Orientador: Paulo Traiman / Banca: Fred Ellinger / Banca: Ana Glória Pontes / Resumo: Estudo dos fatores de risco das pacientes com citologia oncológica cervical e anal alteradas. 64 pacientes encaminhadas ao Ambulatório de Colposcopia da Faculdade de Medicina de Marília-SP foram estudadas prospectivamente de fevereiro de 2006 até fevereiro de 2007, com diagnóstico citológico de HSIL. Suas histórias clínicas foram escolhidas, as citologias cervical e anal coletadas, e a colposcopia e anuscopia realizadas com Tido acético a 2%, lugol e azul de toluidina a 1%, respectivamente. A espátula de Ayres e a cytobrush foram usadas para a coleta das citologias no colo e a cytobrush, no ânus. As lâminas foram fixadas em álcool 70% e as biópsias foram realizadas com a pinça Gaylor-Medina e fixadas em formol a 10%. O Teste do Qui-Quadrado de Pearson e o Teste Exato de Fisher foram empregados para a análise estatística. Os perfis sócio-demográfico e epidemiológico das pacientes foram traçados. Nas 64 pacientes da amostra estudada, no perfilsócio-demográfico, a idade média encontrada foi de 36,6 anos. 60,9% das pacientes eram casadas; 84,4% tiveram até cinco filhos. 100% tinham baixo nível sócio-econômico. Segundo perfil epidemiológico, em média o número de parceiros sexuais foi 2,9 por paciente. A menarca ocorreu aos 12,8 anos; a coitarca, aos 16,5 anos. 76,6% das pacientes usaram método Dntraceptivo hormonal. 75% não praticavam coito anal. 70,3% não fumavam e 100% não bebiam nem usavam drogas. 68,8% colhiam citologia de rotina e 89,1% não tinham história de câncer familiar. Nas cinco pacientes com citologia anal alterada, no perfil sócioográfico, a idade média foi de 30,6 anos. 60% das pacientes eram casadas; 60% tiveram . dois filhos. 100% tinham baixo nível sócio-econômico. Segundo o perfil epidemiológico... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Study of the risk factories in the patients with changed cervical and anal oncological cytology. Methods: 64 guided patients to the Colposcopy Ambulatory from Marília Medical School (SP) were prospectively studied between February 2006 and February 2007, with HSIL cytological diagnoses. Their clinical histories were picked up, the anal and cervical cytologies were gathered and the colposcopy and the anuscopy were done with acetic acid 2%, Lugol's iodine and blue of toluidine 1%. Ayres spatula and the cytobrush were used to the cytology collects at the cervix and the cytobrush at the anus. The microscopic slides were fixed in 70% alcohol and the biopsies were done with Gaylor-Medine's pincers and fixed in formaldehyde 10%. Pearson's Chi-Squared test and Fisher Exact test were used to the statistic analyses. Results: the patients' social demography and epidemiological profile were braided. In the 64 patients from the studied sample, at the social demography profile, the medium age found was 36,6 years old. 60,9% patients were married; 84,4% had got until five children. 100% were low socio-economic leveI. At the epidemiological profile, in medium the number of sexual partners was 2,9 per patient. The menarche happened at 12,8 years old; the first coitus at 16,5 years old. 76,6% patients used hormonal contraceptive method. 75% didn't practice anal coitus. 70,3% didn't smoke and 100% patients didn't used alcohol or any drugs. 68,8% patients picked routine cytology up and 89,1% didn't have familiar cancer history. In the five patients with changed anal cytology at the social demography profile, the medium age found was 30,6 years old. 60% patients were married; 60% had got until two children. 100% were low socio-economic leveI. At the epidemiological profile, in medium... (Complete abstract click electronic access below) / Mestre

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / Objetivou-se realizar a adaptaÃÃo transcultural da Health Belief Model Scale for Cervical Cancer and Pap Smear Test para uso no Brasil e validar o conteÃdo da versÃo brasileira do instrumento traduzido. Trata-se de um estudo metodolÃgico, que para a adaptaÃÃo transcultural, percorreu rigorosamente cinco etapas: traduÃÃo inicial, sÃntese das traduÃÃes, retraduÃÃo, revisÃo por um comità de juÃzes e prÃ-teste. Os participantes dessas etapas foram selecionados obedecendo aos critÃrios estabelecidos pelo referencial metodolÃgico, quais sejam: quatro tradutores, um mediador e seis juÃzes. Na realizaÃÃo do prÃ-teste, ocorrida no Centro de Parto Natural Ligia Barros Costa e Campus do Pici da Universidade Federal do Cearà no mÃs de setembro de 2014, entrevistou-se 40 mulheres, de diferentes nÃveis de escolaridade, utilizando-se a versÃo prÃ-final da escala e um questionÃrio de caracterizaÃÃo sociodemogrÃfica. A validaÃÃo de conteÃdo da versÃo final foi aferida pelo Ãndice de ValidaÃÃo de ConteÃdo, a partir do julgamento de dez juÃzes especialistas, selecionados a partir das experiÃncias de ensino, pesquisa e/ou assistÃncia em SaÃde da Mulher. Os dados referentes Ãs etapas de adaptaÃÃo foram organizados na forma de quadros e analisados descritivamente. Os dados sociodemogrÃficos do prÃ-teste e os resultantes da validaÃÃo de conteÃdo foram analisados no software Statistical Package for the Social Sciences, versÃo 20.0. O estudo foi aprovado no Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. As duas versÃes produzidas na traduÃÃo inicial, em geral, nÃo apresentaram grandes diferenÃas de traduÃÃo. A segunda etapa foi realizada apÃs avaliaÃÃo das versÃes traduzidas com discussÃo quanto à formulaÃÃo dos itens da versÃo sÃntese, obtendo-se total concordÃncia por parte da pesquisadora e mediador. Na retraduÃÃo da versÃo sÃntese de volta ao idioma inglÃs evidenciou-se que as versÃes resultantes desta etapa nÃo apresentaram grandes divergÃncias em relaÃÃo à versÃo original do instrumento, mostrando-se coerentes, explicitando assim a qualidade da versÃo sÃntese no portuguÃs brasileiro. A partir da avaliaÃÃo das equivalÃncias semÃntica, idiomÃtica, experimental e conceitual pelos juÃzes, onze itens foram modificados apÃs as sugestÃes realizadas, resultando em uma versÃo prÃ-final da escala, aplicada no prÃ-teste. Quatro itens nÃo apresentaram total compreensÃo apÃs avaliaÃÃo das mulheres, sendo modificados segundo as sugestÃes das mesmas. ApÃs todas as modificaÃÃes realizadas na escala, obteve-se a versÃo final do instrumento adaptado ao contexto cultural brasileiro. O Ãndice de ValidaÃÃo de ConteÃdo, calculado a partir das avaliaÃÃes dos juÃzes de conteÃdo, foi de 0,82 e os valores individuais dos itens variaram de 0,80 a 1, sendo considerado adequadamente vÃlido em conteÃdo. Nenhum item foi eliminado, porÃm, quatro foram alocados ao domÃnio motivaÃÃo em saÃde por decisÃo unÃnime dos juÃzes. Pode-se concluir que todo o rigor adotado neste estudo garantiu a obtenÃÃo de um instrumento que se mostrou equivalente à versÃo original, apresentando boa compreensÃo e clareza entre os itens, alÃm de um adequado Ãndice de validaÃÃo de conteÃdo.

Orientadores: Ilza Maria Urbano Monteiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T13:46:36Z (GMT). No. of bitstreams: 1 Hidalgo_SimoneRavacci_M.pdf: 1290897 bytes, checksum: c6ce76b97515ddd12198bcbcfe5132af (MD5) Previous issue date: 2008 / Resumo: Introdução: A cirurgia histeroscópica é indicada para o tratamento de doenças intra-uterinas como os pólipos endometriais, miomas submucosos, aderências e septos uterinos, além de investigação de infertilidade. O ensino da técnica histeroscópica costuma ser demorado, apresentando uma lenta curva de aprendizado. Apesar de ser um procedimento menos invasivo, não é livre de complicações e as principais são: perfuração uterina, laceração do colo do útero, absorção excessiva do meio líquido utilizado para distensão, infecção e hemorragia. Objetivo: comparar o serviço de histeroscopia cirúrgica do CAISM (Centro de Atenção Integral à Saúde da Mulher) em dois momentos (1999 e 2007), no que se refere ao tempo cirúrgico, à complexidade dos procedimentos e presença de complicações. Métodos: realizou-se um estudo descritivo de corte transversal, onde foram selecionadas 162 mulheres submetidas à histeroscopia cirúrgica em 1999 e 100 mulheres em 2007, no CAISM. Foram colhidos dados referentes ao tipo e duração do procedimento realizado, tipo e duração da anestesia e presença de complicações no ato operatório. Resultados: houve diminuição significativa do tempo de cirurgia (31,8 minutos para 19,7 minutos; p<0,0001) e do tempo de anestesia (160 min para 141,7 min; p=0,0246). A cirurgia mais realizada foi a polipectomia, com aumento de 54,8% para 71% (p=0,03). As taxas de complicações foram 8,06% e 9%, respectivamente em 1999 e 2007, com 8% de perfurações em ambos os períodos. Conclusão: a equipe cirúrgica evoluiu ao longo do tempo como demonstra o menor tempo de cirurgia sem aumento do número de complicações. A taxa de complicações está dentro do aceitável pela literatura, mas esforços devem ser feitos na tentativa de diminuir complicações. Palavras-chave: histeroscopia cirúrgica, complicações / Abstract: Introduction:hysteroscopy is indicated to treat intrauterine diseases such as endometrial polyps, submucous myomas, septate uterus, uterine synechiae and assessment of infertility. The main complications are uterine perforation, laceration of cervix, fluid overload, infection, hemorrhage. Objective: The purpose of this study was to compare the changes that ocurred in a operative hysteroscopy unit at a tertiary care university hospital in two different moments, analysing factors as operative time, procedure complexity and its complications. Methods: a retrospective descriptive study, including women undergoing operative hysteroscopy in two distinct periods (62 patients in 1999 and 100 in 2007), at CAISM/UNICAMP. Factors analysed were type and length of procedure, type and length of anesthesia, complications during the procedure, collected from medical reports. Results: there were a significant reduction in mean operative time (31,8 minutes to 19.7 minutes; p<0.0001) and mean anesthesia time (160 minutes to 141.7 minutes; p=0.0246). The most common procedure was polipectomy, increasing from 54.8% to 71% (p=0.03). The complication rate was 8.06% and 9%, respectively in 1999 and 2007, with 8% of uterine perforations. Conclusions: there was an evolution throughout the studied period as demonstrated by a decrease in operative time keeping the same complication rate, which is comparable to that in literature. More efforts should be taken to attempt less complications. Key words: operative hysteroscopy, complications / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

Doctor of Philosophy / Department of Animal Sciences and Industry / Luis G. Mendonca / Reproduction is an important part of a dairy operation that directly affects milk production and profitability. Fertility of high-producing dairy cows is less than desired. Reproductive efficiency is further impaired during summer months and after cows develop postpartum uterine disease. Heat stress and uterine disease act as stressors that negatively influence fertility of dairy cattle through a variety of mechanisms. This dissertation further investigates the negative effects of heat stress and uterine disease on reproduction, as well as examines two potential markers for predicting risk of developing uterine disease. Study 1 investigated the treatment of lactating dairy cows with gonadotropin-releasing hormone (GnRH) before first insemination during heat stress. Two experiments were performed to compare ovarian responses, pregnancy per artificial insemination (AI), and patterns of insemination of two estrus detection-based presynchronization protocols before first AI during summer heat stress. Treatment of cows with GnRH during summer heat stress altered ovarian response and pattern of insemination, however, did not improve pregnancy per AI. Study 2 evaluated ovarian response to treatment with GnRH and the odds of bearing a corpus luteum or being inseminated in cows with or without purulent vaginal discharge (PVD). Furthermore, hazard of insemination after administration of prostaglandin F2α was evaluated in dairy cows with or without PVD. Ovarian response was altered in cows with PVD compared with cows without PVD. Odds of bearing a corpus luteum or being inseminated was not associated with PVD in primiparous cows, whereas it was associated with PVD in multiparous cows. Hazard of insemination after prostaglandin F2α was not associated with PVD. Study 3 investigated arginase and matrix metalloproteinase-8 (MMP-8) as potential markers for metritis. Activity of arginase 7 days before parturition has been identified as a potential marker for the risk of developing metritis in dairy cows. In contrast, MMP-8 was not associated with the risk of developing metritis, therefore, MMP-8 is not a good candidate as a marker for metritis. Further research is warranted in the areas of reproductive physiology, heat stress, and uterine disease because several unanswered questions still exist. Improving fertility during times of heat stress and after the occurrence of postpartum uterine disease will improve milk production, animal welfare, and profitability of dairy farms across the world.

During pregnancy, increased uterine blood-flow and efficient placental perfusion is essential for a successful outcome. Despite the essential role of these vascular beds, data on the physiological mechanisms involved in the maintenance of a high-flow/low resistance circulation within the uterus and placenta are limited. The need to fully understand the regulation of blood-flow within the uterine and feto-placental circulations is further highlighted by pathological pregnancies which are characterised by vascular dysfunction within these circulations. Oestrogen and insulin-like growth factor-I (IGF-I) levels increase during pregnancy and correlate with increased uterine blood flow. In vivo and in vitro studies of other vascular beds show that both 17-β oestradiol and IGF-I act as vasodilators. However, surprisingly little is known of their vaso-active effects on human uterine and placental arteries. The aims of the studies described within this thesis, were to investigate, ex vivo, the possible roles of oestrogen and IGF-I in regulating human placental and uterine vascular beds in vivo. Placental chorionic plate arteries and myometrial demonstrated acute vasodilation in response to oestrogen. Vascular bed differences in ER-responsiveness were observed; vasodilation within myometrial arteries was elicited by both oestrogen receptors, ERα and ERβ, although activation of the latter receptor generated a greater response. In contrast, oestrogen-dependent acute vasodilation of placental arteries was via ERβ alone. Furthermore, species differences, between human and rat arteries, were demonstrated in terms of ER-responsiveness. The predominant ER receptor within human arteries studied was ERβ, whilst rat arteries demonstrated a predominantly ERα-mediated mechanism of oestrogen-induced vasodilation. The data presented suggests that within the uterine vascular bed, oestrogen-induced vasodilation involves both an endothelium-dependent and –independent mechanism of action, whilst within the placenta, oestrogen-mediated vasodilation is endothelial-independent. Indeed, data suggests that oestrogen influences the level of intracellular calcium of vascular smooth cells to induce vasodilation of placental arteries.IGF-I did not have a vaso-active effect on chorionic plate arteries isolated from the placenta. However, uterine myometrial arteries exhibited reduced vaso-reactivity in the presence of IGF-I, demonstrated by a depressed response to the vasoconstrictor, U46619. Collectively, these data contribute towards a further understanding of the regulatory mechanisms of the uterine circulation, by identifying oestrogen and IGF-I as possible regulators of the uterine vasculature during pregnancy. Additionally, oestrogen may also have a role in controlling the feto-placental circulation. In the future, targeting ERb may offer a therapeutic strategy for increasing uterine/placental perfusion in pregnancies complicated by vascular dysfunction.

Background: Communicating double uterine anomalies are defined as mullerian defects which involve two hemiuteri with communication between the uterine halves. Nine subcategories of communicating uterine anomalies have been described; only two of these subcategories are associated with hemivaginal obstruction. Case: An 11-year-old white female was brought to the Emergency Department with fever and acute pelvic pain. This condition was found to be caused by abscess formation behind an obstructed left hemivagina with involvement of a communicating double uterine anomaly. Conclusion: To our knowledge, this is the first case report involving a communicating double uterine anomaly in which fever was a presenting symptom.

Background: Women with communicating double uterine anomalies are at increased risk for obstetric complications, including early pregnancy loss, preterm delivery, and breech presentation. We present the pregnancy of a woman with a previously diagnosed communicating double uterine anomaly. Case: An 18-yr-old white female with a previous diagnosis at age 11 of a communicating double uterus, double cervix, and obstructed left hemivagina was followed during the course of her pregnancy. She experienced no complications until 36 6/7 weeks, when she was found to have signs and symptoms of mild preeclampsia. The fetus was in a breech presentation and a cesarean section was performed. Two hemiuteri were identified intraoperatively. The communication was not visualized. A viable male infant was delivered without complications. Conclusion: This patient represents only the sixth report of successful pregnancy in a woman with a Toaff type 5A communicating uterine anomaly.

Abstract Because endometriosis is considered to be the primary cause of infertility in women and the diagnosis is known to be delayed by many years, it is important to understand the association between endometriosis and infertility. The purpose of this cross-sectional, secondary data analysis study was to determine whether there was an association between the age of women when diagnosed with endometriosis and infertility. Using the general model of total patient delay (i.e., the Andersen model) as a theoretical foundation, data for this study was collected by assessing patient medical records of women with endometriosis at multiple OB-GYN clinics in Eastern North Carolina. Multiple logistic regression was conducted to determine potential association between variables. The results presented that diagnosis at an older age and presence of uterine fibroids are significant risk factors for infertility among women with endometriosis. From the results, it can be concluded that infertility may be preventable in women diagnosed with endometriosis and uterine fibroids in younger age. This study presents positive social change by preventing infertility amongst women who suffer from both endometriosis and uterine fibroids; potentially creating preventative programs aimed at better educating women on the risks of endometriosis and uterine fibroids (especially when presented together).

As NASA and other space programs around the world prepare to send astronauts into space for longer missions, it is becoming imperative to understand the biological effects of spaceflight on the human body. In order to better understand how the long-term spaceflight environment affects humans biologically, researchers often utilize other model organisms, like mice, whose biological systems are comparable to human body systems. Our study was performed to determine if spaceflight had any effect on the thickness of the muscular layers of the uterine tissue of female mice. In other words, how does the thickness of the muscular layers in the uterus of spaceflight mice compare to that of control mice that were not subjected to spaceflight. For this study mice were divided into 4 groups (flight animals, baseline animals, vivarium controls, and ground controls) and the flight mice subjected to 37 days of spaceflight. Upon tissue retrieval and histological preparation, five random measurements of the outer longitudinal muscular layer and five random measurements from the inner circular muscular layer of each tissue sample were made. The average thickness for each layer was then calculated and statistical analysis used to determine differences between the four groups of mice. At the time of this presentation final measurements and statistics had not been completed.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20671号 / 医博第4281号 / 新制||医||1024(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 万代 昌紀, 教授 小川 修, 教授 溝脇 尚志 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM