The purpose of this study was to find out about the presence of unannounced home visits in foster families based on a survey of Swedish municipalities. The study also aimed at increasing knowledge about why unannounced home visits were made. In order to achieve the purpose of this study, mixed methods were used in both a quantitative and qualitative approach. The quantitative part of the study consisted of a census where all Swedish municipalities' guidelines and procedures for the prevention of foster homes were collected. Qualitative interviews were held with five social services, which stated in their guidelines that unannounced home visits should be made. To analyze both the study's quantitative and qualitative results, theories of legitimacy and power were used. The study concluded that the law on follow-up of foster homes gives municipalities a large margin of interpretation because the visits are regulated by the municipalities themselves. Another conclusion from the study was that no one knows which follow-up methods that really helps. Therefore, evaluations and research on follow-up of foster care must be established.

Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. In cardiac surgery, one-third of the patients experience episodes of AF during the first postoperative days (postoperative AF), and patients with preoperative AF (concomitant AF) can be offered ablation procedures in conjunction with surgery, in order to restore ordinary sinus rhythm (SR). The aim of this work was to study the relation between postoperative AF and inflammation; the long-term consequences of postoperative AF on mortality and late arrhythmia; and atrial function after concomitant surgical ablation for AF. In 524 open-heart surgery patients, C-reactive protein (CRP) serum concentrations were measured before and on the third day after surgery. There was no correlation between levels of CRP and the development of postoperative AF. All 1,419 patients with no history of AF, undergoing primary aortocoronary bypass surgery (CABG) in the years 1997–2000 were followed up after 8.0 years. The mortality rate was 191 deaths/1,000 patients (19.1%) in patients with no AF and 140 deaths/419 patients (33.4%) in patients with postoperative AF. Postoperative AF was an age-independent risk factor for late mortality, with a hazard ratio (HR) of 1.56 (95% CI 1.23–1.98). Postoperative AF patients had a more than doubled risk of death due to cerebral ischaemia, myocardial infarction, sudden death, and heart failure compared with patients without AF. All 571 consecutive patients undergoing primary CABG during the years 1999–2000 were followed-up after 6 years. Questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.3% of all patients. In postoperative AF patients, 14.1% had AF at follow-up, compared with 2.8% of patients with no AF at surgery (p<.001). An episode of postoperative AF was found to be an independent risk factor for development of late AF, with an adjusted risk ratio (RR) of 3.11 (95% CI 1.41–6.87). Epicardial microwave ablation was performed in 20 open-heart surgery patients with concomitant AF. Transthoracic echocardiography was performed preoperatively and at 6 months postoperatively. At 12 months postoperatively 14/19 patients (74%) were in SR with no anti-arrhythmic drugs. All patients in SR had preserved left and right atrial filling waves (A-waves) and Tissue velocity echocardiography (TVE) showed preserved atrial wall velocities and atrial strain. In conclusion, postoperative AF is an independent risk factor for late mortality and later development of AF. There is no correlation between the inflammatory marker CRP and postoperative AF. Epicardial microwave ablation of concomitant AF results in SR in the majority of patients and seems to preserve atrial mechanical function.

In 2015 a new national Child Health Care Program was introduced in Uppsala County, Sweden. Due to this, the Child Health Center’s speech-language screening for 3-year old’s was moved to 2½ years. The same method of screening - ‘Westerlunds 3-årsmetod’ - is maintained, though there have been a few changes. The children are only expected to use two-word utterances for a passable result, contrary to the earlier requirement for three-word utterances. The absence of three-word utterances now means a follow-up at the age of three. The purpose of the present study was to evaluate the part in “Westerlunds 3-årsmetod” which examines length of utterances, by examining if the absence of three-word utterances could be used as an indicator for language difficulties and whether a postponement of the screening (with approximately a month) could ensue in fewer children being called for a follow-up. The participants were recruited through mail to families with children just above the age for the 2½ year speech-language screening. It proved difficult to find participants for the study with the chosen recruitment method and on that account an additional recruitment was implemented. Despite that, none of the possible participants met all the inclusion criteria in the end, which meant that the prospective analyses could not be performed and therefore the research questions could not be entirely answered. A choice was made to analyze the already collected data, meaning that the entire group of children screened in the right age range (2:6-2:9) were examined. The group consisted of 26 children, 14 girls and 12 boys. The average age was 2:6 years (min: 2:6, max: 2:8). Of these 8% (2 children) were not using three-word utterances, although they also had other difficulties. Based on this group vague indications could be seen suggesting that a connection between age and the time of screening does not exist. Most of the children, 95%, screened at the age of 2:6 years passed the screening without remarks. Furthermore, it turned out that some children were screened as early as 2:5 with passable results. Consequently, no data in this study supports the notion that a postponement of the screening would result in fewer follow-ups. It should be noted that due to insufficient data no clear conclusions can be drawn. / År 2015 infördes det nya nationella barnhälsovårdsprogrammet i Uppsala. Det resulterade i en förflyttning av språkscreeningen på barnavårdscentralen (BVC), från 3 års ålder till 2 ½ år. Samma screeningmetod - Westerlunds 3-årsmetod - används fortfarande, med vissa mindre ändringar. En förändring som skett i och med förflyttningen är att barnen vid 2 ½ år inte längre förväntas tala i treordssatser för godkänt resultat. Istället räcker det att barnen använder tvåordssatser. Avsaknad av treordssatser vid screeningen innebär dock en uppföljning av språkutvecklingen vid 3 år. Syftet med denna studie var att utvärdera hur delmomentet Språkanvändning (som undersöker satslängd) i screeningmetoden fungerar vid 2 ½ års ålder. Detta för att undersöka om avsaknad av treordssatser vid 2 ½ år kan vara en indikation för språkliga svårigheter samt om en senareläggning av screeningen (med någon månad) kan bidra till att färre barn behöver följas upp. Deltagare rekryterades genom brevutskick till familjer med barn som nyligen passerat åldern för 2 ½ -årsscreening på BVC. Det visade sig vara svårt att hitta deltagare till studien med den valda metoden, därav genomfördes en kompletterande rekrytering. Efter fullgjord rekrytering framkom det ändå att ingen av de möjliga deltagarna uppfyllde alla studiens inklusionskriterier, vilket medförde att de tilltänkta analyserna inte kunde genomföras och frågeställningarna inte kunde besvaras. På grund av detta gjordes valet att titta på alla barn som screenats i rätt åldersintervall (2:6 - 2:9 år). Därmed undersöktes 26 barn (14 flickor och 12 pojkar, ålder 2:6 – 2:8 år, medelålder 2:6 år). Av dem var det 8 % (2 barn) som inte talade i treordssatser, dock i kombination med andra svårigheter. Utifrån dessa 26 barn kunde vissa indikationer ses som tyder på att ett samband mellan ålder på barnet och tidpunkt för screening inte existerar. Majoriteten, 95 %, av barnen som screenades vid 2:6 år klarade den helt utan anmärkning. Det visade sig även att ett antal barn screenats så tidigt som vid 2:5 år och ändå presterat utan anmärkning. Därmed ses ingen data i den här studien tala för att en senareläggning av screeningen skulle medföra att färre barn kallas för uppföljning. På grund av bristande data bör det dock påpekas att inga faktiska slutsatser kan dras utifrån den här studien.

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with mean age of 59 years. SAH accounts for 5% of all stroke and more than one quarter of potential life years lost through stroke. With the advanced neurosurgical methods of today two thirds of the patients survive. We know, however, that various cognitive, psychiatric and physical impairments are common that affect quality of life, social life, and the ability to work in the aftermath of SAH. The overall aim constituting this PhD dissertation is to better understand some of the challenges often faced by those surviving SAH. Two SAH patient cohorts have been studied. The first followed 96 consecutively included patients during the first year after ictus. Spasticity and cognitive impairment was assessed after 6 months and the Swedish stroke register follow-up form was used to investigate family support and the use of medical and social services. Return to work was assessed at 12 months. The second cohort assessed attention deficits using the test of variables of attention (T.O.V.A.) at 7 months after ictus in 19 patients with moderate to good recovery. Spasticity was just as common in our SAH patients as after other stroke, though it was rarely treated pharmacologically. By assessing cognitive impairment at 6 months after ictus using the Montreal cognitive assessment, 68% of the patients could be correctly predicted as having returned/not returned to work at 12 months. Seventeen percent of the patients had not had a follow-up appointment 6 months after ictus. These patients were older, more often living alone, had a lower quality of life, more depressive symptoms and more cognitive impairment compared to those having had a follow-up appointment. Twenty percent had had a follow-up in primary care. Seventy-eight percent of those with moderate to severe disability were living in their own accommodations. Fifty-eight percent of the patients had attention deficits. Challenges after SAH were common and often dealt with in the home environment of the patients. The results of this thesis highlight the importance of assisting the patients and their relatives in their struggle back to life after SAH.

No description available.

Les difficultés d’adaptation scolaire que peuvent développer les élèves dans une école secondaire entraînent bien souvent des conséquences. En effet, ces dernières peuvent mener au décrochage scolaire et parfois à l’adoption de comportements délinquants. L’instauration d’un suivi auprès d’élèves prend tout son sens lorsqu’il est question de difficultés d’adaptation. Ce suivi a été offert à cinq élèves présentant ces difficultés de l’école secondaire Honoré-Mercier de Montréal. Il y a deux objectifs à ce stage. Le premier vise une diminution des présences au local de retrait et le deuxième de diminuer les difficultés d’adaptation scolaire des élèves ciblés. L’atteinte de ces objectifs est considérée en fonction de données factuelles sur les présences au local de retrait, des résultats obtenus à un test standardisé, soit le Achenbach (Achenbach, 1991), mais également en fonction des perceptions des élèves et des professeurs sur le cheminement de l’élève. Les résultats illustrent que les élèves n’ont pas modifié significativement leur présence au local de retrait, que différentes problématiques définies dans le Achenbach ont été amplifiées tandis que d’autres ont été diminuées et que, finalement les élèves ont apprécié leur suivi puisque ce dernier les a amené à vivre des changements intrinsèques. Des conclusions découlent de l’analyse des résultats, soit concernant la durée des interventions et les problématiques présentes chez les élèves. Le rôle que peut assumer le criminologue dans le milieu scolaire est également abordé. Mots clés : adaptation, difficulté, scolaire, suivi, école, secondaire, adolescent / There can be many consequences when students have difficulties in adapting to the academic environment. They can lead to higher school dropout rates and to the adoption of delinquent behaviour. In the presence of adaptation difficulties, accompanying and monitoring the students is crucial. A monitoring program was offered to five Honoré-Mercier students presenting adaptation difficulties. The intervention program has two objectives. The first one is to decrease the number of classroom exclusions of those students. Another objective is to offer a place where they have the freedom to express their feelings openly. The results of the program are based on the number of classroom exclusion during the intervention. They are also measured on the results of an Achenbach test (Achenbach, 1991) and on the opinions of the students on their own progress. The results illustrate that the students did not significantly lower their number of classroom exclusion. They also show that some problems detected in the Achenbach test were amplified whereas types of problems decreased. Finally, the results show that students appreciated their follow-up because it allowed them to experience intrinsic changes. Based on these results, we can emit several hypotheses on the need to change the duration of the intervention or the problems experienced by the students. The potential contribution of a criminologist in an academic environment is also analyzed. Keywords: adaptation, difficulty, school, follow-up, secondary, teenager

[pt] Esta pesquisa centra-se no estudo da soteriologia tradicional ensinada pelo protestantismo brasileiro de missão. Busca-se desenvolver o tema a partir da percepção dualista presente nesta soteriologia, bem como a concepção a-histórica da mesma e apresenta como contraponto a teologia Moltmanniana. O trabalho se desenvolve em três capítulos que buscam estruturar esta dissertação: No primeiro, descreve-se a pós-modernidade na visão de Zygmunt Bauman e a herança teológica herdada pelo protestantismo brasileiro de missão; no segundo, desenvolve-se a observação da crise de modelo soteriológico dualista presente na teologia tradicional protestante e no terceiro, a apresentação da teologia Moltmanniana na prática de um seguimento de Cristo e da Missão Integral, propondo uma visão que envolva o ser humano em sua integralidade. / [en] This research focuses on the critical study of soteriology traditionally taught by Brazilian Protestantism focused on Mission. We seek to develop this critique from the dualistic perception present in this soteriology as well as ahistorical conception of it. Moltmanniana theology is presented as a counterpoint. The work is developed in three chapters that seek to structure this thesis: In the first chapter, it is described the postmodern vision of Zygmunt Bauman and theological heritage inherited by Brazilian Protestantism focused on Mission. In the second, it is developed the observation of the dualistic soteriological model crisis in traditional Protestant theology. Finally, the third chapter presents Moltmanniana theology in a practical way concerning concepts of Following Christ and Integral Mission, proposing a vision that involves the human being in his entirety.

Insomni och depression är två  psykiatriska tillstånd med hög prevalens. Prevalensen för insomni är ca 11% hos den svenska befolkningen och motsvarande siffror för depression är ca 5-8%. Komorbiditet mellan dessa två tillstånd är vanligt förekommande. Dessa två tillstånd är ofta teoretiskt sammankopplade med de två kognitiva processerna oro och ruminering. En behandlingsmetod som visat sig vara effektiv mot respektive tillstånd är kognitiv beteendeterapi (KBT). I föreliggande studie har internetbaserad KBT (iKBT) där båda tillstånden behandlas simultant studerats. Studiens huvudsakliga syfte var att undersöka skillnaden i utfall mellan en behandlingsmetod och en kontrollbehandling samt dess långtidseffekter. Totalt inkluderades 124 deltagare som randomiserades till antingen kombinationsbehandling mot komorbid insomni och depression (n=63), eller kontrollbehandling mot depression med desensibilisering som placebo mot insomni (n=61). Resultatet visar att behandlingsgruppen har en statistiskt signifikant större sänkning av insomnisymtom mellan före- och eftermätning jämfört med kontrollbehandling. Statistiskt signifikanta samband förekom gällande förändring i insomnisymtom, depressionssymtom, oro och ruminering mellan två mättillfällen. Förändring i oro mellan före- och eftermätning kunde predicera utfall i förändringsvärde för insomnisymtom mellan föremätning och FU36. Förändring i oro mellan före- och eftermätning kunde predicera nivå av depressionssymtom vid FU36. Studiens resultat stärker hypotesen att insomni är ett tillstånd som kräver specifik behandling och att det finns ett samband mellan insomni och depression samt de kognitiva processerna oro och ruminering men att detta samband bör undersökas ytterligare. / Insomnia and depression are two psychiatric conditions with high prevalence in the general population. Insomnia occurs among around 11% of the Swedish population and the equivalence for depression is around 5-8%. These conditions frequently appear comorbidly. There has found to be a theoretical link between these two conditions and the cognitive processes labeled anxious worry and rumination. One treatment method which has shown itself to be effective in treating these respective conditions is cognitive behavioral therapy (CBT). In the present study, internet-delivered CBT aiming to treat both conditions simultaneously have been studied with the purpose of evaluating two different methods and the long term effects of these methods. A total of 124 participants were included and randomized to either a combined treatment for insomnia or depression (n=63) or a control treatment consisting of treatment for depression and desensibilisation as placebo for insomnia (n=61). The results of the present study indicates a statistically significant effect on symptoms of insomnia between pre- and post measurements depending on treatment group. There was a statistically significant correlation between change in all the four domains, depression, insomnia, rumination and anxious worry between two separate measurements. A change in anxious worry between pre and post measurements was also found to predict the level of change in insomnia symptoms between pre and 36 month follow-up measurements. Change in anxious worry between pre and post measurements could also predict the level of depression observed at the measurement at the 36 month follow-up. The findings in this study corroborates the hypotheses that insomnia is a condition which require a specific treatment and that there is a relation between insomnia and depression and the cognitive processes anxious worry and rumination but that this relation needs to be further examined. / ClinicalTrials.gov Identifier: NCT01663844 New Clinical Applications for Internet-based Cognitive Behavior Therapy for Insomnia and Depression

OBK Sverige AB är en totalentreprenör från Örebro som bildades 2011. De har idag ca 65 anställda. De har inte kunnat arbeta in så mycket tid som de förväntat sig vid projektet Brf Vingen. Olika moment för projektet kommer att granskas och jämföras med ett av OBKs andra projekt, Kv. Sjukhuset. Enhetstiderna för momenten kommer jämföras med den gamla och den nya listan för enhetstider. Syftet med denna uppsats är att få svar på frågorna nedan.  • Hur stämmer vissa enhetstider som finns i den gamla listan i jämförelse med verkligheten? • Vad kan vara anledningen till att tiderna i vissa fall inte går att hålla? • Hur kommer den nya listan stämma överens med verkligheten? Enhetstiderna för momenten kommer jämföras med Nybyggnadslista 1999 och inte Ombyggnadslista 1999, då båda projekten är nybyggnationer. Dessa listor har getts ut av Byggnads, som är ett fackförbund, tillsammans med Sveriges Byggindustrier.  Litteraturstudier samt intervjuer har utförts för att ta fram information om vad enhetstider är. Intervjuer har gjorts för att få fram enhetstider och mängder för de granskade momenten. För att beräkna hur lång tid det tar att bygga en enhet av ett moment används enhetstider. Målning, gjutning och gipsning är exempel på olika moment och enheterna kan vara kvadratmeter, meter, styck osv. Enhetstiden varierar för olika moment och den multipliceras sedan med den totala mängden för momentet. Då får man fram hur lång tid det är beräknat att ett moment ska ta.  Momenten som granskats för båda projekten är betongstomme, taktäckning och gipsning av innerväggar. För projektet Brf Vingen har också fasadpartier av trä granskats. Resultatet i uppsatsen är att förutsättningen för inarbetning, när man arbetar efter nya listan, vid betongstommen för Brf Vingen ökar medan den för Kv. Sjukhuset minskar. Gipsning av innerväggar ökar, taktäckning minskar och fasadpartierna av trä minskar.  Beroende på olika faktorer i de projekt som granskats så stämmer enhetstiderna i den gamla listan olika bra med verkligheten. Anledningen till att vissa tider inte går att hålla är till exempel brant taklutning, små och trånga utrymmen samt byggnadens utformning. Den nya listan stämmer bättre överens med verkligheten för de granskade momenten. / OBK Sverige AB is a contractor company from Örebro that was established 2011. Today they have about 65 employees. They have not been able to save as much time as they where hoping for at one of their projects called Brf Vingen. We are going to view different stages of this project and compare to another of their projects called Kv. Sjukhuset. The unit times for the different stages will be compared to the old and the new list of unit times. The purpose with this essay is to answer these following questions. • How does some of the unit times from the old list come out compared to reality? • What can be the reason that the unit times in some cases can´t be kept? • How is the new list going to come out compared to reality? The unit times for the stages will be compared to Nybyggnadslistan 1999 an not to Ombyggnadslistan 1999 because the projects which are going to be viewed are constructions and not reconstructions. These lists have been published by Byggnads, which is trade union, with Sveriges Byggindustrier. Literature studies and interviews have been used to get the information about what unit times are. Interviews have also been used to get the unit times and amounts we needed for the viewed stages.  Unit times are being used to calculate how much time it takes to build one unit of a stage. Painting, foundry work and plastering is some examples of different stages and the units can be square meter, meter, piece etc. The unit time is different for different kinds of stages. This unit time is multiplied with the total amount of the stages.  The stages which has been selected to be viewed from both of the projects are the concrete frame, the roofing and the plastering of the interior walls. The wood panel at Brf Vingen has also been selected to be viewed. The result in this essay is that the time that has been saved, using the new list, for the concrete frame at Brf Vingen has increased and at Kv. Sjukhuset it has decreased. For the roofing it has decreased, for the plastering of the interior walls it has increased and for the wood panel it has de creased.  Depending on various factors in the viewed projects the unit times in the old list comes out differently well compared to reality. The reason that the unit times in some cases can´t be kept is for example that the roof slope is too steep, small and narrow spaces and also the construction design. The new list comes out better for the viewed stages compared to reality.

A diminuição da sobrevida registrada para pacientes com câncer de laringe nas últimas décadas pode estar relacionada a mudanças nos padrões de tratamento. Na literatura recente, há uma polëmica sobre o tratamento de tumores laríngeos em estádio clínico T3 devido ao emprego disseminado de estratégias de preservação de orgãos (Hoffman, 2006). Embora os critérios de inclusão para o grupo de preservação de órgãos tendam a selecionar tumores de \"baixo volume\", a escolha de uma determinada estratégia depende também da formação profissional do médico, da experiência e da infraestrutura do hospital e dos desejos dos pacientes. Essa consideração pressupõe uma distribuição homogênea dos pacientes entre os grupos de tratamento. No entanto, deve-se destacar o papel prognóstico das variáveis relacionadas ao tumor, ao paciente e à opção terapêutica na prática clínica. Objetivo: Avaliar as características clínicas, patológicas e a expressão de biomarcadores ativados pela via do EGFR em uma série de casos em relação à evolução e ao prognóstico. Metodologia: No presente estudo, 145 pacientes consecutivos com diagnóstico de carcinomas avançados de laringe cT3N0-3M0 foram analisados retrospectivamente. Foram incluídos casos de carcinoma epidermoide de supraglote, glote, subglote e transglotte, tratados em uma única instituição por quatro diferentes estratégias de tratamento (cirurgia exclusiva; cirurgia mais terapia adjuvante; radioterapia exclusiva, e radioquimioterapia). Os dados foram obtidos a partir do Registro de Câncer do Hospital A.C. Camargo, São Paulo (1990-2007). Uma série de variáveis clínicas e patológicas foi avaliada pelo métodos de Kaplan-Meier e de regressão de Cox. Opções de tratamento também foram avaliadas como fator prognóstico. Associações entre características clínico-patológicas do tumor e sobrevida, sobrevida livre de doença e risco de morte, foram investigadas. Resultados: Três variáveis clínicas, as variáveis terapêuticas e cinco variáveis patológicas, foram estatisticamente significativas na estimativa de sobrevida específica em 5 anos (CS-5a). A sobrevida foi influenciada negativamente pela invasão do tumor primário do espaço pré-epiglótico (45,5%, P = 0,003), pescoço clínico (cN) positivo (37,6%, P = 0,031), invasão da área retrocricóide (0,0%, P = 0,009) , invasão linfática (44,1%, P = 0,015), extravasamento capsular (43,1%, P = 0,003), pescoço patológico (pN) positivo (42,9%, P = 0,001), linfonodos positivos nos níveis cervicais IV-VI (33,3%, P = 0,008), margens cirúrgicas positivas (22,2%, P = 0,001). O tratamento teve impacto na sobrevida (CS-5a): a taxa foi de 51,6%, quando houve tratamento adjuvante (devido a achado patológico positivo na peça operatória), diminuiu até 41,5% no grupo de radioterapia exclusiva (P = 0,039). Cirurgia exclusiva e radioquimioterapia influenciaram a sobrevida de maneira semelhante (74,0% ; 77,5%). Considerando variáveis clínicas e terapêuticas, resultaram ser fatores prognósticos independentes: invasão do espaço paraglótico (RR multivariado 1,92; IC 1,02-3,61), pescoço clínico (cN) positivo (RR multivariado 2,24; IC 1,11-4,50), invasão do espaço pré-epiglótico (RR multivariado 2,65; IC 1,46-4,81) e tratamento radioterapico exclusivo (RR multivariado 2,88; IC 1,31-6,30); incluindo as variáveis patológicas, resultaram ser fatores prognósticos independentes achados patológicos de extravasamento capsular (RR multivariado 3,09; IC 1,56-6,12) e margens cirúrgicas comprometidas (RR multivariado 3,45; IC 1,11-10,75). A investigação de expressão imunoistoquímica de dez biomarcadores das vias de transdução de sinal ativadas pelo receptor tirosina quinase Erb B (EGFR, Erb B2, Erb B3, Erb B4, RAS, MEK, ERK, mTOR, PTEN, p53) mostrou associação entre expressão imunoistoquímica positiva de ErbB3 e ErbB4 e expressão de biomarcadores da via MAPKs e AKT-PI3K (MEK e mTOR). A positividade desses biomarcadores, ou seja, a desregulação da rede ErbB foi associada à invasão linfática, ponto de partida do acometimento linfonodal que resultou ser fator prognóstico independente entre as variáveis clínicas e patológicas (extravamento capsular). Conclusões: Entre as variáveis clínicas e terapêuticas, resultaram ser fatores prognósticos independentes: invasão do espaço paraglótico, pescoço clínico (cN) positivo, invasão do espaço pré-epiglótico e tratamento radioterápico exclusivo. Quando foram incluídas as variáveis patológicas, resultaram ser fatores prognósticos independentes achados patológicos de extravasamento capsular e margens cirúrgicas comprometidas. A positividade dos biomarcadores estudados (desregulação da rede ErbB), foi associada a invasão linfática. / The decreased survival recorded for patients with laryngeal cancer in the last decades may be related to changes in patterns of management; in literature a recent debate has been dedicated to the management of clinical stage T3 due to the disseminated use of organ preservation strategies (Hoffman, 2006). Although inclusion criteria for organ preservation group tends to select \"low volume\" tumors, in clinical practice the choice of a determined strategy depends also to medical and hospital experience and infrastructure and on patients\' wishes. This consideration may suppose an homogenous distribution of the patients among the treatment groups, however in clinical practice several clinico-pathological and therapeutic prognostic factors are considered for therapeutic decision. Objectives: Evaluate clinical and pathological characteristics and expression of biomarkers activated by the EGFR cascade in a case series and analise the association with outcomes and prognosis. Materials and method: In the present study 145 consecutive patients with diagnosis of laryngeal advanced carcinomas, cT3N0-3M0, were retrospectively analyzed, including cancer of the supraglottis, glottis, subglottis and trans-glottis, treated in a single institution by four different treatment strategies (exclusive surgery, surgery and adjuvant therapy, radiotherapy alone, and radiochemotherapy). Data was obtained from the Cancer Registry, Hospital AC Camargo, São Paulo (1990-2007). A set of clinical and pathological variables were assessed by Kaplan-Meier and Cox regression methods. Treatment option was also assessed as prognostic factor. Associations between clinical-pathological features of the tumor and survival, disease free-survival and risk of death, were investigated. Results: Three clinical variables, the therapeutic variable and five pathological variables, were statistically significant in estimating cancer specific survival at 5 years (CS-5y). Survival was negatively influenced by primary tumour spreading as filling of pre-epiglottic space (45.5%, P = 0.003), clinical neck (cN) positive (37.6%, P = 0.031), invasion of retrocricoid area (0.0%, P = 0.009), lymphatic invasion (44.1%, P = 0.015), extra-capsular nodal spread (43.1%, P = 0.003), pathological neck (pN) positive (42.9%, P = 0.001), positive IV-VI levels cervical nodes (33.3%, P = 0.008), positive surgical margins (22.2%, P = 0.001); treatment impacted on CS-5y, it decreases at 51.6% if adjuvant treatment (positive pathological finding on operative specimen), up to 41.5% in exclusive radiotherapy group (P = 0.039); exclusive surgery and radio-chemotherapy influenced survival similarly (74.0%; 77.5%). Among clinical e therapeutic variables, invasion of paraglottic space (HR adjusted 1.92; IC 1.02-3.61), positive clinical neck (cN) (HR adjusted 2,24; IC 1,11-4,50), invasion of pre-epiglottic space (HR adjusted 2,65; IC 1,46-4,81) and exclusive radiotheraphy (RR adjusted 2,88; IC 1,31-6,30) resulted to be independent prognostic factors; including pathological variables, extracapsular node invasion (HR adjusted 3,09; IC 1,56-6,12) and positive resection margins (HR adjusted 3,45; IC 1,11-10,75) were independent prognostic factors. Exploration of immunohistochemical expression of ten biomarkers of the signal transduction pathways activated by tyrosine kinases receptor Erb B (EGFR, Erb B2, Erb B3, Erb B4, RAS, MEK, ERK, mTOR, pTEN, p53) showed association between positive immunohistochemical expression of ErbB3 and ErbB4 and biomarkers of MAPKs and AKT-PI3K pathways (MEK and mTOR); the dysregulation of the Erb B network was associated with lymphatic invasion, starting point for lymph-nodes involvement that resulted to be clinical independent prognostic factors. Conclusion: Among clinical and therapeutic variables, the identified independent prognostic factors were: invasion of paraglotic space, clinically positive neck, invasion of pre-epiglotic space and radiotherapy alone. When pathologic variables were included, extracapsular spread and positive surgical margins were identified as independent prognostic factors. Positive results of the studied biomarkers (dysregulation of Erb B network) was associated with lymphatic invasion.