÉTODOS: Foi criada uma falha óssea na região alveolar de 28 ratos Wistar medindo 5 mm de diâmetro. Quatro modalidades de reparo foram comparadas ao método padrão: No grupo 1 (método padrão), as falhas ósseas foram reparadas com o transplante de osso autólogo da região parietal da calvária; nos grupos 2 e 3, as falhas ósseas foram reparadas com o biomaterial carreador osso bovino mineral sem e com o emprego de células-tronco mesenquimais humanas indiferenciadas, respectivamente; nos grupos 4 e 5, as falhas ósseas foram reparadas com o biomaterial carreador -tricálcio fosfato sem e com o emprego de células-tronco mesenquimais humanas indiferenciadas, respectivamente. A neoformação óssea na falha alveolar foi aferida por meio de imagens de tomografia computadorizada e avaliação histomorfométrica após 8 semanas da cirurgia. A neoformação óssea obtida por meio da avaliação histomorfométrica possibilitou a comparação dos grupos 2, 3, 4 e 5 com o grupo 1. Foi criado um sistema de pontos para determinar a distribuição do osso na falha óssea alveolar por meio das imagens de tomografia computadorizada em cinco animais por grupo, sendo 1 ponto para ossificação parcial, 2 pontos para ossificação total e heterogênea e 3 pontos para ossificação total e homogênea. O índice de significância estatístico p<0,05 foi determinado pelo teste não paramétrico de Mann-Whitney. RESULTADOS: Na avaliação histomorfométrica, o grupo 1 apresentou 60,27% ± 16,13% de osso na falha (n=7). Os grupos 2 e 3 apresentaram respectivamente, 23,02% ± 8,6% (n=3) Resumo (p=0,01) e 38,35% ± 19,59% (n=5) (p=0,06) de osso na falha. Os grupos 4 e 5 apresentaram respectivamente, 51,48% ± 11,7% (n=3) (p=0,30) e 61,8% ± 2,14% (n=6) (p=0,88) de osso na falha. Na avaliação radiológica, os animais dos grupos 1, 2, 3, 4 e 5 apresentaram média de pontos respectivamente igual a 2; 1,4; 1,5; 1,6, 1,8. CONCLUSÕES: O grupo de animais cujas falhas ósseas alveolares foram reparadas com -tricálcio fosfato e células-tronco mesenquimais apresentou a neoformação óssea mais semelhante a do grupo de animais cujas falhas ósseas foram reparadas com osso autólogo / INTRODUCTION: The current criterion standard to repair bone defects is an autogenous bone transfer. However, bone engineering strategies may become the first choice in the future. Bone bioengineering strategies are created through the association of inductive factors, stem cells and biomaterial matrices. The objective of this study was to measure the bone formation in an alveolar osseous defect animal model using different bone tissue engineering strategies and to compare them with the autogenous bone transfer. METHODS: Alveolar circular bone defects measuring 5 mm of diameter were created in 28 Wistar rats. Four alternative modalities were compared to the traditional modality of autogenous bone transfer: In group 1 (traditional modality), defects were repaired with autogenous bone graft from the calvarial region; in groups 2 and 3, defects were repaired using bovine bone mineral free of cells and loaded with undifferentiated mesenchymal stem cells, respectively; in groups 4 and 5, defects were repaired with - tricalcium phosphate free of cells and loaded with mesenchymal stem cells, respectively. Groups 2, 3, 4 and 5 were compared with group 1. Bone formation was evaluated by computed tomography imaging, and by histomorphometry at 8 weeks after surgery. Radiologically, a score system was developed to determine the bone distribution measured by computed tomography imaging in five animals of each group. Statistical significance was determined as p<0.05 by the non-parametric statistical hypothesis test called the Mann-Whitney test. RESULTS: Histomorphometrically, group 1 showed 60.27% ± 16.13% of bone in the defect (n=7). Groups 2 and 3 showed respectively, 23.02% ± 8.6% (n=3) (p=0.01) and 38.35% ± 19.59% (n=5) (p=0.06) of bone in the defect. Groups 4 and 5 showed respectively, 51.48% ± 11.7% (n=3) (p=0.30) and 61.80% ± 2.14% (n=6) (p=0.88) of bone in the defect. Radiologically, groups 1, 2, 3, 4 and 5 scored on average 2, 1.4, 1.5, 1.6, 1.8, respectively. CONCLUSION: The group of animals whose alveolar osseous defects Summary were repaired with -tricalcium phosphate and mesenchymal stem cells showed the most similar bone formation to the group whose alveolar osseous defects were repaired with autogenous bone

Clinical trials investigating autologous stem cell transplantation (ASCT) have historically excluded elderly patients due to the risk of treatment-related morbidity related to the administration of high dose chemotherapy. While the availability of this procedure continues to expand, the elderly still represent a population for which the role of ASCT needs to be fully defined. 201 patients who underwent autologous stem cell transplantation (ASCT) for Non Hodgkins lymphoma (NHL) at a single institution following BEAM conditioning between January 1, 2000 and December 31, 2007 were retrospectively identified from the Yale University School of Medicine Bone Marrow Transplant Database. 67 patients were older than 60 years at the time of transplantation (median age 65, range 60 75) and were compared to a matched group of 134 patients transplanted during the same time period. These groups were extremely well-matched for all demographics such as gender, NHL histology, performance status, and comorbidities. Most patients had advanced stage disease at diagnosis and were transplanted at first or second remission. Diffuse large B-cell and mantle cell lymphoma were the most common subtypes but other subtypes were represented. The elderly group experienced significantly more serious toxicities within the first 100 days (63%) when compared to the control group (42%). However, there were no statistical differences (p<0.0001) between the groups regarding specific organ system toxicities. The 1-year non-relapse mortality (3%) was not significantly different when compared to the younger cohort (1%). At a median follow-up of 31 months the median overall survival is 85 months in the elderly group and at a median follow up of 33 months in the younger group the median overall survival has not yet been reached. The overall survival at 3 years is 74% and 75% respectively (p=0.91). The disease-free survival at 3 years is 48% in the elderly group compared to 58% in the control group (p=0.66). By univariate analysis, age >60 years (RR 3.1, 95% CI 1.7 5.7, p=0.004) was the only factor predictive of developing a serious toxicity from ASCT within the first 100 days. HCT-CI score (RR 2, 95% CI 1 4, p=0.043) was the only factor associated with significantly worse overall survival. Autologous stem cell transplantation can be safely performed in selected patients older than 60 years with chemosensitive NHL. Although elderly patients appear more likely to develop acute toxicities, the outcomes are similar to that of younger patients with respect to non-relapse mortality, disease-free survival, and overall survival.

Patient expectations have been shown to be a major predictor of outcomes. Furthermore, fulfilled expectations have been linked to increased patient satisfaction and rehabilitation adherence. Expectations may be influenced by a variety of factors, including patient characteristics, pre-operative function, or disease characteristics. However, it is currently unknown what factors and to what degree they may influence patient expectations prior to knee surgery. Furthermore, understanding the importance and values of those expectations for recovery using qualitative methods has not previously been conducted in this patient population. A mixed methods design was used. Twenty-one participants scheduled to undergo cartilage repair of the knee, including autologous chondrocyte implantation, osteochondral allograft transplantation, or meniscal transplant were included. During their pre-operative visit, participants completed an expectations survey (Hospital for Special Surgery (HSS) Knee Surgery Expectations Survey) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) as a measure of functional ability. At their first post-operative visit, patients completed the Self-Efficacy for Rehabilitation Scale (SER). Rehabilitation adherence was collected by the participant’s rehabilitation provider. A selected sample of 6 participants participated in a semi-structured interview 6 months following surgery to better understand their expectations for recovery. Pearson correlation coefficients were used to determine relationships between expectations and KOOS scores, SER scores, and measures of adherence. Results demonstrated that patients have moderate expectations for recovery and these expectations were positively associated with pre-operative pain, activities of daily living, and knee-related quality of life as measured by the KOOS. In addition, a negative relationship was found between patient expectations and adherence with home exercises, use of a brace, and weight-bearing restrictions. Four qualitative themes emerged as participants’ described how previous recovery experiences shaped their recovery following cartilage repair of the knee. Patient education, pre-habilitation, and the use of psychological skills during rehabilitation may help to manage patient expectations, improve rehabilitation adherence, and assist clinicians in providing more focused and individualized patient care.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 5 uppsatser.

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