MEDICAL SCIENCE (5)

Author: BARTOLOMÉ MORENO CRUZ.
Year: 2004.
University: ZARAGOZA [More theses of this university] [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: OBJECTIVES: To know the prevalence of smoking health, the performance of health in consultation with the patient daily smoker and prior knowledge on the subject. Studying the impact of an intervention aimed at improving professional skills in the treatment of smoking cessation. DESIGN: Essay Community, randomized, parallel control group and triple blind. SCOPE: Primary Care and Specialist of the Autonomous Community of Aragon. METHODOLOGY: Test pilot to establish specialties to be included in the survey questionnaire and to validate. Questionnaire anonymous, aimed at doctors (specialists and MIR) and DE. Intervention after completing the questionnaire on drug therapies in smoking cessation in the intervention group and action on tobacco except drug treatments in the control group. Questionnaire mailed to two months of the intervention to analyze changes. RESULTS: Prevalence smokers health OF 28.7% Medical 25.8% (MIR 28.6% and specialists 23%). Most in Primary Care (26.6%), women, 25.9% between 35 and 49 years. Convivientes smokers at 35.9%. It costs address to 55.9%. Considered trained on 52.9%. They detect smokers the 65.2% of health. They offer advice on 61.6%. They stage a smoker for 53%. They report on drug treatment for 46%. They set definitive dates for quitting the 21.7%. Pautan pharmacological treatment of smoking cessation to 20%. The 67.3% of health treatments did not know at first and second choice. The health quitters current (47% responded correctly to all or any of the questions of gum, 41.3% of patches, 19.9% and 20.1% spray of tablets and 42.1% of bupropion) and never smokers (40.6% responded correctly to all or any of the questions of nicotine gum, 37.9% of patches, 18.6% and 20% spray of tablets and 34.5% of bupropion) were the ones who knew better treatment. The health conducting fewer interventions (questioned whether smoked to patients, investigated the habit and offering health council, set definitive dates for quitting, reported cessation treatments and provided material assistance, continued to smoking) were the least knew pharmacologic therapy with all forms of nicotine and bupropion, the difference being statistically significant for all of them. Results of intervention are: Control Panel intervention group Mean Difference (ES) Mean Difference (S) Statistical Significance Do you smoke? -5 (Â ± 9) -33 (Â ± 35) p = 0289 Do you want to quit? -5 (Â ± 5) +2 (Â ± 7) p = 0435 sets a definite date for quitting 0 (Â ± 1) -2 (Â ± 2) p = 0487 has been given advice on consultation -3 (Â ± 5) -5 (Â ± 9) p = 0866 has been given material in the search +1 (Â ± 1) +1 (Â ± 1) p = 0752 There is monitoring -1 (Â ± 1) - 1 (Â ± 1) p = 0995 CONCLUSIONS: High prevalence of smoking and cohabiting 8 smokers, pets 42f s health in the population. Little intervention to the patient smoker. Great ignorance of the drugs used in cessation. Toilets active smokers are the least active and have less knowledge. Whether improving knowledge about drugs used in cessation, as increasing non-pharmacological skills are achieved similar results with regard to action in the patient smoker.

Author: Ruiz Escusol Salome.
Year: 2004.
University: ZARAGOZA [More theses of this university] [www.unizar.es].
Place of defense: Facultad de Medicina de Zaragoza.
Place of preparation: Facultad de Medicina.

Summary: The neurological disease in neonatal period has great impact on morbidity pediatric neurological later, and in the years lived with disability in adulthood. Advances in perinatal support have led to a decrease in mortality and child morbidity, but still frequent the aftermath of the central nervous system and the sensory organs. The key objectives of our work have been studying the incidence of neurological disease in neonatal period; assess significant data from anamnesis, physical examination, and follow-up treatments, diagnostics determine neonatal Frequently, and analyze the effects more common. We have conducted a descriptive study, cross-sectional observational, retrospective cohort. We have infants with neurological disease that have been studied in the Children's Hospital Universitario Miguel Servet in Zaragoza (HIUMSZ) over a period of 5 years (1996-2000); last update data up to September 2003. The most important findings and conclusions arising from this work are: 1Â th .- There is a high demand for assistance neuropediatric newborn. The incidence rate for RN suffering from neurological disease identified in the neonatal period was 6.76 per thousand per year. 2 Â th .- The most common reason for consultation was suffering perinatal in the 37.56% of children. The premature ranked second. 4 Â th .- The group home perinatal pathology was the largest in the neonatal period with 61.46%, followed by the pathology of prenatal (30.24%), and neonatal seizures (27.80%). With the trend is even the pathology of prenatal and perinatal origin. 11.22% evolved toward some form of epilepsy. 5 Â th .- Studies of genetic diagnostic value were positive in the 6.83%. The ECO transfontanelar was proof of neuroimaging most popular (92.20%). The TAC was the one that had a value greater positive diagnosis in 32.20%. MRI was altered in 77.78% of the cases in which this was done. The EEG was sought in 74.15%. 6 Â th .- Most children requierieron specialized treatment: 60% joined UCI-NN, and the 54.63% received treatment and rehabilitation of early stimulation. 7 Â th .- 46.83% of children continue to monitor the External Consultation. The infant cerebral palsy was the most frequent sequel, in 17.07%, followed by mental retardation. 8 Â th .- The most frequent cause of death was the pathology of origin prenatal (56.67%) followed by perinatal home. He especially in the post - neonatal period. 9 Â th .- The "RN risk" should be done in hospitals with Level III Neonatal Units, capable of offering the best care available at the moment for such infants. We need neuropediatras collaborate with neonatólgos working on them. 10 Â th .- monitoring programs are needed for these ninños where all the necessary specialists collaborate, in close contact with the Centers for Child Development and Early Childhood, in order to assist the upgrading of these children and neurological early lead. They should continue at least until 6 or 7 years, in order to detect effects of late-onset.

Author: MERINO DÍAZ LAURA.
Year: 2004.
University: SEVILLA [More theses of this university] [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: DEPARTAMENTO DE MICROBIOLOGÍA. FACULTAD DE MEDICINA.

Summary: Most of the clinical microbiology laboratories routinely determine the sensitivity to various antibiotics with automated tools based methods in broth microdilution. Although these methods based on broth microdilution. Although these methods based microdilucion in broth. Although these methods based on broth microdilution are good for detecting most of the resistance mechanisms antimicrobina, including resistance to clindamycin constitutive not allow detect induced resistance to clindamycin. These errors in the detection of induced resistance to clindamycin may lead to therapeutic failures in treatments with clindamycin. Recently the NCCLS (National Committee for Clinical Laboratory Standards) has recommended a method to detect the practice inducible clindamycin resistance in Staphylococcus pp. Which consists of placing a disk erythromycin and clindamycin another in a plate of agar Mueller Hinton in adjacent positions at a distance of 15mm., dissemination of erythromycin by the agar induce resistance to clindamycin resulted in a decline in the area inhbición of clindamycin next to the disk erythromycin (area D effect). The objectives of this study were: 1, - Knowing the prevalence of constitutive and inducible resistance to macrolides and lincosamides in different strains of gram positive microorganisms from clinical isolates - S.aureus and coagulase negative Staphylococci (SNA) - Estreptococos beta hemolíticos: * Estreptococos beta-haemolytic group B (S.agalactiae). Invasive. * Estreptococos beta-haemolytic not invasive group A and other non:. Invasive. Respiratory 2-Knowing the distribution of the different phenotypes of resistance and genes involved in every phenotype. 3-Comparative study of the resistance phenotypes in various species as well as in terms of clinical caused by them. 4-To determine the sensitivity to erythromycin and clindamycin by broth microdilution in, the resistance levels correlating with the mechanisms of genotypic resistance of the same. 5, clonalidad - Analysis and study of the genes involved. The results of this study concluded that business methods based on techniques in broth microdilution, which are used in most laboratories Clinical Microbiology, not to detect the induced resistance to clindamycin being necessary for the detection technique for double diffusion disk. The completion of this work led to implant in our laboratory routinely this technique, which previously did not occur to detect this kind of resistance in clinical isolates of Gram positive cocci, which clindamycin may be a therapeutic option. Moreover, the great variability in the rates of resistance to macrolides and lincosmidas between strains of our study and strains studied in other geographical areas within Spain, as in other countries is due mainly to the different political antibiotic which it is carried out in every pious, but also depends delos resistant clones that are circulating in an area at a given time.

Author: GIL PENON TALIA.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD MEDICINA Y ODONTOLOGIA.
Place of preparation: FACULTAD MEDICINA Y ODONTOLOGIA-CLINICA ODONTOLOGICA.

Summary: THE RESINS RESTORATIVES COMPOSITE MATERIALS ARE SOME OF MAXIMUM EFFECT TODAY IN DAY. IT IS NECESSARY TO REVIEW BIBLIOGRÁFICA DESCRIBE IN WHICH ARE THESE MATERIALS THAT CONSISTEN IN MATRIX OF RESIN, FEW PARTICULATE MATTER OF FILLING, AGENTS RADIOPACIFICADORES, AGENTS OF UNION, MODIFICADORES OPTICAL, INHIBITION OF SYSTEMS AND MODIFICADORES OPTICAL AND SYSTEMS FOR BEGINNERS THE POLYMERIZATION. DESCRIBE THE SYSTEM IS ALSO ADHESIVE FOR UNIR THESE MATERIALS FOR DENTAL STRUCTURE, THE SOURCES OF LIGHT FOR PHOTO POLYMERIZATION OF THE SAME AND THE DESCRIPTION OF OTHER MATERIALS ESTÉTICOS. DESCRIBE THE GOALS ARE ACTIONS OF RESISTANCE TO COMPARE THE COMPRESSION FOR PROBETAS WITH VARIOUS COMBINATIONS OF MATERIALS FROM DIFFERENT VISCOSIDADES. IS PROPOSING AN HYPOTHESIS: THE COMBINATION OF COMPOSITE RESINS FOR DIFFERENT VISCOSIDADES IN THE SAME PROBETA NOT PRODUCIRÁ AN INFLUENCE ON THE NEGATIVE RESISTANCE TO THE MATERIAL OF COMPRESSION. HE DESCRIBES THE MATERIALS USED IN THE STUDY AS WELL AS THE METHOD OF MAKING THE SAME, AND HE HAPPENS TO ENUMERACIÓN RESULTS IN WHICH CAN OBSERVE A TREND OF GENERAL TO INCREASE THE RESISTANCE TO THE COMPRESSION RISES UNDER THE PERCENTAGE OF COMPOSITE FLUIDO UP TO GET TO A POINT OF OPTIMO APARTIR IS THE VALUE TIENDE of diminishing. IT IS NECESSARY TO ANALYZE THE STUDY PUBLISHED IN CONNECTION WITH THE LITERATURE FOR MAKING THE METHOD AND REVIEW OF RESULTS AND EXPLAINED WHY IS THAT HAS OPTADO BY METHOD AND COMPARE WITH THE RESULTS OF THESE STUDIES AND EXPLAINED WHY HAVE BEEN ACHIEVED THESE RESULTS. IS FINALLY ARRIVES TO CONCLUSIONS ON SIX POINTS.

Author: Hernández Guillamóm Maria del Mar.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Facultad de Medicina.
Place of preparation: Autónoma de Barcelona.

Summary: The main objective of this dissertation has been exploring the possible contribution of Amino Oxidase Sensitive Semicarbazida (SSAO) in the vascular damage and its implication on the Angiopatia Cerebral Amiloide (AAC) and Alzheimer's disease (AD). The SSAO is a multifunctional enzyme, which have assigned different roles depending on the biological tissue where they locate. His expression is widely distributed in mammalian tissues especially in highly vascularizados, associated with endothelial cells and smooth muscle. Likewise, there is a form of SSAO soluble present in the plasma of all mammalian species studied. In this paper, first, we studied the alteration of the enzyme in the neurodegenerative disorder associated with AD type CCT. The results obtained allowed to demonstrate, on the one hand, sobreexpressión SSAO level in human stroke patients with EA-AAC. Likewise, the activity SSAO plasma of patients with dementia type sporadic AD and established a positive correlation between the values of this activity SSAO soluble in plasma and severity of dementia. Given that the products generated from the catalytic action of SSAO are considered highly reactive and potentially toxic properties, we studied the effect of physiological substrate oxidation of SSAO, aminomethane on vascular cells in culture. The results confirm that the oxidation of aminomethane by both the SSAO soluble as SSAO tissue, was capable of inducing apoptosis in smooth muscle cells. In summary, this paper describes for the first time an alteration SSAO, two isoforms, related EA-AAC. Moreover, it confirms a contribution, through its own catalytic action, the vascular damage.

Author: Alba Molina Aurora.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Facultad de Medicina.
Place of preparation: Hopital Univ. Germans Trias Pujol.

Summary: The term describes a diabetic metabolic disorder of unknown etiology characterized by multiple chronic hyperglycemia, in which there is an imbalance of the metabolism of carbohydrates, fats and proteins due to a change in the secretion and / or insulin action. The type 1 diabetes is characterized by a selective destruction of pancreatic beta cells of the cell-mediated immune system. It is one of the chronic diseases more common and affects 1 in every 300 children. It detect markers of autoimmune destruction: autoantibodies against islet (ICA), insulin (IAAs), GAD (GADAs) and against tirosin phosphatase IA-2 and IA-2. There is a strong association with the alleles HLA-DR/DQ that may be predisposing or protectors. Diabetes inmunomediada or diabetes type 1 (DT1) usually appears in childhood or youth but can occur at any age. Patients with DT1 and their first-degree relatives have a high risk of suffering from other autoimmune diseases. Although genetic predisposition is an important requirement for developing the disease, some evidence-mainly epidemiológicas- point to a critical role of environmental factors: only 10% of individuals genetically predisposed progresses into a diabetes clinic; match of the disease is only un50% Approximate between identical twins; geographical variations; seasonal incidence of the disease, with peaks in the autumn and winter and epidemiological studies of immigrants to areas with the highest incidence resulting in an increase of the disease. The viruses have been proposed as an environmental factor in the development of this disease and have been published some evidence: seasonal incidence of the disease was more common in autumn and winter, the presence of some virus-specific IgM in serum of patients new diagnostic detection IFNs type 1 (cytokines antiviral) in the pancreas of diabetic patients, the presence of enterovirus RNA in the serum of diabetic patients and data from studies in experimental animal models. The expression of IFNs type 1 is the first line of defense of the body against a viral infection. Our hypothesis is that the expression of cytokine antiviral IFN-beta in pancreatic islets could induce an inflammatory situation locally, attracting cells leucocitarias and vary the expression of molecules involved in antigen recognition, favors the local loss, which would attract cells and leucocitarias vary the expression of molecules involved in the reconociiento antigenic, favors the loss of immunologic tolerance to beta cells and causing autoimmune diabetes. To study the role of IFN-beta (IFN type 1) in the development of diabetes, we studied different strains of transgenic mice that express IFN-beta human pancreatic beta cells. The overall objective of the study is to examine the role of IFN-beta in events leading to the destruction of pancreatic beta cells in the DT1. The specific objectives of the study are: 1 .- Transferring the transgene genetic background of CD-1 to genetic backgrounds and NOR NOD model and generate transgenic inmunodeficiente NOD-SCID RIP-HUIFN-beta. 2 .- To determine the time of onset and incidence of the disease in transgenic models generated in the different genetic funds. 3 .- Defining the nature of autoimmune disease; 3.1 .- Descartando a possible disruption of cell metabolism beta caused by the toxic effect of direct transgene and / or its product. 3.2 .- Characterizing the degree of insulitis and its composition (cell types that make up the infiltrators island), as well as possible changes in the expression of molecules involved in immune recognition. 3.3 .- Transferring the disease through transplants splenocytes or lymphocytes infiltrantes pancreas of diabetic animals to immunodeficient NOD mice. 4 .- To characterize the changes IFN-beta place in the blocks at the level of morphology, inflammation and related molecules, as well comodeterminar if 8 his expre 1ff8 sion alter the microenvironment tímico. 5 .- determine the effect of IFN-beta in lymphocyte subpopulations level target organ (pancreas) and peripheral (regional lymph pancreas and spleen) in healthy animals and diabetics. The original model expressing IFN-beta human pancreatic beta cells at the genetic background CD-1 was given by Professor Fatima Bosch (University of Barcelona). It designed a series of retrocruzamientos for generating transgenic mice in genetic background nonobase diabetic (NOD), susceptible to the disease resistant and nonobese (NOR), resistant to the development of type 1 diabetes. These animals generated in our laboratory using retrocruzamientos selective and follow through microsatellites, develop an accelerated autoimmune diabetes (between 3 and 5 weeks) with a higher incidence of the disease to the original model. The transgenic expression of IFN-beta by pancreatic beta cells, involves the development of DT1 in resistant strains and significantly accelerates the onset of the disease in the susceptible strains. The genetic background of transgenic animals determines the starting point and the percentage of individuals who develop DT1. The immunodeficient transgenic animals do not develop the disease. The antimales transgenic all loci in the genome heterocigosis not develop DT1. To discard a toxic effect of the transgene and its product is a series of metabolic determinations: glycemia, tolerance test to intraperitoneal glucose, insulin and contents of pancreatic insulin. None of these parameters showed differences between transgenic animals and controls, which rules out the toxic origin of the disease. In addition, we generated transgenic model in genetic background NOD-SCID (inmunodeficiente). None of these animals developed insulitis and diabetes so that the disease in this model is linfocito-dependiente. It analyzed the degree of infiltration of the islets of all strains of study to determine whether the expression of the transgene determines changes in the level of infiltration and it has been concluded that the expression of HuIFN-beta accelerates infiltration and increases significantly the percentage of islets infiltrated the animal gene pool and NOR NOD. By dobel indirect immunofluorescence have characterized the cell types that make up the pancreatic infiltrated and how are distributed in the lesion in the various study groups. HulFN-beta detected in the islets of transgenic animals in all funds and genetic colocaliza with staining for insulin. The islets in mice healthy group's CD-1 RIP-HulFN-beta are not predominant infiltrators (75%) and within the group of infiltrators, most infiltration of a form of peri-insulitis. The phenotypic characterization dela insulitis shows that the majority of mononuclear cells infiltrantes are T lymphocytes (CD4 greater CD8). The B cells were detected only occasionally. Of the group of APCs, some macrophages were detected around the endocrine and tissue has been observed occasionally in some dendritic cell islets not infiltrantes or shortly infiltrators. The molecule MHC class I hiperexpresa in the endocrine cells of all the blocks, but not MHC class II. The group of diabetic animals presents a greater degree of infiltration that the group of healthy animals CD-1 RIP-HulFN-beta being infiltrated the composition of similar except for the presence of group B cells on the periphery of the islets. The 86% of islets of healthy animals NOR RIP-HulFN-beta presented infiltration. To characterize this shows mainly infiltrated lymphocytes ByT (CD4 amyor CD8) and some cells NG. The B and CD4 + cells distributed in the form of groups around the islets, p ero not the CD8 + and NK shown isolated in the exocrine tissue, the bulk of infiltration and the endocrine tissue that has not yet been destroyed. There has been some macrophages in the periphery or within the islets. The islets infiltrators remain undetected just dendritic cells, when observed occasionally, are located primarily in the endocrine tissue. The islets infiltrators remain undetected just dendritic cells, when observed ocasinalmente, are located primarily in the endocrine tissue. The islets of these animals hiperexpresan MHC class I and endocrine infiltrated epro not MHC class II, which is expressed only in cells that colocalizan with APCs. The islets of diabetic animals NOR RIP-HulFN-beta show a marked decrease of the beta cell mass. The composition of infiltration is similar except for an intensity higher than that of healthy animals. Animals NOD RIP-HulFN-beta presents the same pattern in the composition of that infiltrated NOR RIP-HulFN-beta, both healthy and diabetic. The study of the pancreas of animals NOD-SCID RIP-HulFN-beta shows no infiltrated the islets of these animals after staining with an antibody panleucocitario. The islets of these animals express MHC class I at the islet due to the expression of HulFN-beta by cells producing insulin. During studies dirigios to the characterization of the immunology of diabetes in this model, there has been a larger islets of transgenic animals respect to the controls. The area indicate half a size of the islets by 25% higher in the transgenic animals, and this fact was confirmed statistically (p less 0.01). This is because they have a larger number of cells but not due to a hiperplesia active because of the degree of proliferation shows differences between groups. Since it was detected the presence of IFN-beta at the systemic level and this cytokine have immunomodulatory properties, changes have been analyzed in different lymphocyte populations. We have determined the relative percentages of CD4, CD8, NK and NKT cells B in the different study groups at peripheral level, spleen and lymph pancreatic regional and local levels in lymphocytes infiltrantes pancreas, the presence of HulFN-beta not imply a variation in the relative percentages of splenic populations in the transgenic animals regard to their controls on health conditions. The relative percentages of splenic T lymphocytes, both CD4 and CD8, show a decrease in diabetic animals transgenic background NOR respect to their healthy counterparts. In NOD genetic background can be seen a decrease in lymphocytes CD8 + in transgenic animals young diabetics respect to transgenic diabetic or healthy adults. The percentage of linfoctios B is higher in animals NOR RIP-HulFN-beta diabetics when compared with their counterparts in diabetic NOD genetic background. The proportions of splenic NK cells are lower in the mice NOR RIP-HulFN-beta diabetics respect to NOD RIP-HulFN-beta diabetics. The development of clinical diabetes in transgenic animals involves changes in splenic subpopulations analyzed. There are observable differences in subpopulations of CD4, CD8, B, NK and NKT between the transgenic animals and their respective controls at the level of regional pancreatic ganglion. Nor were found differences between healthy and diabetic animals in these subpopulations regardless of the expression of the transgene. At pancreas, no difference was observed between groups in the study in the relative percentages of T lymphocytes, tnato CD4 and CD8. The percentage of NK cells in pancreatic level increases in transgenic animals diabetics who develop the disease very early ages (between 3-5 weeks old) compared to other groups in the study. In young animals NOD RIP-HulFN-beta diabetics there is a negative correlation between the percentage of NK cells and B lymphocytes pancreatic level. To determine the importance of NK cells in the development of the d 8 iabetes 1ff8 accelerated in animals NOD RIP-HulFN-beta, has been administered the antibody polyclonal anti-asialo GM1 six animals of this condition. The antibody blocking NK cells prevents the development of diabétes accelerated in 100% of cases. At 15 weeks old, none of the animals NOD RIP-HulFN-beta to which it has administered the antibody has developed the disease while animal control has produced a clinical home to the four weeks of life. In diabetic animals, the percentage of NK cells in the infiltration (determined by flow cytometry) is expected in transgenic animals which have accelerated diabetes. NK cells play a crucial role in the development of DT1 accelerated introducing the model animals NOD RIP-HulFN-beta. Experiments have been conducted for the transfer of the disease to determine the nature of autoimmune diabetes in this transgenic model: A - The transfer of splenocytes or lymphocytes intrapancreáticos animal strains diabetic NOD RIP-HulFN-beta and NOR RIP-HulFN- beta animals NOD-SCID, involves the development of the disease in these animals between 8 and 15 weeks post-transferencia. B-injected splenocytes of animals NOD RIP-HulFN-beta diabetic mice NOD RIP-HulFN-beta phase pre-diabéticas involves development of the disease in a very acute in 3-6 days after transfer . C - The transfer of splenocytes from animals of the strain NOR mice NOD-SCID does not imply the development of the disease in any of the animals transferred to the 30 weeks of follow-up. D - The transfer of splenocytes diabetogénicos of NOD RIP-HulFN-beta animals of the strain NOD-SCID RIP-HulFN-beta involves the development of the disease at 8 weeks post-transferencia. The study by inmunofluorescenia indirectly from the pancreas of diabetic animals as a result of the transfer, show a pattern similar to the infiltration of animals and diabetic NOD NOR RIP-HulFN-beta. Since the HulFN-beta is detected at the systemic level and could speak at tímico because of the promoter of trangén, their effect could affect the expression of molecules at tímico. RT-PCR has been made of animal organs CD-1 and CD-1 transgenic. The results were expressed as the ratio between the expression of genes under study (preproinsulina 1, preproinsulina 2, IFN-beta human glucagon and microglobulin) from the gene establishing -actina. The HulFN-beta detected in the pancreas and thymus of transgenic animals, but not in controls, with the expression tímica (0.00085-0, 00024) about 100 times lower than the pancreatic (0095 - 0.11) so parallel to the expression of insulin 2. In analyzing the relative expression of 2-microglobulina in pancreatic tissue. There are statistically significant differences (p less 0.05) among animals trasngénicos (3.19 - 0.55) and controls (1.21 - 0.2), suggesting a hiperexpresión MHC class I in this body in transgenic animals. In thymus, the expression of 2-microglobulina was similar in both groups of animals which are expected differences in the expression of MHC I may alter the microenvironment tímico. The rest show similar gene expression in organs under study by both groups of animals. It has analyzed the relative expression of IFN-gamma regard to the gene establishing 18s in the island infiltrated animal NOD and NOD RIP-HulFN-beta, both healthy and diabetic, as a representative of a cytokine response Th1. The samples obtained by LCM, in the case of healthy animals infiltrated Island and in the case of diabetic animals is the endocrine tissue infiltrated correspondientne. The island infiltrated subjects transgenic prediabéticos (9 weeks) expresses IFN-gamma. In subjects NOD prediabéticos, some animals express IFN-gamma and others not, as I have described other groups due to the variability of this strain in state prediabético. The expression island relative IFN-gamma shows no differences between the samples of the animals NOD-HulFN-beta presenting accelerated diabetes and diabetic NOD mice. These results support a response autoimmune Th1. It has analyzed the relative expression of molecules RAE-1, H60 and MULT-1, which are ligands activators of NK cells via receptor NKG2D, with the objective of determining the activation of this type of cell in the infiltration of animals transgenic presenting an increase of this population in the infiltrator. The expression was analyzed by RT-PCR in endocrine tissues of healthy animals NOD, NOD RIP-HulFN-beta, NOD-SCID, NOD-SCID RIP-HulFN-beta and C57 and endocrine tissue infiltrated with animal diabetic NOD and NOD - RIP-HulFN-beta samples obtained by LCM. As conctrol positive has been used material extracted cell YAC-1, a cell line derived from mouse lymphoma that is used as a target in tests citotoxidad with KNKs and hiperexpresa these ligands activators of NK cells. THE expression of molecules RAE-1 and deH60 was undetectable in all the samples except in the positive control. The expression of the molecule MULT-1 is not detected in the samples except for transgenic animals diabetics, with a relative gene expression regarding gene 18s of 1.82 +-1.02. It has been determined by RT-PCR gene expression relative TLRs in the different study groups. The study material has been endocrine tissue from healthy animals NOD, NOD RIP-HulFN-beta, NOD-SCID RIP-HulFN-beta and C57 and endocrine tissue infiltrated with animal diabetic NOD and NOD RIP-HulFN-beta. The tissue was obtained through LCM sections of the pancreas of animals in each group. It has been determined the expression of TLR2, TLR3, TLR4, TLR7 and TLR9, which are receptors of the natural immunity that have been associated with viral infections. The aniamles diabetic transgenic show high levels of expression of TLR3, TLR4 and TLR9 statistically superior to animals NOD diabetic group. Although the level of expression of TLR2 is 7 times higher in the diabetic group of transgenic animals., Differences regarding NOD diabetic animals are not statistically significant. With regard to non-diabetic animals, the expression of these molecules at endocrine shows no differences between transgenic animals and animals from other groups. The expression of TLR7 has only been detected in the model NOD RIP-HulFN-beta. The relative gene expression was 14 times higher in the diabetic animals respect to healthy animals. The expression of TLRs related to a viral response is increased in animals NOD RIP-HulFN-beta diabetic NOD diabetic respect to the level island. Following these results we conclude that: 1 .- The expression of the cytokine antiviral IFN-beta by pancreatic beta cells accelerates DT1 in NOD model breaks and tolerance to beta cells in mice resistant to disease-carrying allele of MHC susceptibility. 2 .- The genetic background determines the onset and incidence of the disease in transgenic animals RIP-HulFN-beta. 3 .- diabetes caused by the expression of IFN-beta is autoimmune etiology and is not caused by a failure of the beta cells due to the expression of transgene. 4 .- The expression of IFN-beta by the insulin-producing cells of inflammation involves a marked tolerance central island but is not affected because the expression of autoantígenos island and MHC class I is normal. 5 .- The NK cells are a crucial role in the acelaración of diabetes mediated by the local expression of IFN-beta. 6 .- The expression of IFN-beta in islets act as endogenous danger signal incr 8 ementand 4dd or the expression of TLRs associated with a response antiveral that desencadneraían a specific immune response. 7 .- The local expression of the cytokine involves morphological changes in the blocks that translates into an increase in the size of the same due to an increase in the number of cells. 8 .- The IFN-beta secreted by pancreatic beta cells is detected at the systemic level and diabetic transgenic animals that is associated with changes in splenic lymphocyte populations but not at the level of regional pancreatic ganglion.

Author: ARAGÓN TORRES LINA MARCELA.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIDAD DOCENTE HOSPITAL SANT PAU.

Summary: The World Health Organization estimated that in the year 2003, worldwide there were 8.8 million new cases of TB and nearly died 1.7 million people. It is anticipated that between the years 2002 and 2020 this cifrá increase significantly, especially in areas of high incidence TB, if we do not strengthen control measures and prevention. The multiresistencia, it is worrying, particularly in developing countries, which by their nature have the highest rates of TB incidence. The monitoring prospective rates of primary resistance in a population allows empirical guide therapeutic schemes that are used in this population for the treatment of patients with no history of previous treatment. A rapid diagnosis of resistance, is essential to properly treat a sick concrete and prevent the transmission of the resistant strain. Knowing the genetic events that give Mycobacterium tuberculosis resistance to the drugs used in treating tuberculosis, as well as the prevalence of these mutations in different geographic areas, which makes it possible to develop molecular techniques in a closer than usual detect resistance. The main objective of this work is to identify the genetic alterations responsible for the resistance to isoniazid and rifampicin in the clinical isolates of M. Tuberculosis of the Barcelona area and apply the knowledge gained to design and implement a technique for rapid diagnosis of resistance. To achieve this end have been raised following the secondary objectives: 1. Characterize phenotypic and genotypic strains of M. TB area of Barcelona, resistant to isoniazid and rifampicin. 2. Criminalizing molecularly strains of M. TB resistant to isoniazid and rifampicin isolated in the Barcelona area, in order to know the chains of transmission of resistant strains active and determining the transmissibility of different genotypes of resistance found in our population. 3. Designing and evaluating a rapid diagnostic technique for the detection of molecular alterations that cause resistance to isoniazid and rifampicin in the clinical isolates of M. Tuberculosis of the Barcelona area. In a previous study, it was noticed that a 87.8% of the tuberculosis patients in the Barcelona area had not received TB treatment by previous episodes of the disease, while the 12.2% had been previously treated. The rate of resistance in untreated patients was 5.7%. Of these, monoresistencia reached 4.4%, multiresistencia primary by 0.9% and resistance to other combinations of drugs by 0.4%. The most common resistance to isoniazid was with a 3.8%, followed by resistance to streptomycin with a 2.1%, rifampicin and pyrazinamide with a 1.0% each, and finally to ethambutol with a 0.3 %. The rate of resistance in previously treated patients was 20.5%. Of these, monoresistencia reached 10.2%, multiresistencia the 9.3% and resistance to other combinations of drugs by 0.9%. Resistance to isoniazid was 17.3%, from 9.8% to rifampin, pyrazinamide of 6.5%, from 4.7% streptomycin and ethambutol of 1.9%. The population characteristics of tuberculous Barcelona area were: co-infected with HIV 23.2%, drug users injecting 13.6%, alcoholism 22.4%, immigrants 5.9% and indigent 4.0 %. The characterization of the molecular mechanisms that cause resistance to isoniazid was based on the sequencing of the entire gene katG, the region regulator mabA-inhA and the region intergénica oxyR-ahpC. In 55.7% of the isolates were detected alterations in the gene katG, with the mutation at codon 315 the most prevalent (36%). A 31.1% of the strains were found alterations in the region regulator mabA-inhA being the amino acid substitution at position -15 the most prevalent (26.2%). In 3.2% of the strains with mutations in the region regulator mabA-inhA were also detected, changes in the gene katG. The frequency of mutations in the region intergé 8 nica oxy 1017 R-ahpC was 13.1%. A 16.4% of the clinical isolates of M. Tuberculosis of the Barcelona area resistant to isoniazid showed no alteration in the gene katG or region regulator mabA-inhA. The characterization of the molecular mechanisms that cause resistance to rifampicin focused on the search for genetic alterations in the region "core" of the gene rpoB. Alterations in 81pb gene rpoB were found in the 100% of the isolates resistant to rifampicin, and the mutation at codon 531 the most prevalent (47%). The correlation of genotype with the resistance phenotype found us permitó show that the strains with changes at codon 315 of the gene katG showed a decline in activity catalásica - peroxidásica and a high level of resistance to isoniazid. While strains with mutations in the region regulator mabA-inhA were not reduced enzyme activity and resistance was low. The molecular characterization of the strains through technical reference polymorphism size restriction fragments associated with the sequence insertion 6110 (RFLP-IS6110), indicated that the recent transfer contributed substantially to the emergence of tuberculosis resistant to isoniazid in the Barcelona area through short chains of transmission. We found 53 patterns different, of whom 46 were in a single strain and 7 to groups that included 15 strains with a range of 2 to 3 strains per cluster. In most cases it was not possible to identify the epidemiological link between the patients in a cluster, probably because of the difficulty of rebuilding relations epidemiological involving casual contacts outside the family bond. The 24.6% of patients with resistant tuberculosis were included in clusters and eliminating the index case per cluster, 13.1% of the resistant tuberculosis was a recent transmission. The absence of major outbreaks suggests that the program of tuberculosis control is effective enough, which is in relation to the low incidence of primary resistance to isoniazid in the Barcelona area. Following the genetic alterations that cause resistance to isoniazid and rifampicin in the clinical isolates of the Barcelona area, are designed a microarray, in order to quickly detect the genetic mechanisms of resistance. The capture probes for the gene rpoB, covering a region of 90pb coding for the amino acids 504-534. Six probes represent the sequence wild and 12 probes mutations frequently. A probe represents the wilderness (315S) and two probes mutations Frequently 315T and 315D. Probes capture for the region regulator mabA-inhA are designed to detect 3 mutations in the extreme 5 'no-codificante. Two probes represent the wilderness and three probes mutations at positions -8T-C, -15C-Ty -17G-T. The consistency of LCD-Array with the sequencing of different gene fragments was 96.5%. The sensitivity for the detection of mutations within 90pb gene rpoB was 93.8% for the codon 315 of the gene katG of 95.4% and the region's regulatory mabA-inhA was 94.7%.

Author: Martin Aparicio Yolanda.
Year: 2005.
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: In this paper we used 43 backbones human c3-c7, from the collection of the Department of Anatomy and Embryology dela Faculty of Medicine, Valencia, to take place them measurements of variables linear and angular areas, which provide data and relationships between the variables at vertebral body, pedicle, apófisis transverse, foil, and apófisis thorny. We used a two-dimensional model of spinal digitization on previous visions, right side and top of the vertebra, in order to assess the measurements of these variables, analyze the relationships between them and predict the value of a variable conociemdo the value of this same variable at another level, and finally find linear regression models with one or more independent variables that best predigan the value of the dependent variable. For the study of this study were digitized images through a video camera, and the program GIBS for TARGA +, for the analysis of scanned images. After the scanning was to stabilize the vertebra and clarified a number of points and lines of reference for 3 visions. The variables studied were applied a análsis statistical consisted of calculating statistical descriptive test Kolmogorof-Smirnov, T Student, ANOVA 1 factor with 5 levels, curvilinear estimate, and multiple linear regression. All this done with the program SPSS 11.5. Obteniéndose conclusions: 1Â th All variables linear width, height and depth of the vertebral body increases c3 to c7; 2Â th found significant differences in the slope of the pedicle, in its portion average and next to the hole in the transverse side dercho and left, far from the point over and above the central epiphyses higher vertebral body. Being inclinations on the right side above 3 degrees, compared with the left side. 3 Â ª The upper and lower corners of the veneer of articulate apófisis cross, kept the same values of c3 to c6 and increase significantly from c6 to c7. 4 Â ª No significant differences between the width of the sheet right and left. Appearing an increase of the height in connection cefalocaudal. 5 Â ª The height of the thorny apófisis remains constant c3 to c6 and increases in c7. 6 Â ª Areas of the total increase in cervical vertebrae sense cefalocaudal, while the area of spinal hole of the different levels c3 to c7 possesses the same area average. 7 Â ª In multiple regression analysis, chapter lessons, presents the model for calculating the variable linear, angular, and areas with a "r" greater than or equal to 0'75.

Author: BUSTAMANTE MUNGUIRA ELENA.
Year: 2005.
University: VALLADOLID [More theses of this university] [www.uva.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Technical advances and the development of new immunosuppressive drugs have made it possible for a large number of patients can replace a body with impaired by irreversibly from another corpse or more rarely family alive. Despite this, the demand for organs for transplantation is well above the current availability. In fact, we can see how organ donation has been growing in Spain in a gradual manner in parts per million, rising from 14% in the year 1989 to 34% in 2004, this growth in demand is being raised in our country the possibility of donating births; being poorly or not regulated to avoid the mismatch between donation and transplantation. As possible solutions logically would be the promotion of the donation in all respects and that a solution can ever be more forthcoming: xenotrasplantes. In view of this working hypothesis we wanted to ask the following objectives: 1-Review of donation process and identification of problems. 2-What kind of organization would be the most effective. 3-Check as is at present the xenotransplantation. 4-Analyze what is the legal situation of xenotrasplantes. 5, ethical and psychological aspects that may raise the xenotransplantation. 6-Evaluate the attitude to xenotransplantation in our environment. This was a revision of library materials in its legal aspects and bioethical: next to a public opinion poll conducted three different estates but directly involved in the process of donation and transplantation, nurses, family members and health care workers. Through both methods have drawn the following conclusions: 1 - The shortage of donor organs for transplantation is at present a major problem that requires contemplate new therapeutic options. 2-It must optimizarel discovery process from potential donors. 3-We must consider what type of organization would be the most effective way to promote donation. 4-legal and bioethical issues are influencing the process of donation. 5 - There is a need to raise awareness in society at large, trying a change of attitude to process the donation. 6 - There is no specific legislation at national and international levels to prevent organ transplants from animals to humans. 7 - The production of pig trasgénicos has overcome the barrier of immunological rejection hiperagudo. 8-Preventing rejection xenogénico late is the great challenge today. 9 - There is now functional ignorance on the feasibility of xenotransplantation. 10, - will be required to establish and follow control standards in order to prevent the transmission of bacteria, fungi and parasites. 11-New evidence of infection of human cells by endogenous retrovirus of pigs should compel us to be very cautious in accepting clinical trials on xenotrasplantes. 12-Both patients and relatives, in the rank very high, more than 80% accept the possibility of an animal organ to be transplanted. 13 - The health personnel, 74.4% accepts xenotransplantation as a therapeutic option. 14, - 65.9% of health personnel has little information on xenotransplantation.

Author: ESCRIBANO CAÑADAS ISABEL DE LAS MERCEDES.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE [More theses of this university] [www.umh.es].
Place of defense: CAMPUS DE SAN JUAN.
Place of preparation: HOSPITAL GENERAL UNIVERSITARIO DE ELCHE.

Summary: Various mechanisms have been studied in quinolone resistance in clinical isolates and food Salmonella spp.: A-Effects of the targets of quinolones (gyrA parC) by detecting mutations in the gene sequencing of the region determinant of resistance quinolones (QRDR). B-Sobreexpresión expulsion of the systems activated by the use of substances inhibiting the same all isolates are highly resistant to acid naldixico and decreased sensitivity to ciprofloxacin had a single mutation in gyrA and sobrreexpresión of systems expulsion active. Therefore it is recommended screening acid naldixico to detect declining suxceptibilidad to fluoroquinolones and modify the cut points established by CLSI.

Author: GRAJAL MARTINEZ CARMEN.
Year: 2005.
University: VALLADOLID [More theses of this university] [www.uva.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE VALLADOLID.

Author: Rodríguez Mulero María Dolores.
Year: 2005.
University: MURCIA [More theses of this university] [www.um.es].
Place of defense: Facultad de Medicina.
Place of preparation: Hospital Morales Meseguer de Murcia.

Author: Ros Martínez José.
Year: 2005.
University: MURCIA [More theses of this university] [www.um.es].
Place of defense: Facultad de Medicina.
Place of preparation: Facultad de Medicina.

Author: BALANZA MARTINEZ VICENT.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAT DE MEDICINA.
Place of preparation: FACULTAT DE MEDICINA, UNIVERSITAT DE VALÈNCIA.

Author: CIVERA SATORRES MANUEL.
Year: 2005.
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.

Author: FLOR LORENTE BLAS.
Year: 2005.
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: Introduction In the last two decades there have been a number of advances that have chained led to a clear improvement in the prognosis of patients with rectal cancer: basic and decisive achievement has been the acceptance and dissemination of the technique called "total excision mesorrecto "(ETM). Closely linked to the progress of the MDT have seen others, such as the incorporation into the pathological analysis of new factors such as the quality of mesorrecto and macroscopic effect on circumferential margin (MC), a change in some dogmas on the neoadjuvant treatment thanks to the ETM advances in preoperative estadificación thanks to the development of new imaging methods such as ultrasound endorrectal and high-resolution MRI and the practical implementation of multi-disciplinary teams (MDT), which has allowed the analysis of the results to standardize management of these patients, and ultimately improve their prognosis. This has been made possible by the periodic evaluation of the results through audits by the members of the MDT, as advocated by the main international guidelines in the management of cancer of the rectum. Special interest has, today, the study of cancer and the results of the prognostic factors of the MDT in the lower third of cancer of the rectum. Despite the advances made in the MDT, the results of these cancer tumors are worse, especially considering the patients undergoing an amputation abdominoperineal (AAP). The reasons are manifold. It is in these patients where the identification of new prognostic factors may help select more adjuvant therapies and even bring about changes in surgical technique and tactics. Assumptions and objectives After the introduction of MDT, regarded as the surgical technique of choice for rectal cancer, and after more than 10 years carried out in a specialized unit of colorectal cancer, we posed the following questions: Do you has meant an improvement in the results? Do you really as important as the MC defend other authors? To try to answer these questions we posed the following objectives:-To assess the impact of MDT in the post-operative morbidity and mortality rates Recurrence Knowing the Local Systemic and Global Survival-Knowing the factors predicitivos relapse and survival and above all, the forecast impact of the ERM, in the wholeness of the rectum as in the tumors of the lower third of the rectum. Patients and method observational study with prospective data collection, which included all patients with cancer of the rectum, so elective surgery and undergoing potentially curative with ETM standardized according to the criteria and without QRT preoperative Heald, part of the unit Coloproctology of HCUV during the period 1993-2002 (n = 282). For the analysis of results and prognostic factors has divided the study period into two parts (1993-1997) and (1998-2002) and have been set variables related to the patient, surgery, pathology and monitoring. Results The rate of Sphincter preservation has increased significantly (67% vs. 82%). The perioperative transfusions have decreased significantly (p less than 0.001) as well as increased protection of stomata (p less than 0.001), while the anastomotic leaks have not changed significantly (p = 0.46). The perioperative mortality has also declined significantly (7.3% vs. 1.9%) (p = 0.02). It has significantly increased the rate of assessment MC (p less than 0.001) and the number of nodes per specimen (p = 0.001). As for the outcome cancer after implantac 8 ion and re b5e alización in the technique of ATE for over 10 years, there has been no significant differences in the rate of recurrence or survival when comparing the two periods. The rates of local recurrence (RL), systemic (RS) and overall survival (GS) for 5 years have been 7.3%, 23.8% and 71.5% respectively. Involvement of MC (p less than 0,001; HR = 13) and locally advanced tumors (p = 0.04, HR = 4) were the only independent prognostic factors RL. Involvement of MC (p = 0.04, HR = 2), the AAP (p = 0.02, HR = 2) and lymph node involvement (pN +) (p less than 0,001; HR = 4-9) are the only independent prognostic factors RS. Involvement of MC (p = 0,009; HR = 2), the AAP (p = 0,002; HR = 2), age (p = 0.02; HR = 2) and pN + (p = 0.05, HR = 1-2 ) are the only independent prognostic factors of SG. Considering only the tumors of lower third of the rectum, the effect of MC (p = 0,006; HR = 12) and the distance apart anal (p = 0.01, HR = 0.4) were the only independent prognostic factors RL. Involvement of MC (p = 0.04, HR = 5), the AAP (p = 0.03, HR = 6) and pN + (p = 0,001; HR = 5-11) were the only independent prognostic factors of RS. Involvement of MC (p less than 0,001; HR = 8), the AAP (p = 0.01, HR = 3), age (p = 0.01; HR = 4) and locally advanced tumors (p = 0.03, HR = 3) are the only independent prognostic factors of SG. Involvement of the MC has been the only independent prognostic factor RL, RS and GS in the globality of rectal tumors and in the subgroup of the lower third. Conclusions The results surgical oncology and are within the standards deemed appropriate Guides Scientific International surgery on cancer of the rectum. The surgical results have improved dramatically after 10 years of implementation of the technique of MDT, while the results have not changed oncology. Both the globality of the rectum as in the tumors of the lower third, the effect of MC is the main prognostic variable involved in the recurrence and in the survival, while the AAP and lymph node involvement were predictors of adverse RS and GS, but no effect on the RL.

Author: ASENSIO ROMERO Ma. ISABEL.
Year: 2005.
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: INTRODUCTION: At present it is particularly important the study of corneal thickness in the measurement of intraocular pressure and refractive surgery laser excimer (LASIK). The use of anesthetic drops in both fields could change the value of corneal thickness prior. The normal values of central corneal thickness measured with paquimetría ultrasonic range from 503-565 Â µ m and increase towards the periphery. You can see influenced by a multitude of physiological and pathological causes. The purpose of this dissertation is to examine the effect they produce on the values of corneal thickness two drops of two different patterns anesthetic (Oxibuprocaína HCL 0.4% and compound Tetracaína and Oxibuprocaína HCL 0.4%), and also to compare which of the two is what produces major differences when implemented on the same cornea. The results were published in three articles: 1. ASENSIO I Rahhal SM, Alonso L, Palanca-Sanfrancisco JM, and Sanchis-Gimeno JA. Corneal thickness values before and after oxybuprocaine 0.4% eye drops. Cornea. 22:527-32. (2003) 2. ASENSIO I Palanca-Sanfrancisco JM, Granell-Gil M, Alonso L, Rahhal MS, Martínez-Soriano F Sanchis-Gimeno JA. The effect of a combination of tetracaine HCL 0.1% and oxybuprocaine HCL 0.4% on human central corneal thickness measurements. Eur J Anat. 8:7-10. (2004) 3. ASENSIO I Palanca-Sanfrancisco JM, Granell-Gil M, Alonso L, Rahhal MS, Martínez-Soriano F Sanchis-Gimeno JA. Quantitative central corneal anatomy and anesthetic eye drops effects: Comparison between 0.4% oxybuprocaine and a combination of 0.1% tetracaine and 0.4%. Oxybuprocaine. Eur J Anat. (2005); IN PRESS (page proofs) MATERIAL AND METHODS: These are masked prospective studies involving healthy young adults without prior systemic or ocular pathology. (N1 = 52, n2 = 30, n3 = 35) The variables to consider are the corneal thickness prior three minutes after the instillation of two drops of local anesthetics mentioned. For measurements of corneal thickness was used paquímetro non-contact system is the topographical Orbscan II (Orbscan, Inc.. Salt Lake City, UT). Comparisons were made by using parametric statistical tests (Student's t test) and was considered a level of significance of 5% in the three studies. RESULTS: In the first study found no significant difference between the values of corneal thickness before and after instillation of Oxibuprocaína 0.4% but a great interindividual variability (promotion and relegation of corneal thickness> 30 Â µ m) that was not the case in the control group. In the second and third work does differences were found between the values of corneal thickness before and after administration of the combination of Tetracaína 0'1% and Oxibuprocaína 0.4%, after Oxibuprocaína 0.4% alone and also when comparing the two patterns among themselves. The average change in the central corneal thickness was 25 Â µ m with Oxibuprocaína and 48 Â µ m with the combination of Oxibuprocaína and Tetracaína. CONCLUSIONS: The use of anesthetic drops during studies of corneal thickness determines obtaining results that do not correspond to the baseline of the cornea, so that the values obtained are to be analyzed with caution. Increases in corneal thickness secondary to the use of anesthetic drops are more pronounced when using the compound Tetracaína 0.1% and Oxibuprocaína 0.4% when using the Oxibuprocaína 0.4%.

Author: Bellver Pradas Francisco.
Year: 2005.
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 de la Universitat de València.

Summary: Intervention study that analyzes changes in the profiles of Expresividad Emotional family and the rate of relapse of a cohort of schizophrenic patients and their primary caregivers who had been administered, in the context of health care service, two formats therapeutic other than psychoeducational intervention for 12 months. As overall objective is to analyze whether the changes in the levels of Expresividad Emotional and its subscales associated with the realization of a family intervention reduces the risk of relapse in the short and medium term. As identify specific targets subscales of the Expresividad Emotional are more susceptible to change and if the performance of different formats therapeutic intervention family (or group format format focused on the family unit) are associated with different profiles of Expresividad Emotional or different relapse rate . As secondary objectives, describe the profile of the Expresividad Emotional relatives referred to a family intervention program and examine whether these profiles associated with sociodemographic and clinical variables. Interviews are conducted 3 evaluations. A baseline prior to the intervention, another immediately after completing it and a final evaluation after 5 years of the completion of the intervention. No association of Expresividad Emotional or its subscales with no clinical or sociodemographic variable in the baseline, although there was a profile Expresividad Emotional similar to other countries in Latin cultural base and different from commonly found in the Anglo-Saxon studies , revealing the importance of cross cultural differences. Following the completion of the intervention, were significantly reduced levels of Expresividad Emotional and its subscales, and the subscale more likely to change the sobreimplicación emotional and more resistant hostility. The relapse rate was also significantly reduced during the period of intervention. While both formats intervention were effective in reducing the Expresividad Emotional and relapses, produced different results profiles. For the 5 years of the completion of the intervention, levels of Expresividad Emotional and its subscales remained largely stable in those achieved after the intervention. The changes in the profiles of Expresividad Emotional and were not associated with relapse, but the social functioning and severity of the patient's clinical productive. The relapses again increased progressively once the intervention, despite the reduction of Expresividad Emotional. A psychoeducational intervention for 12 months is not enough time to maintain the gains made during its performance on the relapse rate. Data from this thesis directed to an interactive model complex partnership Expresividad Emotional and recurrences in which Expresividad Emotional have both attributes as a feature of state. Attributes feature would have been modified by an enduring intervention, then the emerging association of the attributes of a state with the severity of clinical psychotic or social adjustment.

Author: Beneyto Castelló Francisco.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: Facultad de Medicina y Odontologia.
Place of preparation: Facultad de Medicna.

Author: ESCLAPEZ VALERO JOSÉ PEDRO.
Year: 2005.
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: INTRODUCTION: In the past two decades one of the most important in the management of patients with rectal cancer has been getting a good estadificación preoperative tumor, and surgical anatomopatológica, in stage T3 there is a heterogeneity both clinically and anatomopatológica, commissioning evidenced by many authors. In estadificación preoperative imaging methods (Ecoagrafía Endoanal, CT, MRI, etc.) is not contemplated subclasificación T3 despite the fact that it would have an impact prognosis. Justification: The basis of this work arising from the experience of the unit Coloproctologia of HCUV in the treatment of cancer of the rectum and especially in the use of ultrasound in Rectal estadificación it. We found the system constraints uTN regarding the heterogeneity of T3. Of these assumptions have emerged just answered questions by the current literature as  What is the reliability of estadificación preoparatoria cancer of the rectum by ER and therapeutic implications is in relation to local recurrence and systemic?  Is estadificación preoperative by ER parameter enough to indicate the QRT neoadjuvant?. ASSUMPTIONS AND OBJECTIVES: Assumptions: rectum cancers classified as stadium uT3 can be subdivided preoperatoriamente matter prognosis by rectal ultrasound in relation to tumor thickness and to the perimeter. Objectives: 1-To determine whether the maximum thickness or maximum perimeter of ultrasound tumors uT3 relates to the presence of local tumor recurrence or systemic. 2 - If so, establish a potential value of court with respect to prognosis character or perimeter tumor thickness determined by rectal ultrasound. 3-To analyze the correlation of these parameters ultrasound with other pathological prognostic factors as determinants circumferential margin. 4-Establish goals from the previous one uT3 branched subdivided in a useful way that the T3 in a and b which would make decisions on the indication of preoperative QRT. MATERIALS AND METHODS: We studied 74 patients treated for cancer in the rectum unit Coloproctologia of HCUV from June 1996 until March 2003 estadificados preopeatoriamente as uT3 uN0 / 1, habiéndose excluded patients with tumor stenosis, preoperative and QRT presenting systemic disease. Of all the patients have been identified preoperatoriamente the uMET (maximum tumor thickness ultrasound) and uMPT (maximum perimeter ultrasound tumor) have been operated on with the same criteria, the pieces have been analyzed anatomopatologicanebte by the same pathologist and monitoring of patients had been made with the same scheme by a clinical oncologist The statistical method used has been to the Kaplan-Meier survival curves and the method of proportional hazards regression Cox and parfa determining the uMET (maximum tumor thickness ultrasound) the ROC curve. RESULTS: are exposed datasen regard to age, sex, surgery, pathology data from all patients. The median follow-up was for 41 months. The local recurrences occurred in 7 patients (9Â'82%), systemic recurrence of 19 cases (37Â'82%). Ultrasound Data: Median uMET: 19 mm and uMPT: 180 º. Accuracy of Diagnostic ultrasound for the T 82% and the N of 77%. In the univariate analysis of the factors associated with local recurrence were statistically significant lymph ecográficos affections, locally advanced tumors, the circumferential margin affection and uMET and with respect to the systemic recurrence: ganbglios ecográficos emotions and affections ganglia pathology . In the multivariate analysis of the 8 factore cc0 s forecasts reicidiva locally, the only independent preoperative predicts variable has been the uMET and the intra-and postoperative locally advanced tumors and infiltration circumferential margin. With respect to systemic recurrence the only independent prognostic variable Preoperative lymph ultrasound has been positive while the intra-and postoperative the only independent variable predicts lymph affections are pathological. It has no prognostic significance for the uMPT or local recurrence or systemic. With the implementation of the ROC curve, we have established a cutoff point of uMET below which there is no local recurrence in this series, that the cut is 19Â'5 mm. With a sensitivity of 100%, specificity and accuracy of 61Â'2% of 64Â'9%. CONCLUSIONS: 1-En this study, rectal ultrasound has a high accuracy of 82% for identifying tumors T3 and 78% for lymph estadificación of affection in these tumors. 2 - The thickness of ultrasound tumors considered uT3 is a variable predicts adversely on the development of local recurrence of rectal cancer intervened by excision total mesorrecto. Instead perimeter tumor or the number of blocks do not show affection influence predicts. 3-In this series, the tumor thickness ultrasound together with the presence of positive lymph nodes ecográficas, classification by the surgeon as locally advanced tumor and circumferential margin affection, are associated with the development of local recurrence. Moreover, the presence of lymph ultrasound or pathological, are the only factors associated with the development of systemic recurrence. 4 - The tumor thickness, as well as the circumferential margin affection and consideration of surgical tumor locally advanced, behave as variable pronosticas independent in the development of local recurrence. 5 - tumors uT3 with a maximum thickness of less than 19.5 millimeters would have a minimal chance of developing a local relapse with a sensitivity of 100%. In contrast, tumors uT3 with a maximum thickness greater than 19.5 millimeters are more likely to develop a local recurrence and that the margin circumferential this affection. 6 - The subdivision by rectal ultrasound of the tumors seen T3 in T3a and T3b, in relation to tumor thickness varying from 19.5 millimeters seems a simple, reliable and useful screening to select patients who would be tax preoperative chemoradiotherapy.