Η ρινοκολπίτιδα οδηγεί τους ασθενείς σε συχνές ιατρικές επισκέψεις. Συντελεί σημαντικά στις δαπάνες για την υγεία, τόσο στις άμεσες λόγω ιατρικών επισκέψεων και φαρμακευτικής αγωγής, όσο και στις έμμεσες που συνδέονται με την απουσία από την εργασία, καθώς και με μια γενικότερη πτώση της παραγωγικότητας που οφείλεται σε μείωση της ποιότητας ζωής των ατόμων που πάσχουν. Η βαθύτερη κατανόηση της παθογένειας και αιτιολογίας της χρόνιας ρινοκολπίτιδας είναι απαραίτητη προκειμένου να αναπτυχθούν αποτελεσματικές θεραπείες. Το ιγμόρειο άντρο αποτελεί το συχνότερο κλινικό εντοπισμό της και χώρο εύκολα προσπελάσιμο για την μελέτη της παθογένειας των παθήσεων των παραρρινίων κόλπων. Η καταστροφή του κροσσωτού επιθήλιου ή η δυσλειτουργία των κροσσών του βλεννογόνου της μύτης και των παραρρινίων κόλπων επηρεάζουν αρνητικά την κάθαρση του βλεννοκροσσωτού επιθηλίου, η οποία αποτελεί έναν από τους μηχανισμούς που διαταράσσεται σε ρινοκολπίτιδα. Η ταχύτητα μεταφοράς του βλεννοκροσσωτού επιθηλίου (mucociliary transport velocity – MTV) που εκτιμάται με το ρινοσπινθηρογράφημα θεωρείται μια αξιόπιστη μέτρηση της κάθαρσης του βλεννοκροσσωτού επιθηλίου. Σχεδιάσαμε την παρούσα μελέτη με σκοπό τη διερεύνηση, μέσω του ρινοσπινθηρογραφήματος, της κάθαρσης του βλεννοκροσσωτού επιθηλίου σε ασθενείς με χρόνια ιγμορίτιδα που αντιμετωπίστηκαν συντηρητικά ή χειρουργικά. Επίσης μελετήσαμε την συσχέτιση της με ευρήματα από την αξονική τομογραφία καθώς και με τη βαρύτητα των συμπτωμάτων του ασθενούς. / Rhinosinusitis leads patients to frequent visits to medical doctors. It greatly contributes to healthcare expenses, directly due to medical visits and medication, as well as indirectly due to the subsequent absence from work and a productivity loss due to patients’ life quality deterioration. The deeper understanding of the cause and pathogenesis of the chronic rhinosinusitis is essential to the development of an effective treatment. The maxillary sinus is the most frequent location and it is easily accessible for the study of the pathogenesis of facial sinuses diseases. The ciliary epithelium destruction or the dysfunction of the nose mucosa’s cilia, negatively influences the mucociliary epithelium clearance, which constitutes one of the mechanisms disrupted in a rhinosinusitis. The Mucociliary Transport Velocity (MTV) which is estimated by the use of rhinoscintigraphy, is concerned a reliable measurement of the clearance of the mucociliary epithelium. We have designed the current study, in order to investigate, through the rhinoscintigraphy, the clearance of the mucociliary epithelium in patients with chronic maxillary sinusitis who were treated conservatively or surgically. Also, we studied its correlation with the CT findings, as well as with the quality of patients’ life.

Submitted by LUCIANA GURGEL DA TRINDADE MEIRA HENRIQUES (gustavoluciana@globo.com) on 2016-11-18T17:11:15Z No. of bitstreams: 1 LUCIANA GURGEL TRINDADE HENRIQUES.pdf: 1198247 bytes, checksum: 3ce5ab865cdb5ea1c6e1973bf14b8d1a (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-11-23T19:59:02Z (GMT) No. of bitstreams: 1 henriques_lgtm_dr_bot.pdf: 1198247 bytes, checksum: 3ce5ab865cdb5ea1c6e1973bf14b8d1a (MD5) / Made available in DSpace on 2016-11-23T19:59:02Z (GMT). No. of bitstreams: 1 henriques_lgtm_dr_bot.pdf: 1198247 bytes, checksum: 3ce5ab865cdb5ea1c6e1973bf14b8d1a (MD5) Previous issue date: 2016-09-21 / Introdução: o carcinoma de mama é uma das principais causas de morte no mundo e seu diagnóstico e tratamento precoces tem importante impacto na evolução clínica. A classificação imunoistoquímica (IHQ) determina o prognóstico do carcinoma e qual a melhor forma terapêutica a ser instituída. Autores sugerem que a cintilografia mamária poderia auxiliar a IHQ nessas definições de prognóstico. Casuística e Métodos: este estudo incluiu pacientes portadoras de carcinoma invasivo da mama que tiveram seu diagnóstico no período de 2011 a 2013 no Hospital das Clínicas da Faculdade de Medicina de Botucatu. Em todos os casos foram feitos exames imunoistoquímicos, determinando o índice proliferativo (IP) e a classificação. Associação entre ambos e os achados da cintilografia mamária foram analisadas. Resultados: dos 310 pacientes com carcinoma invasivo de mama diagnosticados no período, 243 tiveram sua classificação e IP definidos pela IHQ. Cintilografia normal está associada a baixo IP e a classificações responsivas à hormonioterapia. As pacientes com cintilografia alterada tiveram mais chance de ter IP maior ou igual a 14%, com alta acurácia, alto valor preditivo positivo e alta sensibilidade, e estão significativamente associadas a formas irresponsivas ao tratamento hormonal. Alterações mais intensas associam-se com formas de pior prognóstico. Conclusão: cintilografia mamária alterada em pacientes com diagnóstico histológico de carcinoma invasivo de mama indicam um pior prognóstico, bem como a normalidade indica a existência de classificação tumoral com melhor resposta à quimioterapia hormonal. Esses achados não permitem que a cintilografia de mama substitua a realização do painel prognóstico imunoistoquímico no tratamento dessa doença, mas sim possa orientar o prognóstico e responsividade a droga. Palavras chaves: carcinoma invasivo de mama; imuno-histoquímica; cintilografia mamária; radioisotopo; medicina nuclear. / Introduction: Breast carcinoma is one of the leading causes of deaths in the world and its early diagnosis and treatment have an important impact in the clinic evolution. The Immunohistochemical (IHC) profile determines the prognosis of the carcinoma and which is the best therapy to be established. Authors suggest that scintimammography could help immunohistochemistry (IHC) in these prognosis definitions. Methods: This study included patients with invasive breast carcinoma who were diagnosed in the period of 2011- 2013 at the Hospital das Clinicas of the Medical School of Botucatu. In all of the cases, IHC exams were performed, determining the proliferative index (PI) and the classification. The association between both results and the scintimammography (SMG) findings were analyzed. Results: of the 310 patients with invasive breast carcinoma diagnosed in the period, 243 had their classification and PI defined by the IHC. Normal SMG is associated to low PI and to hormonal therapy responsive classifications. The patients with altered SMG have had more chances of having a PI greater or equal to 14%, with high accuracy, high positive predictive valor and high sensibility, and are significantly associated to hormonal therapy irresponsive forms. More intense alterations are associated with forms of poor prognosis. Conclusion: altered SMG in patients with histological diagnosis of invasive breast carcinoma indicate a worse prognosis, as well as normaly indicates the existence of tumor classification with better response to hormonal chemotherapy. These findings do not allow the replacement of the immunohistochemistry prognosis profile for the scintimammography in the treatment of this disease, but can guide the prognosis and responsiveness to drug. Key Words: invasive breast carcinoma; immunohistochemistry; scintimammography; radioisotope; nuclear medicine.

O desenvolvimento da Medicina Nuclear, aliado à evolução dos equipamentos de diagnóstico e terapia, necessita, cada vez mais, da disponibilidade comercial de radioisótopos. Nesse contexto, o IPEN tem buscado atender e abastecer o mercado nacional. Um dos investimentos nesta área foi a aquisição de um ciclotron de 30 MeV, modelo Cyclone-30, que permitiu a produção dos radioisótopos tais como, o 18F, 67Ga, 201Tl e o 123I, sendo este último o foco do presente trabalho. Através de dados de produções rotineiras de 123I via irradiação com prótons em alvo gasoso de Xenônio com enriquecimento superior a 99,8% em 124Xe, foi realizado um estudo para identificar os fatores relevantes que influenciam diretamente o rendimento de obtenção de 123I com altíssimo grau de pureza. Embora a metodologia seja bem conhecida, quando se trata de produção comercial há uma escassez de dados sobre os parâmetros operacionais utilizados. Os parâmetros avaliados foram: pressão do gás 124Xe, intensidade de corrente de feixe de prótons, tempo de irradiação, temperatura de operação do sistema durante a irradiação, tempo de espera para formação de 123I, tempo de aquecimento do porta-alvo para recuperação do 123I formado, temperatura de aquecimento da solução de lavagem e influência do revestimento interno da câmara de irradiação com Ni. Com os resultados obtidos, foi possível alterar as condições operacionais nas produções rotineiras, conduzindo a um aumento de eficiência do processo em torno de 30%. / The development of diagnosis equipment and therapy procedures in nuclear medicine depends on the availability of commercial radioisotopes. IPEN is the most important institution that provides radioisotopes for national market. In order to achieve this function, IPEN had invested in the acquisition of a 30 MeV Cyclone-30 cyclotron to produce mainly 18F, 67Ga, 201Tl and 123I. The 123I production is the aim of the present work. With the 123I routine production data obtained by proton irradiation of Xe targets with an enrichment greater than 99.8%, it was possible to identify the important parameters that have direct influence on the production yield of high purity degree 123I. Even though the methodology for the commercial production of 123I, there are an scarcity of operational parameters data for this task. In this work the evaluated parameters were: 124Xe pressure, proton beam quality, irradiation time, operational temperature of the irradiation system under irradiation, waiting time to obtain 123I, temperature of washing solution and the impact of the internal Ni coating in the target. With the obtained results it was possible to modify the operational conditions for routine production and increasing the efficiency in about 30%.

O desenvolvimento da Medicina Nuclear, aliado à evolução dos equipamentos de diagnóstico e terapia, necessita, cada vez mais, da disponibilidade comercial de radioisótopos. Nesse contexto, o IPEN tem buscado atender e abastecer o mercado nacional. Um dos investimentos nesta área foi a aquisição de um ciclotron de 30 MeV, modelo Cyclone-30, que permitiu a produção dos radioisótopos tais como, o 18F, 67Ga, 201Tl e o 123I, sendo este último o foco do presente trabalho. Através de dados de produções rotineiras de 123I via irradiação com prótons em alvo gasoso de Xenônio com enriquecimento superior a 99,8% em 124Xe, foi realizado um estudo para identificar os fatores relevantes que influenciam diretamente o rendimento de obtenção de 123I com altíssimo grau de pureza. Embora a metodologia seja bem conhecida, quando se trata de produção comercial há uma escassez de dados sobre os parâmetros operacionais utilizados. Os parâmetros avaliados foram: pressão do gás 124Xe, intensidade de corrente de feixe de prótons, tempo de irradiação, temperatura de operação do sistema durante a irradiação, tempo de espera para formação de 123I, tempo de aquecimento do porta-alvo para recuperação do 123I formado, temperatura de aquecimento da solução de lavagem e influência do revestimento interno da câmara de irradiação com Ni. Com os resultados obtidos, foi possível alterar as condições operacionais nas produções rotineiras, conduzindo a um aumento de eficiência do processo em torno de 30%. / The development of diagnosis equipment and therapy procedures in nuclear medicine depends on the availability of commercial radioisotopes. IPEN is the most important institution that provides radioisotopes for national market. In order to achieve this function, IPEN had invested in the acquisition of a 30 MeV Cyclone-30 cyclotron to produce mainly 18F, 67Ga, 201Tl and 123I. The 123I production is the aim of the present work. With the 123I routine production data obtained by proton irradiation of Xe targets with an enrichment greater than 99.8%, it was possible to identify the important parameters that have direct influence on the production yield of high purity degree 123I. Even though the methodology for the commercial production of 123I, there are an scarcity of operational parameters data for this task. In this work the evaluated parameters were: 124Xe pressure, proton beam quality, irradiation time, operational temperature of the irradiation system under irradiation, waiting time to obtain 123I, temperature of washing solution and the impact of the internal Ni coating in the target. With the obtained results it was possible to modify the operational conditions for routine production and increasing the efficiency in about 30%.