Made available in DSpace on 2014-06-11T19:30:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-06-20Bitstream added on 2014-06-13T20:20:53Z : No. of bitstreams: 1 curcelli_ec_dr_botfm.pdf: 2108875 bytes, checksum: c4aa12d19e13e38271b7b6d4e3d75acf (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Em 69 pacientes com diagnóstico de osteossarcoma ósseo, primário e secundário, submetidos a tratamento no Hospital das Clínicas da Faculdade de Medicina de Botucatu, Unesp (Botucatu - SP) e no Hospital Amaral Carvalho (Jaú - SP), no período de 1990 a 2004, foi verificada a possível associação entre prognóstico e fatores clínicos, epidemiológicos, histopatológicos e imuno-histoquímicos.Os pacientes foram submetidos a diferentes protocolos de tratamento e, na maioria das peças de ressecção tumoral, procedeu-se à quantificação do efeito quimioterápico neo-adjuvante de acordo com os critérios preconizados por Huvos (1991). Os dados foram coletados dos prontuários hospitalares e nas amostras da biópsia óssea, realizada prétratamento, foi verificada a ocorrência de apoptose e da expressão da proteína p53, pelo método imuno-histoquímico (Tunel e ABC).Os resultados foram submetidos à análise univariada de sobrevida com construção de curvas de Kaplan-Meier.As associações entre procedimento cirúrgico e grau de necrose e, entre recidiva e grau de necrose, foram analisadas pelo Teste de Goodman (Goodman, 1964,1965).Foi constatado que as variáveis, idade, sexo, classificação histológica e localização do tumor, não apresentaram associação com prognóstico; pacientes com tumores estádio III apresentam pior prognóstico.Abandono de tratamento está associado a pior prognóstico e relacionado à evolução clínica insatisfatória; cirurgia de amputação foi indicador indireto de mau prognóstico, pois foi realizada em pacientes com tumores avançados ou que não responderam ao tratamento quimioterápico neo-adjuvante; complicações, sobretudo recidiva local, estão relacionadas a mau prognóstico e necrose pós-quimioterapia apresentou associação significativa com sobrevida.Houve ocorrência de... / A possible association between prognosis and clinical, epidemiological, histopathological, and immunohistochemical factors was evaluated in 69 patients with confirmed diagnosis of primary and secondary bone osteosarcoma treated in the University Hospital of Botucatu Medical School, School of Medicine University Hospital, Unesp (Botucatu, SP, Brazil) and in Amaral Carvalho Hospital (Jaú, SP, Brazil), from 1990 to 2004. Patients were treated by differents treatment protocols and in the majority of resected tumour samples the effects of neoadjuvant chemotherapy were analyzed using Huvos criteria (1991). Data were collected from medical records and in pretreatment bone biopsies, apoptosis and p53 protein expression were evaluated by immunohistochemistry (Tunel and ABC). The results were submitted to univariantate analysis and global survival analyzed by Kaplan-Meier survival curves. Association between surgical procedure and necrosislevel or relapse was tested using Goodman test for differences between and in multinomial populations (Goodman, 1964, 1965). No association was found between prognosis and age, gender, tissue predominance and tumour location; patients with stage III tumours presented worse prognosis. Treatment whitdrawal implied in worse prognosis, as a consequence of unsatisfactory clinical evolution; amputation was an indirected factor of bad prognosis as a possible consequence of its indication for patients with advanced tumours or for those without response to neoadjuvant chemotherapy. Complications, especially local relapse, were related to bad prognosis; while post chemotherapy necrosis had a statistically significant association with survival. There was apoptosis and mutant protein p53 expression that initial phases of osteosarcoma, but without any association with prognosis.

Orientador: Heitor Jose Rizzardo Ulson / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-03T06:53:08Z (GMT). No. of bitstreams: 1 Folberg_CelsoRicardo_M.pdf: 711266 bytes, checksum: 6a66484119abec857cdc67fdf03e478e (MD5) Previous issue date: 2002 / Resumo: O autor apresenta um estudo anatômico-histológico do Ramo Superficial do Nervo Radial (RSNR) no terço distal do antebraço e punho através de dissecções anatômicas em vinte e três cadáveres humanos. O ponto de emergência do RSNR entre os tendões do braquiorradial e extensor radial longo do carpo foi encontrado, em média, a 8,65cm da apófise estilóide do rádio (AER). Em seis casos (26%) foi identificado um tendão acessório do braquiorradial, com RSNR emergindo entre este e o tendão principal. A primeira ramificação teve origem, em média, a 4,58cm da AER. Em 30% dos casos notou-se a presença de um ramo cruzando o punho diretamente sobre a AER. A média de ramos cruzando o punho à altura da AER foi de 3,4. Cortes histológicos do nervo e suas ramificações cruzando o punho à altura da AER foram realizados em vinte dissecções para a contagem do número de fascículos. O número médio de fascículos do RSNR no seu ponto de emergência foi de 6,6. Na sua primeira ramificação, observou-se a média de 4 fascículos. A literatura disponível parece não indicar relato semelhante, o qual pode nos auxiliar nos casos de uso do RSNR para enxerto de nervo. Os achados anatômicos apresentam resultados semelhantes aos da literatura específica sobre o tema. Estes achados vêm a somar para um melhor conhecimento do RSNR e reforçam a necessidade de extremo cuidado em procedimentos cirúrgicos no terço distal do antebraço e punho, principalmente nos procedimentos percutâneos / Abstract: The author presents a study on the morphology of the Superficial Branch of the Radial Nerve (SBRN), at the distal one-third of the forearm and wrist. Anatomical dissections were performed on the upper limbs of twenty-three cadaver specimens. The SBRN emerged between the brachioradialis (BR) and extensor carpi radialis longus (ECRL) tendons, at an average distance of 8.65cm proximal to radial styloid apophysis (RSA). In six cases (26%) there was an acessory tendon of the BR, and the SBRN emerged between that point and the main BR tendon. The first branch of the SBRN arose at an average of 4.58cm proximal to the RSA. A branch, running directly across the RSA, was found in 30% of the cases. At the level of the RSA, the average number of branches crossing the wrist was 3.4. A fascicle count was peformed in twenty anatomical dissections of the nerve and its branches crossing the wrist at the level of the RSA. There was an average of 6.6 fascicles in the SBRN, at its point of entry between the tendons of the BR and of the ECRL. The first branch of the SBRN at the level of the RSA, had an average number of 4 fascicles. There are no similar histological studies in the literature available and thus, the results may be of help when using the SBRN for nerve grafting. The results of the anatomical findings of this study are very similar to those in the literature. The findings in the present study can contribute to a better knowledge of the SBRN, as required during such surgical procedures as the percutaneous bone fixation of the distal one-third of the forearm and of the wrist / Mestrado / Cirurgia / Mestre em Cirurgia

Introducción El arco longitudinal interno (ALI) del pie es responsable de la absorción de impactos y transmisión de fuerzas. Cambios en su altura se relacionan con la aparición de diversas alteraciones y patologías. Un pie plano puede facilitar la presencia de puntos gatillo miofasciales. Objetivos Conocer, tanto en sujetos con y sin disminución en la altura del ALI, la correlación entre el test de caída del escafoides (TCE) y el ángulo de Clarke (AC) , el índice de Staheli (IS) y el índice de Chippaux-Smirnak (ICS); estimar la prevalencia de los puntos gatillo latentes (PGLs) en sujetos sanos en diversos músculos de la extremidad inferior; y conocer la prevalencia de los PGLs en diversos músculos de la extremidad inferior en sujetos con un descenso en la altura del ALI comparados con individuos con una altura normal del ALI. Metodología Se han realizado cuatro estudios. El Estudio 1 estudió la correlación entre el TCE y el AC, el IS y el ICS, y su fiabilidad, en 86 sujetos. El Estudio 2 evaluó la correlación entre el TCE y el AC, el IS y el ICS y el Foot Posture Index-6 (FPI-6), y su fiabilidad, en 71 individuos con el pie plano. El Estudio 3 estudió la prevalencia de PGLs en diversos músculos del miembro inferior, la fiabilidad y prevalencia de los criterios diagnósticos, en 206 sujetos sanos. El Estudio 4 comparó la prevalencia de PGLs en sujetos que presentaban un descenso en la altura del ALI (n=82) comparado con controles (n=82), la fiabilidad y prevalencia de los criterios diagnósticos. Resultados Los Estudios 1 y 2 mostraron unos niveles de correlación fuerte entre el TCE y el AC, IS e ICS, siendo mayor en el Estudio 2 (r=|0,722-0,788|) que en el Estudio 1 (r=|0,614-0,643|). La fiabilidad fue buena o muy buena. En el Estudio 2 se encontró una correlación fuerte entre el TCE y el FPI-6 (r=0,800). El 77,670% de la muestra del Estudio 3 presentaba uno o más PGLs (media=7,484±7,648), con mayor prevalencia en los gastrocnemios. Los criterios diagnósticos más prevalentes y fiables fueron la presencia de banda tensa y el foco hiperirritable. En el Estudio 4 se demostró que los sujetos con un pie plano presentaban un mayor número de PGLs (media=4,463±4,077) que los controles (media=3,317±3.243) (p<0,05). Además, la prevalencia fue mayor (p<0,05) en los PGLs localizados en el flexor común de los dedos, tibial anterior y vasto medial. Conclusiones El TCE presenta una fuerte correlación con el AC, el IS y el ICS, tanto en sujetos con o sin el ALI disminuido, presentando una fiabilidad muy buena. Los PGLs en la musculatura de la extremidad inferior son prevalentes en sujetos sin lesión. Los sujetos con un pie plano presentan una mayor prevalencia de PGLs en la extremidad inferior que los controles. La fiabilidad en el diagnóstico de los PGLs es muy buena, siendo la presencia de banda tensa y el foco hiperirritable los criterios más fiables y prevalentes. / ABSTRACT Background The medial longitudinal arch (MLA) of the foot is responsible for shock absorptions and forces transmission. Changes in its height are related to several changes and pathologies. In fact, it is considered that a flat foot may facilitate the presence of myofascial trigger points. Aims The main aims of the present study were to find out about the correlation between the navicular drop test (NDT) and the Clarke angle (AC), the Staheli index (SI) and the Chippaux-Smirnak index (CSI) in subjects with normal and lower medial longitudinal arch; to evaluate the prevalence of latent trigger points (LTrPs) in non-injured subjects in different lower limb muscles; and to evaluate the prevalence of latent myofascial trigger points in several muscles of the lower limb in subjects with a lower MLA compared with controls with a normal MLA. Methods Four researches have been undertaken. Study 1 evaluated the correlation between the NDT and the CA, the SI and the CSI, as well as its reliability in a sample of 86 subjects. Study 2 evaluated the correlation between the NDT and the CA, the SI and the CSI and the Foot Posture Index-6 (FPI-6), and its reliability in a sample of 71 flat foot subjects. Study 3 evaluated the LTrPs prevalence in different lower limb muscles, as well as the reliability and prevalence of the diagnostic criteria in a sample of 206 non-injured subjects. Study 4 compared the LTrPs prevalence between lower MLA (n=82) and normal MLA subjects (n=82), as well as the reliability and prevalence of the diagnostic criteria. Results Studies 1 and 2 showed strong correlations between the NDT and the CA, the SI and the CSI. The stronger correlation was found in the Study 2 (r=|0,722-0,788|) versus the Study 1 (r=|0,614-0,643|). The reliability of the test was very high in both studies. A strong correlation was also found between the NDT and the FPI-6 (r=0,800) in Study 2. Study 3 showed a 77,670 % of the studied sample with at least one of the LTrPs (mean=7,484±7,648), being the gastrocnemius LTrPs the most prevalent. The most prevalent and reliable diagnosis criteria were the presence of a taut band and a spot tender. Study 4 showed that MLA group presented significantly (p<0,05) more LTrPs (mean=4,463+-4,077) than the control group (mean=3,317+-3,243). The prevalence of LTrPs (p<0,05) in flexor digitorum longus, tibialis anterior and vastus medialis in the MLA group was also higher versus the control group. Conclusions The NDT showed a strong correlation with the NDT and the CA, the SI and the CSI both in lower and normal MLA subjects, also showing a very good reliability. The LTrPs of the lower limb muscles are more prevalent in non-injured subjects. MLA subjects showed a greater prevalence of LTrPs versus controls in the lower limb. The realiability for the LTrPs diagnostic is very good, being the presence of taut band and the tender spot the most reliable and prevalent criteria.

Justificación: La cirugía bimanual (MICS) de la catarata tiene como características básicas la separación de funciones y el concepto de mínima agresión. Se explican las claves para la transición quirúrgica desde la técnica coaxial convencional. Metodología: Estudio prospectivo y comparativo de 222 procedimientos quirúrgicos con un año de seguimiento. Para cada una de las técnicas se seleccionaron diferentes grupos, tal como se especifica: 3 grupos de cirugía coaxial, con incisiones de 3.2, 2.8 y 2.4 mm, con sus respectivos ajustes de fluídica y software; y 3 grupos bimanuales con incisiones de 1.8, 1.7 y 0.7 mm, también con sus ajustes específicos. Se registraron las complicaciones quirúrgicas y se cuantificó su impacto. Resultados: Se objetivó un aumento significativo del grosor macular entre los días 30 y 90, únicamente en el grupo coaxial que no disponía de programa modulador de ultrasonidos. La pérdida endotelial fue inferior en los grupos bimanuales que en los coaxiales, con una diferencia estadísticamente significativa que se mantuvo durante el seguimiento, tanto a corto como a largo plazo, lo que confirma la técnica MICS como la más segura. La explicación para el mejor comportamiento de los grupos bimanuales es que la técnica MICS libera significativamente menos energía (EPT) que la técnica coaxial. En concordancia con este resultado, se demostró que existe una correlación entre la energía liberada y la pérdida endotelial. No se observó, en cambio, correlación de pérdida endotelial ni con el volumen de suero fisiológico utilizado ni con el tiempo quirúrgico. El astigmatismo inducido también es menor con la técnica MICS, con una diferencia estadísticamente significativa con todos los grupos coaxiales, en los que la disminución del tamaño de la incisión no redujo el astigmatismo inducido de forma significativa. Conclusión: La técnica MICS es más segura y precisa que la técnica coaxial habitual, y produce menos iatrogenia. / Rationale: Bimanual cataract surgery (MICS) covers basic features like the separation of functions and the concept of minimal aggression. The keys for surgical transition are explained from the conventional coaxial technique. Methods: Prospective and comparative, cohort-based study of 222 cataract surgery-procedures that were monitored and followed during one year. Every technique, either coaxial or bimanual, was subdivided into 3 groups as follows: coaxial, with incisions of 3.2, 2.8 and 2.4 mm, performed with their fluidic settings and software; and bimanual, with incisions of 1.8, 1.7 and 0.7 mm, with their specific settings as well. Surgical complications were registered, and their impact, measured. Results: Between days 30 and 90, a significant increase in macular thickness was observed only in the coaxial group that did not have modulator ultrasound program available. Endothelial cell loss was lower in the 3 bimanual groups than in the coaxial groups. That difference remained significant for both short- and long-term follow-up, being, therefore, MICS the safest technique. The explanation for the better performance of the bimanual groups is that the bimanual technique releases significantly less energy (EPT) than the coaxial technique. Accordingly, a correlation was proved between the energy liberated and the endothelial cell loss. On the other hand, the endothelial cell loss was neither related to the amount of saline serum used, nor to the duration of the intervention (surgical time). The induced astigmatism was also significantly lower with MICS than with coaxial technique. Despite reducing the incision size in the coaxial technique, there was not found a significant decrease of the induced astigmatism. Conclusions: MICS technique is safer, more precise and less iatrogenic than standard coaxial technique.

Made available in DSpace on 2019-04-05T23:06:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-07-29 / The aim of this study was to determine the social , physical, endocrine, metabolic and orthopaedic profile of young women with PFPS comparing it to young women without SDPF, and identify the possible factors associated with PFPS. From social habits, practice of physical activity, personal and family history of risk of metabolic illnesses, antropométric and orthopaedic parameters, and corporal composition. A quantitative study using transverse analisis was conductede at the Nucleo de Atendimento Médico Integrado (NAMI), and the Biometry Laboratory of the Centro de Ciências da Saúde (CCS) of the University of Fortaleza (UNIFOR). Fifty female volunteers with PFPS and 37 without PFPS were selected. The collection of data was performed by anamnese and physical examination and the corporal composition for bioimpedance was evalueted. There were no diferences seen in the two groups relating to social habits ( wearing higt heeled shoes, climbing stairs, phisical activities and spending long periods of time sitting in hip-adducted position) , antropometric parameters (weight, stature, IMC, measures of abdominal and pelvic waist measurements), orthopaedic parameters (angular or rotational shunting lines of the inferior members, loosening of soft tissues, alterations to the architecture of the feet) or corporal composition (percentile of fat and lean mass). However, there were differences in their history of obesidy, pratice of regular physical activity in their infancy and family history of obesity and diabetes mellitus. The social , physical, endocrine, metabolic and orthopaedic profile of young women with PFPS was shown to be very similar to that of young women without PFPS. The association of SDPF with personal antecedents and family history of obesity and diabetes mellitus may suggest a relationship of PFPS with determinative relating to genetic metabolic syndrome. That would establish a greater susceptibility to this syndrome. Additional prospectives studies will be neeed to clarify the role these and other factors as determinative of PFPS. / Verificar o perfil sócio-esportivo, endócrino-metabólico e ortopédico de mulheres jovens portadoras de síndrome da dor patelofemoral (SDPF) comparando-o com o de mulheres jovens sem SDPF, buscando identificar possíveis fatores associados a SDPF dentre hábitos sociais, prática de atividade física, antecedentes pessoais e familiares de risco para doenças metabólicas; parâmetros antropométricos e ortopédicos, e composição corporal. Estudo de abordagem quantitativa, analítico transversal, conduzido no Ambulatório de Ortopedia do Núcleo de Atendimento Médico Integrado (NAMI), e no Laboratório de Biometria do Centro de Ciências da saúde (CCS) da Universidade de Fortaleza (UNIFOR). Foram selecionadas aleatoriamente 50 voluntárias do sexo feminino com SDPF com 21,0±3,2 anos de idade e 37 sem SDPF, com 22,0±4,4 anos, alunas regulares do CCS-UNIFOR. A coleta de dados foi realizada através de anamnese e exame físico direcionados e avaliação de composição corporal por bioimpedanciometria. Nenhum dos fatores estudados relacionados a: hábitos sociais como o uso de salto, o costume de passar longos períodos sentada, o hábito de subir escadas, prática de atividade física como musculação , esportes e aulas de ginástica, parâmetros antropométricos (peso, estatura, IMC, medidas de cintura abdominal e pélvica), parâmetros ortopédicos (desvios angulares ou rotacionais dos membros inferiores, flacidez ligamentar, alterações da arquitetura dos pés) e composição corporal (percentual de gordura e massa magra) se mostrou diferente entre os grupos de participantes com e sem SDPF. Houve contudo diferença entre os grupos quanto a presença de história de obesidade no passado, de prática de atividade física regular na infância e historia familiar de obesidade e de diabetes mellitus. O perfil sócio-esportivo, endocrino-metabólico e ortopédico de mulheres jovens portadoras da SDPF se mostrou bastante semelhante ao de mulheres jovens sem SDPF. A associação da SDPF com antecedentes pessoais e história familiar de obesidade e história familiar de diabetes mellitus pode talvez sugerir uma relação da SDPF com determinantes genéticos relacionados a síndrome metabólica, que estabeleceriam uma maior susceptibilidade a essa síndrome. Estudos adicionais prospectivos poderão trazer melhores esclarecimentos quanto ao papel desses e de outros fatores como determinantes da SDPF.

Resumo: Em 69 pacientes com diagnóstico de osteossarcoma ósseo, primário e secundário, submetidos a tratamento no Hospital das Clínicas da Faculdade de Medicina de Botucatu, Unesp (Botucatu - SP) e no Hospital Amaral Carvalho (Jaú - SP), no período de 1990 a 2004, foi verificada a possível associação entre prognóstico e fatores clínicos, epidemiológicos, histopatológicos e imuno-histoquímicos.Os pacientes foram submetidos a diferentes protocolos de tratamento e, na maioria das peças de ressecção tumoral, procedeu-se à quantificação do efeito quimioterápico neo-adjuvante de acordo com os critérios preconizados por Huvos (1991). Os dados foram coletados dos prontuários hospitalares e nas amostras da biópsia óssea, realizada prétratamento, foi verificada a ocorrência de apoptose e da expressão da proteína p53, pelo método imuno-histoquímico (Tunel e ABC).Os resultados foram submetidos à análise univariada de sobrevida com construção de curvas de Kaplan-Meier.As associações entre procedimento cirúrgico e grau de necrose e, entre recidiva e grau de necrose, foram analisadas pelo Teste de Goodman (Goodman, 1964,1965).Foi constatado que as variáveis, idade, sexo, classificação histológica e localização do tumor, não apresentaram associação com prognóstico; pacientes com tumores estádio III apresentam pior prognóstico.Abandono de tratamento está associado a pior prognóstico e relacionado à evolução clínica insatisfatória; cirurgia de amputação foi indicador indireto de mau prognóstico, pois foi realizada em pacientes com tumores avançados ou que não responderam ao tratamento quimioterápico neo-adjuvante; complicações, sobretudo recidiva local, estão relacionadas a mau prognóstico e necrose pós-quimioterapia apresentou associação significativa com sobrevida.Houve ocorrência de ...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: A possible association between prognosis and clinical, epidemiological, histopathological, and immunohistochemical factors was evaluated in 69 patients with confirmed diagnosis of primary and secondary bone osteosarcoma treated in the University Hospital of Botucatu Medical School, School of Medicine University Hospital, Unesp (Botucatu, SP, Brazil) and in Amaral Carvalho Hospital (Jaú, SP, Brazil), from 1990 to 2004. Patients were treated by differents treatment protocols and in the majority of resected tumour samples the effects of neoadjuvant chemotherapy were analyzed using Huvos criteria (1991). Data were collected from medical records and in pretreatment bone biopsies, apoptosis and p53 protein expression were evaluated by immunohistochemistry (Tunel and ABC). The results were submitted to univariantate analysis and global survival analyzed by Kaplan-Meier survival curves. Association between surgical procedure and necrosislevel or relapse was tested using Goodman test for differences between and in multinomial populations (Goodman, 1964, 1965). No association was found between prognosis and age, gender, tissue predominance and tumour location; patients with stage III tumours presented worse prognosis. Treatment whitdrawal implied in worse prognosis, as a consequence of unsatisfactory clinical evolution; amputation was an indirected factor of bad prognosis as a possible consequence of its indication for patients with advanced tumours or for those without response to neoadjuvant chemotherapy. Complications, especially local relapse, were related to bad prognosis; while post chemotherapy necrosis had a statistically significant association with survival. There was apoptosis and mutant protein p53 expression that initial phases of osteosarcoma, but without any association with prognosis. / Orientador: Sérgio Swain Müller / Coorientador: Anete Kinumi Ueda / Banca: Ademar Lopes / Banca: Odair Carlito Michelin / Banca: Hamilton da Rosa Pereira / Banca: Mauricio Etchebehere / Doutor

Orientador: Ana Liz Garcia Alves / Banca: Luiz Carlos Vulcano / Banca: Vania Maria Vasconcelos Machado / Banca: Stefano Carlo Filippo Hagen / Banca: Debora Aparecida Pires de Campos Zuccari / Resumo: Este estudo teve por objetivo analisar os efeitos da aplicação de ondas de choque extracorpóreas na placa epifisária proximal da tíbia em coelhos. Foram utilizados 10 coelhos jovens, submetidos a três aplicações de 1500 pulsos de ondas de choque,com intervalo de duas semanas, sobre a epífise proximal da tíbia direita, padronizando a esquerda como controle. As avaliações foram feitas por meio de radiografias, para verificar as alterações na densitometria óptica óssea. Ao final do experimento foi feita a absorciometria de energia dupla de Raios-x (DXA) e eutanásia para a colheita de material para histopatologia e imuno-histoquímica para TGF- , possibilitando a comparação entre os membros tratados e os membros controle. As ondas de choque extracorpóreas causaram um aumento na espessura da placa de crescimento epifisária, tanto na espessura total, quanto na espessura das zonas proliferativa e hipertrófica, uma diminuição do comprimento das tíbias tratadas, em relação ao controle, e o aumento de densidade mineral óssea, ao utilizar a avaliação por meio da densitometria óptica em imagem radiográfica. / Abstract: The aim of this study was to evaluate the effects of the extracorporeal shock wave therapy on the tibial proximal epiphyseal growth plate in young rabbits. Ten rabbits were submitted to extracorporeal shock wave therapy in the right tibial proximal epiphyseal growth plate, three treatments, with interval of two weeks. The left hind limb was untreated as control. The evaluations were done through x-rays and optical densitometry, and at the end of the study dual energy x-ray absorptiometry evaluation, histopathology and immunohistochemistry evaluation for TGF- were done. Extracorporeal shock wave therapy caused increased height of the epyphiseal growth plate, reduction on tibial total length and increased bone mineral density evaluated through optcal radiographic densitometry in mmAl. / Doutor

Objetivo: explorar las limitaciones en la calidad de vida derivadas del padecimiento de cataratas y determinar el nivel de calidad de vida relacionada con la visión (CVRSV), la agudeza visual (AV), las utilidades en salud y la efectividad de la facoemulsificación en estos pacientes. Metodología: Se han combinado la investigación cualitativa y la epidemiológica. En esta última se ha empleado un diseño preexperimetal pre-post cirugía en una población de 201 pacientes intervenidos de cataratas. Para determinar la CVRSV del paciente se ha empleado el cuestionario VFQ25+14. Resultados: La facoemulsificación de la catarata tiene una utilidad media de 0,36. Con ella mejoran, en relación con la situación basal, tanto la AV (79,8%±7,3), como la CVRSV global (69,1%±6,1), especialmente en pacientes sin retinopatía, con catarata subcapsular predominante y con una mayor agudeza visual basal. Conclusiones: la facoemulsificación es una técnica valorada por el paciente y eficaz para mejorar la CVRSV; no obstante esta última depende de la comorbilidad y la sintomatología clínica basal. / Objectives: To explore the life quality limitations caused by eye cataracts, to define vision-related quality of life (VRQOL), the visual acuity (VA) and the healthcare utilities of phacoemulsification procedure on these patients. Methods: This one had combined qualitative and epidemiological researches. In the last one we used a pre experimental design, having regard to the previous and posterior results of the eye cataracts surgery in a 201 population patients. It has been used VFQ25+14 questionnaire to determine the patient´s VRQOL with cataracts. Results: The eye cataracts phacoemulsification has average usefulness rate of 0.36. This procedure improve the (VA) (79,8% +/- 7,3) and the global VRQOL (69,1% +/- 6,1) with respect the baseline; especially in patients without retinopathies, those with a prevailing subcapsular cataract and a higher basal visual acuity. Conclusions: The phacoemulsification is highly valued to enhance the VRQOL according the patient´s comments, nevertheless this procedure depends upon the comorbidity and symptom baseline.

El càncer de pròstata és el tumor amb més incidència en el sexe masculí. S’estima per l’any 2020 que un de cada sis homes desenvoluparà o es trobarà afecte d’ un càncer de pròstata. Des de la irrupció de l’Antigen Prostàtic Específic (PSA), la seva detecció ha anat en augment, però aconseguint detectar-lo en fases més precoces. Fins a dia d’avui el patró de referència ha estat i és la biòpsia de pròstata per al seu diagnòstic. No existeix encara cap prova d’imatge que la pugui substituir. La Ressonància Nuclear Magnètica Multiparamètrica (RMNm) és un tècnica d’imatge morfològica i funcional que integra les seqüències T1, T2, contrast, difusió i espectroscòpia. Aquesta prova ha demostrat en els recents anys que pot ser la candidata a omplir l’espai existent quant a proves d’imatge del càncer de pròstata, tant pel diagnòstic, com per l’estadiatge i el seguiment. Sabem que el 70% de tumors es localitzen a la glàndula perifèrica i la resta a la glàndula central. És per això que en realitzar les biòpsies aleatòries de la pròstata la majoria de les puncions van dirigides a aquesta zona. La majoria dels treballs realitzats fins ara aporten conclusions considerant tota la pròstata globalment o fent èmfasi només en la zona perifèrica. En el nostre treball ens proposem esbrinar quina eficàcia té aquesta tècnica a la glàndula central i comparar-la amb la que obtenim de la glàndula perifèrica. A tal efecte presentem 233 pacients amb sospita de càncer de pròstata, bé sigui per xifres de PSA elevades o per tenir un tacte rectal sospitós. A tots ells els vàrem sotmetre a una RMNm i a una biòpsia de pròstata posterior. Vàrem identificar els cilindres obtinguts de cada zona i els vàrem correlacionar amb les diferents seqüències morfològiques i funcionals de la RMNm per zones. En aquest grup de pacients Obtenim sensibilitats i especificitats elevades per ambdues zones. Realitzem una comparació estadística dels resultats obtinguts a les dues regions anatòmiques. Observem que no hi ha diferències significatives quant a la sensibilitat i valor predictiu positiu, però si quant a la especificitat i valor predictiu negatiu, essent aquests darrers superiors a la glàndula central. Estudiem l’optimització de les seqüències, concloent que emprant la seqüència T2 i la difusió en fem prou per obtenir un rendiment diagnòstic raonablement similar al que obtindríem si utilitzéssim totes les seqüències. A més, proposem en el cas de la glàndula central l’addició de l’espectroscòpia en casos dubtosos. Amb els nostres resultats, i assumint les limitacions del nostre treball, demostrem que la RMNm ens pot ajudar a diagnosticar tumors prostàtics ubicats en ambdues regions anatòmiques. I potser més important encara, ens permet descartar la presència de tumors clínicament significatius, tant a la glàndula central com a la perifèrica. / Prostate cancer is the most incident tumor in males. In 2020, one out of six men will be affected by prostate cancer. The irruption of Prostatic Specific Antigen (PSA) has increased the detection, allowing to detect the cancer in early stages. The gold standard for the certain diagnosis of prostate cancer is prostatic biopsy and to date there is not any imaging test that is able to replace prostate biopsy. The multiparametric Magnetic Nuclear Resonance (mMRI) is a functional and morphological test, integrating T1 and T2 sequences, contrast enhanced, diffusion and spectroscopy. In the last years it has become the main imaging test for diagnosing and detecting and staging prostate cancer. 70% of prostate cancers are originated in the peripheral zone ant the other 30% in the central gland. For this reason the majority of biopsy protocols are focused mainly on the peripheral zone. Most of the papers provide conclusions considerating the prostate globally or emphasizing in the peripheral zone. In our series, our purpose is to study the effectiveness of this technique in the central gland and compare the results with the ones obtained in the peripheral gland. We studied 233 patients under suspition of having a prostate cancer, based on high levels of PSA or abnormal digital rectal examination. They all underwent an endorectal mMRI and a further prostate biopsy. All the cores obtained were identificated and correlated zonally with the morphological and functional images of mMRI. We found high sensibility and specificity values on both the PZ and CZ. We performed an statistical analysis with the results obtained in both zones. We did not find statistical significant differences between sensitivity and positives predictive value. On the other hand we found significant differences in the specificity and negative predictive value, being higher in the central gland. We studied the optimal resonance sequencing, and concluded that using T2 plus diffusion we are able to obtain similar results than using all sequences. Also, we propose the addition of spectroscopy in doubtful cases in the central gland. Assuming the limitations of our study, our results demonstrate that mRMI might help to diagnose those tumors localized in the central and the peripheral gland. And the most important issue is that mRMI may also help us to rule out significant cancer in both regions.

OBJETIVO Nuestro objetivo fue comparar la técnica gastrectomía tubular (GT) con el by-pass gástrico (BP),en cuanto a la pérdida ponderal y resolución de comorbilidades. Analizando los marcadores del síndrome metabólico y las modificaciones hormonales en ayunas con ambos procedimientos. MATERIAL Y MÉTODO El estudio se realizó en el Servicio de Cirugía General del Complejo Hospitalario de Cartagena,entre 2011-2013 y un seguimiento de 24 meses.Estudio observacional de cohortes analíticas prospectivo consecutivo,donde se diseñaron dos grupos de estudio distribuidos de forma no aleatoria: grupo A (100 pacientes BP),y grupo B (100 pacientes GT).Los criterios de inclusión fueron los utilizados por la Sociedad Española de Cirugía de la Obesidad (SECO).La asignación de los pacientes a un determinado grupo se realizó siempre en el mismo orden y según fecha de inclusión en lista de espera quirúrgica. En el protocolo de estudio de incluyeron:datos demográficos (edad y sexo); variables clínicas preoperatorias (peso, talla, peso ideal, índice de masa corporal (IMC),comorbilidades asociadas (diabetes mellitus tipo 2,hipertensión arterial,síndrome de apnea obstructiva del sueño y dislipemias),riesgo anestésico); variables quirúrgicas (tiempo,conversión,complicaciones intraoperatorias,precoces y tardías,mortalidad) y seguimiento (peso,porcentaje de sobrepeso perdido (PSP),IMC y porcentaje de exceso de IMC perdido (PEIMCP) evaluado a 1,3,6,12,18 y 24 meses.La resolución de comorbilidades se midió al año basándose en valores analíticos y en la no toma de medicación. Las determinaciones analíticas se realizaron en el preoperatorio, 5ºdía, 1ºmes, 6ºmes y 12ºmeses,y fueron: hemoglobina glicosilada (HbA1c),glucosa, colesterol total, HDL-colesterol, LDL-colesterol,triglicéridos,aspartato aminotransferasa (AST),alanina aminotransferasa (ALT),gamma-glutamiltransferasa (GGT),fosfatasa alcalina (FA),proteina C reactiva (PCR),interleuquina 6 (IL-6),índice de resistencia insulínica (HOMA),insulina y péptido C.Se complementó un análisis hormonal en 54 pacientes (27 BP vs. 27 GT),midiendo ghrelina acilada,GLP-1 activa y PYY total en ayunas,utilizando un panel metabólico humano diseñado para el estudio de biomarcadores (MILLIPLEX® MAP). CONCLUSIONES La gastrectomía tubular presentó un tiempo operatorio significativamente menor que el by-pass gástrico,con un porcentaje de complicaciones precoces similar.En cambio,cuando se produce una complicación precoz en la gastrectomía tubular,suele tener un mayor índice de Clavien.Las complicaciones tardías son más frecuentes en el by-pass gástrico,destacando en nuestro estudio la estenosis de la anastomosis gastroyeyunal. El by-pass gástrico presentó un PSP significativamente mayor que la gastrectomía tubular al mes,tres,seis,doce,dieciocho y veinticuatro meses de seguimiento.A los dos años, ambas técnicas alcanzaron un PSP del 65%. Al año de seguimiento,no hubo diferencias en la resolución de diabetes mellitus tipo 2,hipertensión arterial,síndrome de apnea obstructiva del sueño y dislipemias entre ambas técnicas quirúrgicas.La gastrectomía tubular resolvió el 77% de la diabetes mellitus tipo 2 frente al 68% del by-pass gástrico. Con ambas técnicas encontramos un descenso significativo en los niveles de triglicéridos y transaminasas,y un ascenso en los niveles de HDL colesterol.Sólo en el by-pass gástrico se aprecia un descenso de colesterol total y LDL colesterol.La PCR descendió con ambas técnicas,si bien el descenso sólo fue significativo con el by-pass gástrico. Observamos un incremento de los valores de ghrelina acilada en ayunas al año con ambas técnicas quirúrgicas,en respuesta a una pérdida ponderal del 30%. No encontramos correlación lineal negativa entre ghelina acilada, IMC e insulina. No hay modificaciones de GLP-1 activa en ayunas al año con ninguna de las dos técnicas quirúrgicas,si bien al 5ºdía postoperatorio se observa un descenso significativo con ambas. El PYY total en ayunas al año aumentó significativamente con ambas técnicas quirúrgicas.La elevación fue mayor en el grupo de gastrectomía tubular,si bien la diferencia con el by-pass gástrico no fue significativa. / OBJETIVE Our objective was to compare the technical sleeve gastrectomy (SG) with the gastric by-pass (GB),in terms of weight loss and resolution of comorbidities.Analysis of markers of metabolic syndrome and the hormonal changes in fasting with both procedures. MATERIAL AND METHOD The study was carried out in the Service of General Surgery of the Hospital Complex of Cartagena,between 2011-2013 and followed for 24 months.Observational cohort study of analytical prospective consecutive,are designed where two study groups distributed not randomly:group A (100 patients GB), and group B (100 patients SG).The inclusion criteria were used by the Spanish Society of Obesity Surgery (SECO).The allocation of patients to a particular group was always in the same order and according to date of inclusion in surgical waiting list. In the study protocol of included:demographic data (age and sex);preoperative clinical variables (weight,height,ideal weight,body mass index (BMI),associated comorbidities (diabetes mellitus type 2,high blood pressure,syndrome of obstructive apnea of the dream and dyslipidemia),anesthetic risk);surgical variables (time,conversion,intraoperative,early and late complications,mortality) and follow-up (weight,percentage of excess weight lost (%EWL),BMI and percentage of excess BMI lost (%EBMIL) evaluated at 1,3,6,12,18 and 24 months.The resolution of comorbidities was measured per year based on analytical values and not taking medication.The analytical determinations were performed preoperatively,5th day,1 month,6 months and 12 months,and were: hemoglobin glycosylated (HbA1c),glucose,total cholesterol,HDL-cholesterol,LDL-cholesterol,triglycerides,aspartate aminotransferase (AST),alanine aminotransferase (ALT),gamma-glutamiltransferasa (GGT),alkaline phosphatase (AP),C-reactive protein (CRP),interleukin 6 (IL-6),index of insulin resistance (HOMA), insulin and C-peptide.Complemented a hormonal analysis in 54 patients (27 GB vs. 27 SG),measuring ghrelin acylated, GLP-1 active and total PYY in fasting,using a human metabolic panel designed for the study of biomarkers (MILLIPLEX ® MAP). CONCLUSIONS Sleeve gastrectomy presented an operative time significantly lower than the gastric bypass, with a similar percentage of early complications.On the other hand, when an early complication in sleeve gastrectomy, usually have a higher rate of Clavien.Late complications are most frequent in the gastric bypass,highlighting the gastrojejunal anastomosis stenosis in our study. The gastric bypass presented a %EWL significantly greater than the sleeve gastrectomy per month,three,six,twelve,eighteen and twenty-four months of follow-up.At age two, both techniques achieved a 65%EWL. A year of follow-up,there was no difference in the resolution of diabetes mellitus type 2,high blood pressure,syndrome of obstructive apnea of the dream and dyslipidemias among both surgical techniques.Sleeve gastrectomy met 77% of diabetes mellitus type 2 compared to 68% of the gastric bypass. With both techniques are a significant decrease in the levels of triglycerides and transaminases, and a rise in the levels of HDL-cholesterol.Only on the gastric bypass is shown a decline in total cholesterol and LDL-cholesterol.The CRP came down with both techniques, although the decline was significant only with the gastric bypass. We observe an increase of the values of acylated ghrelin in fasting a year with both technical surgical, in response to a weight loss of 30%.Found no negative linear correlation between ghelina acylated, BMI and insulin. There is no active GLP-1 changes in fasting a year with none of the two surgical techniques,while the 5th postoperative day is observed a significant decrease in both. The total PYY in fasting a year increased significantly with both surgical techniques.Elevation was greater in the group of sleeve gastrectomy,while the difference with the gastric bypass was not significant.