Thesis (M.D.)--University of Hong Kong, 1990. / Also available in print.

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published_or_final_version / Medicine / Master / Doctor of Medicine

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

Aproximadamente 40% dos casos de Linfoma não Hodgkin (LNH) se originam fora dos linfonodos, sendo então denominados linfomas extralinfonodais. No trato gastrointestinal (TGI), o estômago é o local mais freqüentemente envolvido, representado pelo linfoma MALT e pelo linfoma difuso de grandes células B (LDGCB). No Brasil, apesar da sua freqüência e importância, existem poucos dados epidemiológicos em relação aos linfomas, especialmente no que se refere aos linfomas de origem extralinfonodal. Para avaliar as características dos linfomas primários gástricos em uma população brasileira, 60 casos foram avaliados retrospectivamente. Trinta e oito (63,3%) foram classificados como LDGCB e 22 (36,6%) como MALT. Entre os dois grupos, não houve diferenças significativas em termos de sexo, idade, sintomas dispépticos, sintomas B, presença de massa Bulky, infiltração de medula óssea, estádio, infecção por H. pylori, achados laboratoriais e endoscópicos. Foram adotados diferentes protocolos de tratamento. A taxa de remissão completa foi de 73,1% no LDGCB e de 95% no linfoma MALT. A taxa de sobrevida livre de doença em 7 anos foi de 84,8% no LDGCB e de 94,1% no linfoma MALT. A taxa de sobrevida global em 7 anos foi de 65,7% no LDGCB e de 92,9% em 5 anos no linfoma MALT. Como não conseguimos demonstrar diferenças entre os dois tipos histológicos, concluímos que o diagnóstico histológico correto é essencial para a terapêutica mais adequada. / Approximately 40% of the non-Hodgkins Lymphoma arises outside lymph node tissue, being then termed extranodal lymphoma. In the gastrointestinal tract, gastric is the commonest localization represented by MALT and diffuse large B-cell lymphoma (DLBCL). In Brazil, despite its importance and frequency there are very few epidemiological data concerning lymphomas, specially the extranodal ones. In order to study the primary gastric lymphoma features in a Brazilian population, 60 patients were retrospectively evaluated. Thirty eight cases (63.3%) were classified as DLBCL and 22 (36.6%) as MALT lymphoma. There were no significant differences between the 2 groups in terms of sex, age, gastric symptoms, B symptoms, Bulky disease, bone marrow infiltration, stage, H. pylori infection, laboratory and endoscopic findings. Different treatment methods were adopted. The complete remission rate was 73.1% for DLBCL and 95% for MALT lymphoma. The disease free survival in 7 years was 84.8 for DLBCL and 94.1% for MALT lymphoma. The 7 year overall survival (OS) rate for DLBCL was 65.7% and 5 year OS for MALT was 92.9%. Because we could not demonstrate differences between the two histological groups, we conclude that the correct histological diagnosis is essential for choosing the best therapeutic approach.

Providing a socio-legal analysis of the issues, expert evidence and judgment in Reay and Hope v BNFL plc., the thesis offers an insight into the complexity of the toxic tort. Starting with an overview of the history of Sellafield, the thesis reflects on the scientific and epidemiological concerns surrounding the link between childhood cancer and nuclear installations. Drawing on scientific knowledge and epistemological considerations, the thesis moves on to the difficulties of verifying causation in science and the problems of establishing causation in law. Outlining the role of the expert witness and scientific expert evidence, the thesis proceeds with a case analysis, before broaching the thorny issue of judicial decision making and in particular, the difference between the 'discovery' and 'justification' process. Moving on to the Judgment in Reay and Hope, attention is given to the potential application of probability theory to the judicial decision making process. Lasting just short of one hundred days and including the testimony of numerous scientific experts, Reay and Hope marked new ground in a number of ways; it was the first personal injury claim to test the concept of genetic damage from radiation; the only time that a Queen's Bench Division Judge had been allocated a full-time judicial assistant; and one of the first trials to endorse a satellite video link for examination of international expert witnesses. As far as judicial management is concerned, the case was a forerunner in having Counsels' Opening Statements in writing in advance of the trial, as well as having written daily submissions of key issues from plaintiffs and defendants upon conclusion of oral evidence. The circumstances that led to the trial relate to events in excess of thirty to forty years ago when the fathers of Dorothy Reay and Viven Hope were employed by the Defendants and their predecessors (the United Kingdom Atomic Energy Authority) as fitters for the Sellafield Plant. Intrinsic to the litigation was whether paternal preconception irradiation caused or materially contributed to a predisposition to cancer leading to Dorothy's death from leukaemia and Vivien Hope's non-Hodgkin's lymphoma. As a consequence of the various statutory provisions, the Plaintiffs did not need to prove negligence on the part of the Defendants. In order to succeed the Plaintiffs had to prove on the balance of probabilities that radiation from Sellafield was a material contributory cause of the Plaintiffs' disease. The fundamental issue therefore was causation. In addition to the case analysis, two pieces of empirical research were conducted for the purposes of this thesis. The first, a Social Survey (consisting of thirty four questions) was circulated to 160 members of the Academy of Experts (quantitative research); the second, a letter, involved written communication with sixty five judges from the Queen's Bench Division of the High Court (qualitative research). Underlying this socio-legal case analysis are fundamental questions with regard to existing legal principles, liability and judicial decision making.

Hodgkins lymfom är en cancersjukdom som uppstår i det lymfatiska systemet och i Sverige är det ungefär 200 personer per år som insjuknar. Majoriteten av de insjuknade är mellan 15-34 år och ungefär 90% med diagnosen blir botade. Behandlingsformen för Hodgkins lymfom varierar beroende på stadie och då även vilka substanser som ingår i behandlingen. Alkylerande substanser, till exempel prokarbazin och cyklofosfamid, är substanser som är icke-cell-cykelspecifika och förhindrar DNA syntes. Detta kan leda till azoospermi hos männen och reducerad population av ursprungfolliklar hos kvinnor. På grund av dessa effekter var syftet med denna litteraturstudie att se om behandlingarna ABVD (en kombination av fyra olika cytostatika) och BEACOPP (en kombination av prednisolon samt sex olika cytostatika med större innehåll av alkylerare än ABVD) leder till en nedsatt fertilitet hos kvinnor och/eller män samt om fertiliteten återkommer efter avslutad behandling. Detta gjordes genom en litteraturstudie efter sökningar på PubMed där sju studier valdes ut efter inklusionskriterier och exklusionskriterier. Det kunde ses att spermiekvalitén minskade efter båda behandlingsformerna bland männen och att antalet behandlingscykler hade betydelse för hur nedsatt fertiliteten blev. Färre cykler med mindre intensiv behandling hade mindre effekt än fler cykler av mer intensiv behandling. De flesta männen återfick dock sin fertilitet inom fem år. För kvinnorna sågs ett snarlikt resultat där behandlingen BEACOPP orsakade försämrade värden av anti-müllerskt hormon (AMH) och en frånvaro av menstruationscykeln. Hos kvinnor var förekomsten av prematur ovarialsvikt (POF) korrelerat till ålder vid behandlingens start och antalet cykler administrerade.

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Made available in DSpace on 2014-10-09T12:49:27Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:02:29Z (GMT). No. of bitstreams: 1 10198.pdf: 2777156 bytes, checksum: 6e1e2c70e93aaa5f027c563bbe4dd7ce (MD5) / Dissertacao (Mestrado Profissionalizante em Lasers em Odontologia) / IPEN/D-MPLO / Instituto de Pesquisas Energeticas e Nucleares, IPEN/CNEN-SP; Faculdade de Odontologia, Universidade de Sao Paulo