MEDICAL SCIENCE (12)

Author: MURIACH SAURÍ MARIA.
Year: 2005.
University: CARDENAL HERRERA CEU [More theses of this university] [www.uch.ceu.es].
Place of defense: SALÓN DE GRADOS DE LA BIBLIOTECA DE LA UNIVERSIDAD CARDENAL HERRERA-CEU.
Place of preparation: UNIVERSIDAD CARDENAL HERRERA-CEU.

Author: PUERTAS CUESTA FRANCISCO JAVIER.
Year: 2005.
University: CARDENAL HERRERA CEU [More theses of this university] [www.uch.ceu.es].
Place of defense: SALÓN DE GRADOS, BIBLIOTECA UNIVERSIDAD CARDENAL HERRERA - CEU.
Place of preparation: FACULTAD DE CIENCIAS EXPERIMENTALES Y DE LA SALUD.

Summary: The active oxygen species, which are part of cellular metabolism, are capable of reacting with a lot of biomolecules altering its structure and properties, and producing an oxidative damage. During normal cell is equipped with defensive measures, known as antioxidants, they can be either type enzyme, and neither enzyme (eg, vitamins C and E). It called oxidative stress to the imbalance between the factors and antioxidants prooxidantes the cell in favor of the former. Oxidative stress is involved in many pathophysiological mechanisms such as inflammation, aging, etc.. Likewise, we can study the oxidative stress by the presence of products of lipid peroxidation, as malondialdehído and alkenales, which can serve as markers of this process. In this paper explores the role of oxidative stress and antioxidants in inflammatory and degenerative eye diseases, through various clinical and experimental models, such as cataracts and macular degeneration associated with age (AMD) in humans, uveitis and endotoxin induced in rats and rabbits. This can be useful for a better understanding of this phenomenon, in these and other diseases, and to design new treatment approaches. The results of the work show the deterioration of antioxidant enzyme systems and the increase in products of lipid peroxidation, especially those associated with glutathione system in cataract and AMD, as well as a negative correlation with the levels of vitamin E in this last case. In addition, the model of uveitis pilot induced by endotoxin, shows the beneficial effect of a synthetic antioxidant as ebselén and an inhibitor of nitric oxide synthesis as L-NAME. It also demonstrates the importance of glutathione system in the human retina of healthy donors, and describes for the first time the presence of the activity of glutathione transferase isoenzyme face 4-hidroxi-nonenal in the human retina.

Author: SOLAVERA SÁNCHEZ JAVIER.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION Currently it is widely accepted that the treatment of choice is tense ascites evacuadora paracentesis. Several controlled studies have shown that evacuadora paracentesis is a safe technique, in combination with few complications. Within these must be emphasized, because of its relevance, electrolyte disturbances, mainly hyponatremia, and renal function, along with a newly described disorder, called circulatory dysfunction induced paracentesis (DCIP). The DCIP is an asymptomatic disorder characterized by elevated levels of substances vasoconstrictive after paracentesis and a decline in SVR unchanged total plasma volume, which may occur in up to 80% of cases. Although DCIP is a disorder asymptomatic, their clinical relevance is that it has been observed that their appearance is related to a decrease in the survival of patients. The pro paracentesis-induced alterations can be prevented by using plasma expanders. Albumin has been shown to be effective in preventing these disorders. However, the use of these substances has some drawbacks as its high economic cost and the theoretical viral transmission. SCENARIOS FOR WORK The normal saline, it could be a chemical alternative to albumin in the prevention of complications related to paracentesis. In a small uncontrolled study the physiological serum was able to prevent the activation of the system renina-angotensina-aldosterona. TARGET * To compare the incidence of DCIP in cirrhotic patients with ascites tense undergoing paracentesis evacuadora total albumin infusion versus normal saline. PATIENTS AND METHODS Study prospective, randomized. Patients who met the inclusion criteria were distributed randomly into two treatment groups: Group I: paracentesis evacuadora total followed by replacement of normal saline. GROUP II: Paracentesis evacuadora total followed by replacement of albumin. For inclusion in the study were considered cirrhotic patients with ascites tense, those who went to hospitals via emergency, outpatient and Digestive Medicine Unit Hospitalization Day. The day of the paracenteses patients remained fasting, were weighed and proceeded to control constants (heart rate, blood pressure and temperature). Subsequently, the patient remained in the supine position for 1 hour before extracting blood baseline, which was conducted through a vein characterized income, after discarding 10 mL of blood. Blood extraction was performed for the following determinations baseline: sodium, potassium, urea, creatinine, total and direct bilirubin, AST, ALT, FA, GGT, albumin, prothrombin time, hemoglobin, hematocrit, platelet, ARP, AP and nitrites / nitrates. It was also collected a urine sample at 8 o'clock in the morning to determine ionograma urinary urea and creatinine. He then took out the distribution randomized into two groups, as described later. Group I was treated with total paracentesis evacuadora followed by expansion plasma with normal saline (serum Fisiológico, Braun Medical, Barcelona, Spain, isotonic sodium chloride solution at 3.5% concentration of sodium 154 mEq / L), infundiéndose through intravenous 170 mL per liter of ascites evacuated the infusion of both substances was made at 3 hours onset of paracentesis, infudiéndose total volume in full at a steady rate through a continuous infusion pump volumetric (Lifecare, Abbot, NY, USA) (16 mL / minute in the case of normal saline and 4 mL / minute in the case of albumin). This was followed by paracentesis evacuadora according to proced 8 imiento 52f usual: under sterile conditions, was introduced needle Kuss amended. RESULTS were included in the study 72 patients. After the process of randomization, 35 received normal saline after paracentesis evacuadora Total (Group I), and 37 received albumin (Group II). No significant differences were observed between the two groups in terms of demographics and clinical Child-Pugh classification, systemic hemodynamic parameters, biochemical liver and kidney as well as in the ARP, AP and metabolites of nitric oxide. No differences were observed between the two groups in terms of the volume of ascitic fluid evacuated to the average length of paracentesis. The economic cost for paracentesis (solely to the cost of plasma volume expander employee) was significantly higher in the group receiving albumin compared to the group that received normal saline.

Author: SOGORB GARRI FRANCISCO.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: This paper carries out a comprehensive study of a series of 127 patients diagnosed with hypertrophic cardiomyopathy. Additionally studied 178 first-degree relatives. It confirms the broad spectrum of expression of this disease. So while we have identified completely asymptomatic subjects, most of the players show any symptoms, and even death in the medium term has been remarkable. Moreover, the risk profile, which leads to raise the need for a prophylactic treatment befitting their status. Finally, the diagnostic criteria accepted appear to be inadequate to identify the presence of disease in first-degree relatives.

Author: Valverde Moreno Antonio Javier.
Year: 2005.
University: GRANADA [More theses of this university] [www.ugr.es].
Place of defense: Facultad de Medicina de Granada.
Place of preparation: Facultad de Medicina de Granada.

Summary: MacDonald (1974), defined the term bite (bitemark) and the footprints left by any of the teeth in isolation or in combination with other parts of the mouth. From the medical point of view of law, a more comprehensive definition would be one that considers bites as a figurative marks or scars left by the teeth of humans or animals, on a substrate that can be skin of subjects alive or dead, or inanimate objects relatively soft. The importance we place on a track by bite is because they are injuries that can be found frequently in cases of homicide, sexual assault, assault in general, domestic abuse and, in cases of physical and sexual abuse of minors, ie we are facing a common injury that always arises in the field of criminal jurisdiction. The purpose of the forensic study of these injuries is the ability to identify the perpetrator. The current procedures for the identification of the aggressor cover complementary aspects of the analysis of the footprints by bites: * The morphological: study of shapes, patterns and relationships of the mark. * The bioquímico-molecular: study of the genetic fingerprint of the assailant. The morphological analysis of the footprints by bites is based on the impressions left by the teeth on human skin possess characteristics individualizadoras that can be used for identification of the subject that caused the wound. Indeed, it is widely accepted that human dentition is unique to each individual. Therefore, dentists / as forensic trying to identify the cause of a bite taking into account the characteristics individualizadoras present in the teeth of the suspect. This Doctoral Thesis, aims to improve procedures morphological analysis and comparison of the marks left by the injury bite and teeth or suspects. To which has designed a special computer program to treat digitized images of dental models in three dimensions.

Author: PÉREZ GARCÍA MARÍA JOSÉ.
Year: 2005.
University: LLEIDA [More theses of this university] [www.udl.es].
Place of defense: FACULTAT DE MEDICINA.
Place of preparation: UNIVERSITAT DE LLEIDA.

Summary: The neurons both in vivo and in vitro, neurotrophic factors require for their survival and differentiation. Specifically, the motoneuronas (MNs) respond to various neurotrophic factors, which include the family of ligands of GDNF and the family of neurotrofinas. You are not only surviving cells in the presence of these factors, but that the neuronal activity and therefore the devaluation of membrane also promotes their survival, increasing levels of intracellular calcium and activating different signaling pathways. This paper explores the role of calcium and calmodulina (CaM) in regulating the path of survival Pl3K/PKB, in a model of MNs embryonic chicken treated with GDNF. The results showed that GDNF promotes moderate increases in the concentration of intracellular calcium which may result in the activation of CaM. The mechanism by which CaM exerts this effect is poorly marked. Both the Pl3K as the PKB, protein acting below in the way of signaling the Pl3K are important mediating survival by neurotrophic factors. Indeed, it has been shown that GDNF promotes neuronal survival through activation of this pathway. Experiments show inmunoprecipitación in vitro interaction between the regulatory subunit of the Pl3K and CaM. This interaction is independent of neurotrophic factor, but is blocked by treatment with calcium chelating as EGTA. From these results we conclude that changes in the intracellular calcium concentration, induced by GDNF, promotes neuronal survival through a mechanism that involves direct regulation of the Pl3K by CaM. As a second objective of this study, we analyzed the role of the kinase regulated by calcium / CaM, the CaMKIV in neuronal survival. Following the cloning and characterization of the CaMKIV of Gallus gallus (gCaMKIV), we show that constitutively active form is capable of fosforilar to PKB, which translates into improved survival of MNs in the absence of neurotrophic factors. By contrast, blocking the endogenous expression of gCaMKIV using RNA interference reduces the percentage of survival mediated GDNF and the membrane depolarization. Inmunoprecipitación experiments have demonstrated in vitro interactions between subunit regulator p85 of the Pl3K and CaMKIV. In conclusion, described for the first time as GDNF induced increases in the concentration of intracellular calcium, activating CaM, which is to drive the Pl3K. In addition, CaMKIV can bind to CaM and boards regulating the path of Pl3K/PKB promote survival. These results provide some of the key molecular regulating the survival of these neurons, and may well apply this knowledge to the understanding and potential therapeutic strategies related diseases where there is a degeneration of the MNs.

Author: ARRIBI VILELA ANA.
Year: 2005.
University: COMPLUTENSE DE MADRID [More theses of this university] [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.

Summary: This thesis seeks to demonstrate two hypotheses: 1-sepsis by Malassezia sp. Is more common in neonatal population subjected to lipid parenteral nutrition (NPL) through a central vascular catheter in neonatal population is not subject to the NPL. 2 - The incidence of skin colonization by Malassezia sp. Is higher in infants admitted that in healthy infants. To that end, we performed a prospective study between October 1998 and June 2000, which compared a group of infants under the NPL with a control group of similar characteristics, but not subject to the NPL. Simultaneously, we studied the skin colonization in 350 neonates: 100 healthy, 150 admitted to a care unit means and 100 admitted to an intensive care unit. Blood cultures were subcultivaron amid extracted from Dixon. Colonization skin was studied using plates means of contact with Dixon, applied to the skin medioesternal and interescapular, in the first 24-72 hours of life and was repeated each week in the children admitted. The overall incidence of colonization was 20% and 78.6% were colonized in the first week of life. The newborn intensive care are the most colonize, do so earlier and greater number of species that healthy infants and placed in care facilities. Species that healthy infants and placed in care facilities. The species involved are more often M.furfur and M.sympodialis. Factors associated independently to an increased risk for colonization are low gestational age, prolonged hospital stay, the continued use of a central vascular catheter and continuous employment of broad spectrum antibiotics. The incidence of fungemia is low, but there is a clear component of horizontal transmission through the hands of medical personnel.

Author: MUÑOZ DOMINGUEZ PEDRO.
Year: 2005.
University: PAÍS VASCO [More theses of this university] [www.ehu.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The origin of this study is based on a concern. Concern that emerged a few years ago when considering that the valuation hitherto made in the quality of life of patients with eating disorders through questionnaires generic insufficient, we launched a hard work to be looking delo he first questionnaire specific quality of life for these patients. Three years after the work paid off and we got this questionnaire. In its application in a sample of 355 patients, has been valued the quality of life of these patients from diverse perspectives and using various measuring instruments: CDVRSTCA (Quality of Life Questionnaire-related health for patients with eating disorders) , EAT-26, SF-12, EDI, and a piece of clinical data collection for psychiatrists. These assessments were performed at baseline and one year after the end of the tunnel. The factorial analysis of the results in both times determines the content of our study.

Author: ESMERADO APPIANI CATALINA.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: FACULTAD DE MEDICINA UAB.
Place of preparation: FACULTAD DE MEDICINA UAB.

Summary: The metastasis, the spread and growth of tumor cells in distant organs, represent the most dangerous and devastating in melanoma úvea. Despite advances in diagnosis, surgical techniques and adjunctive therapies, the emergence of metastases remains the leading cause of death in patients with melanoma úvea. Up to 50% of patients will die in the 10 years of initial diagnosis due to the calving metastasis, mainly in the liver. Over the past decades we have identified several parameters forecasts metastatic, clinical and histopathological. Currently, the main research focuses on the analysis of genetic and molecular alterations that may be linked to the development of metastases in melanoma úvea and to establish at an early stage the genotipos-fenotipos more aggressive and developing new therapeutic alternatives. The chemokines are a group of low molecular weight molecules with properties quimioatrayentes involved in a large number of physiological and pathological processes. It has been seen that in a large number of neoplasisas there is a network of chemokines and their receptors whose production, expression and signaling is altered. The quimiocina CXCL12, also called stromal-derived factor-1 (SDF-1) and its transmembrane receptor CXCR4 are one example. The interaction between the two proteins trigger various biological functions within the carcinogenic process, both the primary tumor and in the metastatic cascade. Their presence has been shown to be essential for the survival and cell proliferation, angiogenesis, tumor invasion and the accession and selective migration to the liver metastatic cells in a number of malignancies, interacting with increased expression and tumor malignancy lower patient survival. In this thesis is examined for the first time the expression of CSCR4 and CXCL12 in specimens of melonadas malignant úvea suggesting the possibility that, as in other malignancies, malignant cells melanocíticas are using union quimiocina-receptor to promote growth rumoral local as well as stimulate the formation of foci mathematical distance. To that end, he examines the correlation of the degree of expression of CXCR4 and CXCL12 are the appearance of metastases. And finally explores the relationship between the expression of XCCR4 and CXCL12 and other variables of clinical pathological poor prognosis are known as the cell type, the presence of vascular closed circles and infiltrating lymphocyte tumor.

Author: PUERTAS CASTRO MARÍA CARMEN.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: LABORATORIO DE INMUNOBIOLOGÍA PARA LA INVESTIGACIÓN Y LAS APLICACIONES DIAGNÓSTICAS (LIRAD-BST).

Summary: Diabetes type 1 (T1D) is a complex disease characterized by selective removal of the pancreatic beta cells, which are responsible for the production of insulin, because of a self-destructive process mediated by the immune system. The murine NOD strain is the most widely used animal model in the study of T1D, because these animals develop, spontaneously, a form of diabetes autoinmunitaria similar to that seen in humans. While it is understood that T lymphocytes are the cells responsible for the direct destruction of the beta-cell mass, other types of cells of the immune system, are also involved in the origin and development of this response autoinmunitaria. These include lifnocitos B, which also migrate along with T lymphocytes, the pancreatic islets during the development of diabetes. Our hypothesis is that the population of B lymphocytes which is part of leukocyte infiltration into the pancreatic islets may submit final functional qualities, which provide the ability to regulate spot the activity of T lymphocytes autorreactivos. The first objective in this study has been the phenotypic and functional characterization of B lymphocytes infiltrantes in pancreatic islets, in different murine models of susceptiblidad / resistance to diabetes. Thus, it has been observed that the migration of B lymphocytes to intra environment is more prominent in females, especially at the stage prediabética. This population of B lymphocytes infiltrantes shows a phenotype for mature cells, but significant decrease in the surface of the molecule CD19, which is part of the complex corrective BCR, suggests a functional state suppressed. The results obtained after in vitro stimulation of these cells indicate that within the environment of infiltrated conditions exist that keep this phenotype suppressed, but that these cells are particularly sensitive to stimulation via CD40. These data suggest that these lymphocytes, but no changes in its isotope BCR and therefore do not come from a reaction of germinal center, seem to have been in touch with his previously antigen. However, at the level of production of cytokines (IL-4, IL-10, IFNgamma) and capacity stimulated the proliferation of T lymphocytes There have been detected functional differences of these B lymphocytes infiltrantes of islets, with regard to population peripheral B lymphocytes. The second objective of this study has been the identification of the antigen recognized by this group of predominantly B lymphocytes infiltrantes. In a previous study, carried out by our group, had generated hybridomas producing antibodies, from B lymphocytes infiltrantes of islets, and had shown that the majority of these monoclonal antibodies recognize antigens expressed in the nerve fibers that innervate the pancreas. In this study, from isolation and subsequent molecular identification of the antigen recognized by 21 monoclonal antibodies with the same pattern recognition but in a different clonal origin, it has been shown that periferina is protein recognized by all of them. This antigen is a neuroendocrine cytoskeletal protein that is expressed mainly in the peripheral nerve fibers, but also at lower levels in the pancreatic islet cells. These data support the hypothesis that the auto-immune attack taking place in those affected by T1D, is not exclusively directed against pancreatic beta cells and that the destabilization of pancreatic nervous system may be a factor involved in the development of the disease.

Author: MARTÍNEZ ZAPATA M. JOSÉ.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: HOSPITAL UNIVERSITARIO VALL D'HEBRON.
Place of preparation: SERVICIO DE FARMACOLOGÍA CLÍNICA. HOSPITAL UNIVERSITARIO VALL D'HEBRÓN.

Summary: The number of patients with chronic renal insufficiency who start dialysis (IRT) has been increasing over the years. It is therefore necessary to identify the causes of ESRF that can be prevented. The analgesics and NSAIDs can cause potentially undesirable effects kidney (mainly) derived from its mechanism of action. The main objective of this research work has been conducting a comparative analysis of two case studies and controls (study 1983 -Morlans, 1990-; and study of 1997 -Ibáñez, 2005) in the same geographical area and periods different time to clarify the role of analgesics and NSAIDs in the IRT (in the study area) and also to provide information to improve the design of future epidemiological studies to investigate this possible association. The study of 1197 compared with the study of 1983, has been improved mainly with the selection of all cases that began substitute kidney dialysis treatment, instead of a sample of patients who were receiving IRT such treatment, thus it has avoided a likely selection bias associated with patients' survival and that it is inherent in prevalence studies. Also, it has fallen bias memory with the use of a color catalog for Proprietary Medicinal Products. It has also obtained a better matching of cases to controls according to the hospital source. Both studies have in common two aspects of the design that distinguish them from other epidemiological studies. One of them has been the definition of the day and another index that has been implemented in the same geographical area. In most studies of cases and controls has existed bias protopático important because the definition of the day index has been the date of the start of the study or the diagnosis of end-stage renal disease, whereas in the studies of 1983 and 1997 the day rate has been determined as the date of the first demonstration kidney. This comparison of the two studies, it has been possible to objectify various changes in patients who have entered into a program of dialysis during the period 1983-1997, as the population included in the study for 1997 has submitted an older and better morbidity and foremost a different distribution of diagnostic IRC. Therefore, one of the comments that emerged from the comparison of the two studies is that you design, but also other socio external constraints, difficult to control, they were able to influence the differences in results. The study of 1997, the day the index has been determined as the date of the first demonstration kidney. This comparison of the two studies, it has been possible to objectify various changes in patients who have entered into a program of dialysis during the period 1983-1997, as the population included in the study for 1997 has submitted an older and better morbidity and foremost, a different distribution of diagnostic IRC. Therefore, one of the comments that emerged from the comparison of the two studies is that the design, but also other socio external constraints, difficult to control, they were able to influence the differences in results. The study of 1997, the controls had a significant degree of exposure to analgesics and NSAIDs, similar to the cases. As a result, there was a risk between analgesic use and / or NSAIDs and the IRT. Possibly the greatest exposure controls Studio 1997 with respect to controls of the study, 1983, was due to have an older, greater morbidity was used as a catalog color proprietary products that could facilitate greater recall of medicines. Both studies have agreed on the increased risk of IRT with chronic exposure to ASA. The study of 1997 found that the risk was 8 dependi 4d1 body of the dose and duration of exposure of ASA. In addition, the study of 1997 found an increased risk in patients with renal vascular and with a history of diabetes. Whether some of the causes vascular nephropathy as diabetes are often associated with the use of ASA in the prevention of cardiovascular events, so these results from a subgroup analysis, are to be interpreted with caution and research in future studies to confirm this risk.

Author: CECCHINI ROSELL LLUÍS.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: UNITAT DOCENT HOSPITAL DEL MAR.
Place of preparation: HOSPITAL GERMANS TRIAS I PUJOL.

Summary: INTRODUCTION The urinary bladder cancer is a disease with a high incidence in our country and that in a large proportion of cases, it becomes a chronic disease, with the burden that this implies paralos patients and the health system. There is a great variability in the clinical management, both in the diagnosis and therapeutic approach, which may make the prognosis of the disease. In our midst we have few studies representative of the disease. In our midst we have few studies representative of the disease in analyzing and describing the extent of this health problem from the perspective clinicoepidemiológica. GOALS AND ASSUMPTIONS variability exists in the medical practice can cause that once ruled the different proportions between tumors, the method diagnosis and treatment, the prognosis is different depending on the geographic area or the level of the hospital. Studying the magnitude of this variability, its causes and consequences, is the main objective of this work. MATERIALS AND METHODS The study Epicuro, basic epidemiological information was collected on 1354 patients diagnosed with bladder tumor novo from 18 hospitals in five areas of Spain. We have analyzed the sociodemographic characteristics, tumor diagnosis and therapy according to the geographical area of origin of the case and the type of evidence by hospital association and university multivariables and we have studied the evolution over time of these patients applying Kaplan-Meier curves and Cox regression. RESULTS The male-female ratio was 7:1 and the average age of 65.9 years. The 82% of the cases were or had been smokers. Of the cases included, 1278 (94.4%) were transitional carcinomas, 995 (78%) tumors infiltrantes of the muscular layer (TNIM) and 283 (22%) tumors infiltrantes (TIM). With regard to the TNIM, 70% were Ta, a 24% T1 and a 5% neiplasias low malignant potential (NUBPM). The distribution of the characteristics of tumor areas and categories of hospital showed some significant differences, especially as postgraduate differentiation. However, the most significant differences were seen in the method in the diagnosis and treatment regimens. Using ultrasound, the urografía and CT showed a large variation between geographic areas, without the ability to modify diagnosed. There was a wide dispersion when it comes to the indication of treatment adjuvantes the RTU in TNIM and the use of radiotherapy and cystectomy in TIM areas with a very minor variability between categories of the hospital. Weather monitoring has been 50.8 months on average for TNIM and 44.4 months for TIM. During this period of time, the relapse rate for TNUM was 35%, the progression of 5% to TIM and the death of bladder cancer from 4%. In the group of TIM, the mortality rate was 41.3%. As regards the TNIM were independent risk factors in the multivariate analysis relapse females, multiple, larger than 3cm and protective factors regimens applied to a greater degree of BCG and the QT endovesical. The model prediction of progression to TIM included stadiums T1 and Tis and multiple risk factors, and the area of Tenerife as a protector. With regard to the mortality were Predictores is the stadium T1 and Tis, the number more than one episode of relapse or progression and centers of high technology. For the group of TIM, the model prediction was risk factors unknown size, T Stadium, the presence of M1, the number of previous episodes, and as protectors, treatment with cystectomy and the area of Alicante. The category hospital was not an independent prognostic factor in this group. CONCLUSIONS 8 There are 635 one importate variability in the diagnosis and therapeutic management of bladder tumor in our country. This diversity is most evident among different geographical areas not between different categories of the hospital. This heterogeneity from the point of view therapeutic results in a prognostic variability that allows us to observe a beneficial effect of BCG in TNIM in reducing recurrence and cystectomy in reducing mortality from bladder cancer in the TIM, while the end effect delas areas and categories of hospital are diluted. Mix consensual protocols through the diagnosis and treatment of patients with bladder cancer in our country should be one of the goals delas health administrations, taking into account the magnitude of the health problem that accounts for this disease in our midst.

Author: ATZENI FABIOLA.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: UNIVERSIDAD DE BARCELONA.
Place of preparation: UNIVERSIDAD DE MILAN Y UNIVERSIDAD AUTONOMA DE BARCELONA.

Author: BESCOS ATIN SOCORRO.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: IMPACTO DE LA QUIMIOTERAPIA Y RADIOTERAPIA CONTAMINANTE EN EL MANEJO QUIRÚRGICO DEL CUELLO.
Place of preparation: UNIVERSIDAD AUTONOMA DE BARCELONA.

Summary: The surgical management of neck in patients with advanced cancer of the oral cavity and oropharynx treated with concomitant chemotherapy and radiotherapy is an issue in dispute. In part because of low literature on the subject with a limited number of patients in various series and published mainly to the lack of randomized clinical trials that may establish the benefit of adding a nodal emptying into the treatment protocol of these patients. We conducted a retrospective study of a series of 46 patients in a Phase II clinical trial conducted between 1993 and 1997 at the Hospital Universitari Vall d'Hebron for the services of Radiotherapy and Oncology and Maxillofacial Surgery. The patients included in this study were diagnosed with squamous cell carcinoma of oral cavity and oropharynx in advanced stages and included in a protocol with chemotherapy and radiation therapy prior to surgery. The surgery was done at the turn as the primary response to treatment and was done emptying lymph node in which all patients studied all surgical specimens obtained. The objective was to study the histological response obtained search for clinical prognostic factors in the response Histological analysis of the collections associated with this therapeutic modality and determine the effectiveness of emptying nodal supramohioideo regarding relapse and survival. The results show a complete histological response rate of 82.5%, 28% of complications, and 35% of recurrences (22% at the local level, 11% at the regional level and 2% metastases distance. Overall survival the series has been 52% at 5 years and the disease-free survival of 65%. conclusions of this thesis are: 1-No correlation between the observed clinical and histological cervical level. 2 - The clinical parameters how estadiaje cervical, size and location of the primary tumor have little predictive value in the histological response cervial. 3-histological cervical The answer is an important prognostic factor in the recurrence and survival. 4 - Mean complications emptying nodal after the quimioraditoerapia is acceptable and comparable to other series published indicating that this procedure is feasible within these treatment protocols. 5, - voiding nodal supraomohiodeo is an appropriate therapeutic procedure without significant difference in recurrence or survival with emptying ganglion more extensive or radical.

Author: Balanzà Roure Rafael.
Year: 2005.
University: ROVIRA I VIRGILI [More theses of this university] [www.urv.cat].
Place of defense: Facultat de Medicina de Reus.
Place of preparation: Facultat de Medicina i Ciències de la Salut de Reus.

Summary: First, study the current intake of dietary fiber of the Catalan population and the current nutritional recommendations. Secondly, crossover pilot study evaluating the metabolic effects of a partnership soluble fiber (Plantago ovata and Glucomanano) on carbohydrates in healthy subjects. Finally, we conducted a pilot study conducted in controlled medium term (6 months), evaluator of the effect of the administration of the same association of dietary fiber on body weight, adiposity and various metabolic parameters in a group of patients presented diabetes mellitus associated with overweight or obesity.

Author: VALLEJOS ARROYO VIRGINIA.
Year: 2005.
University: BARCELONA [More theses of this university] [www.ub.es].
Place of defense: UNIDAD DOCENTRE DE BELLVITGE.
Place of preparation: UNIDAD DOCENTE DE BELLVITGE.

Summary: SCENARIOS FOR WORK evaluate the diagnostic value of the indexes catchment 201Tl calculated on the entire tumor volume in patients with glioma. We have used a method of measurement which allows the determination of the volume of brain tumor lesions from SPECT images and capture rates calculated from these volumes (COLI). METHODOLOGY. STUDY DESIGN AND OBJECTIVES 1 PILOT PHASE validation of the method of quantification by a mannequin whose internal injuries were simulated with different areas of volume and activity that were planted in various positions. 2 STAGE CLINICAL determine the applicability of COLI in the study of patients with cerebral glioma. An observational study was designed, descriptivo-transversal (phase inclución of patients between the years 1997 and 2001 at two health centers third level). TOWN OF STUDY GROUP 1 (75 patients studied (p) prior to the completion of surgery, for the valuation of the histological grade of malignancy. GROUP 2 (45 p studied in the first week postcirugía to check the degree of tumor resection). GROUP 3 (24 p treated with suspicion relapse versus necrosis or gliosis posterapeútica). GROUP 4 (20 p in which assessed the degree of response after a 1Â th and 2Â first line chemotherapy -QT- in relation to the criteria Macdonald) . PROTOCOL STUDY early SPECT (P) and late (T) for the 15 "and 2-3h pi of 148 MBq of 201Tl. COLI analyzed: l1p and l1T, l2P and l2T, l3P and l3T, IR (retention rate) . STATISTICAL ANALYSIS sensitivity (S), specificity (E), positive and negative predictive value (NPV and VPP), or degree of agreement of SPECT 201Tl regard to the definitive histologic diagnosis or failing that, with regard to morphological neuroimaging techniques (CT and / or MRI) or clinical outcome. Analysis area under the ROC curve as a measure of overall validity of SPECT 201Tl. Mann-Whitney U test for comparison between groups of COLI. Level of significance p less 0.05. RESULTS 1-Validation of the method of quantification. volume quantified by the program and the actual volume of the spheres were related according to a regression model of linear type: VR = 0418.Vc-22 (r = 0985, p less 0, 01). half error associated with the adjustment was 14%. intraobservador variability in the delimitation of the manual ROI (region of interest) of the areas was 5.9%. 2-Results in the study population. GROUP 1 the S of SPECT 201Tl was 92% with a VPP of 100%. were significant differences between gliobastomas multiform (GBM) and ABG at all COLI between astrocytomas and anaplastic astrocytoma (AA) (ABG) in all except COLI in l3T between GBM and AA only in the l1P and l1T. better diagnostic accuracy was observed for l1P and l1T -95.8% and 92.3% (area under the ROC curve). GROUP 2 The S's SPECT 201Tl for the diagnosis of residual tumor was 90.9% and E of 78.3%, and the TPV VPN of 80% and 90%. GROUP 3 was shown the M & E SPECT 201Tl for the diagnosis of relapse 72.7% and 76.9%. GROUP 4 The SPECT 201Tl coincided with the "status" clinical (criteria Macdonald) in 90% of cases after 1Â first line QT and the 94.4% after treatment second line. Conclusions The data demonstrate good reliability of the method of quantification for application in clinic. COLI focused on aggressive histological delos gliomas allowing differentiation between high and low lesions degree, and within the first between AA and GBM. immediate postoperative period in the absence of attracting 201Tl indicates that the tumor has been completely resected and no evidence of residual tumor. tracking During the qualitative and semi-quantitative assessment (COLI) dela 8 captaci 2a2 engaging 201Tl in bed tumor allows differentiation between tumor tissue and viable radionecrosos or fibrosis posterapéutica. kind of response observed by SPEC 201Tl correlated well with clinical response valued according to the criteria of Macdonald.

Author: ADMETLLA FALGUERAS MARGARITA.
Year: 2005.
University: BARCELONA [More theses of this university] [www.ub.es].
Place of defense: CAMPUS DE BELLVITGE.
Place of preparation: CAMPUS DE BELLVITGE.

Author: RUIZ PÉREZ DE PIPAÓN MAITE.
Year: 2005.
University: SEVILLA [More theses of this university] [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE BIOLOGÍA.

Summary: Tuberculosis, caused by the microorganism Mycobacterium tuberculosis, the disease is most deadly in the adult population. The increase in the number of new cases in developed countries is due to factors such as infection with the Human Immunodeficiency Virus (HIV), the immigration from countries where the prevalence of tuberculosis is high and social problems such as increasing the many of the homeless. Simultaneously with this phenomenon, there has been an increase in the number of isolates of M.tuberculosis resistant to rifampicin and / or isoniazid, two front-line antimicrobials for the treatment of the disease. The aim of the thesis was to design a new method for real-time PCR amplification of DNA from M.tuberculosis, using the Light Cycler TM system, which allows detection of genotypic mutations that confer resistance to isoniazid and rifampicin M. Tuberculosis in 30 minutes, without using this product after the amplification reaction. If it is found this hypothesis will apply this method for the detection of mutations in the DNA extracted directly from clinical samples of these smear-positive, thereby reducing the time dela sensitivity of the determination of 15-21 days for conventional methods phenotypic 24 hours.

Author: MORENO RAMÍREZ DAVID.
Year: 2005.
University: SEVILLA [More theses of this university] [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: DEPARTAMENTO DE MEDICINA.

Summary: Study evaluation of a system teledermatología deferred to the prioritization and selection of patients in primary care consultation by suspicious lesions of skin cancer. MATERIALS AND METHODS multicenter study coordinated by the unit Injuries Pigmentadas and Skin Cancer Hospital Virgen Macarena and involving primary care Health District Seville North. Descriptive study of the methodology of the tool implemented, assessment of the validity and reliability of the same, economic analysis and cost study by study of satisfaction through a survey. RESULTS During the period of study included a total of 2009 patients treated through teleconsultation, with an average delay of 12.31 days for assistance in consultation physics from the first consultation in primary care. The screening rate was 51.20% with a detection rate of cancer 1:3,71. The study showed a consistent reliability kappa exceeding 0.9. The sensitivity was 0.99 and specificity of 0.62. The study showed that the economic assistance through teleconsultation was 1.6 times more economic assistance through the system conveniconal. The levels of patient satisfaction attended were superior to 90%. CONCLUSION teledermatología deferred applied to screening of patients with skin cancer represents an effective, accurate, valid, cost-effective and high levels of patient satisfaction served.

Author: BELTRÁN GARCÍA MARGARITA.
Year: 2005.
University: SEVILLA [More theses of this university] [www.us.es].
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: SERVICIO DE FARMACIA, UNIDAD PACIENTES EXTERNOS. HOSPITAL UNIVERSITARIO VIRGEN MACARENA. SEVIILA.

Summary: OBJECTIVE 1-Determine if there is an increase in the grip of the HIV + patients selected after an intervention: new form of delivery of antiretroviral treatment (ART). 2-Determine if after the speech, there is an improvement in the clinical variables of the patients - log HIV RNA copies / ml, the percentage of patients with viral load suppression (SCV) and counting lymphocytes CD4/ml-. MATERIALS AND METHODS The study was conducted in a general hospital. HIV + patients were included those who during the months of January and / or February of 2002 they released one of the TAR selected in the service of the hospital pharmacy. ART were selected those that met criteria for increased frequency of prescription and could be packaged in blister -bolsitas sealed model and identificadas- available. The intervention consisted of the supply of ART selected in a presentation different from you provide industry, grouped by each takes time and repackaged in blisters. To determine the level of compliance of patients was created variables: adherence combined from 2 indirect measures of adherence: Compliance index and bond autoreferida. They are different 3 study periods: pre-intervención, intervention and post-intervención of 6 months duration each. A descriptive analysis was performed for demographic variables. It was determined before and after the intervention: the combined bond and variable clinical outcome. To check the variables between these 2 periods were used: McNemar test-for qualitative variables -- and the test samples for comparison of measures related-for quantitative --. We performed a logistic regression analysis to determine the variables associated with the bond and combined with clinical response in the pre-intervención period. Results The study population was 70 patients, 86% were male, with an average age of 40 +-86 years. Much uneducated 40% and only 50% in active employment status. The percentage of patients classified with any of the stadiums for AIDS defining would be 45.7% -32 patient. The therapy more relieved -39% -fue the mivudina + stavudine + efavirenz in 27 patients, followed by lamivudine + + indinavir stavudine, lamivudine and stavudine + + nelfinavir each with a 21% -14 patient. A statistically significant difference was observed in the variable bond combined: 41% to 61.4% vs. compliant compliant period in pre and post respectively (p less 0.01). However, this did not translate into a clinical improvement: there was improvement, but not significant, the lymphocyte count CD4/ml (494 vs. 504), and an increase in log HIV RNA copies / ml statistically significant, but clinically irrelevant, since it is only in one case, a patient stopped taking SCV after intervention -56 (80%) vs. 55 (79%) patient. There was no variable associated with clinical response. With regard to the adherence of the patients, only found 2 variables: type of ART defined as complex as to the administration -- (OR = 3.5, 95% CI 1,2-10,31), and consumption cocaine in the last 6 months (OR = 6.9, 95% CI 1.3-36.7) as predictors of poor compliance. Conclusions In this study, and after the intervention described, it evidenica a statistically significant increase in the number of patients with proper adhesion. The same is not true with clinical variables where improvement is seen. Given the lack of consistency in the evolution of the combined bond and clinical variables resulted, among the 2 study periods. It is believed necesa 8 river p 371 eriodo study longer than 1 year, in order to prove that this rise in bond translates into improved clinical outcomes.