Purification of complex biopharmaceuticals with new processes, advanced analytics and computer-aided process design tools

Dissertação para obtenção do Grau de Mestre em Biotecnologia

Faunes ichthyologiques du Néogène Supérieur d’Angola, leur âge, remarques sur le Pliocène marin en Afrique Australe

This note is concerned with fish remains from Upper Neogene beds at Farol das Lagostas (and nearby quarry of SECIL) and Baía Farta, mainly recovered by the author in 1960, 1961, 1963 and 1967. For further data see ANTUNES, 1964, pp. 213-215. All the forms identified until now (many of them for the first time) are show in «tableau I». Smaller ones are poorly represented. I. benedeni is provisorily accepted as a distinct species, though it may correspond to a dental morphotype that does exist equally in the extant I. oxyrhinchus (see text): therefore I. benedeni from Farol das Lagostas may after all represent only some dental variations that really belong in the form described as I. cf. oxyrhinchus. The presence of Aprionodon and Hypoprion could not be ascertained: Procarcharodon megalodon, Carcharodon carcharias, Isurus benedeni. Galeocerdo cuvieri, and Carcharhinus sp. I and sp. II are specially discussed. The whole fauna does not correspond either to a very shallow and coastal environment, or to deep waters far away from the coast. It clearly points out to warm waters: an acceptable model would be the fauna from the tropical Atlantic between Northern Angola and Senegal-Cape Verde. The age of this fauna was long regarded as Burdigalian. The data formerly presented (ANTUNES, 1963) that allowed us to ascribe a pliocene age to the uppermost Neogene beds of Farol das Lagostas (Neogene III, ANTUNES, 1964) are reviewed and developed in this paper. This view is corroborated by planctonic foraminifera and stratigraphical data which provide further evidence to prove the presence of miocene beds much younger than Burdigalian, and that some deposits previously correlated to this stage have instead a Plio-Pleistocene age. Fish fauna from Farol das Lagostas is very characteristic, with giant P. megalodon in association with C. carcharias (which predominates, and whose stratigraphical distribution is particularly discussed), and with other very advanced forms like the extant tiger shark, G. cuvieri, enormous I. Benedeni, Hemipristis, and Carcharhinus (whose size largely exceeds the maximum observed with miocene material). With the exception of P. megalodon (extinct) all the other forms show very close affinities, or even identity with modern species. Comparisons with very similar faunas from some South African localities that may also have a Pliocene age are also presented.

Les Hipparion du Portugal

This paper is concerned with Hipparion from Ribatejo, Portugal, and with the stratigraphy of the Neogene series of this region. The first two chapters are an introduction and an historical review. Paleontological study includes both a revision of the specimens accounted by ROMAN (1907) and the description of new material. Two forms were recognized, an early H. cf. primigenium, lower Vallesian in age, NM 9 mammal unit (from Archino, Vila Nova da Rainha, Aveiras de Cima), and a more advanced H. primigenium cf. melendezi. Upper Vallesian, NM 10 (possibly lowermost Turolian, NM 11) (at Azambujeira and Marmeleira). A synthesis of Middle and Upper Miocene from Ribatejo is also presented. Levels with H. p. cf. melendezi are somewhat older than «Upper Pontian», as it was previously acknowledged, they attain at the best the lowermost Turolian (approximately corresponding to «Upper Pontian»). Even higher levels may be Turolian in age, though they are not yet accurately dated. Almost all the localities are shown (tableau 11) according to its stratigraphical position; age, correspondance to mammal units from NM 5 to NM 10 (and may be also from NM 11 to NM 12), and correlation with marine formations near Lisbon are also taken in account. The stratigraphical position of localities such as Póvoa de Santarém, Quinta do Marmelal, Pero Filho, Azambujeira (lower levels), and Fonte do Pinheiro was revised; the stratigraphical position of Marmeleira was ascertained. The localities so far known correspond to NM 5 (?), NM 6, NM 8, NM 9, NM 10 and possibly to NM II and NM 12. A new interpretation (M. T. ANTUNES) of localities with oysters from Ribatejo allows a better correlation with vertebrate localities. Relationships with Serravallian transgression seem well established. Only two localities, Vila Nova da Rainha and Foz do Alviela, may possibly be correlated to V-b division of Lisbon (Langhian) with «Hispanotherium fauna». All the other localities are younger than Serravallian oyster beds. Undirect correlation shows that NM 6 localities are somewhat younger than the apogee ef Serravallian transgression (corresponding approximately to Blow's N 11 to N 13 zones based on planctonic foraminifera).

Faunes ichthyologiques du Néogène Supérieur d’Angola, leur âge, remarques sur le Pliocène marin en Afrique Australe

This note is concerned with fish remains from upper Neogene beds at Farol das Lagostas (and nearby quarry of SECIL) and Baía Farta, mainly recovered by the author in 1960, 1961, 1963 and 1967. For further data see ANTUNES, 1964, pp. 213-215. All the forms identified until now (many of them for the first time) are show in «tableau I». Smaller ones are poorly represented. I. benedeni is provisorily accepted as a distinct species, though it may correspond to a dental morphotype that does exist equally in the extant I. oxyrhinchus (see text): therefore I. benedeni from Farol das Lagostas may after all represent only some dental variations that really belong in the form described as I. cf. oxyrhinchus. The presence of Aprionodon and Hypoprion could not be ascertained: Procarcharodon megalodon, Carcharodon carcharias, Isurus benedeni. Galeocerdo cuvieri, and Carcharhinus sp. I and sp. II are specially discussed. The whole fauna does not correspond either to a very shallow and coastal environment, or to deep waters far away from the coast. It clearly points out to warm waters: an acceptable model would be the fauna from the tropical Atlantic between Northern Angola and Senegal-Cape Verde. The age of this fauna was long regarded as Burdigalian. The data formerly presented (ANTUNES, 1963) that allowed us to ascribe a pliocene age to the uppermost Neogene beds of Farol das Lagostas (Neogene III, ANTUNES, 1964) are reviewed and developed in this paper. This view is corroborated by planctonic foraminifera and stratigraphical data which provide further evidence to proove the presence of miocene beds much younger than Burdigalian, and that some deposits previously correlated to this stage have instead a Plio-Pleistocene age. Fish fauna from Farol das Lagostas is very characteristic, with giant P. megalodon in association with C. carcharias (which predominates, and whose stratigraphical distribution is particularly discussed), and with other very advanced forms like the extant tiger shark, G. cuvieri, enormous I. Benedeni, Hemipristis, and Carcharhinus (whose size largely exceeds the maximum observed with miocene material). With the exception of P. megalodon (extinct) all the other forms show very close affinities, or even identity with modern species. Comparisons with very similar faunas from some South African localities that may also have a Pliocene age are also presented.

Les Hipparion du Portugal

This paper is concerned with Hipparion from Ribatejo, Portugal, and with the stratigraphy of the Neogene series of this region. The first two chapters are an introduction and an historical review. Paleontological study includes both a revision of the specimens accounted by ROMAN (1907) and the description of new material. Two forms were recognized, an early H. cf. primigenium, lower Vallesian in age, NM 9 mammal unit (from Archino, Vila Nova da Rainha, Aveiras de Cima), and a more advanced H. primigenium cf. melendezi. Upper Vallesian, NM 10 (possibly lowermost Turolian, NM 11) (at Azambujeira and Marmeleira). A synthesis of Middle and Upper Miocene from Ribatejo is also presented. Levels with H. p. cf. melendezi are somewhat older than «Upper Pontian», as it was previously acknowledged, they attain at the best the lowermost Turolian (approximately corresponding to «Upper Pontian»). Even higher levels may be Turolian in age, though they are not yet accurately dated. Almost all the localities are shown (tableau 11) according to its stratigraphical position; age, correspondance to mammal units from NM 5 to NM 10 (and may be also from NM 11 to NM 12), and correlation with marine formations near Lisbon are also taken in account. The stratigraphical position of localities such as Póvoa de Santarém, Quinta do Marmelal, Pero Filho, Azambujeira (lower levels), and Fonte do Pinheiro was revised; the stratigraphical position of Marmeleira was ascertained. The localities so far known correspond to NM 5 (?), NM 6, NM 8, NM 9, NM 10 and possibly to NM II and NM 12. A new interpretation (M. T. ANTUNES) of localities with oysters from Ribatejo allows a better correlation with vertebrate localities. Relationships with Serravallian transgression seem well established. Only two localities, Vila Nova da Rainha and Foz do Alviela, may possibly be correlated to V-b division of Lisbon (Langhian) with «Hispanotherium fauna». All the other localities are younger than Serravallian oyster beds. Undirect correlation shows that NM 6 localities are somewhat younger than the apogee ef Serravallian transgression (corresponding approximately to Blow's N 11 to N 13 zones based on planctonic foraminifera).

Estudo da influência do material inorgânico na formação de H2S e HCl durante a co-gasificação de CDR com carvão

O objectivo principal deste trabalho relaciona-se com a compreensão dos mecanismos de formação de H2S e HCl durante a co-gasificação de C.D.R com carvão. A presença de material inorgânico nas cinzas dos combustíveis utilizados poderá ter alguma influência na formação e subsequentes reacções de H2S e HCl, tornando-se importante compreender qual a extensão da influência destes materiais na formação destas espécies, encaradas como contaminantes do gás produzido. A utilização de misturas de C.D.R. com carvão em gasificação poderá contribuir para a redução das quantidades de resíduos depositadas em aterro. Sendo a gasificação um processo menos poluente do que a incineração, a gasificação destes materiais poderá traduzir-se num menor impacto ambiental. Os C.D.R. são materiais heterogéneos e portanto as quantidades de S, Cl e material inorgânico poderão variar tornando relevante o estudo de potenciais sinergias entre os C.D.R. e o carvão com o objectivo de 1) minimizar a emissão de poluentes gasosos, 2) minimizar a quantidade de cinza produzida e 3) aproveitar o material inorgânico, que pode desempenhar actividade catalítica conduzindo à redução da formação de H2S e HCl. Com este estudo foi determinada uma aparente relação linear entre os teores de enxofre nos combustíveis e a formação de H2S, sendo que no entanto a forma sob a qual o enxofre se encontra nos combustíveis poderá desempenhar um importante papel na conversão do enxofre em H2S. No caso do HCl, a referida relação não pareceu ser tão clara. Foi igualmente determinado que maiores temperaturas de operação promovem a formação de H2S, ao mesmo tempo que reduzem a formação de HCl, e que enquanto o aumento da quantidade de oxigénio poderá conduzir à redução da formação de H2S, não terá impacto significativo na formação de HCl. No que diz respeito aos metais foi verificado que Ca, Fe e Zn terão um papel importante na redução da formação de H2S e HCl, enquanto que K e Na terão apenas influência na formação de HCl e o Al e a Si, não afectaram nem a formação de H2S nem a de HCl.

Estudo da influência do material de enchimento na remoção de matéria orgânica, azoto e sólidos em leitos de macrófitas do tipo ESSH

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Sanitária

Um segredo bem guardado: Leques mandarim – caracterização material e conservação

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Conservação e Restauro

Advanced image processing techniques for detection and quantification of drusen

Dissertation presented to obtain the degree of Doctor of Philosophy in Electrical Engineering, speciality on Perceptional Systems, by the Universidade Nova de Lisboa, Faculty of Sciences and Technology

Sustentabilidade do SIG municipal da CM de Vila Franca de Xira - Operacionalização de um grupo de trabalho multidisciplinar, estruturalmente suportado pelo ArcGis Server Empertrise Advanced

Relatório de Estágio apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Gestão do Território.

A conservação material e documental da obra “Instalação191093,parte1” de Francisco Rocha

Dissertação apresentada na Faculdade de Ciências e Tecnologia para obtenção do grau de Mestre em Conservação e Restauro

Braquiterapia prostática: morbilidade urinária e sexual

RESUMO: Objectivos 1. Avaliar a morbilidade urinária e sexual secundária à braquiterapia prostática com implante de I125. 2. Avaliar a influência da hormonoterapia neoadjuvante e adjuvante na morbilidade urinária e sexual secundária à braquiterapia(I125). 3. Avaliar a influência da associação da radioterapia externa na morbilidade urinária e sexual secundária à braquiterapia(I125). 4. Avaliar a morbilidade urinária dos doentes com contra-indicação relativa (próstatas volumosas, IPSS elevado).Material e métodos De Setembro de 2000 a Dezembro de 2004 foram recrutados 204 doentes com o diagnóstico de carcinoma da próstata localizado (T1 e T2) ou localmente avançado (T3) e expectativa de vida superior a 10 anos. Foram submetidos a braquiterapia, com implante transperineal de Iodo 125 (I125) em monoterapia ou combinada com hormonoterapia e/ou radioterapia externa (tratamento trimodal). Definiram-se diversos sub-grupos de pacientes, consoante algumas características habitualmente referidas como factores de risco para a morbilidade do tratamento de braquiterapia prostática, com o objectivo de analisar a sua influência sobre a morbilidade urinária e sexual: Grupo 1: Braquiterapia em monoterapia (MONO) versus braquiterapia associada a radioterapia externa (BCOMB) Grupo 2: Próstatas volumosas (>50ml) versus próstatas não volumosas (<50ml)Grupo 3: Braquiterapia associada a hormonoterapia (HORM) versus braquiterapia sem hormonoterapia (NHORM)Grupo 4: IPSS elevado versus IPSS baixo Avaliou-se a evolução do IPSS, QoL, taxa de RTU-P e retenção urinária pós implante, e evolução do BSFI durante todo o período de seguimento. Resultados Grupo 1: Para o grupo MONO o IPSS iniciou-se com 7.1, sofreu agravamento para 16.1 e 15.9 ao primeiro e terceiro meses. Aos 12 meses, o IPSS desceu para 10.1 enquanto que, aos 18 e 24 meses, o IPSS foi de 7.3 e 5.8. O grupo BCOMB iniciou com IPSS de 9.4. Sofreu agravamento ligeiro e pouco acentuado até aos 6 meses (IPSS de 14). A evolução do IPSS foi, então, flutuante com IPSS de 5.9 aos 12 meses e 9.5 aos 18 meses. Aos 24 meses apresentava IPSS de 6.7. A taxa de retenção urinária (6.4% e 0%) e de RTU-P (2.0% e 0%) foram semelhantes nos grupos MONO e BCOMB, respectivamente (p=0.375 e p=1). A evolução da qualidade das erecções foi semelhante nos dois grupos excepto aos 6 meses em que MONO apresentou o valor 6 e BCOMB 3.7 (p=0.029). A percentagem de doentes potentes foi significativamente inferior nos primeiros 6 meses após a braquiterapia para o grupo BCOMB relativamente ao grupo MONO: 36%–74%; 33%–73%; 33%–75%. Após os 6 meses os grupos foram homogéneos. Grupo 2: O IPSS evoluiu nas próstatas <50ml e >50ml de 7–9 para 15-19 ao primeiro mês e 15-18 ao 3.º mês. Apenas ao primeiro mês é que as diferenças no IPSS foram significativas (p=0.061). Após o 3.º mês os dois grupos foram semelhantes: IPSS de 8 e 12 ao 12.º mês e 5.7 e 6 ao 24.º mês. As taxas de retenção urinária e de RTU-P foram semelhantes (p=0.054 e p=0.286) Grupo 3: A evolução do IPSS, taxas de retenção urinária e de RTU-P foram sobreponíveis em ambos os grupos. A evolução da líbido, erecções, percentagem de doentes potentes, ejaculação, incómodo e satisfação foi significativamente inferior no grupo HORM relativamente ao grupo N HORM apenas ao primeiro mês (valores de p<0.0001; <0.0001; < 0.0001; 0.009 e 0.002 respectivamente) Grupo 4: A evolução do IPSS nos doentes com IPSS elevado foi a seguinte: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M) A evolução do IPSS nos doentes com IPSS baixo foi a seguinte: 5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M) As taxas de RTU-P (2.8% e 0%) e retenção urinária (5.1% e 5.9%) foram semelhantes em ambos os grupos de doentes (p=1). Conclusões 1. A radioterapia intersticial da próstata com implante transperineal e ecoguiado de Iodo 125 é frequentemente acompanhada de morbilidade urinária transitória e de intensidade moderada. A Morbilidade consiste em sintomatologia do aparelho urinário baixo (“LUTS – lower urinary tract symptoms”) que, na maioria dos doentes, sofre um agravamento máximo do primeiro ao 3.º mês. Segue-se uma melhoria ligeira até ao 6.º mês que é mais acentuada daí em diante. Por volta do 12.º e 18.º mês, a maior parte dos doentes apresenta sintomatologia urinária muito semelhante à que apresentava antes do tratamento. Após o 18.º mês, os doentes mantêm uma melhoria da sintomatologia urinária para além da que apresentavam previamente ao implante. As taxas de retenção urinária e de ressecção transuretral prostática após o implante de braquiterapia são muito baixas, inferiores a 10%. 2. A associação da braquiterapia prostática com radioterapia externa adjuvante influencia a evolução da sintomatologia urinária: o aparecimento da sintomatologia urinária é mais lento, demorando 6 meses a atingir o seu valor máximo que, por sua vez, é de intensidade menos acentuada do que quando a braquiterapia é utilizada em monoterapia. 3. O volume prostático superior a 50 ml não influencia a morbilidade urinária. 4. A terapêutica hormonal, neoadjuvante e adjuvante, não influencia a sintomatologia urinária. 5. Os doentes com sintomatologia urinária prévia muito acentuada não sofrem agravamento da referida sintomatologia. Pelo contrário, apresentam uma melhoria de sintomas urinários desde o primeiro mês, e que se mantém ao longo dos 24 meses de seguimento, apresentando, no final deste período, sintomatologia urinária ligeira e muito inferior à que apresentavam antes do implante. As taxas de retenção urinária e RTU-P após a braquiterapia são semelhantes às que ocorrem nos doentes assintomáticos previamente ao implante. 6. A vida sexual está preservada, em mais de 70% dos casos, ao fim dos 24 meses de seguimento. No entanto, imediatamente após o primeiro mês de seguimento, ocorre uma diminuição ligeira da qualidade das erecções que se mantém, sem melhoria ou agravamento, durante todo o período de seguimento. A hormonoterapia afecta todos os parâmetros da vida sexual, embora de forma apenas temporária. Após a suspensão da terapêutica hormonal este grupo de doentes recupera a actividade sexual e apresenta-se idêntico ao grupo de doentes que não foram sujeitos a essa terapêutica.----------------ABSTRACT: Objectives 1. To assess urinary and sexual morbility after prostatic brachytherapy with the implant of I125 seeds. 2. To assess the influence of neoadjuvant and adjuvant hormone therapy in urinary and sexual morbility after prostatic brachytherapy with the implant of I125 seeds. 3. To assess the effects, on urinary and sexual morbility, of associating external radiotherapy after prostatic brachytherapy with the implant of I125 seeds. 4. To assess the urinary morbility in patients with relative contraindications (voluminous prostates, high IPSS). Material and Methods From September, 2000 to December, 2004 a total of 204 patients were recruited with a diagnosis of localized (T1 and T2) or locally advanced (T3) carcinoma of the prostate and a life expectancy in excess of 10 years. The patients underwent brachytherapy with transperineal seed implant of iodine (I125) as a monotherapy or in combination with hormone therapy and/or external radiotherapy (trimodal treatment). With the aim of evaluating the treatment’s influence on urinary and sexual morbility, a number of patient sub-groups were defined in accordance with certain characteristics normally mentioned as morbility risk factors for prostatic brachytherapy treatment: Group 1: Brachytherapy as monotherapy (MONO) versus brachytherapy in combination with external radiotherapy (BCOMB) Group 2: Voluminous prostates (>50ml) versus non- voluminous prostates (<50ml) Group 3: Brachytherapy in combination with hormone therapy (HORM) versus brachytherapy without hormone therapy (NHORM)Group 4: High IPSS versus a low IPSS. The evolution of the IPSS, QoL, TURP rate and post-implant urinary retention as well as the BSFI were assessed throughout the entire follow-up period. Results Group 1: For the MONO group the IPSS began at 7.1, and then rose to 16.1 and 15.9 in the first and third months, respectively. At month 12, the IPSS had dropped to 10.1 and at month 18 and 24 the IPSS was registered at 7.3 and 5.8, respectively. The BCOMB group started out with an IPSS of 9.4. It underwent a slight and little-significant rise until month 6 (IPSS at 14). The evolution of the IPSS then began to fluctuate from an IPSS of 5.9 at month 12 and 9.5 at month 18. At month 24 we registered an IPSS of 6.7. The urinary retention rate (6.4% and 0%) and TURP rate (2.0% e 0%) were similar to those of the MONO and BCOMB groups, respectively (p=0.375 and p=1). The evolution regarding the quality of erections was similar for the two groups except at 6 months when the MONO group displayed a value of 6 and the BCOMB group 3.7 (p=0.029). The percentage of sexually potent patients was significantly lower in the first six months after brachytherapy for the BCOMB group when compared with the MONO group: 36%–74%; 33%–73%; 33%–75%. After six months, the results became more consistent. Group 2: IPSS results evolved in <50ml and >50ml prostates from 7–9 to 15-19 in the first month and from 15-18 after the third month. It was only in the first month that the differences in the IPSS were significant (p=0.061). After the third month, the two groups displayed similar outcomes: IPSS 8 and 12 at month 12 and 5.7 and 6 at month 24. Urinary retention and TURP rates were similar (p=0.054 e p=0.286). Group 3: IPSS evolution and rates of urinary retention and TURP were identical in both groups. Figures regarding libido, erections, percentage of sexually potent patients, ejaculation, discomfort and sexual satisfaction were always significantly lower for the HORM group, when compared to the NHORM group in the first month only (values of p<0.0001; <0.0001; <0.0001; 0.009 e 0.002, respectively). Group 4: IPSS evolution in patients with a high IPSS was as follows: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M) IPSS evolution in patients with a low IPSS was as follows: 5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M)TURP rates (2.8% e 0%) and those for urinary retention (5.1% e 5.9%) were similar in both patient groups (p=1). Conclusions 1. Interstitial radiotherapy of the prostate with transperineal, ultrasound-guided implant of Iodine-125 seeds is often followed by transitory urinary morbility of moderate intensity. The morbility involves symptoms of the lower urinary tract which, in most cases are at their worst from the first to the third months. There is a slight improvement up to the sixth month, at which point improvement becomes more accentuated. Around months 12 or 18, most patients display urinary symptoms that are very similar to those noted before treatment. After month 18, patients’ urinary symptoms continue to improve past the point they displayed prior to the implant. Urinary retention rates and those for transurethral resection of the prostate are very low (below 10%), after brachytherapy seed implant. 2. The combination of prostatic brachytherapy and adjuvant external radiotherapy affects the evolution of urinary symptoms: the appearance of urinary symptoms is much slower, taking six months to peak, and is less intense than when brachytherapy is employed as the only means of treatment. 3. The fact that the prostate displays a volume greater than 50 ml does not influence urinary morbility. 4. Neoadjuvant and adjuvant hormone therapy do not influence urinary symptomology. 5. Patients with severe, preexisting symptoms of the urinary tract do not experience a worsening of those symptoms. On the contrary, they exhibit an improvement in urinary symptoms as of the first month. This improvement continues for the 24 months, after which patients display symptoms of the urinary tract that are slight and a noticeable improvement over the urinary complaints registered before the implant. Urinary retention and TURP rates subsequent to brachytherapy are similar to those registered for asymptomatic patients. 6. The patient’s sexual performance is maintained in more than 70% of the cases, as noted after 24 months of follow-up. However, immediately after the first follow-up month there is a lessening in the quality of erections that continues, without improving or worsening, for the whole follow-up period. Hormone therapy affects all the parameters of sexual performance, albeit temporarily. After suspending hormone therapy, this group recovered with regard to sexual performance, and showed itself to be identical to the group of patients that had not undergone hormone therapy.-------------------RESUMÉ:Objectives 1. Évaluer la morbilité urinaire et sexuelle après la realisation la curiethérapie de la prostate avec implant de I125. 2. Évaluer l’ influence de la thérapie hormonale néoadjuvante et adjuvante en ce qui concerne la morbilité urinaire et sexuelle après la réalisation de la curiethérapie (I125). 3. Évaluer l’influence de l’association de la radiothérapie externe dans la morbilité urinaire et sexuelle après la réalisation de la curiethérapie (I125). 4. Évaluer la morbilité urinaire des malades avec des contre indications relatives (prostates volumineuses, IPSS élevé). Matériel et méthodologie De Septembre 2000 à Décembre 2004, on a recruté 204 patients ayant pour diagnostique un carcinome de la prostate localisé (T1 et T2) ou localement avancé (T3) et dont l’expectative de vie était de plus de 10 ans. Ils ont été soumis au traitement de la curiethérapie avec l’implantation transpérinéal de l’iode 125 (I125) en monothérapie ou en traitement combiné avec une thérapie hormonale et/ou radiothérapie externe (traitement trimodale). Il y a eu plusieurs sous-catégories de patients, et cela dépend de quelques caractéristiques normalement considérées comme des facteurs à risque en ce qui concerne la morbilité du traitement de la curiethérapie de la prostate, et l’objective étant d’analyser son influence sur la morbilité urinaire et sexuelle. Groupe 1: Curiethérapie en traitement unique (MONO) par rapport à la curiethérapie associée au traitement externe (BCOMB). Groupe 2: Prostates volumineuses (>50ml) par rapport au prostates qui ne sont pas volumineuses (<50ml). Groupe 3: Curiethérapie associée au traitement hormonale (HORM) par rapport à la curiethérapie sans traitement hormonale (NHORM). Groupe 4: IPSS élevé par rapport au IPSS diminué. Nous avons évalué l’evolution du IPSS, Qualité de vie, le taux de RTU-P et la retention de l’urine après l’implant, BSFI pendant toute la période du traitement. Résultats Groupe 1: Pour le groupe MONO l’IPSS a commençé avec un taux de 7.1, et les patients ont souffert d’un empirement allant jusqu’à 16.1 et 15.9 pendant le premier et le troisième mois. 12 mois après l’IPSS diminua jusqu’à 10.1 À 18 mois le taux fût de 7.3 et à 24 mois il diminua encore jusqu’à atteindre 5.8. Le groupe BCOMB commença avec un taux d’IPSS de 9.4. Ils souffrirent un empirement légér et peu accentué jusqu’aux 6 premiers mois (IPSS de 14). L’évolution de l’IPSS était fluctuante allant de 5.9 à 12 mois et 9.5 à 18 mois. À 24 mois, l’IPSS était de 6.7. Le taux de retention de l’urine (6.4% et 0%) et de la RTU-P (2.0% et 0%) étaient simmilaires dans les groupes MONO et BCOMB respectivement (p=0.375 et p=1). L’ évolution de la qualité des érections fût semblable dans les 2 groupes excepté le groupe MONO qui présenta une valeure de 6 à 6 mois et le groupe BCOMB qui présenta une valeure de 3.7 (p=0.029). Le pourcentage des malades sexuellement puissants a été significativement inférieur pendant les 6 premiers mois depuis la curiethérapie pour le groupe BCOMB si on le compare au groupe MONO: 36%–74%; 33%–73%; 33%–75%. Après cette période, les groupes eûrent des résultats homogénes. Groupe 2: L’ IPSS a évolué dans les prostates <50ml et >50ml de 7–9 jusqu’à 15-19 pendant le premier mois et jusqu’à 15-18 au 3ème mois. C’est seulement pendant le premier mois que les différences de l’IPSS ont été significatives (p=0.061). Après le 3ème mois les deux groupes ont eu des résultats semblables: IPSS 8 et 12 à 12.º mois et 5.7 et 6 à 24.º mois. Le taux de retention de l’urine et de la RTU-P ont été simmilaires (p=0.054 e p=0.286). Groupe 3: L’evolution de l’ IPSS, les taux de retention de l’urine et de la RTU-P pourraient se surposer pour les deux groupes. L’évolution de la libido, des érections, le pourcentage des malades sexuellements puissants, l’incommodité et la satisfaction ont été toujours significativement infériures dans le groupe HORM par rapport au groupe NHORM dès le premier mois (valeurs de p <0.0001; <0.0001; < 0.0001; 0.009 et 0.002 respectivement) Groupe 4: L’évolution de l’ IPSS pour les malades ayant un IPSS élevé fût ainsi: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M)L’évolution de l’ IPSS pour les malades ayant un IPSS diminué fût ainsi:5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M) Le taux de RTU-P (2.8% e 0%) et de retention de l’urine (5.1% et 5.9%) ont été semblables dans les 2 groupes de malades (p=1). Conclusions 1. La radiothérapie interstitielle de la prostate avec implant transpérinéal de l’iode 125 est fréquamment acompagnée d’une morbilité urinaire transitoire et d’intensité modérée. La morbilité consiste d’une symptomatologie de l’apparéil urinaire inférieure qui, dans la plupart des malades, empire gravement du premier au troisième mois. La situation s’améliore légèrement jusqu’au 6ème mois, l’amélioration étant plus accentuée à partir de là. Autour du 12ème jusqu’au 18ème mois, la majorité des malades présente une symptomatologie urinaire qui se ressemble beaucoup à celle qu’ils avaient avant le traitement. Après le 18ème mois l’amélioration de la symptomatologie urinaire est constante par rapport à celle qu’ils présentaient avant l’implant. Le taux de retention de l’urine et de RTU-P après l’implant de la curiethérapie sont très basses, au dessus de 10%. 2. L’association de la curiethérapie de la prostate avec la radiothérapie externe adjuvante a une influence sur l’évolution de la symptomatologie urinaire: l’apparition des symptômes est plus lente, prenant jusqu’à 6 mois pour atteindre son niveau maximum, qui à son tour, a une intensité moins accentuée que lorsque la curiethérapie est utilisée en monothérapie. 3. Le volume de la prostate supérieure à 50 ml n’a pas d’influence sur la morbilité urinaire. 4. La thérapie hormonale, néoadjuvante et adjuvante, n’a pas d’influence sur la symptomatologie urinaire. 5. Les malades ayant une symptomatologie urinaire préalable et très accentuée ne souffrent pas d’empirement de leur situation. Au contraire, ils présentent une amélioration des symptômes urinaires à partir du premier mois et ceci se maintient tout au long des 24 mois que dure le traitement, ayant à la fin de cette période une symptomatologie urinaire légère et beaucoup plus basse que celle qu’ils présentaient avant l’implant. Le taux de retention de l’urine et de la RTU-P après la curiethérapie est simmilaire à celui que les malades qui n’ont pas de symptômes présentent avant l’implant. 6. La vie sexuelle est préservée dans plus du 70% des cas à la fin de la période de traitement (24 mois). Entretemps, immédiatement après le premier mois d’étude, on note une légère diminution de la qualité des érections qui se maintient sans amélioration ou empirement tout au long du traitement. Le traitement à base d’hormones affecte tous les paramètres de la vie sexuelle, mais de façon temporaire. Après la suspension de la thérapie hormonale ce groupe de malades récupère l’activité sexuelle et se présente de façon égale au groupe de malades qui n’ont pas été soumis à ce traitement.

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