O interesse pela doença de Crohn tem aumentado progressivamente em nosso país.Muitas publicações têm surgido na área nos últimos anos. O tratamento inicial é clínico, mas a maioria dos doentes precisa de tratamento cirúrgico ao longo da evolução. Mais de 70% dos pacientes com doença de Crohn serão operados durante o curso da doença. A recorrência sintomática ou não da doença de Crohn na anastomose íleo-cólica tem levado diversos autores a tentar novas técnicas cirúrgicas com o objetivo de retardá-la ou previni-la. Taxas de reoperação de 40% em cinco anos e 55% em dez anos já foram publicadas. O tipo de técnica cirúrgica utilizada e a sua relação com a recorrência na anastomose após ressecção ileal ou ileocolônica é, portanto, um tópico de grande importância quando se trata a doença de Crohn. Considerando-se a importância da recidiva na qualidade de vida dos pacientes com Doença de Crohn, julgamos oportuno avaliar e comparar a taxa de recorrência da doença de Crohn e a morbidade das anastomoses látero-laterais em relação às termino-terminais em pacientes com acometimento da doença em íleo terminal. Foram revisados prontuários cujos dados foram coletados prospectivamente no ambulatório de doenças inflamatórias no período de setembro de 1984 a março de 2004. Apenas os pacientes com diagnóstico de doença de Crohn em intestino delgado exclusivamente ou associada a manifestação em intestino grosso que foram submetidos a enterectomia ou a ressecção de intestino delgado e cólon direito em algum momento do tratamento foram incluídos na pesquisa (total de 141 pacientes e 185 procedimentos analisados-média de 1,65 por paciente). A indicação cirúrgica mais frequente foi por intratabilidade clínica, seguida por fístula intestinal, das quais a mais frequente foi a enterocutânea.Em 185 procedimentos realizados,101 foram seguidos de anastomose látero-lateral mecânica e 84 seguidos de término-terminal manual. Das cirurgias realizadas, a mais frequente foi a enterectomia associada a ressecção de colon direito.As complicações foram divididas em precoces e tardias.A complicação precoce mais frequente foi deiscência de anastomose.A taxa global de complicações foi de 15,1%.Dos 84 procedimentos com anastomose término-terminal realizados, 40 recidivaram(47,6%), com um intervalo médio de cinco anos entre o procedimento inicial que deu origem à recidiva e o procedimento de correção. Entre os 101 procedimentos realizados com anastomose látero-lateral, apenas seis pacientes foram reoperados, num intervalo médio de três anos, e nenhum deles foi por complicação junto à anastomose látero-lateral. Concluímos portanto, que a enterectomia seguida de anastomose láterolateral mecânica deve se constituir na técnica cirúrgica de eleição, por determinar número de reoperação por Doença de Crohn sintomática significativamente menor que as anastomoses término-terminais. / Around 70% of patients with ileal Crohn´s disease will be submeted to a surgical procedure during their lives. This study compares the recurrence rates and morbidity between surgeries followed by a wide-lumen stapled anastomosis and conventional endto-end anastomosis. We studied 185 surgical procedures in a retrospective analyses. There were 84 procedures followed by an end-to-end anastomosis and the recurrence rate was 47,6%.Among the 101 wide-lumen stapled anastomosis procedures, only 6 patients had to be submeted to a new surgery. We conclude that the enterectomy followed by a wide-lumen stapled anastomosis is the gold standard surgery for patients with ileal Crohn´s disease.

L’hétérogénéité tumorale (HT) est un trait caractéristique du cancer. Elle peut être rencontrée chez la majorité des tumeurs malignes solides, au travers de la clinique, la biologie, l’histologie, et la génétique. Au-delà de l’hétérogénéité inter-patient, on distingue l’hétérogénéité spatiale, qui regroupe l’hétérogénéité au sein de la tumeur primitive, entre tumeur primitive et métastases, entre métastases, au sein d’une métastase et l’hétérogénéité temporelle, qui fait référence à l’évolution de la tumeur au cours du temps de manière spontanée ou sous l’effet des traitements. L’HT explique la survenue inéluctable de la résistance aux thérapies anticancéreuses actuelles. L’objectif général de cette thèse était d’explorer l’hétérogénéité tumorale au plan clinique, histologique et génétique en utilisant le modèle d’hépatectomies pour métastases d’origine colo-rectales. Dans l’article 1, nous avons étudié la réponse histologique à la chimiothérapie chez des patients opérés de métastases hépatiques colo-rectales après chimiothérapie systémique ou intra-artérielle. Ainsi, nous avons montré que la réponse histologique complète était plus souvent observée après administration d’oxaliplatine par voie intra-artérielle et était associée à un meilleur pronostic. Cependant la réponse histologique complète n’est observée que chez une minorité de patients. Nous avons émis l’hypothèse qu’une réponse histologique incomplète représentent un groupe hétérogène de patients, ayant des pronostics différents. Ceci nous a conduit à proposer dans l’article 2 une méthode reproductible pour évaluer la réponse histologique, incorporant taille et nombre de nodules. La relecture des lames de pièces d’hépatectomie nous a conduit à observer une hétérogénéité de la réponse histologique au sein d’un même patient (hétérogénéité intermétastatique) et de l’aspect histologique (nécrose, fibrose). Nous avons ensuite exploré la valeur pronostique de cette hétérogénéité et chercher à identifier les facteurs prédictifs de cette hétérogénéité. Une réponse dissociée (une différence de réponse histologique > 50% entre deux nodules chez un même patient) a été observée chez 20% des patients et ne modifiait pas le pronostic. Chez les patients ayant une hétérogénéité pathologique, une discordance (mutation et absence de mutation pour les gènes KRAS, BRAF, NRAS et PI3K) entre les métastases a été mis en évidence dans 28% des patients analysés (article 3). Afin d’étudier l’hétérogénéité génétique selon le site tumoral et le type de prélèvements, nous avons utilisé les données disponibles de la plateforme de biologie moléculaire (article 4). Nous avons ainsi mis en évidence que les métastases hépatiques étaient moins souvent mutées pour KRAS, NRAS, BRAF que les tumeurs primitives ou les lésions pulmonaires. Nous avons ensuite recherché une hétérogénéité génétique intra-métastatique pour KRAS, NRAS, BRAF et PI3K au sein d’une métastase hépatique colo-rectale (article 5). Parmi les 54 patients ayant une tumeur unique analysable (2 prélèvements par tumeur), une discordance pour KRAS (N=2) et BRAF (N=1) a été mise en évidence chez 3 patients (5%). L’ensemble de ces travaux confirment que l’HT est observée à travers de nombreux points de vue. L’élaboration de nouvelles stratégies de prise en charge du cancer devra prendre compte cet aspect. / Tumor heterogeneity is a typical feature of cancer. It is observed in the majority of solid malignancies regardless of the point of view: clinical, biological, pathological, and genetic. Different levels of heterogeneity have been described: interpatient, spatial heterogeneity (within the primary tumor, between primary and distant lesion) and temporal heterogeneity (tumor evolution under the influence of treatment). Tumor heterogeneity widely explains the emergence of resistant clones to anticancer drugs. The objective of the current thesis was to explore tumor heterogeneity at a clinical, pathological and genetic level, by using the model of hepatectomy for colorectal liver metastases (CLM).In the article 1, we studied pathological response to chemotherapy in patients operated on for CLM after either systemic or intra-arterial hepatic oxaliplatin-based chemotherapy. We showed that complete pathological response was more often observed after intra-arterial chemotherapy and yield far better outcomes. However, complete response was observed in a minority of patients. We hypothesized that uncomplete pathological response encompass a large group of patients with different oncological outcomes. This lead us to propose a reproducible method (article 2) to assess pathological response, including size and number of nodules. Pathological review found heterogeneity in the response among nodules within the same patients and in the type of pathological features (necrosis, fibrosis). We then explore the prognostic value of pathological heterogeneity and sought to identify predictors of heterogeneity. A dissociated response (difference in pathological response > 50% between two nodules) was observed in XX and did not impact long-term outcomes. IN patients with dissociated response, genetic heterogeneity (mutation and no mutation for KRAS, NRAS, BRAF and PI3K) between metastases was shown in 28% of patients (article 3). To study genetic heterogeneity according to tumor location and the tumor tissue analyzed (specimen, biopsy), we used data from the department of molecular biology (article 4). We found that liver metastases were more often wild type for KRAS, NRAS, BRAF compared to lung metastases or primary tumors. In the article 5, we then sought to evaluate intrametastatic heterogeneity (KRAS, BRAF, NRAS, PI3K) within a single liver metastasis (2 samples per tumor). Among the 54 patients with single lesion analyzed, a discrepancy for KRAS (n=2) and BRAF (n=1) were observed un 3 patients (5%). This work confirms that tumor heterogeneity can be observed at various levels. Elaboration of new therapeutical strategies will have to take this aspect into consideration.

Spel om pengar finns i olika former och har blivit en del av många personers vardag, dessvärre kan inte alla hantera spelet. Spelmissbruk påverkar personen som för en ständig jakt på pengar och speltid vilket medför konsekvenser och känslor som är svåra att hantera. Ett spelmissbruk påverkar även omgivningen i form arbetsgivare, vänner, familj, barn med flera som alla blir en del av ett missbruk. Denna kvalitativa studie avser studera hur en person inträder i ett spelmissbruk, hur personen upprätthåller ett liv som spelmissbrukare och hur personen tar sig ur missbruket. Vårt syfte med studien är att få en djupare förståelse samt att urskilja vilka känslor ett spelmissbruk medför. Vi har genomfört djupintervjuer med åtta personer och tolkningen och analysen har skett hermeneutiskt. Genom vår analys har sju teman kunnat urskiljas intresse för spel i tidig ålder, inträde i spelmissbruk, ångest skuld och skam, verklighetsflykt, förändringar i identiteten och beteende, relationer och interaktion och avslutningsvis strategier. Vi har tagit del av åtta gripande berättelser och fann att spelmissbruk medför stora konsekvenser för den enskilde individen men även för personer i omgivningen. Spelmissbruk är viktigt att belysa och lyfta i samhället då det är ett växande problem som berör många och att det ofta är ett dolt missbruk. / Gambling with money comes in different forms and have become a part of many people's everyday lives, unfortunately not everyone can handle the game. Compulsive gambling affects the person who has a constant search for money and playing time, that gives consequences and feelings that are difficult to manage. The addiction affects people in the environment as employers, friends, family, children and others who all become part of an addiction. This qualitative study intends to study how a person enters a gambling addiction, how the person maintains a life as a compulsive gambler and how the person enter the abuse. Our purpose of the study is to gain a deeper understanding and to identify what emotions the addiction brings. We have conducted in-depth interviews with eight people and the interpretation and analysis has been hermeneutic. Through our analysis seven themes have been distinguished interest in the game at an early age, entry into gambling addiction, anxiety, guilt and shame, escapism, changes in the identity and behavior, relationships and interactions and finally strategies. We have taken note of the arrest of eight stories and found that compulsive gambling entails serious consequences for the individual but also for people in the surroundings. Compulsive gambling is important to highlight and promote in the community as it is a growing problem that affects many and it is often a hidden addiction.

Evidências sugerem que o fator de crescimento de fibroblasto 2 (FGF2), produzido por melanomas, possui importante papel no crescimento tumoral, angiogênese e metástase. Assim, o uso de anticorpo monoclonal (mAb) que reconhece e bloqueia a atividade de FGF2 é uma abordagem a ser considerada em oncologia. O propósito desse estudo foi avaliar a aplicação diagnóstica e terapêutica de um novo anticorpo anti-FGF2, 3F12E7 IgG1, em melanoma experimental B16-F10. Para isso, camundongos C57Bl/6 foram implantados subcutaneamente (ou intravenosamente, para ensaios de metástase) com células de melanoma murino B16-F10 (5x105 células/animal). Quando tumores alcançaram 3-4 mm de diâmetro (ou 24 h pós-inóculo de células B16-F10, no caso de ensaios de metástase), camundongos foram tratados com anti-FGF2 3F12E7 IgG. Animais controle receberam igual volume do veículo ou quantidade de anticorpo controle de isotipo. Grupos: animais tratados com (1) anti-FGF2 3F12E7 IgG1; (2) ligante de CEA IgG1 (controle de isotipo); e (3) veículo. O tratamento dos camundongos portadores de tumor com anti-FGF2 IgG resultou, comparado com os controles salina e de isotipo, em uma redução no número de focos metastáticos nos pulmões (ANOVA, p < 0,05), em ensaios de metástase experimental, bem como em uma menor taxa de crescimento de tumores subcutâneos (n=7/grupo). Esse resultado é acompanhado por uma redução na densidade vascular do tumor, conforme determinado por imunomarcação para CD34 ou CD31. A captação tumoral de anti-FGF2 3F12E7 IgG foi avaliada por métodos de medicina nuclear, usando esse anticorpo radiomarcado com tecnécio-99m. Estudos SPECT/CT in vivo e de biodistribuição ex vivo revelaram que 99mTc-anti-FGF2 3F12E7 IgG pode atingir eficientemente tumores subcutâneos e metastáticos de B16-F10. Assim, esses dados sugerem que anti-FGF2 3F12E7 IgG pode ser uma estratégia antitumoral promissora para melanoma, bem como uma potencial ferramenta de imagem a ser explorada, atuando como um possível traçador para rastrear tumores FGF2-positivos e mapear esse estímulo angiogênico no microambiente tumoral. Aprovado pelo comitê de ética (CAPPesq): número 0942/09 / Compelling evidence suggests that fibroblast growth factor 2 (FGF2), produced by melanomas, plays important role in tumor growth, angiogenesis and metastasis. Therefore, the use of a monoclonal antibody (mAb) that recognizes and blocks FGF2 activity is seen as an approach to be considered in oncology. The purpose of this study was to evaluate the diagnostic and therapeutic application of a new anti-FGF2 antibody, 3F12E7 IgG1, in experimental melanoma B16-F10. For this, C57Bl/6 mice were subcutaneously (or intravenously, for experimental metastasis assay) implanted with murine melanoma B16-F10 cells (5x105 cells/animal). When tumors reached 3-4 mm in diameter (or 24 h after B16-F10 cells injection, in the case of metastasis assay), mice started receiving anti-FGF2 3F12E7 IgG. Control mice received equal volume of vehicle or isotype control IgG amount. Groups: (1) anti-FGF2 3F12E7 IgG1-treated, (2) CEA-binding IgG1-treated (isotype control) and (3) vehicle-treated mice. The treatment of tumor-bearing mice with anti-FGF2 IgG, compared with saline and isotype controls, led to a reduction in the number of metastatic foci in the lungs (ANOVA test, p < 0.05), in experimental metastasis assays, as well as to a lower subcutaneous tumor growth rate (n=7 per group). This result is accompanied by a reduction in the tumor vascular density, as determined by CD34 or CD31 staining. The anti-FGF2 3F12E7 IgG tumor uptake was evaluated by nuclear medicine approaches, using this antibody radiolabeled with technetium-99m. In vivo SPECT/CT and ex vivo biodistribution studies reveled that 99mTc-anti-FGF2 IgG could efficiently achieved B16-F10 subcutaneous and metastatic tumors. Thus, these data suggest that the anti-FGF2 3F12E7 IgG may be a promising antitumor strategy for melanoma, as well as a potential imaging tool to be explored, working as a possible tracer to identify FGF2-positive tumors and map this angiogenic stimulus in the tumor microenvironment. Ethics committee (CAPPesq) approval number 0942/09

O significado prognóstico do fenômeno de regressão espontânea em melanoma, especialmente nas lesões finas, tem sido controverso. Estudos recentes sugerem que regressão extensa e tardia (fibrótica) possa estar relacionada a pior prognóstico. Linfangiogênese e angiogênese predizem metástase em melanoma. Objetivos: Analisar a densidade microvascular linfática e panvascular em melanomas extensivo-superficiais finos (Breslow 1,0 mm), comparando: melanomas regressivos e não-regressivos, área regressiva e não-regressiva de um mesmo tumor , os diferentes estágios de regressão (precoce ou inflamatória e tardia) de um mesmo tumor e correlacionar angiogênese e linfangiogênese a fase de crescimento tumoral. Métodos: Análise retrospectiva, histopatológica e estudo imunoistoquímico de melanomas com os anticorpos monoclonais D2-40 (37 tumores, sendo 16 regressivos e 21 não-regressivos como controles) e CD31 (29 tumores, sendo 13 regressivos e 16 não regressivos como controles), e posterior quantificação da densidade microvascular por análise de imagem. Resultados: Foi encontrada maior densidade microvascular linfática na fase tardia de regressão quando comparada à área dos melanomas regressivos que não apresentava regressão (controle interno). Conclusões: A fase tardia da regressão espontânea nos melanomas finos apresentou maior densidade microvascular linfática, fato que pode relacioná-la a pior prognóstico, já que densidade microvascular linfática estaria relacionada a risco aumentado de disseminação metastática. Essa suposição necessita ser confirmada por um maior seguimento dos nossos casos para detecção de metástases linfonodais / The prognostic significance of spontaneous regression in melanoma, especially thin lesions, has been a controversial issue. Recent studies suggest that extensive and late regression may be related to worse prognosis. Angiogenesis and lymphangiogenesis predict metastatic spread in melanoma. Objectives: To quantify lymphatic and panvascular microvascular density in thin (Breslow 1,0 mm) superficial spreading melanomas comparing: regressive and non-regressive melanomas, regressive and non-regressive areas from the same tumor; early and late histological stages of regression in the same tumor and to correlate angiogenesis and lymphangiogenesis and tumor growth phase. Methods: We conducted retrospective study, histological examinations and immunohistochemical analyses using the monoclonal antibodies D2-40 (37 melanomas, 16 regressive and 21 non-regressive as controls) and CD31 (29 melanomas, 13 regressive and 16 non-regressive as controls) with subsequent quantification of microvascular lymphatic and panvascular density by image analysis. Results: We found greater lymphatic microvascular density in the late stage of regression compared with non-regressive area (internal control) of regressive melanomas. Conclusions: The late stage of spontaneous regression in thin melanomas showed greater lymphatic microvascular density and this may be related to worse prognosis as lymphatic microvascular density is related with increased risk of metastatic spread. This supposition must be confirmed by a longer follow-up for detection of lymph node metastases

O fator de crescimento endotelial vascular (VEGF) tem sido considerado o principal indutor da angiogênese tumoral por sua ligação a receptores específicos tirosina-quinase presentes nas células endoteliais (VEGFR). Uma importante via reguladora da angiogênese é caracterizada pela ligação do VEGF ao seu receptor VEGFR-2 ativando a via de sinalização de PI3-K, que estimula a expressão da proteína antiapoptótica Bcl-2 elevando a expressão de citocinas pró-angiogênicas CXCL-8 e CXCL-1, o que resulta na proliferação de células endoteliais. Recentemente, foi descoberta uma droga com ação antiangiogênica denominada de PTK787/ZK 222584 (PTK/ZK), que se mostrou um potente inibidor do receptor tirosina-quinase de VEGF, sem aparente efeito citotóxico em células que não expressam esses receptores. Visando a melhor compreensão do mecanismo de ação e da via de atuação antiangiogênica VEGF/VEGFR do PTK/ZK nos carcinomas espinocelulares de cabeça e pescoço, foram desenvolvidos estudos in vitro e in vivo avaliando-se a expressão de Bcl-2, CXCL-8 e CXCL-1. No presente estudo foi utilizado um modelo experimental de angiogênese humana em camundongos imunodeprimidos que receberam co-implantes de células tumorais e endoteliais ou apenas células endoteliais, tratados com administração oral de PTK/ZK por 21 dias. A progressão tumoral nos animais foi avaliada por meio de imagem de bioluminescência. Após o sacrifício dos camundongos, os implantes foram incluídos em parafina sendo obtidos cortes de 3µm para análise da densidade vascular e de 7µm para a técnica de microdissecção a laser visando a avaliação de RNA por meio de RT-PCR e PCR em tempo real nas células malignas e endoteliais. Concomitantemente, experimentos in vitro de co-cultura de células tumorais e endoteliais foram realizados para a análise de expressão de Bcl-2, CXCL-8 e CXCL-1 avaliados por meio de RT-PCR, Western Blot e teste ELISA. Os resultados demonstraram uma redução importante da expressão de Bcl-2, bem como de CXCL-8, em células endoteliais in vitro e in vivo quando tratados com PTK/ZK. Além disso, houve uma redução significativa na densidade vascular nos implantes dos animais tratados com o medicamento. Estes resultados reforçam a ação antiangiogênica do PTK/ZK nas células endoteliais sugerindo uma provável via de sinalização na qual a redução da expressão da proteína antiapoptótica Bcl-2 causou uma diminuição da expressão da molécula pró-angiogênica CXCL-8, o que resultou numa menor densidade vascular e, conseqüentemente, menor crescimento tumoral. Conclui-se, portanto, que o PTK/ZK mostrou ser um medicamento antiangiogênico eficaz que poderá, no futuro, ser utilizado como terapêutica adjuvante nos pacientes portadores de carcinomas espinocelulares de cabeça e pescoço / The Vascular Endothelial Growth Factor (VEGF) has been considered the most important mediator in inducing tumor angiogenesis. It binds to specfic receptors known as Vascular Endothelial Growth Factor Receptor (VEGFR). An important pathway for angiogenesis is VEGF binding to VEGFR-2 and through PI3-K stimulates expression of antiapoptotic protein Bcl-2, inducing expression of proangiogenic cytokines CXCL-8 and CXCL-1, resulting in endothelial cell proliferation. A recently developed antiangiogenic drug is PTK787/ZK 222584 (PTK/ZK), a potent tyrosine kinase VEGFR inhibitor, without aparent cytotoxic effect on cells without expression of these receptors. For the better understanding of this mechanism and the angiogenic VEGF/VEGFR pathway of PTK/ZK in head and neck squamous cell carcinoma, it was developed in vitro and in vivo studies evaluating Bcl-2, CXCL-8 and CXCL-1 expression. A human angiogenesis experimental model was used in immunodeficient mice that received implants of tumor and endothelial cells or endothelial cells only, treated with PTK/ZK orally administered during 21 days. Tumor progression was evaluated by bioluminescence imaging. After mice sacrifice, the implants were paraffin embedded and 3µm sections were obtained for microvessel density analisis and 7µm sections for tumor and endothelial cells RNA retrieving by laser microdissection and analyzed by RT-PCR and Real time PCR. In vitro studies with co-culture of tumor and endothelial cells were analyzed by RT-PCR, Western Blot and ELISA to evaluate Bcl-2, CXCL-8 and CXCL-1 expression. The in vitro and in vivo results showed important downregulation of Bcl-2 as well as CXCL-8 expression in endothelial cells when treated with PTK/ZK. In addition, it was observed a significant reduction of microvessel density in implants of animals treated with the drug. These results suggest that the antiangiogenic mechanism of PTK/ZK on endothelial cells seems to occur by downregulation of antiapoptotic Bcl-2 expression leading to downregulation of pro-angiogenic CXCL-8, resulting in less tumor growth. In conclusion, PTK/ZK seems to be an efficient antiangiogenic drug for future adjuvant therapy of patients with head and neck squamous cell carcinoma.

Made available in DSpace on 2016-04-28T20:37:40Z (GMT). No. of bitstreams: 1 Daniela Cespedes Guizzo.pdf: 626105 bytes, checksum: a77296091cc47f1d227384470f169eab (MD5) Previous issue date: 2011-07-01 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The purpose of this thesis is to analyze the Piggle case as a pathologic depression case in the light of the winnicottian psychoanalysis. The Winnicott s comments, written in the book which title is The Piggle An Account of the Psychoanalytic Treatment of a Little Girl and just after the sixteen consultations with the patient, were developed with the main purpose to amplify the theoretical discussion on the case. The Theory of Personal Maturation oriented the case´s study as a whole. For doing so, there were selected parties of the description of the case that made evident the fundamental theoretical questions for its comprehension. From this study I could infer that the Piggle case is one of the pathologic depression. The incapacity of parent´s survival and the child necessity to make psychoanalytic therapy determined the diagnosis. In this approach there were analyzed questions related to the integration of her personal aggressiveness, her instincts, her conquest of the Oedipal stage and the passage through concerning stage. The case´s analysis and the study of the childhood´s depressions allow us to conclude that the winnicottian psychoanalysis contributes to the development of the children´s psychoanalytic attending. The Piggle case is an instance model of the winnicottian psychoanalytic clinic for children / O objetivo desta tese é a análise do caso Piggle como um caso de depressão patológica sob a luz da psicanálise winnicottiana. Os comentários de Winnicott no livro em que o autor relatou as dezesseis consultas realizadas com a paciente foram desenvolvidos com o objetivo de ampliar a discussão teórica sobre o caso. A teoria do amadurecimento orientou a análise do caso como um todo. Para tanto, foram selecionados trechos do relato do caso que evidenciassem as questões teóricas fundamentais para sua compreensão. Desse estudo, pude concluir que o caso Piggle é um caso de depressão patológica. A não sobrevivência dos pais e a necessidade de análise determinaram este diagnóstico. Para tal, foram analisadas questões relacionadas a integração da sua agressividade pessoal, a sua instintualidade, a conquista do estágio edípico e a passagem pelo estágio do concernimento. A análise do caso, assim como o estudo das depressões infantis, permite concluir que a psicanálise winnicottiana contribui para o desenvolvimento do atendimento psicanalítico de crianças. O caso Piggle é um modelo exemplar da clínica psicanalítica winnicottiana com crianças

Racial differences in the distribution of cerebrovascular occlusive disease are well documented. Extracranial stenosis is more common in Caucasian while intracranial stenosis is more common in Asian, Hispanic and African-American. The prevalence of asymptomatic intracranial stenosis in middle age and elderly general population in China was about 7%. The frequency of intracranial atherosclerosis among patients with stroke and TIA is 40 to 50% in Chinese populations. Concurrent extracranial and intracranial stenoses is common in Asian, the incidence range from 10 to 39% in patients with stroke. The current population of China is 1.3 billion and it was estimated that 30% of the population will be aged 60 and above by 2050 in China. The incidence of stroke in China is 215 per 100000 which is one of the highest among the world and this burden is expected to escalate in the coming decades. However, studies of concurrent stenoses among Chinese are scarce. The aim of this precis is to present my studies that were conducted mainly among Chinese stroke patients on this particular field. The scope of the studies covers the following 4 areas: (1) Identification of Long-term prognosis of patients with concurrent stenoses; (2) Long-term prognosis of patients with concurrent stenoses and ischemic heart disease; (3) Lesion pattern and stroke mechanisms in concurrent stenoses; and (4) genetic polymorphisms of ischemic stroke patients with concurrent stenoses. The background, objectives, subjects, methods, results, and conclusions of these studies will be presented in this precis. / Man, Bik Ling. / Adviser: Lawrence K.S. Wong. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 144-184). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

O melanoma é a forma mais letal entre os cânceres de pele. Essa neoplasia freqüentemente apresenta-se resistente a abordagens terapêuticas. A angiogênese associada ao tumor representa um crítico passo da tumorigênese, resultado da ação de diferentes citocinas e fatores de crescimento como VEGF produzidos no microambiente tumoral. As galectinas extracelulares participam de múltiplos processos biológicos incluindo angiogênese tumoral e metástases, sua interação com as células presentes no microambiente tumoral pode ocorrer via receptores toll-like sugerindo seu envolvimento nos processos pro-inflamatórios e na secreção de citocinas. Recentemente mostramos que a ausência de gal-3 no estroma e parênquima tumoral diminui a angiogênese por interferir na resposta de macrófagos via VEGF e/ou TGFbeta1. Entretanto, o envolvimento de galectinas extracelulares na angiogênese e na modulação do sistema imune no microambiente tumoral ainda não está esclarecido. Assim, este estudo visa buscar respostas ao envolvimento das galectinas no crescimento tumoral e angiogênese contribuindo ao combate do melanoma maligno. Nossos resultados mostram a participação das galectinas 1 e 3 no crescimento tumoral e seu envolvimento com macrófagos via receptores toll-like, além de coordenarem a modulação do perfil de polarização de macrófagos derivados da medula óssea de camundongos wild-type. Dessa forma, podemos inferir que essas galectinas agem como coordenadoras de mudança de perfil dos macrófagos, uma vez que inibidas extracelularmente promovem uma diminuição do crescimento tumoral em camundongos wild-type, inoculados com células de melanoma murino e uma manutenção do perfil de macrófagos M1 in vitro. Assim, concluimos que as galectinas 1 e 3 extracelulares são importantes para o crescimento tumoral de melanomas murinos pois promovem o crescimento tumoral e são coordenadoras da mudança do perfil de macrófagos / Melanoma is the most aggressive form of skin cancer. This tumor often presents itself resistant to therapeutic approaches. The tumor-associated angiogenesis is a critical step in tumorigenesis and the result of the action of several cytokines and growth factors such as VEGF produced in the tumor microenvironment. The extracellular galectins participate in multiple biological processes including tumor angiogenesis and metastasis, their interaction with cells present in the tumor microenvironment may occur via toll-like receptors suggesting their involvement in pro-inflammatory processes and the secretion of cytokines. We have recently shown that the absence of Gal-3 the stroma and tumor parenchyma decreases angiogenesis by interfering with the macrophage response by VEGF and / or TGFbeta1. However, the involvement of extracellular galectins on angiogenesis modulation of the immune system in the tumor microenvironment is not yet clear. This study aims is to find answers to the involvement of galectins on tumor growth and angiogenesis contributing to the study of the malignant melanoma. Our results demonstrate the involvement of galectin 1 and 3 on tumor growth and its involvement in macrophage by toll-like receptors pathway, and coordinating the modulation of the polarization profile in wild-type mice bone marrow derived macrophages. Therefore, we show these galectins act as coordinators of macrophages profile change, since inhibited extracellularly promote a reduction in tumor growth in wild-type mice inoculated with murine melanoma cells and macrophages M1 maintenance of profile in vitro. Thus, we conclude that galectins 1 and 3 extracellular are important for tumor growth of murine melanomas because they promote tumor growth and are coordinators of change macrophages profile

Angiogenesis is a process of new blood vessels sprouting from the pre-existing vasculature, and mediated by multiple angiogenic and anti-angiogenic factors. Disturbance of the balance often leads to development of neovascular diseases. Neovascularization affecting the eye is a common cause of visual impairment and even blindness, particularly when corneal or choroidal neovascularization (NV) is involved. While there are effective treatment modes for ocular neovascularization, they are expensive and only inhibit disease progress. Since herbal medicine has been applied for anti-angiogenesis and anti-carcinogenesis therapies, we investigate the anti-angiogenic effect of selected herbal molecules: isoliquiritigenin (ISL), a flavonoid from licorice; epigallocatechin gallate (EGCG), a polyphenol from green tea; and resveratrol (Rst), a polyphenol phytoalexin derived from grapes. / In conclusion, by in vitro and in vivo studies, we showed that ISL, EGCG and Rst contributed to anti-angiogenesis via different biological mechanisms. We propose that these three herbal molecules (ISL, EGCG and Rst) are candidate anti-angiogenic agents for the treatment of ocular angiogenesis diseases. Their distribution profiles and pharmacokinetic properties should be investigated. / Results showed that sub-toxic levels of ISL (10 microM), EGCG (50 microM) and Rst (10microM) effectively suppressed endothelial cell proliferation and migration in the scratch-wound assay. Treatment with ISL was found to significantly up-regulate PEDF, which is known as a potent angiostatic factor. EGCG and Rst downregulate VEGF signaling cascade by suppressing Akt and FAK activation and affecting MMP-2, MMP-9 expression. In vivo angiogenesis assays further showed the suppressive effect of ISL, EGCG and Rst on neovascularization in three different animal models. Application of ISL at 1 microM showed the suppressive effect on chick CAM assay, corneal NV and choroidal NV assays consistently, the most effective dosage was close to 10 microM. EGCG at 1 microM showed the effect to reduce chick CAM vessel formation and corneal NV, and at 10 microM (the lowest tested concentration) to suppress choroidal NV in mice. Variable effects were observed in Rst treatment. Rst at 10 microM prohibited vessel growth in chick CAM, and 1 microM suppressed corneal NV formation and 2 microM deterred choroidal NV development. / This thesis contains two major parts. The first in vitro cell-based analysis investigated the toxicity of these herbal chemicals and their effect on endothelial cell growth and migration. The expression profile of vascular endothelial growth factor (VEGF) signaling cascade events, including Akt and focal adhesion kinase (FAK) activation, VEGF, pigment epithelium-derived factor (PEDF) and matrix metalloproteinases (MMPs) were examined by Western blotting. Then three in vivo models were established to study the effect of these herbal chemicals on angiogenesis. They were (1) developmental angiogenesis in chick chorioallantoic membrane (CAM), (2) pathological angiogenesis in silver nitrate cauterization-induced corneal neovascularization in BALB/c mice and, (3) laser photocoagulation-induced choroidal neovascularization in C57BL/6 mice. Changes of vascularization were determined by qualification of vessel number changes on the edge of gelatin sponge in 24 hours (chick CAM assay), measurement of vascularized area, live imaging of vessel leakage (fundus fluorescence angiography, FFA) and immunochemistry using antibodies specific for endothelial cells (corneal & choroidal NV assays) respectively. / Liu, Huanming. / Adviser: Chi Pui Pang. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 155-180). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.