Li Chun-bong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 147-169). / Abstracts in English and Chinese. / Abstract --- p.i / Declaration --- p.vi / Acknowledgments --- p.vii / Table of Contents --- p.xi / List of Figures --- p.xii / List of Tables --- p.xvi / Abbreviations --- p.xvii / Chapter CHAPTER 1 --- INTRODUCTION AND LITERATURE REVIEWS / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Carcinoma of the cervix --- p.6 / Chapter 1.2.1 --- Squamous carcinoma --- p.6 / Chapter 1.2.2 --- Adenosquamous carcinoma --- p.7 / Chapter 1.2.3 --- Adenocarcinoma --- p.8 / Chapter 1.3 --- Molecular biology of Human papillomavirus --- p.9 / Chapter 1.3.1 --- Genome structure and organization of HPV --- p.9 / Chapter 1.3.2 --- Expression of papillomavirus genes --- p.11 / Chapter 1.3.3 --- Taxonomy of HPV --- p.20 / Chapter 1.4 --- Diagnostic techniques in HPV detection --- p.23 / Chapter 1.4.1 --- Southern blot analysis --- p.23 / Chapter 1.4.2 --- Dot blot analysis --- p.25 / Chapter 1.4.3 --- In situ hybridization --- p.26 / Chapter 1.4.4 --- Hybird Capture System --- p.28 / Chapter 1.4.5 --- Polymerase Chain Reaction --- p.30 / Chapter 1.5 --- Human papillomavirus in cervical carcinoma --- p.33 / Chapter 1.5.1 --- Prevalence --- p.33 / Chapter 1.5.2 --- Transmission --- p.37 / Chapter 1.5.3 --- Risk Factors --- p.39 / Chapter CHAPTER2 --- MATERIALS AND METHODS / Chapter 2.1 --- Materials --- p.44 / Chapter 2.1.1 --- Chemicals and regents --- p.44 / Chapter 2.1.2 --- Specimens collection --- p.48 / Chapter 2.2 --- Methods --- p.49 / Chapter 2.2.1 --- Summary of methodology --- p.50 / Chapter 2.2.2 --- DNA extraction from fresh and paraffin embedded tissues --- p.51 / Chapter 2.2.3 --- Polymerase Chain Reaction using HPV Consensus Primer MY09/11 --- p.55 / Chapter 2.2.3.1 --- Template for PCR --- p.55 / Chapter 2.2.3.2 --- PCR amplification --- p.55 / Chapter 2.2.3.3 --- PCR product analysis --- p.56 / Chapter 2.2.4 --- DNA sequencing --- p.57 / Chapter 2.2.4.1 --- DNA sequencing reaction for ALFexpress DNA automatic sequencing --- p.57 / Chapter 2.2.4.2 --- ABI comparative PCR sequencing --- p.59 / Chapter 2.2.4.3 --- DNA sequence analysis --- p.60 / Chapter 2.2.5 --- Restriction Fragment Length Polymorphism --- p.61 / Chapter 2.2.5.1 --- Template preparation --- p.61 / Chapter 2.2.5.2 --- Restriction enzyme digestion --- p.62 / Chapter 2.2.5.3 --- Agarose gel electrophoresis analysis --- p.62 / Chapter 2.2.6 --- HPV Type Specific PCR --- p.63 / Chapter 2.2.6.1 --- Preparation of positive control DNA --- p.63 / Chapter 2.2.6.2 --- Preparation of HPV 52 and HPV 58 type specific PCR --- p.63 / Chapter 2.2.6.3 --- PCR primer design --- p.66 / Chapter 2.2.6.4 --- PCR amplification --- p.68 / Chapter 2.2.7 --- Polymerase Chain Reaction using HPV Consensus Primer GP5+/6+ --- p.71 / Chapter 2.2.7.1 --- Template for PCR --- p.71 / Chapter 2.2.7.2 --- PCR amplification --- p.71 / Chapter 2.2.7.3 --- PCR product analysis --- p.72 / Chapter 2.2.8 --- Statistical analysis --- p.72 / Chapter CHAPTER3 --- RESULTS / Chapter 3.1 --- Histology review of tumor specimens --- p.73 / Chapter 3.2 --- Polymerase chain reaction of HPV consensus primer MY09/11 --- p.76 / Chapter 3.3 --- DNA sequencing reaction --- p.81 / Chapter 3.4 --- Restriction fragment length polymorphism --- p.86 / Chapter 3.5 --- HPV type specific polymerase chain reaction --- p.90 / Chapter 3.6 --- Polymerase chain reaction of HPV consensus primer GP5+/6+ --- p.109 / Chapter 3.7 --- "Correlations of HPV prevalence, geographical variation, histology and age of the cervical cancer patients" --- p.112 / Chapter CHAPTER4 --- DISCUSSION / Chapter 4.1 --- Prevalence of HPV infection in cervical cancer in China --- p.118 / Chapter 4.2 --- DNA extraction and detection methods --- p.131 / Chapter 4.3 --- Intratype variation of HPV --- p.141 / Chapter CHAPTER5 --- CONCLUSION AND FUTURE PERSPECTIVE --- p.143 / REFERENCES --- p.147 / RELEVANT PUBLICATIONS --- p.170

Diss. (sammanfattning) Göteborg : Univ. , 2008. / Härtill 4 uppsatser.

Base Teórica: O Câncer cervical é uma neoplasia maligna comum no mundo, especialmente nos países menos desenvolvidos. O diagnóstico e tratamento de lesões intraepiteliais de alto grau do colo do útero através de programas de rastreamento provaram ser eficazes na redução da mortalidade por câncer. Diferentes métodos estão disponíveis para o tratamento de lesões de alto grau. Métodos de excisão são geralmente preferidos em todo o mundo, porque eles são seguros e fornecem uma quantidade grande de material para o patologista, mas eles exigem uma estrutura que não é sempre disponível nos países em desenvolvimento. Métodos ablativos também são usados para tratar lesões de alto grau com altas taxas de sucesso sendo, geralmente, mais práticos e menos dispendiosos. A termocoagulação (cold coagulation) é um método ablativo que usa um instrumento portátil e de baixo custo que pode ser uma boa opção de tratamento, especialmente em países com recursos limitados. Objetivo: Neste artigo avaliamos a efetividade e a segurança da termocoagulação para o tratamento de lesões intraepiteliais cervicais de alto grau. Métodos: 52 mulheres de 25 a 59 anos com lesão intraepitelial de alto grau confirmada em biópsia e sem tratamento prévio foram convidadas a fazer parte deste estudo de janeiro de 2013 a dezembro de 2013. Resultados: A idade médiafoi de 34.2 anos. Um total de 52 pacientes foram tratadas com a termocoagulação sendo 61,5% com neoplasia intraepitelial cervical grau 3 (NIC 3) e 38,5% NIC 2. Após 6 meses, nenhuma das pacientes teve suspeita de lesão de alto grau persistente no exame citopatológico ou colposcopia. Após 12 meses, 2 pacientes tiveram NIC 3 confirmada em biópsia. A taxa de cura após a termocoagulação foi de 96,1% após um ano (IC 87.9% a 99.4%.). Nenhum efeito adverso grave foi documentado durante ou após o tratamento. Conclusão: A termocoagulação é um método seguro e eficaz para o tratamento de lesões intraepiteliais de alto grau. Este tratamento pode ser uma alternativa útil especialmente em países com recursos limitados. Estes são os primeiros resultados publicados utilizando a termocoagulação para o tratamento da displasia cervical de alto grau no Brasil encontrados na literatura. / Background: Cervical Cancer is a common malignant neoplasia in the world, specially in poor countries. The diagnosis and treatment of high grade intraepithelial lesions (HSIL) of the cervix through screening programs proved to be effective in reducing cancer mortality. Different methods are avaiable for treating high grade lesions. Excisional methods are usually preferred all over the world because they are safe and give a lot of material to the pathologist but they require a structure to be performed that is not always avaiable in developing countries. Ablative methods are also used to treat HSIL with extremely high rates of success and they are usually more practical and less expensive. Cold Coagulation is an ablative method that uses a portable and inexpensive instrument that can be a good treatment choice specially in countries with limited resources. Objective: In this article we present the data to evaluate the effectiveness and safety of the cold coagulation to treat high grade cervical intraepithelial lesions. Methods: 52 women from 25 to 59 years old with HSIL confirmed in a biopsy and no previous treatment were invited to be part of this study from January 2013 to December 2013. Results: The mean age of the patients was 34.2 years old. A total of 52 patients were treated with cold coagulation being 61.5% with Cervical Intraepithelial Neoplasia grade 3 (CIN3) and 38.5% CIN2. After 6 months none of the patients had any suspicion of persistent high grade lesion at citopathologic exam or colposcopy. After 12 months, 2 patients had CIN3 confirmed in a biopsy. The cure rate after cold coagulation was 96.1% after 1 year (CI 87.9% a 99.4%). No serious adverse effect was documented during or after the treatment. Conclusion: Cold Coagulation is a very effective and safe way of treating HSIL. It can be anusefull alternative specially in countries with limited resources. These are the first published results using cold coagulation for the treatment of HSIL in Brazil.

Base Teórica: O Câncer cervical é uma neoplasia maligna comum no mundo, especialmente nos países menos desenvolvidos. O diagnóstico e tratamento de lesões intraepiteliais de alto grau do colo do útero através de programas de rastreamento provaram ser eficazes na redução da mortalidade por câncer. Diferentes métodos estão disponíveis para o tratamento de lesões de alto grau. Métodos de excisão são geralmente preferidos em todo o mundo, porque eles são seguros e fornecem uma quantidade grande de material para o patologista, mas eles exigem uma estrutura que não é sempre disponível nos países em desenvolvimento. Métodos ablativos também são usados para tratar lesões de alto grau com altas taxas de sucesso sendo, geralmente, mais práticos e menos dispendiosos. A termocoagulação (cold coagulation) é um método ablativo que usa um instrumento portátil e de baixo custo que pode ser uma boa opção de tratamento, especialmente em países com recursos limitados. Objetivo: Neste artigo avaliamos a efetividade e a segurança da termocoagulação para o tratamento de lesões intraepiteliais cervicais de alto grau. Métodos: 52 mulheres de 25 a 59 anos com lesão intraepitelial de alto grau confirmada em biópsia e sem tratamento prévio foram convidadas a fazer parte deste estudo de janeiro de 2013 a dezembro de 2013. Resultados: A idade médiafoi de 34.2 anos. Um total de 52 pacientes foram tratadas com a termocoagulação sendo 61,5% com neoplasia intraepitelial cervical grau 3 (NIC 3) e 38,5% NIC 2. Após 6 meses, nenhuma das pacientes teve suspeita de lesão de alto grau persistente no exame citopatológico ou colposcopia. Após 12 meses, 2 pacientes tiveram NIC 3 confirmada em biópsia. A taxa de cura após a termocoagulação foi de 96,1% após um ano (IC 87.9% a 99.4%.). Nenhum efeito adverso grave foi documentado durante ou após o tratamento. Conclusão: A termocoagulação é um método seguro e eficaz para o tratamento de lesões intraepiteliais de alto grau. Este tratamento pode ser uma alternativa útil especialmente em países com recursos limitados. Estes são os primeiros resultados publicados utilizando a termocoagulação para o tratamento da displasia cervical de alto grau no Brasil encontrados na literatura. / Background: Cervical Cancer is a common malignant neoplasia in the world, specially in poor countries. The diagnosis and treatment of high grade intraepithelial lesions (HSIL) of the cervix through screening programs proved to be effective in reducing cancer mortality. Different methods are avaiable for treating high grade lesions. Excisional methods are usually preferred all over the world because they are safe and give a lot of material to the pathologist but they require a structure to be performed that is not always avaiable in developing countries. Ablative methods are also used to treat HSIL with extremely high rates of success and they are usually more practical and less expensive. Cold Coagulation is an ablative method that uses a portable and inexpensive instrument that can be a good treatment choice specially in countries with limited resources. Objective: In this article we present the data to evaluate the effectiveness and safety of the cold coagulation to treat high grade cervical intraepithelial lesions. Methods: 52 women from 25 to 59 years old with HSIL confirmed in a biopsy and no previous treatment were invited to be part of this study from January 2013 to December 2013. Results: The mean age of the patients was 34.2 years old. A total of 52 patients were treated with cold coagulation being 61.5% with Cervical Intraepithelial Neoplasia grade 3 (CIN3) and 38.5% CIN2. After 6 months none of the patients had any suspicion of persistent high grade lesion at citopathologic exam or colposcopy. After 12 months, 2 patients had CIN3 confirmed in a biopsy. The cure rate after cold coagulation was 96.1% after 1 year (CI 87.9% a 99.4%). No serious adverse effect was documented during or after the treatment. Conclusion: Cold Coagulation is a very effective and safe way of treating HSIL. It can be anusefull alternative specially in countries with limited resources. These are the first published results using cold coagulation for the treatment of HSIL in Brazil.

Base Teórica: O Câncer cervical é uma neoplasia maligna comum no mundo, especialmente nos países menos desenvolvidos. O diagnóstico e tratamento de lesões intraepiteliais de alto grau do colo do útero através de programas de rastreamento provaram ser eficazes na redução da mortalidade por câncer. Diferentes métodos estão disponíveis para o tratamento de lesões de alto grau. Métodos de excisão são geralmente preferidos em todo o mundo, porque eles são seguros e fornecem uma quantidade grande de material para o patologista, mas eles exigem uma estrutura que não é sempre disponível nos países em desenvolvimento. Métodos ablativos também são usados para tratar lesões de alto grau com altas taxas de sucesso sendo, geralmente, mais práticos e menos dispendiosos. A termocoagulação (cold coagulation) é um método ablativo que usa um instrumento portátil e de baixo custo que pode ser uma boa opção de tratamento, especialmente em países com recursos limitados. Objetivo: Neste artigo avaliamos a efetividade e a segurança da termocoagulação para o tratamento de lesões intraepiteliais cervicais de alto grau. Métodos: 52 mulheres de 25 a 59 anos com lesão intraepitelial de alto grau confirmada em biópsia e sem tratamento prévio foram convidadas a fazer parte deste estudo de janeiro de 2013 a dezembro de 2013. Resultados: A idade médiafoi de 34.2 anos. Um total de 52 pacientes foram tratadas com a termocoagulação sendo 61,5% com neoplasia intraepitelial cervical grau 3 (NIC 3) e 38,5% NIC 2. Após 6 meses, nenhuma das pacientes teve suspeita de lesão de alto grau persistente no exame citopatológico ou colposcopia. Após 12 meses, 2 pacientes tiveram NIC 3 confirmada em biópsia. A taxa de cura após a termocoagulação foi de 96,1% após um ano (IC 87.9% a 99.4%.). Nenhum efeito adverso grave foi documentado durante ou após o tratamento. Conclusão: A termocoagulação é um método seguro e eficaz para o tratamento de lesões intraepiteliais de alto grau. Este tratamento pode ser uma alternativa útil especialmente em países com recursos limitados. Estes são os primeiros resultados publicados utilizando a termocoagulação para o tratamento da displasia cervical de alto grau no Brasil encontrados na literatura. / Background: Cervical Cancer is a common malignant neoplasia in the world, specially in poor countries. The diagnosis and treatment of high grade intraepithelial lesions (HSIL) of the cervix through screening programs proved to be effective in reducing cancer mortality. Different methods are avaiable for treating high grade lesions. Excisional methods are usually preferred all over the world because they are safe and give a lot of material to the pathologist but they require a structure to be performed that is not always avaiable in developing countries. Ablative methods are also used to treat HSIL with extremely high rates of success and they are usually more practical and less expensive. Cold Coagulation is an ablative method that uses a portable and inexpensive instrument that can be a good treatment choice specially in countries with limited resources. Objective: In this article we present the data to evaluate the effectiveness and safety of the cold coagulation to treat high grade cervical intraepithelial lesions. Methods: 52 women from 25 to 59 years old with HSIL confirmed in a biopsy and no previous treatment were invited to be part of this study from January 2013 to December 2013. Results: The mean age of the patients was 34.2 years old. A total of 52 patients were treated with cold coagulation being 61.5% with Cervical Intraepithelial Neoplasia grade 3 (CIN3) and 38.5% CIN2. After 6 months none of the patients had any suspicion of persistent high grade lesion at citopathologic exam or colposcopy. After 12 months, 2 patients had CIN3 confirmed in a biopsy. The cure rate after cold coagulation was 96.1% after 1 year (CI 87.9% a 99.4%). No serious adverse effect was documented during or after the treatment. Conclusion: Cold Coagulation is a very effective and safe way of treating HSIL. It can be anusefull alternative specially in countries with limited resources. These are the first published results using cold coagulation for the treatment of HSIL in Brazil.

Orientador: Ibsen Bellini Coimbra / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-08T15:22:56Z (GMT). No. of bitstreams: 1 Santos_Elizangelados_M.pdf: 1146638 bytes, checksum: 6c22665ed4ca26b8c6d58369b61b8268 (MD5) Previous issue date: 2006 / Resumo: A osteoartrite (OA), osteoartrose, ou ainda doença articular degenerativa é enfermidade que tem sido muito estudada em razão do grande número de pessoas acometidas por ela. A espondilose cervical é o tipo de osteoartrite que acomete a coluna cervical e é também conhecida pela sua grande incidência. Os trabalhos disponíveis na literatura e que estudaram a OA limitaram-se fundamentalmente à sua etiologia, métodos diagnósticos, marcadores bioquímicos e formas de tratamento, não considerando, no entanto, algumas queixas apresentadas por esses pacientes sobre alguns sinais e sintomas auditivos como as disacusias, os zumbidos e as tonturas, muitas vezes presentes e relatados pelos pacientes por ela acometidos. Este estudo analisou em uma amostra de 50 pacientes, a prevalência de sinais e sintomas auditivos em portadores de espondilose cervical através da anamnese e da avaliação audiométrica e da vectoeletronistagmografia. Verificou-se através das respostas obtidas na anamnese que 44% (22) dos enfermos consideravam sua audição boa, enquanto 56% (28 pacientes) não. Dentre esses pacientes, encontraram-se em 33% deles alterações na orelha direita, 48% na orelha esquerda e em 19% alterações nas duas orelhas. Na avaliação dos resultados dos exames audiométricos (audiometria tonal) encontrou-se ainda uma maior porcentagem de indivíduos com uma alteração auditiva nas freqüências altas (4,6,8Hz) (52%,66%,66%) na orelha esquerda e na orelha direita somente na freqüência de 6 Hz (56%). Em relação à presença de zumbidos, 36 (72%) pacientes relataram a sua presença. Quando verificada a ocorrência de vertigem, 37 (74%) dos 50 pacientes a apresentaram, no entanto, os exames de vectoeletronistagmografia foram normais. conclui-se, portanto, que há prevalência de sinais e sintomas otológicos em portadores de espondilose cervical, embora eles não apareçam, necessariamente, concomitantemente, sendo que a vertigem aparece com maior freqüência, seguida por zumbido e, logo após, pela hipoacusia / Abstract: The osteoarthiris (OA) is the most common rheumatologic disease and cervical spondylosis is the OA on the cervical spine. It has been well studied in the past few years, mainly due to its high prevalence, as well as the costs to the health systems all over the world. The great majority of those studies have been focusing on its pathophysiologic aspects, etiology, diagnosis and its treatment. However few studies considered some symptoms that cervical spondylosis carriers can present, such as tinnitus and vertigo, in a such way frequent in the practical clinic. The aim of this study was to analyze in a sample of 50 patients with cervical spondylosis the auditory prevalence of signs and symptoms. It was observed that 56% of them (28 patients) didn't consider their audition as ?Good?, whereas 44% (22 patients) didn?t have any complaint. Among those subjects that didn't consider audition good the right ear was reported with deficit by 33%, the left ear by 48% and by 19% patients, both ears had problems.All patients underwent to a tonal audiometric evaluation. Its was observed a greater percentage of individuals with an audition "No Good" in the high (4, 6, 8Hz) (52%, 66%, 66% respectively) frequencies in the left ear and in the frequency of 6 Hz (56%) in the right ear. The results showed that 36 (72%) patients presented tinnitus complaint. When it verified the complaint of vertigo, 37 (74%) patients presented complaint, whose examinations of vectography had been normal. We concluded that there is a connection between signs and hearing symptoms, such as hearing loss, tinnitus e vertigo, among the patients with cervical spondylosis, suggesting that more studies in this area are required / Mestrado / Clinica Medica / Mestre em Clinica Medica

Orientador: Alberto Cliquet Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T16:33:33Z (GMT). No. of bitstreams: 1 Sakai_DenisSeguchi_M.pdf: 2873973 bytes, checksum: aeb14c04fce3c257f6e361abd03d43e1 (MD5) Previous issue date: 2013 / Resumo: Introdução: O trauma raquimedular apresenta maior incidência em indivíduos do sexo masculino entre 15 e 40 anos de idade. A denervação da musculatura segmentar da coluna vertebral abaixo do nível da lesão medular altera a postura do tronco no plano sagital destes indivíduos. Adaptações posturais ocorrem na coluna cervical e podem predispor à degeneração precoce do disco intervertebral e/ou das articulações facetárias, resultando na formação de osteófitos nos corpos vertebrais, diminuição do calibre dos forâmens intervertebrais e do canal vertebral. O envelhecimento da coluna cervical (espondilose cervical) é um processo lento. Sua sintomatologia é imprevisível e ocorre após a 5a década de vida na população geral, podendo decorrer de compressões radiculares ou medulares. As compressões radiculares apresentam-se clinicamente como dores irradiadas nos membros superiores, diminuição da força muscular (paresia) e alterações da sensibilidade (parestesia). Já as compressões medulares (ou mielopatia cervical) levam à incoordenação dos movimentos finos nas mãos, alterações de marcha (claudicação), do equilíbrio e disfunções no controle esfincteriano vesical e anal. Os paraplégicos preservam as funções nos membros superiores e dependem exclusivamente destes para a realização das atividades diárias. As alterações mecânicas no plano sagital na coluna cervical de indivíduos paraplégicos poderiam, deste modo, desencadear precocemente o processo de envelhecimento da coluna cervical levando a sintomas compressivos radiculares e/ou medulares cervicais com uma importante perda de função para estes indivíduos. Objetivo: O objetivo primário deste estudo foi correlacionar o alinhamento da coluna cervical no plano sagital de indivíduos paraplégicos com o nível de lesão neurológica torácica. O objetivo secundário foi caracterizar e comparar as alterações degenerativas radiográficas em diferentes níveis de lesão medular torácica. viii Metodologia: Foi realizada a análise radiográfica da coluna cervical de 12 indivíduos paraplégicos torácicos (9 do sexo masculino e 3 do sexo feminino) com lesão medular há mais de 1 ano (média de 9,1 anos, de 4 a 15 anos). Os indivíduos foram divididos em 2 grupos: 6 apresentavam lesão medular abaixo de T9 e outros 6, acima ou em T8, de acordo com a classificação da American Spinal Injury Association (ASIA). A lordose global, mensurada de C2 a C7 e a lordose local, mensurada para cada nível cervical foram comparadas. Sinais radiográficos de degeneração cervical (diminuição da altura do disco intervertebral, formação de osteófitos e esclerose dos platôs vertebrais) também foram analisados utilizando o método de Gore et al., e os resultados foram comparados entre os grupos. Resultados: O grupo com lesão medular em T8 ou acima apresentou maiores medidas de lordose global (55o ± 5,7o vs 26,2o ± 3,8o, p<0,0001), especialmente nos segmentos C5-C6 (10,7o ± 5,9o vs 1o ± 3,1o, p=0,02) e C6-C7 (18o ± 3,5o vs 4,5o ± 3,6o, p<0,0001). Não foram encontradas diferenças quanto às alterações degenerativas radiográficas entre os grupos em C4-C5 (p=0,16), C5-C6 (p=0,06) e C6-C7 (p=0,31). Conclusão: Este estudo preliminar indica que o nível de lesão medular influencia o alinhamento cervical no plano sagital aumentando a lordose especialmente nos segmentos mais distais e nos indivíduos com lesão medular em T8 ou acima / Abstract: Introduction: Spinal cord injury occurs more frequently in males between 15 and 40 years old. The loss of innervation in the segmental musculature of the spine below the level of spinal cord injury modifies the posture of the trunk in these subjects. Consequently, adaptative postural changes occur in the cervical spine predisposing to early degeneration of the intervertebral disc and/or facet joints, osteophyte formation and narrowing of the spinal canal and foramina. The degeneration of the cervical spine, known as cervical spondylosis, is a slow process and its symptoms usually occur after the 5th decade of life, and may result in radicular and/or cord compressions. Radicular compressions may present as radiating pain to the upper extremities, diminished strength and abnormal sensation. Spinal cord compressions, on the other hand, may present as a loss of fine movements in the hands, abnormal gait, impaired balance and dysfunctions in the vesical and anal sphincters. Paraplegics depend on the upper extremities for everyday activities and the development of radicular and/or spinal cord compressive symptoms in these subjects can be devastating. Mechanical changes in the sagittal plane of the cervical spine of paraplegics might result in early degeneration of this segment and an increasing disability for everyday activities over time. Objective: The primary endpoint of this study was to analyse the differences in the cervical spine alignment in paraplegics according to their level of spinal cord injury. The secondary endpoint was to compare degenerative findings on conventional radiographs between two different groups of paraplegics. Participants/methods: Twelve paraplegics (9 males and 3 females) sustaining more than 1 year of injury (average 9,1, from 4 to 15 years) had their sagittal cervical spine x-rays analyzed. They were divided into 2 groups: 6 patients had injuries below T9 and another 6, at or above T8, according to the American Spinal Injury Association (ASIA) classification. The global lordosis, x measured from C2 to C7, and the local lordosis, measured for each level were compared between the groups. Radiographic cervical degeneration (loss of disc height, osteophytes formation and end-plate sclerosis) was also quantified using a previous method described by Gore et al. and compared between the groups. Results: Results indicate that paraplegics sustaining higher spinal cord injuries (at or above T8) have an increased global lordosis (55o ± 5,7o vs 26,2o ± 3,8o, p<0,0001) specially in the lower segments - C5-C6 (10,7o ± 5,9o vs 1o ± 3,1o, p=0,02) and C6-C7 (18o ± 3,5o vs 4,5o ± 3,6o, p<0,0001). No differences were found comparing the radiographic scores for cervical degeneration between the groups at C4-C5 (p=0,16), C5-C6 (p=0,06) and C6-C7 (p=0,31). Conclusion: This preliminary study indicates that the level of spinal cord injury influences the cervical sagittal alignment with an increase in lordosis specially in the lower segments and in subjects with spinal cord injury at or above T8 / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

No description available.

Made available in DSpace on 2011-11-09T14:45:46Z (GMT). No. of bitstreams: 2 license.txt: 1648 bytes, checksum: e095249ac7cacefbfe39684dfe45e706 (MD5) 000232.pdf: 784982 bytes, checksum: 4f41fbc5c9c9b8e2a3af0a8aa222d83e (MD5) Previous issue date: 2008 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / A classificação citológica cérvico-vaginal mais atualizada, e que tem sido empregada em quase todo o mundo, é a do Sistema Bethesda. Sua última atualização, em 2001, subdividiu a categoria de células escamosas atípicas de significado indeterminado (Atypical Squamous Cells of Undetermined Significance – ASCUS) em ASC-US (de significado indeterminado) e ASC-H (quando não se pode excluir lesão intra-epitelial de alto grau), na qual espera-se maior probabilidade de se encontrar lesão precursora do câncer do colo. No Brasil, esta subdivisão foi adotada oficialmente pelo SUS (Sistema Único de Saúde) em junho de 2006, fazendo parte da Nomenclatura Brasileira para Laudos Citopatológicos. Esta pesquisa tem por objetivo medir a prevalência de lesão intra-epitelial escamosa de alto grau e câncer cervical em pacientes encaminhadas do SUS com citologia ASC-H, e comparar o risco desta lesão nas subcategorias de células escamosas atípicas (Atypical Squamous Cells - ASC) através do cálculo da Razão de Prevalências. Sua metodologia é baseada em casos com citologias ASCUS do SITEC (Sistema Integrado de Tecnologia em Citopatologia) recebidos no IFF (Instituto Fernandes Figueira) no período de agosto de 1998 a setembro de 2007, que foram revisados de acordo com o Sistema Bethesda 2001 até que se chegasse a um diagnóstico de consenso. Os casos ASC-H e ASC-US resultantes desta revisão, bem como os casos novos recebidos a partir de 2004, foram incluídos e analisados em relação ao desfecho. Para esta análise, incluíram-se os casos com diagnóstico histológico. Nos casos sem histologia, a colposcopia e a citologia foram consideradas como padrão-ouro. A prevalência da lesão de alto grau na citologia ASC-H foi de 19,29% (IC 95% 9,05 – 29,55%) e a possibilidade de doença de alto grau foi maior entre as pacientes com citologia ASC-H comparado às pacientes com citologia ASC-US (RP = 10,42 ICvii 95% 2,39 – 45,47) p = 0,0000764. Encontrou-se lesão de alto grau com maior freqüência nas pacientes abaixo dos 50 anos (RP = 2,67 IC 95% 0,38 – 18,83) porém sem significância estatística (p = 0,2786998). Não foram encontrados casos de câncer do colo do útero. A prevalência de lesão de alto grau em pacientes com citologia ASC-H foi significativa e a divisão em subcategorias do diagnóstico ASC se mostrou com boa capacidade para discriminar a presença de lesões de alto grau. / The Bethesda System is the most recent cervical and vaginal citopathology classification used almost worldwide. The Bethesda System’s last revision (2001) subdivided the category of Atypical Squamous Cells of Undetermined Significance (ASCUS) in ASC-US (of undetermined significance) and ASC-H (cannot exclude highgrade intraepithelial lesion), the last one carrying greater probability of finding precursors lesions of cervical cancer. This subdivision was adopted oficially by Brasilian Public Health System (SUS) in June 2006, becoming part of the Brasilian Nomenclature for Citopathological Reports. The aim of the study was measure the prevalence of High-grade Squamous Intraepithelial Lesion (HSIL) and cervical cancer, in patients whit citology of ASC-H and compare the risk of HSIL in the subcategories of ASC-H and ASC-US by Prevalence Ratio. The metodology was based in cases with citology ASCUS from SITEC (Integrated System of Tecnology in Citopatology) received in IFF (Fernandes Figueira Institute) from August 1998 to September 2007. The cytologies were reviwed by Bethesda System 2001 until a consensus diagnostic. The resultant cases of ASC-H and ASC-US from this review and the new cases recived from 2004, were included and analysed in relation to final diagnostic. This analysis included histology (gold standard) and those cases without histology, citology and colposcopy were the gold standard. We found 19,29% (CI 95% 9,05 – 29,55%) of prevalence of HSIL in ASC-H citology and the possibility of HSIL was greater in ASC-H cytology than in ASC-US (PR= 10,42, CI 95% 2,39 – 45,47%). We did not find cervical cancer. The prevalence of high-grade intraepithelial lesion in patients with ASC-H citology was significant and the subdivision of ASC (Atypical Squamous Cells) was good in discriminating the presence of HSIL.

Yeung Sze-wan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references. / Abstracts in English and Chinese. / ACKNOWLEDGEMENT --- p.i / ABSTRACT --- p.ii / ABBREVIATIONS --- p.vii / TABLE OF CONTENTS --- p.ix / Chapter CHAPTER 1 --- INTRODUCTION --- p.1-1 / Chapter 1.1 --- Anatomy of the Cervix --- p.1-1 / Chapter 1.2 --- Histology --- p.1-1 / Chapter 1.2.1 --- Squamous Epithelium --- p.1-1 / Chapter 1.2.2 --- The Endocervical Epithelium --- p.1-3 / Chapter 1.2.3 --- The Squamo-columnar Junction --- p.1-4 / Chapter 1.2.3.1 --- The Embryology --- p.1-4 / Chapter 1.2.3.2 --- Definition --- p.1-4 / Chapter 1.3 --- Human Papillomaviruses (HPVs) --- p.1-6 / Chapter 1.3.1 --- Structure of the Viruses --- p.1-6 / Chapter 1.3.2 --- The Nomenclature --- p.1-7 / Chapter 1.3.3 --- HPVs Genomic Structure and Properties of Gene Products --- p.1-7 / Chapter 1.3.4 --- Target Tissues --- p.1-8 / Chapter 1.3.5 --- Role of HPVs in the Carcinogenesis of Lesions --- p.1-9 / Chapter 1.3.6 --- Risk Groups of HPVs --- p.1-10 / Chapter 1.4 --- Pathology --- p.1-11 / Chapter 1.4.1 --- Macroscopic Features --- p.1-11 / Chapter 1.4.2 --- Symptoms and Diagnosis --- p.1-12 / Chapter 1.4.3 --- Histopathology --- p.1-13 / Chapter 1.4.3.1 --- Histopathological Grading of Cervical Intraepithelial Neoplasia --- p.1-19 / Chapter 1.4.3.2 --- Staging of Cervical Cancer --- p.1-24 / Chapter 1.5 --- Epidemiology of Cervical Intraepithelial Neoplasia and Cervical Cancer --- p.1-27 / Chapter 1.5.1 --- Descriptive Epidemiology --- p.1-28 / Chapter 1.5.2 --- Risk Factors --- p.1-30 / Chapter 1.6 --- Human Papillomavirus Type 16 --- p.1-42 / Chapter 1.6.1 --- Role of HPV16 in CIN and Cervical Carcinoma --- p.1-42 / Chapter 1.6.2 --- Viral Load of HPV 16 in CIN --- p.1-43 / Chapter 1.6.3 --- HPV 16 Viral Load as a Screening Tool --- p.1-46 / Chapter 1.7 --- Quantitation of HPV 16 --- p.1-48 / Chapter 1.7.1 --- Methods in Viral Quantification --- p.1-48 / Chapter 1.7.2 --- Selection of Methodology --- p.1-51 / Chapter 1.7.3 --- Correlation of HPV 16 Viral Loading with Severity of Cervical Lesions --- p.1-54 / Chapter CHAPTER 2 --- AIMS OF STUDY --- p.2-1 / Chapter CHAPTER 3 --- MATERIALS AND METHODS --- p.3-1 / Chapter 3.1 --- Materials --- p.3-1 / Chapter 3.1.1 --- Patients and Specimens --- p.3-1 / Chapter 3.2 --- Methods --- p.3-3 / Chapter 3.2.1 --- DNA Extraction --- p.3-3 / Chapter 3.2.2 --- Polymerase Chain Reaction --- p.3-7 / Chapter 3.2.3 --- Gel Electrophoresis --- p.3-8 / Chapter 3.2.4 --- Real-time Quantitation Polymerase Chain Reaction --- p.3-11 / Chapter 3.2.5 --- Statistical Analysis --- p.3-15 / Chapter CHAPTER 4 --- RESULTS --- p.4-1 / Chapter 4.1 --- Grading of Cervical Smears --- p.4-1 / Chapter 4.2 --- Incidence of HPV 16 Detected in Cervical Smears --- p.4-2 / Chapter 4.2.1 --- Detection of HPV 16 in Women for Routine Pap Smear --- p.4-2 / Chapter 4.2.2 --- Detection of HPV 16 in Women for Colposcopic Examination --- p.4-5 / Chapter 4.3 --- Quantification of HPV 16 by Real-time PCR --- p.4-5 / Chapter 4.3.1 --- Range of Detection --- p.4-10 / Chapter 4.3.2 --- Standard Curve --- p.4-12 / Chapter 4.3.3 --- Reproducibility of Quantitative Real-time PCR --- p.4-17 / Chapter 4.3.4 --- Sensitivity of Quantitative Real-time PCR --- p.4-17 / Chapter 4.3.5 --- Detection and Quantification of HPV 16 E6/7 Genes in HPV16 Positive Cervical Scrapes --- p.4-21 / Chapter 4.4 --- Comparison of HPV 16 Copy Number Detected among Three Lesion Groups --- p.4-22 / Chapter 4.5 --- Clinical Analysis --- p.4-27 / Chapter 4.6 --- HPV 16 DNA Copy Number in Lesion Groups --- p.4-28 / Chapter CHAPTER 5 --- DISCUSSION --- p.5-1 / Chapter 5.1 --- Selection of Material (Scrapes) --- p.5-1 / Chapter 5.2 --- Detection of HPV 16 in Cervical Scrapes --- p.5-3 / Chapter 5.2.1 --- Selection of HPV Type --- p.5-3 / Chapter 5.2.2 --- Techniques in Detecting HPV Viral Load --- p.5-3 / Chapter 5.2.2.1 --- Advantages of Quantitative Real-time PCR --- p.5-6 / Chapter 5.2.2.2 --- Parameters Affecting the Performance of Real-time PCR --- p.5-8 / Chapter 5.2.3 --- Selection of Detection Sites --- p.5-9 / Chapter 5.2.4 --- Standard Curve Establishment --- p.5-10 / Chapter 5.3 --- Comparison between Real-time PCR and Traditional PCR --- p.5-12 / Chapter 5.4 --- Role of HPV Viral Load in Cervical Neoplasm --- p.5-13 / Chapter 5.5 --- HPV Infection in Hong Kong Chinese Women --- p.5-17 / Chapter 5.6 --- Clinical Significance of HPV 16 Viral Load Detected in Cervical Neoplasm --- p.5-18 / Chapter 5.7 --- Future Prospect --- p.5-20 / Chapter CHAPTER 6 --- CONCLUSION --- p.6-1 / REFERENCES --- p.R-I