Os tumores adrenocorticais (TAC) são lesões que se originam do córtex da glândula suprarrenal e ocorrem tanto em crianças quanto em adultos. Técnicas de imagem que forneçam informações quantitativas relativas à citoarquitetura desses tumores ainda não foram estabelecidas neste contexto. A difusão por ressonância magnética (DWI) é uma técnica que pode fornecer informações quantitativas dos tecidos através do valor do coeficiente aparente de difusão (ADC). O papel do ADC nas lesões tumorais adrenais tem sido estudado, porém sua relação com critérios histopatológicos e prognósticos ainda não foram descritos. O objetivo geral deste estudo é investigar a utilidade dos métodos de imagem realizando um paralelo na correlação clínica, histopatológica entre TAC em crianças e carcinoma adrenocortical (CAC) nos adultos. Os objetivos específicos são correlacionar os valores do ADC tumoral a escores histopatológicos, celularidade e Ki-67 tanto em crianças quanto em adultos, avaliando ainda a concordância entre-observadores nas medidas dos ADCs em pacientes e em controles. Este trabalho será baseado em três artigos, nos quais mostrarão a metodologia, resultados e discussões relativos à cada uma das etapas. O primeiro artigo, \"Neoplasias adrenocorticais em adultos e crianças: apresentações distintas. Revisão dos aspectos clínicos, patológicos e do diagnostico por imagem\" trata-se de uma revisão da literatura e análise comparativa sobre as características clínicas, histopatológicas e por imagem dos TAC em crianças e adultos. O segundo artigo, Estudo dos parâmetros derivados do histograma do coeficiente aparente de difusão obtido pela técnica de difusão por RM na avaliação de prognóstico do carcinoma adrenocortical\", estudou CAC em adultos e buscou associar o ADC com os critérios clínicos, histopatológicos, celularidade e o Ki-67. No terceiro artigo \"Tumores Adrenocorticais Pediátricos valores de ADC na diferenciação entre adenomas e carcinomas e sua relação com critérios histopatológicos\" foi realizado em crianças com TAC buscando uma tentativa de diferenciação pelo ADC entre tumores com comportamentos benignos e malignos seja clínica ou histopatologicamente. Os valores de ADCmínimo (ADCmín) e máximo nos adultos, demonstraram ser úteis para diferenciar controles de pacientes com CAC. O ADCmín nos pacientes adultos com CACs evidenciaram que podem ser utilizados para inferir celularidade tumoral. Este estudo ainda reafirmou em adultos com CAC, os valores do Ki-67 como marcador prognóstico e demonstrou uma boa relação da celularidade com o sistema de Weiss. Já nas crianças, houve correlação inversa de alguns dos valores do ADCs com o peso tumoral. Os valores de ADCs não demonstraram relação com a celularidade e com o comportamento clínico e histopatológico dos pacientes, reafirmando, portanto, a peculiaridade dos TAC pediátricos em relação à população adulta. Apesar de neste estudo, os valores de ADCs terem sido mais baixos nos TACs e em CACs que os valores na glândula saudável e de nos adultos ter havido correlação do ADCmín e a celularidade tumoral e em criança com o peso lesional, estas alterações não foram suficientes para predizer objetivamente, critérios preditores de agressividade tumoral ou de prognóstico, podendo eventualmente no futuro, representar uma ferramenta para tal. / Adrenocortical tumors (TAC) are lesions that originate from the cortex of the adrenal gland and occur in children and also in adults. Imaging techniques that provide quantitative information about the citoarchitecture of these tumors have not been established in this context yet. The diffusion magnetic resonance imaging (DWI) is a technique that can provide quantitative information of the tissues by the value of the apparent diffusion coefficient (ADC). The role of the ADC in adrenal tumors has been studied, however its relationship with histopathological prognostic criteria has not been described yet. The aim of this study is to investigate the usefulness of imaging methods performing a parallel in the clinical and histopathologic correlation of the TACs in children and adrenocortical carcinoma (CAC) in adults. The specific objectives are to correlate the values of tumor ADC histopathologic scores, cellularity and Ki-67 in children and also in adults, still evaluating the agreement between observers in the measurements of ADCs in patients and controls. This study will be based on three articles in which show the methodology, results and discussions relating to each of the steps. The first paper, \"Adrenocortical neoplasms in adults and children: different presentations. Review of clinical, pathological and diagnostic imaging \" is about a literature review and comparative analysis of the clinical, histopathological and imaging of CT in children and adults. The second article, \"Utility of the parameters derived from the histogram of the apparent diffusion coefficient obtained by MR diffusion technique in the assessment of adrenocortical carcinoma prognosis,\" studied CAC in adults and sought to link the ADC with the clinical, histopathological, cellularity and Ki-67 of these lesions. In the third paper \"Pediatric adrenocortical tumors: ADC values to differentiate between adenomas and carcinomas and its correlation with histopathological criteria\" was conducted in children with TAC seeking an attempt to differentiate between the ADC tumors with benign and malignant behavior either in clinical or histopathological prism. The ADCmín and max values in adults proven to be useful to differentiate patients from controls. The ADC min in adult patients with CACs showed that it could be used to infer tumor cellularity. This study also reaffirmed in adults with CAC, the values of Ki-67 as a prognostic marker and demonstrated a good relationship with Weiss score and cellularity. Also in children, there was a significant inverse correlation of some of the ADCs values with tumor weight. Some ADCs values showed no relationship to the cellularity and the clinical and histopathological behavior of patients, re-affirming therefore the peculiarity of pediatric TAC relation to the adult population. Despite this study, the ADCs values were lower in TACs and CACs than the values in healthy gland and also that in adults have been correlation the ADCmín and tumor cellularity and in children with weight, these changes were not enough to predict objectively, criteria predictive of tumor aggressiveness and prognosis possibly could in the future represent a tool for such.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-08-09T18:26:50Z No. of bitstreams: 1 carolainebitencourtferreirafernandes.pdf: 1669281 bytes, checksum: 34f68a915c16a0c85f114101af871242 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-14T17:07:25Z (GMT) No. of bitstreams: 1 carolainebitencourtferreirafernandes.pdf: 1669281 bytes, checksum: 34f68a915c16a0c85f114101af871242 (MD5) / Made available in DSpace on 2017-08-14T17:07:25Z (GMT). No. of bitstreams: 1 carolainebitencourtferreirafernandes.pdf: 1669281 bytes, checksum: 34f68a915c16a0c85f114101af871242 (MD5) Previous issue date: 2013-08-28 / O câncer de colo do útero é o segundo tumor mais frequente na população feminina e a segunda causa de morte por neoplasia entre mulheres. A infecção persistente pelo vírus HPV é condição necessária para o aparecimento da doença, bem como de suas lesões precursoras. O uso da vacinação profilática contra o HPV tem se mostrado efetivo na prevenção da doença e, devido ao mecanismo de desenvolvimento do câncer a partir da infecção viral, novas partículas vacinais vêm sendo desenvolvidas com o objetivo de uso terapêutico, ou seja, na vigência de lesões. Este trabalho teve como objetivo realizar uma revisão sistemática da literatura sobre o uso de vacinas terapêuticas contra o HPV e sobre as novas partículas utilizadas com este fim. Foi feita uma consulta às bases de dados MEDLINE, PUBMED e LILACS, às coleções SciELO e à BIBLIOTECA COCHRANE, utilizando-se as palavras-chave “papillomavirus humano”, “”HPV”, “vacina”, “vacinação”, “terapêutico” e “imunoterapia” em diferentes combinações, sem limite de data. Dos 713 artigos encontrados inicialmente, 352 foram excluídos por estarem repetidos nas diferentes bases de dados, 217 por serem artigos de revisão, 86 por serem realizados em animais, 24 publicados em idiomas que não o inglês, português e espanhol, 15 de outras localizações anatômicas que não o colo do útero, 2 em pacientes HIV positivos, 1 em homens, 2 cujas pacientes possuíam apenas infecção pelo vírus, mas não lesão no colo e 1 realizado in vitro. Um último artigo foi excluído pois utilizava a vacina após a retirada da lesão do colo das pacientes. Desta forma foram selecionados 12 artigos para esta revisão sistemática. Estes são artigos de fase I e II, realizados com poucas pacientes e apenas 2 deles são randomizados e cegados. Não se pôde atribuir nenhuma medida estatística aos resultados, visto a heterogeneidade das publicações. Os estudos analisados utilizaram partículas vacinais baseadas nas proteínas E6, E7 e E2 do HPV, concluindo que a proteína E7 é a mais promissora para uso nas vacinas terapêuticas. Esta revisão concluiu que o uso das vacinas baseadas na proteína E7 de HPV é potencialmente benéfico no tratamento das lesões de colo uterino, sendo um campo de estudo promissor, mas esta conclusão deve ser analisada com cautela devido à ausência de estudos realizados com maior número de pacientes e com critérios metodológicos mais rígidos. / Cancer of the cervix is the second most common tumor in the female population and the second cause of death from cancer among women. Persistent infection by HPV is a necessary condition for the onset of the disease and its precursor lesions. The use of prophylactic vaccination against HPV has been shown to be effective in preventing disease and mechanism of cancer development from the viral infection, new particle vaccine have been developed with the aim of therapeutic use, in other words, in the presence of injuries. This study aimed to perform a systematic review of the literature on the use of therapeutic vaccines against HPV and the new particles used for this purpose. Was made a query to the databases MEDLINE, PUBMED and LILACS, SciELO and the collections COCHRANE LIBRARY, using the key words "human papillomavirus", "" HPV "," vaccine "," vaccination "," therapeutic " and "immunotherapy" in different combinations, without a time limit. Of the 713 articles found initially, 352 were excluded because they were repeated in different databases, 217 to be review articles, 86 were conducted in animals, 24 published in other languages than English, Portuguese and Spanish, 15 other anatomical locations than the cervix, 2 in HIV-positive patients, 1 in men, 2 whose patients had only infection, but not injury lap and 1 conducted in vitro. One last item was deleted because the vaccine used after removal of the lesion of the cervix patients. Thus 12 articles were selected for this systematic review. These articles are phase I and II, realized with few patients and only two of them are randomized and blinded. We were unable to assign any statistical measure the results, since the heterogeneity of publications. The analyzed studies used particle vaccine based on proteins E6 and E7 of HPV E2, concluding that the E7 protein is the most promising for use in therapeutic vaccines. This review concluded that the use of vaccines based on HPV E7 protein is potentially beneficial in the treatment of lesions of the cervix, being a promising field of study, but this finding should be considered with caution due to the lack of studies with larger numbers of patients and strict methodological criteria.

Les cellules souches pluripotentes induites (CSPi) permettent la modélisation de processus avec, en oncologie, un intérêt potentiel pour la modélisation de syndromes de prédisposition au cancer liés à des mutations germinales d’oncogènes. Nous avons généré des lignées de CSPi à partir de patients atteints de néoplasies endocriniennes multiples de type 2 (NEM2), porteurs de mutations germinales du gène RET : RETC620R, RETC634Y et RETM918T. Nous avons généré une CSPi RETY634C, contrôle isogénique, par correction de la mutation RETC634Y via CRSPR/Cas9. Ces CSPi présentent tous les critères de pluripotence avec un caryotype normal et expriment Ret. L’étude histologique approfondie des tératomes a mis en évidence le développement de cellules C en leur sein et également de cellules neuroendocrines exprimant la Chromogranine A mais sans aspect d’hyperplasie des cellules C ou de carcinome médullaire de la thyroïde ni de tumeur neuroendocrine réminiscente du phénotype des NEM2. L’analyse comparative de l’expression des gènes de ces CSPi a mis en évidence, dès le stade de pluripotence, une activation du réseau transcriptionnel du gène EGR1 qui pourrait constituer un des mécanismes moléculaires responsables de la mise en place du phénotype des NEM2. La différenciation en cellules souches de la crête neurale (CSCN), cellules d’origine cibles des tumeurs développées dans le cadre des NEM2, en particulier le phéochromocytome, était efficace et reproductible pour toutes nos lignées. Nous avons mis en évidence l’activation d’un programme commun invasif au niveau des CSCN avec mutation RETC634Y et RETM918T ainsi qu’une forte dérégulation du réseau des intégrines entraînant une forte dérégulation de l’adhésion cellulaire. Ceci était confirmé par une augmentation des capacités de migration CSCN avec mutation de RET par rapport aux CSCN témoins. Ainsi, la génération de CSPi avec mutation de RET a permis d’identifier des voies de signalisation potentiellement impliquées dans la physiopathologie des NEM2 et constitue une première étape vers la modélisation des NEM2 in vitro. / Induced pluripotent stem cell (iPSC) offer major perspectives in disease modelling and, in the oncology field, can be used for modelling cancer predisposition syndromes. We generated IPSC lines from somatic cells of patients with multiple endocrine neoplasia type 2 (MEN2) who harboured germline mutations in the RET gene: RETC620R, RETC634Y et RETM918T. We have also generated an isogenic RETY634C iPSC control line by genome engineering using CRSPR/Cas9-mediated method to "correct” C634Y mutation. All iPSC lines exhibited all markers of pluripotency with a normal karyotype and expressed Ret. A thorough histological study of teratomas from these iPSC highlighted the development of C cells and Chromogranin A-expressing neuroendocrine cells within them but without C-cell hyperplasia, medullary thyroid carcinoma or neuroendocrine tumours reminiscent of MEN2 phenotype. Comparative gene expression analysis revealed an activation of the EGR1 transcriptional network, at the pluripotent stem cell stage which could be one of the molecular effector of the phenotype. Neural crest stem cell (NCSC), the cell of origin of some of the tumoral features of MEN2, could be differentiated in vitro from all our RET-mutated iPSC lines effectively. Gene expression analysis revealed an activation of cell invasion program in RETC634Y and RETM918T–mutated NCSC and a deregulation of integrin network causing a strong deregulation of cell adhesion which was confirmed with increased migration capabilities in vitro. Thus, the generation of the first RET-mutated iPSCs allowed the identification of signalling pathways potentially implicated in the pathophysiology of MEN2 and constitute a first step in modelling these tumours in vitro.

No description available.

Inflammatory bowel disease (IBD) represents a group of multifactorial illnesses with increasing incidence worldwide. Crohn's disease (CD) and ulcerative colitis (UC) are the two most thoroughly defined phenotypes of IBD. IBD associated with primary sclerosing cholangitis (PSC) - a progressive biliary disease leading to cirrhosis and liver failure - is considered as specific IBD phenotype (also referred to as 'PSC - IBD') due to its clinical and pathophysiological characteristics. The aim of the experimental part of this thesis was to define specific features of PSC - IBD in the key areas of IBD pathogenesis. These are: microbiota composition, gut - barrier failure, genetic predisposition and aberrant cellular and antibody immune response. Furthermore, the other goals were to describe relation of IBD status and activity to liver transplantation (LTx) and carcinogenesis based on thorough analysis of clinical data in patients under surveillance at the liver transplantation unit. Using the next-generation parallel sequencing technology, we discovered specific bacterial and mycobial features of gut microbiota composition in PSC - IBD which significantly differed from UC and healthy controls recruited from Czech general population. Moreover, we identified numerous seral biomarkers distinguishing CD, UC...

Cytokine steuern die Kommunikation von verschiedenen Zelltypen untereinander und regulieren deren Überleben, Differenzierung und Wachstum. Kommt es zu einer Deregulation der Expression von Cytokinen oder deren Rezeptoren, kann es zu autoimmunen oder malignen Erkrankungen kommen. Ein besonderes Beispiel der aberranten Cytokinexpression ist das klassische Hodgkin Lymphom. Die malignen Hodgkin/Reed-Sternberg (HRS) Zellen des Hodgkin Lymphoms stammen ursprünglich aus Keimzentrums B-Zellen ab, haben aber ihren B-Zell Phänotyp verloren. Des Weiteren exprimieren sie eine Vielzahl von verschiedenen Cytokinen und Cytokinrezeptoren, die ursprünglich nicht in einem Genexpressionsprogramm von B-Zellen vorkommen. In dieser Arbeit wurden zwei dieser Cytokin-Rezeptorsysteme (IL-21/IL-21R und CSF-1/CSF1R) hinsichtlich ihrer Funktionen für die HRS Zellen des Hodgkin Lymphoms charakterisiert. Die Expression des T-Zell assoziierten Cytokins IL-21 konnte in dieser Arbeit erstmals in HRS Zellen nachgewiesen werden. Für die Expression des myeloiden CSF1R zeigen Ergebnisse dieser Arbeit eine neuartige Regulation durch ein Long Terminal Repeat (LTR) Element, welche zu einem bis dahin unbekannten mRNA Transkript des Protoonkogens CSF1R in den HRS Zellen führt. Sowohl für IL-21 als auch für CSF1R konnte in der Doktorarbeit die Expression und Funktionalität des jeweilig korrespondierenden Rezeptors (IL-21R) bzw. Cytokins (CSF-1) nachgewiesen werden. Die Bedeutung dieser B-Zell fremden Gene für die HRS Zellen lag hauptsächlich in der Stimulation von Wachstum und Überleben und der Induktion von wichtigen Signalwegen (z.B. STAT3). Die Ergebnisse der Dissertation können als Ausgangspunkt für neue Strategien in der Diagnostik und der spezifischeren Therapie von Hodgkin Lymphom Patienten dienen. Der außergewöhnliche Mechanismus der Genregulation des CSF1R Gens über ein endogenes LTR Element kann in anderen Tumorentitäten ebenfalls ein Grund für die Aktivierung von Onkogenen sein. / Cytokines in the human body are responsible for cell-cell communication and regulate survival, differentiation and proliferation of different cell types. Deregulation of expression levels of cytokines might contribute to autoimmune diseases or tumor growth. One of the most prominent examples of aberrant cytokine expression is the classical Hodgkin Lymphoma. The malign Hodgkin/Reed-Sternberg (HRS) cells of classical Hodgkin Lymphoma are derived from germinal centre B cells, however they lost their B cell-specific phenotype. Moreover they express a huge variety of cytokines and cytokine receptors, normally not expressed in B cells. Two of these cytokine-receptor systems (IL-21/IL-21R and CSF-1/CSF1R) and their expression and function in HRS cells are subject of this dissertation. The expression of the T cell-associated cytokine IL-21 has been shown for the first time in HRS cells. The results for the myeloid-specific proto-oncogene CSF1R identified a unique, so far unknown mRNA transcript, expressed due to activation of a long terminal repeat (LTR) element. For both, IL-21 and CSF1R, the expression and functionality of the corresponding receptor (IL-21R) or cytokine (CSF-1), respectively, was demonstrated in this dissertation. Protection from apoptosis, proliferation and stimulation of several pathways are the main functional consequences of auto- and paracrine stimulation of HRS cells with either IL-21 or CSF-1. These results might lead to new diagnostic and more specific treatment strategies for Hodgkin Lymphoma patients. Regarding the unusual expression of CSF1R via LTR activation this mechanism might also be the reason for oncogene activation in several other tumor entities.

Das essentielle Spurenelement Selen (Se) wird als einziges Spurenelement über den genetischen Code als Bestandteil der 21. proteinogene Aminosäure Selenocystein (SeCys) in eine kleine Gruppe von Proteinen eingebaut. Als Bestandteil des aktiven Zentrums dieser Selenoproteine ist Se bzw. SeCys essentiell für deren Funktion. Die Biosynthese der Selenoproteine ist durch eine Reihe von Besonderheiten gekennzeichnet, so z.B. durch eine hierarchisch abgestimmte Versorgung der unterschiedlichen Organe mit dem limitierenden Spurenelement bzw. durch eine hierarchische Versorgung der einzelnen Selenoproteine während ihrer Biosynthese. Für die biologische Verwertung und Verteilung ist das Selenoprotein SePP von zentraler Bedeutung. Transkriptomanalysen haben aufgezeigt, dass gerade in Tumoren die Expression von SePP stark erniedrigt ist. In dieser Arbeit wurde untersucht, inwieweit der Verlust von SePP einen kausalen Einfluss auf die Tumorigenese nimmt. Hierzu wurden zwei transgene Mausmodelle verkreuzt: zum einen Mäuse mit einem partiellen bzw. kompletten genetischen Verlust der SePP-Expression und zum anderen Mäuse mit einer Mutation im APC-Tumorsuppressorgen, welche multiple intestinale Neoplasien (Min) auslöst und als Paradigma in der experimentellen Darmkrebsforschung dient. Der komplette Verlust des SePP-Gens bewirkte eine stark erhöhte Tumorrate im Dünndarm der APCmin-Mäuse. Hierdurch konnte SePP als neuer wichtiger Modulator der APC-abhängigen Tumorigenese etabliert werden. Interessanterweise genügte bereits der Verlust eines einzelnen SePP-Allels, um mehr, größere und weniger differenzierte Adenome im Dünndarm entstehen zu lassen. Diese Beobachtung deutet auf einen entscheidenden Gen-Dosis-Effekt von SePP für die intestinale Tumorigenese hin und könnte damit als weiteres sinnvolles Kriterium zur Feindiagnostik von Darmkrebs dienen. Die molekularbiologischen Untersuchungen der Tumore lassen eine Aktivierung von Zellzyklus-, Angiogenese- und Akutphaseprozessen vermuten. Hierdurch und über die erhöhte Produktion von Wachstumsfaktoren kann die vermehrte Tumorigenese bei SePP-Mangel erklärt werden. Weitergehend konnte auch der Darm, ungeachtet seiner primären Rolle bei der Selenaufnahme, als abhängig von einer regulären SePP-Expression erkannt werden. Somit stellt sich SePP als zentraler Vermittler des Selenmetabolismus dar, und könnte auf lange Sicht als funktioneller Biomarker des Selenstatus für die individuelle Risikoabschätzung etabliert werden. / Selenium (Se) is the only trace element which is encoded in the genome as the 21st proteinogenic amino acid selenocystein (Sec). Se is essential for the catalytic activity of the small group of Sec-containing selenoproteins. The biosynthesis of this group of extraordinary proteins is characterized by several specialities, e.g. the distribution of Se differs between the organs giving rise to a hierarchical biosynthesis of the selenoproteins and there is an intracellular hierarchy of selenoprotein biosynthesis in times of Se depletion. One particular selenoprotein is of central importance for the organification and trafficking of Se within the organism, i.e., Selenoprotein P (SePP). From transcriptome analyses it was deduced that this Se transport protein is markedly reduced in tumours of several origins. The aim of this thesis was to elucidate whether SePP has a causal impact on the tumourigenesis within the intestinal tract. For this purpose, the SePP-KO mouse model with a genetically impaired SePP expression was crossed with the well-established APCmin intestinal tumour model. A stop mutation in the APC tumour suppressor gene causes multiple intestinal neoplasias (Min) in these mice. The combined deletion of SePP caused a sharp increase in tumour incidence in the small intestines of APCmin mice. Interestingly, even the inactivation of only one SePP allele was sufficient to induce more and less well differentiated adenomas in the small intestine. These results indicate that SePP acts as an important modulator of APC dependent tumorigenesis in a gene dose dependent manner. In the long run, SePP might turn out as another valuable biomarker to estimate the individual cancer risk. From a mechanistic point of view, the transcriptome analyses indicate that an impaired SePP expression favors cell cycle progression, angiogenesis and acute phase response. In addition, an elevated production of growth factors in response to SePP deficiency might contribute to the phenotype of bigger and more undifferentiated tumours. Additional analyses of the intestines revealed that the intestinal tract is dependent on a regular SePP expression in order to synthesise its regular set of selenoproteins even so it represents the prime organ of Se absorption. Therefore, SePP represents a central Se transport and storage protein also within the intestinal tract, highlighting its essential role to preserve health and regular Se metabolism.

Hintergrund: Die Pathogenese nicht-familiärer kolorektaler Neoplasien ist heute noch nicht bekannt. Die Besonderheiten der Epidemiologie der Erkrankung sprechen für die Beteiligung von Umweltfaktoren, wie sozioökonomischer Faktoren, der Ernährung oder der bakteriellen Flora des Darmes. Eine intrazelluläre, von E.coli dominierte Flora wurde in Kolonbiopsien dieser Patienten beschrieben. Methoden: Es wurden Virulenzfaktoren von Escherichia coli untersucht, die aus gewaschenen koloskopischen Biopsien von 43 Patienten mit kolorektalen Adenomen und Karzinomen isoliert worden waren. 100 Stämme wurden mittels PCR auf Gene für folgende Virulenzfaktoren untersucht: s-Fimbrien (sfa), pyelonephritisassoziierter Pilus (pap), Hämolysin A (hlyA), hitzestabiles und -labiles Toxin (ST, LT, EAST), Intimin (eae), Verotoxin (stx), Invasionsplasmid (ipa), cytolethal distending toxin (cdt) und cytotoxic necrotizing factor 1 (cnf1). Für die Kontrollgruppe wurden E.coli aus Biopsien von 55 Patienten mit chronisch-entzündlichen Darmerkrankungen (CED) und unspezifischer Kolitis, von 16 Patienten mit Colon irritabile (IBS) und aus Stuhlproben von 29 gesunden Probanden isoliert und untersucht. Ergebnisse: Bei 69% der Patienten mit kolorektalen Karzinomen und bei 58% der Patienten mit kolorektalen Adenomen wurde mindestens einer der Virulenzfaktoren gefunden, dagegen nur bei 25 bis 39% der IBS- und CED- Patienten sowie der gesunden Probanden (p / Background: Pathogenesis of non-hereditary colorectal neoplasia is poorly understood. The differences in regional incidence indicate an influence of environmental factors, as socio-economic conditions, nutrition and intestinal flora. An intracellular flora with a predominance of Escherichia coli in colon biopsies has been described in these patients. Methods: We studied virulence factors of Escherichia coli isolated from washed colonoscopic biopsies of 43 patients with colorectal carcinoma and adenoma. 100 strains of E.coli were isolated and used for detection of a broad range of virulence genes by PCR encoding: s-fimbriae (sfa), pyelonephritis-associated pili (pap), hemolysin A (hlyA), heatstable and heatlable toxins (ST, LT, EAST), verotoxin (stx), invasionplasmidantigen (ipaH), intimin (eae), cytolethal distending toxin (cdt) and cytotoxic necrotizing factor 1 (cnf1). E.coli from biopsies of 55 patients with inflammatory bowel disease (IBD) and non-specific colitis, of 16 patients with irritable bowel syndrom (IBS) and from stool samples of 29 healthy individuals were isolated and examined as controls. Results: The prevalence of virulent strains bearing at least one of the tested genes was 69% in colorectal carcinoma and 58% in colorectal adenoma, but only 25 to 39% of IBD and IBS patients and healthy individuals (p

OBJETIVO: O objetivo deste estudo foi analisar a concordância entre o esfregaço anal e a biópsia guiada por anuscopia de alta resolução no diagnóstico da displasia anal em pacientes infectados pelo HIV. MÉTODO: Conduzimos uma análise transversal de pacientes infectados pelo HIV submetidos a rastreamento de displasia anal rotineiro. A concordância entre mensurações foi estimada por índice de kappa ponderado através de sistema de avaliação citológica e histológica de três categorias (normal, displasia de baixo grau, e displasia de alto grau). Estimativas de sensibilidade, especificidade e valores preditivos foram calculados através de sistema de avaliação citológica e histológica de duas categorias (ausência de displasia e displasia de qualquer grau). Estimativas foram calculadas também para a detecção de displasia de alto grau. RESULTADOS: No decorrer de um ano, 222 pacientes foram submetidos a 330 esfregaços anais seguidos de biópsias guiadas por anuscopia de alta resolução. Trezentos e onze (311) esfregaços com biópsias concomitantes foram satisfatórios. Considerando-se a histologia como padrão, a freqüência de displasia anal foi de 46%. O índice kappa ponderado para concordância entre o esfregaço anal e a biópsia foi de 0,20. Para detecção de displasia anal de qualquer grau, o esfregaço anal demonstrou sensibilidade de 61%, especificidade de 60%, valor preditivo positivo de 56% e valor preditivo negativo de 64%. Para displasia de alto grau, o esfregaço anal demonstrou sensibilidade de 16% e especificidade de 97%. CONCLUSÃO: Os resultados obtidos no presente estudo, em que comparamos os achados da citologia dos esfregaços com os achados histológicos das biópsias dirigidas pela anuscopia de alta resolução em pacientes infectados pelo HIV permitiram concluir que houve baixa concordância entre eles / Purpose: To analyze the agreement between anal Pap smear and high resolution anoscopy guided biopsy to diagnose anal dysplasia in HIV-infected patients. Methods: Cross sectional analysis of HIV-infected patients receiving anal dysplasia screening as part of routine care. Agreement between measures was estimated by weighted kappa-statistics, using 3-tiered cytologic and histologic grading system (normal, low grade dysplasia, and high grade dysplasia). Estimates of sensitivity, specificity, and predictive values were calculated using a 2-tiered cytologic and histologic grading system (without dysplasia, and with dysplasia of any grade). Estimates were also calculated for the detection of high grade dysplasia. Results: Two hundred and twenty-two patients underwent 330 anal Pap smears followed by high resolution anoscopy guided biopsies in one year period. There were 311 satisfactory Pap smears with concurrent biopsy. Considering histology the standard, the frequency of anal dysplasia was 46 percent (95 percent confidence interval: 40-51 percent). Kappa-agreement between anal Pap smear and biopsy was 0.20 (95 percent confidence interval: 0.10 0.29). Anal Pap smear showed sensitivity of 61 percent, specificity of 60 percent, positive predictive value of 56 percent, and negative predictive value of 64 percent for detection of anal dysplasia of any grade. For high grade dysplasia, anal Pap smear showed sensitivity of 16 percent, and specificity of 97 percent. Conclusion: The present study showed a low concordance between anal Pap smears and high resolution anoscopy-guided biopsy

OBJETIVO: O objetivo deste estudo foi analisar a concordância entre o esfregaço anal e a biópsia guiada por anuscopia de alta resolução no diagnóstico da displasia anal em pacientes infectados pelo HIV. MÉTODO: Conduzimos uma análise transversal de pacientes infectados pelo HIV submetidos a rastreamento de displasia anal rotineiro. A concordância entre mensurações foi estimada por índice de kappa ponderado através de sistema de avaliação citológica e histológica de três categorias (normal, displasia de baixo grau, e displasia de alto grau). Estimativas de sensibilidade, especificidade e valores preditivos foram calculados através de sistema de avaliação citológica e histológica de duas categorias (ausência de displasia e displasia de qualquer grau). Estimativas foram calculadas também para a detecção de displasia de alto grau. RESULTADOS: No decorrer de um ano, 222 pacientes foram submetidos a 330 esfregaços anais seguidos de biópsias guiadas por anuscopia de alta resolução. Trezentos e onze (311) esfregaços com biópsias concomitantes foram satisfatórios. Considerando-se a histologia como padrão, a freqüência de displasia anal foi de 46%. O índice kappa ponderado para concordância entre o esfregaço anal e a biópsia foi de 0,20. Para detecção de displasia anal de qualquer grau, o esfregaço anal demonstrou sensibilidade de 61%, especificidade de 60%, valor preditivo positivo de 56% e valor preditivo negativo de 64%. Para displasia de alto grau, o esfregaço anal demonstrou sensibilidade de 16% e especificidade de 97%. CONCLUSÃO: Os resultados obtidos no presente estudo, em que comparamos os achados da citologia dos esfregaços com os achados histológicos das biópsias dirigidas pela anuscopia de alta resolução em pacientes infectados pelo HIV permitiram concluir que houve baixa concordância entre eles / Purpose: To analyze the agreement between anal Pap smear and high resolution anoscopy guided biopsy to diagnose anal dysplasia in HIV-infected patients. Methods: Cross sectional analysis of HIV-infected patients receiving anal dysplasia screening as part of routine care. Agreement between measures was estimated by weighted kappa-statistics, using 3-tiered cytologic and histologic grading system (normal, low grade dysplasia, and high grade dysplasia). Estimates of sensitivity, specificity, and predictive values were calculated using a 2-tiered cytologic and histologic grading system (without dysplasia, and with dysplasia of any grade). Estimates were also calculated for the detection of high grade dysplasia. Results: Two hundred and twenty-two patients underwent 330 anal Pap smears followed by high resolution anoscopy guided biopsies in one year period. There were 311 satisfactory Pap smears with concurrent biopsy. Considering histology the standard, the frequency of anal dysplasia was 46 percent (95 percent confidence interval: 40-51 percent). Kappa-agreement between anal Pap smear and biopsy was 0.20 (95 percent confidence interval: 0.10 0.29). Anal Pap smear showed sensitivity of 61 percent, specificity of 60 percent, positive predictive value of 56 percent, and negative predictive value of 64 percent for detection of anal dysplasia of any grade. For high grade dysplasia, anal Pap smear showed sensitivity of 16 percent, and specificity of 97 percent. Conclusion: The present study showed a low concordance between anal Pap smears and high resolution anoscopy-guided biopsy