INTRODUÇÃO: Tradicionalmente, a omentectomia total (OT) é realizada juntamente com a ressecção gástrica associada à linfadenectomia na cirurgia do câncer gástrico (CG). No entanto, evidências sólidas em relação ao seu benefício oncológico são escassas. Este estudo foi elaborado para avaliar a incidência de metástases em linfonodos (LN) do grande omento em pacientes submetidos à gastrectomia potencialmente curativa por CG, assim como, avaliar os fatores de risco para a ocorrência de linfonodos metastáticos no grande omento e a evolução dos pacientes. PACIENTES E MÉTODOS: Foram avaliados 284 pacientes operados pelo Serviço de Cirurgia de Estômago, Duodeno e Intestino Delgado do HCFMUSP, no período de março de 2009 a abril de 2016, com diagnóstico de adenocarcinoma. Critérios de inclusão: pacientes submetidos a cirurgias potencialmente curativas com ressecção R0, com linfadenectomia a D2 ou D2 modificada conforme preconizado pela Escola Japonesa. Foram excluídos os pacientes que apresentaram doença disseminada ou metástases a distância, mesmo sendo submetidos a ressecções paliativas, assim como, pacientes com invasão macroscópica do grande omento, pacientes com neoplasias sincrônicas ou metacrônicas, neoplasia de coto gástrico, cirurgia com menos de 15 LN ressecados e ausência de tumor na análise anatomopatológica. O tempo de seguimento de todos os pacientes variou entre 1 e 89,5 meses, com mediana de 27,6 meses. O tempo de seguimento mediano dos pacientes livres de doença foi de 34,3 meses (mínimo de 1 e máximo de 89,5). A associação entre o acometimento de LN no omento com variáveis categóricas foram investigadas por testes exatos de Fisher ou teste qui-quadrado e com variáveis numéricas por testes de Wilcoxon-Mann-Whitney. Adotou-se nível de significância de 5%. RESULTADOS: A média de idade foi 61,8 anos (±11,9; entre 25 e 86). Dos 284 pacientes, cinco (1,8%) tinham LN metastáticos no grande omento (um: pT3N3bM0; dois: pT4aN3bM0; um: pT4aN2M0 e um pT4bN3bM0). Quatro deles faleceram e um estava sob tratamento paliativo com quimioterapia devido à recidiva da doença. Os LN metastáticos no grande omento tiveram correlação significativa com o tamanho do tumor, no qual se encontrou o ponto de corte de 5,25cm (área sob a curva ROC: 0,8072; IC95%: 0,6645 - 0,9498), estádio N (p < 0,001), estádio clínico (p=0,022), invasão venosa (p=0,003), recorrência (p=0,006), local de recorrência (peritôneo: p=0,008; fígado: p=0,023; ovário: p=0,035) e óbito (p=0,008). CONCLUSÃO: A incidência de LN metastático no grande omento de pacientes submetidos à gastrectomia radical por CG é baixa. A OT pode ser evitada em tumores menores que 5,25 cm e estádios T1/T2. Entretanto, a presença de metástases linfonodais no grande omento está associada a recidiva no peritônio, fígado, ovário e óbito / BACKGROUND: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit still lacks. The aim of this study was to evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing potentially curative gastrectomy for GC, as well as its risk factors and patients\' outcomes. PATIENTS AND METHODS: In order to perform this analysis, 284 patients with adenocarcinoma operated at the Department of Surgery of Stomach, Duodenum and Small Intestine at HCFMUSP from March 2009 to April 2016 were reviewed. Inclusion criteria was: patients who underwent potentially curative R0 surgery with D2 lymphadenectomy as recommended by the Japanese School. Patients with disseminated disease or distant metastases, even if undergoing palliative resections were excluded from the study. As well as patients with macroscopic omental invasion, synchronic or metachronous neoplasms, gastric stump neoplasia, surgery with less than 15 harvested LN and absence of tumor in pathological analysis. The follow-up period of all patients ranged from 1 to 89.5 months, with a median of 27.6 months. The median follow-up period of disease-free patients was 34.3 months (minimum of 1 and maximum of 89.5 months). The association between omental LN involvement with categorical variables was investigated by Fisher\'s exact tests or chi-square test and numerical variables by Wilcoxon-Mann-Whitney tests. A significance level of 5% was adopted. RESULTS: The mean age was 61.8 years (± 11.9, range 25 - 86). Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor\'s size in which the cut-off found was 5.25cm (area under the ROC curve: 0.8072; IC95%: 0.6645 - 0.9498), N stage (p < 0.001), clinical stage (p=0.022), venous growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008). CONCLUSION: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low and may be avoided in tumors smaller than 5.25cm and T1/T2 tumors. Though, when present is associated with recurrence in peritoneum, liver, ovary and death

INTRODUÇÃO: Asma é uma doença inflamatória crônica das vias aéreas que envolve diversos tipos de células, especialmente eosinófilos, células T, macrófagos, células epiteliais e células dendríticas. Durante a exposição alérgica, células dendríticas migram para os linfonodos broncopulmonares e iniciam a resposta imune na asma. Em asma humana, poucas informações sobre células dendríticas, células B, células T, eosinófilos, VCAM em linfonodos broncopulmonares são conhecidas. Poucos estudos também descrevem a interação celular entre linfonodos e vias aéreas na asma durante exacerbações. MÉTODOS: Foram analisados por método histoquímico, imuno-histoquímico e análise de imagens as expressões de Vermelho Congo, FatorXIIIa+, CD83+, CD207+, CD1a+, CD23+, CD20+, CD4+, CD8+, VCAM, em vias aéreas grandes e linfonodos broncopulmonares de 11 indivíduosnão asmáticos falecidos por asma e 8 controles não asmáticos. A análise dos marcadores foi realizada na região cortical dos linfonodos e em três regiões das vias aéreas: camadas interna, muscular e externa. RESULTADOS: Os indivíduos asmáticos apresentaram maior expressão de eosinófilos nos lifonodos broncopulmonares e nas três camadas das vias aéreas. Os marcadores FatorXIIIa+, CD23+, CD20+, CD4+ e CD8+ apresentaram aumento na camada externa das vias aéreas dos indivíduos asmáticos. CONCLUSÕES: Os eosinófilos estão aumentados nos linfonodos broncopulmonares e nas vias aéreas dos asmáticos. Alguns marcadores como o FatorXIIIa+, CD20+, CD4+, CD8+ e CD23+ estão aumentados apenas na camada externa das vias aéreas dos asmáticos. VCAM, CD83+, CD207+, CD1a+ não apresentaram aumento nos asmáticos. Este resultado sugere que esses marcadores não estão relacionados ao evento da asma fatal nos indivíduos estudados. As correlações encontradas entre vias aéreas e linfonodos nos asmáticos sugerem que na asma fatal ocorra um fluxo celular direcionado. Nossos resultados fornecem novas evidências para a participação do linfonodo broncopulmonar na exacerbação da asma / INTRODUCTION: Asthma is a chronic inflammatory disease of the airways that involves many different cells, specially mast cells, eosinophils, T cells, macrophages, epithelial cells and dendritic cells (DCs). During allergen exposure, pulmonary DCs migrate to bronchopulmonary lymph nodes (LNs) and prime the immune cells that will characterize the immune response in asthma. In human asthma, there is no information about the composition of DCs, B cells, T cells, and vessels in the regional LNs involved in the immune responses to inhaled antigens. Also, there is little information about the lung - LN cells trafficking occurring in asthma during exacerbations. METHODS: Using histochemistry, immunohistochemistry and image analysis, we investigated the expression of Congo Red+ (eosinophil), factor XIIIa+, CD23+, CD4+, CD8+, CD20+, CD207+, CD83+, CD1a+ cells and VCAM-1+ in the large airways and bronchopulmonary lymph nodes of 11 non-smoker patients that died due to an asthma exacerbation and compared with 8 deceased non-asthmatic controls. The analysis of the markers was carried out in the cortical área of the lymph nodes and three layers of the airways: internal, airway smooth muscle and outer layer. RESULTS: The LNs of asthmatics had increased expression of eosinophils when compared to controls. The large airways of asthmatics had increased expression of eosinophils in all the layers and factor XIIIa+, CD4+, CD8+, CD20+ and CD23+ had increased in the outer layer. CONCLUSIONS: A fatal asthma episode is associated with an altered expression of eosinophils in LNs and large airways.Factor XIIIa+ monocyte dendritic cel, CD4+, CD8+, CD20+, CD23+ cells had increased in the large airways without a concomitant increase in the expression of these cells in bronchopulmonary LNs.However, some DC cell trafficking between the airway mucosa and LNs seems occurs in this severe fatal asthma exacerbation

Signalverarbeitung im Nervensystem hängt sowohl von der Netzwerkstruktur, als auch den zellulären Eigenschaften der Nervenzellen ab. In dieser Abhandlung werden zwei zelluläre Eigenschaften im Hinblick auf ihre funktionellen Anpassungsmöglichkeiten untersucht: Es wird gezeigt, dass neuronale Morphologie die Signalweiterleitung unter Berücksichtigung energetischer Beschränkungen verstärken kann, und dass selbst kleine Änderungen in biophysikalischen Parametern die Aktivierungsbifurkation in Nervenzellen, und damit deren Informationskodierung, wechseln können. Im ersten Teil dieser Abhandlung wird, unter Verwendung von mathematischen Modellen und Daten, die Hypothese aufgestellt, dass Energie-effiziente Signalweiterleitung als starker Evolutionsdruck für unterschiedliche Zellkörperlagen bei Nervenzellen wirkt. Um Energie zu sparen, kann die Signalweiterleitung vom Dendrit zum Axon verstärkt werden, indem relativ kleine Zellkörper zwischen Dendrit und Axon eingebaut werden, während relativ große Zellkörper besser ausgelagert werden. Im zweiten Teil wird gezeigt, dass biophysikalische Parameter, wie Temperatur, Membranwiderstand oder Kapazität, den Feuermechanismus des Neurons ändern, und damit gleichfalls Aktionspotential-basierte Informationsverarbeitung. Diese Arbeit identifiziert die sogenannte "saddle-node-loop" (Sattel-Knoten-Schlaufe) Bifurkation als den Übergang, der besonders drastische funktionale Auswirkungen hat. Neben der Änderung neuronaler Filtereigenschaften sowie der Ankopplung an Stimuli, führt die "saddle-node-loop" Bifurkation zu einer Erhöhung der Netzwerk-Synchronisation, was möglicherweise für das Auslösen von Anfällen durch Temperatur, wie bei Fieberkrämpfen, interessant sein könnte. / Signal processing in nervous systems is shaped by the connectome as well as the cellular properties of nerve cells. In this thesis, two cellular properties are investigated with respect to the functional adaptations they provide: It is shown that neuronal morphology can improve signal transmission under energetic constraints, and that even small changes in biophysical parameters can switch spike generation, and thus information encoding. In the first project of the thesis, mathematical modeling and data are deployed to suggest energy-efficient signaling as a major evolutionary pressure behind morphological adaptations of cell body location: In order to save energy, the electrical signal transmission from dendrite to axon can be enhanced if a relatively small cell body is located between dendrite and axon, while a relatively large cell body should be externalized. In the second project, it is shown that biophysical parameters, such as temperature, membrane leak or capacitance, can transform neuronal excitability (i.e., the spike onset bifurcation) and, with that, spike-based information processing. This thesis identifies the so-called saddle-node-loop bifurcation as the transition with particularly drastic functional implications. Besides altering neuronal filters and stimulus locking, the saddle-node-loop bifurcation leads to an increase in network synchronization, which may potentially be relevant for the initiation of seizures in response to increased temperature, such as during fever cramps.

Les codes correcteurs d’erreurs Non-Binaires Low Density Parity Check (NB-LDPC) sont connus pour avoir de meilleure performance que les codes LDPC binaires. Toutefois, la complexité de décodage des codes non-binaires est bien supérieure à celle des codes binaires. L’objectif de cette thèse est de proposer de nouveaux algorithmes et de nouvelles architectures matérielles de code NB-LDPC pour le décodage des NBLDPC. La première contribution de cette thèse consiste à réduire la complexité du nœud de parité en triant en amont ses messages d’entrées. Ce tri initial permet de rendre certains états très improbables et le matériel requis pour les traiter peut tout simplement être supprimé. Cette suppression se traduit directement par une réduction de la complexité du décodeur NB-LDPC, et ce, sans affecter significativement les performances de décodage. Un modèle d’architecture, appelée "architecture hybride" qui combine deux algorithmes de l’état de l’art ("l’Extended Min Sum" et le "Syndrome Based") a été proposé afin d’exploiter au maximum le pré-tri. La thèse propose aussi de nouvelles méthodes pour traiter les nœuds de variable dans le contexte d’une architecture pré-tri. Différents exemples d’implémentations sont donnés pour des codes NB-LDPC sur GF(64) et GF(256). En particulier, une architecture très efficace de décodeur pour un code de rendement 5/6 sur GF(64) est présentée. Cette architecture se caractérise par une architecture de check node nœud de parité entièrement parallèle. Enfin, une problématique récurrente dans les architectures NB-LDPC, qui est la recherche des P minimums parmi une liste de taille Ns, est abordée. La thèse propose une architecture originale appelée first-then-second minimum pour une implantation efficace de cette tâche. / The Non-Binary Low Density Parity Check (NB-LDPC) codes constitutes an interesting category of error correction codes, and are well known to outperform their binary counterparts. However, their non-binary nature makes their decoding process of higher complexity. This PhD thesis aims at proposing new decoding algorithms for NB-LDPC codes that will be shaping the resultant hardware architectures expected to be of low complexity and high throughput rate. The first contribution of this thesis is to reduce the complexity of the Check Node (CN) by minimizing the number of messages being processed. This is done thanks to a pre-sorting process that sorts the messages intending to enter the CN based on their reliability values, where the less likely messages will be omitted and consequently their dedicated hardware part will be simply removed. This reliability-based sorting enabling the processing of only the highly reliable messages induces a high reduction of the hardware complexity of the NB-LDPC decoder. Clearly, this hardware reduction must come at no significant performance degradation. A new Hybrid architectural CN model (H-CN) combining two state-of-the-art algorithms - Forward-Backward CN (FB-CN) and Syndrome Based CN (SB-CN) - has been proposed. This hybrid model permits to effectively exploit the advantages of pre-sorting. This thesis proposes also new methods to perform the Variable Node (VN) processing in the context of pre-sorting-based architecture. Different examples of implementation of NB-LDPC codes defined over GF(64) and GF(256) are presented. For decoder to run faster, it must become parallel. From this perspective, we have proposed a new efficient parallel decoder architecture for a 5/6 rate NB-LDPC code defined over GF(64). This architecture is characterized by its fully parallel CN architecture receiving all the input messages in only one clock cycle. The proposed new methodology of parallel implementation of NB-LDPC decoders constitutes a new vein in the hardware conception of ultra-high throughput rate decoders. Finally, since the NB-LDPC decoders requires the implementation of a sorting function to extract P minimum values among a list of size Ns, a chapter is dedicated to this problematic where an original architecture called First-Then-Second-Extrema-Selection (FTSES) has been proposed.

INTRODUÇÃO: A excisão total do mesorreto é o procedimento cirúrgico padrão para o tratamento do adenocarcinoma do reto. Resultados satisfatórios, em termos de prognóstico, alcançados com a associação da linfonodectomia retroperitoneal e pélvica lateral questionam se somente a excisão total do mesorreto seria suficiente para um estadiamento adequado, podendo afetar decisões relacionadas ao tratamento adjuvante. Este estudo avaliou o impacto das metástases em linfonodos retroperitoneais e/ou pélvicos laterais na mudança do estadiamento de pacientes com adenocarcinoma do reto e a acurácia da identificação de metástases em linfonodos das cadeias retroperitoneais e/ou pélvicas laterais com o uso de tecnécio-99m-fitato e/ou azul patente. MÉTODOS: Foi realizado estudo prospectivo de janeiro de 2004 a agosto de 2008, composto por 97 pacientes com adenocarcinoma do reto extraperitoneal submetidos a tratamento cirúrgico curativo com excisão total do mesorreto e linfonodectomia retroperitoneal e pélvica lateral, com pesquisa de linfonodos das cadeias retroperitoneais e pélvicas laterais identificados com tecnécio-99m-fitato e/ou corados em azul patente. Os linfonodos radioativos e/ou azuis, quando negativos ao exame histopatológico com hematoxilina-eosina, foram submetidos à multisecções histológicas com uso de técnicas imunohistoquímicas com anticorpos anticitoqueratinas (AE1/AE3). RESULTADOS: A média de linfonodos nas peças de excisão total do mesorreto foi de 11,5 (1119/97) e nas cadeias retroperitoneais e pélvicas laterais foi de 11,7 (1136/97). A linfonodectomia retroperitoneal e pélvica lateral identificou metástases em 17,5% dos pacientes do estudo e promoveu aumento do estádio TNM II para III em 8,2% dos pacientes. As variáveis relacionadas à presença de linfonodos retroperitoneais e/ou pélvicos laterais metastáticos foram o estádio III estabelecido na peça cirúrgica da excisão total do mesorreto (P < 0,04); a classificação pT3/pT4 do tumor primário (P = 0,047); níveis elevados de antígeno carcinoembrionário, com média de 30,6 ng/ml e mediana de 9,9 ng/ml (P = 0,014); e grandes tumores, com tamanho médio de 5,5 ± 3,2 cm (P = 0,03). A migração do tecnécio e/ou azul patente para linfonodos retroperitoneais e/ou pélvicos laterais ocorreu em 37,1% (36/97), modificando o estadiamento em 11,1% dos pacientes estudados. A acurácia do uso do tecnécio e/ou azul patente na detecção de metástases nos linfonodos retroperitoneais e pélvicos laterais foi de 100%, com sensibilidade de 100%, valor preditivo negativo de 100% e zero de falso-negativos. CONCLUSÕES: Deve-se aprimorar o uso de marcadores na identificação de metástases para indicação seletiva da linfonodectomia retroperitoneal e pélvica lateral em adenocarcinoma retal. / BACKGROUND: Total mesorectal excision is the standard surgical procedure for rectal adenocarcinoma treatment. Good prognostic results achieved with retroperitoneal and lateral pelvic lymphadenectomy have questioned that total mesorectal excision might not be satisfactory for adequate patient staging, affecting adjuvant therapeutic definitions. The aims of this study were to define the upstaging impact of metastasis to retroperitoneal and/or lateral pelvic nodes in patients with rectal adenocarcinoma and the accuracy of dye and/or probe search in the detection of metastatic retroperitoneal and/or lateral pelvic nodes. METHODS: A prospective study was carried on from January of 2004 to August of 2008, composed of 97 extraperitoneal rectal adenocarcinoma patients submitted to curative intent surgeries with total mesorectal excision and retroperitoneal and lateral pelvic lymphadenectomy, with retroperitoneal and lateral pelvic nodes mapping using technetium-99m-phytate and/or patent blue. The radioactive and/or blue nodes, when negative to histopathological hematoxylin-eosin staining, were submitted to step-sectioning and immunohistochemical examination with antibody against cytokeratin (AE1/AE3). RESULTS: Mean node count of the mesorectal excision specimen was 11.5 (1119/97) and of the retroperitoneal and lateral pelvic lymphadenectomy was 11.7 (1136/97). Retroperitoneal and lateral pelvic lymphadenectomy identified metastasis in 17.5% of the studied patients and modified TNM stage II to III in 8.2% of the patients. Factors related to metastatic retroperitoneal and lateral pelvic nodes were stage III defined by examination of the surgical specimen of the total mesorectal excision (P < 0,004); tumor pT3/pT4 classification (P = 0,047); high levels of carcinoembryonic antigen, with average of 30.6 ng/ml and median of 9.9 ng/ml (P = 0,014); and large tumors, with mean size of 5.5 cm ± 3,2 cm (P = 0,03). Technetium and/or patent blue migration to retroperitoneal and/or lateral pelvic nodes occurred in 37.1% (36/97), upstaging 11.1% of the studied patients. Technetium and/or patent blue accuracy in the detection of metastasis to retroperitoneal and/or lateral pelvic nodes was of 100%, with sensibility of 100%, negative predictive value of 100% and zero false negatives. CONCLUSIONS: The use of markers should be improved in the identification of metastasis for selective indication of retroperitoneal and lateral pelvic lymphadenectomy.

Introdução: o status dos linfonodos axilares permanece um dos mais importantes fatores prognósticos no carcinoma de mama em estágios iniciais, além de definir o uso de terapias complementares. A biópsia de linfonodo sentinela (BLNS) surgiu com a finalidade de estadiar a axila com o mínimo de morbidade, tendo como objetivo a identificação e o estudo patológico do primeiro linfonodo axilar proveniente da drenagem linfática da mama. Pacientes com axila clinicamente negativa têm indicação de biópsia de linfonodo sentinela como método de estadiamento da axila, e quando o resultado era positivo para metástase recomendava-se o esvaziamento axilar. Por recomendação do ACOSOG Z0011, o esvaziamento axilar (EA) após uma biópsia de linfonodo sentinela positivo não é necessário. Esse estudo demonstrou não haver benefício em realizar o EA na presença de LNS positivo na sobrevida global ou na sobrevida livre de doença. Objetivos: Avaliar a taxa de recidiva e morte em pacientes submetidas à cirurgia conservadora de mama e BLNS positiva com posterior esvaziamento axilar no Hospital de Clínicas de Porto Alegre; e, como objetivo secundário, avaliar as características clínicas e patológicas dessa população. Método: foi realizado um estudo de coorte retrospectiva, incluindo pacientes com diagnóstico de carcinoma de mama invasor submetidas à cirurgia conservadora da mama e BLNS, cujo resultado foi positivo para presença de metástases, e foram submetidas ao EA o período de janeiro de 2004 a dezembro de 2008. Resultados: foram incluídas 144 pacientes submetidas à biópsia de linfonodo sentinela e CCM; 33 tiveram o achado de biópsia de linfonodo sentinela positivo para metástase, e dessas 33 pacientes restaram 27 para análise dos dados. A taxa de sucesso na identificação do LNS foi de 0,96. A idade média das pacientes foi de 53,8 anos, o número de LNS ressecados foi de 1,6 por paciente; a média do tamanho tumoral foi de 2,3 cm. Seis pacientes apresentaram doença axilar residual correspondendo a 22,2% da amostra e tiveram um risco relativo de morte de 3 vezes mais para aquelas sem doença axilar residual e 50% a mais de desenvolvimento de metástases. Conclusão: O comprometimento axilar é importante fator no prognóstico das pacientes com câncer de mama, quanto maior o comprometimento da axilar pior será o desfecho de sobrevida livre de doença e de morte. Acreditamos que se pode aplicar a conduta do ACOSOG Z0011 também nas pacientes do HCPA devido à alta sensibilidade do método no nosso meio. / Introduction: The status of axillary lymph nodes remains one of the most important prognostic factors in breast carcinoma in the early stages, in addition it helps to defining the use of complementary therapies. Sentinel lymph node biopsy (SLNB) was developed with the purpose of staging the axilla with minimal morbidity, aiming at the identification and pathological study of the first axillary lymph node from the lymphatic drainage of the breast. Patients with clinically negative lymph node have indication of SLNB as a method of axillary staging, and with a positive finde for metastasis the axilar clereance was performed. Nowadays, due to the ACOSOG Z0011 Study, the axillary dissection (AD) after a positive SLNB for metastasis was put in check. This estudy have as a result no difference in global survive ou disease free survive if ALND was not performed in a positive SLNB. In the present study, we intend to evaluate the clinical and histopathological characteristics of patients submitted to breast conservative surgery and sentinel lymph node biopsy with a positive result for metastasis. Main objective: Evaluate the rate of recurrence and death in patients submitted to conservative breast surgery and BLNS with posterior axillary emptying at Hospital de Clínicas, Porto Alegre. It is a secondary objective to evaluate the clinical and pathological characteristics of this population. Material and Methods: A retrospective cohort study was performed, including 144 patients diagnosed with invasive breast carcinoma submitted to conservative breast surgery and SLNB, whose results were positive for metastases, and were submitted to AD, at the Mastology Unit of the Hospital de Clinicas de Porto Alegre (HCPA), from January 2004 to December 2008. Results: Of 144 patients submitted to SLNB and BCS, 33 had SLNB positive for metastasis, of these 33 patients remained 27 for data analysis. The success rate in LNS identification was 0.96. The mean age of the patients was 53.8 years, the number of resected SLN was 1.6 per patient; The mean tumor size was 2.3 cm. Six patients had residual axillary disease corresponding to 22.2% of the sample and had a relative risk of death of 3 times more for those without residual axillary disease and 50% more for the development of metastases. Conclusion: Axillary involvement is an important factor in the prognosis of patients with breast cancer, and the greater the axillary impairment, the worse the diseasefree survival outcome and death. We believe that the ACOSOG Z0011 trial can also be applied to HCPA patients who meet the inclusion criteria for this purpose, due to the high sensitivity of the method in our environment.

A fluorescência é uma técnica amplamente empregada na área de diagnóstico médico, com aplicações distintas. Uma de suas aplicações é a detecção de um determinado marcador que pode ser injetado no paciente. A indocianina verde (ICG) é um exemplo de marcador fluorescente que pode ser empregado para auxiliar na identificação do linfonodo sentinela. A excitação é realizada em 780 nm e a emissão detectada ao redor de 850 nm. Tais comprimentos de onda são muito favoráveis para aplicação médica por apresentarem pouca absorção por tecidos biológicos. O objetivo deste trabalho foi desenvolver um sistema de imagens por fluorescência de ICG. Este sistema é basicamente constituído por um dispositivo de iluminação e de aquisição e tratamento de imagem. Dois protótipos foram construídos e testados, um com excitação Laser e o segundo a LED. O dispositivo de iluminação oferece uma iluminação uniforme em uma área de 10 por 15 cm a uma distância de 30 cm. A fluorescência é captada por um sistema composto por duas câmeras perpendiculares uma à outra e um espelho dicroico angulado 45&deg; a ambas, cuja função é separar a imagem por bandas. Uma das câmeras capta a imagem refletida do espelho no espectro visível e a outra capta a imagem transmitida pelo espelho no infravermelho. As imagens obtidas pelas câmeras recebem tratamento em uma rotina desenvolvida em plataforma LabVIEW&reg; para destacar a região com fluorescência sobreposta na imagem sob iluminação branca em tempo real, sendo possível salvar figuras ou vídeos, dependendo da necessidade do operador. O equipamento foi testado no Hospital de Câncer de Barretos em pacientes para ressecção cirúrgica de tumores de cabeça e pescoço e de melanoma e apresentou resultados promissores. / Fluorescence is a widely used technique in medical diagnostic, with several applications. One of its applications is the screening of a particular marker that can be injected into the patient. The indocyanine green (ICG) is an example of fluorescent marker that can be used to assist the identification of the sentinel lymph node. The excitation is performed at 780 nm and the emission is detected around 850 nm. Such wavelengths are very suitable for medical applications due to their little absorption by biological tissues. The objective of this study was to develop a system of fluorescence imaging of ICG. This system is basically constituted by an irradiation and image acquisition device and a routine for image processing. Two prototypes were built and tested, the first one with Laser excitation and the second with LED. The lighting device provides uniform illumination in an area of 10 by 15 cm at a distance of 30 cm. The fluorescence is collected by a system with two cameras orthogonal to each other and a dichroic mirror angled 45 &deg; to both, whose function is to separate the image in bands. One of the cameras captures the image reflected from the mirror in the visible spectrum and the other captures the image absorbed by the mirror in the infrared. The images obtained by the cameras receive treatment on a routine developed in LabVIEW&reg; platform to highlight the fluorescent region overlapping the image under white light in real time, making it possible to save pictures or videos, depending on the needs of the operator. The equipment was tested in Barretos\' Cancer Hospital in patients for surgical resection of head and neck tumors and melanoma tumors and presented promising results.

O presente trabalho tem por objetivo avaliar o comportamento dos campos eletromagnéticos no interior de câmaras reverberantes de modos misturados através do método numérico TLM (Transmission Line Matrix). Inicialmente, apresenta-se uma descrição dos diversos tipos de câmaras aplicáveis na avaliação de desempenho de compatibilidade eletromagnética de equipamentos e sistemas elétricos, destacando-se suas principais características físicas e geométricas, com ênfase nas câmaras reverberantes. Os aspectos teóricos relacionados à descrição do método TLM são detalhados e sua aplicação na avaliação do ambiente eletromagnético das câmaras é então abordada. Diversos resultados são apresentados, considerando-se configurações pré-definidas de câmaras reverberantes, ressaltando-se a definição e cálculo de índices de mérito, bem como os principais aspectos relacionados à representação e definição de critérios adotados nas simulações destas. / The aim of this report is the evaluation of the behavior of electromagnetic fields inside reverberation chambers by means of Transmission Line Modeling (TLM). Initially, it is presented a description of several kinds of chambers applicable for electromagnetic compatibility tests followed by a more detailed description regarding reverberation chambers. Theoretical aspects of TLM method and its application for electromagnetic fields solution are covered. Some results are presented, considering pre-defined reverberation chambers configurations, highlighting some merit indicators and the main aspects adopted on its simulation.

Les protocoles de routage dans les réseaux peuvent être amenés à changer pour de nombreuses raisons : la détection d'un événement particulier, un changement de topologie planifié ou non, la mobilité des nœuds, l'obsolescence de version, etc. Ces changements ne pouvant être simultanément détectés ou pris en compte par tous les nœuds du réseau, il est nécessaire de considérer le cas où certains nœuds utilisent le protocole de routage initial, tandis que d'autres ont migré vers le nouveau protocole de routage. Les travaux de cette thèse portent sur le problème de boucles de routage susceptibles d'apparaître dans ce contexte, et qui dégradent considérablement les performances du réseau. Nous proposons des solutions d'ordonnancement des nœuds, dans le but de contrôler la migration afin d'éviter ces boucles. Premièrement, nous considérons le contexte des réseaux statiques et des protocoles centralisés avec pour cas particulier le changement de métriques dans le réseau. Nous proposons deux solutions d'évitement des boucles centralisées : SCH-m (amélioration mineure d'un protocole existant), et ACH (nouvelle contribution), basées sur l'identification des boucles de routage dans les composantes connexes que contient l'union des deux protocoles de routage. Nous accélérons la migration du réseau par une opération de fusion étape par étape des différentes transitions produites. Deuxièmement, nous évoluons vers les protocoles distribués en conservant le contexte statique du réseau, et considérons le cas particulier du retrait ou de la panne d'un nœud. Nous proposons également deux solutions : RTH-d (amélioration mineure d'un protocole existant) et DLF (nouvelle contribution traitant les boucles de taille 2) basées sur un échange de messages entre les nœuds tant pour la détection de la panne que pour la notification de la migration. Troisièmement, nous considérons le contexte de mobilité des nœuds, et étudions les performances de DLF-k (version améliorée de DLF qui prend en compte les boucles de taille inférieures ou égales à k, avec k >= 2) sur deux types d'applications : les applications avec un unique nœud mobile qui est la destination, et les applications avec un groupe de nœuds mobiles. / Routing protocols in networks may change for many reasons: detection of a particular event, planned or unplanned change of topology, mobility of nodes, version obsolescence, etc. As these changes can not be simultaneously detected or taken into account by all nodes of the network, it is necessary to consider the case where some nodes use the initial routing protocol, while others have migrated to the new routing protocol. The work of this thesis deals with the problem of routing loops that may appear in this context, and which considerably degrade the performance of the network. We propose node scheduling solutions to control migration to avoid these loops. First, we consider the context of static networks and centralized protocols with the particular case of changing metrics. We propose two centralized avoidance solutions: SCH-m (minor improvement of an existing heuristic), and ACH (new contribution), based on the identification of the routing loops in the strongly connected components contained in the union of the two routing protocols. We accelerate the migration of the network by a step-by-step merge operation of the different transitions produced. Second, we evolve towards the distributed protocols while preserving the static context of the network, and consider the particular case of the withdrawal or breakdown of a node. We also propose two solutions: RTH-d (minor improvement of an existing heuristic) and DLF (new contribution for loops of size 2) based on message exchange of nodes for both failure detection and for migration notification. Thirdly, we consider the context of nodes mobility, and study the performance of DLF- k (improved version of DLF which takes into account loops of size less than or equal to k, with k >= 2) on two types of applications: applications with a single mobile node that is the destination, and applications with a group of mobile nodes.

Linfadenopatia pode estar presente em qualquer fase da infecção pelo HIV a apresenta uma variedade de diagnósticos diferenciais possíveis, desde manifestações secundárias ao próprio HIV até doenças oportunistas ou neoplasias. Foi realizado um estudo de corte transversal de pacientes que realizaram biópsias de linfonodo periférico no Hospital de Clínicas de Porto Alegre entre Janeiro de 2004 a Dezembro de 2008. Foram realizadas 210 biópsias, 131 (61,9%) pacientes eram do sexo masculino, a mediana da idade foi 36 (18-74) anos e da contagem de CD4 149 (1-756) cels/mm3. Cento e seis (50,5%) biópsias foram realizadas na região cervical. Os diagnósticos mais prevalentes incluíram micobacteriose 105 casos (50,2%) sendo que mais de 90% dos casos foram tuberculose; hiperplasia reacional (HR) 48 casos (22,7%), linfoma 19 casos (9,0%) e micoses sistêmicas 12 casos (5,7%) que incluíram a histoplasmose, paracoccidioidomicose e criptococose. Esse estudo demonstra que a biópsia de linfonodos periféricos em pacientes com infecção pelo HIV é uma importante ferramenta no diagnóstico de doenças oportunistas no nosso meio. / Peripheral lymphadenopathy is commonly present in HIV- infected patients and has a wide spectrum of differential diagnoses. We performed a cross-sectional study of peripheral lymph node biopsies performed from 2004 to 2008 in HIV patients assisted in a public hospital in Southern Brazil. Two hundred and ten biopsies were performed, 131(61.9%) patients were male, median of age was 36 years old with a mean of lymphocyte CD4 count of 149 (1-756) cells/mm3. Most of biopsies were performed in the cervical site 106 (50.5%). The most prevalent diagnosis were mycobacteriosis 105 (50.2%), more than 90% was tuberculosis; reactive follicular hyperplasia 48 (22.7%); lymphoma 19 (9.0%); systemic mycosis 12 (5.7%), including histoplasmosis, paracoccidioidomycosis and cryptococcosis. Peripheral lymph node biopsy is a useful tool to diagnose opportunistic diseases such as mycobacteriosis, HIV related malignancies and invasive fungal infections in HIV-infected patients.