MEDICAL SCIENCE (17)

Author: MÍNGUEZ ROSIQUE BEATRIZ.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD AUTONOMA DE BARCELONA.

Summary: This dissertation consists of three work aimed at understanding the pathophysiology of hepatic encephalopathy. Firstly, it includes a study in patients with portal thrombosis without liver injury. This study was notable for being the first to perform a valuation of the role played by shunting blood porto-sistémica in the pathogenesis of hepatic encephalopathy. It investigates a group of patients using a technology that had previously been applied in patients with liver cirrhosis, ie, magnetic resonance, spectroscopy techniques to assess the concentrations of different molecules at the brain and Index transferring Magnetización, estimating the presence of cerebral edema low grade, a comprehensive neuropsychological evaluation evidence for the presence of encephalitis and the minimum oral tolerance test to assess the glutamine metabolism of ammonia. The findings demonstrate the latest ideas in the pathogenesis of hepatic encephalopathy. It shows unequivocally that shunting blood porto-sistémica without liver injury can cause hepatic encephalopathy and cerebral edema low grade. The second and third studies are complementary. Initially find focal lesions of the white matter detected with magnetic resonance imaging in patients with hepatic encephalopathy, noting that the volume of these lesions decreased after neurological improvement, once exceeded episode encephalopathy. The findings are novel and open the door to exploring the participation of the blood-brain barrier in the genesis of cerebral edema. Following this finding conducted a study that evaluated 27 patients suffering from liver cirrhosis in liver transplant list, by means of magnetic resonance to assess whether focal lesions in the white matter and the size of the same, as well as a full exploration neuropsychological assessing the presence of minimal hepatic encephalopathy. The patients were reassessed in a few months after the transplant, once stabilized liver function. It was felt that the white matter lesions were indicators of the focal edema and investigated the relationship of the same with hepatic encephalopathy with important findings. The results of the theory are useful to understand the pathogenesis of hepatic encephalopathy. On the one hand support the hypothesis that the incriminating ammonia and cerebral edema in encephalopathy. Moreover suggest that the swelling is located at extracellular and that the blood-brain barrier may have an important role in its development. The extracellular localization of cerebral edema low grade goes against previous assumptions, but is supported by the results of recent research using magnetic resonance imaging in patients and in those studies the apparent diffusion coefficient. From the clinical point of view, this finding may facilitate the assessment of candidates for liver transplantation and making clinical judgment in complex situations, such as the coexistence of cerebrovascular disease and encephalopathy.

Author: GELBER PABLO EDUARDO.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Hospital Universitari Del Mar.
Place of preparation: Hospital Universitari del Mar. Barcelona.

Summary: Although the glenohumeral ligament lower (LGHI) has a recognized role in the mechanical, propiocepción and stability of the shoulder, little is known about the relationship between them and their patterns of innervation. In the first of the publications that are part of this thesis were identified patterns of innervation of LGHI, linking them to the wide range of mobility in this articulation and even compared with episodes of glenohumeral dislocation. The microscopic analysis showed a pattern of lax and undulating nerve fibers intraligamentarias. The branches nerve joints and relax away from the capsule in external rotation and abduction and remain unscathed after a macroscopically anteroinferior glenohumeral dislocation. These results manifestarían design distribution neural specially prepared to avoid a denervation of the ligament before a desinserción or break intrasustancia it. The neural circuit would be left unscathed after a dislocation, and a reintegration restored normal activation of the mechanoreceptors. Knowledge of the anatomy of the shoulder innervation clearly helps to reduce the risk of iatrogenic injury during surgical procedures. In the second of the publications are assessed by a prospective randomized into corpses, and in the context of current knowledge of the treatment of anterior instability of the shoulder, the controversial arthroscopic portal called in the literature 5 o'clock. The portal showed a risk of nerve injury musculocutáneo and the cephalic vein very high, which discouraged their use for routine arthroscopic practice.

Author: Fortuny Moya Joan.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Institut Muinicipal d'Investigació Mèdica.
Place of preparation: Institut Municipal d'Investigació Mèdica.

Summary: The aim of the thesis was to evaluate the association between use of inflammation-related drugs and cancer risk. This PhD thesis includes five manuscripts derived from four epidemiological studies. Bladder cancer studies. The bladder cancer case control study "Epicuro" was conducted in Spain. Two manuscripts were published based on this study. The first one showed that in Spain the chronic use of aspirin and paracetamol was low (8% users of aspirin and 5% users of paracetamol) compared to that of the US or Northern Europe. Differences in drug use related to sociodemographic variables were observed. The second article showed that regular use of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) related to a decreased risk of bladder cancer (OR= 0.4, 95%CI= 0.2-0.9). Polymorphisms in the NSAID metabolism-related CYP2C9 gene did not modify this inverse association. No evidence was found of an overall effect related to use of aspirin (AAS) or paracetamol. However, paracetamol was associated to an increased bladder cancer risk (OR=1.8, 95%CI= 0.9-3.6) among subjects with a genetically determined poor capacity of eliminating paracetamol's toxic metabolite (N-acetyl-p-benzoquinone-imine, NAPQI). For the Epicuro study we developed a drug exposure matrix to automatically and accurately recode the reported brand names into active ingredients and doses. In a second bladder cancer study, conducted in New Hampshire, USA, we found an increased risk of bladder cancer among long term users of phenacetin (OR= 3.0, 95%CI= 1.4-6.5). In this study, use of paracetamol was associated with a decreased risk of bladder cancer, especially among long-term users and non-invasive, low grade, TP53 negative tumors. We also found that the use of NSAIDs was associated to a significantly decreased risk of bladder cancer, specifically for AAS use (OR= 0.5, 95%CI= 0.3-.8). The association with NSAIDs was particularly strong among invasive, high grade and TP53 positive tumors. A drug exposure matrix adapted to the American market was used for this study. Esophagogastric cancer study. In a US study on esophagogastric cancer, use of AAS and corticosteroids was related to significantly reduced risks of the four main cancers occurring in this anatomic region i.e., esophageal adenocarcinoma and squamous cell carcinoma, and gastric cardia and non-cardia adenocarcinomas. ORs for the use of corticosteroids were between 0.4 and 0.7 and were statistically significant. ORs for use of aspirin were between 0.4 and 0.6 and were statistically significant. Use of non-aspirin NSAIDs was only related to a decreased risk of non-cardia gastric cancer. Use of drugs relaxing the lower esophageal sphincter was not related to an overall increase in the risk of esophageal adenocarcinoma (OR=1.1, 95%CI= 0.7-1.7), which was reassuring for the large number of users of these drugs. Lymphoma study. In the European study Epilymph on lymphoma risk factors, use of statins, which are known to modulate inflammation, was related to a significant reduction in the risk of lymphoma (OR= 0.61, 95%CI= 0.45-0.84), adding to the increasing literature showing anti-neoplastic properties for this group of drugs. Discussion of the methodology and possible biases. Part of the work presented in this thesis is focused on the methodology used to overcome the biases and limitations related to the use of the case-control design in pharmacoepidemiology studies, especially in hospital-based studies. We have shown that it is unlikely that our results might have been affected by the protopathic bias, since we excluded drug use that took place close to the diagnosis/index date. We also evaluated the possibility that confounding by indication could bias our results. To evaluate this, we used different techniques depending to the study: critical evaluation of the indications of each drug and their possible relation with the studied cancer, restriction of the analysis to subjects affected by a putative confounding condition, and finally, conducting sensitivity analyses to evaluate the plausibility of the required prevalence of the possible confounding indication among users and non-users of the studied drug to account for the observed results. We also excluded any significant effect of Berckson's bias through a sensitivity analysis that co 8 nsecutiv 935 ely excluded different admission diagnoses of the hospital-based controls. A certain degree of non-differential misclassification is possible, mainly due to inaccuracies in the recall of past history of medication use. The use of drug exposure matrix limits, to some extent, this misclassification. It is unlikely that our main results have been affected by differential misclassification since the general population does not usually relate the studied drugs with the assessed cancers. The use of prescription automated databases excludes the possibility of any recall bias in the gastroesophageal study. Small numbers, especially in gene-environment interaction analyses and other subanalyses, limit the statistical power of our studies. General conclusion. We found an inverse association of use of drugs limiting inflammation with different cancers. The results we present are consistent with an inflammatory theory of the origin of cancer. The inverse association between statin use and risk of lymphoma is particularly important because an increasing number of subjects are exposed to this group of drugs, especially since early studies had found increases in the risk of blood malignancies in rodents exposed to statins. Future research. Based on findings from these studies we plan to work on a series of projects in the near future to further assess the relationship between cancer and anti-inflammatory drugs. We will focus our work on studies on lymphomas but will also work on projects on bladder, esophagus and colon cancers. In these new studies we will take particular care to implement adequate study designs to minimize potential biases and increase the power of the studies.

Author: ROMERO VIELVA LAURA MARÍA.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: HOSPITAL UNIVERSITARIO VALL D'HEBRON.
Place of preparation: HOSPITAL UNIVERSITARIO VALL D'HEBRÓN, BARCELONA.

Summary: The mediastinal lymph node involvement is the main prognostic factor in lung cancer. A stratification correct and as precise as possible can treat the patient after surgery for the most suitable form. ASSUMPTIONS AND OBJECTIVES Knowing the difference between survival and disease-free time of patients with mediastinal lymph positive and negative. Evaluate the role of the extent of lymphadenectomy for estadificación make a more correct. To determine if extended lymphadenectomy improves survival and disease-free time depending on the number of nodes obtained. PATIENTS AND METHODS Study restrospectivo of 485 consecutive patients operated on for lung cancer between 1995 and 2001. It analyzes the mediastinal lymph resected. The groups depending on the T facto divided in two depending on the number of nodes resected (less 10 and 10). Statistical analysis was performed using SPSS see. 12 in a Windows environment. Contingency tables were performed using the Statistical Chi Square and Fisher's exact test to analyze the differences between the joint distribution of the qualitative variables. For the analysis of survival and disease-free time, the method of Kaplan-Meier. To compare the different curves and survival time free of disease using the hypothesis tests log-rank, breslow and Tarone-Ware. In order to find possible associations between different prognostic factors and the time disease-free survival or, we applied the model decox getting different HR (Hazard Ratio) and his confidence interval at 95%. RESULTS The average nodes resected was 11.16 ganglia (0-48). A larger number of lymph nodes resected highest percentage of positive gain (statistically significant difference, 35.85% of patients with node-positive in the group increased 10 nodes resected and 61.14% in the 10 nodes resected). Survival at 5 years of the entire series was 40% and that of the patients who show some positive node to 5 years up to 21% decreases. The univariate analysis of survival with the variables studied objectively that the more resection of lymph is a protective factor, reducing the risk of death. The presence of node-positive is a risk factor for survival. In the multivariate analysis shows that the number of nodes resected behaves as a protective factor in survival (HR 0.97, 95% CI: 0,95-0,99, p = 0001) and in free time disease (RH 0.91, 95% CI: 0,96-0,99, p = 0004) decreasing the risk of relapse. In patients with mediastinal lymph negative median survival and disease-free time in which resecaron more than 10 nodes is better than in the group that was resecaron less than 10 nodes (statistically significant difference). In patients with mediastinal lymph positive median survival and disease-free time in which resecaron more than 10 nodes is better than in the group that was resecaron less than 10 nodes (statistically significant difference). CONCLUSIONS Survival and disease-free time of the patients with lymph mediastínticos positive is lower. The probability of finding a positive node mediastínico increases in the group of patients with a lifadenoctomía longer. Throughout the series in which patients were resecaron more than 10 lymph show improved survival and disease-free time. The lifandenectomía mediatínica complete estadifica better and improves survival and disease-free time, so be recommended as an essential step in the surgical treatment of lung cancer.

Author: SOLDEVILLA AGREDA JOSE JAVIER.
Year: 2006.
University: SANTIAGO DE COMPOSTELA [More theses of this university] [www.usc.es].
Place of defense: DEPARTAMENTO DE ENFERMERIA.
Place of preparation: DPTO.ENFERMERIA. ESCUELA U. DE ENFERMERIA. UNIVERSIDAD DE SANTIAGO DE COMPOSTELA.

Summary: Pressure ulcers are seen as a major syndromes in gerontological all treaties gerontology clinic, more dedication on the part of researchers and clinicians to date has been limited and secundarizada, fueled by the mistaken belief that consideration is a banal, inevitable and sufficiently rapid. To help overcome ignorance, apathy or irresponsibility of these lesions before severe impact on health, quality of life and the survival of those who suffer, this paper know the epidemiological evolution of pressure ulcers and their special significance in the group of older people in this country, as well as the specific costs of treatment of these processes and possible legal and ethical implications involved in the development of these lesions, which are considered preventable by the scientific community, almost all of the cases.

Author: Padín Nogueira Juan Fernando.
Year: 2006.
University: SANTIAGO DE COMPOSTELA [More theses of this university] [www.usc.es].
Place of defense: Facultad de Farmacia.
Place of preparation: Facultad de Farmacia.

Summary: Following the discovery of G proteins by Rodbell & Gilman, which received the Nobel Prize in Medicine and Physiology in 1994, was created a paradigm to deal with them as the sole mechanism of action of G protein coupled receptors (GPCRs). This had a significant impact in pharmacology, the establishment since then that the drugs are effective for activating proteins G, and hence the antagonist ligands were lacking effectiveness. Today, we know that GPCRs show pleiotrópicos or promiscuous behavior toward multiple effector proteins other than those G for example, the kinases, arrestinas, ADS domain proteins, protein RAMP (modifying the signal receiver), and so on. , Which are involved in a variety of intracellular signaling processes, and therefore, in pursuit of a particular physiological response. Moreover, another important milestone in the pharmacology of receptors was the discovery by Costa et al. In the mid-90's behavior "agonismo reverse" of the ligands. As a result of this discovery, efficiency became mathematically considered as a vector magnitude, and therefore the ligands present efficiencies ranging from positive to negative values depending on the conditions genotypic / phenotypic the type of cell in which it expresses the receiver. In other words, the value of effectiveness of a ligand is also dependent upon cellular system which is the subject of study. Because of all these circumstances, the classical models of interaction ligando-receptor are not able to explain all of these behaviors of GPCRs, in part because they have the overview of the receiver obvious that the mechanisms that are involved in conformational the transformation of a stimulus response. Today, the "probability distribution model conformations" proposed by Onaran & Coast (1997) is the most widely accepted explanation for such behavior. This model provides a more comprehensive view of the activity of the receptor, suggesting that the ligands are capable of inducing or select multiple active conformations populations receptor presenting the energy required to produce a particular effect. For all these background exposed, it is considered that the challenge of this first decade of the twenty-first century in the pharmacology of receptors is to exploit the advantages of new methodologies that are capable of detecting conformations to deepen the understanding of the role of the receiver . To that end, this Doctoral Thesis proposes methodologies to validate in-depth analysis of behavior conformacional of ligands. By analyzing all of these behaviors of drugs constitutes their particular "chemical fingerprint". For this purpose, we compared the behavior of unity and pleiotropía or promiscuity functional different ligands agonists and antagonists in a heterologous expression system receiver 5-HT2A (cell CHO-FA4) cellular system with a native (human blood platelets) recital different wireless systems because the effectiveness of the ligand is conditional on cellular system receptor expression. In addition, we have critically examined the results obtained in the context of interaction models ligando-receptor more accepted, in order to advance the development of phenomenological models that can predict mathematically explain and interpret all the behavior of GPCRs. The study of the receptor conformations that are relevant in the production of a response, as well as factors affecting their achievement, are of vital importance in the search for drugs to show a new concept of selectivity: "selectivity conformacional" . On the other hand, there is an interest crecien 8 you in the 846 pursuit of GPCRs that are involved in the mechanisms of action of antipsychotic drugs, whose variations in parameters pharmacological or expression when expressed in somatic cells may serve as biomarkers in the peripherals esquizofrenias. Specifically, it has been proposed serotonin receptor 5-HT2A expressed in human blood platelets, and the receptor mRNA dopamine D3 in lymphocytes of blood, as potential biomarkers in various psychiatric illnesses that are associated with alterations in central neurotransmission. The pharmacological regulation of GPCRs is a behavior that depends on the phenotypic properties / genotypic of cellular system, the inherent characteristics of the ligand, as well as the conformations that it is able to "induce or select" into the receiver and are involved phenomena in the regulation of receptors. For this reason, this Doctoral Thesis we also analyzed changes in the expression of serotonin receptor 5-HT2A and dopamine D3 after treatment with the atypical antipsychotic olanzapine to study a possible parallel between the CNS and cells peripheral blood. Of happen so, it may propose both receivers as potential biomarkers for the study of regulation exercised by the antipsychotic in the CNS in patients with esquizofrenias.

Author: PUERTAS GARCÍA-SANDOVAL JOSE PABLO.
Year: 2006.
University: MURCIA [More theses of this university] [www.um.es].
Place of defense: HOSPITAL UNIVERSITARIO VIRGEN DE LA ARRIXACA.
Place of preparation: UNIVERSIDAD DE MURCIA.

Summary: HE MAKES AN ANALYSIS RETROSPECTIVO OF THE GENERAL CHARACTERISTICS OF SICK DIAGNOSTICADOS AND TREATY OSTEOSARCOMA OF LONG BONES IN THE HOSPITAL UNIVERSITY OF ARRIXACA BETWEEN VIRGIN JANUARY 1967 AND OCTOBER 2006. ANALYSIS IS THE SURGICAL TREATMENT AND ONCOLÓGICO THESE TUMORS, HOW HAS VARIADO THE SAME WITH THE TIME, AND THAT HAVE IMPACT IF THESE CHANGES IN THEIR RESULTS. FINALLY IS VALORAN RESULTS ACHIEVED IN EACH OF THE ÉPOCAS FROM THE POINT OF VIEW OF DIAGNOSIS AND SURGERY AND MEDICAL TREATMENT WITH THE PURPOSE OF DEVELOPING AN AGENDA CURATIVO FOR OSTEOSARCOMA.

Author: ALMELA SÁNCHEZ RAMÓN MIGUEL.
Year: 2006.
University: MURCIA [More theses of this university] [www.um.es].
Place of defense: FACULTAD DE VETERINARIA.
Place of preparation: HOSPITAL CLÍNICO VETERINARIO.

Summary: The technique electrorretinográfica is basically stimulate the retina with light in environmental conditions given, and then record the responses of the retina in that light stimulus. In our study objectives were to be raised a protocol to standardize the examination electrorretinográfico in green iguanas healthy to get electrorretinogramas normal identify existing photoreceptors in the retina and evaluate the influence of weight and length narina-cloaca in different parameters electrorretinográficos. In the peer-reviewed literature, there are few studies on the electrorretinografía in green iguana; addition, none of these studies used a standardized protocol and accepted for review ophthalmological human and veterinary medicine. In the study used 44 iguanas (Iguana iguana) green adults of both sexes -21 males and 23 hembras- clinically sound coming from the Center for Wildlife Recovery "The Valley" or Exotic Animal Service and Ophthalmology Clinical Veterinary Hospital at the University of Murcia. The protocol electrorretinográfico done was similar to that established by the European College of Veterinary Ophthalmology-European Society of Veterinary Ophthalmology for the dog and yielded electrorretinogramas good quality and so repetitive. In our case review electrorretinográfico was conducted with the electrorretinógrafo model Roland consult incorporating software RETIsystem version 1.32. The combination of medetomidine, at a dose of 100 µ g / kg, ketamine, 10 mg / kg, kept the iguanas in a plane anesthetic adequate throughout the review electrorretinográfico and also met the requirements set for the dog. The morphology of the waves showed a wide base and some gentle slopes, ie slow kinetics. There were obtained statistically significant differences between the right eye and the left or between males and females, so that in the end the sample considered for the statistical study was equal to 88. The measures biometric -peso and longitude narina-cloaca- we were useful for predicting values electrorretinográficos because it had no significant correlations. After quantitative analysis, the values obtained confirm the existence of a single retinal photoreceptors formed mainly by type cone. This fact suggests that consideration electrorretinográfico in the green iguana is set in a protocol based largely on an assessment fotópica.

Author: ASENSIO SÁNCHEZ SANTOS.
Year: 2006.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD MIGUEL HERNÁNDEZ.

Summary: * Surgery remains the best option for the cure of bronchogenic carcinoma but many resectable tumors occur in patients with deterioration of lung function that increases the risk postoperative surgical, and although numerous studies analyzing markers for predicting complications found a wide disparity in the published results. Objectives To determine what the parameters used in the preoperative evaluation of patients with bronchogenic carcinoma contribute to a better prediction of the surgical risk. MATERIALS AND METHODS prospective observational study of 120 consecutive patients operated on for bronchogenic carcinoma over a period of 27 months in a service Pneumology and Thoracic Surgery reference center. Clinical Evaluation and conducting: spirometry, lung diffusion, maximum oxygen consumption and predicted postoperative lung function (ppo) before surgery. Division of complications arising from medical and surgical technique. Bivariate analysis of the complications and mortality by dividing the population depending on the absence or presence of the same and subsequent multivariate analysis using logistic regression. RESULTS * The average age of the 120 patients was 62.8 - 9.6 years, 85% men. The 89.2% had smoked, and 81 (67.5%) had some kind of disease. 45 (37.5%) suffered some sort of complication, 20 (16.7%) medical and 28 (23.3%) from the surgical technique. 5 (4.2%) of patients died within the first 30 days after surgery. * The risk was associated with postoperative surgical history of smoking, hypertension, cardiovascular disease, the degree of airflow obstruction (FEV1/FVC), pulmonary diffusion capacity (Tlco%) and predicted postoperative lung function (Tlco% ppo and FEV1 % ppo). The Tlco% and Tlco% ppo were the only variables that had the independent status in the logistic regression analysis. But the only variables associated with postoperative mortality were those arising from the exploration respiratory functional: Tlco%, the NAFTA% and FEV1 ml ppo, FEV1% ppo and Tlco% ppo predicted postoperative. The Tlco% ppo and NAFTA% behaved with independent status. * None of the parameters derived from the stress test was associated with increased morbidity and mortality in the general population. The 5 patients who died had a Tlco% ppo less than 50%, and the mortality for this value of 13.2% (5 of 38 patients), p = 0,005, and a 28.6% (2 of 7 patients), p = 0,035 for a value of less than 30%. Four of the 5 patients who died had a FEV1% ppo less than 50% of theoretical remain mortality for this cutoff point of 15.8% (4 of 27 patients), p = 0,015. CONCLUSIONS * In addition to smoking, hypertension and cardiovascular comorbidity diffusion lung (Tlco) and the variables calculated by scintigraphy (FEV1% ppo and Tlco% ppo) were associated with increased morbidity and mortality. The Tlco retains the independent morbidity and mortality in the regression analysis and Tlco% ppo for mortality. * Patients with an FEV1 ppo or Tlco ppo less than 50% had an increased risk of complications, and this was particularly high in patients with a Tlco% ppo less than 30%. The maximum oxygen consumption and walking distance proof of the 6-minute walk do not appear to predict risk of complications, so it should be reserved for selected groups of patients.

Author: CREMADES HERNANDEZ NIEVES.
Year: 2006.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL GENERAL UNIVERSITARIO DE ALICANTE.

Summary: INTRODUCTION microinjections intracitiplasmática sperm (ICSI) radically changed the treatment of male infertility caused (Palermo et al., 1992). The microinjection, first applied to cases of patients with abnormalities partial espermiogrmaa evolved to also apply in treatment, and successfully, to cases of obstructive azoospermia and secretory azoospermia. In cases of azoospermia secretory even then there were the first pregnancies to term using espermátidas round (ROSI), espermátidas elongándose (ENSI) and espermátidas elongadas terminals (ELSI). As of this moment, the papers published in zoospermia secretory only describing clinical outcomes associated with sperm microinjection (ICSI), without specifying resutlados by specific type of testicular pathology. There was no histopathological testicular subgroups, allowing establish a real prognosis for patients in terms of collecting espermátidas and sperm for the treatment of testicular biopsy. And on the other hand published papers regarding the use of espermátidas describing conflicting results. In this situation we ask the following objectives: 1-To proceed methodically to the study of patients with azoospermia secretory relating to clinical parameters with those obtained in the treatment of testicular biopsy. And the need for the other two goals. 2-Establish a culture medium capable of sustaining maturation in vitro espermátidas round, in those patients for whom no other cell found more mature. 3-To determine the determinants of espermiogénesis human cultivation and using in vitro maturation of sperm to espermátidas round. For this meet for four consecutive years, the largest number of global clinical study and treatment of patients with azoospermia secretory (148 patients). For the second goal were isolated by the micromanipulation espermátidas round of patients with obstructive azoospermia secretory and to avoid any contamination by a hotbed of hidden espermátidas or sperm, and were cultivated in complex media. To increase the efficiency of in vitro differentiation potential of espermátidas round will supplement the culture medium with rFSH and water-soluble testosterone, in addition to cells and Sertoli cells diploid germ. It confirmed the purity of the cell populations by FISH and mRNA expression by RT-PCR. CONCLUSIONS It has been found to correct a forecast with azoospermiano obstructive patients taking into account the probability, before treatment, a testicular sperm extraction (TESE) successful. A-It has established a new classification of syndromes more realistic clinic. B - has been identified, with the largest published series clinic, which ROSI is not routine application. C - has been established injection espermátidas elongándose (ENSI). The first baby was born in 1999. It has achieved espermiogénesis in vitro (Sa1 Sd: 13%). The first children were born in 2000. A has been achieved in vitro meiosis (ST1 ST2 Sa1: 7%), which can be applied clinically. B - The development potential of espermátidas elongándose and elongadas morphologically normal mature in vitro is nearly normal. It has identified the factors limiting the espermiogénesis. Future projects are aimed at the purification of populations of diploid germ cells (DGC) for studying the molecular characteristics of adult stem cells from testicular tissue (hTASC).

Author: GARAIKOETXEA ITURRIRIA ANA ISABEL.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: HOSPITAL SANT PAU SALA DE GRADOS.
Place of preparation: UNIVERSIDAD AUTÓNOMA BARCELONA.

Summary: OBJECTIVE: To ascertain the views and expectations of economic migrants on our health care system MATERIAL AND METHODS: qualitative study. It conducted 32 interviews open to visitors economic migrants, mediators health professionals and health of the city of Barcelona. Those interviews were taped and transcribed. It was subsequently conducted a content analysis. The theoretical framework used is the theory on which they are based quality control. It analyzes the user's perception of services obtained from their expectations. He or she is trying to draw proposals for improvement by analyzing the differences between users and health professionals. Field of study: health centers in the city of Barcelona (Camp de l'Harp, Congres, Encants, Besós) and the Center for Tropical Medicine Drassanes. RESULTS: economic migrants waiting to be empathic with a professional and effective in resolving their health needs. Professionals are with unrealistic expectations of users, due to ignorance of our health care system. Users part of public health systems in deficit in their home countries, the prestige of ours is high among them. Their health concepts are sometimes different from ours. Both circumstances and personal needs mark the use they make of the primary health care system of our country. Their views on the services provided are generally good, although they complain of difficult access administrative, cultural and linguistic background. They also complain of racism. Women's access is especially difficult. Professionals corroborate the difficulties especially cultural and linguistic minorities. Both the immigrant population as health professionals suggest improvement measures as host visits, cultural mediators / health workers, professionals origin and gender equal to the users, as well as health education for both groups (users and professionals) CONCLUSIONS : user expectations mark their perception of quality of service, as well as the use it makes of it. There is a need to bring those expectations with a series of proposals to improve our primary health care services. They suggest mediation, bilateral health education and awareness of health professionals. It prioritize access to women and research on discrimination in the health system. KEYWORDS: economic migrants, the health system, expectations.

Author: Rabanal Bodelón María Elena.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Facu.de medicina. Valle de Hebrón Barcelona.
Place of preparation: Universidad Autónoma de Barcelona.

Summary: The objective of this thesis is to conduct a detailed assessment of the evolution and development of a unit in breast pathology service radiology primary care and also define the role of the radiologist in the team of patient care in primary care. Materials and methods. In the period between 1985 and 2004 were studied 116,726 patients of whom 912 were men. Rseultado and discussion. As initial two basic factors that highlight for the proper functioning of the unit breast: a radiologist dedicated and a reference center. A radiologist devoted significantly increases productivity, which in our unit increases and stabilizes to an average of 8000 scans / yr, from the moment he joins the radiologist. It also enhances the quality, translated into a decline in the loss of previous studies (10% initial 4%), the elimination of unnecessary or poorly specified studies and the establishment of diagnódtico fast breast cancer in conjunction with the reference center . The quality parameters most commonly used are threefold: cancer detection rate per thousand women studied, benign biopsies Relationship / malignant and the percentage of ecografías complementary. The detection rate in women referred for screening should not be lowered from 2 per thousand. In our performance ranges between 2 and 5.5 per thousand, with an average of 3.3. In symptomatic patients must be greater than 10 per thousand patients studied. Our result is between 15.9 and 24.79 per thousand with an average of 22.6. The percentage of biopsies benign / malignant admitted ranges between 25 and 40%. Our percentage is 48.6%. THE percentage of ecografías up should not be greater than 10% in women referred for screening. In our study reaches 15%. We believe this is justified to our practice is mixed, with women referred for screening and clinical. In primary care radiologist acts as the consultant physicians reference because of the geographical spread of the same. Serves as liaison with the center of reference and archive the results to your query by family doctors and gynecologists. A reference center is essential for carrying out consultations and examinations (estereotaxia RM) is not available in our primary medical practices 98% of women are diagnósticadas in central primary. The performance of the radiologist avoid saturating the center of reference which only sends the 2% of patients for more sophisticated studies in primary medicine are patients and diseases that do not reach hospitals. Worthy of note is the large number of young women (under 25 years) who are visiting as well as a large number of male patients, sent mostly by gynecomastia. The primary medicine is not incompatible with the scientific output: In our case has been presented posters and communications in national and international congresses, with the awarding of prizes in one of them.

Author: MARTINEZ GONZALEZ M. SALOMÉ.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: UNIVERSIDAD AUTÓNOMA DE BARCELONA.
Place of preparation: HOSPITAL VALL D'HEBRON. UNIVERSIDAD AUTÓNOMA DE BARCELONA.

Summary: The objective of this thesis is to develop a predictive model based on the patient's clinical data and histological features of primary melanoma and Immunohistochemical to assess the probability of metastasis in sentinel node. The variables were analyzed by age, sex, location of melanoma, the index Breslow, the level of Clark, the growth phase, the rate of melanoma, the index mitósico, ulceration, the invasion angiolinfática, peritumoral inflammation The signs of regression, the neurotropism, microsatelitosis, afectación anexial, the presence of residual nevi, the immunohistochemical expression of ki67, p53, p16, bcl2, Melan A and HMB45. The Statistical analysis showed that the index of Breslow (P = 0019), the index mitósico (P = 0033) and the percentage of ki67 (P = 0022) were independent predictors of the presence of metastases in sentinel node. Although this study has not shown an association of the remaining variables analyzed with the results of sentinel node biopsy of the small sample size has been able to contribute to any observed association has not reached statistical significance, requiring the replication of the same more cases.

Author: OJER TSAKIRIDU DOMINGO.
Year: 2006.
University: OVIEDO [More theses of this university] [www.uniovi.es].
Place of defense: AULA MAGNA DEL EDIFICIO DE ESTOMATOLOGIA.
Place of preparation: UNIVERSIDAD DE OVIEDO.

Summary: Background: Despite the fact that women in prostitution are a group at high risk for suffering a voluntary interruption of pregnancy (IVE), they have been little studied in these women. Our objectives were to know the frequency of EVI on women in prostitution in Asturias, know the socio-demographic variables and the related knowledge and use of contraceptive methods that can be associated with the presence of EVI on them, and describe the knowledge and use of the contraceptive methods. Materials and Methods: A descriptive study was conducted by transverse self-administered questionnaire to 212 women who were prostitutes and went to the two consultations of Sexually Transmitted Infections (STI), Oviedo and Gijon, the Health Service of Asturias and the Doctors of the World Asturias in Aviles, throughout the year 2003. The questionnaire was designed to investigate both perceived contraceptive knowledge (what women concerned know) and real (what really knew), the use of contraceptive methods in the private and business relationship, and socio-demographic variables. In developing the questionnaire included a panel of experts, conducted a focus group with users of the consultations and took a pre piloting. Results: 92.5% of women were immigrants. The 61.2% of the women concerned have sufficient information on methods of contraception, although the actual knowledge measured for questionnaire is much lower. The method most frequently referred is the ability to use condoms (97.6%) but only 55.9% of those concerned know do know how to use properly. The method used was the condom, and only 52.2% of those who used it in the last business relationship did together with otrométodo safe. In the last ruptured condom commercial, 39.6% of those surveyed did not have an attitude effective in preventing pregnancy. The 46.1% of pregnant women have ever had any EVI, and 8.5% of the survey concerns have suffered in the last year: 37.7% of those who have suffered any EVI over his life suffered more than one. The 21.1% of which had any EVI has made herself the last EVI has suffered. The misoprostol (Cytotec) as agent abortion is widely known. The variables associated significantly and by multivariate analysis (logistic regression) to the presence of EVI were the number of pregnancies, the exercise time in prostituticón, actual knowledge contraceptives, the number of children and the age of women. Another was nearly significant: marital status (p 0,078). The first two and the state divil (single versus with her) were associated in a direct manner (on a larger number of pregnancies and exercise time, more likely to have suffered a EVI; couple have implied more likely to not take EVI) . The three following variables were associated in a reverse (a larger actual knowledge, the greater number of children and older, less likely to EVI). We did not find any statistical association between the presence of EVI and knowledge contraceptive percibdio. Discussion: EVI figures are very high and many of them are held without medical supervision, given that spropiedades abortion of misoprostoi are widely known, and that the percentage of women who hans ufrido an EVI in the last year is very important, not it seems that the trend may improve in the short term if there is no intervention. The characteristics associated with the reproductive history of women in prostitution (as in pregnancy, children, marital status) together with the knowledge conctraceptivo real and the time period in prostitution explain the presence of this group IVES women better than the factors related to the conditions for the year (as a place of activity, other activities compatibilizadas with prostitution, the use of safe method on the last business relationship). The EVI could be used as a control method natalida 8 d, given 52f the inverse association found between the number of children and the presence of EVI. Therefore, promoting the use of methods contraceptivosseguros in the commercial relationship should be a priority, especially when the use of effective method asoicado the condom is scarce, and many women are not stained an attitude effective in preventing pregnancy in the event of breakage of condoms . If knowledge contractivo actual measured way to decuada, and given the relationship found in our study between it and the presence of EVI, all women led to an increase could be justified because they reduce the numbers of EVI among women who exercise prostitution.

Author: ESPARZA BASTIT AMPARO.
Year: 2006.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGÍA DE VALENCIA.
Place of preparation: HOSPITAL CLÍNICO UNIVERSITARIO DE VALENCIA.

Summary: This Doctoral Thesis deals with a technical neurophysiological, electroretinograma ERG in the difficult field of application newborn preterm RNPT in neonatal intensive care units UCIS. We studied a total of 51 RNPT of gestational ages fall between 29 and 36 weeks, conducting a study weekly until reaching the age of RNAT (37 weeks) and a final registration at 41 or 42 weeks of postnatal age. It was used as an electrode active registration ERG called cable DTL (Dawson-Trick-Litzkow) moistened with normal saline in the conjunctiva of the lower eyelid. As recording equipment was used Nicolet Compact Four C-2000-evoked potentials and electrorretinografía. ERG The study was conducted using two different types of stimulation, light blue and white light escotópicas. As for the results was found increased latencies of the waves ayby an important reduction in the amplitude ab. With these results to design tables reference to the two types of stimulation, light blue and white light escotópicas and in different weeks of postnatal dad. As for the statistical method used was you "method Gibbs Smaplign." With the samples were obtained from the ratios and statistical model was used to design the graphical representation of the bands of confidence for a generic RN and in different weeks of postnatal age. With them it is possible to predict the results of 4 variables to study latencies of the waves a and b for the two types of stimulation, reflecting dela maturation of the ERG and therefore the RNPT studied, especially in regard to the development of their structures and neural glial. Of shows, for both, with this Doctoral Thesis usefulness of this technique in the assessment of the condition madurativo the RNPT.