Made available in DSpace on 2016-08-10T10:39:21Z (GMT). No. of bitstreams: 1 CIRCONCISTO LAURENTINO RIBEIRO JUNIOR.pdf: 2083186 bytes, checksum: bfcfede933b252abac1e5de63aa561f2 (MD5) Previous issue date: 2009-03-13 / Endometriosis it is considered as the presence of ectopic endometrial tissue, with similar histology and function to the endometrium usually located. However, the explanation for the implantation of the endometrial tissue in certain women is still unknown. The determination of the degree of compromising of the endometriosis is based on a system of points proposed by American Fertility Society finds of the laparoscopy. Endometriosis is a disease that occurs mainly in women in reproductive age. The disease can be related with infertility in 30% to 40% of the cases. The possible mechanisms as the endometriosis as cause of the infertility are: (a) interference with the sexual function (dyspareunia, reduction of the frequency of sexual intercourse). (b) Interference with the ovulation: (anovulation; deficient luteal phase and luteinization phase. The aim of this study was to determine the frequency of p53 polymorphism codon 72, in two groups of patients with endometriosis and other symptoms of the disease. The study included 38 peripheral blood samples from women submitted to videolaparoscopy that confirmed endometriosis. The patients were divided into two groups of 19 women each, one with infertility and the other not. The polymorphism was evaluated by PCR. The data were submitted to statistical analysis using the chi-square and odds ratio tests. Of the patients who only had pain and/or bleeding without infertility, 09 (47.3%) were arginine homozygous and 10 (52.6%) were proline homozygote or heterozygote. Of those who presented with infertility associated with pain and/or bleeding, 12 (100%) were proline homozygous or heterozygous, and in those with only complaint of infertility, 05 (71.4%) were arginine homozygous and 02 (28.6%) proline homozygous or heterozygous). In correlating pain intensity, 04 (23.5%) women with the proline allele (homozygous or heterozygous) reported slight or moderate pain and 20 (95.5%) intense pain. All these differences were statistically significant (p= 0.003). In relating pain intensity to laparoscopic classification, the following was found: 08 (50%) patients who showed slight or moderate pain had a classification I or II and 08 (50%) III or IV. Of those with intense pelvic pain, 08 (36.4%) were included in classification I or II and 14 (63.6%) in III or IV. The proline allele (homozygous or heterozygous) is linked more to patients with infertility and with a more severe clinical picture. / A endometriose é conceituada como a presença de tecido endometrial ectópico, com histologia e função semelhante ao endométrio normalmente situado. No entanto, a explicação para a implantação do tecido endometrial em determinadas mulheres ainda é desconhecida. O grau do comprometimento da endometriose baseia-se num sistema de pontos proposta pela American Fertility Society (1978), hoje denominada American Society for Reproductive Medicine com base nos achados de laparoscópica. A intenção deste estudo foi determinar a freqüência do polimorfismo do p53, códon 72, em dois grupos de pacientes com endometriose e outros sintomas da doença. O estudo incluiu 38 amostras de sangue periférico de mulheres submetidas à videolaparoscopia com diagnóstico confirmado de endometriose. As pacientes foram divididas em dois grupos de 19 mulheres cada, um com infertilidade e o outro não. O polimorfismo foi avaliado por PCR. Os dados foram submetidos a análise estatística sendo usado o teste de qui-quadrado e Odds Ratio. Dos pacientes que só tiveram dor e/ou sangramento sem infertilidade, 09(47,3 %) eram arginina homozigoto e 10(52,6%) eram prolina homozigoto ou heterozigoto. Das pacientes que apresentaram infertilidade associado à dor e/ou sangramento 12(100%) era prolina homozigoto ou heterozigoto. Das pacientes que queixavam apenas de infertilidade, 05 (71,4%) eram arginina homozigoto e 02 (28,6%) prolina homozigoto ou heterozigoto. Correlacionando intensidade da dor, 04(23,5%) com alelo prolina (homozigoto ou heterozigoto) informaram dor leve e/ou moderada e 20(95,5%) dor intensas. Todas essas diferenças foram estatisticamente significativas (p=0,003). Em intensidade da dor relacionado com a classificação laparoscópica foi encontrado o seguinte: 08(50%) pacientes que tiveram dor leve e/ou moderada tiveram classificação I ou II e 08(36,4%) foram incluídos na classificação III ou IV. Das pacientes com dor intensa, 08(36,4%) foram incluídas na classificação I ou II e 14 (63,6%) em III ou IV. Conclui-se que a presença do alelo prolina (homozigoto ou heterozigoto) está mais relacionado com pacientes com endometriose e com quadro clínico mais severo da doença.

The presence of TP53 mutations has been associated with inferior outcome in diffuse large B-cell lymphoma (DLBCL) and chronic lymphocytic leukemia (CLL). In DLBCL, the impact of the TP53 codon 72 polymorphism and MDM2 SNP309 has not been clearly elucidated, whereas MDM2 SNP309 was suggested as a poor-prognostic marker in CLL. In addition, p16INK4a promoter hypermethylation has been implicated as a negative prognostic factor in DLBCL. The aim of this thesis was to further evaluate these molecular markers in well-characterised materials of DLBCL and CLL. In paper I, we investigated the prognostic role of TP53 mutation, codon 72 polymorphism and MDM2 SNP309 in DLBCL (n=102). The presence of TP53 mutations (12.7%) correlated with a poor lymphoma-specific and progression-free survival, and a particularly pronounced effect was observed in the germinal center subtype. Neither the MDM2 SNP309 nor the TP53 codon 72 polymorphism had an impact on age of onset or survival. In paper II, we applied pyrosequencing to measure the level of p16INK4a methylation in DLBCL (n=113). Thirty-seven percent of cases displayed p16INK4a methylation; however, no clear association could be observed between degree of methylation and clinical characteristics or lymphoma-specific survival. In papers III–IV, we investigated the prognostic role of MDM2 SNP309 (n=418) and TP53 mutation (n=268) in CLL. No correlation was observed between any particular MDM2 SNP309 genotype and time to treatment and overall survival. Furthermore, no association was found between the different MDM2 SNP309 genotypes and established CLL prognostic markers. TP53 mutations were detected in 3.7% of CLL patients; where the majority showed a concomitant 17p-deletion and only three carried TP53 mutations without 17p-deletion. We confirmed a significantly shorter overall survival and time to treatment in patients with both TP53 mutation and 17p-deletion. Altogether, our studies could confirm the negative prognostic impact of TP53 mutations in DLBCL, whereas MDM2 SNP309 and TP53 codon 72 polymorphisms appear to lack clinical relevance. We also question the role of p16INKa methylation as a poor-prognostic factor in DLBCL. Finally, the presence of TP53 mutation in CLL appears to be rare at disease onset and instead arise during disease progression.