<b>Background:</b> The survival rate of preterm children has risen steadily due to advances in obstetric and neonatal intensive care. Children born extremely preterm (&le;28 weeks of gestation) are at high risk of long term developmental problems, including cerebral palsy, motor and cognitive impairment, visual and auditory deficits and behavioural problems. This can have serious implications for their quality of life and that of their family and carers. These children take up a disproportionate amount of neonatal intensive care unit resources and overall costs, and as they grow up are more likely to require additional health and social care services beyond routine care to compensate for their functional limitations. The early identification and management of factors that mediate long term outcome is necessary to assist healthcare professionals in selecting appropriate treatment pathways, and to develop, target and evaluate interventions. Many risk factor analyses for neurodevelopmental impairment have been published in preterm populations, but this vast literature has not been formally summarised. Furthermore, there is a dearth of studies reporting longitudinal analysis of neurodevelopmental trajectories from early childhood to adulthood. <b>Objectives:</b> The first aim of this thesis was to perform a comprehensive systematic review of the world literature over the last two decades, to consolidate the evidence about the prognosis of neurodevelopmental outcome in children born very preterm or with very low birth weight. The second aim was to conduct a longitudinal analysis of a cohort of extremely preterm participants followed up into early adulthood to investigate the trajectories of long term sequelae over time, and to examine the association of neurodevelopmental course in relation to the predictive factors identified in the systematic review. <b>Methods:</b> A systematic review was conducted using MEDLINE, EMBASE and PyscINFO databases to identify studies published between January 1 1990 and June 1 2014 reporting multivariable prediction models for the neurodevelopment of children born &le;32 weeks of gestation or with a birth weight &le;1250 grams (protocol registration number CRD42014006943). Seventy-eight studies reporting 222 risk factor models for neurodevelopmental outcome were identified. Two independent reviewers extracted key information about study design, outcome definition, risk factor selection, model development, reporting, and conducted a risk of bias assessment. To address the second objective of the study, a longitudinal analysis of cognitive and behavioural trajectories was conducted using a prospective, population-based cohort study in the United Kingdom and the Republic of Ireland. Three hundred and fifteen surviving infants born less than 26 completed weeks of gestation recruited at birth in 1995 and 160 term-born classroom peers recruited at age six were followed-up to 19 years. Participants were invited for up to four standardized, blinded cognitive assessments and the parent-completed Strengths and Difficulties Questionnaire was used to assess behavioural problems. <b>Results:</b> The systematic review of risk factors for motor impairment in children born very preterm or with very low birth weight provided strong evidence that neonatal brain injury is a robust prognostic factor for cerebral palsy, and some evidence that the use of postnatal steroids increases the risk and the use of antenatal steroids reduces the risk of cerebral palsy. There was moderate evidence that male sex was prognostic for motor impairment at school age in children free of major disability. The systematic review of risk factors for cognitive impairment identified male sex, non-white ethnicity, lower levels of parental education and lower birth weight as significant predictors of global cognitive dysfunction in early infancy, with parental education having a sustained impact after five years of age. There was also evidence that male sex was predictive of delayed language development in early infancy. Gestational age was found to be of limited use as prognostic factor for cerebral palsy, motor and cognitive impairment in cohorts restricted to &le;32 weeks of gestation. There was a dearth of good quality studies investigating risk factors for behavioural problems and psychiatric disorders and the findings of this review were inconclusive. The only factors that appeared to be consistent predictors of general behavioural problems were markers of socio-economic deprivation, neurodevelopmental or cognitive delay, and an abnormal behavioural screen in early infancy. In the longitudinal analysis of the prospective, population-based cohort of extremely preterm children, cognitive trajectories were stable in both the extremely preterm and term-born groups over time with persistent deficit in the extremely preterm group of 25.2 IQ points (95&percnt; CI: -27.8 to -22.6, p&LT;0.001) and only minimal catch-up over time. Participants with neonatal brain injury and of male sex had the largest deficits, but a lower level of maternal education and earlier gestational age at birth were also associated with reduced IQ scores. Behavioural problems were also more prevalent among the extremely preterm participants who had a mean Total Difficulties Score of 4.81 points above their term-born peers (95&percnt; CI: 3.76 to 5.87, p&LT;0.001) and which persisted over the time period. Behavioural difficulties were mainly due to hyperactivity, inattention and peer problems and were strongly associated with a positive behavioural screen in early infancy. <b>Conclusions:</b> The most robust predictors of poor neurodevelopmental outcome identified by the systematic review were neonatal brain injury, male sex, and markers of social disadvantage. The unclear findings for many risk factors may reflect differences in study design, study population, methodological quality and lack of standardization of measures. Or it may simply reflect the fact that prognostic modelling in such a heterogeneous population is challenging and complex, with multiple risk factors acting sequentially over time, and often with the existence of multiple impairments within the same individual. The main conclusions from the longitudinal analysis of children born extremely preterm is that being born too soon appears to place limits on brain plasticity and function which is not recovered over time; with the most vulnerable being males and those with evidence of brain injury early in life. These structural abnormalities may disturb neurodevelopmental processes and impede the brain from maintaining a normal developmental trajectory. If extremely preterm children fail to achieve optimum levels of cognitive function and are still experiencing behavioural problems once they have reached maturity, then this has implications for health and well-being in later adulthood and old age. Cognitive test scores in infancy and early childhood reflect early adult outcomes and a positive behavioural screen in infancy is strongly associated with early adult behavioural outcomes. <b>Recommendations:</b> The systematic review revealed some shortcomings in methodology and reporting that could be improved in future studies, and confirmed that that there is a dearth of properly designed and well-conducted prognostic modelling studies in this field. The findings and recommendations of this critical review should be used as a basis for the design, analysis and reporting of future studies seeking to develop multivariate risk factor or prognostic models in this population. There is an urgent need for larger population cohorts followed up routinely beyond two years as subtle outcomes such as impairment of executive function and fine motor skills cannot be reliably assessed at this age, and the natural course of some disorders may have their onset later in childhood. / Studies with larger sample sizes and greater power are needed for studying less common conditions in preterm populations and there should be more standardisation of outcome and risk factor measurements, particularly with the use of standard diagnostic evaluations to assess psychiatric disorders. Future studies should include a term-born comparison group and adopt appropriate statistical analysis techniques to analyse longitudinal outcome data and the impact of risk factors on these trajectories. Additional research is required to improve the prediction of individual differences, and to identify the neuropathological differences underlying different developmental trajectories and their interaction with environmental influences over time.

Bakgrund: Fler kvinnor överlever sin bröstcancer tack vare tidig upptäckt och behandling av tumörer. Den primära behandlingen för bröstcancer är omfattande med operation, cellgifter samt strålning som ger biverkningar. Den ökade överlevnaden ställer krav på uppföljningsvården, där uppgiften är att följa upp förändringar i hälsan efter avslutad primär behandling. Syfte: Syftet var att belysa kvinnors upplevelser av vården efter primär behandling för bröstcancer. Metod: En litteraturöversikt genomfördes enligt Fribergs metod. Databassökningen av resultatartiklar gjordes med sökord relaterade till “bröstcancer”, “uppföljningsvård” samt “upplevelser” eller “erfarenheter” i MEDLINE with Full Text samt Cinahl Complete. Sökningarna gjordes med begräsningen att artiklarna skulle ha publicerats mellan åren 2008 och 2018. Nio kvalitativa studier samt en med mixad metod analyserades avseende likheter/skillnader och tematiserades. Resultat: Analysen resulterade i tre teman. Kvinnornas informationsbehov som har två underteman: Informationsbrist angående uppföljningsvården som handlar om informationsbrist från specialistvården vid utskrivning av primär behandling som påverkade kvinnorna i tiden efter och informationsbrist i uppföljningsvården som handlar om informationsbrist under uppföljningar. Det andra huvudtemat är: Hur kvinnorna föredrogs att följas upp och kontinuitet. Det tredje huvudtemat är: Stressade besök och att inte bli bemött utifrån sina behov. Diskussion: I metoddiskussionen diskuteras litteraturöversiktens styrkor samt svagheter. I resultatdiskussionen diskuteras resultatet utifrån bakgrunden, annan forskning samt Antonovskys teori om känsla av sammanhang. Resultatet visar att kvinnor efter avslutad primär behandling upplever att det finns informationsbrister. Författarna diskuterar sjuksköterskans roll i uppföljningsvården av bröstcancerpatienter. / Background: More women survive their breast cancer due to early detection and treatment of the tumour. The primary treatment for breast cancer is extensive with surgery, chemotherapy, radiation and side effects. The increased survival poses higher demands for the follow-up care, where the task is to monitor changes in health after completion of primary treatment. Aim: The aim was to explore women's’ experience of care following end of primary treatment for breast cancer. Method: A literature review was performed according to Friberg's method. The following electronic databases were searched: Cinahl Complete and Medline with Full Text. Terms related to “breast cancer”, “follow upp care” samt “experience” eller “perceptions” were used in all searches. One mixed method and nine qualitative articles, published between 2008 and 2018, were included in the review. Results were thematized based on similarities and differences. Results: The analysis resulted in three themes. Women's information needs that have two sub-themes: Lack of information regarding follow-up care, which is about the lack of information from the specialist care which affected women posttreatment and The lack of information in the follow-up care which is about information shortages during follow-ups. The second main theme is: Womens preference about follow-up care and continuity. The third main theme is: Stressful visits and not being met from their needs. Discussion: In the method discussion the literature review strength and weaknesses are discussed. In the result discussion, the results are discussed based on the background, new research, and Antonovsky's theory of sense of coherence. The result shows that there are information shortages. The authors discuss the role of the nurse in the after care for breast cancer patients.

Loss to follow-up (LTF) is an important issue that can affect the validity of longitudinal studies. Further, LTF among adolescent study participants may be predicted by variables such as substance use, educational attainment, and demographic information. The purpose of this study was to determine if alcohol or marijuana use, high school completion, or demographic information was correlated with LTF among adolescent participants in the Real Talk Study. The Real Talk study is a randomized control trial that employs a brief motivational interview intervention in a clinical setting to reduce perpetration of teen dating violence (TDV) in Boston. Current participants of the Real Talk study who were eligible for follow up comprised the study sample (N=127). Baseline characteristics on age, gender, race/ethnicity, high school completion, alcohol use, and marijuana use were analyzed using Pearson’s Chi Square, and the level of significance set to p < 0.10. A post-hoc analysis was conducted on frequency of alcohol use using Pearson’s Chi Square. Of the total sample, 13% were LTF (n=17). The results of the analyses indicated that there was a statistically significant difference between those LTF and those retained for gender and drinking 6 or more drinks of alcohol per occasion. Females were more likely to be LTF than males (p<0.10), and those participants who responded “never” or “less than monthly” to the question, “how many times do you drink 6 or more drinks per occasion?” were more likely to be retained, or less likely to be LTF (p<0.10) than those who responded differently. While some of the results were consistent with the literature, it is also possible that the follow-up procedure for Real Talk ensured that there were minimal differences in LTF.

INTRODUCTION: Celiac disease is a chronic immune disorder for which the only treatment is strict life-long adherence to a gluten-free diet (GFD). Collaborative management through regular follow-up with a care team that includes physicians and dietitians may improve long-term outcomes. However, many individuals with celiac disease are lost to follow-up. OBJECTIVE: This primary objective of this study was to identify factors associated with pediatric celiac disease patients being lost to follow-up. Secondary aims included identifying adherence to recommended care practices by both patients and providers. METHODS: A chart review of 250 randomly selected children with biopsy-confirmed celiac disease diagnosed between 2010 and 2014 at Boston Children’s Hospital (BCH) was conducted. Follow-up records were reviewed from diagnosis to 2017. Eligible children were diagnosed prior to age 18 and did not attend BCH solely for a second opinion. Demographics, medical history, visit information, and lab results were collected using an online database. RESULTS: Of the 241 eligible subjects (64% female, 1-17 years, median 9.7 years) the median time until lost to follow-up was 2.8 years from diagnosis (IQR, 1.0-4.7 years) with 22 subjects (9%) not attending any follow-up visits with their pediatric gastroenterologist (GI) after diagnosis and an additional 37 subjects (14%) lost within the first year. A majority of subjects (83%) attended a GFD education visit with a registered dietitian, although this was not associated with follow-up adherence (P>0.5). Excluding those who had aged out of the clinical practice, children who were adherent to follow-up had a younger mean age of diagnosis (95% CI 0.5-3.1, P<0.01). Children who were insured under Medicaid/CHIP (N=20) were more likely to be lost within one year compared to those with private health insurance (P<0.01). Celiac serologies taken at time of last clinical visit were abnormal in 25% of the subjects with available results (N=141) and the median time since diagnosis in this positive serology subgroup was 20 months (IQR, 12-29 months). DISCUSSION: The present study illustrates that children with celiac disease are not being followed-up adequately and that identifiable disparities exist in the pediatric celiac disease population. Within three years of diagnosis, 50% of the cohort was lost to follow-up with the majority of subjects lost within the first year of diagnosis. Children diagnosed at a younger age were more adherent to follow-up compared to those diagnosed during adolescence. Factors associated with decreased adherence included reliance on public medical insurance and older age at diagnosis. Improvement in long-term management of celiac disease may be achieved by increased outreach and education.

This diploma thesis deals with the topic of wind power plants and environmental impact assessment. The first part it describes the issue by the method of literature review. It focuses especially on the issue of wind power, the EIA process and post-project analysis. This thesis analyzes existing methodological approaches of EIA evaluation in the Czech Republic and transboundary context. The second part handles with the specific case study of post-project analysis of the wind park Strážný Vrch Nová Ves v Horách with emphasis on checking compliance with the conditions contained in the EIA review and its integration into follow-up documentation and operation of the project. The work also formulates methodological principles for EIA wind power plants in the Czech Republic and evaluating the impact of wind turbines on the environment.

Introdução: Após o tratamento primário do câncer invasor de colo de útero, não existe protocolo de seguimento rigorosamente definido para essas pacientes. O tipo de acompanhamento dessas mulheres é individualizado, e não há consenso sobre a melhor estratégia a ser adotada. Objetivo: Avaliar o papel dos exames de seguimento (exame físico, citologia e exames de imagens) pós-tratamento de neoplasia de colo uterino no diagnóstico de recidivas assintomáticas e sintomáticas. Material e métodos: Foram revisados todos os prontuários das pacientes com diagnóstico de câncer de colo uterino desde 1985 até 2010. Nesse período, houve um total de 359 pacientes elegíveis para o estudo, sendo 64 destas com recidiva tumoral. Todas as análises estatísticas foram realizadas com a ajuda do programa SPSS v.18.0. Foi considerado um nível de significância de 5%. Resultados: Das 359 pacientes consideradas para o estudo, 64 (17,8%) apresentaram recidiva tumoral. Destas, 34 (53,1%) foram sintomáticas, e 30 (46,9%), assintomáticas. A maioria das pacientes teve sua recidiva diagnosticada através do exame físico, tanto no grupo das pacientes sintomáticas (50%) como no das assintomáticas (66,7%) (p = 0000). O exame citopatológico foi o responsável pela detecção da recidiva em somente um caso em ambos os grupos, correspondendo a 2,9 e 3,3%, respectivamente (p = 0000). Os exames de imagem (raio X de tórax, tomografia abdominal, ecografia abdominal, cintilografia óssea) somam 10 casos (29,4%) dos diagnósticos nas pacientes sintomáticas e oito casos (26,6%) nas assintomáticas (p = 0000). Não houve diferença estatisticamente significativa entre os grupos ou entre os diferentes métodos de detecção de recidiva. Ajustando para potenciais fatores de confusão, como a idade e o tipo de tratamento, também não houve associação. Conclusão: O grande sinalizador de recidiva tumoral neste estudo foi o exame físico. Nenhum dos exames coadjuvantes foi capaz de detectar as recorrências, tanto nas pacientes sintomáticas como nas assintomáticas. Esses resultados mostram a grande necessidade de estudos prospectivos que comparem a efetividade de diferentes regimes de seguimento que avaliem questões como a sobrevida global e a qualidade de vida. / Introduction: There is no strictly defined follow-up protocol for patients who have undergone primary treatment for invasive cervical cancer. These women are managed on a case-by-case basis and there is no consensus on the first-choice strategy. Objective: To evaluate the role played by follow-up tests and examinations (physical examination, cytology and imaging exams) in diagnosing symptomatic and asymptomatic relapses after treatment for neoplasms of the cervix. Materials and Methods: Data were collected from medical records for all patients diagnosed with cervical cancer from 1985 to 2010. There were a total of 359 eligible patients during that period, 64 of whom had tumor relapses. All statistical analyses were performed with the aid of SPSS v.18.0. The significance level adopted was 5%. Results: Sixty-four (17.8%) of the 359 patients investigated suffered tumor relapse. Thirty-four (53.1%) were symptomatic and 30 (46.9%) were asymptomatic. A majority of patients had tumor relapse diagnosed during physical examination, both among the symptomatic patients (50%), and the asymptomatic patients (66.7%) (p = 0.274). Cytopathology was responsible for detecting relapse in just 1 case in each group, corresponding to 2.9 and 3.3%, respectively (p = 0.999 Imaging exams (chest X-ray, abdominal tomography, abdominal ultrasound, bone scintigraphy) detected 10 (29.4%) relapses among symptomatic patients and 8 cases (26.6%) among asymptomatic patients (p = 0.770). There were no statistically significant differences between the two groups or between the different methods of detecting relapses. There was still no association after adjustment for potential confounding factors such as age and type of treatment. Conclusions: Physical examination was the preeminent method for detecting tumor relapse in this study. None of the other tests or exams were capable of detecting relapses in both symptomatic and asymptomatic patients. These results highlights the urgent need for prospective studies that compare the efficacy of different follow-up regimes, analyzing factors such as global survival and quality of life.

A presente dissertação tem como objetivo investigar o impacto da cirurgia de redesignação sexual em quatro dimensões da vida de transexuais masculino para feminino que foram acompanhados no PROTIG em um seguimento de dois anos póscirúrgico. Foi avaliada a satisfação em relação à cirurgia de redesignação sexual, as relações sexuais, as relações com parceiros e os relacionamentos familiares. Os sujeitos deste estudo foram entrevistados pela equipe do PROTIG. Participaram deste estudo 52 transexuais MpF que realizaram a cirurgia entre 2000 e 2008 (média 3,8 ± 1,7 anos póscirúrgico) e que responderam a um questionário estruturado, antes e depois da cirurgia. Os resultados encontrados evidenciaram que nenhum paciente se arrependeu de submeter-se ao procedimento cirúrgico de redesignação sexual. Após a cirurgia, a maioria dos pacientes (88,61%) referiu que as relações sexuais haviam melhorado. O sexo com a neovagina foi considerado agradável para 88,46% dos pacientes e 78,84% referiram que manter e/ou iniciar um relacionamento tornou-se mais fácil após a cirurgia. O número de pacientes com parceiro aumentou de 51,93% para 65,38%. Não ocorreram relatos de prejuízo nas relações com os membros da família após a cirurgia de redesignação sexual e 29 participantes (56,77%) relataram melhoria nas relações familiares, enquanto 23 (44,23%) não relataram diferença. / This thesis aims to investigate the impact of sex reassignment surgery in four dimensions of life of male to female transsexuals who were follow up by PROTIG after two postoperative years. Satisfaction in relation to sex reassignment surgery, sex, relationships with partners and family relationships was assessed. The study subjects were interviewed by the PROTIG team. The study included 52 MPF transsexuals who underwent surgery between 2000 and 2008 (mean 3.8 ± 1.7 years post surgery) who responded to a structured questionnaire before and after surgery. The results showed that no patient regretted to undergo sex reassignment surgery. After surgery, most patients (88.61%) reported that sexual relations had improved. Sex with the neovagina was considered enjoyable for 88.46% and 78.84% of patients reported that maintain and / or start a relationship has become easier after surgery. The number of patients with partners increased from 51.93% to 65.38%. There were no reports of damage in relations with family members after sex reassignment surgery and 29 participants (56.77%) reported improvement in family relationships, while 23 (44.23%) reported no difference.

En 2006 Dilmanian et al. ont proposé une méthode d'irradiation par rayonnement synchrotron innovante appelée minifaisceaux. L'irradiation de tumeur par minifaisceaux monochromatiques consiste en un motif fractionné spatialement de faisceaux de rayons X submillimétriques produits par un synchrotron. Afin d'obtenir une dose homogène dans le volume cible, deux incidences orthogonales sont entrecroisées. Le tissu sain environnant ne subit que l'irradiation fractionnée, entre les faisceaux la dose n'est dûe qu'au diffusé et l'énergie déposée y est donc 10 à 15 fois inférieure à celle déposée sur les axes des faisceaux. Cela permet un effet protecteur des tissus sains tout en distribuant de fortes doses à la tumeur. Cette thèse porte sur le développement de la méthode expérimentale des minifaisceaux monochromatiques, ce qui comprend le contrôle de la géométrie d'irradiation, la dosimétrie expérimentale et l'étude Monte Carlo correspondante. Afin d'évaluer son efficacité, des études précliniques ont été réalisées sur un modèle de tumeur cérébrale implantée chez le rat (F98). Un suivi de traitement est réalisé par de l'imagerie anatomique et fonctionnelle afin d'évaluer son efficacité. L'imagerie de perfusion cérébrale (menant aux volumes et débits sanguin cérébrales, au temps de transit moyen) est d'après la littérature un moyen efficace de pronostique du résultat du traitement. Les paramètres clés de la vascularisation cérébrale sont principalement étudiés par imagerie IRM, du fait de l'innocuité de ce type d'imagerie. La Synchrotron Radiation Computed Tomography (SRCT) est une modalité d'imagerie dont les performances sont proches des limites théoriques dans l'obtention de mesures absolues des concentrations d'agent de contraste et peut être utilisé en tant que gold-standard. Les modèles pharmacocinétiques utilisés nécessitent comme paramètre d'entrée des concentrations d'agent de contraste en fonction du temps. La relation entre le signal obtenu par IRM et la concentration d'agent de contraste est très complexe et difficilement quantitative. Une comparaison des mesures de perfusion effectuées par IRM et par SRCT a été effectuée afin de calibrer les mesures IRM. / An innovative method of synchrotron radiation therapy, called minibeams, was proposed by A. Dilmanian et al. in 2006. Minibeams consists in tumor irradiation with monochromatic submillimetric x-ray beams spatially fractionated produced by a synchrotron source. To obtain a homogeneous dose in the target volume, an interleaving is realized using two orthogonal incidences. Adjacent healthy tissue is only partially irradiated by minibeams, the areas between the beams only receive scattered radiation and therefore the energy deposited is 10 to 15 times lower than on one minibeam axis, leading to a sparing effect of healthy tissue even when a high dose is deposited in the target volume. The thesis project is the development of this experimental method of monochromatic minibeams, which involves the control of the irradiation geometry, the control of dosimetry and its modeling by Monte Carlo simulations. To evaluate the method, preclinical experiments on models of brain tumors implanted in rats (F98) are performed. Follow-up by anatomical and functional imaging is carried out to evaluate the effectiveness of the treatment. Functional imaging of cerebral perfusion (volume and cerebral blood flow, mean transit time of heavy elements) appears to be associated in the literature as a relevant method for monitoring prognostic. The key parameters of the cerebral vasculature are mainly studied in magnetic resonance imaging (MRI), because of the harmlessness of this imaging modality. The relation between MRI signal and contrast agent concentration is very complex and no quantitative relationship is well known. Synchrotron Radiation Computed Tomography (SRCT) is an imaging modality with performances to measure absolute contrast agent concentration very close to the theoretical limits and can be used as gold-standard. The used pharmacokinetic models need as input parameters a contrast agent concentration versus time. A comparison of perfusion measurements between MRI and SRCT has been done in order to calibrate MRI measurements.

Made available in DSpace on 2014-06-11T19:27:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T19:57:02Z : No. of bitstreams: 1 sene_mg_me_botfm.pdf: 956728 bytes, checksum: fe9e35a9180c7ad377bc30cbf9974ccd (MD5) / A paracoccidioidomicose (Pbmicose) é micose sistêmica causada pelo fungo dimórfico Paracoccidioides brasiliensis, que acomete principalmente trabalhadores rurais do sexo masculino. A doença tem como principais manifestações clínicas a forma aguda/subaguda e a forma crônica. Métodos sorológicos têm considerável valor na Pbmicose e diferentes testes têm sido utilizados no diagnóstico e monitoramento da resposta do paciente ao tratamento. O objetivo deste estudo foi avaliar a IFI, a ID e o ELISA antes e após introdução do tratamento de pacientes com a forma aguda/subaguda e a forma crônica da Pbmicose. Para cada teste, os seguintes parâmetros foram avaliados: sensibilidade (SE), especificidade (EP), valor preditivo positivo (VPP), valor preditivo negativo (VPN) e eficiência (EF). No período pré-tratamento a IFI teve SE=92,3%, VPP= 87,5%, VPN= 92% e EF=88,6%. A ID teve SE=94,93%, VPP=97,4%, VPN=95% e EF=96,2%. Para o ELISA, SE=100%, VPP=95%, VPN=100% e EF=97,4%. No grupo de doadores de sangue, a EP da IFI, da ID e do ELISA foram, respectivamente, de 93,3%, 100% e 100%. Em soros de pacientes com outras micoses sistêmicas (histoplasmose, criptococose, actinomicose, aspergilose e adiaspiromicose), as EP para os testes foram de 60%, 90% e 80%, respectivamente. Durante o tratamento, maior correlação foi obtida entre a ID e o ELISA (r= 0,61591, p<0,05), obtendo-se baixas correlações com a IFI. O tempo necessário para negativar o ELISA (Md= 20,0 meses) foi maior do que a ID (Md= 13,5 meses). O ELISA se negativou em geral nove meses após a ID, o que sugere que este teste passe a ser um referencial para suspensão do tratamento de manutenção. Devido à sua elevada sensibilidade, especificidade, VPP, VPN e eficiência, o ELISA deve ser incluído na rotina sorológica de pacientes com Pbmicose. / Pararaccidioidomycosis (Pbmycosis) is a systemic mycosis caused by the dimorphic fungus Paracoccidioiodes brasiliensis, which often affects rural workers, usually male adults. The overt disease is manifested by two clinical forms, acute/subacute and chronic forms. Serological methods are of considerable value in Pbmycosis, and various tests has been utilized in the diagnostic and monitoring the patient's response to treatment. The aim of this study was to evaluated the reliability of the double immunodiffusion test (ID), indirect immunofluorescence (IIF) and immunoenzymatic assay (ELISA) in the pre-treatment and during the period of treatment of patients with acute/subacute and chronic forms of Pbmycosis. For each test the following parameters were evaluated: Sensitivity (SE), Specificity (SP), Positive and Negative Predictive Values (PPV and NPV) and Efficiency (EF). In the pre-treatment period these values for IFI were SE=92.3%, PPV=87.5%, NPV=92% and EF=88.6%. For ID: SE=94.9%, PPV=97.4%, NPV=95% EF=96.2%. For ELISA: SE=100%, PPV=95%, NPV=100% and EF=97.4%. In the group of blood donors, for IFI, ID and ELISA the ES were, respectively, 93.3%, 100% and 100%. In patients with other deep mycosis (histoplasmosis, cryptococcosis, actinomycosis, aspergillosis and adiaspiromycosis) the ES for these tests were respectively 60%, 90% and 80%. During the period of treatment, the highest correlation was observed between ID and ELISA (r= 0,61591, p<0,05), and the lowest correlations with IFI. The time elapsed to negative the ELISA was larger (Md=20 months) than for ID (Md= 13,5 meses). In overall, the ELISA negativated nine months after ID. This result suggests that the ELISA may be a referential test to monitoring the time for interruption of the treatment in Pbmycosis. Moreover, owing to its high values of SE, SP, PPV, NPV and EF, ELISA should be included in the serological routine for patients with Pbmycosis.

Introdução: Após o tratamento primário do câncer invasor de colo de útero, não existe protocolo de seguimento rigorosamente definido para essas pacientes. O tipo de acompanhamento dessas mulheres é individualizado, e não há consenso sobre a melhor estratégia a ser adotada. Objetivo: Avaliar o papel dos exames de seguimento (exame físico, citologia e exames de imagens) pós-tratamento de neoplasia de colo uterino no diagnóstico de recidivas assintomáticas e sintomáticas. Material e métodos: Foram revisados todos os prontuários das pacientes com diagnóstico de câncer de colo uterino desde 1985 até 2010. Nesse período, houve um total de 359 pacientes elegíveis para o estudo, sendo 64 destas com recidiva tumoral. Todas as análises estatísticas foram realizadas com a ajuda do programa SPSS v.18.0. Foi considerado um nível de significância de 5%. Resultados: Das 359 pacientes consideradas para o estudo, 64 (17,8%) apresentaram recidiva tumoral. Destas, 34 (53,1%) foram sintomáticas, e 30 (46,9%), assintomáticas. A maioria das pacientes teve sua recidiva diagnosticada através do exame físico, tanto no grupo das pacientes sintomáticas (50%) como no das assintomáticas (66,7%) (p = 0000). O exame citopatológico foi o responsável pela detecção da recidiva em somente um caso em ambos os grupos, correspondendo a 2,9 e 3,3%, respectivamente (p = 0000). Os exames de imagem (raio X de tórax, tomografia abdominal, ecografia abdominal, cintilografia óssea) somam 10 casos (29,4%) dos diagnósticos nas pacientes sintomáticas e oito casos (26,6%) nas assintomáticas (p = 0000). Não houve diferença estatisticamente significativa entre os grupos ou entre os diferentes métodos de detecção de recidiva. Ajustando para potenciais fatores de confusão, como a idade e o tipo de tratamento, também não houve associação. Conclusão: O grande sinalizador de recidiva tumoral neste estudo foi o exame físico. Nenhum dos exames coadjuvantes foi capaz de detectar as recorrências, tanto nas pacientes sintomáticas como nas assintomáticas. Esses resultados mostram a grande necessidade de estudos prospectivos que comparem a efetividade de diferentes regimes de seguimento que avaliem questões como a sobrevida global e a qualidade de vida. / Introduction: There is no strictly defined follow-up protocol for patients who have undergone primary treatment for invasive cervical cancer. These women are managed on a case-by-case basis and there is no consensus on the first-choice strategy. Objective: To evaluate the role played by follow-up tests and examinations (physical examination, cytology and imaging exams) in diagnosing symptomatic and asymptomatic relapses after treatment for neoplasms of the cervix. Materials and Methods: Data were collected from medical records for all patients diagnosed with cervical cancer from 1985 to 2010. There were a total of 359 eligible patients during that period, 64 of whom had tumor relapses. All statistical analyses were performed with the aid of SPSS v.18.0. The significance level adopted was 5%. Results: Sixty-four (17.8%) of the 359 patients investigated suffered tumor relapse. Thirty-four (53.1%) were symptomatic and 30 (46.9%) were asymptomatic. A majority of patients had tumor relapse diagnosed during physical examination, both among the symptomatic patients (50%), and the asymptomatic patients (66.7%) (p = 0.274). Cytopathology was responsible for detecting relapse in just 1 case in each group, corresponding to 2.9 and 3.3%, respectively (p = 0.999 Imaging exams (chest X-ray, abdominal tomography, abdominal ultrasound, bone scintigraphy) detected 10 (29.4%) relapses among symptomatic patients and 8 cases (26.6%) among asymptomatic patients (p = 0.770). There were no statistically significant differences between the two groups or between the different methods of detecting relapses. There was still no association after adjustment for potential confounding factors such as age and type of treatment. Conclusions: Physical examination was the preeminent method for detecting tumor relapse in this study. None of the other tests or exams were capable of detecting relapses in both symptomatic and asymptomatic patients. These results highlights the urgent need for prospective studies that compare the efficacy of different follow-up regimes, analyzing factors such as global survival and quality of life.