GYNECOLOGY

Author: ORTEGA MARTÍNEZ JOSÉ ANTONIO.
Year: 2002.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: 1,- HOSPITAL CLÍNIC-UNIVERSITAT DE BARCELONA 2,- PROGRAMA DE ATENCIÓN A LA MUJER - INSTITUTO CATALAN DE LA SALUD.

Summary: The female urinary incontinence is a health problem and the cause of high prevalence of frequent consultation to gynecologists, general practitioners and urólogos. In general population, the prevalence found in the literature is around 20% and varies depending on parameters such as the definition of incontinence or questionnaire symptoms utilziados, the method of collecting information and the use of tools or not goals , among others. The recommendations of the consensus documents of the International Continence Society-ICS (2002), Spanish Society of Gynecology and Obstetría-SEGO (2002) and the American Health Care and Research policy-AHCPR (1996), among others, and publications various authors endorse the possibility of conducting the initial assessment of incontinence of urine from Primary Care. It is generally accepted, and so confirms the ICS in its report of 2002 that the lower urinary tract symptoms do not, by themselves, make a definitive diagnosis of lower urinary tract dysfunction, and therefore, the clinical diagnosis or initial assessment should be supported with tools more goals. It is also accepted that the study urodinámico represents more objectively analyze the possible causes of urinary incontinence, although its actual conditions of application make it a test specialist, located in cenros hospital or specialized units of Level III and with some difficulty accessibility to the level of primary health care. Furthermore, in reviewing the literature, it is found that most of the published studies that evaluán the conocrdancia between clinical diagnosis and study urodinámico of female urinary incontinence are made from the hospital level of care. All of the above justify a study on the degree of concordance between the clinical diagnosis of urinary incontinence in women and diagnosis urodinámico basis of the actual conditions of work of a unit Soil Pelviano for Primary Care. It was established as a clinical diagnosis of incontinence of urine esfuezo, demonstrating incontinence effort in the search, conducted under the conditions specified in the study, together with a pattern of frequent urination day and night normal obtained from a newspaper Urinary. It was established as a clinical diagnosis of urinary incontinence emergency, the absence of incontinence effort in the search, conducted under conditions especioficadas in the study, together with a pattern of frequent urination increased 7 and daytime nocturnal largest 1 obtained from Urinary a newspaper. It obsdrvó a moderate degree of concordance between the clinical diagnosis and urodinámico of patients with incontinence of urine. With the criteria of the study and considering the study urodinámico as "gold standards", the validity of clinical diagnosis is limited. The clinical diagnosis of urinary stress incontinence, presented the positive predictive value higher. The symptoms most often presented the patients, were: loss of urine to the effort, Urinary urgency, increased day and night Urinary incontinence and urinary urgency. It is difficult to establish a pattern that will allow a clinical diagnosis of urge incontinence without resorting to study urodinámico to highlight the detrusor overactivity. The clinic performs more diangósticos incontinence of urine mixed. In an environment of care, as outlined in Primary Care, incontinence of urine my 8 xta resu 1c8 ltaría the main indication study urodinámico.

Author: VIGUERA SALVAGO FRANCISCO JAVIER.
Year: 2002.
University: EXTREMADURA [www.unex.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: OBJECTIVE observe in experimental animals the effect that the exercise, a diet rich in polyunsaturated fatty acids w3 and estrogenoterapia have on the concentration of fatty acids in plasma, abdominal subcutaneous fat, breast and uterus. CONCLUSIONS I.1. In plasma, Exercise, as in dietary supplementation with fatty acids w3, and the administration of unopposed estrogen, changes in the composition and distribution of AG of plasma lipids that could help reduce the risk of diseases cardiovascular. II.1. The fatty deposits occurs with any of the therapies a decrease in the content of acid Arauidónico (w6), and an increase in alfa-Linolénico (w3). There is a composition of AG appears to be beneficial against the risk of certain chronic processes, which could include cancer. II.2. In the breasts, both the exercise as supplementation of the diet changes in the composition of AG appear to be beneficial against the risk of occurrence of cancers. For its part, the administration of unopposed estrogen, produced some changes in the AG deemed that could encourage the development of processes cancer. II.3. In Úteros, in a manner similar to what happens in the breast, Exercise and the administration of the supplement in the diet changes in the composition of AG that are considered protective against the risk of developing cancer processes. The administration unopposed estrogen, however, resulted in changes to the composition of AG appear to be seen as supportive to the development of cancers of the uterus.

Author: RAMOS MAESTRE M. JOSÉ.
Year: 2003.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: MEDICINA.
Place of preparation: UNIVERSIDAD MIGUEL HERNÁNDEZ.

Summary: Endometriosis is a disease known for over a hundred years and yet remains a matter of research at the present time because of their high prevalence and the uncertainties about its pathogenesis. There are many theories that attempt expicar its causes and which is gaining more importance today is the involvement of the immune system. Based on this premise, in confirming changes in the behavior of the immune system in women with endometriosis and profit obtendio other diseases inmunoinflamatorias after blocking TNF raise our hypothesis. ASSUMPTIONS Inhibition of TNF-alpha antibodies antiTNF-alfa reduced by experimentally induced endometriosis in Wistar rats. OBJECTIVE determine whether intramuscular administration of antibodies antiTNF-alfa significantly decreases the size of the implants endometriosicos in the experimental model of Wistar rats. DESIGN This design a pilot study, longitudinal, prospective, randomized, double-blind. Our experiment was to induce endometriosis in 115 Wistar rats of which 100 were included in estuido after a second laparotomy. They were distributed in a random into three groups that received placebo GnRH analogues and antiTNF-alfa respectively for a month, being valued at a third laparotomy after the end of treatment and again in a fourth laparotomy spent a month with subsequent slaughter of the animal . RESULTS There was a statistically significant reduction in the size of endometriosis in the three treatment groups and statistically indistinguishable between them in the long run. DISCUSSION Given our surprise given the result mainly by the placebo group decided to expand the sample in 36 rats getting more results similar to the first experiment. We remain confident in the potential therapeutic blockade of antiTNF-alfa in endometriosis, many studies related to TNF-alpha in the pathogenesis of endometriosis and various investigations that objetivan a sniveles of antiTNF-alfa high. The latest research concludes that this increase would only be in early stages of the disease but were not in the advanced, and perhaps for this reason, it would be appropriate to test this treatment in early stages and not in endometriosis already established as we did, although on the latter there is some controversy aspect. CONCLUSION block TNF-alpha by an antibody antiTNF-alfa administered via intramusuclar not reduce endometriosis experimentally induced in the rat Wistqar significantly compared to placebo

Author: CREUS FERRE MONTSERRAT.
Year: 2003.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD DE BARCELONA.

Summary: HIPÃâTESIS OF WORK: The identificaciÃÂ ³ n and study of new markers implantaciÃÂ ³ n: integrins and pinÃÂ ³ podos, in different situations clÃÂnicas, deberÃÂan afford define in a way mÃÂ ¡s accurate and objective level of receptivity of the endometrium luteÃÂnico for implantaciÃÂ ³ n. OBJECTIVES: 1.Determinar sila expresiÃÂ charges of integrins and pinÃÂ ³ podos endometrial or is not a manifestaciÃÂ ³ n functionally independent dated histolÃÂ ³ gico clÃÂ ¡sico of the endometrium. 2, establish whether or not there is a good correlaciÃÂ ³ n temporary her alleged dilimitaciÃÂ ³ n of the window implicaciÃÂ ³ n. 3. Determine whether or not there were differences in their expresiÃÂ charges inthe endomÃÂ © trio of women estÃÂ © riles and women of proven fertility. 4, investigate whether its expresiÃÂ charges or not correlated to the cause of infertility and the instauraciÃÂ ³ No further embrazo. 5. Establish the effects of different terapÃÂ © cies hormone used in infertility or in the control of fertility on the expresiÃÂ ³ n of these markers. 6. Investigate the usefulness of determinaciÃÂ ³ n sÃÂ © rich inhibina-A phase lÃÂ fifth marker of how tea half endometrial receptivity. 7. Establish variability cycle to cycle the expresiÃÂ charges of intetgrinas and pinÃÂ ³ podos endometrial on the same woman. CONCLUSION. At conclusiÃÂ charges generally interÃÂ © s clinÃÂco-prÃÂ ¡ctico we can say that there is no relaciÃÂ charges between cause and the presence or absence of these two markers endometrial during dinominada "window implantaciÃÂ ³ n" and the fertility of women.

Author: LEON LUIS JUAN ANTONIO.
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The cell therapy by introducing hematopoietic stem cells in a patient affection of a disease susceptible to treatment, is a form of gene therapy. The alo-trasplante stem cell hemamtopoyéticas occurs naturally in dicigóticos twin pregnancies, which provide communications placental in utero. This is due to various characteristics of embryo development, provide an opportunity to tolerate blood from a donor during this period. If refined methods of introducing stem cells in the embryo, this kind of genetic therapy in utero, could become a viable alternative, especially to treat metabolic diseases, immune and hematopoietic of hereditary origin, before the deficit genetic has committed signitivativamente different fetal organs. Moreover, the existence of a "window immunological" in embryonic development, before beginning the process of training tímica, with the presence of mature T cells, allowing tolerance to foreign antigens. In ideal conditions, the gene transfer initiated during this period would result in a prolonged tolerance, perhaps permanently, if these antigens are kept in a persistent, which would avoid any cellular immune response against the host cells donated and facilitate transplantation of other organs in a postnatal period. Our hypothesis is based on demonstrating, through transplantation of hematopoietic stem cells to human CD34 + embryos baboons, between days 36 and 46 postfecundación via celocentesis, ecoguiada, the possibility of creating xenoquimeras hematopoietic humano-babuino. To this end, aíslaron methods inmunomagnéticos, mother CD34 + cells from the umbilical cord blood of newborns to términom and uncomplicated intrapartum. Thanks to the similarity in embryonic development between human and baboon model based on the model parameters ecográficos baboon becomes suitable surrogate model for human experiment prenatal diagnostic techniques, physiology studies of the first quarter, as well as transplantation hematopoietic stem cells in space extracelómico. Finally, we have developed different methods to demonstrate xenoquimerismo in infants undergoing transplantation.

Author: GILES JIMÉNEZ JUAN MANUEL.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTA DE MEDICINA.
Place of preparation: UCM FACULTA MEDICINA. HOSPITAL SEVERO OCHOA (LEGANES).

Summary: OBJECTIVES To study the usefulness of the use of color doppler and pressed into uterine arteries as a technique for screening of preeclampsia or gestational CIR ultrasound in the second quarter in the general population in an area of low prevalence for both diseases. MATERIALS AND METHODS During the period between January 2000 and June 2001 were studied prospectivametne the uterine circulation in all gestations alone (n = 5046) relating to the morphological study the fetal unit Prenatal Diagnosis Severo Ochoa Hospital between weeks 20 and 22 of gestation. The OVF was considered abnormal in the presence of a notch protodiastólico, evaluated 4 weeks after all those pregnant women in which the ultrasound done the 20-22 week revealed his presence. RESULTS The presence of bilateral notch at 24-26 weeks is associated with a higher prevalence of preeclampsia and CIR, as well as a higher rate of caesarean sections, pH cord pathological, requiring neonatal care and reduced weight of newborns. Its sensitivity was 50% for pre-eclampsia and 58.6% for CIR, whereas in severe forms (EG childbirth less 34 weeks) allowed identification of the 66.7% and 75% respectively. Screening in two phases (20-22 and 24-26 weeks pregnant at those that appeared notch to 20 weeks) improved sensitivity for both. The bilateral notch is the only variable that shows a statistically significant OR for pre-eclampsia and CIR. CONCLUSIONS would be advisable to introduce the velocimetría uterine artery Doppler ultrasound performed during the second trimester of pregnancy to the general population in order to identify pregnant women at risk. While it is necessary to carry out studies to improve as a technique for screening of complications related to inadequate placentation.

Author: UBEDA HERNÁNDEZ ALICIA.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: INSTITUT UNIVERSITARI DEXEUS.
Place of preparation: ESCUELA DE POSTGRADO.

Summary: In October 2001, European Economic Community, Australia, Canada and Singapore approved clinical application of Essure ®. This method obtains or bstrucción of light tubal by placing a device titantio through hysteroscopic. A priori seems gather all the features ncesarias to replace tubal ligation. Thus, Essure ®, represents a technique that provides safety and efficacy without the need for surgery, skin incision, hospital or recovering at home. The first two multicentre studies published their results in 2003. The success rates in the placement run around 92%, but necessary considering the administration of local or general anesthesia. Refieren side effects such as uterine perforation or tubal and inadvertent removal of the devices by up to 7% of the cases, without serious consequences for the patients. The monitoring is done by HSG, the dual shows obstruction within three months of insertion. The contraceptive efficacy turns out to be absolute during the mean follow-up time of about three years. IN July 2002 introduced the technique at the University Institute Dexeus under the premise of not administering anesthesia and reduction of the selection criteria. After two years of experience with a series of 124 patients, our conclusions were as follows: 1 - There has been no complication and no severe adverse side effects in our series. 2-We have restricted the inclusion and exclusion criteria for the method Essure ® initially proposed, without any assumption lower eficaica, less security or adverse side effects or postoperative Intra, in the short or medium term, on women in our series. 3 - The rate of successful placement of the device intratubárico Essure ® has been a 97.6%. 4 - The average length of the proceedings Essure ® has been a 50% lower compared with the average of other centers and overall has decreased statistically significantly from the first 40 patients. 5 - The average time of recovery method Essure ® in our patients has been 20 minutes, 80% less than the world average obtained from the data published in the literature. 6-Except for three women, was not implemented or local anesthesia. Patients referred satisfaction "good" or "very good" to the procedure in 95% of cases. 7 - The four failures insertion of the devices in our population occurred in the first 51 patients. Starting with the case number 52, the placement rate has been 100%.

Author: GONZÁLEZ BÁEZ ENRIQUE JAVIER.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: HOSPITAL MATERNO-INFANTIL VALL D'HEBRON.
Place of preparation: ESCUELA DE POSTGRADO.

Summary: INTRODUCTION For the normal development and steroidogenesis requires a defined sequence of hormonal changes. Basic and clinical studies reviewed by Chappel and Howles (1991) suggest that LH during the follicular phase plays a minor role, even in follicular development. It has been documented that the presence of LH in the late follicular phase improvement follicular maturation of oocyte and embryonic development (Commenges - Ducos et al., 2002). Filicori., 2003 documented that follicles reaching a diameter of 10-12 mm. Have receptors for LH; at this stage FSH and LH are equally effective to support and promote the role of granulosa cell. OBJECTIVE determine whether it is necessary and what is the optimal dose d eLH for the proper growth and follicular development in women 34-40 years. MATERIALS AND METHODS This is not a randomized study stratified. The aleatorizaicón be conducted by computer with a parallel distribution 1:1. Once obtaining the informed consent of patients will be randomized to one of three treatment groups for study, being composed of the following groups: Group A: Receive Treatment with recombinant gonadotropins, FSH-r alpha 300 IU. (Gonal F ® Serono) subcutaneously. Group B: Receive Treatment with recombinant gonadotropins, FSH-r alpha 300 IU. (Gonal F ® Serono) and LH-r 150 IU. (Luveris ® Serono) in the form sucutánea. Group C: Receive Treatment with recombinant gonadotropins, FSH-r alpha 300 IU. (Gonal F ® Serono) and LH-r 75 IU. (Luveris ® Serono) subcutaneously. RESULTS In the present study we enrolled 33 cycles of IVF-TE / ICSI made in 31 mujres with a mean age of 36.7 years + - 1.89 years SD (range 34-40 years). When making a comparison between treatment groups in the length of ovarian stimulation documented a statistically significant difference (P = 0027) from the days of stimulation in the medicated groups with LH-r. There was no statistically significant difference in estradiol level on the day of aplicaicón of hCG. The average number of oocytes retrieved metaphase II was 6 oocytes for the group FSH-r alone for the group FSH-r 1/LH-r 1 / 2 was 7.5 oocytes and 6.4 oocytes for the group FSH- r 1 / LH-r 1 / 4. In groups medicated with LH-r documented improved quality embryo (P = 0007). CONCLUSION In our study dose FSH-r needed are lower as more LH-r is administered. This is not significant, but trended sharply. Therefore, the LH-r appear to have an effect enhanced on FSH-r, decreasing requirements FSH-r.

Author: GIMENO SOLSONA FAUSTO.
Year: 2004.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The defecografia is an exploration done with the preparation and proper technique, so carefully and with the highest hygiene measures and pñvacidad not cause significant discomfort being accepted without problems for the patients. The technique of defecografia should be done with the patient sitting in a chair radiotransparente, the contrast must be rectal paste barium in dense amount not less than 300 mi, via opacification of the small bowel with oral intake prior 400 my bathing liquid is compulsory and is essential to the realization of projected effort at the end of the evacuation of rectal contrast. The rectocele yel enterocele identified without difficulty during the development of defecografia. The accurate assessment of both disorders, often synchronous enables the choice of appropriate surgical technique. The rectal intussusception that can accompany the rectocele and that must persist for the evacuation of the contrast seems to be a non-obstructive functional alteration that affects the sense of incomplete defecation whose main cause is the existence of waste in the vaginal portion of the end of the rectocele evacuation. The study of fecal incontinence in women must understand ecografa endoanal for the valuation of esfínteres and defecografia to rule changes that may have an associated their appearance. The defecografía is useful in the study of constipation especially if it shows the existence of rectoceles and / or sigmoidocele in patients with clinical obstruction dístal (outlet obstruction), and should join the enema opaque and the determination of colonic transit time marker. In valuing anismo, defecografla confirms the diagnosis obtained with the manometria anorectal. The ténninos "peñneo fallen" and "fall in the floor of the peMs" should be replaced by the concept. Patologias combination of soil from the peMs "which defines more clearly the existence of synchronous changes in the same compartment (rectocele and enterocele) or a combination of patologias compartments of urinary, gynecological and digestive.

Author: BECERRA MARTEL JUAN ANTONIO.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: In this thesis, we wanted to do a study of the tocoginecología in Cadiz in 1800 to 1850.En this work we conducted a search of elos archives of the Royal Academy of Medicine and Surgery in Cadiz and the Faculty of Medicine of the same city, in addition to studying all the articles in the print media that time period. First we got a description of the specialty in Europe and Spain, and as applied conocimienatos to tocoginecologia Cadiz. Secondly, we developed the evolution of this specialty from an academic point of view, and discover the vicissitudes which passed by the Royal College of Medicine and Surgery to become School of Medicine. Thirdly, we have studied the techniques obstétricias and tocúrgicas being made at the time of which, some of them, practiced at present. Fourthly, we also develop the study of breast and gynecological pathologies that were known in addition to the surgical techniques and treatments used in those years decimonónicos. Fifthly, we study of the life and work of two great doctors but not developed their business at the time, was formed and studied in this period of time, these two teachers were Don Cayetano del Toro and Cuartillers and Don Federico Rubio and Galli.

Author: MENDIZABAL VICENTE ELSA.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA UCM.

Summary: INTROOUCCION: The uterine sarcomas account for 3-5% of all malignant tumors of the uterus, however, are responsible for 26% of cancer mortality body. Uterine. Hence the i (1terésde investigate new techniques Immunohistochemical that favorecezcan the correct diagnosis of the disease and provide new insights into his prognosis or alternative therapies. OBJECTIVES: To examine the biological behavior of uterine sarcomas and identify those variables relevant to the prognosis of the disease . investigate the expression of estrogen and progesterone receptor, c-kit, CO10, Ki-67 and markers (1euroendocrinosen these tumors, as well as their possible involvement in the pronósticode disease. MATERIALS AND METHODS: A retrospective cohort observational study in which discusses 64 cases of uterine sarcomas (29 leiomyosarcomas, 27 tumors mà ¼ llerianos mixed 6 sarcomas of the stroma endometriaJy 2 adenosarcomas) diagnosed in HGU Gregorio Maranon between the years 1985.Y 2002. pathological anatomy is reviewed and determined by techniques 1 nmunohistoquímicas, the expression "1 hormone receptors, c-kit, CD10, ki-67 and marctJdóres neuroendocrine. CONCLUSIONS: In the univariate analysis, age, status menopáusico, the antecedent of pathology staff prior oncology. (particularly breast cancer treated with tamoxifen), the tumor stage, the index -mitósico, progesterone receptor expression y. of CO10 relate in a significant way with the prognosis of the disease. Ki-67 is a prognostic factor for overall survival for disease-free survival at LMS. analysis multívariante, the antecedent staff prior cancer is associated with significantly disease-free survival. The expression of c-kit in uterine sarcomas is minimal or absent. CO10 expressed in all histological types of uterine sarcomas analyzed. The presence of component undifferentiated appearance neuroendocrine tumor occurs in a significant number of tumors mà ¼ llerianos mixed malignant.

Author: VILLASANTE MORÁN AMPARO.
Year: 2004.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: INSTITUTO VALENCIANO DE INFERTILIDAD EN MADRID.

Summary: BACKGROUND ovarian hyperstimulation syndrome (OHSS) is a phenomenon rare but potentially serious. It appears on half of the luteal phase and is usually secondary to treatment controlled ovarian hyperstimulation in patients who are going to bring assisted reproductive techniques. It has been described a significant increase in serum levels of endothelial growth factor (VEGF) vascular after administration of human chorionic gonadotropin (hCG) in patients with increased risk of developing OHSS. The VEGF affect vascular permeability in vitro because induces phosphorylation of tyrosine residues in the caderina vascular endothelial (VE), protein involved in the intercellular space of unions that control the permeability transmembrane. The phosphorylation of these proteins has been implicated in the modulation of cellular adhesividad. ASSUMPTIONS suggest that VEGF is half the increase in vascular permeability in patients who develop the SHO, in part through its action on caderina EV. Objectives To determine changes in the caderina EV following in vitro stimulation with estradiol, hCG and VEGF and observing the changes occurring at the permeability of cell cultures. To assess the systemic changes in the soluble fraction of the caderina EV in patients undergoing fertilization cycles in in vitro (IVF). METHOD Studying the increase in the secretion of soluble fraction of caderina EV on cell cultures in endothelial monolayer of human cord ubilical (HUVEC) after stimulation with increasing dose estradiol, VEGF hCG + hCG VEGF, VEGF + anti-VEGF. Check that the increase in the soluble fraction of the VE-Cadherina is not a result of the lysis or cell proliferation. Analyzing the morphological changes caused by the reorganization of the actin filament and its effect on the permeability of crops. A measure of the permeability of the monolayer by measuring the amount of albumin marked with fluroescencia facing the monolayer subjected to various stimuli. Measuring the changes in serum levels of soluble fraction of the caderina EV in patients undergoing IVF, comparing those symptoms hyperstimulation with a control group, and monitor these levels in patients who got pregnant. RESULTS demonstrated statistically significant stimulation with increased VEGF secretion caderina EV. This increase was blocked after addiction cultivation of a antibody anti-VEGF. It was found that doses which were capable of producing this increase was blocked after the addition to the cultivation of an antibody anti-VEGF. It was found that doses which were capable of producing these extra caderina EV did not cause or lysis or cell proliferation, as evidenced by staining with Blue Tripan and testing clorimétrico with MTT. After stimulation with VEGF and noted the reorganization of the actin filament and these changes may explain the increase in permeability functional described in the monolayer HUVEC. Compared to controls, the patients who developed severe OHSS earlier had serum caderina EV significantly higher. Instead, it has been demonstrated that the determination of caderina EV day puncture serve as prognostic value of early development of OHSS. CONCLUSIONS 1, VEGF-induced increase in the release of the soluble fraction of the caderina of vascular endothelium in vitro effect is enhanced when coupled with the encouragement of hCG. 2, - estradiol, which is considered a risk factor but not trigger the SHO, does not induce the release of caderina EV. 3, VEGF-induced 8 changes 665 in cell morphology and organization of actin filaments cell skeleton of the monolayer HUVEC. 4 - The VEGF induces a significant increase in the permeability of the monolayer HUVEC. 5, - Patients who develop the early severe OHSS has significantly increased serum values of the soluble fraction of the caderina EV. 6 - The release of the caderina EV correlates significantly with nivelas serum estradiol on the day of hCG administration. 7-These findings on the one hand partly explain the importance of caderina of vascular endothelium in the pathophysiology of hyperstimulation syndrome, but also can help develop new therapeutic strategies for hyperstimulation syndrome by blocking selective inhibitor of VEGF , or with antibodies anti-VEGF, or VEGF receptor antagonist if we come to a perfect understanding of the mechanisms that initiate and sustain the development of this disease.

Author: RAMOS CORPAS DOMINGO JESÚS.
Year: 2004.
University: SEVILLA [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE SEVILLA.

Summary: OBJECTIVE To assess the usefulness of the sonographic assessment of the presence / absence of the nasal bone in the first quarter in a population of pregnant women at low risk. DESIGN OF THE STUDY Prospective study of ultrasound marker "presence / absence of the nasal bone" in 1800 pregnant consecutive unselected, with complete tracking perinatal outcomes. RESULTS got a proper valuation ultrasound bone nose in 1682 (93.44%) pregnant. The nasal bone was assessed as absent in 19 (1.06%) from 1790 fetuses with normal karyotype and 2 (28.57%) of the 7 cases observed SD. The overall sensitivity to the absence of the nasal bone to SD in the first quarter was 28.57% (2 / 7), with a false positive rate of 1.13%. The positive predictive value of the nasal bone was absent for SD of 9.52% (2 / 21). The addition of the nasal bone assessment of the combined screening of the first quarter did not increase the rate of detection, but improved moderately rate of false positives. CONCLUSIONS populations low risk assessment of the presence / absence of the nasal bone at screening SD in the first quarter has a sensitivity much less than reprotada for high-risk pregnant, so its usefulness is questionable at screening population .

Author: SOLER RUIZ PATRICIA.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of preparation: HOSPITAL CLÍNICO SAN CARLOS.

Summary: The Down Syndrome is the most viable common chromosomal abnormality. Its incidence increases gradually to 35 years from here makes it very quickly. Until now offered conducting a amniocentésis from 35 years to all women for the detection of Down Syndrome. At present the discovery of the various biochemical markers and ultrasound provides us with the possibility of carrying out the population a screening test to select risk pregnancies. The emergence of specific biochemical markers of the first quarter (PAPP-Ay beta-HCG) with ultrasound markers in the same quarter (translucencia nucal) is presented as a more effective alternative (and more sensitive and more specific) that the biochemical screening of second quarter, which allows for before a diagnostic test and reduce anxiety and maternal mortality and morbidity and to the interruption of pregnancy if it took place. Furthermore, in view of the results obtained with the combined screening of the first quarter, which unites the maternal age biochemical and ultrasound data, we can conclude that is an alternative to the markers epidemiological and family history as risk factors for the realization of a test-invasive prenatal diagnosis.

Author: MENDOZA CRUZ CANDELARIO.
Year: 2004.
University: LA LAGUNA [www.ull.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Despite the known negative association of maternal smoking during pregnancy on linear growth and density in prepubertal bone mineralization, is not well known is happening with the development and fetal bone metabolism. Against this background the present work was designed to study the effect of maternal smoking during pregnancy on hormones that regulate bone metabolism fetal through a longitudinal study over the third trimester of pregnancy and the neonatal period, valuing fetal ultrasound parameters , anthropometric and neonatal bone markers in the serum of pregnant women and their infants. We raised check rejects or accepts the hypothesis nular of no difference in markers of bone formation (bone fraction of alkaline phosphatase and osteocaloina) and PTH levels and vitamin D metabolites in pregnant women and their infants on the basis of the maternal consumption of snuff during pregnancy, once controlled many variables that may affect fetal bone mineralization.

Author: PÉREZ BAZO ASCENSIÓN.
Year: 2004.
University: EXTREMADURA [www.unex.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACUTLAD DE MEDICINA.

Summary: INTRODUCCiÓN AND OBJECTIVES: Given the relationship observed in the medical literature between free radicals and cancer, as well as between estrogen metabolism and the production of free radicals, we intended to see the possible relationship between these radicals. Free and adenocarcinoma of the endometrium (JI), as well as the implications for the same cholesterol and fractions, triglycerides (TG) and hormonal parameters such as estradiol (E2), progesterone (PRG), testosterone (T) and prolactin (PRL). MATERIALS AND METHODS: This work on a sample of 75 patients in the study that was conducted blood total cholesterol (col-T) HDL-col, LDL-col, VLDL-col and TG, as well as E2, PRG, TY LRP. In the same way to all of them were performed with an endometrial biopsy reading double-blind anatomopatológica and determination in endometrium of malondialdehyde (MDA) and catalase (CAT) activity, as representatives of oxidative stress endometrium. Patients were classified according to the study anatomopatológíco in endometrios proliferative (PD): 22, endometrios secretory (S): 15, without atipías hyperplasia (HSA): 18, hiper'plasías with atípias (HCA): 5 and AC: 15, according to the SIPG (International Society of Pathologists Gynecologists). The data were processed with statistical program STATISTICA version 6. RESULTS: The average age of all patients was 46.01 years (range 25-77), with older patients with HCA and AC (p = 0, OOOOO03). E2 And PRG had the lowest in groups with HCA and AC p = 0.00002 and p = O OOO1respectivamente, while the Ty PRL showed no significant differences between the study groups. The col-Ty HDL-col presented concentrations lower in the groups HCA and CA with p = 0, O193 and p = 0, OOOO9respectivamente while LDL-col, VLDL-col and TG no differences significativas-entre groups studied . The MDA showed lower concentrations in HCA and AC (p = O OOO3), the opposite happened with the CAT, whose highest figures were obtained in the group of AC (p = O OOOOO1). These do:> last parameters made us divide the sample into dos-grupos, a benign that grouped EP, AND IS HSA, and other malignant qua included HCA and CA, whose behavior in the study of multiple regression were different depending on the group of benign or malignant. The discriminant analysis showed that the CAT difference reasonably well the benign group of malignant, with a discriminating power of 70%. CONCLUSIONS: 1. Both physiological states endometrial as pathological, they have a clear impact on the concentrations of MDA and endometrial CAT. In endometrios physiologic or benign, there is a regulation of oxidative balance by the plasma concentrations of E2 PRG, T, col-Ty HDL-col. In éndometrios pathological, this regulation is lost. 2. This loss of correlation in endometrios evil, we believe that the result is the degree of autonomy they purchase tumor tissues malígnos and that can help them in their promotion and progression. 3. There is a clear correlation between the number of HDL-col and col-T regard to the state endometrial, with endometrios malignancy, which have a lower plasma concentration. - This finding needs to be carefully assessed by further studies. 4. The values of MDA and CAT allow differentiation with the situation quite reliability of malignancy or benign, but do not provide benefits diagnostic or prognostic possibly on histological techniques with 8 venciona 196 them.

Author: SANCHEZ FERRER MARIA LUISA.
Year: 2004.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: New contributions in the study of embryology of the vagina: Objective: desmostrar experimental hypothesis on the origin embriologico the vagina human proposed by Acién (1992-2004) deduced from patients with malformations genito-urinarias, especially patients with renal agenesis ipsilateral blind sided and vagina. This hypothesis states that the vagina as a whole comes from the merger of the channels wolffianos with the participation of the tuber of Muller and explains the cause of all malformations embryological described. Materials and methods: 25 pregnant rats sacrificed to analyze embryos female (250) between days 15 postcoitum (stadium indifferent) and 21 postcoitum (vagina fully formed). We applied immunohistochemical markers (GZ1 and GZ 20) éspedíficos of Wolff. Also four adult rats were used to check the persistent Wolff in the vagina of the adult rat. Results: Muller pipelines converge to put together into a single tube, but they are separated distalmente diverge and blending with the bulbs breast uroginital, that are really wolffianos because it is marked with antibodies specifically targeted pipelines Wolff, left the center an islet tissue mesenquimatoso: the tuber Muller of the most interesting highlight is the positivity to marking with the antibody segment of the breast remains between the two bulbs breast. This segment corresponds to the space between the mouth of the ureter and the ducts of Wolff, whom we called patch Wolffiano, product certainly stretch of growth space between Wolff and his bud ureteral. In implementing the scoreboard GZ1 and GZ 20 produces a marking in the vagina of adult rats, demonstrating their nature wolffiana (although undergo a process of cavitation of the tuber Muller, so that their cells be tapizando internally vagina). Conclusions: verify participation tuber of Muller and channels of Wolff in the formation of the vagina and how the portion of the breast between the ink Wolff and ureter are nature wolffiana. Therefore, we have shown that the hypothesis Acién on the embryology of the vagina is correct and therefore the classification clínico-embriológica of genitourinary malformations of Acién, P Acién My Sanchez Ferrer M proposal should be as widely used as it allows justify embriológicamente all malformations genito-urinarias, including more complex.

Author: LAFUENTE GONZALEZ PILAR.
Year: 2004.
University: REY JUAN CARLOS [www.urjc.es].
Place of defense: FACULTAD DE CIENCIAS DE LA SALUD.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD.

Summary: The cell proliferation is an important prognostic factor in breast cancer. The study of the cellular fraction phase synthesis by flow cytometry is a method already in place to quantify the activity prollferativa of mammary tumors. In the case of breast tumors containing dna aneuploide, there is still no clear rule on what stage s is the most important, if for the people diploid, the aneuploide, or an average of the two. / We have studied 280 carcinomas of the breast untreated patients prior to surgery. The flow cytometry for the study of cell cycle was performed on tumor tissue frescoi'v1ientrasque immunohistochemistry for determining the status of hormone receptors, expressing ki67, c-erb-b2 and p53, was conducted on cuts tissue parafinado. The factor of proliferation ki67 was evaluated in 277 cases, while the rate of dna was evaluated in 275 of 280 tumors analyzed. Of the latter, 151 were diploid, while the 124 remaining were aneuploids. The percentage of cells in phase synthesis could be determined in 273 cases. In aneuploids tumors, it was determined tant.ola phase synthesis for the diploid population, as the aneuploide. We calculated the 75 percentile for each of the phases was used as a lintel sy to discriminate against tumors with low or high stage s. Phase s high in diploid tumors was correlated directly and meaningfully with high histologic grade (p = 0.04), high nuclear grade (p = 0.01), tumor size (p = 0.0008), and inversely with the expression estrogen receptor (p menor0.0001) and progesterone (P less 0.0001). In tumors aneuploids, s-phase fraction aneuploide showed a direct and significant correlation with high histological grade (p = 0.005), high nuclear grade (p = 0.001), the expression of p53 mutation (p = 0.0009) and reverse - with the expression of estrogen receptors (p less o.00o1) and progesterone (P = 0.oo01). however, the s-phase fraction of diploid tumors aneuploids showed no correlation with any of the parameters analyzed . As a main conclusion, we emphasize that aneuploids breast tumors, the S phase of the subpopulation aneuploide is the only relevant biological lack thereof s phase of the subpopulation diploid.

Author: VALLADOLID URDANGARAY AMELIA.
Year: 2004.
University: PAÍS VASCO [www.ehu.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGÍA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGÍA.

Summary: A high concentration of plasma homocysteine is a risk factor paralos neural tube defects, abortion repetition and detachment of the placenta. Outside the field perinatal is related to vascular problems, especially atherosclerosis and thrombosis. The pharmacological doses of folate, reduces plasma homocysteine. This study was designed to compare the effect of the oral intake of folic acid, folic acid levofolínico and more vitamin B12 on plasma homocysteine in young women of reproductive age. It is a randomized and controlled study, conducted with 60 healthy women, not pregnant, aged between 18 and 40 years. The women were randomly selected to receive for 30 days one of the following treatments: 5 mg / day of folic acid (n = 20), 5 mg / day of acid levofolínico (n = 20) or 400 ug of folic acid more 2 ug of vitamin B12 (n = 20). All patients continued with their usual diet. We determinations blood plasma homocysteine, folate and serum folate intraeritrocitarios on days 0 (before starting treatment), +2, +5, +10, +30, +60 and +90. The plasma homocysteine was determined by fluorescence polarization immunoassay, while the serum folate and intraeritrocitarios identified through chemo luminescence immunoassay. For the statistical study used the Kolmogorov test, Student's t, ANOVA and Bonferroni. The results suggest that supplementation with 5 mg / day of acid levofolínico induce a more rapid decline and intense of the total plasma homocysteine that the same dose of folic acid or folic acid partnership more vitamin B12. This difference is significant since the fifth day of tratmiento. Furthermore, the duration of effect is higher than for other compounds analyzed, keeping homocysteine levels below baseline to 30 and 60 days of the treatment. This allows us to raise the hypothesis that women who are taking folate preconcepcionalmente, the establishment of therapeutic rest periods of one month, would not reduce its effectiveness defensive. This scenario would only be valid for acid levofolinico which is the only preparation that keeps folates intraeritrocitarios elevated to the 30 days of the treatment.

Author: LÓPEZ MADURGA EVA T..
Year: 2004.
University: ZARAGOZA [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The main objective of this study is to analyze the clinical practice of Caesarean sections in the Community of Madrid. The specific objectives are: to describe the distribution of risk obstetric and other factors related to the practice of childbirth care at the global level of the CA Madrid and in different hospitals; describe the variability in the rate of Caesarean sections according to different factors risk overall level of CA Madrid and in different hospitals; estimating models that identify and quantify the source of variation between hospitals, and to describe and quantify the association between the risk of having a cesarean factors both clinical and non - clinical. A cross-sectional study was conducted through retrospective analysis of births registered in the Madrid region during the year 2001. Data were obtained from three sources of information: The registration or Minimum Basic Data Set (CMBD) High Ambulatory Surgery Hospital and the Community of Madrid, which offers individualized data for each delivery, primarily risk obstetric and age the mother. Or catalog Hospital de la Comunidad de Madrid, which provides the main hospital characteristics, in terms of dependency, or size, among others. The typology or Municipal de la Comunidad de Madrid published in November 2000, produced by the Statistical Institute of the Community of Madrid. It offers a socioeconomic classification of municipalities in the community. They relate these three sources of information, so that is assigned to each delivery recorded in the CMBD, characteristics of the hospital where he attends, and the municipality where lies the woman who gives birth. It carries out a logistic regression analysis mulitnivel (two levels: level 1: women; Level 2: hospital) and measures clustering and variance used the odds Medium (MOR) and the interval of Odds Ratio (IOR). The main findings and conclusions are that: - The average number of diagnostic and procedural codes per case is higher in public hospitals than in private. The rate of any of the hospitals in the Madrid region is higher than the standard recommended by the WHO, with a range between 15.7% and 46.15%. The rate of cesarean section in public hospitals is 20.63% and in the private 32.38. In each of the public hospitals, the percentage that each hospital provides to all births is higher than that contributes to the total Caesarean sections, whereas in the case of private hospitals opposite is true. The four-diagnostics classics (the breech position, dystocia, fetal distress, after caesarean), represent nearly 70% of the indications for cesarean section. - The pattern of risk is addressed in public and private hospitals of the Community of Madrid, is not homogeneous: public hospitals cater to younger women and they are diagnosed more breech presentations, fetal distress, and other diagnoses after caesarean possible causes of caesarean sections. - The likelihood of caesarean section to be present any of the conditions studied obstetric (buttocks, dystocia, fetal distress, previous caesarean section, a multiple birth) is not constant, but depends on the hospital. In fact some hospitals always perform a cesarean once diagnosed one of these factors. In any of these diagnostic probability cesarean average is lower in public hospitals - the characteristics of the hospitals that have been considered, only the type of hospital (public-private), has had an important role to explain the variability among hospitals. - The likelihood of caesarean section in women older than 34 years is a 31% (CI 1.23-1.39) higher than the lowest of 20 years, regardless of their risk obstetric and go to the hospital. - The likelihood of having a cesarean section in a private hospital is 2 8, 07 (CI 397 1.32-3.25) times higher than in a public even after adjusting for risk obstetrics. There residual variability in the probability of carrying out a caesarean section, not explained by the characteristics of women, nor by the fact go to a public hospital or private.