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Made available in DSpace on 2018-08-01T21:58:48Z (GMT). No. of bitstreams: 1 tese_10611_Flavia Tosato.pdf: 3350639 bytes, checksum: 70973978751713caf9a8020e18b13280 (MD5) Previous issue date: 2016-12-09 Análises rápidas, baratas e eficientes são necessárias para as rotinas laboratoriais, principalmente quando aplicada em química forense. As utilizações de fontes ambientes permitem que as análises sejam diretas e rápidas. Assim, são opções inovadoras para melhorar a sensibilidade e seletividade. Neste trabalho, foi desenvolvida uma metodologia utilizando a espectrometria de massas ambiente por paper spray ionization mass spectrometry (PS-MS) para diferentes matrizes de dados: (i) identificar e quantificar cocaína e seus adulterantes a partir da cromatografia em camada delgada acoplada ao PS-MS; (ii) realizar a discriminação ou classificação de dez marcas brasileiras de cervejas em pilsen e lager; e (iii) identificar a falsificação controlada de Uisque com cachaça visando quantificar o volume de cachaça adicionado na mistura. Na análise de cocaína e adulterantes, os padrões foram identificados na CCD e analisados por PS-MS, e uma curva de calibração foi otimizada. A cerveja foi previamente fracionada usando a metodologia de extração em fase sólida (SPE) com água/metanol e os quatro extratos foram caracterizados no modo positivo de ionização, PS(+)MS. Para ambos os casos, foram aplicados de 20 µL do analito sobre a superfície do papel do PS-MS. Na quantificação de cachaça em misturas de whisk-cachaça. Os resultados indicam que, utilização da CCD acoplado ao PS-MS possibilita a identificação de cocaína e seus adulterantes uma ótima linearidade paras as curvas foi encontrada (cocaína (R2 = 0,9989), benzocaína, (R2 = 0,9934), a cafeína (R2 = 0,9988), a fenacetina (R2 = 0,9966), e a lidocaína (R2 = 0,9987)) e LOD inferior ao da técnica de CCD. Para as amostras de cerveja os sinais de açúcares se sobressaem sobre os demais grupos, e após a extração com água/metanol foi possível distinguir os espectros das diferentes marcas de cervejas e classifica-las em pilsen e lager pela técnica de PCA. Utilizando o PS(±)-MS e PLS com seleção de variáveis foi possível estimar quantitativamente o teor de cachaça misturado ao uísque. Com isso, utilização de fontes ambientes, como PS mostra-se eficaz para identificação de diversas matrizes, facilitando as análises de rotina.

Anaplastic thyroid carcinoma (ATC) and primary thyroid lymphoma (PTL) are uncommon tumors of the thyroid gland with several overlapping clinical and pathologic features that may render their differentiation difficult in fine-needle aspiration (FNA) cytology. MicroRNA (miRNA) signatures have been recently reported as useful diagnostic tools applied to cytology specimens.Smears of 23 ATCs, 14 PTLs, and 20 non-neoplastic materials with multinodular goiter (MNG) were retrieved and classified based on their cytologic features and flow cytometric profiles. The ATC-related expression of hsa-miR-26a, hsa-miR-146b, hsa-miR-221, and hsa-miR-222 was quantified using quantitative reverse transcriptase-polymerase chain reaction analysis.All miRNAs were remarkably up-regulated in ATC samples compared with PTL samples (P .01). Moreover, expression levels of hsa-miR-146b, hsa-miR-221, and hsa-miR-222 were significantly higher in ATCs than in MNG samples (P .01). Significant down-regulation of hsa-miR-26a was observed in PTLs compared with MNG samples, whereas hsa-miR-146b was overexpressed. Receiver operating characteristic analysis was used to determine the optimal cutoff for distinguishing ATC from PTL. The estimated receiver operating characteristic thresholds displayed a sensitivity level greater than 0.80 in achieving a diagnosis of PTL, allowing the correct identification of 13 of 14 PTL samples (93%).Histotype-specific miRNA signatures can provide new insight into the molecular mechanisms of thyroid carcinogenesis. The tested 4-miRNA signature is a promising diagnostic tool for differentiating ATC from PTL and non-neoplastic MNG, even in the presence of scant material obtained from minimally invasive procedures.

The aim of this study was to demonstrate the efficacy of laparoscopic antireflux surgery in controlling Barrett's esophagus progression, through functional study.Between January 2008 and December 2009, 21 patients with a preoperative diagnosis of Barrett's esophagus underwent Nissen-Rossetti fundoplication.All patients underwent preoperatively a 24-hour pH-metry (100%). Twenty patients (95.2%) had postoperative pH monitoring at six months, 16 patients at 12 months (76.2%), eight at 24 months (57.14%). Median De Meester and Johnson score was preoperatively 18.55 (range 8.6-179.7), at six months 7.65 (range 6.4-13), at 12 months 7.5 (range 6.4-14.2), at 24 months 11.95 (range 6.4-20.6). CLE was still present in 18 patients (18/21, 85.7%), but no patient developed dysplasia or esophageal adenocarcinoma. Two patients with gastric- and one patient with intestinal metaplasia showed complete regression at 12 and 24 months after fundoplication (3/21, 14.3%). Symptom control alone does not manage acid reflux in patients with Barrett's esophagus after surgery, and postoperative 24-hour pH-metry confirms acid reflux abolition. A persistent reflux is more likely to develop cancer than in monitored patients.Only the presence of intact and effective anti-reflux wrap guarantees protection of the esophagus against CLE progression or its regression. Functional study after surgery identifies patients with Barrett's progression risk.

Gastro-esophageal reflux disease (GERD) rapresents the fastest growing disease affecting the alimentary and breathing apparatus. Incidence of esophageal adenocarcinoma with Barrett Esophagus (BE) imposes a decision about therapy management.Between January 2006 to December 2009, 3 653 patients were subjected to our observation; 2 095 patients underwent endoscopy (57.4%), of these 598 underwent twenty-four hours pH-Metry (16.3%); 1 558 patients (42.6%) had clinical consult.A total of 1 255/2 095 referred typical symptoms (60%), 644 patients typical and atypical symptoms (30.7%), 96 patients atypical symptoms (4.6%); 4.7% had dysfagia and cramps; 1 897 patients (90.5%) had Los Angeles A esophagitis, 62 Los Angeles B (2.96%), 6 had Shatzki Ring (0.3%). NERD in 26 patients (1.24%); 3.4% had Hp Gastritis; 33 had BE (1.6%), 10 intestinalized type (30.3%), 23 gatric type (69.7%). Eighty-five/2 095 patients (4%, 36 M and 49 F, m.a. 42.5 years, range 20-72) underwent laparoscopic Nissen-Rossetti Fundoplication (4%), 69 with preoperative typical symptoms (81%), 11 typical and atypical symptoms (13%), 5 atypical symptoms (6%). Twenty-three had BE (27%, 9 intestinal metaplasia, 3 Long and 6 Short Barrett, 14 Gastric metaplasia); 61 with Los Angeles A esophagitis (98.3%), 1 with Shatzki Ring (1.7%). PH-Metries were positive.GERD requires specialistic and qualified centers.

A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire.The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED.The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.

After a careful revision of the various papers and on the basis of their personal experience, the persons responsible for this project analyse the factors that, today, influence the development of an adenocarcinoma in the region of the gastro-esophageal junction. They also study therapeutic strategies on the basis of new findings in anatomic-physiological matters of this region. From this analysis, specialists notice an increase in adenocarcinomas which affect the gastric region of the cardia, in comparison with carcinomas which affects the gastric region in toto. By considering Barrett, Hayward, Riedel and Ruol's studies, they maintain that the fundamental factor which causes the development of cardial adenocarcinoma is the gastroesophageal reflux. This reflux acts as a chronic irritative stimulus on the esophageal wall and therefore it provokes an increase in mucous secretion and the formation of metaplasia. This metaplasia is initially mucosecreting, acid-secreting and in the end it becomes intestinal. This also leads to the appearance of absorbent calciform cells; the absorption of toxic or mutagenic substance for the cell itself, will be the next step for the development of an adenocarcinoma. Nowadays the therapy of intestinal metaplasia provides for different therapeutic levels: from the endoscopic monitoring (which is used for the most serious cases of dysplasia), to the PPI medical treatment(today in disuse), to the surgical laparoscopic treatment with non-refluxing plasty (Nissen, Toupet). This last treatment is today associated with endoscopic esophageal mucosectomy in order to achieve a better effectiveness. This happens through the use of various methodologies, for example the multipolar electrocoagulation.

The authors analyse gastroduodenal reflux (GDR) in the light of the progress made over the past ten years. The good results achieved using mini-invasive techniques in cholecystectomy prompted the authors to compare laparotomic and laparoscopic cholecystectomy in order to evaluate the influence of both techniques in determining GDR and clinical symptoms.Symptoms were evaluated before and after surgery in 30 patients operated using a laparotomic technique and in 30 patients operated using a laparoscopic technique. Two groups of 10 patients, operated respectively using laparotomic and laparoscopic techniques, were studied both clinically and endoscopically before and after surgery.The analysis of the results shows a lower incidence of GDR and typical symptoms of GDR in patients undergoing laparoscopic surgery. The rationale underlying the lower incidence of GDR and its symptoms in these patients compared to the more conventional group is not completely clear.These results may be influenced by reduced surgical trauma and the careful selection of case or the laparoscopic technique, hence the exclusion of cases complicated by severe cholecystitis.

Lung surgery in the elderly, once considered a major risk, to be avoided if possible has become more popular in recent years as a result of many factors. First: lung cancer incidence has increased significantly in every age group but mostly in the elderly. Second: diagnosis at an early stage of the disease is higher in patients over 70 due to more frequent medical control in old subjects. Third: we now have more and more humans over 80 and a life expectancy increasing over the years. Fourth: preoperative, operative and postoperative medical supports are now safer and more reliable than previously. Operability criteria in the elderly are substantially the same as in younger group of patients for lung cancer. There are no reasons to refuse surgery in a subject over 80 because he is old. Lobectomy is the procedure of choice for lung cancer even in the elderly. Pneumonectomy must be avoided preferring a less radical procedure (wedge resection) so avoiding the risk of a postoperative respiratory failure that is often fatal for a patient with in border line functional respiratory tests, as often happens in the elderly. Thoracoscopic atypical resections must be considered in patients when a wedge resection is indicated preoperatively and almost always metastatic pulmonary lesion.