MEDICAL SCIENCE (11)

Author: ALMEIDA HERRERO FERNANDO LUIS.
Year: 2005.
University: VALENCIA [www.uv.es].
Place of defense: F. DE MEDICINA Y ODONTOLOGIA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGIA.

Summary: Pain femoropatelar is a major challenge both in terms of diagnosis and treatment that appears in young patients with advanced ages. Increasing pressure intraosseous at rotuliano, related to an increase in the venous drainage, it has been postulated as a cause of pain in the knee earlier. We have described numerous techniques descompresivas with various clinical outcomes and seeking less aggressive techniques, drilling bone can be an alternative. It employed 12 sheep adult females of the breed marine with an average weight of 60 kg and an average age of 4 years split into two groups. Group A was designed to demonstrate that the patellar decompression results in a decline in intraosseous pressure. It conducted a controlled trauma in both ball joints and subsequent decompression in the patella being left patella right the control group. Group B was designed to observe the effect of bone decompression technique itself, in the absence of hiperpresión through a trauma prior decompression performed on the left patella being right the control group. In both groups pressure measurements were performed at baseline, at 6 weeks prior and after completion of the decompression and 4 months performed histological study in both ball joints. After statistical analysis of the figures of pressure in different time intervals, we can conclude that the conduct of drilling bone does not produce a decrease in number of pressure, whether or not there is a state of hiperpresión beforehand. From the point of view pathological, such perforations not inhibit or reverse the degenerative changes histological and finally, the very technique of measuring the intraosseous pressure may itself constitute an assault may trigger long-term degenerative disorders.

Author: DOMÍNGUEZ BERROT ANA MARÍA.
Year: 2005.
University: VALLADOLID [www.uva.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: VALLADOLID.

Summary: Introduction. For predicting the outcome of weaning were used various clinical and functional parameters, which are useful in patients who have remained on mechanical ventilation (MV) a short period of time, but when it is reduced from prolonged. Recently, interest has grown by describing patterns in the rhythms of biological systems, and by far its variability in physiological and pathological conditions. The objective of this study is to analyze the variability of respiratory pattern through the measurement of the sample Entropy (SampEn), to find out their prognostic value in patients undergoing weaning, and seek similarities or differences with the varaibilidad pattern of the individual healthy. METHOD. Intubated patients were included critics, who have received VM for more than 48 hours, they were able clinics be desconecatdos. It also included a group of healthy volunteers, not intubated. It utilizón a system for respiratory monitoring (Bicore CP-100 2.0), to measure Vti, Vte, PIFR, PEFR, Ti / Ttot, respiratory rate. It was recorded and stored values obtained by the monitor, breathing to breathing during a test shutdown in O2T of 30 min. We calculated the variability of these parameters by measuring its SampEn. With a whole `tests, it produced the following groups: GC: (control group test volintarios healthy); GE: (tests disconnection followed by successful extubation), GF (evidence of disconnection is not followed by extubation either followed by failed extubation), GI (test intubated GE = + GF) RESULTS are included 40 patients who performed 51pruebas disconnection (GI = 51), of which GE GF = 26 and = 25. They include 15 healthy volunteers (G = 15). No significant differences were found between GE and GF in terms of SampEn any variable ventilation. The SampEn Vti sample values greater than in GF GE, approaching statistical significance. As for the comparison between GI and GC, all parameters are obtained values SampEn higher in the GC, achieving statistical significance the SampEn Ti / Ttot, SampEn PIFR and SampEn PEFR. CONCLUSIONS. Analysis of variability by SAmpEn of PIFR, PEFR, Ti / Ttot shows higher values in healthy volunteers in intubated patients. The measure of the variability of the parameters of the respiratory pattern, even showing differences, it has not been useful in discriminating which patients can be extubated successful and which are not.

Author: Mano Bonin Aníbal de la.
Year: 2005.
University: VALLADOLID [www.uva.es].
Place of defense: Facultad de Medicina.
Place of preparation: Facultad de Medicina - Universidad de Valladolid.

Summary: Determination of pattern temporo-espacial expression of Interleukin 1B and 6 during the development of the central nervous system in rat embryos, including vesicles brain, pituitary and spinal cord. Studies of the influence of both processes interleukins on cell proliferation and neuronal differentiation in the brachial region of the spinal cord of chicken embryos, using techniques of stimulation and inmunobloqueo local

Author: RIESCO FAGUNDO ARMENIA MARÍA.
Year: 2005.
University: VALLADOLID [www.uva.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: THE INHIBITION BY HIPOXIA THE CHANNELS MAXIK OF CELLS QUIMIORRECEPTORAS OF BODY CAROTÍDEO OF RAT IS WELL CARACTERIZADO. NONETHELESS, THE MOLECULAR MECHANISMS OF SENSITIVITY AND INHIBITION OF AS THE ROLE OF THESE CHANNELS IN THE PROCESS OF TRANSDUCCIÓN TO ENCOURAGE HIPÓXICO PERMENECEN NOT RESOLVE. WE HAVE REVIEWED MECHANISMS OF INTERACTION WITH OXYGEN CHANNEL MAXIK EXPLORING THE EFFECTS OF HIPOXIA ON REGISTERED WITH THE CURRENT CONFIGURATIONS WHOLE-CELL E INSIDE-OUT USING THE TECHNIQUE PATCH-CLAMP. THE HIPOXIA INHIBE ACTIVITY OF BOTH CHANNELS IN CONFIGURATION, THIS IS DEPENDENT EFFECT OF CALCIUM AND VOLTAGE, AND IN EFFECT HIPÓXICO MAXIMUM A MERGER OF CALCIUM AND LOW VOLTAGE LESS DESPOLARIZADOS. ANALYSIS IN THE CINÉTICA OF REGISTERED SINGLE CHANNEL TO UNVEIL THE BEHAVIOR OF CHANNEL CAN WE DESCRIBE THROUGH THREE STATES AND FIVE STATES OPEN CLOSED.

Author: ROMÁN PÉREZ FRANCISCO JOSÉ.
Year: 2005.
University: GRANADA [www.ugr.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD DE GRANADA.

Summary: Under the term of diffuse interstitial lung diseases, are grouped many processes usually subacute and chronic respiratory which are characterized by compromise difusamente the pulmonary parenchyma, affecting primarily the interstitium and the alveolar spaces. Despite his great heterogeneicidad Such diseases can be grouped as presented clinical features, radiological and functional similar. The prevalence of this type of disease is not precisely known (about 10 cases per 100000 inhabitants). It is estimated that the prevalence is increasing in recent years. Despite being a very diverse group, with more than 180 cases etiologic, these diseases are generally progressive and lethal. It is estimated that one sees developed fibrosis, the patient's life expectancy is only 50% at five years. In recent years, he has taken special significance the effect of oxidative stress on the pathogenesis of diseases fibrosantes lung. The secretion is increased oxidants checking is a major imbalance between oxidant / antioxidant, in favor delos first such patients. In this pilot study animal is a pulmonary fibrosis caused by inhalation powder, as the anatomical lesions produced are very similar to those observed in patients with pulmonary fibrosis. This fact, coupled with the absence of a study into animal experimentation to analyze oxidative stress in relation to pulmonary fibrosis induced by talc, has led us to raise this research work with the following objectives: 1-evaluate stress oxidative generated by the talc-induced pulmonary fibrosis. 2-Analyzing the behavior of antioxidant mechanisms induced by the stress. 3-To evaluate the balance oxidative stress / antioxidant mechanisms to provide an antioxidant (alfa-tocoferol to 200 Ul / day). The experimental design was established three groups of rats wistar females (control group, a group which is a pulmonary fibrosis caused by inhalation of talc and group similar to the previous one which was provided tocopherol). In all groups was detected in plasma, as in liver and lung, markers of oxidative stress (hidroperoxidos and substances which react with thiobarbituric acid), as well as determinations of you major antioxidant enzyme (superoxide dismutase, catalase, and glutathione peroxidase) and not enzyme (coenzaima Q9 and Q10, viatamina E retinol). Among the findings that were obtained are: 1 - The model of pulmonary fibrosis used in the study is valid, as evidenced by the results of the pathological anatomy, as well as markers of oxidative stress. 2 - There is a decrease in levels of oxidative stress in the group that sumplementó tocopherol compared to the other two groups.

Author: HIDALGO CARMONA M. ESTHER.
Year: 2005.
University: GRANADA [www.ugr.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE GRANADA.

Summary: INTRODUCTION During normal pregnancy occurring in the kidney a series of changes that will alter the structure and function of this. There are biochemical markers of great sensitivity to early detect this dysfunction and that are very useful in the early diagnosis of complicated forms of hypertensive disorders of pregnancy. But very little follow-up studies in normal pregnancy. One of those is the urinary markers of N-acetil-beta-glucosaminidasa (NAG). Enzyme lisosómico, loaded with the degradation of mucopolysaccharides and glycoproteins located primarily in the renal proximal tubule cells. ASSUMPTIONS AND OBJECTIVES The goals of our research are: * Investigate the urinary NAG activity during normal pregnancy at different times and in the same delivery. * To study the biochemical parameters of renal function such as serum urea, serum creatinine and urinary tract in pregnant women healthy. * Relate urinary NAG activity in the different study groups with biochemical parameters described above. MATERIALS AND METHODS Our study comprises a total of 157 women divided into two groups. * Control Panel healthy non-pregnant women: 64 cases. * Group of women with pregnancies nomoevolutivos: 93 cases, which were followed up during the week, 20, 30 of pregnancy and at delivery. To that end, systematic analytical determinations were performed both in venous blood and in 24-hour urine analysis serum creatinine, urea serum and urinary creatinine. The determination of the urinary NAG activity was conducted in 24-hour urine and according to the spectrophotometric method of Horak. RESULTS find a progressive elevation of urinary enzyme according pregnancy progresses, with peak levels at the time of delivery with statistically significant differences between groups of pregnant women (p less 0.05). In the first nine months of gestation activity urinary NAG behaved in healthy non-pregnant women. Being following the week of gestation 30 when the levels of NAG were fired (p less 0.05). There was a correlation of the activity urinary NAG with creatinia serum urea and serum during weeks 20 and 30 (p less 0.05). However, at the time of delivery did not obtain a correlation of enzyme activity with any of the studied parameters of renal function. CONCLUSIONS 1-During normal pregnancy occurring in the kidney a series of cambioss anatomical and functional that will alter the activity of some enzymes urinals. 2, Up-week 20 of gestation urinary excretion of N-acetil-beta-glucosaminidasa (NAG) behaves as in healthy non-pregnant women. 3-In the last trimester of gestation the urinary delNAG is aumetno gradually because the largest changes occurring in the tubular function conditioned by the incremtno volume cirulante. 4-At the time of birth is when is the peak of NAG and is not correlated with other parameters.

Author: RODRÍGUEZ MORATA ALEJANDRO.
Year: 2005.
University: GRANADA [www.ugr.es].
Place of defense: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE GRANADA.
Place of preparation: FACULTAD DE MEDICINA DE GRANADA.

Summary: In Angiology and Vascular Surgery using techniques Tissue Engineering grows especially in the sense of improving the permeability of vascular grafts, with the development of crops and cocultivos cell associated with endothelial cell lines fibroblásticas with anchors to parent protein fibronectin, for surfacing these grafts. Any line therapeutic use these cells must be based on criteria of cell viability solidly established. To work with endothelial cells and to ensure their optimal conditions for the future graft, it is essential to familiarize themselves with its nature structural, functional and pathophysiological, participation in endothelial tissue repair of vascular structures and participation in some programs Tissue Engineering which is based cell cultures. In order to improve the permeability of the grafts have been followed different lines of research. One is changing its inner surface impregnándola or covering it with substances: carbon, silicon, gelatin, albumin, collagen, which decreases in one way or another their trombogenicidad; another line has been set up grafts of biodegradable material that serves as scaffolding of neoíntima; otherwise is lined with cell grafts or crops, as mentioned above. The development of electron microscopy in the last third of S. XX and the joint implementation of the same detection systems and X-ray developed synchronously, which currently call Analytical Electron Microscopy, have revealed in a short time -segundos- and spot morphology and chemical composition of a particular biological sample by means of non-destructive techniques. Through it can be analyzed on a qualitative, quantitative or semi-quantitative amount of ions of the endothelial cells. The determination not indicators microanalíticos in endothelial cells of donors at different stages of cultivation for their subsequent therapeutic use is the overall objective of this basic Doctoral Thesis. To achieve this have also set the following specific objectives: 1-Set experimental model for evaluating the viability endothelial with analytical electron microscopy. 2-Establishing microscopic patterns of endothelial cells in primary culture and the three subsequent subcultures, optical microscopy and scanning electron microscopy. 3-Establish patterns microanalíticos of endothelial cells in the first three subcultures, analytical electron microscopy with energy dispersive X-ray 4-Establish indicators of endothelial cell viability in the first three subcutlivos for use in programs Tissue engineering. The endothelial cells were obtained from the umbilical vein of human umbilical cord (HUVEC). After drawing primocultivo and development come to the state of semiconfluencia, proceeded systematically to its recount, subculture in new falcoms (first subcultures), and also directly onto grids for microanalysis. In falcoms, then transported to the stage, again, semiconfluencia was also a second and a third time (second and third subcultures). In our results with microscopic M. Optics and Electronics Sweep, it is possible to demonstrate in the three subcultures that employers have a microscopic character ortotípico without developing signs preapoptóticos. In addition to a morphology ortotípica, each cell has a profile analyzed ion. The analysis highlights in the esp 8 ectros or fe2 btenidos, the presence of elements Na, Mg, P, S, Cl and K. The cells processed in accordance with the procedure described in chapter materials and methods, have a typical profile of intracellular balance, with high quality and quantity of P and K. The analysis microanalítico quantitative our three subcultures have found numerous differences in rank statistically significant between the average concentrations of the various elements along the three subcultures. In general, all elements analyzed steadily increasing with each subculture, except Na ion, which descends. In the case Cl not get significance in the data. CONCLUSIONS 1 - The methodology of collection, provision and cultivation of human endothelial cells used in this Doctoral Thesis, allows the evaluation of cell viability of these elements with microscopic approaches and microanalíticos, without generating artefactuales alterations. This methodology allows also the correlation of the two criteria in the evaluation process. 2 - The microscopic evaluation of the human endothelial cell Optical Microscopy and Scanning Electron Microscopy with secondary electrons and retrodispersos, it is effective to determine that in the first three subcultures, there is a pattern of microscopic endothelial character ortotípico, without any apparent sign one of nature preapoptótica or degenerative. 3 - The evaluation by Analytical Electron Microscopy Dispersiva energy X-ray of human endothelial cells, it is able to demonstrate with statistical significance, patterns microanalíticos profile ion in the three different subcultures studied, without any apparent sign of character preapoptótico or degenerative. 4-evaluation with quantitative by Analytical Electron Microscopy Dispersiva Energy X-ray of human endothelial cells, highlights the gradual increase in the K ion in the three subcultures studied, and their correlation with the gradual reduction of Na. The gradual increase of this relationship, K / NA, in the presence of a level of Cl maintained over the three subcultures studied, is an excellent indicator of cell viability, useful for ensuring the adequacy biological endothelial cells to implement therapeutic . 5-evaluation with quantitative by Analytical Electron Microscopy Dispersiva Energy X-ray shows that in the three subcultures studied, there was a progressive increase of P, Mg Their it relates to the gradual increase in the first three subcultures of the proliferative activity and biosintética of endothelial cells, which also their suitability biological evidence for the therapeutic application. 6 - The microscopic evaluation and microanalítica of human endothelial cells, helps determine cell viability of them and their suitability for biological therapeutics, using morphological criteria (Optical Microscopy and Scanning Electron Microscopy with secondary electrons and retrodispersos) and indicators microanalíticos (Dispersiva Energy X-Ray), linked to the levels of Na, K, Cl, P, S and Mg, which is generated without significant alterations artefactuales.

Author: DOMÍNGUEZ MUÑOA MARTA.
Year: 2005.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: U. COMPLUTENSE DE MADRID.

Summary: Women with severe left ventricular dysfunction have lower right ventricular impairment than men, despite present parameters heomodínamicos and values of systolic left ventricular function matched. This difference was observed regardless of the etiology of ventricular dysfunction, which suggests the possible existence of a factor related to the sex that protects the right ventricle of women in the presence of systolic left ventricular dysfunction. In routine clinical practice systolic pressure of the pulmonary artery through the study Doopler gradient trasntricusídeo not be estimated at half of the patients due to the absence of a jet tricuspid insufficiency analyzable. When done, the systolic pressure of the pulmonary artery often overestimates the actual pressure of the pulmonary artery, especially in patients with ventricular function preserved. Women with very advanced systolic heart failure have a better prognosis than men, especially in the case of patients in coronary disease significantly.

Author: CLIMENT PERIS LAURA.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: CAMPUS DE SAN JUAN.
Place of preparation: UNIVERSIDAD MIGUEL HERNNDEZ. CAMPUS SAN JUAN..

Summary: The IASP (International Association for the study of Pain) defines pain as an unpleasant sensory and emotional experience associated with an actual or potential tissue damage or described in terms of such damage. Data from the study Pain in Europe showed that the prevalence of chronic non-cancer pain in spain is 11% (vs. 19% EU average) despite the fact that the Spanish Society of Pain (SED) estimated between 25-40 %. Painkillers are the most prescribed NSAIDs (49% vs. Spain. 45% EU average) with paracetamol (8% vs. Spain. 18% EU average) against opioid children (13% vs. Spain. 24% EU average) and older (1% vs. Spain. 5% EU average). All this despite the fact that the WHO includes morphine as the drug of choice for the third level for the treatment of chronic pain and severe acute postoperative and traumatic. In view of the results suggest that there is a mishandling of pain with a limitation of prescription opioid, possibly by the problems traditionally associated with their ability to generate tolerance and dependence. In this sense the SECPAL (Spanish Society of Palliative Care) estimates that the percentage of patients who develops tolerance and dependence in chronic treatment with morphine is less than 1%. From this standpoint it is important to study neurochemical systems and possible chemical factors that contribute to the modulation of the analgesic activity of morphine and the development of tolerance. At present there are no conclusive studies to explain the relationship between the system serotonérgico and opioid. During the 80's accumulated sufficient certainty as to accept that the stimulation of the gray periacueductal (SPGA), kernel magno pontomedular or kernel magnocelular lattice adjacent (NMR) produced an analgesic effect mediated by opioid receptors and the release of serotonin (5-HT), noradrenaline (NA) and inhibitory amino acids at the dorsal horn of the spinal cord. Anatomical studies established that neurons serotonérgicas and not serotonérgicas projected NMR from the dorsal horn of the ME zone initial processing of the signal nociceptiva peripheral. The analgesia produced by systemic administration of opioid drugs, in addition to exercising analgesic effects at midfield and supramedular by stimulating the opioid receptors, and indirectly through other systems and neurotransmitters such as 5-HT, suggesting the involvement of mechanisms serotonérgicos mediated receptor 5-HT1 and 5-HT2. Because the data that are available are inconclusive, it seems very likely that the 5-HT may produce different effects in the modulation of the feeling nociceptiva depending on the type of receiver stimulated, its location, the place of application of the drugs evaluated and the test used to assess analgesia. To analyze the effect modulatorio of antagonists selective receptor serotonérgicos 5-HT2 on the analgesic effect and the development of tolerance to morphine, various meetings were designed experimental eleven days in Swiss mice type. The response of the opioid analgesic was assessed through the test of the hot plate. Analysis of the modulation of different medications to study on morphine analgesia and the development of tolerance was carried out after obtaining the cumulative effect dose curves. The first part looked at the effect of selective antagonists of the recipients serotonérgicos 5-HT2, ketanserin, on the analgesic effect of morphine and the development of tolerance. It ruled that the effect should be observed in the properties as ketanserin receptor antagonist a1-adenérgicos. In a second part explored the mechanism involved in changing the analgesic response and the development of tolerance induced antagonists sel 8 ectivos b22-receptor 5-HT2. It entailed the activity of kappa opioid receptor. This coadministró norbinaltorfimina in treated and untreated mice with ketanserin. It showed the effect of empowerment on a ketanserin receptor agonist kappa opioids, espiradolina. A third discussed potential bias interpretation of the results associated with the experimental conditions and / or pharmacological effects of the receptor antagonists serotonérgicos 5-HT2 not linked directly to this mechanism of action, and involved in the changes the response antinociceptiva. In analyzing the results it was observed that after the acute administration of a selective antagonist of the recipients serotonérgicos 5-HT2, ketanserin, in our experimental conditions of work, potentially the effect antinociceptivo morphine in mice not tolerant and tolerant. Such empowerment is mediated by the action receptor antagonist 5-HT2 of ketanserin, and is not explained by the component antagonist a1-adrenérgico this drug. The daily administration of ketanserin during the induction of tolerance is able to inhibit its appearance. This inhibition can be explained by the action blocking a1-adrenégica of ketanserin. A mechanism to explain the effect of empowering ketanserin on activity antinociceptiva morphine, it would be the facilitation of kappa opioid effect of morphine. The potent analgesic action of the kappa opioid receptors could be inhibited by a tone serotonérgico or activation serotonérgica under the study conditions. Also, it was observed that the experimental conditions of work modulate the analgesic effect and the development of tolerance to morphine. The acute administration of ethanol intraperitoneal or environmental exposure to it, the potential effect antinociceptivo of morphine in mice not tolerant and tolerant, and the observed effect is the same on both tracks. The intraperitoneal administration of ethanol daily during the induction of tolerance is able to inhibit its appearance.

Author: LOPEZ MONDEJAR PEDRO.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Although considered cancer differentiated thyroid pathology how a low aggressiveness, there are cases that are behaving in a different way and whose early identification undoubtedly bring benefits in registration. Moreover monitoring classic patient with differentiated thyroid cancer include conducting regular six-monthly or annually for a long time scans of tumor extension after hormone deprivation, leading to a decline in their quality of life by withdrawing hormonal treatment, and how a stimulus for the growth of thyroid remnants due to increased holdings of the endogenous TSH has recently been incorporated hormone tirotropa recombinant human (rhTSH) how a new technique in the follow-up of differentiated thyroid cancer. The presence of studies with this new diagnostic technique in the follow-up of patients with differentiated thyroid cancer considered disease-free is the subject of current study, staying in establishing an accurate diagnostic their profitability. Additionally, there are doubts about the usefulness of the GET as a primary diagnostic test for these patients. On the other hand, have been incorporated into the battery of diagnostic tests new tumor markers that can be helpful for the risk stratification of patients with differentiated thyroid cancer and its clinical evolution, although there are few studies that assess the profitability of the same . Therefore, the expression of various immunohistochemical markers should be correlated with different clinical behavior in the evolution of CDT, and the result coupled with new diagnostic techniques as rhTSH should allow for a different handling of the classic form of action in these patients. Our objectives were to quantify whether the presence of immunohistochemical markers galectina 3, citoqueratina 34bE12 and Ki67 are relevant to the clinical management of patients with differentiated thyroid cancer, as well as to quantify the diagnostic efficiency of the determination of plasma triglycerides post rhTSH in the patients with differentiated thyroid cancer considered disease-free how a screening test in the monitoring of them. The study design corresponds to a total population of 90 cancer patients with papillary and follicular thyroid where he studied the descriptive characteristics of this population. Then, the study was divided into two distinct parts. On the one hand, a retrospective study in which molecular markers were determined in 53 cases and studied the correlation between these various molecular markers and clinical variables. In the same way, we performed a prospective study of hospital setting in which they included 38 patients were applied where various diagnostic tests in patients with cancer papillary and follicular thyroid considered free of disease. Upon completion of the study, it was observed that the implementation of the determination of plasma triglycerides post rhTSH is very useful along with the realization of the cervical ultrasound in the monitoring of patients with differentiated thyroid cancer considered free of disease, for his high sensitivity, no notable side effects, lower cost direct and indirect connection to other evidence such as scan tumor extension and its positive impact on the quality of life of patients by preventing the withdrawal of hormonal treatment. Moreover, how to conduct a screening test in the follow-up of patients with differentiated thyroid cancer considered free of disease extension tumor scintigraphy provides no more information than the use of plasma triglycerides post rhTSH and conducting an ultrasound cervical, but if major direct and indirect economic costs as well as a negative impact on the quality of life of patients to specify the re 8 circulation d 3c7 hormone treatments. Secondly, the galectina 3 is shown as a useful marker in predicting the behavior of patients with papillary thyroid cancer. Rather, the anchor citoqueratina 34bE12 and Ki67 not provide relevant information for the clinical management of patients with differentiated thyroid cancer.

Author: Vazquez Mahia Ines.
Year: 2005.
University: A CORUÑA [www.udc.es].
Place of defense: Facultad de Ciencias de la Salud.
Place of preparation: Facultad de Ciencias de la Salud.

Summary: The squamous cell carcinoma is the most common malignant tumor, making the 95% of malignant tumors of the oral cavity. There are multiple factors studied forecasts of whom the stadium is the largest clinical interest. Overall survival at 5 years of oral cancer ranges between 40% and 50%, and involve a significant morbidity and mortality. The objective of this work is to determine the likelihood of recurrence and their determinants. We analyze our clinical experience in the squamous cell carcinoma of the oral cavity and oropharynx, in the Department of Surgery Maxilofacila of Juan Canalejo Hospital de la Coruña, between January 1998 and December 2003. The recorded data included medical history and medical history, clinical features of the tumor locally and regionally, TNM stage, treatment and developments, including recurrence and survival of patients. The data were collected using the statistical package SPSS.12. We conducted a follow-up study involving prospective and retrospective, performing a descriptive analysis. Comparing average was conducted with student's t test or Mann-Whitney as appropriate after comparison with normal test Kolgomorow-Smirnof. It was estimated survival and the probability of relapse with the Kaplan-Meier method. To adjust for various covariates and determine the likelihood of recurrence was analyzed by multivariate Cox regression. We studied a sample of 118 patients who met the inclusion criteria. During a follow-up period of 60 months, a 52.36% had tumor recurrence and overall survival rate was 60% with the regression analysis COx, the variables independently influence relapse, comorbidity, tumor stage together, the pattern macroscópcio and the degree of tumor differentiation. With these data it is concluded that the probability of recurrence after surgical treatment of squamous cell carcinoma of the oral cavity is 47.64% at 5 years. A 84.9% of patients Relapse do the first two years, the average time of filing of 9.9 months. Comorbidity, the stadium's overall tumor, the macroscopic pattern and the degree of differentiation has been the independent prognostic factors capable, in terms of recurrence for patients in the series studied. The elderly seem to be a protective factor with regard to the recurrence of oral squamous cell carcinoma, but not independently predicts. In our series scaly carcinomas of the oral cavity are usually more advanced stages.

Author: SIMANCAS PEREIRA YANET CLARET.
Year: 2005.
University: GRANADA [www.ugr.es].
Place of defense: FACULTAD DE ODONTOLOGIA.
Place of preparation: FACULTAD DE ODONTOLOGIA.

Summary: This paper conducted a pilot study to evaluate in vitro in several dental sealants: the influence of humectabilidad the influence of the type of preparation of a tooth in sealable, the influence of aging. We also valued the morphology of the union and the sealing of various materials shutter. In a sample of 260 teeth were studied with the parameters above confocal microscopy, stereo-microscope and scanning electronic microscope. There was a correlation directly proportional relationship between humectabilidad and ability to penetrate. The use of engraving, and adhesive resin fluid along with ameloplastia increases the pervasiveness of sealer. Aging affects the ability of sealing sealers. In the samples which were not performed ameloplastia was observed incomplete penetracion material.

Author: PEREZ DE ISLA LEOPOLDO.
Year: 2005.
University: COMPLUTENSE DE MADRID [www.ucm.es].

Summary: The current non-invasive methods for valuing rheumatic mitral stenosis presented a number of limitations. Recently, the three-dimensional echocardiography has expanded the diagnostic possibilities. Their usefulness in assessing the mitral stenosis is not yet well established. ASSUMPTIONS The real-time three-dimensional echocardiography is a non-invasive technique, more accurate than at present, for the valuation of the area valve in patients with mitral valve stenosis. MATERIALS AND METHODS All patients were subjected to a study Eco-Doppler two-dimensional and three-dimensional. Patients who were undergoing percutaneous mitral valvuloplasty were subjected to two studies, the first not later than 24 hours prior to valvuloplasty and the second within the next 24 hours wing valvuloplasty. It was determined the score Wilkins using two-dimensional echocardiography and echocardiography 3DTR. RESULTS were included in the study for evaluation of mitral valve area, a total of 80 patients with mitral stenosis. The comparison of different methods showed that the mitral valve area determined by the method of Gorilin has better correlation with the one obtained by planimetry 3DTR which are determined by other noninvasively. The valuation of the "score" valvular through real-time three-dimensional echocardiography showed a better agreement that interobservador determined by two-dimensional echocardiography. The percutaneous mitral valvuloplasty was performed in 29 patients. In this group the AVM invasively obtained using the method of Gorlin had a better agreement with the results of the mapping 3DTR that with the results of the THP or planimetry 2D. After valvuloplasty, the best accuracy of the mapping 3DTR remained. CONCLUSIONS echocardiography 3DTR is a useful tool, accurate and highly reproducible area to estimate the mitral valve in patients with rheumatic mitral stenosis. It is the technique that provides a better agreement with the calculation of the same invasive. Also has the best grade in accordance with the determination of invasive mitral valve area in the period pre valvuloplsatia mitral percutaneous, and especially in the period after valvuloplasty. On the other hand, ecocardiografía3DTR improves the agreement between and intraboservador to assess the score Wilkins.

Author: LACRUZ DE DIEGO M. ELENA.
Year: 2005.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA, UCM.

Summary: The objective of this work is to study the relationship between declarative memory, temporal lobe and other cortical areas, through analysis of the memory deficits resulting from the removal perramente (cirugía9 or temporary (electrical stimulation) on the role of the temporal lobe, and connections fronto-temporales in patients with drug-resistant epilepsy. The study of changes in memory function, in connection with a higher (temporal lobectomy) or lower (amigdalohipocampectomía) Temporal lobe resection, we found that both operations have a similar effect on memory function. Considering scores on the test Wada preoperativo found that the patients who underwent resection having failed the biggest test Wada showed higher díficits visual memory than those who passed the test Wada (Z = -2,068, p less 0.05). addition, the Wada test is a good predictor prequirúrgico in those patients undergoing temporal lobectomy (rho = 0765, p less 0.01). Analyzing the replies evoked by electrical stimulation pulses with unique showed that the temporal lobe has a high rate of internal connection (between 67 and 95%) and a lower rate of external connection (between 0 and 25%), suggesting the existence of circuit reverberantes who may be involved in memory function. frontal lobe also has a high rate of internal connection (between 43 and 88%) and a lower rate of external connection (between 12 and 40%). stimulation medial temporal unilateral pulse only during the execution of a task recognition had no effect on the implementation of the same (p greater 0.05). however, the subjects committed more errors during the bilateral stimulation (Z = -2,207, p less 0.05 ). These results provide direct evidence that the medial temporal structures are involved in the declarative memory function in humans. suggest that it is necessary inactivation of both medial temporal to produce a deficit of memory, and that would be sufficient to maintain a single hemisphere an acceptable.

Author: PÉREZ FERNÁNDEZ PEDRO.
Year: 2005.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE COMUNICACIÓN Y DOCUMENTACIÓN.
Place of preparation: FACULTAD DE MEDICINA - UNIVERSIDAD DE MURCIA.

Summary: OBJECTIVES 1-To determine the level of quality cientificotécnica of care provided to subjects with hypertension. 2-drug interactions describe in subjects receiving antihypertensive therapy: magnitude, involving drugs and severity of the potential impact. 3-To determine the degree of acceptability of health care (adhesion and pharmacological level of satisfaction) by the subjects in antihypertensive therapy. 4-To determine the degree of effectiveness of care provided in hypertension (normalization of blood pressure numbers). 5-Analyze the relationship between the quality of health care provided to the subject hypertensive and outcomes of care (normalization of blood pressure numbers, level of satisfaction and therapeutic adherence). 6-Analyze the relationship between the level of satisfaction and therapeutic adherence. DESIGN retrospective descriptive study cohort. SCOPE OF THE STUDY Six Health Center of Basic Areas I and VI of the Primary Care Management of Murcia. INSTRUMENTALIZACIÓN was selected a sample consisting of all hypertensive patients cared for antihypertensive treatment in incidents in each of the centers for a period of 3 months. We used two sources of information: a questionnaire designed former professed from a qualitative study of focus groups, and which was referred to home users, and the stories of clinic patients from computerized system OMI-AP. Data obtained from the questionnaire were: 1, - Information about health care received (council higienicodietético and information on hypertension provided by the doctor, prescribed antihypertensive treatment and information about the side effects of medication, and style of the clinical interview) . 2-User satisfaction with the care received, and the adhesion of the same pharmacological treatment prescribed by the primary care physician. In clinical data were collected to evaluate the technical quality of care provided on the basis of explicit criteria and regulatory both the diagnosis and the monitoring of hypertensive subject, and the latest figure of blood pressure. STATISTICAL SURVEY distribution of frequencies with confidence interval 95%. Bivariate analysis method with chi-square for dichotomous variables nominal and residue analysis for the rest. Multivariate analysis to estimate the strength of association. This method uses the "Enter" and the "step forward". RESULTS Of the 410 subjects included in the study who were sent postalmente the questionnaire, the final number of cases was 264, with 59% of boys. CONCLUSIONS 1 - The quality of care in the management of hypertension in primary care presents a space for improvement. 2-One out of every two users is likely to present any interaction. 3-drugs more involved in the interactions are ACE inhibitors and diuretics. 4 - The valuation of the fund's eye, the calculation of cardiovascular risk and regular physical examination are the least being carried out in medical practice. 5-Most of the subjects are satisfied with the care they have received in the context of hypertension. 6 - The requirements relating to the quality of clinical interview, have a better level of compliance with the requirements of a technical nature. 7 - The quality cientificotécnica varies depending on the characteristics of the user hypertensive. 8-Greater expertise in a positive influence on user satisfaction. 9 - The middle-aged subjects are those who are less satisfied. 10 - The quality of the interview is also associate clinical c 8 on a m 58f ayor user satisfaction. 11 - The pharmacological grip on the use of antihypertensive drugs in the sample study is higher than that referred to by studies conducted in other communities. 12 - When the process of care meets the requirements of technical quality adherence drug is better and more likely to be normalized figures blood pressure. 13 - Better adherence pharmacological relates so directly to the normalization of tensionales figures. 14 - The suffering from diabetes concomitant decreases the likelihood that the figures are normalized blood pressure. 1 5 - There is a causal link between the process of care and outcomes of primary care.

Author: MOYA SANZ MARIA AMPARO.
Year: 2005.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: This thesis examines the waiting list outpatient in specialized care in a hospital district from the point of view of the general theory of systems, through the implementation of a simulation model and involving a pilot study for the analysis of demand and the quality of information in formats referral of patients between levels of care, all within a generic modeling process in seven stages. The significance of this study lies in mortality and morbidity resulting from the waiting list and the ability to manage resources after obtaining a policy applicable to the real system and after having experimented with a number of simulated action policies. Using the methodology of the systems theory, an analysis was made of the system to study to benchmark it, study its flow and variable input and output, detect symptoms of the system and classify problems optimal decision. In the analysis phase included a pilot study of the demand from primary care to specialized care, their flow, their characteristics, their systems prioritization and length of service necessary to go out of the system demand. We built a simulation model ad hoc environment for the creation and succession of pseudo numbers and forwarded to a subsequent validation by the statistical study of the probability density curves. After this, they analyzed the behavior of the system by applying different policies for action. The results of the statistical analysis of the simulation showed that the model was superponible to reality. Moreover, the survey results showed demand resulting poor quality of information that is derived patients to another level of care as well as a lack of correlation in the prioritization of derivation and a percentage of bad derivation. The results of the experimental model in the system identified a policy optimum resource management to assume demand in outpatient and reduced its expected average. With this model could predict the behavior of the system for the gradual increase in demand in the years ahead. The implementation of the outcomes in the real system led to the introduction of a program of direct summons interniveles and management of the weekly outpatient pair detect changes in demand and allocate resources.

Author: FLOREZ RIAL MARÍA DEL PINO.
Year: 2005.
University: MÁLAGA [www.uma.es].
Place of defense: FACULTAD DE MEDICINA DE MÁLAGA.
Place of preparation: FACULTAD DE MEDICINA DE MÁLAGA.

Summary: The BCL2 and C-KIT are genes involved in carcinogenesis colo-rectal and its expression has been associated with prognosis in different types of tumors, observandose in general expression of BCL2 associated with a good prognosis and the C-kit to poor prognosis, or the lack of correlation with prognosis. A study of immunohistochemical proteins BCL2 and C-KIT in a series retrospective of 230 carcinomas colo-rectas. The prognosis of the study was to evaluate the immunohistochemical expression of proteins BCL2 and C-KIT and its correlation with histopathologic parameters with prognostic significance as pathological stage of the disease (system Astler and Coller) and the histologic grade. Patients were between 30 and 94 years of age. 130 were men and 100 women. Tumor sizes ranged from 1 to 12 cm. 90 cases were well differentiated, 135 showed a moderate differentiation, and the rest, 5 cases a little differentiation. Of the 230 cases, 217 were common type, 12 cases of type mucinosos and 1 case adenoescamosso. The 5.2% of the cases were stage A, 20.8% B1, 38 "% B2, 0.8 C1, 32.6% C2 and 2.2% D. The expression of BCL and C-KIT was detected respectively at 27.2% and 36.5%. Statistical analysis was performed using logistic regression analysis and test extract Fisher. The bottom line is that in our series the expression of BCL2 and C-KIT not correlate with histopathological parameters with prognostic significance as with the stadium pathological nor with the histological grade in colorectal cancer ..

Author: DORTA ESPIÑEIRA MARIA MERCEDES.
Year: 2005.
University: LA LAGUNA [www.ull.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: There will always be a retrospective longitudinal study descriptive with 980 patients diagnosed with colorectal cancer (CRC) for the years 1985-2002, following the service of general surgery and digestive university hospital in the Canary Islands, which caters to the population of the area north of Tenerife and the island of La Palma. The main objectives were: to calculate the years lost overall for the whole of the population which is the study sample and for each individual in particular, to analyze the factors related perfectly with the number of years of life lost (YLL) in patients with RAC, referring to the population of deceased as to the total population and describe the independent prognostic factors related to the amount of AVP in patients with colorectal cancer. In the methodology we emphasize statistical analysis of the data, making first a descriptive analysis, then a bivariate analysis compared the general population and the deaths of CRC and finally a multivariate analysis linking the variables that were statistically significantly related with the AVP in the bivariate analysis, among themselves, and identifying which behaved as independent prognostic factors of loss of AVP in patients with CRC. The conclusions are: 1-In our environment, the patient bearer of CRC, tend to be a man or woman with an average age of between 64.4 and 66.2 years. The most common presenting symptom is the rectorragís, singuiéndole lesser proportion abdominal pain and changes in bowel habits. More than half of patients are diagnosed before the 3 months. 2-In connection with treatment, about the 3 / 4 parts are practiced surgery with curative intent, and one tenth of them were involved as a matter of urgency. The overall operative mortality was 1.7%. The anatomic location is the most frequent colon rectosigmoideo, whereas in the rectal location is most often locate in the rectum infraperitoneal. At the time of diagnosis, all globally, half of the patients were treated with adjuvant therapy. 3 - The median survival of patients is 103 months with a median of 71.79 months. The probability of being alive to 3 years is 65% and 52% at 5 years. 4-Regarding the AVP, overall, patients who die by CCR in our midst lose an average between 14 and 16 years of life. 5 - The factors were directly related to the number of years of life lost in patients with RCC are in the negative, that is, increase the amount of AVP, age, sex, the syndrome constitutional changes in the habit bowel location rectal surgery urgent, palliative surgery, amputation abdominoperineal, operating Hartamann, resection of bodies invaded, stay and postoperative more advanced stages. In a positive sense, ie, decreases the amount of AVP: rectorragia, curative surgery, the right colectomy, colectomy left anterior resection. 6, - were independent prognostic factors for RCC AVP age, condition and location rectum.

Author: CALLEJO MELGOSA ANA MARÍA.
Year: 2005.
University: VALLADOLID [www.uva.es].
Place of defense: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE VALLADOLID "AULA DE GRADOS REINA SOFÍA".
Place of preparation: HOSPITAL UNIVERSITARIO RÍO HORTEGA DE VALLADOLID.

Summary: In recent years have published several epidemiological studies in which reference is made to an increase in the growing prevalence of allergy. In terms of grass pollen allergy, seems to be involved environmental pollution. In this dissertation comparing alargenicidad for grass pollen Lolium perenne, collected in rural and urban areas of the province of Valladolid. We demonstrated through studies "in vivo" and "in vitro", which the allergenicity of the same kind of pollen can vary in rural and urban areas, and that the symptoms presented by patients with allergies, not only depends on the degree of atopy and the immune response from the receiver. In addition, our results support the hypothesis that pollen allergens, in addition to being powered by environmental contaminants, may themselves trigger exacerbations of allergic respiratory diseases, due to changes in its allergenicity.

Author: PIZARRO DÍAZ VLADIMIR.
Year: 2005.
University: POMPEU FABRA [www.upf.edu].
Place of defense: DEPARTAMENTO DE CIENCIAS EXPERIMENTALES Y DE LA SALUD.
Place of preparation: DEPARTAMENTO DE CIENICAS EXPERIMENTALES Y DE LA SALUD.

Summary: BACKGROUND oral health problems can result from a wide range of factors including the cumulative exposure to sugars, the bacterial plaque, smoking, certain medications, malnutrition, poor general health or psycho-social problems, being the most common oral diseases caries and periodontal disease. Although these diseases are generally not life-threatening or do not pose a serious injury parala most people, it is very common chronic conditions, which affect different degrees to the entire population at some point in their lives. Currently, one of the main objectives for the various Health Systems is the reduction of inequalities in health. However, even these inequalities are especially notable in those services not fully covered by the National Health System (NHS) Spanish, as dentistry. Objectives To assess the socio-economic inequalities in the state of oral health and the use of dental services to the people of Catalonia. FIRST STUDY METHODS Between the years 1993 and 1994, we performed a cross-sectional study of a cohort of elders, formed in 1986, with a representative sample of individuals from the city of Barcelona 65 years or older (n = 1,315). The oral exam was performed in 561 people, representing 62.9% of the 891 survivors in 1993, and was carried out according to the index CAO. Further information was collected demographic and utilization of dental services. We bivariate and multivariate analysis to assess the association of socioeconomic and demographic variables with the level of desdentamiento (multinomial regression) and the index CAO (log-lineales Poisson models). SECOND STUDY were analyzed data from the Survey of Health of Catalonia (ESCA), which is a cross-sectional study to be conducted on a regular basis on a representative sample of the non-institutionalized population Catalan. The first ESCA was conducted in the year 1994 (n = 15,000) and the second in 2002 (n = 8,400). The survey, administered in the homes, including information on use of health services, as well as socio-demographic variables. All analysis was performed separately for individuals 17 and under age ( "youth"), and those who were 18 years or older ( "adult"). We bivariate analysis and logistic regression models to estimate the association of variables predisposing, enabling, and need the use of dental health services. RESULTS The non-institutionalized elderly of 72 years or older, residents of the city of Barcelona, show a high accumulation of dental problems, including a high proportion of desdentamiento Total (41.7%). Among individuals jagged, the low number of teeth remnants (14.9 average), along with a small number of teeth with fillings (1.2 average) and needs untreated (2.2 teeth careados needing fillings) indicate that the extractions have been the main form of treatment for this group. The index CAO in jagged individuals (mean = 16.4) showed a significant association with social class (p = 0001) after adjusting for age, gender, health coverage and use of dental services. The use of services was low in both individuals jagged as in desdentados, 20% and 7.7%, respectively, had visited a dentist during the six months preceding the interview. In Catalonia, only 37.3% of young people and 29.5% of adults had used dental health services during the year preceding the year 2002. However, it should be noted that this meant an increase i 8 mportant abf and in the use of dental services in Catalonia between the year 1994 and 2002, that passage of 26.7% to 34.3% in the whole population. The factors that had a statistically significant association with the non-use of dental services in the multivariate analysis were being male (adjusted OR 1.2), belong to the most disadvantaged social classes (adjusted OR of 1.6 for youth and 1 , 2 for adults), and possess a low level of education (adjusted OR 1.7). Considering the trend of inequalities between 1994 and 2002, this inequality to the above factors remained stable between the two periods. However, inequalities observed depending on the type of health coverage and the group of elders declined between the two periods. CONCLUSIONS The existence of socio-economic inequalities in health status dentral of non-institutionalized elderly in the city of Barcelona, coupled with the low use of dental services, indicate a problem of access to such services. Such findings are especially relevant to countries like Spain, but have a national health system for the entire population, have a limited coverage for adult dental treatment, which only includes dental extractions. While during the decade of the 90's has seen an increase in the rate of utilization of dental health services in Catalonia, this indicator is still low compared to other countries in Europe. On the other hand, despite the fact that there have been reductions in inequality in the use of dental health services according to certain characteristics assessed as the type and the group health coverage for the elderly, desigualadas in using persist for the most disadvantaged social classes and for people with little education. Therefore, future studies are needed to help publicize the future developments in this trend.