MEDICAL SCIENCE (3)

Author: HERNÁNDEZ SÁNCHEZ SALVADOR.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGÍA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGÍA DE VALENCIA.

Summary: The pineal gland of lower vertebrates and mammals, has been studied from various perspectives in order to try to establish the parameters of its operation rhythmic both morphologically and physiologically. Studies conducted by cariométricos Quay and Renzoni (1966) and Renzoni and Quay (1964) in pinealocitos rodent revealed the existence of nuclear size variations during cycles 24 hours. Such variations furon also pointed between cortical and medullary regions of the gland. Such differences corticomedulares have not been confirmed by all authors (Welsh, 1979; Heidbà ¼ chel and Vollrath, 1983), uanque if it has been suggested by others (Brumfield, 1970; Lopez Iglesias, 1987; peaks et al. 1992). Voltrath, (1981) describes several types of pineales according to their length in relation to the third Ventrículo, qualifying in pineales Type A (shorter), Type AB and Type ABC (longer), suggesting that these differences sizes could match types with different morfofuncionalidad ground. Recently Hira (1998) notes the existence of a gradient of progressive changes in the indices nuclear dela pinela of rat proximal and distal peripheral to the central, these results appear to point to what mentioned by some authors on the activity of the morfofuncional pineal. Based on these data, and responding to the majority of the experiences have not been followed by unplantamiento with some characteristics of hoarario, circadianidad and seasonality simlares, which may affirm or deny categorically's diverse morfofuncionalidad that some authors suggest, we raised this work in order to study whether the fluctuations duncionales pointed maintained or changed significantly over an entire year, and say besides these fluctuations sonsimilares odiferentes in each of the different prociones difinidas the pineal. MATERIALS AND METHODS To do the job we elected rat, being an animal that mostly covered by the literature in this type of studies. The pineal these rodents belongs to ABC type, so that the study will make it in each of all three portions. Sacrificaremos five animals every four hours apartir of 06:00 pm (local time) to schedule the same point the next day, so you will need 35 animals. This operation will be repeated in each of the four seasons. After obtaining the parts and their subsequent prosecution by the usual procedures, mount and teñiremos in porteaobjetos, from which the captaremos by a camera adapted to proceed with a microscope and image analysis program to identify variacioens volumetric delos nuclear indexes , hoping to gain some evolutionary graphics and compartivas between different portions of the pineal, between different points and times seen between each delas elected stations that will allow us to reach valid conclusions about our work. Our job is to basr in the study of the index cariométrico, expression volume nuclear whose manifestation of genetic variations are changes in cellular activity. In its calculation using the formula Jacobj (1935): V = pi / 6. A.AB.K. Where: V = volume Nuclear: A = diameter larger kernel, B = dle smaller diameter core, K = constrante conversion (= 1.72) Given the large amount of existing data and the status of temporary experiment, the statistical study arose the implementation of dela Variance Analysis from a model in which interactions are considered only second order and where explores the relationships between items considered schedules, the station dle year, the peripheral area or central regions proximal and intermediate or lasa distal gland, all through aplicac 8 ion of 1ff8 model: IXijKlm = hi ZK + + + ex rl + (hxe) ij + (hxr) il + (hxr) il + (exr) jk + (zxr) kl + ¬ â ijklm. Where h coresponde point harario, za the region, the area and re ¬ â is the mistake that is distributed and is independent of other remarks. RESULTS proximal portion (A) First, the overall analysis of the measures in the areas of the central and peripheral portion prosimal analyzed, are not unlike points schedules stations, shows that the average volumes of both area are not similar but those in the peripheral area are algho higher than those in the central zone. If desglosmos the evolution of each of the areas for hours points and stations, the major changes between each one. In the case of the layer "cortical", its evolution during the spring tien a peak at 06:00 hours descends to reach the minimum value at 14:00 hours to start again a curve literamente upward until 22: 00 hours a continuing slight decilinación at 02:00. In the case of the summer, the evolutionary curve is different, there are two peaks similar to 06:00 and 02:00 and a plateau thresholds downwards from 10:00 to 22:00 hours, being at this time last point is reached where the minimum value of the train station. During the otoñó, vurva has two components evolutionary. Between 06:00 and 14:00 hours are the minimum values following a gradual downward direction, while from that point inica an upward curve that reaches its peak at 22:00 am to return to descend sharply at 02:00 hours. The winter season is where there is a curve more erratic, with promotion and relegation alternative entities different points schedules, with the highest value at 14.00 hours and the minimum at 02:00. In evolucón cicadiana and seasonal average values of the area "or central core can be seen during the season of p rimavera that peak values occur between 06:00 and 10:00 hours began a decline from that point until 18:00 pm, hours maximum point decline, turning to inicier a gradual ascent until 02:00 pm. In the case delverano, the curve is almost similar to that of the peripheral area between the hours of the points 06:00 (maximum of the whole evolution) and 14:00, from which there is a climb to the 18:00 pm to return to descend in a progressive manner until 02:00 pm. In the fall, the curve presents a sharp peak of maximum value at 18:00 hours and a minimum of 10:00 between the two amounts cuva progressively until 14:00 pm and more steeply apartir latter point, vomliendo to decline constrantemente until 02:00 hours. Throughout the winter, volumetric values are similar to the 06:00 and 02:00, with values asceso and progressive decrease around the point of time which is the maximum value of 18:00 hours. Estacionalmente it can be seen clearly that the average value of the peripheral area are higher than those of the plant, with a aevolución mirror during the spring and summer, which tend to unite in esetaciones of short photoperiod. portion intermediate (B) if laprociónintermedia, unlike ocn the proximal portion, the average values of the peripheral area are lower than those of laporción Central. These differences are statistically significant. In the same way that occurs in the proximal portion in the middle The circadian and seasonal analysis shows significant variations occurring in the evolution of nuclear values. Developments circadiana of the cortical portion is similar in fotofases short (autumn and winter) where values are highest at the extremes dela curve, ie at 06:00 and 02:00 hours and the lowest between 14:00 and 18:00 hours, while during the spring valres are highest between the 22:00 and 02:00 am and the lowest at 14:00 am to values that remain high between 18.00 and 02:00 hours. in the central portion curves of fotofases long (Spring and Summer) will cruzándose what long delas 24 hours. In spring the highest peaks occur at 10:00 and 22:00 hours, with the area between the two lowest values of the evolutionary curve, 14:00 and 18:00 hours. In contrast, during the summer the highest values are attained such masmas hour, while the peaks are lower wings 06:00 and 10:00 hours. Curiously, the evolutionary curve of fotofases short (Autumn and Winter) although the totals are higher during the winter, run very similar between 06:00 and 14:00 hours coicidiendo the lowest values of the two curves at 18:00 pm, at which point the values are still rising winter gradually during the winter, while the autumn occurs unligero ascent followed by another modest declines. Developments in the peripheral and central areas in the middle ranges portion of the proximal and distal portions. values in this area of both layers are very similar over the four seasons. Observándose a light a downward trend since laprimevaera until autumn in both layers, which experienced a sharp rise in the winter. both inthe spring as the autumn, the core values sonsuperiores was puperponan in the summer and get older those of the peripheral area in the winter. distal portion (C) In the case of the distal portion, and as in the intermediate portion, the average total value of the central portion of the gland are significantly higher than in the peripheral. observation overview of the evolucín of curves areas peripheral and central portion of this, there are also variations, but these are so obvious as in the proximal portions and intemedia desceitas earlier. This part there are several interesting facts to emphasize. On the one hand, the curve of spring shows the highest values compared to the other stations, while the lowest of the summer. On the other side, the spring curve shows the highest values with ralción at other stations, while the lowest summer. Furthermore, the curves of autumn and winter are almost parallel evolution and values very easy, while the spring and summer, is overlapping between 06:00 and the 10:00 pm, bringing about a slight decline gracious and gentle curve autumn from 14:00 hours remains uniform for the rest of the points times, while the summer is experiencing a sharp rise at 18:00 hours to descend again at 20:00 pm and continue with values very similar to the early morning hours. region in the overall evolution of spinal curves circadianas is very similar to the peripheral area, especially during the summer , autumn and winter. one can observe a slight variation during the spring season which produce oscillations ascent (10:00 h), fall (14:00 h) and upload maximum at 18:00, similar to the layer peripheral with new descent and ascent in the points following schedules. seasonal evolution of both layers pineales in the distal portion of the same Co., is paraleal. with maximum values during the spring, fall in summer, autumn and taking manteniéndose in both curves to join in winter to descend uy rise slightly, medullary and cortical areas respectively. It destacr during tosas stations values of the nuclear core layer are greater than the peripheral you. DISCUSSION The first data concerning the existence of differences size nuclear dating back wing decade delos 60 dle past century and indicated that in the nuclear area medullary volumes were higher than in the cortical (Renzoni and Quay 8, 1964: e20 Quay and Renzoni, 1966). Subsequently Romijn (1975) described two alleged cortical and medullary regions in the pineal rabbit. since published papers on the subject hansido numerous and contradictory. Our results support, the existence of at least two zones (peripheral and central) and three servings (proximal, middle and distal ) in the et al. 1992: Hira et al: 1998; Martínez-Soriano et al. 2002). This is the first job, along with that of Hira et. al (1998), which is conducted in rats in a way systematic, taking into account not only factors fotofásicos, circadian or seasonal but also the location. systematization This not considereda in most lso studies conducted earlier, could be the explanation for the discordant results obtained in these studies. This distribution topográfia morfo-funcional is suggestive of the possible existence of several zonasl or "organ" in him parénquina pinela, which would justify the application of the term "complex pineal" whole, and that it could be a body with subórganos of carctrísticas functional cyclical different in inside. This hypothesis would be supported by data electrofisológicos (Dafny et al.1975; Semm and Vollrath, 1979 and 1980: Vollrath and Reuss, 1984) and even the existence of circadian rhythms, ultra and infradianos in secreciónde melatonin (Vollrath, 1984 ) in the light of tosso our opinion, one of the differentials may be the innervation of the pineal, as it is known to the distal region receives large numbers and vegetative afferent terminals from cervical ganglion higher, while in the region would proximal many of these fibers origin Central qu reach the pineal through the commissures habenualr and later. These differences could confer peculiariddes functional innervation different from these two regions, distal and proximal, is the area intemedia a transition zone esntre both. CONCLUSIONS So then, after decripción of the results obtained and on the same considerations we can arrive at the following conclusions of our work: 1. rates carimétricos total of porcióndistal are higher than those of the other two regions. 2. differences exist significant among cariométricos peripheral and central indexes of all regions pinerales analyzed. 3. rates carimétricos of the central area are significantly higher in the distal region and the peripheral area in the proximal and intemedia. 4. There are significant differences evolutionary circadiana. fotofásicas and seasonal between each of the three regions and two layers pineales analyzed. 5. It follows that the rat pineal has at least three regions teas and two tiers in each funcinalmente different.

Author: GARCÍA MEDINA JOSÉ JAVIER.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGIA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGIA.

Summary: Oxidative stress (imbalance between production and neutralization of free radicals, in favor of the former) has been implicated in the pathogenesis of many diseases according to the literature. The present study examines the role of oxidative stress and the influence of supplementation with a complex vitamínico-mineral with antioxidant properties (nutritional dose) groups of individuals with diabetes, hypertension and healthy, with special emphasis on the assessment of retinopathy diabetic and Hypertensive leves-moderadas on track for 5 years. It selected a total of 604 individuals in 1999 (distributed in a group of diabetes, hypertension group and the group of healthy controls) who were subjected to a detailed anamnesis (contemplating possible risk factors for retinopathy), measuring the voltage diastolic blood pressure (TAD), a complete eye examination and determination of blood parameters classics (glucose, glycated hemoglobin, total cholesterol, HDL, LDL, urea and creatinine) and parameters emerging indicators of stock oxidativo-antioxidante (malonildialdehído (MDA) , the total antioxidant activity and superoxide dismutase activity). Part of the sample was randomly assigned to antioxidant supplementation. Annual revisions were made to highlight changes clinical strengthen intake of the supplement and note any changes affiliation. At the end of follow-up (2004) were subjected to a anamnesis, physical examination and analytical identical to the original to the 490 individuals who remained in the study. It showed that the balance of oxidative activity was altered in groups of diabetes mellitus and hypertension, in favor of oxidative stress, with respect to a group of healthy controls. Studies were conducted correlation between the different parameters, obtaining significant association between duration of illness and degree of retinopathy, MDA and glucose, and total cholesterol and MDA in blood. It was found that increased oxidative activity and decreased antioxidant activity related to the progression of diabetic retinopathy and hypertensive although levels of biochemical markers of oxidative status antioxidants were not associated with the degree of severity of impairment eye. Visual acuity media with the best correction and the TAD not changed in the groups and subgroups along the track, regardless of whether or not to receive the supplement. However, the degree of retinopathy, diabetic and hypertensive, stable in groups and subgroups with supplementation and worsened in subjects without antioxidant supplementation. Moreover, the antioxidant supplementation was reflected in the maintenance and improvement of plasma antioxidant status and the concomitant decrease of the activity prooxidativa plasma. In summary, the results suggest that oxidative stress is implicated in the pathogenesis of diabetic retinopathy and hypertensive and that the long-term supplementation with a complex vitamínico-mineral with antioxidant properties to diminish their nutritional dose clinical progression in early stages.

Author: MARCO GIL MARÍA DOLORES.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGÍA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGÍA.

Summary: The surgical removal of the lower third molar Included is the most frequent intervention of those in the oral cavity due to the high incidence with which appears in the current population. Almost always associated with postoperative pain swelling and trismo, demonstrations that are directly related to the manipulation of soft and hard tissue during surgery. In an attempt to ascertain to what extent the surgery affects the postoperative, justify the study of 200 patients who underwent the surgical removal of a third lower molar included and have the following scenarios: surgery more complex, more time ostectomía, with dental and longer duration, will have greater postoperative side effects. The targets set were: 1) Know the clinical development of pain and inflammation during the first week after surgery, depending on the scale analógica-visual for pain, and a scale of four descriptive values for inflammation. 2) Determine what intraoperative variables influencing the postoperative period. 3) To explore how these variables influence intraoperative in pain, inflammation and trismo postoperative. Following a protocol previously established intervene surgically 200 healthy patients, which were extracted 200 third impacted mandibular molars, in all cases using the technique of vestibular approach. The protocol recorded in an orderly and detailed curriculum vitae of interest, clinical and radiographic, and the variables of postoperative pain, swelling, trismo and hematoma. The data is coded according to the targets set. We conducted a thorough statistical treatment; descriptive analysis of each of the variables, test parametric and non - parametric tests correlations timely, and we found the statistical significance tests employed through the p-valor with a value of less than 0Â'05 . The average age of our patients was 25Â'9 years, 65Â'5% were women, most of the cordales were semiincluidos 42Â'5% and submucosal 44% position mesioangular 37% and vertical 31%. The ostectomía was performed in 91% of cases, with a median time of 174Â'72 seconds. The dental was used in 98 cases, and the average length of our interventions was 29 minutes higher compared with the series of other authors reviewed According to our study and concurring with the majority of authors 1-Los patients showed maximum pain at 6 hours after surgery, he was of moderate intensity decreased progressively until almost negligible at seven days postoperative, and was higher in the elderly 2-La maximum inflammation of the patients had occurred at 24 pm and was of moderate intensity a severe, began to decrease from the third day, and was void or in some cases, mild to seven days postoperative. 3 - The ostectomía, dental and duration of the intervention positively influenced the postoperative patients. 4 - The ostectomía was associated with increased inflammation and trismo, and increased dental pain and trismo. 5 - The duration of the intervention influenced very positively in all postoperative manifestations, is therefore a very important data for predicting the postoperative our patients. 6 - The highest level of trismo appears at 48 hours and continued for 7 days post-operatively. It was higher in women and in the longer speeches, where he practiced ostectomía and dental.

Author: MUELA MOLINERO ALBERTO.
Year: 2004.
University: LEÓN [More theses of this university] [www.unileon.es].
Place of defense: FACULTAD DE VETERINARIA.
Place of preparation: UNIVERSIDAD DE LEÓN.

Summary: INTRODUCTION: The phenomenon of primary malignant neoplasms multiple (NPMM) has risen in recent decades to be considered in isolation or whim of nature to be established as a reality oncology worthy to be taken into account. But in his study, there are many gaps, leading to a chaotic accumulation of information does not allow qu draw conclusions useful for the clinician in the prácrica daily. Objectives: The main objective of this thesis is to describe the characteristics of patients diagnosed with NPMM in the area of health Leon, as well as malignancies associated with this phenomenon more frequently. Secondary objectives were to determine the incidence of NPMM synchronous and metacrónicas, his prognosis, and the variables that affect it, and finally, to determine the impact on the survival associated with the suffering of a NPMM in the general population oncology, analyzing groups more prevalent in our entrono, ie tumors colo-rectales and urologic. PATIENTS AND METHODS: Using data from the Registry of Tumors Hospital Leon has analyzed the characteristics of the cancer patients diagnosed furante the years 1993-2002 that have been diagnosed with a NPMM. CONCLUSIONS: NPMM constitute a major problem affecting our health area around dle 3% of the population cancer was more common among men lso and anicanos. Half of the patients with NPMM presented background cancer in first-degree relatives, suggesting that there may be a hereditary basis serving as predisposing factor in the development of a NPMM. Also, the external carcinogens, prinicpalmente alcohol and snuff, play a crucial role as advocates for the development of a NPMM. Neoplasms most frequently voiced associated with NPMM were the most prevalent in the general population of our area health, ie tumors digestive urológicas neoplasms and tumors vias aerorespiratorias and digestive superiors. The most frequent associations of NPMM were multicenter, both colo-rectales as urológicas. The period of greatest risk for developing a NPMM metacrónica are the first three years after the first diagnosis of the tumor. The prognosis of these patients in generally similar to that of patients with malignancies unique so it is essential to deepen him study of a cancer patient with two to differentiate clearly recurrence, tumor progression and NPMM. The characteristics of the second neoplasm, its location, the stadium and the kind of treatment received are prognostic factors in the majority of cases. Patients diagnosed with cancer with a history of first-degree relatives with cancer, and male smokers constitute a very high-risk population for developing a NPMM. The high number of malignancies relacinadas with consumption detabaco, advised the suspension of habit tabáquico around cancer patient.

Author: CHALMETA VERDEJO CONCEPCIÓN.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA.

Summary: The differential diagnosis of stress fractures knee includes conditions that are clinically enrolling in a similar manner. The importance of a correct diagnosis at the earliest time possible, is essential for proper treatment and can be determinant of prognosis. Our study, on a prospective basis, aims to achieve an early diagnosis of stress fractures of the knee, conducting a physical examination and directed anamnesis of the painful knee for areas hypersensitivity shinbone and femoral condyle, asking the precociously imaging tests necessary (bone scan and / or MRI) if the suspicion is high and diagnostic radiography simple knee is nonspecific. The profile of our group of patients were elderly and overweight. More than half of patients (57%) were located in pain shinbone internal; not keeping pace defined in pain and in most cases the pain is not interrupted sleep at night. Tests conducted showed image, radiology simple, moderate degenerative changes in most patients. The bone scan showed abnormalities consistent with a diagnosis of stress fracture in 75.51% patients, of which 14 diagnosis coincided with the MRI, showing a sensitivity of the technique in our case of 93% and a specificity of 34.3 %. After installation of treatment observe amelioration of pain up to 50% of the initial value of the EVA in 69% of patients within the first month of treatment. On the third month of follow-up, 38 patients had a VAS <5mm and 8 patients were asymptomatic (EVA = 0mm). Conclusions: 1. Our data indicate that stress fractures in the knee are common, although the data on this preliminary pathology confined to sporadic cases (when the patient profile defined in our series), so that the causes of knee pain should to be evaluated independently of the radiographic findings of osteoarthritis 2. The bone scan technique is a simple and low cost, which allows an orientation of the problem when the time evolution is a few months but low specificity of the same may require the completion of an MRI for a diagnosis.

Author: LOPEZ SERRANO ANTONIO.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA..
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA.

Summary: Background: Acute Pancreatitis (PA) is a disease of rapid establishment and that can present complications, both local and systemic, and may jeopardize the lives of patients. For proper management of the disease is important to identify those with an increased risk of presenting them, and there are various systems developed for predicting disease progression (clínico-analíticos, laboratory tests and imaging tests). Moreover, some studies have shown that white blood cells play a key role in the pathogenesis of the PA. These can be located in the inflamed area marked by Gammagrafías leukocyte (GLM) with radionuclides. It has been suggested that the location of these white blood cells in the pancreas area can be a sign of poor prognosis. Objectives: To assess the usefulness of the GLM with 99mTc-HMPAO in predicting the severity of the PA compared with other systems that have the same goal. In addition, valuing this technique as evidence of image alternative to contrast enhanced computed tomography (TCRC). Materials and methods: prospective study in which they included 92 consecutive patients with PA in which there is a clinical indication for an TCRC. We calculated systems multifactorial prediction of the severity of the PA Ranson, Glasgow and APACHE-II, plasma levels of C-reactive protein (CRP) between 48-72 hours after hospital admission and forth by gravity computed tomography (IGTC) from the 72 hours after hospital admission. We conducted a GLM with 99mTc-HMPAO with imaging anteroposteriores to 30 minutes and 3 hours after injection of tracer and a SPECT centered mesogastrio, with 4 degrees of pathological isotope uptake in the area pancreatic: grade 0, no catchment ; grade 1, attracting less than or equal to that of the bone marrow; grade 2, attracting greater than that of the bone marrow and less than or equal to the liver; grade 3, the highest uptake of the liver and less than or equal to spleen. Statistical analysis included descriptive analysis of the variables and to assess the predictive power of the gravity of the PA evidence in the study were calculated sensitivity, specificity, positive and negative predictive values, areas under the ROC curve [and its interval confidence 95% (95% CI)] and likelihood ratios. We calculated the risk of serious PA through a logistic regression analysis (odds ratio). For GLM, was also calculated the sensitivity, specificity and odds ratio for each level of activity gammagráfica. Bivariate analysis was conducted according to the presence or absence of pathological isotope uptake in the pancreatic area. It was also calculated sensitivity and especicifidad of GLM for the diagnosis of PA forecasting severe (defined it antre presence: 3 or more factors Ranson or Glasgow or 8 or more points APACHE-II, or PCR equal to or greater than 150 mg / L, or degree of pancreatitis, pancreatic necrosis presence or IGTC of 4 or more points). To study the usefulness of the technique GLM as an alternative to the TCRC were selected patients who saw the TCRC> 3 days and scintigraphy <8 days after the onset of symptoms and a intervaloentre both tests +-2 days. The degrees of pancreatitis was agruparonen A, BC and DE, pancreatic necrosis in present or absent and gradosde lagammagrafía en0, 1and 2-3. To compare the IGTC and GLM is realizóla test Kruskal-Wallis. These patients were also compared GLMcon serum CRP through an analysis of variance (ANOVA). Addition, it was felt statisticians Gamma deGoodman yRho of Spearmancon intend to measure, respectively, the correlation between GLMy the IGTC and GLM and serum levels of CRP. The match entrela GLM and the TCRC was estimated by the statistical 8 s Cohen 1757 and kappa ponderado.Secalculólasensibilidad, specificity and the ratio of each probability level of activity gammagráfica to detect damage pancreáticoimportante (ie OF degree of Balthazar and / or the presence of necrosispancreática). In addition, with this mismoobjetivo, we calculated the area bajola ROC curve [and his confidence interval 95% (95%)] of the GLM yde PCR. For the analysis of data were considered as significativosvalores p <0.05. Result: The study included a total de92pacientescon PA, 64% males and 36% females. Mean age was 59 years (range: 20-96años). The etiology biliary was the most frequent (46%), followed by alcohol (25%). The PA was mild in 79 patients (86%) and severe in 13 patients (14%). Lascomplicacionesque presented patients with severe PA were: necrosispancreática (11 patients), pseudoquiste pancreatic (two patients), hypocalcemia (a patient) and insufficient respiratory (one patient). After making the GLM con99mTc-HMPAO, 43delos 92 patients (47%) presented captaciónpatológica of tracer level pancreatic; grade 1 in 24 patients (26%), grade 2 in 14 patients (15%) and grade 3 in 5 patients ( 5%). In restantes49 patients (53%), there was no actividadgammagráfica (grado0). According lagravedad's episode, PA severe higher scores inall indices in the study (p <0.05), the largest difference for laPCR, the IGTC and GLM (p <0001). All systems analyzed presentanunos VPN elevated (> 90%), being the VPP the GLM the highest (58%), with a sensitivity of 85% and a specificity of 90%. The areas under the ROC curves showed that the PCR and GLM will have a similar accuracy for the diagnosis of acute PA, accuracy greater than systems multifactorial. The results of the logistic regression model, we show that patients with scores Ranson, Glasgow and APACHE-II of more than 3, 3 and 8 points, respectively, presented a risk of a PA severe 11, 11 and 6 times higher respectively, the remainder of patients with lower scores, the risk of having a serious PA is 10 times higher in patients with a PCR of more than 150 mg / L than in the rest, and patients with a GLM grade 2 -3 present a risk to present a serious PA almost 50 times higher than the rest of patients. The odds ratios were consistent with this finding, being the largest of all the GLM 2-3, with a value of 8; thus, the pretest probability of proof from a 14% amounted to a probability posttest of 58% . The analysis of the variables predictive of the severity of the PA on the basis of the positivity or negativity of the GLM, showed that there were only statistically significant differences in the values of CRP and the IGTC (higher value on the positive GLM) , and there is a correlation between GLM and the PCR and the IGTC (p less 0,001). It was the highest activity rate gammagráfico in the PA with forecasting severe than in the forecast mild (p less 0,001). After selecting 66 patients to assess the GLM as a technique for image alternative to the TCRC, the degree of uptake gammagráfica was related to the components of the IGTC (degree of pancreatitis and pancreatic necrosis, p less 0,001). The correlation between GLMy the degree of pancreatitis, was kappa = 0.54 (95% CI = 0.37-0.71) and weighted kappa = 0.68 (95 = 0.51-0.84). There was a statistically significant correlation (p less 0,001) between the activity grammagráfica and IGTC, with a correlation coefficient of Goodman of 0.82 (p less 0,001). Plasma levels of CRP were significantly higher in patients with a positive GLM where was negative (p = 0.021) with a correlation coefficient of Spearman of 0.44 (p less 0.01). (Figure 7). The ROC curves of the GLM and PCR showed that both methods have a similar capacity for the detection of pancreatitis and for the detection of pancreatic necrosis, although differences for pancreatic necrosis approached statistical significance in favor of GLM (p = 0.068). The values of sensitivity, specificity and odds ratio of GLM in detecting the degree of pancreatitis were 62%, 96% and 14 respectively, and in detecting necrosispancreática, 90%, 90% and 8, respectively. Conclusions The results of this study indicate that: 1 .- The complications presented by patients with PA entrants usually in the room hospitalization Digestive tend to be kind locally, especially pancreatic necrosis. 2 .- In these patients, the GLM with 99mTc-HMPAO is a reliable technique for the assessment of the gravity of the PA. 3 .- The GLM with 99mTc-HMPAO show greater precision clinical systems and / or analytical standard for predicting the presence of severe PA. 4 .- The GLM with 99mTc-HMPAO is useful as a technical alternative to the TCRC for estadiaje of the PA. 5 .- It would be of interest conducting more studies that include a larger number of patients with systemic complications to assess the usefulness of the GLM with 99mTc-HMPAO in this situation.

Author: RODRIGO GUANTER VICENTE.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA DE VALENCIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA.

Summary: INTRODUCTION The evidence that the growth and progression of prostate cancer is dependent angiogenesis has been demonstrated by the correlation between tumor neovascularization in prostate tissue with the increase in vascular density and the expression of the angiogenic growth factors. There is evidence supporting the involvement of growth factors VEGF and bFGF in the development and progression of prostate cancer. OBJECTIVES To check if there is a relationship between serum levels of VEGF and urinary bFGF with benign and malignant prostate at the time of initial diagnosis. To determine whether there is a relationship between serum levels of VEGF and urinary bFGF with serum PSA, age, clinical tumor stage, grade of Gleason and the presence of metastases at the time of initial diagnosis, as well as the cancer mortality specifically in the first eight years of follow-up. MATERIALS AND METHODS was quantified by ELISA techniques, serum VEGF and bFGF in the urine of 71 patients with an indication of prostate biopsy for suspected malignancy. We grouped according to the results of the biopsy in group A, 23 patients with adenocarcinoma of the prostate, Group B: 48 patients with benign prostatic hyperplasia. RESULTS appreciated significant differences between the values of serum VEGF and the presence of metastasis. There was no significant difference between the values of serum VEGF and urinary bFGF with both study groups or with the age of patients, PSA, clinical stage, and Gleason grade of cancer-specific mortality. CONCLUSIONS High levels of VEGF in the serum are associated with patients with metastatic prostate cancer. Quantifying the levels of VEGF may be useful as a marker of disease spread and may add to the prognostic information provided by the degree of Gleason, clinical stage and PSA serum.

Author: TORRES SÁNCHEZ Ma. TERESA.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FA CULTAD DE MEDICINA Y ODONTOLOGIA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGIA.

Summary: INTRODUCTION: The management of breast cancer has changed in recent years, tending ever to perform surgical more conservative attitudes. Thanks to the methods of screening diagnose this disease becoming more early in stadiums for estadiaje status of axillary lymph homolateral remains today an important prognostic factor. Approximately 70% of the axillary linfadenectomías are negative, the rise in these diseased morbidity innecesariamente.El study of the sentinel node is proposed as a minimally invasive method to ascertain the status axillary without need for lymphadenectomy in a systematic way. If we can validate this technique a sentinel node negative axillary would not make lymphadenectomy. OBJECTIVES: 1-Validar the technique of sentinel node in our working group. 2-Getting an index of technical efficiency exceeding 90%, and a false negative rate of less than 5%. 3-Conduct a statistical study, using a regression model Logistics simple to detect which variables at the individual level, can alter the overall diagnostic indices. 4-To carry out a statistical analysis using a model of multiple Logistic Regression to detect what possible combinations of variables can alter the overall diagnostic indices. 5-Rate, based on our data of sensitivity and specificity, as well as the threshold prevalence of the disease, what kind of sick we must apply the technique. MATERIALS AND METHODS: Of the patients diagnosed with breast cancer who have been sent to the Department of Surgery Hospital Dr.Peset between March 1999 and June 2002, we have selected our group of patients, according to our inclusion and exclusion criteria. 2-18 hours before the intervention takes place peritumoral injection of the tracer, it is Nanocoll * in a volume of 4ml marked 1mCi of Tecnecio-99. We shall now proceed to obtain images through a gammacámara that captures the isotope, and a computer that processes imágenes.En surgery by detecting gamma probe (Navigator *) locates and removes the sentinel node, it refers to pathological anatomy where is studied by staining with Hematoxilina - Eosina and if accurate Citoqueratinas. EVALUATION OF STATISTICAL METHODS: We analyzed a number of variables to test the correlation between the pathological anatomy of sentinel node (QA) and the axillary lymphadenectomy (LA). To do this we: descriptive analysis of the variables, calculating indices global diagnostics (Sensitivity, specificity, positive and Likelihood Ratio negative Prevalence of axillary lymph affected, and Positive and Negative Predictive Value), multivariate analysis using the Logistic Regression first simply place to detect which variables at the individual rates can alter global diagnostics, and then how to detect multiple possible combinations of variables could alter these indexes, finally calculating the thresholds prevalence of the disease to detect where the patient is indicated technique. RESULTS: Average GC removed: 1.59. 1 GC 47.5%. Technical Efficiency: 93.7%. Sensitivity: 87.5% (61-98), negative predictive value (NPV): 96.2%. Overall prevalence of axillary involvement in the lymphadenectomy: 21.3% (13-33). Logistic regression simple: VPN in tumors <2cm 98%,> 2cm 85%. Multiple logistic regression: VPN ranging from 37% to 100 % VPP range 23% -98%. Thresholds prevalence: below 0.8%, above 27%. CONCLUSIONS 1-En our study, 80 cases have achieved some results in terms of adequate Effectiveness Technical, and VPN. 2 - If it meets the criteria for exclusion, sentinel node biopsy, is a high docs 8 isión pa 63b ra identify a negative armpit. 3 - The linfogammagrafía prior to the intervention, aid for intraoperative localization of sentinel node. 4-To evaluate a new diagnostic test, it is not enough to calculate the overall results, because if we apply the Logistic Regression, we found that a negative sentinel node does not guarantee a negative armpit in any situation. 5-In tumors under 2cm. The technique has a high Negative Predictive Value, therefore, in these cases the technique is indicated. 6 - With our data, we can not conclude that a positive sentinel node indicates a negative armpit, and that there is no combination of variables that we demonstrate a Positive Predictive Value of less than 10%. 7 - If we apply our data to the study of thresholds prevalence of the disease, we obtain a lower threshold of 0.8% and a threshold of 27% Senior.

Author: Velló Ribes María Ángeles.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: Facultad de Odontología.
Place of preparation: Facultad de Odontologia (Universidad de Valencia).

Summary: Introduction: The children of low birthweight presented some defects in the development of tooth enamel which are of 3 types: the opacity, hypoplasia and the defect combined. Objectives: To determine the prevalence of enamel defects in children of low birth weight. To compare the prevalence with other control groups. Evaluate whether there was a pattern of involvement by enamel defects in these children. E identify factors that may induce perinatal enamel defects in children with low birth weight Material and Methods: The sample consisted of 152 children. And was distributed in 3 groups. Group 1 consisted of 52 children born in the BPN Clinical Hospital in the city of Valencia, with an average birth weight of 1950g (590-2480g), and a mean gestational age of 34.4 weeks (25 - 37 wk), and of this group, 18 children were intubated in the neonatal period, the Group 2 consisted of 50 children born PNN in the same hospital that the group 1, with an average birth weight of 3383g (2750 - 4650 g) and the Group 3 consisted of 50 children PNN who attended a dental clinic or revisions to the treatment, with an average birth weight of 3293g (2700-4000g), children in groups 2 and 3 were conclusion. The criterion for selecting the sample was that children born between 1995-1997, for the day of the review were between 4 and 5 years. The data were collected demographic background; pregnancy, childbirth, birth weight, gestational age, size for gestational age, Apgar score, assisted intubation and ventilation, phototherapy, food and other diseases. The exploration was carried out by a single browser, using the dental chair, light equipment, mirror, probe and gauze to dry teeth. There were defects of enamel (DDE Index) in primary teeth. For the statistical method was used: Descriptive statistics and frequency tables. To compare the variables, analysis of variance, Student's t tests and Pearson correlations. Results and conclusions: The prevalence of enamel defects in the overall sample was 84.9%, higher prevalence of opacities (79.6%), followed by hypoplasias (34.2%) and the combined default (7.2%). The prevalence of hypoplasia was higher in group 1 (59.6%), particularly those who were intubated (72.2%), followed by group 2 (16%) and group 3 (26%). The prevalence of opacities was high but there was not much difference between the groups in the sample, as well as the combined default. The average number of teeth affected by enamel defects in the overall sample was 4.6. The average number of teeth affected by defects of enamel in general in group 1 (mean = 5.7) was statistically higher than the average for the group 2 (median = 3.6). The average number of teeth affected by defect type hypoplasia was statistically higher in group 1 (mean = 1.6) than in group 2 (mean = 0.3) and group 3 (mean = 0.4). In group 1 defects type hypoplasia were located in the temporary incisors, whereas in group 2 and 3 defects type hypoplasia were located in temporary canines and molars. In group 1 defects observed in the incisal portion of the teeth and in groups 2 and 3, were found on the faces vestibular. The children in the sample who were intubated in the neonatal period had a higher prevalence of enamel defects than those who were not intubated, greater involvement by default combined and the defects were found in hemiarcadas left. Some perinatal variables such as low birth weight, age of mother, higher consumption of cigarettes in pregnancy, multiple births, caesarean section, artificial feeding, food parentaral, low gestational age, low apgar score, mixed acidosis and respiratory problems were statistically associated with a higher prevalence of enamel defects.

Author: ATIÉNZA GÓMEZ M. CARMEN.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA.

Summary: Work hypothesis: evaluation of analgesic efficacy of a new local anesthetic via epidural, levobupivacaine, in relation to other local anesthetics (bupivacaine and ropivacaine) for pain control of the first stage of labor childbirth. Objective: To evaluate the no-inferioridad in terms of analgesic effect of bupivacaine and levobupivacaine versus ropivacaine. Attempts will be made to demonstrate that analgesia obtained with levobupivacaine 0125% plus 1 g / ml fentanyl, which is administered for continuous infusion in the first stage of work delivery, is non-inferior to that obtained with doses equianalgésicas of two other local anesthetics: Bupivacaine 0125 % fentanyl 1 g / ml and Ropivacaine 0.2% more fentanyl 1 g / ml. Secondary objectives: Starting dose (amount of local anesthetic required time needed for the establishment of analgesia); consumption of local anesthetic during continuous infusion; Blockade motor and sensory; Stability maternal hemodynamics, side effects and maternal satisfaction; impact on the dynamics childbirth and clinical status of the newborn. Materials and Methods: After obtaining the approval of the ethics committee, included 102 patients (after signing informed consent) in the clinical trial, double-blind NO-Inferioridad. Criteria: cervical ripening 4cm, primiparous, ASA I-II fetus 37 weeks only, cephalic presentation. They are distributed randomly into 3 groups to receive continuous infusion of anesthetic assigned (8 mL / h). At any time during the period of expansion that featured an EVA 4 (analgesia inadequate) was administered a bolus for rescue analgesia: 8ml local anesthetic in the study. The primary endpoint: comparison of the difference in pain from baseline among the three groups by EVA (0 to 10 cm) for 60 minutes. If the estimate of the difference in averages in assessing pain using EVA between groups at 60 'and its upper limit of the confidence interval at 95% bilateral failed to exceed the delta design (d = 1 cm) , it could be concluded no-inferioridad. We +15 min +30 min and every hour until full dilatation degree of pain (VAS), motor block, block sensitive, vital signs (TA and FC), and adverse events. Statistics: Test Fisher (categorical variables), Anova (continuous variables) and Kruskall-Wallis (ordinal variables). If global significance perform contrasts post (Bonferroni approximation). 97 patients completed the study. Results: Similar groups (demographic characteristics and obstetrical). Mean Difference of the degree of pain (60 min): levobupivacaína-bupivacaína 1.86 (0.97-2.74); levobupivacaine -ropivacaína 1.82 (0.95-2.68); bupivacaína-ropivacaína -0, 04 (-0,92-0,83), mean difference (95%). The degree of pain (VAS) increased with Levobupivacaína that Bupivacaine and Ropivacaine (all periods of observation, p 0.05). Consumption local anesthetic: 13.48 mg / h 10,6-16,9; 10 mg / h 10-11,5 and 16mg / h 16,0-16,0 levobupivacaine, bupivacaine and ropivacaine (respectively), medium range intercuantil , p. 0001. Need for bolus rescue 24, 8 and 3 patients levobupivacaine, bupivacaine and ropivacaine (respectively) median, p 0001. Duration of and need for continuous infusion dose perineal similar between groups. Locking engine: bupivacaine higher than levobupivacaine (p = 0013). Among other groups with no difference. Blocking sensitive no differences between groups. Starting dose: 12.5 mg 12.5 -20; 12.5 mg 12,5-12,5 and 20 mg 20-20 levobupivacaine, bupivacaine and ropivacaine, respectively, median range intercuantil, p 0001. Without differences in the need for rescue initial bolus or time calls 8 box 76b analgesia initial. Side effects, type of delivery, neonatal and maternal satisfaction state with no difference between groups. Conclusions: It is not possible to conclude the non - inferiority of levobupivacaine or bupivacaine or ropivacaine in the scheme administered and the population studied. We can not claim that it provides analgesia levobupivacaine is similar to that analgesia provides us with bupivacaine and ropivacaine. The consumption of local anesthetic in mg / h during the dilation was ropivacaine levobupivacaine bupivacaine. Maximum motor block reached higher in the bupivacaine group in the levobupivacaine group. There were no differences in initial dose of levobupivacaine and bupivacaine. The initial dose of ropivacaine was greater than that of levobupivacaine and bupivacaine. There was no difference in the time required for the initial establishment of analgesia between the three groups. There were no significant differences between groups Levobupivacaína, Bupivacaine and Ropivacaine in blocking obtained sensitive, maternal hemodynamics, side effects, maternal satisfaction, the impact on the dynamics of delivery nor clinical status of the newborn.

Author: MARIN GOMEZ MANUEL.
Year: 2004.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: FACULTAD MEDICINA.
Place of preparation: FACULTAD MEDICINA.

Summary: OBJECTIVES The overall objectives of the research project are: 1.Describir, from the information available in the Basic Minimum Data Set (CMBD), surgical complications occurred and detected by the program Detection Complications (CDP) - the adaptation of Complication Screening Program (CSP) to CMBD the Spanish National Health System in patients undergone major surgery at the hospital in Mataró during the period January 1995-Junio 1999. 2. Analyze the factors of the patient's income (including temporary) and intervention, which are associated with the presence of complications. 3. Monitor surgical complications through the analysis of the temporal evolution of complication rates to identify the possible existence of moments with a higher incidence of complications, once controlled the differences among patients that could justify the change in rates. MATERIALS AND METHODS retrospective cohort of all episodes of hospitalization, with at least three days of stay (6928), included in the group of "major surgery" CDP from January 1995 until June 1999 (two months included) in the Hospital Mataró (Barcelona). Patients were followed to identify complications from entry to discharge, strictly using data from the Minimum Data Set Basic (CMBD) at discharge Hospital Mataró the years 1995 to 1999 (the latter only for the first six months) , was performed a descriptive analysis of the characteristics of the episodes of hospitalization, including the proportion of complications identified by the CSP. This was followed by an analysis of bivariable associations of greater interest among the patient or episode and the presence of complications. It also conducted a multivariate analysis (logistic regression), to assess the factors associated with the presence of complications controlling the effect of other covariates and subsequently modelizó the risk of developing complications intrahospital (predictive model). Finally, to study the possible relationship between the months and years and the presence of complications, controlling for other covariates, a modeling of the time series by a Poisson regression. First, as in previous phases, an explanatory model, and once established, we moved on to determine the predictive model, based on the model saturated (all variables) and by eliminating those steps did not make a significant predictive capacity the model (LR test or test because of verisimilitude). Determined predictive model, were detected unusual month from the contrast between observed and expected rates. It was found if the oscillations observed in the rates of complications in the series there was a trend or seasonal behavior is not controlled through an analysis of the same figure, representing the substrings through annual and monthly charts boxes, as well as the diagnosis and control autocorrelation (auto correlation functions of ACF and ACF partial) model basal RESULTS Screening Program of complications identified 732 episodes in which there had been a complication hospitalized, which accounted for 10.56% (95% CI: 9.85 - 11.31) on total 6928 episodes surgical treated in the period. The most frequent were the surgical wound infections, present in 211 episodes (28.83% of the total complications), followed by bruising or bleeding postprocedimentales with 137 cases (18.37%) and complications iatrogénicas (14.89% ). The least common were those related to the urinary tract and the central nervous system and peripheral (0.14% each) These complications occurred primarily in episodes from the GDR 148 "major interventions on the small intestine. Thick with cc , "with 108 episodes com 8 plicados d44 a total of 259 (41.70%), the GDR 358" speeches on the uterus and annexes, no malignancy, with cc "with 83 cases complicated about 218 (38.07%) ; GDR 209 "Interventions articular higher / lower limb rehabilitation" with 56 cases on 575 (9.74%), or GDR 210 "Interv. hip and femur, except those in the GDR 209, age> = 18 with cc" 54 episodes on 230 (23.48%). Other GDR presenting a high proportion of episodes were complicated for the GDR 164 "Apendicectomía diagnosed with primary complicated, with cc" with 27 cases on 31 (87.10%), the 166 "Apendicectomía without primary diagnosis complicated, with cc "with 18 cases on 40 (45.00%) or 146" rectal resection, with cc "with 31 complicated cases on 66 (46.97%). The highest rates of complications, both in the analysis and logistical bivariable, are positively associated with male patients, belonging to groups older, with a greater burden of comorbidity with greater severity of their diagnosis or complexity of the interventions they were subjected, as well as the income urgent. Moreover, the modeling temporary (Poisson regression) were associated significativavente in a positive manner to higher rates of complications during February (IRR: 1001), November (IRR: 1002) and with a Charlson comorbidity> 1 (IRR 1.04), while the month of August, 1999 and the Level of Risk 1 (complexity of the episode and / or intervention average) had a negative association (IRR 0.99). The series showed a downward trend in complication rates from mid-1998, with substantial variability in different months and some seasonality. CONCLUSIONS 1. The surgical complications were associated positively to sex (male), age, as measured by higher comorbidity index Charlson, and the greatest severity and complexity of the processes. They were also associated income urgent. 2. The surgical complications, once controlled factors of patient severity and income presented temporary differences, with a reduction in the months of August and by the end of the follow-up period. 3. The predictive models of complications developed, both based on individual data such as those based on aggregate data monthly statistics showed a good performance and a predictive capability sufficient. 4. The series of complications due (according to the multivariate adjustment for risk factors identified) differed from those observed, suggesting that the hospital Mataró reduced its rate of complications adjusted for severity in the past year period studied.

Author: BARA CASAUS JAVIER.
Year: 2004.
University: INTERNACIONAL DE CATALUÑA [More theses of this university] [www.unica.edu].
Place of defense: CAMPUS SANT CUGAT.
Place of preparation: CAMPUS SANT CUGAT.

Summary: In this thesis are reviewed a total of 240 tumors of the parotid gland, diagnosed and treated in the Service of Oral and Maxillofacial Surgery Hospital Gregorio Maranon in Madrid and at the Institute of Maxillofacial Surgery Dr.Acero Madrid during the period of time between the years 1988-1999. There will always be a retrospective clinical study of 131 cases of adenoma pleoformo. The findings of the study were as follows: 1. The adenoma pleoformo of the parotid gland is the most frequent tumor. 2. Most of our review of clinical data stored fully consistent with data from other published series. 3. The diagnosis of adenoma pleoformo of the parotid gland is essentially clinical, and the physical examination paramount. FNAB represents the diagnostic method of choice next to thorough clinical examination. Other diagnostic techniques only help in the surgical approach. 4. The enucleation or tumor biopsy techniques are contraindicated in the management of such tumors, as they are associated with a high rate of tumor recurrence. The parotidectomía surface is considered by us as the téÑcnica surgical minimum to perform in a patient affection of one adenoma pleoformo of the parotid when located in the superficial lobe. 5. Our casuistry shows a low rate of tumor recurrence and get control of the tumor in most cases recidivados treaties. 6. Conducting a enucleation or a parotidectomía total relate to a higher percentage of permanent facial nerve injury compared with the practice of a parotidectomía surface.

Author: SÁEZ CASSANELLI JOSÉ LUIS.
Year: 2004.
University: PABLO DE OLAVIDE [More theses of this university] [www.upo.es].
Place of defense: FACULTAD DE CIENCIAS EXPERIMENTALES.
Place of preparation: FACULTAD DE CIENCIAS EXPERIMENTALES.

Summary: The project was based on the study of the analgesic effects of the Restriction Calórica (CR) and antagonism specific cannabinoid receptor type 1 (CB1-R) on pain (acute and subcrónico) heat and visceral. My job has consitido around this time in using experimental mice race swiss (albino) and subjecting them to both treatments (RC and antagonism of CB1-R). The analysis of the interaction between the opioid and cannabinoid system, which was the main point of our study, first carried out through in vivo studies (behavioral). Secondly techniques were used to study post-morten (immunohistochemistry and PCR), which we used to correlate cellular and molecular bases underlying the analgesic effects expressed by animal study. Soon these works will be submitted for consideration by international experts with a view to their subsequent publication in scientific journals.

Author: ARROYO DOMINGO MARTA MARÍA.
Year: 2004.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGÍA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA DE VALENCIA.

Summary: The objective of this thesis is to study the infiltration of thyroid cartilage in the larynx cancer. The determination of the invasion cartilage is essential for the diagnosis of laryngeal extension of the tumor. It is necessary to know its possible involvement in order to perform the estadiaje of patients in a way that allows precise choose the most appropriate treatment. As valuation is hard to do just with the clinic, it is considered necessary to use complementary methods of image that will help the diagnosis. We have used methods such as computed tomography and resonance, with good results. Some authors have suggested that ultrasound may have a useful role in assessing the infiltration cartilage. In our thesis work on a population of patients suffering from cancer of the larynx were treated surgically with techniques that include resection cartilage to assess the infiltration of the thyroid cartilage. We studied the frequency of infiltration cartilage in the series, in a comprehensive manner and for different tumor locations. We research on the relationship between various indicators of clinical and pathological with the infiltration of cartilage. Also explored to patients with high-resolution ultrasound tomography and to see their effectiveness in assessing the infiltration cartilage. Also follow the evolution of patients for five years to see what influence the infiltration had cartilage on the survival of patients. We got a rate of infiltration cartilage from 32%. The incidence of tumor invasion was higher in those patients who had tumors with size than three cm. Who produced fixation of the vocal cord, affecting the level glótico and outreach to hipofaringe. Because of the discordance between the clinical and pathologic classification, mainly due to errors in not detecting the invasion cartilage, it is necessary to use additional diagnostic methods to improve diagnosis. Both methods tomography and ultrasound are useful for diagnosing such infiltration but have some limitations. In the case of ultrasound, if there is a complete examination laryngeal calcification is not possible to do this because of the intense shadow after it is produced. The tomography is a technique more specific ultrasound, which recognizes good big destruction, but the minimum destruction may pass unnoticed. Involvement of the thyroid cartilage is a factor of poor prognosis in terms of patient survival. Also the fact that the ultrasound or CT scan report that the cartilage is affection is another symptom of poor prognosis.

Author: NIETO POL ENRIQUE.
Year: 2004.
University: SANTIAGO DE COMPOSTELA [More theses of this university] [www.usc.es].
Place of defense: FACULTAD DE MEDICINA DE SANTIAGO DE COMPOSTELA.
Place of preparation: SANTIAGO DE COMPOSTELA..

Summary: With the development of ambulatory monitoring of blood pressure (MAP), has been to deepen the knowledge of the variability of the same, both in its intrinsic circadian profile in the (actividad-descanso), which allows assess their clinical significance in relation to cardiovascular morbidity and mortality. A night drop in blood pressure (BP) equaled higher al1 0% of the systolic BP (SBP) and diastolic (DBP) PA during the day, characterized the profile dipper; by contrarío, when there is such a decline, we talk about profile no-dipper. Several studies suggest that subjects no-dipper have an increased injury to the organs and tissues increased cardiovascular morbidity. It is considered resistant or refractory hypertension (HTAR) that arterial hypertension (ETS) whose treatment regimen includes at least three antihypertensive drugs in adequate doses, and it fails to sufficiently reduce the SBP and DBP -. In elderly patients with isolated systolic hypertension (HSA), is considered HTAR when figures are SBP> 160 mmHg in the therapeutic situation above. A high percentage of patients with HTAR show changes in the circadian pattern of the PA, with a predominance profile no-dipper and the consequent increase in cardiovascular risk. Faced with a patient with HTAR, usually there were three treatment options: first, to increase the dosage of drugs (if they were using to subtherapeutic doses), to achieve the maximum therapeutic effectiveness, secondly, changes sequence of drugs they always with synergistic effect; finally, the last option is to add a fourth antihypertensive drug. With this protocol performance in the HTAR, solar Jente is achieved improved antihypertensive efficacy in a small percentage of patients. The present study raises a new therapeutic alternative, which is the change in the time for making one of the drugs, the administration contemplating the same night, which is the foundation of cronoterapia antihypertensive. As primary objective was to evaluate the influence that arises on the circadian pattern of the PA in resistant hypertension, is the temporary administration hoisting of the antihypertensive therapy and its posibléS impact on the control of the PA in these patients. This is a prospective, longitudinal study of two sets of patients diagnosed with HTAR, by far clinic PA and subsequent confirmation by MAP. After clinical evaluation, it was decided to change the sequence of one of three antihypertensive drugs. In a first series of patients, after this change, maintaining the pattern of 3 drugs in administration morning. In another second round, is being tried out a new form of administration temporalizada of antihypertensive treatment: a drug is replaced by another with synergistic effect, but said the drug was administered at a dose night (schedule therapeutic dose of 2 drugs in the morning and 1 drug dose Night ). After 3 months of treatment, with the realization of a second MAP, compared the effectiveness of the two alternatives in controlling the PA and changes in the circadian pattern of the same. From the results obtained, we can conclude a number of potential advantages of cronoterapia antihypertensive: "In hypertension resistant or refractory, take into account the time of treatment in relation to the cycle of activity and rest for each subject, it may be more important in control of the patient and in the proper modeling of circadian profile of the PA that the change in the combination therapy "cronoterapia improving the degree of control of patients with resistant hypertension, while allowing a high percentage in the reversal of the pattern no-dipper characteristic of the majority of patients with hypertension resi 8 stente and 52e clearly associated with increased cardiovascular risk "cronoterapia can offer increased protection in the morning of the PA in patients with increased risk of cardiovascular events (HTAR). "The cronoterapia provides new evidence in the individualized treatment of hypertension (ETS), according to the profile of circadian PA each patient. "The cronoterapia could help improve the degree of control of hypertensive patients and possibly reduce the risk of cardiovascular them, by modulating the circadian pattern of the PA.

Author: ARGIBAY VAZQUEZ SONIA.
Year: 2004.
University: SANTIAGO DE COMPOSTELA [More theses of this university] [www.usc.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The Experimental Allergic Encephalitis (SEA) is an inflammatory disease of the central nervous system mediated by T cells that has been adopted as animal model of Multiple Sclerosis. In Lewis rats and mice CB57l / 6, basic protein (MBP) and glycoprotein oligodendrocítica of myelin (GOM), respectively, emulsified in complete Freund adjuvant (FCA), a rise SEA characterized as a disease monophasic acute that the animals recover fully. In our experiment daily (from the first day of the inoculation of PBM-ACF and GOM-ACG) with the receptor agonist serotonin 1A (R (+) -8-OH-DPTA) caused an increase in dose histological and neurological signs in animals that were induced EAE. The effect of R (+) -8-OH-DPAT could be reduced by simultaneous administration of receptor antagonist serotonergic 5-HT1A (WAY 100635) at the height of the acute illness. In addition, WAY 100635 from the inoculation, resulting in a delay in the appearance of the first clinical manifestation, disease lighter and a regression earliest signs of neurological together with a decrease in inflammation of the CNS. Moreover, the receptor agonist serotonergic 5-HT1A increases levels of corticosterona plasma increases in a dose-dependent proliferative response of T lymphocytes esplénicos sensitized with GOM35-55, which is an indicator of reactivity, output increases the proinflammatory cytokines (Th1) IL-2, IFN-gamma and TNF-alpha, whereas decreases the synthesis of anti-inflammatory cytokines, IL-4 and TGF-beta, and also elevates the levels of specific antibodies both face GOM35-55 as rGOM. Because recipients 5-HT1A appear to be implicated in immune-related functions such as MS responds to regulation of T cells, because the production of cytokines and anti-inflammatory activity and fagocitaria, drugs agonists and antagonists 5 - HT1A may have therapeutic implications and atrogénicas or in this disease. The drug therapies that modulate receptor 5-HT1A (depression, anxiety, tremor) in a patient with MS may have an adverse impact on disease progression. By contrast, the pharmacological blockade of receptors 5-HT1A can provide a new avenue in the treatment of MS.

Author: ORTIZ FERRON GUSTAVO.
Year: 2004.
University: GRANADA [More theses of this university] [www.ugr.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: TRAIL is a ligand of the family of TNFa with a great therapeutic potential due largely to its ability to induce apoptosis in different human tumors both in vitro and in vivo, without afecrte to normal cells. However, despite this, it has been found that some tumor cells, especially breast tumor cells are rsistentes to TRAIL for reasons unknown. In fact, very little is known about the mechanism that regulates the sensitivity of tumor cells to TRAIL - induced apoptosis. This thesis has tried to bring some light on the regulation of apoptosis induced by TRAIL in breast tumor cells. It is known that a high percentage of breast tumors have a track MAPK activity increased. This thesis has studied the impact of the activation of the path of MARK/Erk1/2 in regulating the apoprosis induced TRAIL modeled line tumor MCF-7. We found that when activated path MARPK, TRAIL - induced apoptosis was inhibited independently of the synthesis of new porteínas. We use a construction Full-Bid-GFP noted that while mitochondrial localization of Bid-GFP cut eera reduced. It reviewed the translocation of tBid to the mitochondria with a fusion protein GFP-Tbid and found that the mitochondrial localization was inhibited, at least partially, when the path of MAPK was activated. The localization of mitochondrial protein GFP-tBid with a domain BH3 turcado was also reduced after the activation of MAPK. Moreover, in cells permeabilizadas with digitonina, release of cytochrome c from mitochondria induced tBID recombinant was also reduced after the activation of MAPK. These data suggest that the path of MAPK/Erk1/2 inhibits TRAIL - induced apoptosis in cells MCF-7 inhibiting the location of tBID in the mitochondria. Moreover, h aintentado sensitize different breast tumor lines to apoptosis induced by TRAIL ultilizando pora this different drugs and has sought to elucidate the mechanism that causes such sensitivity. It was observed by flow cytometry that treatment with roscovitina, an inhibitor of CDKs currently tested in clinical trials as a therapy against cancer, sensitized almost all breast tumor lines tested, even those highly resistant to TRAIL. It was detected by Western-blot that pretreatment with roscovitina caused an increase in the activation of caspase-8 produced by TRAIL, which suggests that awareness has nothing to do with changes in the cell surface receptor for TRAIL one of the ways that have been described that cells can be sensitized. However, pretreatment with roscovitina facilitates the formulation of DISC of TRAIL and further drops FLIP levels of both protein and mRNA (detected by RT-PCR), which promotes activation of the caspasa-8. These data suggest that roscovitina sensitizes breast tumor cells to apoptosis induced by TRAIL facilitating the formation of DISC and causing a decrease in the expression of porteína anti-apoptótica FLIP. Lastly, seha described in this thesis that agents affecting microtubule as nocodazol or taxol, also sesibilizan the apopotosis induced by TRAIL. Through studies inmunodetección was observed that these agents porvocan an increase in the activation of caspase-8, a break from the levels of porteína of FLIP and an increase in the translocation of Bax wing mitochondria and greater release of cytochrome c from the . Activation of caspase-8 is increased, which suggests that, like roscovitina, AAMs are affecting apical events in the signaling of apoptosis by TRAIL, however, was not any effect on the TRAIL receptors, membrane, or in the formation of DISC. Nor were observed changes in proteins involved in signaling / regulating signal apoptótiva part of FLIP. Probably lower levels FLIP facilitate the activation of caspase-8 and increased apoptotic response to TRAIL.

Author: VIDAL PÉREZ OSCAR.
Year: 2004.
University: BARCELONA [More theses of this university] [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA UB.

Summary: Introduction Although the overall incidence of gastric cancer (GC) is decreasing in the developed world, this malignancy remains the second leading cause of cancer death. A better understanding of the mechanisms involved in gastric carcinogenesis can help identify molecular targets for therapeutic intervention susceptible. OBJECTIVE evaluate the predictive value of various molecular factors involved in angiogenesis, and the degradation of the extracellular matrix in relation to overall survival and recurrence in patients with CG after surgical resection with radical purpose. METHODS have been evaluated 148 patients treated with CG in our unit with curative resection (RO). -2), angiopoyetina 2 (Ang-2), endothelial growth factor (VEGF) vascular, p53 and microvascular density (MVD) in the primary tumor by immunohistochemical. It has also evaluated 14 variables epidemiologic (age and sex), histology (stadium pTNM, degree of differentiation, Lauren classification, the existence of cells in ring seal, degree of curabilidad, vascular invasion, and perineural lymphatic and lymph affection quotient / resected) and therapeutic (type of surgery and delinfadenectomía and chemotherapy). We conducted univariate analysis (Kaplan-Meier, log-rank) and multivariate (Cox) to select independent prognostic factors and adjust the results of the study molecular clinical variables with significant (p0, 05). RESULTS The average age was 68 years and 67% were men. The median time of survival was 56 + -4 months, with the probability of overall survival of 2, 5 and 10 years of 66%, 49% and 31%, respectively. Univariate analysis identified the expression of MMP-9 (p = 0.01), PAI - 1 (p = 0.0002), COX-2 (p = 0.04), Ang-2 (p = 0001) and VEGF (p00, 002) as variables associated with overall survival, with the stadium pTNM, classification Lauren, degree of curabilidad, lymphatic invasion, lymph effects quotient / resected and type of lymphadenectomy. In relation to tumor recurrence, the average time free of recurrence was 52 + -4 months, with a probability of 2, 5 and 10 years of 67%, 51% and 45%, respectively. Variables predictive of recurrence were identical to those obtained for overall survival. Multivariate analysis identified PAI - 1, Ang-2 and VEGF as independent predictors, but when the model was adjusted with significant clinical variables, only the expression of VEGF maintained its independent prognostic value. CONCLUSIONS The VEGF expression in the primary tumor predicts the prognosis of patients with CG after resection with curative intention.

Author: HUERTAS NADAL CARLOS FCO..
Year: 2004.
University: GRANADA [More theses of this university] [www.ugr.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE GRANADA.

Summary: Currently resistance to antiviral treatment in patients with chronic hepatitis dela hepatitis C virus (HCV) remains a public health problem throughout the world. Given the cost and side effects of therapy there is a need to identify those factors at the beginning of treatment that could effectively predict the likelihood of obtaining sustained response, equivalent to the cure of the disease, with particular emphasis on determining delas cuasiespecies viral reflecting variability génetica HCV, has been implicated in resistance to treatment. To this end design is a retrospective study which included a total of 125 patients diagnosed by liver biopsy of chronic hepatitis C treated with interferon or interferon plus ribavirin, evaluated the predictive power of responses from cuasiespecies initiation of treatment. It was noted that the only independent variables in the logistic regression of sustained virologic response were infection genotype not-1, lower baseline viral load and fewer cuasiespecies (reflected by the number of bands obtained through the following analysis technique called 2polimorfismo conformacinesl of simple string "or SSCP). Likewise, cuasiespecies helped explain the different kinds of responses obtained equality of the rest of viral factors. A second objective of this study was to analyze the importance of the core antigen as a response factor. was observed that levels directly related to the viral load to top treatment and virological response sotenida in him univariate analysis, it could be a marker valid alternative and cheaper, to assess and predict viraemia the early response to treatment. Therefore, in the future, you could define a subset of patients "difficult to treat" Subsidiary receive treatment regimens longer or higher doses of those described for other patients.

Author: VILLASANTE MORAN AMPARO.
Year: 2004.
University: AUTÓNOMA DE MADRID [More theses of this university] [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: DE INFERTILIDAD EN MADRID.

Summary: Background: The ovarian hyperstimulation syndrome (OHSS) is a phenomenon rare but potentially serious. It appears on half of the luteal phase and is usually secondary to treatment controlled ovarian hyperstimulation in patients who are going to bring assisted reproductive techniques. It has been described a significant increase in serum levels of endothelial growth factor (VEGF) vascular after administration of human chorionic gonadotropin (hCG) in patients with increased risk of developing OHSS. The VEGF affect vascular permeability in vitro because induces phosphorylation of tyrosine residues in the caderina vascular endothelial (VE), protein involved in the intercellular space of unions that control the permeability transmembrane. The phosphorylation of these proteins has been implicated in the modulation of cellular adhesividad. Assumptions: We propose that the VEGF half increased vascular permeability in patients who develop the SHO, in part through its action on caderina EV. Objectives: To determine changes in the caderina EV following in vitro stimulation with estradiol, hCG and VEGF, and to observe the changes taking place at the permeability of cell cultures. To assess the systemic changes in the soluble fraction of the caderina EV in patients undergoing cycles of in vitro fertilization (IVF). Method: Study the increase in the secretion of soluble fraction of caderina EV on cell cultures in endothelial monolayer of human umbilical cord (HUVEC) after stimulation with increasing dose estradiol, VEGF hCG + hCG VEGF, VEGF + anti-VEGF . Check that the increase in the soluble fraction of the VE-Cadherina is not a result of the lysis or cell proliferation. Analyzing the morphological changes caused by the reorganization of the actin filament and its effect on the permeability of cultivos.Valoración the patency of the monolayer by measuring the amount of albumin marked with fluorescence facing the monolayer subject to various stimuli. Measuring the changes in serum levels of soluble fraction of the caderina EV in patients undergoing IVF, comparing those symptoms hyperstimulation with a control group, and monitor these levels in patients who got pregnant. Results: We demonstrated statistically significant stimulation with increased VEGF secretion caderina EV. This increase was blocked after addiction cultivation of a antibody anti-VEGF. It was found that doses which were capable of producing these extra caderina EV did not cause or lysis or cell proliferation, as evidenced by staining with Blue Tripan and testing with MTT colorimetric. After stimulation with VEGF was observed reorganization of the actin filament and these changes may explain the increase in permeability functional described in the monolayer HUVEC. Compared to controls, the patients who developed severe OHSS earlier had serum caderina EV significantly higher. Instead, it has been demonstrated that the determination of caderina EV day puncture serve as prognostic value of early development of OHSS. Conclusions: 1. The VEGF induces an increase in the release of the soluble fraction of the caderina of vascular endothelium in vitro effect is enhanced when coupled with the encouragement of hCG. / 2. The estradiol, which is considered a risk factor but not trigger the SHO, does not induce the release of caderina EV. 3. The VEGF induced changes in cell morphology and organization of actin filaments cell skeleton of the monolayer HUVEC. 4. The VEGF induces an increment 8 or signif 5c2 icativo the patency of the monolayer HUVEC. 5. Patients who develop the SHO early grave has significantly increased serum values of the soluble fraction of the caderina EV. 6. The release of the caderina EV was significantly correlated with serum levels of estradiol on the day of hCG administration. 7. These findings on the one hand partly explain the importance of caderina of vascular endothelium in the pathophysiology of hyperstimulation syndrome, but also can help develop new therapeutic strategies for hyperstimulation syndrome by blocking selective inhibitor of VEGF, or antibodies anti-VEGF, or VEGF receptor antagonist if we come to a perfect understanding of the mechanisms that initiate and sustain the development of this disease.