Androgens are well documented as important regulators of male health, primarily in the maintenance and development of male sexual characteristics. However, a decline in circulating androgens has also been associated with co-morbidities such as obesity, cardiac disease and metabolic syndrome. Previous research has focussed upon the body wide impact of adrenal androgens, however whilst androgen receptor (AR) is abundantly expressed in the adrenal cortex of both rodents and humans, surprisingly little is known about androgen action on the adrenal cortex itself. This gap in our understanding is at least in part due to the perceived lack of suitable animal models. Rodents have largely been overlooked as a model system as their adrenals are unable to produce androgens due to lack of 17α Hydroxylase and 17, 20 lyse activity and they therefore do not have a zona reticularis. However, historical studies using castrated mice showed that removal of androgens leads to the redevelopment of an additional cortex zone known as the transient X-zone. The foetal adrenal is thought to give rise the adult adrenal cortex in human and rodents. These foetal cells are maintained for a period postnatally and regress differently depending on species and sex. In the human this zone is known as the ‘foetal zone’, and the rodent homologue termed the ‘X-zone’. The mechanisms underpinning the regression of the X-zone and its purpose and maintenance postnatally still aren’t clearly understood. To provide a comprehensive overview of androgen signalling in the adrenal cortex, multiple mouse models were utilised. First, Cre/loxP technology was used to ablate AR specifically from the adrenal cortex. Further androgen manipulation was achieved through castration (removal of androgens) and human chorionic gonadotropin (hCG) treatment (increased androgens). The initial study investigates the impacts on the male mouse adrenal. Histology analysis revealed the presence of an X-zone in all experimental cohorts following loss of AR or circulating androgens, confirmed by 20- α-hydroxysteroid dehydrogenase (20 alpha-HSD) expression. These data demonstrate that androgens signalling via AR is required for X-zone regression during puberty. However, interrogation of morphology of hCG treated cohorts revealed no phenotypic changes compared to controls, this demonstrates that hyper stimulation with androgens does not negatively impact the adrenal cortex or influence X-zone morphology. Differences in X-zone morphology and 20 alpha-HSD localization prompted cortex measurements which revealed significant differences in X-zone depth and cell density depending on ablation of AR, circulating androgens or both. This suggests that androgens and androgen receptor are working together and also independently to regulate the adrenal cortex. This result was strengthened through analysis of steroid enzyme genes and cortex markers, which revealed that normal AKR1B7 expression was absent following loss of androgens but not androgen receptor. A final part of this study examined the impacts long term androgen receptor ablation and long term castration in ageing animals. A final part of this study examined the impacts long term androgen receptor ablation and long term castration in ageing animals. These results demonstrate that following prolonged loss of androgens that there is no major disruption to the adrenal cortex. Morphology analysis and X-zone measurements revealed that X-zone regression was occurring in mice with long term castration, characterized by a reduction in size and pockets of vacuolization throughout the X-zone. This phenotype is also observed in ageing females with X-zone regression via vacuolization. These data suggest that following prolonged loss of androgens, the male adrenal is feminized and behaves as such. In contrast, AR ablation only, results in an enlarged adrenal with large spindle cell lesions and X-zone expansion confirmed by X-zone measurements. Initial experiments have demonstrated that androgens can work independently of AR to regulate the adrenal cortex. Together these data suggests that AR is required to control the appropriate action of circulating androgens in the adrenal cortex, with loss of AR resulting in off target signalling from circulating androgens in the adrenal leading to spindle cell hyperplasia, X-zone expansion and X-zone mislocation. A second set of studies were carried out to determine the role of androgen signalling in the female adrenal, specifically, if loss of AR leads to the absence of normal X-zone regression during pregnancy. To answer this question the same selective AR ablation model was used. Analysis of litters comparing observed and expected genetic distribution revealed significantly fewer females being born carrying complete ablation of adrenal AR. Morphology analysis of these mice revealed severe cortex disruption and spindle cell hyperplasia similar to that observed in mutant males. Investigation of adrenals following pregnancy revealed that X-zone regression still occurred despite loss of AR. This result shows that X-zone regression in the female is under different regulation compared to male adrenal and occurs via an androgen-independent signalling mechanism. However, loss of AR still leads to anatomical dysregulation of the adrenal cortex. AR ablation revealed changes in glucocorticoid receptor (GR) expression in the adrenal cortex. To dissect this relationship further a final study was conducted, attempting to ablate GR from the adrenal cortex also using the Cyp11a1 Cre. Initial observations of these mice revealed excessive hair loss through barbering, curved spines and stressed behaviour when monitored in the cage under normal conditions. Immunohistochemistry was used to confirm GR ablation in the adrenal cortex, however, to our surprise, GR expressing cells were not steroidogenic and thus were not targeted by the Cre recombinase. Despite no GR ablation in the adrenal, morphology analysis revealed severe disruption to the adrenal cortex. The Cyp11a1 Cre not only targets the adrenal but is expressed in the hindbrain. To determine if GR ablation in the hindbrain explains the phenotype, we next used PCR analysis interrogating hindbrain genomic DNA to determine if there was recombination of GR. Results confirmed GR recombination in the hindbrain. Due to the observation of stressed behaviour and adrenal cortex disruption, we wanted to determine if this was a result of hyperactivity of the adrenal cortex. Serum corticosterone was analysed and was elevated in these animals. These data revealed that GR ablation in the hindbrain results in adrenal cortex disruption and an elevated stress response, potentially highlighting a new model to investigate stress disorders and their impact on the hypothalamic-pituitary-adrenal axis. Together this data defines new roles for AR signalling in the adrenal cortex and the role of the hindbrain GR signalling in regulating adrenal morphology and function.

Made available in DSpace on 2014-06-11T19:25:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-08-31Bitstream added on 2014-06-13T19:53:39Z : No. of bitstreams: 1 shimomura_jz_me_araca.pdf: 344713 bytes, checksum: 8d8139cc4432fb9c3f2741e4494816c1 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Ahiperplasiaprostática benigna(HPB) é a afecção mais comum da próstata canina, porém, a comparação dos diferentes métodos diagnósticos como o exame de palpação retal, citologia, histologia e imunoistoquímica é pouco estudada nesta espécie, diferentemente do que ocorre no homem. Este trabalho teve por objetivo estudar, em vinte cães idosos, as alterações cito e histológicas com emprego de imunomarcadores, na glândula prostática. Em todas as glândulas observou-se HPB cística, associada ou não à hiperplasia glandular ou estromal. A imunomarcação com citoqueratina (CK) AE1/AE3 foi relevante em ácinos com epitélio achatado ou com proliferação acentuada. A Vimentina (VIM) V9 teve expressão moderada em áreas com hiperplasia estromal acentuada. O toque retal e o lavado prostático mostraram ser métodos de auxílio no diagnóstico das prostatopatias, sendo indispensável o uso da histopatologia para um diagnóstico definitivo. O emprego de imunomarcadores teciduais prostáticos infere que próstatas com HPB demonstram alterações metabólicas que respondem à imunomarcação em células hiperplásicas. / Benign Prostatic Hyperplasia (BPH) is the most common affection of the canine prostate, however, the comparison of different diagnostic methods for BPH through, digital rectal examination, cytology, histology and immunohistochemistry has a few studies in this specie, unlike man. The purpose of this study was understood, in twenty old dogs, cytology, histology alterations using immunomarkers in the prostate gland. All the glands showed the presence of cystic BPH, associated or not with glandular or stromal hyperplasia. The immunomarking with AE1/AE3 cytokeratine was relevant in alveoli with flat epytelium or with a strong proliferation. V9 Vimentine showed to be moderate in areas with a deep stromal hyperplasia. Rectal palpation and the prostatic washing product compose auxiliary diagnostic methods for prostatic diseases, being undismissable the use of histopathology for a conclusive diagnosis. Prostatic tissue immunomarkers employment to conclude that the prostate with HPB demonstrate metabolic changes which react with immunomarking in hyperplasic cells.

Made available in DSpace on 2014-06-11T19:32:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-12-09Bitstream added on 2014-06-13T19:21:17Z : No. of bitstreams: 1 castro_evfl_dr_araca.pdf: 208031 bytes, checksum: 9315c888cbc65fc52c5d2cf626bd81c1 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Considerando-se a significativa importância do melhor conhecimento acerca das lesões de maior ocorrência no cotidiano do cirurgião-dentista, justifica-se o estudo das hiperplasias fibrosas inflamatórias em geral, especialmente aquelas de inter-relacionamento com a atuação direta do profissional, como as hiperplasias protéticas. No presente estudo, foram observados os aspectos clínicos e microscópicos da mucosa palatina em pacientes não usuários e usuários de prótese, com a finalidade de se identificar a possibilidade de direta relação entre lesão e suposto agente causal. No sentido de se tentar realizar um estudo mais abrangente e com resultados mais confiáveis, o presente trabalho foi desenvolvido em dois capítulos distintos, analisando-se inicialmente a mucosa palatina clinicamente normal de trinta pacientes usuários e não usuários de prótese total superior, observando-se que a presença de hiperplasia no epitélio de revestimento da mucosa palatina é um achado constante, tanto em usuários como em não usuários de prótese, sendo que a ausência de alterações clínicas nem sempre reflete a mesma normalidade ao exame histopatológico, sem uma relação de dependência entre inflamação e presença de hiperplasia epitelial e vice versa, em ambos os grupos. No segundo capítulo, foram estudados vinte e três pacientes com hiperplasia fibrosa palatina por câmara de sucção, antes e após tratamento compressivo, observando-se que lesões hiperplásicas podem não apresentar um quadro inflamatório crônico, sugerindo que o preenchimento gradativo da área de câmara de sucção é uma opção terapêutica de valor para esses casos. / Being considered the significant importance of the best knowledge concerning the lesions of larger occurrence in the routine of Surgeon Dentist, it is justified the study of the inflammatory fibrous hyperplasias in general, especially those of inter-relationship with the professional's direct performance, as the prosthetic hyperplasias. In the present study, the clinical and microscopic aspects of the palatine mucous membrane were observed in patients wearing or not total prosthesis, with the purpose of identifying the possibility of direct relationship between lesion and supposed causal agent. As an examining to try to accomplish a broader study with more reliable results, the present work was developed in two different chapters, being analyzed the clinically normal palatine mucous membrane of thirty patients initially wearing and not wearing of upper complete denture, being observed that the presence of hyperplasia in the epithelium coating of palatine mucous membrane is a constant discovery, as in wearing as in not prosthesis wearing individuals, and the absence of clinical alterations not always it reflects the same normality to the histopathologic exam, without a dependence relationship between inflammation and presence of epithelial hyperplasia and vice-versa, so much in wearing as in not prosthesis wearing. In the second chapter, twenty-three patients with palatine fibrous hyperplasia for suction chamber were studied, before and after treatment by use of tissue conditioning. It was observed that hyperplasic lesions cannot present a chronic inflammatory picture, suggesting that the gradual completion of the area of suction chamber is an important therapeutic option for those cases.

Made available in DSpace on 2014-06-11T19:27:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-25Bitstream added on 2014-06-13T20:36:38Z : No. of bitstreams: 1 cardoso_apf_me_botfm.pdf: 463235 bytes, checksum: f5c3dd035d2b9e83db6356001aa70012 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Diuron [3-(3,4-dichlorophenyl)-1,1-dimethylurea] is a herbicide that in a previous longterm study with Wistar rats fed at 2,500 ppm concentration showed high incidence of urothelial tumors in both genders. Accordingly, USEPA categorized Diuron as a “known/likely” human carcinogen. The accepted non-genotoxic mode of action (MOA) of Diuron encompasses urothelial necrosis induced by direct cytotoxicity, followed by regenerative cell proliferation and sustained urothelial hyperplasia that may favor neoplasia development. Scanning electron microscopy (SEM), light microscopy and labeling index are essentials tools for identification and classification of cytotoxic and proliferative changes in the bladder. The present study evaluated the dose-response of Diuron regarding urothelial lesions. Sixty male Wistar rats were fed Diuron for 20 weeks mixed in the diet at 0, 60, 125, 500, 1,250, or 2,500 ppm. Simple hyperplasia was significantly increased in the Diuron 1,250 and 2,500 ppm groups, and the cell proliferation at 2,500 ppm group. By SEM, the incidences and severity of lesions were significantly greater in the 500 and 1,250 ppm. Although numerically increased, the incidence of lesions in the 2,500 ppm group did not differ significantly from the control. The present study documented a doseresponse influence of Diuron on the rat urothelium, with a no observed effect level (NOEL) of 125 ppm.

Made available in DSpace on 2014-06-11T19:23:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-07-29Bitstream added on 2014-06-13T18:50:08Z : No. of bitstreams: 1 carvalho_lfcs_me_sjc.pdf: 413099 bytes, checksum: d80f145875346778f3ffe2427182fbf7 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A hiperplasia fibrosa inflamatória (HFI) é um processo proliferativo não neoplásico, encontrado em mucosa bucal, geralmente decorrente de traumatismos crônicos. A Espectroscopia Raman fornece informações dos tecidos avaliados através de suas propriedades ópticas. Tem sido empregada em estudos biológicos para a caracterização de alterações neoplásicas. No entanto, são escassos os estudos que envolvam processos inflamatórios. Objetivou-se caracterizar através da Espectroscopia FT-Raman HFI com tecidos bucais normais de mucosa jugal, avaliando a especificidade e a sensibilidade deste método, relacionando os espectros obtidos aos achados histopatológicos. Foram utilizados 19 amostras de HFI e 6 amostras de mucosa normal (MN) que localizavam-se em mucosa jugal, obtendo-se, totalizando 92 espectros de HFI e 27 espectros de MN. Os resultados demonstrados pela análise dos componentes principais revelaram que PC3 e PC5 foram os responsáveis por uma melhor classificação, podendo ser observada no gráfico de loading plots como espectros com picos invertidos. Pela análise de discriminantes linear, foi possível observar que 19 espectros de MN e 85 espectros de HFI foram classificados corretamente, correspondendo, respectivamente, a 70,4 % e 92,4 % do total de dados. A curva de Roc revelou um valor preditivo do modelo de 0,87. Concluiu-se que a análise dos espectros Raman permitiu detectar similaridades e diferenças biológicas e bioquímicas entre HFI e MN de mucosa jugal, demonstrando que a Espectroscopia Raman apresenta sensibilidade e especificidade no diagnóstico de processos proliferativos não neoplásicos. Observou-se correlação entre os achados histopatológicos e os obtidos pela utilização da técnica. / Inflamatory fibrous hyperplasia (IFH) is considered a non-neoplasic proliferative process that generally occurs in association to trauma. This pathology has typical hystopathological features in both epithelial and conjunctive tissues. Raman spectroscopy of pathological tissues has become a reality that can contribute to knowledge enhancement about biochemical alteration making possible the differential diagnosis of oral pathologies. The objective of the present study was to use FT-Raman Spectroscopy to identify biological and biochemical alterations that exist between oral IFH in buccal mucosa and normal tissue from the same site. Therefore 92 spectra of inflammatory fibrous hyperplasia from 19 patients were compared to 27 spectra of normal tissue from6 patients. It was observed that the relation between the data of IFH and normal tissue was more evident when the Principal Components Analysis (PCA) of all spectra were calculated and when the Principal Components (PC) PC3 vs. PC5 were analysed. Results of Box Plot show great differences in normal group. This was confirmed by the analysis of the Loading Plot of the PC’s that showed great modifications between normal and IFH identified by inverted peaks in Raman band 500 e 1110 cm-1; 1300, 1580 and 1730 cm-1. These bands correspond mainly to molecular vibrations of lipids, collagens (I and III) and proteins. The predictive value of diagnostic model was calculated by linear discriminates analysis that showed 0,87 ROC curve. Biological and biochemical similarities and differences between IFH and normal tissues were confirmed by Raman Spectroscopy when compared to hystopathologycal analysis.

Made available in DSpace on 2014-06-11T19:23:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-22Bitstream added on 2014-06-13T18:48:32Z : No. of bitstreams: 1 mostachio_gq_me_jabo.pdf: 1253600 bytes, checksum: c1f946210aa85f9b2c8aa26f7af6e985 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A hiperplasia prostática benigna (HPB) tem início no animal com um a dois anos de idade, sendo que 80% dos cães com cinco anos apresentam evidências histológicas de sua presença. A fisiopatologia da doença não está totalmente compreendida, no entanto, a diidrotestosterona é o principal hormônio envolvido. Recentemente, o efeito da toxina botulínica A (TB-A) foi investigado na próstata, mostrando que esta induz atrofia do parênquima e redução do volume. Como o cão é o único animal doméstico que apresenta esta alteração, este se apresenta como modelo experimental para novos estudos da HPB humana. Com base nisso, este estudo objetivou fornecer informações acerca dos efeitos da TB-A sobre a próstata, libido e qualidade do sêmen, comparando os dados com animais orquiectomizados. Para tanto, 18 cães adultos, com evidências ultra-sonográficas de HPB foram submetidos à castração ou administração de 250 ou 500 U de TB-A, e avaliados durante 16 semanas. A orquiectomia mostrou-se um excelente tratamento para a HPB, promovendo redução de 80% do volume prostático. Aplicação da TB-A não ocasionou alterações significativas na libido, ereção ou qualidade e características seminais. Efeitos locais e sistêmicos também não foram observados. Administração de 250 U da TB-A promoveu redução máxima de 9,4% do volume prostático, entretanto, tal redução não foi significativa. Por outro lado, a administração de 500 U de TB-A reduziu significamente as variáveis comprimento, altura e volume da próstata. Desta forma, o presente ensaio contribui de forma singular e inovadora para o conhecimento dos efeitos desta nova modalidade de tratamento na HPB canina. / Benign prostatic hyperplasia (BPH) starts the development in animals aging about 1 – 2 years. 80% of 5 years-old dogs have histologic evidences of BPH. Despite the little knowledge concerning about this disease, dihydrotestosterone is the main involved hormone. Recently, the effect of botulinum toxin A (BT-A) on rat and human prostate was investigated, and prostatic parenchyma atrophy and decrease in glandular volume were observed. The dog is one of a few animals that can develop BPH spontaneously and is frequently used as an animal model for human prostatic hyperplasia. Based on that, this study aimed to provide information on BT-A effects on prostate, libido and semen quality, in comparison to orchiectomized dogs. For that, 18 adults dogs, with Ultrasonographic evidences of BPH were submitted to orchiectomy or administration of 250 or 500 U of BT-A, and evaluated along 16 weeks. Orchiectomy presented excellent results on BPH, reducing the prostate volume up to 80%. Administration of BT-A did not significantly interfered on libido, erection or semen characteristics. Local and systemic effects also were not observed. Administration of 250 U of BT-A has promoved a maximum decrease of 9,4% on prostatic volume. However, this reduction was not statistically significant. On the other hand, 500 U of BTA administration has shown to significantly reduce the length, height and volume of prostate. This way, the present study is an innovative and singular contribution for the knowledge of the effects of BT-A on canine prostate.

(ENGLISH) Background: The investigation of the immunosuppression usage in cardiovascular surgery and interventional cardiology is, at present, concentrated on three main topics: 1) influence on intimal hyperplasia of coronary and peripheral vascular reconstructions 2) influence on rejection of allogeneic vascular grafts and 3) influence on intimal hyperplasia of coronary arteries after endovascular interventions. Modern immunosuppressive drug FK506 (Tacrolimus) could have a positive effect for these indications. In experimental study, FK506 inhibited rejection of arterial allografts and also inhibited intimal hyperplasia in percutaneous coronary interventions. Aims: The purpose of this study was to evaluate the effect of systemic tacrolimus treatment on the process of arterialisation of allogeneic and syngeneic venous grafts in a rat vein-to-artery implantation model. Material and Methods: Lewis (LEW) rats were used as recipients of syngeneic (Lewis) or allogeneic (Brown-Norway; BN) iliolumbar veins which were implanted into abdominal aorta. Recipients were divided into six groups. In groups A, E and F were animals after syngeneic (LEW to LEW) and in groups B, C and D were animals after allogeneic (BN to LEW) transplantations. Animals in the groups C and F had daily intramuscular injections of...

Objetivo: Avaliar se a administração sistêmica de cilostazol reduz a hiperplasia neointimal nas artérias ilíacas de suínos submetidas a angioplastia com cateter balão. Métodos: O trabalho foi desenvolvido na Unidade de Experimentação Animal do Hospital de Clínicas de Porto Alegre. Vinte suínos foram submetidos a angioplastia com cateter balão 6 x 40 mm na artéria ilíaca comum direita, guiada por ultrassonografia com Doppler. Os animais foram randomizados em dois grupos: grupo 1 (n = 10), no qual foi administrado cilostazol 50 mg em duas doses diárias, e grupo 2 (n = 10), considerado controle. Após 30 dias, os animais foram sacrificados, e as artérias ilíacas preparadas para análise histológica. Os cortes histológicos foram digitalizados e analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student e o de Mann-Whitney. Resultados: Comparando as artérias ilíacas submetidas a angioplastia com as não submetidas a angioplastia, houve hiperplasia neointimal significativa (0,228 versus 0,119 mm2; p = 0,0001). Nas artérias submetidas a angioplastia, não houve diferença entre o grupo 1 (cilostazol) e o grupo 2 (controle) na área do lúmen (2,277 versus 2,575 mm2; p = 0,08), área da íntima (0,219 versus 0,237 mm2; p = 0,64), área da média (2,262 versus 2,393 mm2; p = 0,53) e no percentual de obstrução neointimal (8,857 versus 9,257 %; p = 0,82). Conclusão: O uso de cilostazol 50 mg em duas doses diárias não reduziu a hiperplasia neointimal em artérias ilíacas de suínos submetidas a angioplastia com cateter balão. / Objective: To evaluate whether systemic administration of cilostazol reduces neointimal hyperplasia in the iliac arteries of pigs after balloon angioplasty. Methods: This study was conducted in the Experimental Animal Unit of Hospital de Clínicas de Porto Alegre, Brazil. Twenty pigs underwent angioplasty of the right common iliac artery under Doppler ultrasound guidance using 6x40-mm balloon catheters. The animals were randomized to one of two groups: group 1 (n = 10) received 50 mg cilostazol in two doses a day; and group 2 (n = 10) was the control group. After 30 days, the animals were killed and their iliac arteries were prepared for histological analysis. Histological images were digitalized and analyzed using digital morphometry. The Student t and the Mann-Whitney tests were used for statistical analyses. Results: Iliac arteries that underwent angioplasty had significantly more neointimal hyperplasia than those with no angioplasty (0.228 versus 0.119 mm2; p = 0.0001) Group 1 (cilostazol) and 2 (control) had no significant differences in lumen (2.277 versus 2.575 mm2; p = 0.08), intima (0.219 versus 0.237 mm2; p = 0.64) or media (2.262 versus 2.393 mm2; p = 0.53) area, or in percentage of neointimal obstruction (8.857 versus 9.257 %; p = 0.82). Conclusion: The use of 50 mg cilostazol in two doses a day did not reduce neointimal hyperplasia in iliac arteries of pigs that underwent balloon angioplasty.

Orientador: Gil Guerra Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T14:57:15Z (GMT). No. of bitstreams: 1 Goncalves_EzequielMoreira_M.pdf: 3646841 bytes, checksum: 92edeb1af3250e23a5dd5ef4630bd584 (MD5) Previous issue date: 2008 / Resumo: A Hiperplasia Adrenal Congênita na forma clássica da deficiência da 21-hidroxilase (HAC-C-D21OH) caracteriza-se pela deficiência na síntese do cortisol e, em alguns casos, na aldosterona, e pelo excesso de andrógenos. O objetivo do estudo foi avaliar a composição e as proporções corporais de pacientes do sexo feminino com HAC-C-D21OH e comparar em relação ao controle, à forma clínica da doença e a um grupo controle de ambos os sexos. A casuística foi composta por 28 pacientes (grupo casos) do sexo feminino com HAC-C-D21OH divididas de acordo com o controle hormonal (bem e mal controladas) e com a forma da doença (virilizante simples e perdedores de sal). O grupo controle foi composto por 112 indivíduos saudáveis de ambos os sexos, divididos em dois grupos, de acordo com o gênero. Para verificar os efeitos da puberdade nas medidas avaliadas, os três grupos foram subdivididos em três faixas etárias: até 10 anos, de 11 a 14 anos e acima de 15 anos. Para a avaliação das proporções e composição corporais foram utilizadas medidas antropométricas e a impedância bioelétrica. Os dados das medidas antropométricas foram convertidos em escores de desvio padrão (z). Em relação à forma clínica da doença, as virilizantes simples apresentaram valores significativamente maiores de z do IMC, do perímetro da cintura e da área gorda do braço, e no percentual de massa gorda. Em relação ao controle laboratorial, as mal controladas apresentaram z do comprimento da perna significativamente menor. Os casos apresentaram valores significativamente maiores que os controles no z do IMC, área muscular e gorda do braço, perímetro braquial, da cintura e do quadril, do diâmetro biilíaco e no percentual de massa gorda, e menores no z do comprimento da perna e da mão e nos percentuais de água e massa magra. Pode-se notar que as alterações na composição corporal foram observadas em todas as faixas etárias, mas foram se intensificando com a idade, com o predomínio do aumento da massa gorda enquanto as alterações nas proporções corporais se tornaram mais evidentes após a puberdade, com comprometimento principal das extremidades (perna, mão e pé). As variáveis que melhor se ajustaram para diferenciar os grupos caso e controles foram o percentual de gordura, o comprimento da mão e o perímetro do quadril (94,7%). Esse grupo de pacientes apresentou diferenças nas proporções e principalmente na composição corporal, justificando uma avaliação antropométrica ampla e cuidadosa no monitoramento das pacientes com HAC-C-D21OH / Abstract: Congenital Adrenal Hyperplasia due to classical 21-hydroxylase deficiency (CAH-C-21OHD) is characterized by deficiency in the synthesis of cortisol, and, in some cases, also of aldosterone and by excess of androgens. The aim at of the study was to evaluate the body composition and body proportion of women with CAH-C-21OHD in relation to the control and the clinical form of the disease and to a group control of both sexes. The casuistic was composed by twenty-eight patient (cases group) female with CAH-C-21OHD were divided according to control (good or bad) and the clinical form of the disease (salt-wasting and simple-virilizing). The control group was composed by 112 healthy individuals of both sexes, divided in 2 groups, in agreement with the gender. To verify the effects of the puberty in the appraised measures, the 3 groups were subdivided in 3 age groups: up to 10 years, from 11 to 14 years and above 15 years. To evaluate body proportions and composition, anthropometric measurements and electric impedance were analyzed. The data of anthropometric measurements were converted in standard deviation scores (z). In relation to clinical form of the disease, the simple-virilizing presented values significantly larger of z of BMI, of the perimeter of the waist and of the fat area of the arm, and in the percentage of fat mass. In relation to disease control, the patients with bad control showed significantly lower leg length. The cases showed significantly higher values in relation to controls in z of BMI, arm muscle and fat area, brachial perimeter, of the waist and of the hip, of the biiliac diameter and in the fat percentage and smaller in z of the length of the leg and of the hand and in the percentages of water and lean mass. Alterations in the body composition were observed in all of the age groups, but they were if intensifying with the age, with the prevalence of the increase of the fat mass while the alterations in the body proportions if they turned more evident after the puberty, with main compromising of the extremities (leg, hand and foot). The more adjusted variables to explain the differences between cases and controls were percentage of fat mass, hand length and hip perimeter, comprising 94.7% of the differences between the groups. This group of patients showed differences in body proportions, but mainly in body composition, justifying a broad and careful anthropometric evaluation in the monitoring of CAH-C-21OHD patients / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Introdução: Um dos fatores mais comuns de falha do procedimento das angioplastias vasculares periféricas é a estenose recorrente (reestenose). A inflamação vascular após angioplastia e implante de stent desempenha papel importante na proliferação de células do músculo liso vascular e posterior crescimento de neoíntima hipertrófica. Diversos estudos têm sugerido que a superfície dos stents, quando impregnada com determinadas moléculas, pode limitar a reestenose de forma eficaz. O carbono diamante, polímero de hidrocarboneto amorfo, pode ser usado para essa finalidade, reduzindo liberação de íons metálicos e a trombogenicidade. Diversos mediadores têm sido implicados na resposta inflamatória vascular, como o sistema calicreína-cinina (SCC), as citocinas, proteína C reativa (PCR) e o óxido nítrico (NO). Portanto, estudos clínicos específicos correlacionando o implante do stent aos níveis séricos destes possíveis marcadores podem contribuir no entendimento desse processo. Objetivo: Estudar a perviedade do dispositivo e a evolução clínica de doentes submetidos a angioplastia com stents impregandos de carbono no território vascular periférico, assim como o comportamento de mediadores séricos envolvidos nas fases mais precoces do processo inflamatório pós angioplastia. População e Método: Estudo prospectivo envolvendo 32 pacientes submetidos à angioplastia com stent no segmento ilíacofêmoro-poplíteo, selecionados no Ambulatório de Cirurgia Vascular e Endovascular do HCFMRP/USP. Foram tratadas lesões estenosantes ou oclusivas com angioplastia e colocação de stents de nitinol, com superfície impregnada de carbono (Carbostent®). Foram estudados os seguintes marcadores: SCC - com quantificação dos substratos (cininogênio de alto e baixo peso molecular - CAPM / CBPM) e das enzimas calicreína plasmática e tecidual, além da quantificação da cininase II; a determinação dos níveis de nitrito e nitratos para a avaliação de óxido nítrico; dosagem sérica de PCR e citocinas (IL-1 beta, IL-6, IL-8, IL-10, TNF-alfa e TGFbeta). Também foi realizado a dosagem dos leucócitos. Amostras séricas foram coletadas antes, 24 horas e 6 meses após o implante do stent. Os pacientes foram seguidos por um ano, para avaliação da perviedade nesse período. Resultados: Dos 27 pacientes que completaram seis meses de estudo, houve apenas uma reestenose (3,7%) e nenhuma oclusão (96,3% de perviedade). No período de um ano, quatro pacientes perderam seguimento e todos os 23 doentes avaliados, mantiveram a perviedade dos stents, com exceção do paciente no qual houve reestenose no tempo seis meses. Houve redução significativa das concentrações das citocinas inflamatórias (IL-1 beta, IL-6, IL-8 e TNF-?) no tempo 24 horas e seis meses quando comparado com o pré-procedimento (p<0,05); exceto a IL-8 no tempo 24 horas. As citocinas anti-inflamatórias (IL10 e TGF-beta) comportaram-se de maneira antagônica, com elevação do TGF-beta no tempo 24 horas e elevação, tanto do TGF-beta quanto da IL-10, no tempo 6 meses versus pré-tratamento e 6 meses versus 24 horas (P<0,05). A PCR apresentou queda no tempo seis meses em relação ao tempo 24h (p<0,05). Os níveis de NO não se alteraram entre os tempos; os de leucócitos elevaram-se no tempo 24 horas e reduziram-se no tempo seis meses em relação ao tempo 24 horas (p<0,05). Conclusão: No presente estudo a taxa de reestenose precoce foi de 3,7% nos primeiros 6 meses e 5% em 12 meses de seguimento. O comportamento dos marcadores inflamatórios evidenciou sua correlação direta com o processo de angioplastia e implante de carbostent, em especial o SCC, as citocinas, PCR e os leucócitos. Contudo, não foi possível relacionar a variação dos seus níveis séricos com o processo de reestenose. / Background: One of the most common factors of failure of the peripheral vascular angioplasty procedure is recurrent stenosis (restenosis). Vascular inflammation following angioplasty and stent implantation plays an important role in vascular smooth muscle cell proliferation and subsequent hypertrophic neointimal growth. Several studies have suggested that the surface of stents, when impregnated with certain molecules, can limit restenosis effectively. Diamond carbon, amorphous hydrocarbon polymer, can be used for this purpose, reducing release of metal ions and thrombogenicity. Several mediators have been implicated in the vascular inflammatory response, such as the kallikrein-kinin system (SCC), cytokines, C-reactive protein (CRP) and nitric oxide (NO). Therefore, specific clinical studies correlating stent implantation with serum levels of these possible markers may contribute to the understanding of this process. Objective: To study the patency of the device and the clinical evolution of patients undergoing angioplasty with carbon-impregnated stents in the peripheral vascular territory, as well as the behavior of serum mediators involved in the earlier stages of the inflammatory process after angioplasty. Population and Method: Prospective study involving 32 patients submitted to angioplasty with stent in the iliac-femoro-popliteal segment, selected at the HCFMRP / USP Outpatient Vascular and Endovascular Outpatient Clinic. Stenosis or occlusive lesions were treated with angioplasty and placement of nitinol stents with a carbon impregnated surface (Carbostent®). The following markers were studied: SCC - with quantification of substrates (high and low molecular weight cincinogens - HMWC / LMWC) and plasma and tissue kallikrein enzymes, besides quantification of kininase II; determination of nitrite and nitrate levels for the evaluation of nitric oxide; serum levels of CRP and cytokines (IL-1 beta, IL-6, IL-8, IL-10, TNF-a and TGF-b). Leucocytes were also dosed. Serum samples were collected before, 24 hours and 6 months after stent implantation. The patients were followed for one year to assess the patency in this period. Results: Of the 27 patients who completed six months of study, there was only one restenosis (3.7%) and no occlusion (96.3% of patency). In one year, four patients lost follow-up and all 23 patients evaluated, maintained stent patency, with the exception of the patient who had restenosis over time for six months. There was a significant reduction in the concentrations of inflammatory cytokines (IL-1 b, IL-6, IL-8 and TNF-a) in the time 24 hours and six months when compared with the pre-procedure (p <0.05); except for IL-8 in the 24 hour time. Anti-inflammatory cytokines (IL10 and TGF-b) behaved in an antagonistic manner, with TGF-b elevation in the 24 hour time and elevation of both TGF-b and IL-10, at 6 months versus pre- treatment and 6 months versus 24 hours (P <0.05). CRP showed a decrease in time six months in relation to time 24h (p <0.05). NO levels did not change between the times; the leukocytes increased in time 24 hours and reduced in time six months in relation to time 24 hours (p <0.05). Conclusion: In the present study, the rate of early restenosis was 3.7% in the first 6 months and 5% in 12 months of follow-up. The behavior of the inflammatory markers showed its direct correlation with the angioplasty and carbostent implantation process, especially SCC, cytokines, CRP and leukocytes. However, it was not possible to relate the variation of their serum levels to the restenosis process.