MEDICAL SCIENCE (6)

Author: LÓPEZ MUÑOZ ANA CRISTINA.
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. So far no anesthetic technique has been shown to be a risk factor or protector of postoperative vomiting (VPO) in children. The inhalation anesthesia in the pediatric population has many advantages, however it is known the ability of nitrous oxide to accumulate in the hollow cavities of the body such as producing her bowel distension. Also known are the benefits of total intravenous anesthesia to reduce the incidence of VPO in adults. If an anesthetic slows the rate of gastric emptying, and most other factors when combined, will have a higher risk of postoperative pulmonary aspiration of VPO, delays in the restoration of intake and decrease the effectiveness of oral medications. The objectives of this study were to demonstrate that the technique anesthetic sevoflurane, oxygen and air produces no greater incidence of VPO or more delayed gastric emptying that the technique with propofol, oxygen and air in children. MATERIALS AND METHODS. 114 children ASA I and II between 1 and 12 years scheduled for elective surgery less than 2 hours were randomly assigned into two groups according to the anesthetic technique: propofol, oxygen and air (Group 1) and sevoflurane, oxygen and air (Group 2), using as analgesic fentanyl at the same doses in both groups. Postoperative analgesia was achieved with nonsteroidal anti-inflammatory drugs. We studied demographic variables and hemodynamic variables heart rate and mean arterial pressure (TAM) before, at the beginning, the end and after anesthesia. It also studied the gastric residual volume (VGR), and gastric pH with the method of blind ambition at the beginning and end of anesthesia, and the incidence of VPO for the first 24 hours with both techniques. RESULTS. They were demographically homogeneous groups. The VGR and pH at the start of anesthesia were similar. Among the hemodynamic variables, there was a statistically significant difference in the TAM at the beginning of anesthesia

Author: MORCILLO AIXELÁ ALFONSO.
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: While previously 1975 had existed some references to surgery pathology estenótica the air, is starting this year when Pearson is the first step in the systematic use of the techniques resectivas in this area. Based on the ideas of Gerwat and Bryce standardizes the technique of resection cricoidea subpericondral addressing thus an area forbidden in the surgical management. Thereafter, the line of resection is putting more proximal level with the work of Couraud, Grillo and Maddaus. The resections cricoideas become increasingly broad becoming total exceptional occasions and forced as concerns Couraud. The introduction of the scheme by laringofisura, most of otorrinolaringólogos own, marked elevation of the line of resection level ropes what virtually ceased to exist a limit to the techniques resectivas subglótica in the region. OBJECTIVES. 1) Establishment of the indications in surgical pathology estenótica not subglótica tumor in the region. 2) Valuation of total resection of the cricoid cartilage as a therapeutic maneuver. 3) Establishment of trends in the use of adjuvant therapies such as grafting techniques recalibraje laryngeal. 4) Determination of maneuvers laryngeal reconstruction causing disturbances at deglutorio and fonatorio. MATERIALS AND METHODS: The sample consists of one hundred twenty five percent procedures in five patients (twenty reinterventions) intervened between 26 February 1976 and on February 7, 2005. Inclusion criteria were: patients suffering from tumor stenosis not cover at least the region subglótica notwithstanding involvement in the region glótica and trachea. Exclusion criteria were stenosis original tumor and patients with severe functional impairment that involve a high risk of post-operative mortality. RESULTS: The results overall are breathing ninety-five patients with respiratory excelente-bueno which result represents a 90.4% of patients. Six deaths in one hundred and five patients which represents a 5.7%. Three patients (2.8%) had a stenosis tolerated that does not prevent him from carrying out his daily activities. One patient is still carrying guardian Montgomery on a voluntary basis. CONCLUSIONS: surgical indications were established in the treatment of stenosis subgloto-traqueales not tumor. It is determined that the maneuver finger is associated with the occurrence of disorder in swallowing. It determines the feasibility of the total cricoid resection. It outlines the plastic maneuvers associated with the upheavals of phonation.

Author: RUIZ CARMONA Ma. DOLORES.
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: fecal incontinence (FI) is a symptom with a significant impact on the lives of patients whose management should be individualized and begin with conservative measures. Faced with patients who have a structural defect of the external anal sphincter the esfinteroplastia is the first choice of surgical treatment. However, there is a group of patients with severe IF failure of conventional treatments that could benefit from more innovative surgical alternatives. SCENARIOS FOR WORK: To establish the real value of the anal sphincter artificial transposition anal stimulated gracilis muscle and sacral neuromodulation roots as a firm and secure options in the surgical treatment of patients with faecal incontinence serious. PATIENTS AND METHODS: Prospective study of 30 patients with severe IF treated by one of these techniques: implantation of artificial anal sphincter (EAA), graciloplastia dynamics (GD) and sacral neuromodulation roots (NMS). Studies: valuation clinical scale for quantitative assessment of severity IF Survey, Minnesota and scale-specific quality of life, anorectal manometry, endoanal ultrasound and electrostimulation nervous pudenda. RESULTS: Implantation EAA: With a median follow-up of 42 months there morbidity in 94% of patients. The 53% of the series explained some re-operation. At the end of the study explant system had occurred in 29% of cases. In the group of patients who had the implant there was a statistically significant improvement in the severity of IF and in the quality of life in all controls surgery. There was an increase in pressure at rest with the anal duct sleeve activated statistically significant differences with regard to their preoperative value. The gravity of the IF and the quality of life after the implant showed correlation of the prosthesis. Graciloplastia dynamics: With a median follow-up of 72 months there morbidity in 80% of patients. The functional outcome was unsatisfactory in 60% found no variation in the severity of the FIs nor on the quality of life in the overall series to follow up. The pressure resting anal duct rose after the intervention but did not reach the value of the pressure in preoperative voluntary contraction. Neuromodulación of sacral roots: During Phase subchronic existed significant improvement in the number of episodes of urgency and IF respect to the initial situation. The 62% of patients had positive response to this stage and were proposed for permanent stimulation. At the end of the study the rate of explants was 20%. After stimulation, there was a permanent reduction in episodes of urgency and IF and the severity of the crisis and an increase in quality of life. Pressures anal duct rose after the implant regarding their preoperative value. CONCLUSIONS: The surgical techniques for the treatment of severe IF analyzed in this study are useful alternatives for the treatment of the same in selected patients, but our experience in functional outcome obtained by GD is less than the introduction of an EAA or sacral neuromodulation roots.

Author: SOLVES ALCAINA PILAR.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The dendritic cells are key regulators of the innate and acquired immune response. Their morphological characteristics, phenotypic and functional make them worthy some formidable antigen presenting cells. They are the only cells capable of stimulating T lymphocytes virgins. Because of their role in immunity are involved in many processes in which there is an alteration of the immune system, such as cancer and infectious diseases, and therefore have been considered suitable candidates for use in immunotherapy protocols. Therefore, it has been the main objective of this work, designing a protocol that will generate a large number of DCs from hematopoietic CD34 + progenitors of umbilical cord blood, for therapeutic purposes, in the absence of serum, and to permit identification of intermediate precursors. The use of antibody DC-SIGN has allowed us to identify 2 cell subpopulations CD34-CD1a + DC-SIGN + and CD34-CD1a + DC-SIGN +. Being that the monocytes are the main source of obtaining myeloid DCs have also been DCs generated from monocytes isolated from cord blood, in order to make comparisons with the phenotypic and functional DCs generated from cells CD34 +. Finally, given the importance that the DCs have in the emergence of EICH after transplantation and even though the incidence is lower in EICH of transplants from umbilical cord blood than in the peripheral blood of MO and has been compared DCs blood from umbilical cord with the peripheral blood of adult, getting the DCs of WCS are inmunofenotípica and functionally more immature than those of peripheral blood of adult.

Author: MAYANS MORENO JORGE.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: THE ESGUINCE CERVICAL, AN INJURY THAT IS MEANT TO 30% IN INJURY PROVOCADAS BY TRAFFIC ACCIDENT THAT AFFECTS WOMEN IN 57% OF ALL BETWEEN 23-34 YEARS, AND IN BOTH BY LESS FREQUENT IN MEN WITH A 43%. FOR ITS RECOVERY AND RESTITUTO AD INTEGRUM, KEY IS THE TREATMENT REHABILITADOR, CONDUCTED IN SPECIALIZED CENTER, WITH THE HELP OF PROFESSIONAL. IS AN INJURY THAT IN A 43% OF CASES SUELE curing WITH AFTERMATH, BEING IMPRESCINDIBLES FOR THE DETERMINATION OF THE PROPER WAY OF THE SAME, THE USE OF MRI, CT AND ELECTROMYOGRAPHY. THE AFTERMATH MAS BANALES ARE CERVICALGIAS POSTRAUMATICAS WELL WITH IRRITACION RADICULAR OR WITHOUT HER, AND AGRAVACION OF THE PRIOR ARTHROSIS. AMONG THE MOST IMPORTANT THE HERNIAS AND STRESS / O PROTUSIONES DISCALES. THERE IS A SMALL PERCENTAGE TO CURAN WITH THE PRODUCTION OF A SECOND AFTERMATH

Author: BARJAU ESCRIBANO AMAYA.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGIA DE VALENCIA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGIA DE VALENCIA.

Summary: Advances in Dentistry to restore teeth destroyed much has been made possible by, among other factors, the study of the biomechanics of the bolts intrarradiculares. The bolts are the retention system intrarradicular of teeth treated endodóncicamente when coronal destruction is so great that it prevented by maintaining stable restoration later. Thus the main purpose of the bolts is the retention of the material restorer. The search for an increasingly Aesthetic Dentistry has necessitated the investigation of new materials and designs delos bolts intrarradiculares, so the restorations are increasingly safe and static. The objective of this thesis is to study the biomechanics of these elements retentivos, they have been carried out through a two-pronged study: On the one hand, a study by the virtual technique finite element and on the other hand the pilot study through Use of real teeth. Through both lines of inquiry have been studying three basic aspects of the bolts: The manufacture of the same material (such as studying the materials fiberglass and stainless steel), the length and thickness of the bolt, and has been valued as affecting each one of these aspects in the occurrence of fractures root. The results of the virtual model and the experimental model match, so that in both cases, we can conclude that the material in manufacturing significantly affect the appearance of concentration of tensions between the bolt and dentine so used to be always a bolt whose elastic modulus it is very similar to dela root dentin (property that is fiberglass). Regarding the length of pin insertion, it is not a variable that affects, for any of the materials studied, significantly to the occurrence of fractures root for the range of lengths studied in the thesis. Finally, the thickness parameter is not significant for the case of fiberglass, however, shows an increasing trend of increasing tensions according to the thickness of bolt cases restored with steel bolts. From what can be seen above ensure that the bolts fiberglass are actually a therapeutic indication for its good mechanical behavior, its static, good adhesive characteristics and low sensitivity factor operator.

Author: FERRANDIS COMES RAQUEL.
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. The ventilator pressure support is the method most widely used to assist patients in the units Resuscitation and Critical. In all modes ventilatory assisted used for the partial ventilatory support, it is essential a perfect adaptation ventilator patient demand. Respirators current recognize the beginning, but not the end, of the inspiration of the patient (inspiratory time neural). This lack of synchronization at the end of the inspiration represents a significant increase in the inspiratory work, muscle fatigue, shortness of breath, coming to prolong the time required mechanical ventilation. The solution to this problem involves the recognition of the end of the inspiration patient in a non-invasive, point not succeeded so far. Our team has identified a number of points at the end of inspiration on the curves of pressure and air flow that could mark the end of the inspiratory time neural so easy, reliable and not bloody. However, so far these points have not been validated so sistemática.HIPÓTESIS. It is possible to detect the neural inspiratory time on curves noninvasive pressure and flow during ventilated with pressure soporte.OBJETIVOS. 1. Obtaining electromyography diaphragmatic as a benchmark for measuring neural inspiratory time. 2. Calculation of the coincidence of the points that define the neural inspiratory time in a non-invasive (in the curves of pressure and air flow) with the records of simultaneous electromyogram diaphragmatic. 3. Calculation of the coincidence of other items commonly used in studies of respiratory mechanics, such as pleural pressure and transdiafragmática. 4. Comparison of measuring inspiratory time based on neural recording airway pressure (beginning and end) with the measurement of electromyogram diafragmático.METODOLOGÍA. The study was conducted during the postoperative patients scheduled for derivation aorto-coronaria, performing one of the derivations with the internal mammary artery (after assessing the patient and obtaining informed consent). Intraoperatoriamente were inserted two electrodes in the left diaphragmatic dome and left pleural catheter in the left pleural space. In the resuscitation unit was placed gastric tube balloon. The pressure and air flow was recorded between the piece and the respirator and the endotracheal tube. Weaning was conducted in pressure mode support, progressively less than 20, 15, 10 and 5 cm H2O. In each of the pressure levels were recorded 3 minutes, and each of the records were analyzed 25 consecutive cycles. Each cycle was analyzed separately recognizing dots that identify the patient's inspiratory activity: the diaphragmatic electromyography (reference), in air pressure, flow and pressure in the pleural and transdiafragmática. The electromyographic signal was validated by specialists in clinical neurophysiology. A descriptive study was conducted in the frequency of points unrecognized, coincident with the reference electromyographic and the mismatched that were considered positive when they were following the reference point, and if not negative. For mismatched points was calculated mean and standard deviation, both in absolute terms (milliseconds) as a percentage of the form (of the total time neural inspiratory). A comparative study was made according to different pressures of support, both in terms of the percentage of matches (logistic regression robust clustering per patient) and in terms of the magnitude of the differences (linear regression robust clustering per patient). The pressure curve in air as a signal unique to the measurement of time inspiratory neural compared with the extent refer 8 fer ence I e70 diante a Pearson Correlation (grouping by the patient) and the Bland - Altman method (which accepted a percentage error of 30%). In all cases, the statistical significance was found at p <0.05%. RESULTS. We have studied a total of 1000 cycles in 10 patients. The onset of inspiration patient was identified in the pressure curve in air for 99% of cycles and pleural pressure in 98%, coincident with the electromyography diafragmática in 62% and 64% the cycles, respectively. The differences observed in average points mismatched was 83 + /-51 ms. And 74 + /-39 ms., Which accounted for 8.8 + / -5.4% to 8.4 + / -5% of the length of time inspiratory neural according to electromiogafía. In both cases the differences observed with the pressure support of 20 cm. H2O were significantly higher. The end of inspiratory time neural acknowledged in the 98% cycles on the curve of pressure on air, in 86% of cycles in the flow curve and the 93% of pressure transdiafragmática; being matched the 53% , 28% and 57%, respectively. The temporary differences observed were 91 + / -68 ms., 116 + / -86 ms. , And 80 + / -58 ms. Representing regard to the duration of the inspiration the 9.5 + / -6%, 12.2 + / -14% and 9.2 + / -6.6%. The extent of the patient's inspiratory effort in the pressure curve in air showed a correlation of 0.88 (significant at 0.01 bilateral) with the signal electromyographic, no significant differences grouping by pressure support. Applying the method Bland Altman, for example, found a systematic error of 4.5 ms. And an accuracy of 96.5 ms.; Error percentage was calculated from 20%. DISCUSSION. It discusses various aspects of the methodology and results. The present work shows, unlike literature, the possibility of recognizing easily and reliably the end of the patient's inspiratory effort in the curve noninvasive pressure air. The validation allows this point, in many of the respirators commercial adapt inspiration mechanics (the respirator) to the inspiration of paciente.CONCLUSIONES. 1. In the postoperative patients referral aorto-coronaria, inserting electrodes into the diaphragmatic dome, the intraoperative offers an ideal method for recording the activity diaphragmatic. 2. The inspiratory activity or neural inspiratory time can be measured on the basis of records incruentos: pressure and air flow. 3. The fall of the pleural pressure by the inspiratory effort is the most accurate for measuring the start of neural inspiratory time. 4. The "peak" of the pressure transdiafragmática is the most accurate for measuring end of the neural inspiratory time. 5. In recognition of the time inspiratory neurla, in a single curve, the analysis of the registration pressure air is ideal, allowing for easy and reliable, both the beginning and the end.

Author: Garcés Sánchez María Desamparados.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: Facultad de Medicina.
Place of preparation: Facultad de Medicina.

Summary: INTRODUCTION: otitis media (OM) is one of the most common diseases of childhood, and one of the most common causes of pediatric consultation. Its high frequency implies a high impact on both economically and socially. The estimate of the incidence of Acute Otitis Media (AOM) in our environment, as well as the impact of Otitis Media Serosa (WHO) and implementation of ventilation tubes, are required to calculate their impact on the social and economic spheres and this, in turn, it is critical to estimating the impact of the administration universal pneumococcal conjugate vaccine or the influenza vaccine in the WCO. OBJECTIVE: To estimate the impact (incidence, treatment and complications) of Acute Otitis Media (AOM) and Otitis Media Serosa (WHO) in children under 5 years of the Community of Valencia (Spain). Calculate the cost of direct medical WCO through analysis of costs required number of visits per episode, query type and place of diagnosis and calculating the cost pharmacist caused. SUBJECTS AND METHODS: A retrospective cohort of 1399 children followed during the first 5 years of life. 17 paediatricians reviewed the medical histories of their patients who were born in 1995 and 1996, controlled from birth to 5 years. Each child was obtained from the number of ear infections, treatment, complications and interventions required. For the analysis of direct costs were identified resources involved in the process, considering as direct costs to health generated at the consultation pediatric primary care. It quantified resources through the collected data and conducted a detailed analysis of the elements involved to avoid overlapping costs. It was assigned a standard unit price for each of the identified resources. RESULTS: There were 2961 episodes of AOM in the first 5 years of life (2.23 cases / child), 476 cases (16.1%) by the year and 1346 between the first and second year (45.5%). In the third year the 59.8% had submitted at least one episode. The majority of cases (80.9%) were diagnosed in Primary Care, with 1.81 visits / episode average for follow-up. The 94.5% of the episodes were treated with antibiotic (amoxicilina-clavulanico 38.8%, cefuroxima-axetilo 14.3%, clarithromycin 8.2% and amoxicillin 5.9%). The 8.5% change required a second antibiotic. 217 children (15.2%) had at least one episode of WHO. 26 patients (1.8%, 95% 1,2-2,7%) required implantation of ventilation tubes. 24 children (1.7%) had secondary hearing loss. There was one case of meningitis and 2 of chronic otorrhea. There was no mastoiditis. To estimate the direct cost of the WCO, it was considered the expenditure on medical visits and medication prescribed for both microbial and symptomatic. The estimated total direct cost of AOM in our sample totaled 108.348,94 euro. CONCLUSIONS: The incidence of AOM in the Community of Valencia is 40014 episodios/100.000 children under 5 years / year (95% CI 39700-40300). It is a great health impact at the high number of visits, antibiotic use, surgery and associated need for rehabilitation hearing. In Valencia, the direct cost of AOM in children under 5 years between 1995 and 2001 amounted to a total of 18.2 million euros, 36.59 euros and 81.59 euros per episode per child.

Author: Macía Soler María.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: Facultad de Medicina y Odontología.
Place of preparation: Facultad de Medicina y Odontología.

Summary: INTRODUCTION: In the mid-90 had been given a series of special relevance in pneumococcal infection as a growing trend, the influence she had on HIV infection and the spread of Streptococcus pneumoniae with reduced susceptibility to penicillin. Carrying out this study was raised to know what was the status of pneumococcal infection in the population base in the area 9 health valence. OBJECTIVES: To know the pneumococcal bacteremia its epidemiological characteristics, risk factors, clinical expression, susceptibility to various antibiotics and their relationship to clinical presentation, and overall mortality and infection-related and their prognostic factors. METHOD: observational study, retrospective, analytical and descriptive; done in the University Hospital Dr. Peset Valencia from June 1, 1995 to May 31, 2001. We reviewed the medical records and the data was collected using a structured questionnaire. We included all cases> 14 years, admitted to the hospital during the study period, which was isolated S. Pneumoniae in at least one blood culture. RESULTS: We identified 128 episodes in 127 patients, 6% nosocomial. Average incidence 6.9 per 100,000 inhabitants> 14 years / year. There is a growing number of cases in the years 1998 and 1999 at the expense of patients> 64 years, which coincided with an increase in the rate of flu. The HIV infection remained stable over the years. There was an increase in the number of cases in winter and lower in summer. In summer was a feature that is affecting patients <65 years with HIV infection and liver disease. Predominaban men, with an average age of 60 Â ± 20 years. There were two peaks of the highest incidence in patients> 65 years and in those of 30 to 40 years, while in the latter group associated with HIV infection. Because all patients were <40 years (50% of patients with age) with typical clinical pattern of pneumonia, leukocytosis, immunosuppressed and without antiretroviral treatment. The second outbreak was meningitis (7%), 67% had diabetes and the clinic was 48 hours of treatment with ear infections and abnormal levels of consciousness and CSF: pleocitosis and proteinorraquia with glucose levels variable. In 12.5% of cases not identify any outbreak and were considered primary bacteremia. The empirical treatment of pneumonia was more frequent combined with a third generation cephalosporin and a macrolide, but from 1998 gradually declined until the end of the study the use of these antibiotics and increased the use of quinolones (levofloxacino). All blood cultures were positive at 48 hours. S. was isolated Pneumoniae in sputum in 34% of cases. The predictive factors of resistance to penicillin and macrolide antibiotic were after and immunosuppression. The rate of penicillin resistance was 28% (2% CIM> 2.0 Â µ g / mL) and the macrolides from 23%. The overall fatality rate was 19.5% and the related infection of 12.5%. The 60% occurred during the first 5 days, in spite of adequate treatment. The independent risk factors of mortality in the multivariate analysis were the immunosuppressive treatment, severe sepsis, thrombocytopenia and increased creatinine, and survival was the presence of fever. No patient had received related pneumococcal vaccine, being shown in 84% of cases.

Author: PLAZA MARTÍNEZ ÁNGEL.
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 Non-steroidal anti-inflammatory drugs and, more recently, selective inhibitors of cyclo-oxygenase 2 (COX-2) seem to have greater activity anti-inflamatoria and anti cope with the development of colorectal cancer. Aims To investigate the effect of the selective inhibition of COX-2 in fewer tumors induced, as well as the activity of COX-2 expressed in the tumor tissue and assess whether this effect is greater than that achieved by the inhibition non-selective COX. Materials and methods have been designed a prospective study, randomized, double-blind on an animal model consisting of 35 male Sprague-Dawley rats of 225 grams of average weight (range 155 to 400 g), randomly assigned to one of four groups following : a control group (n = 5) without experimental manipulation, a group of chemical carcinogenesis (n = 10) with colonic cancer induction and promotion with 1,2-dimetilhidrazina dihydrochloride (1,2-DMH) (Group DMH), a group inhibition of carcinogenesis and non-selective COX (n = 10) (Group DMH + ASA) with administration acid acetil-salicílico (ASA) while the chemical carcinogenesis, and a group of carcinogenesis and selective inhibition of COX-2 (n = 10) (Group DMH + RFC), with administration of rofecoxib (RFC) near the chemical carcinogenesis. Carcinogenic induction was performed with 1,2-DMH a weekly dose of 25 mg / kg for 18 weeks subcutaneously. The anti-inflammatory drugs were administered orally at the rate of ASA 30 mg / kg weight of the animal / day and rofecoxib 3 mg / kg / day dissolved in water consumption. We analyzed the tumors induced in week 20 of initiation of experimental manipulation, and immunohistochemical studies microscopic. Results have been gained 57 tumors, 27 adenomas and 30 adenocarcinomas, with no difference between groups. The tumors of animals in the group DMH + RFC presented results significantly lower in relation to tumors of animals DMH group in terms of total tumor size (with a reduction of 55%), the percentage of malignant tumor surface ( reduction of 62%) and the percentage of total tumor size (reduction of 58%). Similarly, can be seen significant reductions in the expression of the activity of COX-2 in the fabric of adenomas (no expression in the adenoma group animals DMH + RFC), the expression of COX-2 on activity tumor tissue and peritumoral of adenomas (down by 68%) and the term COX-2 in tumor tissue of adenocarcinomas (down by 80%) in favor of tumors of animals in the group DMH + compared with the RFC DMH group. There are significant differences in analyzing the results of tumors in animals DMH + ASA group compared to those of other groups or in the number of tumor-induced or in the expression of the activity of COX-2 in tumor tissue. Conclusions The selective inhibition of the activity of COX-2 produces a significant decrease in the number of tumor induced by a decrease in the expression of the activity of COX-2 in tumor tissue.

Author: GUAITA MARTÍNEZ MARCOS.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA DE VALENCIA.
Place of preparation: FACULTAD DE MEDICINA DE VALENCIA.

Summary: The clinical complications that occur after the introduction of a CABG in elderly patients or ventricular failure is the leading cause of morbidity and mortality and its pathogenic mechanism underlying hormonal disturbances such as reduced levels of 3,3-triyodo- L-tironina (T3). As in hypothyroid patients, there is a decrease in cardiac contractility, and increased peripheral vascular resistance. Some studies have shown the beneficial effect is that the administration of T3 in the perioperative period, but the mechanism responsible for its action on the human saphenous vein, glass used in the CABG is not known accurately. The objective of our study was to analyze the response of the saphenous vein, glass used in the CABG, the T4 and T3. The study of the response of vascular smooth muscle is required to assess the participation of component and the release of endothelial nitric oxide, in addition to other vasoactive substances such as prostacyclin or EDHF. Likewise, it has been investigated as a possible mechanism involved in the Na + / K +-ATPase, K + channels rectifiers input and the possible involvement of both the cAMP and cGMP. In the human saphenous vein segments previously contracted with norepinephrine, the administration of T3 or T4 induces relaxation concentration-dependent and independent of the presence or absence of endothelium, discarding the involvement of nitric oxide and prostacyclin as responsible for endothelial relaxation. This relaxation is accompanied by an increase in cGMP levels, without being altered levels of cAMP, thus indicating that relaxing these effects are mediated, at least in part, by the activation of guanylate cyclase, but not the adenilato cyclase. The relaxation induced by T3 either amending when block K + channels dependent Ca2 +. Without emballo, inhibition of Na + / K +-ATPase or blocking of the channels of input rectifier K + is accompanied by the relaxing effect of the inhibition induced by T3. The results of our work suggests that the effects vasorrelajantes acute arising from the administration of T3 in patients who were conducting a CABG, may be related to an increase in cGMP levels. This response is mediated by activation of the Na + / K +-ATPase and intervene channels rectifier K + entry. The results of our work indicate that T3 has a direct impact, not genomic on the contractility of the human saphenous vein. These relaxing effects may be beneficial in the treatment of patients undergoing CABG.

Author: CALPE CALPE JOSÉ LUIS.
Year: 2005.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: MORE THAN A CENTURY AFTER THE DISCOVERY OF MYCOBACTERIUM TUBERCULOSIS BY ROBERT KOCK IN 1882, THE TUBERCULOSIS (TB) IS A PROBLEM FOR PUBLIC HEALTH IN DEVELOPED COUNTRIES. IN 1985 IS APRECIÓ AN INVESTMENT IN ITS TREND DESCENDENTE. OBJECTIVES OF THE STUDY WERE: 1) DETERMINE IF, AS DECLARÓ IN THE MEETING OF ALMATY IN 1978, THE CENTERS OF TB OR NOT ACCURATE PERSONNEL WITH SPECIAL DEDICATION. 2) VALORAR THE STATE OF THE DECLARATION OF THE TB. 3) KNOW THE IMPACT OF TB AND CHARACTERISTICS EPIDEMIOLÓGICAS 4) AVERIGUAR IF CHANGES HAVE OCCURRED IN OUR AREA HEALTH IN THE LAST 15 YEARS. 5) EXPLORE THE ASSOCIATION BETWEEN THE HIV AND TB AND ANALYZING THE INFLUENCE OF THIS RISK FACTOR IN THE IMPACT OF TB CLINICS AND ITS MANIFESTATIONS. IT IS IN CONNECTION WITH THE STUDY OF CONVENTIONAL CONTACTS (ECC) TWO TEACHERS IN SENDOS SCHOOLS OF EGB, ONE BY PRIMARY CARE WHERE APARECIERON LATER 6 CASES OF TB IN CONNECTION TO DEBIERON BRING QUIMIOPROFILAXIS AND NOT LES INDICÓ, NONE IN THE FACE ECC CONDUCTED BY ATTENTION ESPECIALIZADA, THAT DETERMINES THAT THE PRECISE TB STAFF WITH SPECIAL DEDICATION. ONLY CONSTATÓ DECLARATION IN 60% OF CASES TO TREND TO MEJORÍA OVER THE STUDY. NOT BE DISTINGUISHED CHANGES IN THE RISK FACTORS IN THE PATTERNS NI RADIOLÓGICOS. HAS IMPROVED THE DIAGNOSIS BACTERIOLÓGICO OF PULMONARY TB. THE 99% OF CASES OF TB COINFECTADOS THE HIV BE FACTOR TO THIS WELL AS THE 15.8% OF THE EVENT OF OUR AREA HEALTH TB. HIV INFECTION BY THE CHANGES IN DETERMINING THE PATTERN RADIOLÓGICO, MANIFESTATIONS EMERGENCE OF MORE SERIOUS AS MILIAR AND LOCATIONS INFRECUENTES AS ENDOBRONQUIAL.

Author: CANTERO SANTAMARIA JOSE IGNACIO.
Year: 2005.
University: CANTABRIA [More theses of this university] [www.unican.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The study was conducted in the emergency services of four emergency systems, three pertenencientes countries of the European Union (systems; Cantabria, Bonn and coventry) and the fourth to the United States (Richmond). OBJECTIVES The outcome of the study is to establish a methodology for comparing systems of care for medical emergencies in the field prehospitaliro. The specific objectives are: 1) compare the accessibility mediente evaluation of the response times. 2) compare the efficacy by assessing the outcome of care to cardiac arrest. 3) compare the efficiency by measuring variations in the scale of Mainz processes for chest pain and dyspnea, and by measuring the ages of assistance to the three processes under study; cardiac arrest, chest pain and breathlessness. 4) Compare the quality management prehospitalario of chest pain and breathlessness. The ultimate objective of the study is to identify potential areas for improvement in the systems analyzed. METHODOLOGY To meet the goals outlined in the study had used a cohort of cases handled in the area prehospitalario by emergency systems under study, in the period between September 2002 and August 2003. They have selected three 'ENTITIES TRACE' for the study; heart stop, non-traumatic chest pain and breathlessness. RESULTS The total number of cases in the series is 6,513, of whom are valid 6,277, this represents a 96% of the total. The distribution of cases is as follows; 3,152 are dyspnoea, 679 are cardiac arrest and 2,446 for chest pain. In terms of gender, the percentage of men is 51% and 49% of women. The average age ees of 57 years for men and 60 years for women. The emergency systems Coventry and Richmond responded faster than those of Cantabria and Bonn for porcesos; stop heart, chest pain and breathlessness. In the procentaje of cardiac arrest patients who arrive alive at hosplital is greater in systems of Cantabria yBonn (37% and 47% respentivamente) than in Coventry and Richmond (11% and 14% respectively).

Author: Freitas Fregonezi Guilherme Augusto de.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Facultat de Medicina Departamento de Medicina UAB.
Place of preparation: Hospital de la Santa creu i Sant Pau.

Summary: Myasthenia gravis (MG) is an autoimmune disease of unknown etiology, although attributable to a change in neuromuscular transmission, which is characterized by weakness and muscle fatigue, especially after exercise repetitive. The muscle weakness and fatigue are present in a large majority of patients diagnosed with MG, particularly in the variety known as "widespread". In the current literature, there are few jobs that assessed muscle weakness and respiratory lung function in myasthenia gravis, although there is some commonality on this weakness and the pulmonary disorders, there is some inconsistency with regard to the relationship, type and degree these alterations. Of the total number of patients with myasthenia gravis generally between 30 to 40% will develop some type of respiratory complications in the course of the disease, which is why our work is restricted to patients with myasthenia gravis widespread. These complications are largely due to alterations of the respiratory muscles, which in the long term also reflect a change in lung function. The continuous weakness and respiratory muscle fatigue produce an alteration ventilation, initially kind of "restrictive", with a decrease in respiratory failure by hypoventilation and clear changes in the pattern of ventilatory these patients. The characteristics of the disease, especially its chronicity and progression produce psychological alterations and family well-known, and whole muscle in general and especially respiratory, amending related quality of life (HRQOL) health. In recent years, several authors have analyzed lung function in patients with MG widespread and, moreover, HRQOL has also recently been evaluated in this type of patient. However, the relationship between these two areas, which will go a priori progressively deteriorate in the MG, has not been evaluated. Therefore, the thematic unity of this Ph.D. thesis is as a first step to explore changes in respiratory function by spirometry, lung volumes, respiratory pattern, pressure respiratory maximum, maximum voluntary ventilation and HRQOL, as well as relations between the two, in a sample of patients diagnosed with MG widespread. Based on the results of these evaluations, we seek to develop the research work focused on the physical (training) of the respiratory muscles. As results of this preliminary assessment found a inspiratory muscle weakness, a slight alteration in the respiratory pattern and a declining quality of life related to health, especially in areas related to physical activity, so we went for the implementation a program of physical training, designed by us, rehabilitation techniques to deal with respiratory and respiratory physiotherapy with proven scientific evidence. In summary, there are two jobs, both prospective, one describing the results of the evaluation of lung function and quality of life related to health and their relationships, and the second, a job random, controlled, which assesses the effectiveness of the treatment of respiratory rehabilitation (inspiratory muscle training associated with breathing exercises) on respiratory function (spirometry, lung volumes, respiratory pattern, pressure respiratory maximum, maximum voluntary ventilation) HRQL chest and mobility in patients with generalized MG . With our first job confirm the results previously published in connection with the type and degree of impaired lung function and particularly of the respiratory muscles. Deterioration found relates to the degree and extent of disease progression. Quality of life related to health 8 is lig 750 was damaged and especially in the areas related to physical activity and the perception of having power to carry it out. Finally inverse correlations between rate RR / Vt and respiratory muscle strength as well as inspiratory capacity is a variable that is very dependent on the strength of the respiratory muscles, makes us conclude that the ventilatory efficiency is closely linked to muscle strength respiratory. Studies of respiratory function allows us to evaluate the progression of MG widespread and contributes to know the magnitude of the problem, especially with regard to the deterioration of the function of the respiratory muscles. With regard to the second work, we can conclude that the program semi-domiciliario based training at intervals associated with breathing exercises for patients with MG widespread carries a marked improvement in respiratory muscle strength, mobility of the rib cage, the pattern respiratory and muscle endurance. Though apparently contradictory in this disease, respiratory muscle training in myasthenia gravis, implemented and monitored weighted charges may benefit these patients.

Author: PASCUAL SEDANO BERTA MARÍA.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: HOSPITAL DE LA SANTA CREU I SANT PAU (BARCELONA).
Place of preparation: HOSPITAL DE LA SANTA CREU I SANT PAU (BARCELONA).

Summary: INTRODUCTION In patients with Parkinson's disease (PD) and cognitive anímicas fluctuations exist in relation to the administration of levodopa (LD). There are no formal studies that explore the relationship of these fluctuations with no motor response to the patient's motor oral LD (stable or fluctuating) or with different pharmacokinetic profiles of oral LD. OBJECTIVE Primary objectives of the thesis was to analyze changes of mood and cognitive and their relationships into two groups PD patients with motor response to the fluctuating and stable oral LD, which were given a dose of LD acute or immediate release standard (LD-St) and an acute dose of LD controlled release (LD-R). A secondary objective was to assess HMPAO-SPECT changes in regional cerebral blood flow (FSCr) of PD patients during a task activation Front (Wisconsin Card Sorting Test -WCST). METHODS study randomized double-blind crossover and in 14 patients (seven stable, fluctuating seven). We monitored the state engine, the plasma levels of LD, cognitive functions headlamps (with the -WCST-, test memory Sternberg, Stroop test and Tower of Hanoi), the mood and anxiety (with visual analog scales, VAS ) from one hour before until six hours after administration of a dose acute LD-St and LD-R. RESULTS Cognition: under the administration of LD-R, patients improved over the meetings performance WCST (fluctuating patients) and the test Sternberg (aggregate sample of patients), and no significant changes in the performance test Stroop and the tower of Hanoi. The analysis of humor showed that only patients had significant fluctuating mood swings, especially under the influence of LD-St. There was a strong correlation between levels of anxiety and mood, revealing the biggest changes of humor before that the biggest changes in anxiety and state engine, which were parallel. Unable to find a consistent relationship between cognitive performance and scores of humor. The study of brain activation with HMPAO-SPECT, patients fluctuating with LD-R activated significantly more frontal cortex that the remaining groups, which coincided with a better performance in the WCST. Conclusions The results of this study suggest that patients with motor fluctuations are at an increased risk of fluctuations in mood and anxiety that the patients are stable, and that the fluctuations of mood and anxiety are more marked than those of cognitive 'front '. Over time, LD-R improvement rather than LD-St performance tests in front of chief executive demand, and there is a decoupling of performance against dopaminergic stimulation tests in acute executives, both in terms of different demand cognitive and complexity of the unit subcircuitos fronto-estriatales different. The gap between the earlier improvement of anxiety and later improved mood suggests that both phenomena although relacionados- depend circuit segregated, with fluctuations of the most anxiety-related motor fluctuations. There is a direct correlation between mood swings and anxiety and performance tasks in front of high demand, such as the WCST. Finally, patients are able to activate fluctuating more frontal areas before a task frontal patients stable, especially under the influence of LD-R.

Author: GUSSINYÉ CANABAL SANDRA.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: H.U. MATERNO INFANTIL VALL D'HEBRON.
Place of preparation: HOSPITAL UNIVERSITARIO MATERNO INFANTIL VALL D'HEBRON.

Summary: This thesis shows the results of the program eduación Multidisciplinary treatment of overweight and obesity among children Children / as in the Movement. This is a structured program of 11 weeks' duration, group or individual format, which consists of educational materials, both for the instructor and participants for patients who sirvirán to run the program. The maerial to the instructor, is a guide book to carry out the treatment. The material for the children are 10 notebooks of work, where children work in the house and later in the session and a half hours weekly. It caters to children and prepubescent girls from 6 to 12 years of age with problems of overweight or obese exogenous. It is a problem that aims to make those changes on lifestyles and eating habits that contribute to weight gain, contemplating nutrition education, physical activity and the emotionality of the child. It uses techniques cognitive and affective. Work with your health-related topics such as: Food, misleading advertising, self-body image, communication, conflict resolution, assertiveness, self-esteem, relaxation and physical activity (hours of television and computer games). Allows a place where children can discuss and express their emotions in relation to the issue of overweight, obesity and its consequences. According to the results obtained in anthropometric parameters, psychological and quality of the Mediterranean diet (there was a reduction of BMI, an increase in the quality of the diet medieterránea, an improvement of the features of anxiety and depressive and greater satisfaction body), the program children on the move, can be an effective tool and applicability easy, useful to the need to implement programs that offer solutions to a problem that every day occurs most frequently.

Author: QUERALT ALCARAZ MONTSERRAT.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: HOSPITAL UNIVERSITARIO VALL D' HEBRON.
Place of preparation: HOSPITAL UNIVERSITARIO VALL D' HEBRON.

Summary: Introduction: There were defined as those self-care activities aimed at recognizing and evaluating symptoms and the response to them in the context of everyday life, although in our country have made various descriptive work on self care, interventional studies you have been scarce. The objectives of this study are to understand the characteristics of self-care that makes our people to common symptoms and analyze the influence of different socio-demographic variables have on them, as determinants of performance, as well as observe the influence that an educational intervention would have on visits the consultations in primary care and on correcting the actions of self. Method: We designed a case-control study of intervention on a sample of 800 individuals older than 15 years and with clinical history open at the Center for Primary Care at least one year before the start of the study, which was extracted form of randomized an urban population. These individuals are moved by mail a questionnaire autoadministrable, with options multirrespuesta, which inquiring about sociodemographic data, habits of consultation and self-care to 10 health problems common, chosen for their frequency in the consultations in a qualitative study that held previously (fever, headache, respiratory problems, digestive and musculoskeletal). This survey was passed to the sample prior to the intervention, and a year later, to detect differences. The intervention consisted of mailing to half the sample brochures with information on self-care to correct the symptoms studied, reinforced with informative talks. It was also extracted data from the visits to the center during the year before and after the educational intervention. Statistical analysis was performed for the evaluation of socio-demographic determinants through univariate analysis, and multivariate to know the relationships between sociodemographic variables and self-care behavior before each symptom. Analysis after the intervention in relation to the frequency and effectiveness before matching was conducted by a Poisson regression in the first case, and using a logistic regression in the segundo.Resultados: first consultation with a health problem over the doctor , the couple and mother. The attitude varies in each symptom. In fever persons performing self-medication are young women, workers with high perception of health, and consults older men who do not work. In headache is automedican young people who are not widows, elderly consult with bad perception of health, not singles or education; abstain people young and unmarried. In respiratory problems are automedican singles; perform home remedies if advanced education; abstain young, unmarried with higher education. In digestive problems performing home remedies older, unmarried, workers who believe that their health is good; abstention therapeutic realized unmarried men and youths. At problems musculoesquéleticos abstention therapeutic realized youth. The appropriate action is higher than 75% in all symptoms. Following the educational intervention was observed that the quality of self-care not varied significantly, and remained very high. Regarding patronage, and no appreciable difference between before and after the educational intervention. Conclusions: The variables that influence decision making in self-care activities are primarily age, marital status, sex and patronage. An intervention educativ 8 to sencil 35f the on the common symptoms in self-care has not been disclosed as valid to reduce visits to primary care or for actions to improve these symptoms.

Author: Guzman López Abel.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Hospital Universitario de la Vall dHebron.
Place of preparation: Facultad de Medicina-Universidad Autonoma de Barcelona.

Summary: The screening includes prenatal counseling prepregnancy, biochemical screening and maternal ultrasonography, in addition to invasive diagnostic tests such as amniocentesis classical, early and filtration technique, the villi biopsy coriales, fetal biopsy and cordocentesis. The main objective of this study was to comparatively analyze the method of amniofiltración, their advantages and disadvantages in relation to existing methods such as biopsy corial and amniocentesis early without amniofiltración. Analyzing the time required to perform each procedure, failures in the cultivation, as well as complications intraprocedimiento and postprocedimiento of each technique. The study involved 921 women candidates for fetal karyotype. In 310 patients underwent biopsy corial, 302 patients amniocentesis early amniofiltración and 309 patients early amniocentesis conventional without amniofiltración. Corial biopsy was performed at 11.09 weeks, amniocentesis early amniofiltración at 12.45 weeks and amniocentesis early without amniofiltración at 12.98 week average. Comparatively, amniocentesis early aminiofiltración required more time to conduct in connection with the other two techniques of the 921 cases alone in a 3.4% complications classified as mild, moderate and severe: 6 of them in the biopsy procedure corial, 12 during the procedure of amniocentesis early amniofiltración and 11 in the procedure aminiocentesis early without amniofiltración. It presetaron 6 cases of crop failures in karyotype biopsy corial, 2 in amniocentesis early amniofiltración and 3 in early amniocentesis without amniofiltración. From these results it can be concluded that the method of prenatal diagnosis of early amniocentesis carries with amniofiltración not on the technical advantages of early amniocentesis without amniofiltración and biopsy corial and that most of the authors agree that there is further complications when such techniques are performed at lower gestational age. There are no randomized studies to amniocentesis between weeks 13-15 that demonstrates clearly the effectiveness of early amniocentesis and amniocentesis classical and coriales villi biopsy, in addition to the actulidad techniques such as in situ hybridization with inmunoflourescencia and chain reaction the fluorescence quantitative polymerase, which provide a diagnosis cytogenetic faster and secure in most of the chromosome abnormalities.

Author: Placer Santos José.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Hospital del Mar de Barcelona.
Place of preparation: Hospital del Mar de Barcelona.

Summary: The dissertation consists of two conducted research works published in international scientific journals and their summaries below. Clinical Usefulness of a FISH test for the non-invasive diagnosis of bladder cancer Goals. To evaluate the clinical usefulness of a test Multi-color FISH (fluorescence in situ hybridization) in urine samples for the detection of bladder cancer and its recurrence, comparing the results with those obtained by the urinary cytology. Methods. Urine samples were collected obtained by spontaneous micturition of 86 patients, and cytologic study performed FISH analysis with them. The study of FISH was performed using a mixture of DNA probes marked with fluorescence in the regions centroméricas of chromosomes 3, 7 and 17, and the region 9p21. In all patients conducted a cystoscopy with biopsy or tumor resection, and the results anatómico-patológicos compared with the findings of cytology and FISH. Citologia, FISH%,% Grade G1 25% 53.3% G2 66.7% 83.3% G3 94.7% 100% Venue PTa 42.3% 64% WP1 91.7% 100% PT2-T4 88.9% 100% Type of tumor tumor new 73.3% 86.2% Recurrence 47.1% 70.6% Size <10mm 28.6% 46.2% 10-30mm 66.7% 93.3%> 30mm 88.9% 94.4% Global 63.8% 80.4% Results. The table shows a comparison of different sensitivities obtained by cytology and FISH technique in the detection of cancer, according to the size, grade and tumor stage, as well as the type of tumor. The specificity of cytology and FISH were 86.1% and 85.3% respectively. Conclusions. The FISH technique increases the sensitivity rates obtained with urinary cytology for the detection of bladder cancer in all grades and stadiums and offers similar tumor specificity. The FISH doubles the diagnostic capability of the urinary cytology in tumors under grado-estadio, and detects all high-grade tumors and infiltrantes. European Urology 2002:42; 547-552 Characterization cytogenetic of bladder carcinoma and its correlation with histologic grade and Target Stadium. Analyzing chromosomal alterations present in the urinary bladder carcinomas using a test FISH (fluorescence in situ hybridization), and genetic findings correlate with histologic grade and stage. Patients and methods. We obtained samples of 37 carcinomas of the bladder at the time of the making of an endoscopic resection or cystectomy. In all cases be made a histological evaluation and analysis of FISH. To test FISH probes were used DNA pericentroméricas for chromosomes 7, 8, 9 and 17 and DNA probes specific locus for bands 9p21 and 9q34. Results. In 28.6% of the tumor grade 1 there were losses of chromosome 9, 14.7% trisomy of chromosome 7, and the rest were not detected abnormalities. The tumor grade 2 were marked by the loss of genetic material from chromosome 9 in 40%, and the absence of detectable abnormalities or multiple aneusomías at 30% each. The polisomía was the dominant event in carcinomas grade 3 and pT1-T4. No significant differences were found between the losses 9p21, 9q34 or chromosome 9, and the different categories tumor. There was a statistically significant difference in the frequency of polisomías between tumor grade 1-2 and 3, and between tumors pTa and pT1-T4 to chromosomes 7, 8, 9 and 17, and gangs chromosome 9p21 and 9q34 (P < ; 0005). Conclusions. These findings show that deletions of chromosome 9 is not correlated with tumor stage or grade, but are the only alterations found by leaps and bounds in low-grade tumors. The results suggest that tumors pT1 are very close to those tumors músculo-invasivos a genetic level, and show that polisomía of chromosomes is assessed more frequently in high-grade bladder carcinomas and stadium. Urology 2005:65; 913-918

Author: ZABALA JAUREGIALTZO MIREN ARANTZAZU.
Year: 2005.
University: PÚBLICA DE NAVARRA [More theses of this university] [www.unavarra.es].
Place of defense: DEPARTAMENTO DE CIENCIAS DE LA SALUD.
Place of preparation: DEPARTAMENTO DE CIENCIAS DE LA SALUD.

Summary: Descriptive study conducted in school population in a rural area of northern Navarre with the objectives of: 1) estimate the prevalence and severity of asthma, allergic rhinitis and eczema or atopic dermatitis in children aged between six and seven years, and among the thirteen and fourteen years from five core areas of rural health (Doneztebe / Santesteban, Elizondo, Leitza, lesaka and Ultzama). 2) compare the prevalence data of the rural population studied with the data obtained in urban population of Pamplona and its Region, and other autonomous regions. 3) compare the data on asthma in the study area as international video, video European and written questionnaire. 4) Identify existing differences in the prevalence and characteristics of asthma, allergic rhinitis and atopic eczema by sex. 5) Identifying risk factors for allergic diseases. 6) Contrast the results of the questionnaire with the computerized medical records of each center salud.La study population had been 464 schoolchildren 6.7 years and 554 school 13-14 years, belonging to 30 different municipalities. It opts for the draft "International Study of Asthma and Allergies in Chidhood" (ISAAC) as a reference methodology using the same questionnaires written and video questionnaires. The novelty of this study is that for the first time applied this methodology in a rural population. Along with this questionnaire is attached other related risk factors. The questionnaire addressed to children of 6-7 years consists of 76 questions and is answered by parents, while the 13-14 age 78 questions and answer their own school. On the other hand, as a source of information has been taken into account registration of allergic diseases of the health centers in the area estudio.La involvement has been 89.7% in children 6-7 years and 92, 6% in the 13-14 years. The results correspond to the objectives of the study, emphasizing: 1) The prevalence of asthma is about 6.7% in children 6-7 years and by 10.5% in children 14-14 years. 2) The prevalence of rhinitis is a 15.6% in the group of 6-7 years and 36.5% in the group of 13-14 years. 3) The prevalence of atopic dermatitis is a 5.8% in the group of 6-7 years and 4.3% for 13-14 years. 4) In the group of 13-14 years, women have double the risk of having rhinitis than men (OR = 2.10) and five times higher risk of dermatitis (OR. 5.20) than males. 5) The 14% of children 6-7 years (compared to 6.5% for girls) deal over two weekly episodes of shortness of breath when doing physical exercise. 6) For children 13-14 years who have wheezing related to the exercise there is a greater number of children who would like to make a sport and if they can not make their breathing problems (OR. 7.21). 7) has been associated significantly in the group of schoolchildren in 6-7 years, the presence of moisture stains in the house with having had in the last year symptoms of asthma and dermatitis ever. 8) In the group of 6-7 years, has been associated significantly having had asthma ever with the consumption of snuff from the mother during pregnancy or during the first year of the child's life. 9) Among the school 6-7 years, notes higher percentage of problems with asthma and dermatitis, and those who have been treated with antibiotics more than 4 times during the first year of life and where their mothers possess a university degree. 10) In the health centers of the study area there infrarregistro computerized diagnosis of asthma, rhinitis and eczema