MEDICAL SCIENCE, 4

Author: GARCIA ZARAGOZA MARIA ELENA.
Year: 2004.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA, DEPARTAMENTO DE BIOQUIMICA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The formation and differentiation of muscle of a body is a complex process that requires quick and coordinated activation of genes encoding structural proteins. The gene of TnT D. Melanogaster is a good model for studying the mechanisms that control the expression of genes muscle. Their transcriptional regulation is controlled by two elements, located in the region 5 'regarding the site of transcription initiation (ERU), and the intrón 1 (IRE). Both regions have a modular organization. In point ERUs, we find two regions activating called Proximal and Distal. Distal The region is primarily responsible for the expression of the gene in the muscles and specialized adult MFI DTT. The region leads the Proximal expression in the rest of muscle types. In an IRE have located two modules, known as Module I and II, capable of directing the expression of the gene in all stadiums and muscles in Drosophila. The study on the regulation of gene transcription of TnT D. Melanogaster, has led us also to identify a new mechanism that regulates its quantitative expression. This system depends on the synergistic interaction of the elements ERUs and REI, through macromolecular complexes that bind to them, in different ways depending on the type muscle. This analysis has been extended to other regions of gene regulatory muscle. Through analysis in vivo, we have identified a new regulatory region in the genes Tm1, Tm2 and Mhc, located in the region 5 'of the gene (ERU). The gene PM, this new region is located in introns 1 and 2 gene (IRE). The correct expression of these genes also depends on both elements ERUs and REI. Moreover, the genes analyzed muscle shared presence in their regions regulators, ERUs and REI, clusters of binding sites for factors miogénicos MEF2 and CF2. Moreover, we have demonstrated that not only the factor MEF2, but also CF2, has an essential role in controlling the expression of genes muscle. Declining CF2 causes an imbalance in the levels of transcription of TnT, TnI, Mhc and PM, which is reflected in the inability of flight and disruption of the structure of sarcomere. Based on the results obtained in this paper, we propose a system for regulating genes common to all muscle, based on the interaction of two regulators, which yields the correct levels of expression in muscle and each type stadium.

Author: HONRUBIA FERNANDEZ MARIA TERESA.
Year: 2004.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Context .- The non-invasive mechanical ventilation (VMNI) improves the clinical course of patients with acute respiratory failure (ARF) seriously, when added to conventional medical treatment. This benefit has been observed mainly in patients with exacerbation of chronic bronchial pneumonopathy with edema and acute lung cardiogenic. However, its role as an alternative to conventional mechanical ventilation (MV) with intubation is still controversial. Objective of the study .- To compare the efficacy and resource consumption of VMNI front of the VM in the treatment of severe ARI of various etiologies. Clinical Trial Design .- multicenter, controlled, with random distribution. Scope .- Seven Intensive Care Units multipurpose experienced in the use of VMNI for the treatment of acute respiratory failure. The study was approved by the Ethics Committees of Clinical Trials of all participating hospitals Patients .- Sixty-four patients with acute respiratory failure from various causes, if they met certain criteria and clinical gasométricos previously established need for mechanical ventilation. Intervention .- Randomization was stratified by the Center. The group VMNI received ventilation through a face mask and pressure mode support more pressure Positive end-expiratory. It established strict criteria for failure of the VMNI and step by conventional ventilation with intubation. The group of VM received ventilation through a tube orotraqueal. Both groups were ventilated with respirators standard Intensive Care. Variables .- As a result clinical efficacy variables were measured avoidance of intubation, mortality, complications and the onset of functional status at discharge from the ICU. As a variable resource consumption were measured work of nursing and stay in the ICU and hospital. It also measured the time VMNI and times total ventilation in both groups. We analyzed the physiological changes and gasométricos the first few hours of implementation of the VMNI to assess their ability to forecast the failure of the technique. All analysis was performed by assigned treatment. Results .- We recruited 64 patients. Thirty-one were assigned to the group VMNI and 33 to a group of VM. The baseline characteristics of the two groups in terms of physiological variables and the level of severity were similar. Although the number of patients with lung disease after was similar in the two groups, there was an increased number of patients with exacerbation of chronic bronchial pneumonopathy edema and acute lung as a result of the IRA in the group VMNI. In the intervention group were intubated for 58% of patients compared with 100% in the control group (relative reduction in the risk 42%, p = 0.00003). The stratified by type of respiratory failure gave similar results, except in the case of pneumonia in which all patients were intubated. The ICU mortality was 23% in the treatment group and 39% in the control group (p = 0.09) and had a complication 52% and 70% of patients (p = 0.07) in group of VMNI and VM respectively. There were no differences in functional limitation to the discharge from the ICU. The level of therapeutic intervention was lower in the first three days in the group VMNI, but not the measurement of nursing activities. The average time of stay in the ICU was 8.9 days in the treatment group and 9.7 days in the control group. Ratio between times of stay 0.9 (95% CI: 0,54-1,5, p = 0.69). Similarly, we found no difference in the times of stay only if we analyze the survivors. In patients receiving VMNI noted a considerable improvement of oxygenation, respiratory frequency and work but these changes were not different in patients who avoided intubation and those who do not. Conclusions .- ventilation not invas 8 vat evit 3fc to intubation nearly half of the patients with severe acute respiratory failure with the possible exception of pneumonia. The study notes a trend, not significantly towards lower mortality and fewer complications during his stay in the ICU. The VMNI implies a lower level of therapeutic intervention and does not increase the time spent by nurses.

Author: PAÑO PARDO JOSE RAMON.
Year: 2004.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION: Strategies for inducción-mantenimiento for the treatment of HIV infection, would, from the theoretical point of view, avoiding toxic effects resulting from antiretroviral drugs, preserve therapeutic options and reduce the cost of such treatment. No study has desmostrado the feasibility of this therapeutic strategy. PATIENTS, MATERIALS AND METHODS: Clinical Trial exploratory or proof-of-concept (Phase IV-II) seeks to assess the feasibility in terms of efficiency (suppression of viral replication) and security of a maintenance strategy for the treatment of infection HIV with a single drug: Lopinavir boosted with ritonavir (LPV / r). This is a trial, not enmasacarado where were included 42 patients whose participation in each intervention group (then with triple therapy on the one hand and monotherapy with LPV / r on the other) was random and with a ratio of 1:1. The intervention is not enmascaró and its duration was 48 weeks. All patients were infected with HIV and were receiving antiretroviral therapy (HAART) great intensity on a continuous basis with suppresion of viral replication demonstrated for at least six months prior to baseline. We excluded those patients with a history of prior virologic failure, if this had happened while receiving treatment, including a protease inhibitor. RESULTS: 81% of patients (17/21) receiving LPV / r monotherapy maintained suppression of viral replication at week 48 (IC 95 64% -98%) compared to 95% (20/21) of those who continued with triple therapy, these differences are not statistics from the statistical point of view (0.39). No patient continued with triple therapy introduced virologic failure (in a Modified treatment originally assigned by hypertriglyceridemia). In the treatment arm LPV / r monotherapy was lost track of a patient, was found in two virologic failure attributable to poor adhesion therapy, and in another patient with virologic failure occurred adequate compliance. In none of these cases of virologic failure was detected mutations of HIV capable of conferring resistance PVL, and in all of them the reintroduction of the same nucleoside suspended at the start of the study allowed for a reinducción sustained suppression of the viral kinetics. The persistent viral replication showed no differences significtivas between the two treatment arms. CONCLUSIONS: maintenance treatment with LPV / r monotherapy is a feasible strategy from the standpoint of effectiveness and safety in patients with HIV infection and HAART with triple therapy with a deletion of the viral replication of a length in excess of 6 months. The casod of virologic failure, mostly secondary to a suboptimal adherence) is not associated with the selection of resistant variants of HIV to PVL and the reintroduction of nucleoside suspended, in these cases, will again reach the suppression of viral replication. A clinical trial designed to confirm the hypothesis of non - inferiority monotherapy LPV / r front of a triple therapy with a statistical power of 80%, an alpha of 0.05 and a maximum of the difference in the non - inferiority of 12% should include 200 patients.

Author: GALAN LABACA IÑAKI.
Year: 2004.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: OBJECTIVES: This Doctoral Thesis deals with the study of the validity of convergence and reproducibility in measurement of risk factors associated with the behavior and preventive practices through telephone survey. Likewise, he examines the major trends in the adult population of the Community of Madrid from 1995 to 2003, with an estimated pattern of clusters of risk factors and their association with the perceived health and non-compliance with the recommendations of preventive practices. MATERIALS AND METHODS: The source of information used is the Monitoring System Risk Factors associated with Noncommunicable Diseases (SIVFRENT), based on the conduct of interviews with monthly telephone methodology to an annual sample of 2000 people from 18 to 64 years representative the Community of Madrid. To assess the validity of convergence, the same questionnaire was administered in two independent samples, which developed a telephone interview and another interview face to face at home. On the other hand, to evaluate the reporoducibilidad the same questionnaire was administered by telephone to the same people twice, with an interval of 13 to 32 days. The trend 1995 to 2003 of risk factors, it was felt across the grounds of average annual prevalence obtained by generalized linear models with logarithmic link and binomial family. Finally, the association of the aggregate consumption of snuff, alcohol, a sedentary lifestyle and an unbalanced diet, health and perceived non-compliance with the recommendations of preventive practices, were examined using logistic regression. RESULTS: The results of the telephone survey and the "face to face" at home were very similar: in total, 19 of the 28 variables showed a relative variation between the two polls less than 10%, 8 variable differences were between 10 and 20%, and 1 was over 20%. The overall cost of the telephone interview was half that of the home "face to face". It was also obtained high reproducibility of the questionnaire: Kappa coefficients and intraclass correlation coefficients exceeded the value of 0.8 in 10 variables, 13 ranged between 0.6 and 0.8, 3 between 0.4 and 0, 6, and only 1 was less than 0.4. The trend 1995 to 2003 shows that the largest changes in men relate to the increase of overweight and obesity, which suffers a relative increase of 3.7% per annum, and the decline in the performance of DSA (-3%), consumption high alcohol (-6.1%) and the non-use of seat belts (-4%). In women are increased significantly overweight and obesity (3.3%), the abandonment of the use of snuff (3.1%), and conducting mammograms (6.4%), and decreases the performance of diets (-4.1%) and the non-use of seat belts (-4.5%). Nearly 20% of the subjects presented three or four risk factors simultaneously. Most combinations of three risk factors are higher than expected, highlighting the aggregation of the four factors with a ratio observed / expected 2.15 in men and 2.96 in women. In both sexes, the single factor that most closely associated with other risk factors is the snuff. The aggregation of risk factors is more common in men, ages young and low educational level. Compared with those without the four risk factors, which simultaneously three or four of them presented more often perceived health suboptimal (OR 2.49, 95% CI :1,59-3, 90 men and OR: 1.96, 95% CI :1,29-2, 97 women). There was a positive association dose in both sexes, between the number of risk factors present simultaneously and non-determination

Author: MATHEU FERNANDEZ ANDER.
Year: 2004.
University: AUTÓNOMA DE MADRID.
Place of defense: CENTRO NACIONAL INVESTIGACIONES ONCOLOGICAS.
Place of preparation: CENTRO NACIONAL INVESTIGACIONES ONCOLOGICAS.

Summary: The locus Ink4a/Arf is of great importance in defending the body against cancer. In particular, its members are among the most important ways suppressor known Ink4a/Rb and Arf/p53. In this paper, we have deepened in action suppressor locus Ink4a/Arf investigating its regulation by chemotherapeutic drugs and through the generation of new animal models. First, we investigated the impact of inhibitors desacetilasas of histone (HDACIs) in the expression of Ink4a and Arf. The HDACIs regulate the expression of many genes and exhibit a potent activity citostática. We noticed that HDACIs modulate transcripcionalmente the expression of the members of locus Ink4a/Arf. The HDACIs repress the expression of Ink4a and induce the expression of Arf. We noticed that the association of transcription factor Sp-1 to the promoter of Ink4a is necessary for the repressive effect of HDACIs on Ink4a. On the other hand, we discovered that the activation of Arf develops an important role in the cell cycle arrest induced by HDACIs. Finally, we demonstrated that the anti-tumor action undertaken by HDACIs is mediated by the activation of Arf. The negative consequences associated with the functional loss of Ink4a and Arf have been extensively characterized in the past. We have created different animal models deficient in Ink4a and / or Arf which are characterized by the development of tumors at an early age. We are interested in studying the beneficial effects against cancer obtained by the increase in gene dosage of Ink4a and Arf. To that end, we have created an animal model with an extra copy of the gene locus Ink4b/Ink4a/Arf full. Prior to this work, in the lab we have created lines of mice with extra gene copies of p53. This model "Super p53" provides increased resistance to the development of tumors without being affected by other parameters of the body including the aging. First, we analyzed the functionality of the copy Ink4a/Arf Ectopic in a gene pool with the alleles Ink4a/Arf endogenous delecionados. We have noted that the allele transgenic remains the hallmark of endogenous allele as a stress sensor. Moreover, the allele transgenic rescues the phenotypes associated with the deficiency in Ink4a/Arf. Together, we concluded that the transgenic allele is providing active and functional tumor suppressor activity. Here, we are dedicated to studying the phenotype of mice with extra copies of locus Ink4a/Arf. The mouse "Super Ink4a/Arf" is significantly more resistant to chemical carcinogenesis his brothers litter wild. Regarding the rest of essential parameters of the body, the mice "Super Ink4a/Arf" are fertile and no signs of premature aging. Thus, we conclude that can be increased depending on Ink4a and Arf providing an increase in resistance to cancer at the same time, without causing negative effects on survival notorious and aging. These results are consistent with those obtained previously in the "Super p53". Moreover, in this work we generated double transgenic mouse, "Super p53" / "Super Ink4a/Arf" whose resistance to cancer is further increased. Overall, our findings suggest that tumor suppressor activity can be enhanced in mammals without incurring side effects harmful to the body

Author: RODRIGUEZ VIERBUCHER LORENA.
Year: 2004.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE CIENCIAS.
Place of preparation: FACULTAD DE CIENCIAS.

Summary: The matrix protein (M), human respiratory syncytial virus (VRSH) is a protein structural, internal membrane of 256 residues. This paper shows that the M protein is capable of uniting RNA, and has identified waste important for such interaction. This capability of the M-protein of VRSH has been described for protein matrices virus families Orthomyxovirus and Filovirus, but not members of the family Paramyxovirus. Its binding to RNA has been demonstrated in three types of tests: delay mobility electroforética gel RNAs marked radiolabelled with P32, intersecting with UV light and Northern-Western. It showed specific sequence or length requirements. It showed a cooperative saturable kinetics with an apparent Kd of 25 nM, and probably two binding sites for RNA. Test preparations for intersecting with UV light with probes marked P32, followed by enzymatic and chemical treatments, and identification of peptide sequences N-terminales of marked and unmarked, showed that the residue contact were located between amino acids 120 and 170. Variants of deletion and directed mutagenesis of residues in this region showed that the residue lysine (K) at positions 121, 130, 156 and 157, and the residue arginine (R) at position 170, which were stored in proteins M different members of the genus Pneumovirus, were essential for the binding to RNA. The RNA binding protein M (through waste 156, 157 and 170) was not essential to its inhibitory effect of the processes of viral replication and transcription in vivo. Neither union was necessary to RNA to form high molecular mass oligomers on, which probably formed annular structures, in other viral systems have been linked to RNA metabolism. It has also been shown that the M protein expressed transiently, was able to get out of the cell membranes in vesicles. Their ability to unite RNA was not associated with the ability of the protein M. His co-expresión with the P protein increased this activity through interaction not mentioned MP, which was nullified when the P protein is phosphorylated in the S54. Finally, it shows that the protein M VRSH both expressed transiently like that of cells infected by the virus, were fosforilaba in tyrosine (Y). Of the 10 waste And that has the protein, those in positions 229, 236 and / or 237 are likely to be fosforilan.

Author: MARTINEZ VICTORIO PEDRO ANTONIO.
Year: 2004.
University: MURCIA.
Place of defense: FACULTAD MEDICINA. UNIVERSIDAD DE MURCIA.
Place of preparation: UNIVERSIDAD DE MURCIA.

Summary: The decline in the extensibility of muscle isquisural conditions at the adult anomalous provision of the spine, especially during flexion of the trunk, predisponiendo to the emergence of acuñamientos vertebral previous discales and investments in the region tóraco-lumbar, among other changes . It develops a study in skeletally mature individuals with the intention of determining the influence of short isquiosural on the degree of kyphosis and lordosis lumbar dorsal bipedestación in, check the status of lumbar spinal column during flexion of the trunk in these cases, setting limits normality of the extensibility of the musculature and analyze the frequency of symptoms associated spine.

Author: Fernández Delgado Lourdes.
Year: 2004.
University: SEVILLA.
Place of defense: Facultad de Medicina..
Place of preparation: Facultad de medicina. Universidad de Sevilla.

Summary: At present, every day there are more evidence of the involvement of neutrophils in allergic diseases in general, and asthma in particular. The polymorphonuclear leukocytes are neutrophils, which play an essential role in the immune system, the first line of defense against infection by bacteria. Their role in the inflammation is thought that was restricted their ability to phagocytosis and release of enzymes and other cytotoxic agents. However, currently known as these cells can release various mediators who can exert a profound impact on the airways of asthmatic individuals. Previous studies have shown that a provocation to a specific allergen, neutrophils arrive before eosinophils to the target organ. The neutrophils possess the three IgE receptors on the cell surface. And our group has shown in numerous works, including specific allergens can functionally activate neutrophils of allergic patients sensitized to these and mediators release after a stimulus IgE dependent. The lactoferrina is an iron carrier protein, which is present in the grain or specific secondary neutrophils and reveals increasingly as a key element in the pathophysiological events linked to infection and inflammation. Participates in antibacterial mechanisms of polymorphonuclear and behaves as an important regulator of mielopoyesis and iron metabolism. The lactoferrina plays a central role in the modulation of inflammation of the airways, their ability to join the free-ferrous ions makes these do not contribute to catalysis of toxic oxygen radicals will be able to continue to exercise their functions. At the same time, lactoferrina is able to promote the adhesion of leukocytes to endothelial wall, which amplifies the cellular inflammatory response. Speakers in the activation of natural killer cells and promotes activation of macrophages by promoting the secretion of TNF, IL-8, NO, IL-1Ã, GM-CSF. The lactoferrina neutrophilic in amounts similar to those found in the liquid from the airway eosinophils induces in several effects: the production of superoxide, the degranulation of the same with the release of EDN, and the synthesis of leukotriene with the subsequent secretion the leukotriene C4, suggesting that the accession of the lactoferrina the epithelium may constitute a mechanism of the inflammatory process originator eosinofílico into the airway. Therefore it is possible that other factors than IgE (eg lactoferrina released by neutrophils and their receptors), act as inducers of activation of eosinophils in the processes atopic IgE-mediados. In addition, the findings that CCA secreted by neutrophils stimulated release of the lactoferrina by glands serosas of the lining of the respiratory tree, it increases the possibility that the eosinophil activation of this lactoferrina can take place via a positive feedback mechanism generated by the CCA's eosinophil with the consequent persistent activation of this unit within the air. Therefore it is possible that the activation of the neutrophil-mediated IgE may modulate the response of eosinophils in atopic processes. Different granules have different physiological functions, the exocytosis of the same is governed by independent mechanisms, while the degranulation of azurófilos can be done without being made to the side and vice versa. Well, our group has demonstrated as specific granules are released through a mechanism IgE-dependiente. Faced with the increased presence of lactoferrina in allergic diseases, we wanted to see that actually could make a exocytosis of granules side or specific and concrete 8 the liber 1961 ation lactoferrina, by a mechanism antígeno-específico IgE-mediado . The neutrophils from asthmatic patients were stimulated with the allergen which were specifically sensitive measuring the release of lactoferrina in the cell supernatant. The treatment of neutrophils with the allergen resulted in the release of the lactoferrina by neutrophils from patients who were allergic to that specific allergen, revealing the release of lactoferrina is rather higher in the cells of asthmatic patients incubated with the allergen that are sensitive to compare it with the lactoferrina released by neutrophils from healthy controls and neutrophils from asthmatic stimulated with an allergen to which they are not aware. Therefore, we can conclude that the release of lactoferrina it is a specific reaction and depends on the existence of allergen sensitivity tested, and that this release was to turn dose and tiempo-dependiente. We have also demonstrated how neutrophils from patients with skin test and positive allergen-specific IgE were studied on the cell surface of neutrophil positive allergen-specific IgE, and after incubation with the same, only in these neutrophils showed release lactoferrina as a deduction appears to be IgE-specific cell surface of the neutrophil responsible for the release of the lactoferrina through a mechanism IgE-dependiente. In no case was found or specific IgG in the serum or in supernatant from the elution of immunoglobulins from the surface of neutrophils, which exclude the participation of IgG. Besides specific IgE eluted from the cell surface corresponds completely with the amount of IgE-specific serum. Moreover, as the figures for specific serum IgE increases so does the amount of lactoferrina released by neutrophils after stimulation specific allergenic, which further strengthens the role of IgE in liberating lactoferrina. But despite this, we do not get a correlation between the total number of lactoferrina released and the amount of serum specific IgE, which is even talk that a mechanism dependent on the amount of this immunoglobulin, there may be other factors that influence the release of lactoferrina by neutrophils in atopic patients. Like all the studies conducted so far had been conducted in patients allergic asthmatics could believe that these findings may only be able to achieve with cells from these patients, which might lead us to think that they do not reflect the nature of Eczema the patients, but his asthmatic condition. To check this end we have studied the release of lactoferrina by neutrophils stimulated with the allergen that are sensitive in patients with bronchial asthma and rhinitis in patients with extrinsic. When encourage neutrophils in both groups of patients, we observe as there were no significant differences in the lactoferrina secreted in both cases. This shows that our findings are a result of the nature of atopic patients, independent of the clinical picture (rhinitis / asthma). To discard that one can only produce the release of lactoferrina after stimulation of neutrophils with a single allergen, we decided to study the lactoferrina secreted after stimulation of neutrophils with different allergens to which patients were sensitive. In this way we could see how the secretion lactoferrina is not specifically single allergen but after stimulation of neutrophils with any of the allergens to which the patient is allergic. Subsequently, in order to clarify whether the release of lactoferrina by neutrophils of allergic patients is related in some way with the respiratory function of asthmatics, and thus in turn clarify the role of products secreted by the on neutrophil function respiratory, we studied the correlation between the amount of lactoferrina released after incubation of neutrophils with these allergens and lung function of patients, measuring FEV1, and found that there is an inverse relationship between the release of lactoferrina and FEV1. This corroborates the possible role of the neutrophil in impairment of respiratory function in patients with bronchial asthma extrinsic. We have seen through the bronchial provocation with normal saline and metacholine not observed variations in the amount of lactoferrina released from the baseline determination and following the provocation. By provocation allergen specific note as there is a larger quantity of release of lactoferrina after provocation, whether the patient has had only an immediate response as if it had dual immediate and late. And when there is a belated reaction determinations after the provocation are higher than if it only gets an immediate reaction. Not surprisingly, since this reaction is conditioned by the presence of secondary effector cells such as eosinophils and neutrophils themselves. We have also tested as to compare levels of lactoferrina in different degrees of severity of asthma and in healthy controls, there is a greater amount of lactoferrina released in all subgroups of asthma compared with the healthy control subjects, while the figures lactoferrina released by neutrophils of the patients are older, the greater the severity of asthma.

Author: ALAPONT OLAVARRIETA VICENTE.
Year: 2004.
University: VALENCIA.
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA.

Summary: : THE GOAL OF WORK HAS BEEN ANALYZE THIS IS HAS BEEN THE CONTRIBUTION OF CIRUJANOS SPANISH TO TREATMENT OF Hernia INGUINAL BETWEEN 1820 AND 1936 BY PUBLICATIONS IN THE EXISTING MEDICAL JOURNALS OF BOOKS AND SPANISH PUBLICATION OF THIS PERIOD. THROUGH THE PUBLICATIONS ORIGINAL REVIEW COULD BE AS INFLUIDO THE DISCOVERY OF THE ANESTHESIA AND ANTISEPSIA IN THE AUTHORS SPANIARDS AND COMPARANDO WITH ARTICLES OF AUTHORS EUROPE (ARTICLES TRADUCIDOS) THERE A DIFFERENCE FOR TEN YEARS IN THE INCORPORATION OF NEW TECHNICAL BOTH ANESTÉSICAS AS QUIRÚRGICAS. BE ANALIZADO ARTICLES AND BOOKS ORIGINALS, ARTICLES AND BOOKS TRADUCIDOS, NEWS, NOTES IN BRIEF, GETTING AN EXTENSIVE RELATIONSHIP OF CREATING REFERENCES TABLES MAXIMUM OF AUTHORS, TABLES OF YEARS OF PRODUCTION AND TABLES OF THE MATERIALS OF PUBLICATIONS, RELACIONÁNDOLAS BETWEEN THEM AND RELACIONÁNDOLAS WITH DIFFERENT SITUATION AS BOTH POLITICAL SCIENCE OF THE PERIOD IN WHICH WERE PUBLISHED. HAS MADE AN ANALYSIS OF TEXT, BEING SELECTED FOR THESE ARTICLES ORIGINALS (AUTHORS SPANISH), AND METHOD CHRONOLOGICAL, ANALIZANDO WHICH HAVE BEEN THE CONTRIBUTIONS OF OUR TREATMENT OF AUTHORS TO HERNIA INGUINAL. HAS BEEN ANALIZADO THE WORK OF RICARDO EGEA AS FIRST AUTHOR TO SPANISH PUBLIC THE TREATMENT OF CASH Hernia INGUINAL NOT ESTRANGULADA BY THE TECHNICAL CAP AUTOPLÁSTICO. HAVE BEEN EXPOSED THE FINDINGS FOR ALL THIS TIME INCLUDING AN ANALYSIS OF MORTALITY AND RECIDIVA HERNIARIA AFTER THEIR TREATMENT.

Author: SEVILLA TORAL BEGOÑA.
Year: 2004.
University: SALAMANCA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The aortic valvular stenosis (EAo) is the tract obstruction of left ventricular output level of the aortic valve. The calculation of the severity of EAo is very important, especially in symptomatic patients for therapeutic decision making. Sometimes this is not easy transtorácica by echocardiography (TTE) due to the existence of potential sources of error. Echocardiography transesofágica (ETE) enables imaging with higher resolution and makes certain patients in the proper quantification of valvular aortic area (AVA). The purpose of this study was to compare the utility of the multi SUMMER with the agency in the calculation of the severity of EAo. The study was conducted in 95 patients with EAo, correlating actions of AVA obtained by planimetry by ETE and continuity equation by agencies, as well as with gradients up and medium obtained by ETT. They divided the patients with and without significant aortic insufficiency, making the same correlations. In 35 patients were obtained gradients and maximum average SUMMER, correlacionándolos with those obtained by ETT. A study of reproducibility between the two methods of measurement valvulares areas and among those used to measure maximum gradients and a half. We conclude that the calculation of AVA by ETE is a good method to estimate the severity of EAo, especially in patients presenting with potential sources of error by ETT and not changed in patients with aortic insufficiency significantly. The calculation of gradients by ETE is also useful to estimate the severity of EAo. Both methods of measurement AVA as methods for the calculation of gradients presented good match.

Author: MARTÍN FRANCO MIGUEL ÁNGEL.
Year: 2004.
University: VALENCIA.
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA.

Summary: Introduction. The portal hypertension is a clinical syndrome characterized by an increase in pathological pressure in the portal system as a result of resistance to blood flow in this area. Objectives. It is intended to show whether patients in low-risk surgical Child A or B with bleeding esophageal varices and portal hypertension, surgical decompression portal get a survival greater than the TIPS. Material and methods. A retrospective study, and descriptive longitudinal 146 patients with portal hypertension (56 TIPS compared with 90 referrals surgical) intervened in the Balearic Islands between 1974 and 2001. Data were collected for affiliation, age, sex, national origin, etiology, comorbidity, signs, morbidity, complications, reoperation, because of exitus, transplant program, transplant or stay, HDA, encephalopathy, ascites, ultrasound, angiografías, survival, mortality and speaking time. We analyzed the relationship of the variables with the survival of the disease and entered the variables that might cause a selection bias, in a model of multivariate Cox regression to determine whether survival in patients operated on was significant compared to that they placed TIPS. Results. The study sample consisted of 146 patients, 46 women (31.5%) compared to 100 men (68.5%). Mean age 58.3 in TIPS versus 52.3 in surgery. In the multivariate analysis of the Cox regression, hematemesis (0.0104) and degree Child (0.0296) were significant and had a confounding effect in the sample. The comparative survival (TIPS / Surgery) by the log rank test was not statistically significant (p = 0.6491). Conclusions. In the low-risk surgical patients (Child A or B) with bleeding esophageal varices and portal hypertension, portal surgical decompression fails to survival greater than the shunt portosistémico intrahepatic transjugular (TIPS).

Author: FRASQUET ARIAS JULIA LUCIA.
Year: 2004.
University: MIGUEL HERNÁNDEZ DE ELCHE.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION acute pancreatitis (AP) is a disease whose evolution can range from mild cases to other serious with high mortality. Therefore, for years has sought a series of forecasts markers to recognize those serious cases as quickly as possible to establish an intensive surveillance on patients and dealt with early complications that arise. These markers can be of different nature: clinical, analytical or combinations of both. No forecasting system that meets the characteristics of an ideal system. Therefore, the search for early markers remains a necessity in the PA. Recently it has been suggested the usefulness of procalcitonina (PCT) in the early identification of serious PA. Proteinuria is a common finding in the PA. The increase in urinary protein excretion may be due to an alteration in the function of renal proximal tubule induced by substances released by the pancreas. The degree of tubular dysfunction could reflect the gravity of the PA. OBJECTIVES To study the prognostic value of: 1) Proteinuria and Ã2-microglobulina, as a marker of renal tubular injury in patients with PA. 2) Determination of rapid serum PCT in the first day of hospitalization in our everyday clinical practice. PATIENTS AND METHODS We studied 51 patients with PA = 24 hours (h) of evolution from the beginning of symptoms. Serum samples were extracted from the 1Â º and urine samples were taken from the 1Â º, 2Â ° and 3Âş day of hospitalization. In a subgroup of 25 patients out of 51 total, the samples of serum and urine of 1Â th day were obtained within the first 24 h early hours of developments since the onset of symptoms. The gravity of the PA was classified according to the criteria in Atlanta. The PCT is determined with a test semi inmunocromatográfico in solid phase. Concentrations = 0.5 ng / ml after 30 minutes of incubation is considered a positive result. It quantified proteinuria and Ã2-microglobulina in the urine of the day 1Â º, 2Â ° and 3Âş hospitalization and were adjusted by the amount of urinary creatinine. RESULTS The sensitivity (SE), specificity (Sp), positive predictive value (VPP) and negative (NPV) and positive likelihood ratio [LR (+)] test PCT was: 26.7%, 77.7% , 33.3%, 71.4% and 1.3, respectively (p> 0.05). Median proteinuria obtained in the days 1Â º, 2Â ° and 3Âş were 180.5, 164.3 and 136.7 mg / g creatinine, showing in the 2Â th day statistically significant differences between major and minor cases. The medians for the reason Ã2-microglobulina were: 9.7, 27.6 and 88.3 Â µ g / mg creatinine, respectively. No significant differences were found between mild and severe pancreatitis. When we select the subset of patients whose serum and urine were obtained within the 24 hours from the start of symptoms, the results of the PCT or markers studied in the urine did not improve. CONCLUSIONS 1 -. The present study indicates that the semi-quantitative determination of PCT test strip is not useful in the early prognosis of the PA. 2 -. Proteinuria provides prognostic value on the second day of hospitalization. 3 -. The Ã2-microglobulina, as a marker of renal tubular alteration, it is not useful as a forecasting system in patients with PA in our study.

Author: ALCALÁ TORRES JOSÉ JAVIER.
Year: 2004.
University: GRANADA.
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The addition to the diet of pollen, propolis or more pollen propolis (14g/Kg more 1g/Kg) for ten days, do not cause changes in the concentration of Fe, Ca, P, Mg, Cu and Zn in the spleen, brain, heart , lung, kidney and testes of rats controls. In rats with anemia feropénica nutritional adding pollen, propolis, or more pollen propolis (14g/Kg more 1g/Kg) does not result in changes to the content of Fe, Ca, P, Mg, Cu and Zn in the bodies studied and the changes found in the state are the result of anemia.

Author: ALAMINOS GARCÍA MARÍA PILAR.
Year: 2004.
University: GRANADA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTD DE MEDICINA.

Summary: Introduction Although there are numerous studies carried out to learn about the structure and functioning of neuroendocrine cells, knowledge of these is relatively recent. You can say it was Enrico Solica in 1967, who helped in the initial identification of the neuroendocrine cells of the stomach. The gastric mucosa is endowed with a rich fabric of different types of endocrine cells. At least have been identified seven different types of endocrine cells based on the ultrastructural features; ECL cells, D cells, the cells A, P cells, the cells D1, G Cells cells X. In humans this group represents approximately 0.5 to 12% of the total cells in the mucosal fúndica. Taken together constitute an endocrine organ equivalent to the endocrine pancreas. ASSUMPTIONS The distribution of neuroendocrine cells of the stomach must have different areas of density related to the functional activity of gastric secretion. OBJECTIVES Using computerized morphometry to quantify and map the distribution of populations cell neuroendocrine GD and ECL of the gastric mucosa. Applying this technique to study the stomach full obtained by total gastrectomy. MATERIALS AND METHODS closed cross-sectional descriptive study involving the collection and processing of samples of gastric mucosa from 4 stomachs full from gastectomía total and subsequent morphometric study, which is carried out through digitization and computerized analysis of the samples from biopsies. The different cell densities are represented in a gracious gastric mucosa road maps on a scale of color. RESULTS cartographic representation of the neuroendocrine cells of the stomach show the following results: The greatest density of D cells producing somatostatin is at the focal points of the club, just below the incisura angle, decreasing direction and being lower in pyloric such incisura. In the central part of the body density is minimal and increases again in the region yuxtacardial. D cells show greater density in the deep portion of the gastric glands with respect to the wing surface at all locations. The greatest density of gastrin-producing cells G is located in the rear face of the area of union between the body and gastric antrum, remains very high in the club, especially in the curvadura smaller and decreases in the region pyloric. Towards the upper body portion gastric, from the point of maximum density, expansion of the population of G cells is low. The G cells show greater density in the deep portion of the glands with respect to the surface in all locations. The cells stained with cromogranina (ECL cells, mast cells and neurons) have a maximum density in the central portion of the gastric body, especially in the incisura angle and the rear face of the stomach. The density of these cells retained week high in the portion of the gastric antrum and border loses intensity in the pyloric and cardial directions. The cells stained with cromagranina have a higher density in glands on the gastric crypts. CONCLUSIONS our work is the first of literature in addressing the distribution of the populations of neuroendocrine cells in full stomachs. The distribution map of the endocrine cells of the stomach helps to understand the functioning of complex mechanisms involved in the gastric acid secretion and pathological changes related úler duodenal and infection helicobacter pylori.

Author: LARA TORRANO JUAN.
Year: 2004.
University: GRANADA.
Place of defense: FACULTAD DE MEDICINA DE GRANADA.
Place of preparation: FACULTAD DE MEDICINA DE GRANADA.

Summary: The characteristics of non-select group without ECC with multiple arterial grafts, brings circumstances of interest as revascularization in patients with unstable angina with intra ball. He made 7 grafts sequential breast connected with two T, controlling the flow through each new anstomosis with a flow meter dopler (flowmeter Transonic). The patient could be discharged without postoperative myocardial. At present, our philosophy is revascularizar the miocardío without ECC and without clampar the aorta to prevent probleas with atherosclerotic plaques removed especially during the withdrawal because of the aortic clamp palpation of the ascending aorta identifies the problem only by 38% of cases infravalorándolo (475). Statistical study. We studied two sets of coronary patients operated for approximately the same time period, between 2000 and 2004, where he used two different surgical techniques for revascularizar myocardium in ischemic heart disease, a CEC revascularization using a cardiopulmonary bypass and heart stopped with cardioplejia hematic, technical considered standard, and another technique, which seeks novel first prove to be as safe as the standard technique in ECC, and secondly to demonstrate advantages of both global and timely use. Of more than 450 patients operated on CEC which data are available, has been selected the group of patients operated exclusively with arterial grafts, ie total arterial revascularization without extracorporeal circulation, as they are the most complex terms doctor. Then we selected the same number of patients operated with ECC, so that their medical characteristics were similar. Therefore, comparing the group operated without ECC and myocardial revascularization arterial grafts done with the group of patients with MPS operated on the same dates, similar characteristics in terms of number of patients and type of population surgically intervened in our group. Ultimately, we have two groups: 217 operated OPTAG without using CPB. In 217 operated with technical conventional ECC, ie using a standard cardiopulmonary bypass. Valuation Results and Discussion. The "gold standard" of both myocardial revascularization with or without ECC ECC is complete revascularization of ischemic myocardium. Understanding obtained by the complete revascularization in vessels with sufficient size and geographical distribution. In more than 43%, the vascular bed was considered regular or bad. With this surgical technique is the need for inotropic low, having been necessary to use only about 28% of cases. The choice of surgeon and the anesthesiologist was related to the technique used (p 0015). Neither sex nor age relates to the technique used (p 0248). The hospital stay was shorter when operated without ECC (p 0000). Mechanical ventilation was lower when using the technique of myocardial revascularization without EC. Mortality was similar for both techniques (p 0471). The reoperación showed no statistical differences with one or another technique (p 0995). The nature of the surgery showed no statistical differences with one or another technique (p 0121). The significance both for Parsonet (p 0009) to Euroscore (p 0000) said that both score were worse in the group with CEC, which can involve a certain tendency among some surgeons to operate with CEC these patients. The Association functional class of the Canadian Cardiovascular however was not related to the type of technique used (p 0669). The heart failure not related to the technique used (p 0092). Smoking is independien 8 you the 1ff8 technique used (p 0599). Diabetes is independent of the technique used (p 0919). Hypertension is systematic independent of the technique used (p 0549). The cholesterol level is independent of the technique used (p 0224). There is dependence between the existence of COPD and the use of one or the other technique being considerably higher n ° patients operated without ECC (p 0001) The renal failure unrelated to the technique used (p, 0401) The level of creatinine is not regarding the technique used (p 0214) Obesity is related to the technique used (p 0000) in this study appear more obese operated without CPB. The vascular disease is related to the technique used (p 0000) in this study, the n fourth largest being sick CEC operated without this risk factor. The degree of coronary obstruction torso is related to the type of operation (p = 0005). The action on the anterior descending unrelated to the technique used (p, 0733) in this study. The number of intermediate grafted arteries bisectrices or failed to submit to the type of technique used (p 0852). The number of obtusas marginal Circunfleja grafted not submitted relationship (p 0215) with the type of technique used. Yes there are differences with the n ° circunflejas grafted with the MPS, there is a clear trend in favor of ECC (p 0000). The number of right coronary artery grafted submitted differences (p 0020) depending on the type of technique used, being higher among those with MPS. The number of arteries downstream after presenting the EC not statistically different (p 0392) between the two techniques. The number of arteries posterolaterales of the CD grafted, did not differ (p 0449) between the two techniques. Not revascularizó any marginal artery acute among selected patients in this study there were differences give the number of grafts performed (p 0012) in favor of the surgery with CPB. The number of patients with multiinjerto is higher among operated with techniques without ECC (p 0032). The number of patients with complete revascularization is higher in the ECC are operated (p, 0016). The number of arterial grafts is higher in operators without ECC (p 0000). The number of vein grafts is higher in the operated with CEC (p 0000). The number of radial artery used is higher among operated without ECC (p0, 000). The number of mammary arteries used is higher among operated without ECC (p 0000). The number of sequential grafts used is higher among operated without ECC (p 0000). No differences in the quality of the beds in both groups (p 0331). There are no differences between the two groups regarding the use of the ball contrapulsación (p 0207). The use of inotropes in surgery is higher in the patients operated on with CEC (p 0000). The number of perioperative stroke is lower in the group are CEC (p 0000). The number of patients with postoperative atrial fibrillation is lower in the group without ECC (p 0000). There is no difference in postoperative stroke. The postoperative bleeding despite the use of aprotinin in the group with CEC no differences (p 0254). The re-operation for bleeding no differences (p 0544) The ejection fraction did not differ (p 0110) There connection with a larger number of patients operated fully with injertoarterial in the group revascularizado without ECC (p 0000). Time spent in UVI no differences between the two groups (p 0052). The difference between the hospital stay (time not UVI) is higher among operated with CEC (p 0000). Conclusions The technique of complete arterial myocardial revascularization without MPS are two connected T breast without touching the aorta has advantages compared with myocardial revascularization using CPB. It can be said that the technique of myocardial revascularization without CEC presents a morbiomortalidad lower with respect to myocardial revascularization with conventional ECC, for various reasons found in the comparative study of the two groups. The time of postoperative mechanical ventilation was lower when using the technique of revascularization without CPB. In patients operated without CEC explained fewer inotropic in surgery. The number of perioperative stroke was lower when operating without ECC. The incidence of postoperative atrial fibrillation was lower in the group operated without CPB. There was no difference in the postoperative hemorrhage, although the group was treated with aprotinin CEC and the CEC was treated group without antiplatelet. The hospital stay was shorter when operated without CPB. There are a number of risk factors such as obesity, vascular disease, peripheral and carotid and chronic obstructive pulmonary disease who have conditioned the indication for surgery without ECC and make it advisable to use with these cases. Although the technique revascularization with arterial grafts without ECC is more complex, the number of patients with complete revascularization was higher in the operated without CPB. Also the number of patients with three or more grafts were higher in the group without CPB. Although in statistical terms mortality was similar in both groups, there is a tendency to lower mortality, 3.2% in the group without ECC versus 5.1% in group operated with MPS. Final recommendations. The surgery for coronary revascularization without ECC allows us to solve difficult situations in patients most at risk, and therefore consider it necessary in their learning and use in situations with appropriate surgical indication. This technique must be learned so correct, and that its application is recommended by its lower morbidity and mortality, not only in high-risk patients as COPD, vascular disease, obesity, etc., but in all those requiring myocardial revascularization. Summary of Thesis in the field of this university, has been developed, while in the rest of the world, the technique of coronary bypass without ECC, has been made at present more than 500 interventions with this technique and developed specifically surgery without CEC with coronary artery graft using both mammary and radial artery left. The Service Cardiovascular Surgery (SCCV) Hospital Universitario Virgen de las Nieves of Grenada (HUVN), in relation to other hospitals in our country is at the forefront in terms of techniques myocardial revascularization using different methods and systems, being reference for learning and training in the techniques of revascularization without the CEC honoree and SCCV of HUVN of Grenada. On this trajectory, the development of coronary surgery without CEC and the implementation of its techniques from HUVN of Grenada, followed by a doctorate in recent years, with the aim of improving the results obtained in the field of surgical revascularization surgery with ECC, which is based dissertation present. Many processes have been reduced drastically invasive methods, obtaining better results as evidenced by increased survival, fewer complications and a faster return to activity and productive life. The focus of a minor or minimal invasion has gained momentum and has been the subject of intense research in recent years regarding the myocardial revascularization surgery, the exclusion of extracorporeal circulation (EC) believe that is what determines a smaller invasion . These novel techniques are already in a phase of full implementation, which makes it absolutely necessary evaluation and comparison regarding techniques have been employed for over time. The disclosure of a technical or otherwise, the disuse of one over the other, or the eventual abandonment, largely depend on a comparative analysis correct. The thesis is divided into chapters, the first of which was the historical evolution of surgery for coronary revascularization. This hemo 8 s realiz 1ff8 ate a series of historical complications resulting basic to understanding the evolution of the concepts and methods to tackle the problem. Also, in the current state of revascularization miocárdica take place in different sections the most interesting aspects of Extracorporeal Circulation, its special impact on the development of cardiac surgery, its advantages and its harmful effects, and to also review its complications fund technique coronary revascularization without CEC and the evolution towards a more futuristic robotic surgery less invasive. The second chapter is dedicated to justify this work, presenting, discussing and trying to demonstrate the advantages of using the technique of myocardial revascularization without CPB. The working hypothesis also incorporates a new element that is both revascularizar myocardium without ECC, do with arterial grafts. We provide the most important evidence currently available about the benefits of their use. In subsequent chapters, the material and method used is the subject of our study. Evaluates and discussed the results before reaching conclusions. It also provides an extensive bibliography at the end of the study as it is obligated in any scientific work. Early coronary revascularization without CPB. The surgery for coronary revascularization, (28) after various historical landmarks, such as the introduction of Scones by coronary arteriography, was born with the heart beat (Kolesov in 1964 conducted a breast anastomosis to the anterior descending coronary artery by toractomía left with the heart beat) . But since the publication of the book Dr.Favaloro in 1970, the expansion of CEC with coronary surgery that began in 1967 at the Cleveland Clinic, and was attended by more than 700 patients. From there developed the coronary surgery with the heart stopped, in a surgical field without blood and protected in principle with moderate hypothermia, and then cardioplejia. The indications for surgical ischemic heart disease may have been established over the years by the various working groups. About 1985, a few surgeons in Argentina (Benetti) and Brazil (Buffolo) used coronary revascularization without ECC, primarily for economic reasons, however, angiographic study claimed to have the same results as in ECC, without the harmful effects of bypass cardiopulmonary. Their work formed the basis and beginning of the revival of coronary surgery without CPB. In recent years, coronary surgery without ECC have resurfaced with force, after having been limited growth for different reasons, the difficulty of grafting suturing a coronary artery with the heart beat could compromise the reliability of the anastomosis; bleeding after open artery Coronaria difficult vision, and occurred important hemodynamic alterations to lift the heart to access to access the heart arteries of the rear face of the left ventricle. Also, encourage the development of techniques of myocardial revascularization without ECC, the belief that this prevents or significantly decreases the dangerous potential of cardiopulmonary bypass, such as: The stroke and neurological complications (262) The phenomena of immunosuppression after The CEC bleeding complications platelet dysfunction secondary to the marked increase in the risk in patients with renal and respiratory Possible complications resulting from a bad myocardial protection Overall, the problems of multiple organ failure resulting from a systemic inflammatory response difficult to control. The experience of the groups that practice these techniques, it is clear that the benefits provided to their use would be based on: Less time ventilatory support and less inflammatory response extubation in the operating theater more frequent minor blood loss. The crowning surgery without ECC is a procedure different from the usual, because while the heart is still throbbing. The surgeon does not use the machine corazón-pulmón to stop the heart. Instead instruments are used to stabilize the area located where he performed the bypass. This allows to continue the flow of blood through the coronary artery, while it is being anastomosis. The basic argument of this kind of revascularization is to avoid the complications of extracorporeal circulation, mainly the systemic inflammatory response syndrome (SIRS), and postoperative anemia. From the very beginning was handled as an argument against the CEC surgery without decreasing the rate of patency of grafts, due to increased technical difficulty in the anastomosis. This was due both to increased technical difficulty in carrying out the anastomosis, as a lack of experience in implementing these techniques. To remedy this problem have made significant efforts, both in anesthesia as standardizing the surgical technique. Chance of this investigation. The surgical myocardial revascularization with CEC is not without risks and complications attributable mainly to the technical CEC; intend to demonstrate the advantages and benefits of myocardial revascularization using techniques without ECC, with the help of a series of devices that allow us to do surgery Revascularization with coronary heart beat. The advantages of revascularizar myocardium without ECC become more noticeable in surgical patients arriving in the operating room with more limitations, ie patients most at risk: Renal, respiratory, liver, a history of stroke, and especially in patients with strong calcification of the aorta, where the entry into MPS involves a major manipulation of the same. Although surgery myocardial revascularization in ECC, ie surgery bypassa aortocoronario standard is a technique adapted and with good results, which have been improving d over the past 35 years. The coronary revascularization surgery with CEC, has been unable to prove to be better than the technique of coronary revascularization without ECC, despite the fact that the development would not exceed much on site or eight years and most of the surgical groups that the practice they are still learning curves. Despite being a technical convention and the well-known progressive improvement in regard to the results, sets of authors with great prestige in the field of cardiovascular surgery published that make myocardial revascularization in CEC is an independent predictor of mortality. Our experience is limited, the number of patients being operated on with this technique potentially insufficient to obtain decisive conclusions, but on our firm belief in this technique which prompts us to present our results, discussion and advocacy of the method in the present work done as doctoral thesis. Aims to achieve the aim of the thesis is to present, discuss and demonstrate the advantages it can bring in morbiomortalidad using techniques revascularization miocárcica with the heart beat without using ECC, compared to the standard technique and conventional cardiopulmonary bypass. Another objective is to try to demonstrate the benefits of myocardial revascularization without using ECC exclusively arterial grafts, basically two breast, occasionally supplemented with radial artery. It attempts to show how in recent years, the emergence of techniques coronary revascularization without ECC ie, myocardial revascularization with the heart beat, has led to an improvement in the outcomes of coronary surgery, both in mortality in morbidity when compared with the results obtained with myocardial revascularization with circulation 8 n Extra 11f7 corpóreas. We believe that this is especially true in high-risk groups. The comparison between a cohort of patients operated on with CEC and the number of patients revascularizados without forward CEC has an unavoidable bias not being conducted with an experimental design prior selecting patients also are decoupled in time, as the author of the thesis and surgeon responsible for most of the patients operated without ECC, used this technique for myocardial revascularization by more than 90% of coronary patients operated, making it difficult to establish statistical comparisons with risks. However, we expect the design of statistical study of the two groups as a result of data analysis, conclusions that will allow us to validate the working hypothesis of the doctoral thesis. Assumptions of work. The technique of complete arterial myocardial revascularization without ECC breast connected with two T, avoiding touching the aorta, offering advantages over myocardial revascularization using CPB. We intend to demonstrate that the complete myocardial revascularisation is better with artery grafts, breast connected better with two T to perform multiple sequential grafts, without touching the aorta, and better without CPB. During the period from 1997 to June 2004 in the surgical group SCCV of HUVN of Grenada, we have conducted more than 450 operations coronary revascularization with the heart beat (techniques beating heart) without CPB. Of more than 450 patients operated without ECC (extracorporeal circulation) is studied a group of 217 operated exclusively with arterial graft (OPTAG), ie total arterial revascularization, compared with other similar group in number operated with MPS. It will attempt to draw conclusions on the comparison of results of the two groups. 217 operated with conventional techniques CEC, ie using a cardiopulmonary bypass. 217 operated OPTAG. It also compared the results of the group without ECC with those published in the medical literature, with and without ECC. This group of patients with arterial revascularization complete without ECC, using double breast esqueletizada, is the core work in developing this thesis. Materials and methods. As we said, in recent years, coronary surgery without ECC, re-emerging after having been limited growth for different reasons: the difficulty of grafting suturing a coronary artery with the heart beat could compromise the reliability of anastomoses : bleeding after opening the coronary artery difficult vision, and occurred important hemodynamic alterations to lift the heart to access the arteries of the rear face of the left ventricle. Experience Surgery Coronaria CEC without really began in HUVN from Watford in 1999, after 20 patients selected and operated with a disease or two glasses since 1197. Until June 2004, a total of over 450 patients underwent surgery for coronary artery disease without ECC, which will highlight a subgroup of patients revascularizados fully with arterial grafts, mainly double breast esqueletizada and connected T, plus some radial artery grafts for the realization of sequential grafts with coronary revascularization complete without CPB. The material used in this thesis is based on two groups of patients with coronary disease operated with two different techniques: conventional revascularization with CEC and CEC without revascularization during the same time period. Patients in both groups were not selected and the statistical method compared the results with contingency tables and chi-square tests. Statistical data of the two groups undergoing surgical studies were obtained with the program SPSS 12.0.

Author: MANCEBO MORENO GEMMA.
Year: 2004.
University: AUTÓNOMA DE BARCELONA.
Place of defense: UNITAT DOCENT VALL D HEBRÓN.
Place of preparation: Unidad de Ginecología Oncológica. Servicio de Ginecología y Obstetricia.Hospital materno-infantil Vall dHebron. Barcelona.

Summary: For many years, the standard treatment of invasive carcinoma of cervix locally advanced, was carried out almost entirely by radiotherapy. Beginning with the publication in the años1999 and 2000 from 5 clinical trials randomized patients diagnosed with cancer of cervix locally advanced and / or type Bulky, which showed that the use of radiation therapy in conjunction with chemotherapy reduced in a 30-50 % mortality of these patients. Since then, the treatment by radiquimioterapia conocmitante has emerged as the standard for such cases. Based on those results would be quite reproducible outside the clinical trial, designed a protocol based on the concomitance therapeutic treatments. Tarif MAIN GOAL assess the efficacy of treatment with concomitant chemoradiotherapy of cases of cervical cancer locally advanced and bulky (IB2-IIa> 4cm to IVa), in an unselected population of patients treated outside of a clinical trial. 69 patients were included in the study between June 1999 and julio2003, of which only were evaluable 60, with a good tolerance to treatment after an average follow-up of 25.4m survival at 3 years was 61.8%, with an average of 41.8 months. Parted by stages as it were cases stadium FIGO ib2-IIB VS. III-IVa and showed no statistically significant differences between supervivenca of both groups. We performed a multivariate analysis of risk factors for response by identifying himself as an independent prognostic factor in the application of radiotherapy endocavitaria after external beam radiation. The results were quite similar to those previously published, saving methodological differences between each of the studies. We conclude that concomitant therapy with radiotherapy and chemotherapy in these cases of locally advanced carcinomas of the cervix and / or type Bulky, it is efficient and effective in routine clinical practice.

Author: COSSI CERBASI LAURA LUCIA.
Year: 2004.
University: GRANADA.
Place of defense: FACULTAD DE ODONTOLOGIA.
Place of preparation: UNIVERSIDAD DE GRANADA.

Summary: The goals outlined in the present study were as follows: 1. To check whether the use of a silicone catheter serves as a guide for tissue regeneration duct excretory parotídeos severed. 2. Check in cases of loss of substance duct paro-tídeo injured, the use of a silicone catheter in conjunction with an autologous vein graft is a valid therapeutic option for the reconstruction of the same. 3. Assessing the recovery of salivary function and the possible existence of post-surgical complications through a trial, sialo-gráfico and histological. The animals selected for this study were 20 dogs adulthood, of both sexes, of different races, and with a weight varying between 20 and 33 kg, from the Animals Service Experimental Medicine and Surgery of the Central Military Hospital the National Defense. The animals were kept with the same diet and similar!

Author: RITE ZAMBRANO INMACULADA.
Year: 2004.
University: SEVILLA.
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The brain derived neurotrophic factor (BDNF) is a member of the neurotrofinas, secretion of peptides that act as growth factors during development phenotypic and contribute to the maintenance of specific neuronal populations in the CNS in the state adult and during development. The administration of BDNF has been shown to be one of the most effective therapies in different animal models of Huntington's disease (HD). This disease is associated with the degeneration of one of the cores that are part of the basal ganglia, striated. Given that most of the BDNF protein which is found in the striped comes from its tissue invervante, namely, the cerebral cortex and the black substance compacta (SNc), we wanted to know what's going on the expression of c BDNF in these structures after the injury of their target neurons in the striated. In this sense, therefore, we have looked at what are the factors that regulate the expression of BDNF in different areas of the CNS degeneration under conditions very similar to those occurring in Huntington's disease. The striated was injured by the administration of KA, QA or DCG-IV, toxic, causing the death of neurons projection of striated through a mechanism known as excitotoxicidad. After the injury, a noticeable increase in the expression of BDNF mRNA in the crust and SNc. Therefore, it may be a relationship between loss of the target tissue and expression of BDNF in the fabric inervante. Either way, BDNF is a prototype of gene whose expression is regulated by an increase in neuronal activity, so we decided to study increases in neuronal activity in the conditions of our injury in the nuclei where observábamos an increase in the expression of BDNF. We used as a marker of increased activity neuronal expression Arnm of cFos, an early gene induction. Thus, we see an increase in the expression of cFos in the cortex but not in the SNc. Therefore, the results of this thesis show that the expression of BDNF in the cortex and the SNc, which are the structures that provide virtually all of this neurotrofina the striated, is regulated for different mechanisms. In the cortex, the injury exitotóxica of striated cause an increase in the expression of BDNF, proportional to the increase in neural activity in layers and parts thereof that innervate the estraido. However, in the SNc increasing the expression of BDNF is completely dependent on the integrity of the target tissue and independent of a possible increase in neuronal activity. To the best of our knowledge, this is the first time in literature has been described regulation of the expression of BDNF exclusively dependent on the loss of target tissue. This phenomenon suggests a potent activity neurotrófica of BDNF expressed in the SNc on their target neurons of striated in terms of degeneration very similar to those seen in Huntington's disease.

Author: RUIZ ARAGÓN JESÚS MARÍA.
Year: 2004.
University: SEVILLA.
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The etiology of infectious vaginitis is a clinical entity that has been increasing in recent years to constitute at present one of the main reasons for gynecological consultation. The distinction between colonization and asymptomatic vulvovaginal candidiasis is difficult because the signs and symptoms of thrush overlap with those of other vaginal diseases. In introducing infection plays a prominent role risk factors inherent in the host, but also the virulence factors of each yeast that comes to colonize the genital tract. The characterization of strains of Candida albicans with different markers are useful for epidemiological studies, but not in an appropriate manner enables the selection of strains with a predilection for the colonization of the vagina and production of vulvovaginitis. The knowledge regarding the role as determinants of pathogenicity hydrolytic enzymes, primarily acid and phospholipase proteinase, are not fully clarified and are continuing studies relevan new types of these proteins involved in the pathogenic yeast in the vulvovaginal candidiasis . Our aim has been to conduct a comprehensive and detailed study of vulvovaginal candidiasis in women's health area of Cadiz, on the basis of a dual clínico-epidemiológica and microbiological. To do this we conducted a comprehensive study for the year 2003, in consultation with gynecological patients served in the Hospital Puerta del Mar in Cadiz. Patients were classified according to clinical manifestations in asymptomatic, paucisintomáticas and sontomáticas. It proceeded to the characterization of the strains of Candida albicans from vaginal exudate of these patients pair aborregar differences between the clinical groups. The phenotypic markers with the most differences were found in all three clinical groups were established: the ability to grip the proteinase production and the production of phospholipase. They also found very useful qualification in the cultivation and planting of fungal samples media mycological cromogénicos.

Author: RUIZ CORREA ADRIANA.
Year: 2004.
University: SEVILLA.
Place of defense: FACULTAD DE FARMACIA.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The objective of this research was to determine whether arrays developed with the resulting graft copolymers of methyl methacrylate on the potato starch derivatives, hidroxipropilalmidón (HAMMA) and starch (CAMMA), prolongs the release of theophylline anhydrous in vivo since previous studies showed that prolonged their release in vitro. Before assessing behavior in vivo was assessed the effect of variability interlote's so copolymers, a pH gradient, resistance to breakage tablets matrix, the variability of output and speed of agitation trial dissolution on the release of theophylline. We found that the variability interlote of copolymers and the production process affects little release of the active ingredient. In relation to the pH gradient and the resistance to breakage, tablets made with HMMA show a release independent of the pH of the medium of dissolution and an increase in the speed of release with increasing resistance to breakage, while the developed with CAMMA present the opposite behavior. On the other hand, an increase in the rate of release with increasing resistance to breakage, while those developed CAMMA presented with the opposite behavior. On the other hand, an increase in the speed of agitation trial release originates, in general, an increase in the rate of release of theophylline. The in vivo test in Beagle dogs, shows that the prolonged release formulations of theophylline. This extension is most marked with the formulations developed with CAMMA.