Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-29T23:29:42Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇAO RENATO GOMES.pdf: 1085453 bytes, checksum: 52c34bec90105d63a6d951a99405c02d (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-29T23:31:18Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇAO RENATO GOMES.pdf: 1085453 bytes, checksum: 52c34bec90105d63a6d951a99405c02d (MD5) / Made available in DSpace on 2017-09-29T23:31:18Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇAO RENATO GOMES.pdf: 1085453 bytes, checksum: 52c34bec90105d63a6d951a99405c02d (MD5) Previous issue date: 2012 / Santa Casa de Misericórdia de Vitória. Escola Superior de Ciências / Objetivo: Comparar a acuidade visual em pacientes com oclusão de ramo de veia central da retina (ORVCR), antes e após tratamento combinado de injeção intravítrea de bevacizumabe com fotocoagulação a laser. Método: Uma análise retrospectiva de pacientes com ORVCR que foram tratados com injeção intravítrea de bevacizumabe (1,25mg/0,05ml) seguida de fotocoagulação a laser na área afetada. Os pacientes passaram por avaliação oftalmológica completa, incluindo medida da acuidade visual (AV) com tabela de Snellen no momento do diagnóstico e nas visitas de acompanhamento. Foram excluídos prontuários incompletos ou com erros de preenchimentos e prontuários de pacientes com outras alterações oculares que pudessem interferir nas medidas da acuidade visual. Resultados: Foram analisados 26 prontuários (11 homens e 15 mulheres) de pacientes com diagnóstico de ORCVR no Serviço de Oftalmologia da Santa Casa de Vitória durante todo o ano de 2010. Todos os pacientes foram acompanhados por 6 meses. O tempo médio de baixa da acuidade visual antes do diagnóstico foi de 21,2 dias (1-140 dias). Com acuidade visual inicial média de 0.74 LogMAR (p<0.001) e com melhora média após 6 meses do início do tratamento para 0.32 LogMAR (p<0.001), representando assim um ganho médio de 0.42 LogMAR (p<0.001) ou 19.4 letras de ETDSR (p<0.001). Foram utilizados testes não paramétricos a fim de permitir mais generalização aos resultados evitando a premissa de normalidade. O teste de Wilcoxon foi utilizado para verificar a variação da acuidade visual inicial e final. Não foram observadas complicações oculares ou sistêmicas durante o acompanhamento. Conclusão: Houve melhora da acuidade visual comparando pré o pós tratamento combinado de injeção intravítrea de bevacizumabe com fotocoagulação a laser. A estabilidade do ganho obtido no tratamento combinado com a ausência de complicações demonstra o potencial do uso combinado de injeção intravítrea de bevacizumabe com fotocoagulação a laser no tratamento de ORVCR / Purpose: Compare the visual acuity (VA) in patients with branch retinal vein occlusion (BRVO), before and after been treated with a combination of intravitreal injection of bevacizumab followed by laser photocoagulation. Method: A retrospective analyses of patients with BRVO that underwent a treatment of intravitreal injection of bevacizumab (1,25mg/ 0,05ml) followed by laser photocoagulation on the affected area. Patients went through complete eye examination, including visual acuity measure with Snellen chart on the diagnostic visit and on the follow-ups. Uncompleted and miswritten charts ware excluded as well as charts of patients with others ocular affections that could interfere in visual acuity measure Results: 26 charts (11 male and 15 female) of patients with BRVO from the Ophthalmological Department of Santa Casa de Misericórdia Hospital during 2010 were analyzed. All patients underwent a 6 months follow-up. The average VA loss before diagnostics was 21.2 days (1-140). The average VA was 0.74 LogMAR (p<0,001) with improvement after 6 month of treatment to 0.32 LogMAR (p<0,001), representing a average gain of 0.42 LogMAR (p<0,001) or 19.4 ETDRS letters (p<0,001). Non parametric tests ware used to allow more generalization of the results avoiding normality assumption. The Wilcoxon was applied to verify de VA variation during de study. No eye or systemic complications ware observed during the study. Conclusions: Visual acuity gain occur comparing before and after treatment with bevacizumab intravitreal injection followed by laser photocoagulation. The stability of the gain combined with a absences of complications demonstrate de potential of combined intravitreal bevacizumab and laser photocoagulation in patients with BRVO

Objetivo: A trombose da veia porta é uma causa importante de hiper-tensão porta em crianças e adolescentes, porém, em uma proporção importante dos casos, não apresenta fator etiológico definido. O objetivo desse estudo é determinar a freqüência de deficiência das proteínas inibidoras da coagulação – proteínas C, S e antitrombina − e das mutações fator V Leiden, G20210A no gene da protrombina e C677T da metileno-tetraidrofolato redutase em crianças e adolescentes com trom-bose da veia porta, definir o padrão hereditário de uma eventual deficiência das pro-teínas inibidoras da coagulação nesses pacientes e avaliar a freqüência da deficiên-cia dessas proteínas em crianças e adolescentes com cirrose. Casuística e Métodos: Foi realizado um estudo prospectivo com 14 crianças e adolescentes com trombose da veia porta, seus pais (n = 25) e dois gru-pos controles pareados por idade, constituídos por um grupo controle sem hepato-patia (n = 28) e um com cirrose (n = 24). A trombose da veia porta foi diagnosticada por ultra-sonografia abdominal com Doppler e/ou fase venosa do angiograma celíaco seletivo. A dosagem da atividade das proteínas C, S e antitrombina foi determinada em todos os indivíduos e a pesquisa das mutações fator V Leiden, G20210A da pro-trombina e C677T da metileno-tetraidrofolato redutase, nas crianças e adolescentes com trombose da veia porta, nos pais, quando identificada a mutação na criança, e nos controles sem hepatopatia. Resultados: Foram avaliados 14 pacientes caucasóides, com uma média e desvio padrão de idade de 8 anos e 8 meses ± 4 anos e 5 meses e do diagnóstico de 3 anos e 8 meses ± 3 anos e seis meses. Metade dos pacientes pertenciam ao gênero masculino. O motivo da investigação da trombose da veia porta foi hemorra-gia digestiva alta em 9/14 (64,3%) e achado de esplenomegalia ao exame físico em 5/14 (35,7%). Anomalias congênitas extra-hepáticas foram identificadas em 3/14 (21,4%) e fatores de risco adquiridos em 5/14 (35,7%) dos pacientes. Nenhum pa-ciente tinha história familiar de consangüinidade ou trombose venosa. A deficiência das proteínas C, S e antitrombina foi constatada em 6/14 (42,9%) (p < 0,05 vs con-troles sem hepatopatia), 3/14 (21,4%) (p > 0,05) e 1/14 (7,1%) (p > 0,05) pacientes com trombose da veia porta, respectivamente. A deficiência dessas proteínas não foi identificada em nenhum dos pais ou controles sem hepatopatia. A mutação G20210A no gene da protrombina foi identificada em um paciente com trombose da veia porta e em um controle sem hepatopatia (p = 0,999), mas em nenhum desses foi identificado a mutação fator V Leiden. A mutação C677T da metileno-tetraidrofo-lato redutase foi observada na forma homozigota, em 3/14 (21,4%) dos pacientes com trombose da veia porta e em 5/28 (17,9%) controles sem hepatopatia (p = 0,356). A freqüência da deficiência das proteínas C, S e antitrombina nos pacientes com cir-rose foi de 14/24 (58,3%), 7/24 (29,2%) e 11/24 (45,8%), respectivamente (p < 0,05 vs controles sem hepatopatia), sendo mais freqüente nos pacientes do subgrupo Child-Pugh B ou C, que foi de 11/12 (91,7%), 5/12 (41,7%) e 9/12 (75%), respectivamente (p < 0,05 vs controles sem hepatopatia). Conclusões: A deficiência de proteína C foi freqüente nas crianças e adolescentes com trombose da veia porta e não parece ser de origem genética. A deficiência de proteína S, antitrombina e as presenças das mutações G20210A da protrombina e C677T da metileno-tetraidrofolato redutase foram observadas mas não apresentaram diferença estatística significativa em relação ao grupo controle sem hepatopatia. O fator V Leiden não foi identificado. Os resultados deste estudo sugerem que a deficiência da proteína C pode ocorre como conseqüência da hiper-tensão porta. Os distúrbios pró-trombóticos hereditários não parecem apresentar um papel importante em relação à trombose nas crianças e adolescentes estudadas. / Objective: Portal vein thrombosis is a major cause of portal hypertension in children and adolescents; yet, its etiology is not clearly defined in a considerable number of cases. The present study aims at determining the prevalence of blood coagulation disorders – protein C, protein S and antithrombin – and factor V Leiden, G20210A prothrombin, and C677T methylenetetrahydrofolate reductase mutations in children and adolescents with portal vein thrombosis, as well as assessing the hereditary character of these disorders in these patients, and also evaluating the prevalence of blood coagulation disorders in children and adolescents with cirrhosis. Study design: A prospective study was carried out, including children and adolescents with portal vein thrombosis (n = 14), their parents (n = 25), two age-matched control groups, one without liver disease (n = 28), and another with cirrhosis (n = 24). Portal vein thrombosis was diagnosed through abdominal Doppler ultrasonography and/or venous phase of selective coeliac angiograms. The activity of protein C, protein S and antithrombin was evaluated for all individuals; the presence of factor V Leiden, G20210A prothrombin, and C677T methylenetetrahydrofolate reductase gene mutations was investigated in children and adolescents with portal vein thrombosis, in parents when their respective children presented any of these mutations, and in the control group without liver disease. Results: 14 Caucasian patients were assessed. The mean and standard deviation for age were 8 years and 8 months ± 4 years and 5 months while the mean and standard deviation for diagnosis were 3 years and 8 months ± 3 years and six months. Half of the patients were males. Initial clinical manifestations upon diagnosis were digestive hemorrhage in 9/14 (64.3%) and splenomegaly on physical examination in 5/14 individuals (35.7%). Patients presented extrahepatic anomalies in 3/14 (21.4%) and acquired risk factors in 5/14 (35.7%) of the cases. None of the patients had a family history of consanguinity or venous thrombosis. The frequency of protein C, protein S and antithrombin deficiency was observed in 6/14 (42.9%) (p < 0.05 vs. controls without liver disease), 3/14 (21.4%) (p > 0.05) and 1/14 (7.1%) (p > 0.05) of patients, respectively. None of the portal vein thombosis patients or controls presented protein C, S or antithrombin deficiency. One portal vein patient and one control (p = 0.999) presented G20210A prothrombin mutation. None of these patients presented the factor V Leiden. The homozygous form of C677T methylenetetrahydrofolate reductase mutation was observed in 3/14 patients with portal vein thrombosis (21.4%) and in 5/28 controls (17.9%) (p = 0.356). The frequency of coagulation inhibitor deficiency was high in cirrhotic patients (14/24 (58.3%) PC, 7/24 (29.2%) PS and 11/24 (45.8%) AT; p < 0.05 vs. controls), especially in Child-Pugh B and C patients (11/12 (91.7%) PC, 5/12 (41.7%) PS and 9/12 (75%) AT; p < 0.05 vs. controls). Conclusions: Protein C deficiency was frequent in children and adolescents with portal vein thrombosis and does not seem to be an inherited condition. Protein S and antithrombin deficiency, and G20210A prothrombin and C677T methylenetetrahydrofolate reductase mutations were observed but did not present statistically significant differences when compared to the controls without liver disease. Factor V Leiden was not observed. The results suggest the protein C deficiency may originates from portal hypertension. The hereditary prothrombotic disorders do not seem to play a vital role in thrombosis in children and adolescents with portal vein thrombosis.

As Oclusões Venosas da Retina são complicações do sistema vascular retiniano com grande potencial de impacto no sentido da visão. As oclusões Venosas são classificadas de acordo com a anatomia da região acometida e podem ser divididas em oclusão de ramo e da veia central da retina. O edema macular é a principal causa de baixa acuidade visual na Oclusão de Ramo da Veia Central da Retina (OVR). Sua detecção, localização e classificação são cruciais para a prevenção e tratamento da perda visual na OVR. A Biomicrospia Macular e a Angiofluoresceinografia são os métodos tradicionais de avaliação do edema macular na OVR, a Tomografia de Coerência Óptica (TCO) é uma tecnologia nova, que permite uma avaliação objetiva da morfologia macular. O objetivo primário do presente estudo foi avaliar, em uma mesma população, a acurácia dos métodos de diagnóstico do edema macular na OVR através da análise de três quesitos, aumento da espessura macular e da sua localização, presença de cistos intra-retinianos e a presença de descolamento seroso macular (DSM). Indivíduos com OVR foram selecionados com base nos achados fundoscópicos da doença e com tempo de história da doença entre três e vinte quatro meses. Todos os sujeitos foram submetidos a exames com o Stratus OCT (TCO), Angiofluoresceinografia digital (Angio) e o exame da biomicroscopia macular com lente de Volk de 78 D (BM) dentro do período de uma semana, além de exame oftalmológico completo. As medidas utilizadas para avaliação da acurácia diagnóstica foram o índice de concordância Kappa e a sensibilidade. Dos 32 indivíduos inicialmente avaliados, 8 foram posteriormente excluídos por não cumprirem os critérios de inclusão ou de exclusão, restando 24 indivíduos para análise. Na avaliação da espessura macular, a concordância entre BM e a TCO foi substancial e significante para a detecção do aumento da espessura macular com Kappa = 0,778 (p < 0,001) e a sensibilidade foi 95,5%. Na comparação entre a BM e a TCO para a detecção de cistos intra-retinianos, a concordância foi fraca com Kappa = 0,250 (p = 0,066) e a sensibilidade foi 57,9 %. A concordância entre a Angio e a TCO para os cistos foi pobre e não significante com Kappa = 0,124 (p = 0,237) e a sensibilidade foi 58,7 %. Houve uma correlação significante entre a presença de extravasamento na angiofluoresceinografia e a presença de cistos intra-retinianos na TCO (p=0,042). Na avaliação do DSM a concordância entre a BM e a TCO foi fraca com Kappa = 0,314 (p = 0,062) e a sensibilidade foi 60%, não houve concordância entre a Angio e a TCO para a detecção do DSM com Kappa = 0 e sensibilidade de 0%, e também não houve correlação significante entre a presença de descolamento seroso na TCO e a presença de extravasamento na angiofluoresceinografia (p=0,615). Os dados obtidos no presente estudo sugeriram que o Stratus OCT têm acurácia superior para a detecção dos cistos intra-retinianos e do descolamento seroso macular, se comparado à biomicroscopia macular e à angiofluoresceinografia / Retinal Vein Occlusions are complications of the retinal vascular system that can cause a great impact on vision. The Vein Occlusions are classified according to the anatomy of the affected region and can be categorized as: branch retinal vein occlusion and central retinal vein occlusion. Macular edema is the main cause for low visual acuity in Branch Retinal Vein Occlusion (BRVO). Its detection, location and classification are crucial for the prevention and treatment of vision loss in BRVO. Both Macular Biomicroscopy and Angiofluoresceinography are traditional methods for the evaluation of the macular edema in BRVO; the Optical Coherence Tomography (OCT) is a new technology that allows for an objective evaluation of macular morphology. The main objective of the present study was to evaluate, among the same population, the accuracy of the diagnostic methods of macular edema in BRVO through the analysis of three items: the increase of macular thickness and its location, the presence of intraretinal cysts, and the presence of serous macular detachment. Patients with BRVO were selected according to the fundoscopic findings of the disease and a disease history of three to twenty-four months. All of the individuals underwent exams with the Stratus OCT, digital Angiofluoresceinography (Angio) and a macular biomicroscopy with a 78D Volk lens (MB), within a period of one week, as well as a complete ophthalmologic exam. The parameters used in the evaluation of the diagnostic accuracy were sensitivity and the kappa coefficient. Of the 32 subjects who were initially evaluated, 8 were later excluded since they did not meet inclusion or exclusion criteria. The remaining 24 subjects were analyzed. In the evaluation of macular thickness, the concordance between the MB and the OCT was substantial and significant in the detection of the increase in macular thickness, with Kappa = 0.778 (p<0.001) and a sensitivity of 95.5%. When comparing the MB and the OCT in the detection of intraretinal cysts, the concordance was fair, with Kappa = 0.250 (p = 0.066) and a sensitivity of 57.9%. The concordance between the Angio and the OCT for cysts detection was poor and non significant, with Kappa = 0.124 (p = 0.237) and a sensitivity of 58.7%. There was a significant correlation between the presence of leakage in the angiofluoresceinography and the presence of intraretinal cysts in the OCT (p = 0.042). In the evaluation of the SMD, the concordance between the MB and the OCT was fair, with Kappa = 0.314 (p = 0.062) and a sensitivity of 60% an there was no concordance between the Angio and the OCT in the detection of SMD, with Kappa = 0 and sensitivity of 0%. There was also no significant correlation between the presence of serous detachment in the OCT and the presence of leakage in the angiofluoresceinography (p = 0.615). The results obtained in the present study suggest that Stratus OCT is more accurate to the detection of intraretinal cysts and serous macular detachment than macular biomicroscopy with a 78D Volk lens, and by angiofluoresceinography

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Diabetes mellitus is a frequent endocrinopathy in dogs. Exogenous insulin and nutritional management are the mainstays of therapy. High carbohydrate and fibre diets have been traditionally recommended for canine diabetes mellitus. However, recent studies in healthy and diabetic dogs have challenged the use of these traditional diabetic diets. In addition, dietary carbohydrate content was found to be the main determinant of postprandial blood glucose concentrations over 1.5 hours in healthy dogs. Increasing carbohydrate content increased blood glucose concentration. In a search of the literature, no studies in dogs were found comparing the effects on postprandial plasma glucose, insulin, triglyceride and free fatty acid concentrations of a traditionally recommended high carbohydrate and fibre diabetes diet with a moderate carbohydrate and fibre diet, or a commercially-available maintenance diet. Although fasting plasma triglyceride concentrations are commonly used for diagnosis and management of canine hyperlipidemia, a review of the literature found that in human beings, it may not to be predictive of the highest postprandial concentration. Importantly, in overweight and obese dogs with postprandial plasma triglyceride concentrations >5 mmol/L (>445 mg/dL), it was found there was a 6 fold increase in risk of laboratory evidence of exocrine pancreatic disease. However, there are limited studies on the effect of maintenance diets on postprandial plasma triglyceride concentrations in dogs, and no reference intervals determined for a triglyceride meal challenge test in healthy dogs. For the dietary studies in this thesis, animal welfare was of paramount importance, and minimally invasive peripheral venous catheterization and blood collection techniques were needed to collect 4 mL blood samples over 13 hours in conscious dogs. A search of the literature found no studies evaluating the reliability of using peripheral catheterization via the cephalic vein for the collection of larger blood volumes (for example, 4 mL). The aims of this thesis were firstly, to investigate the influence of three diets with varying carbohydrate and fibre content on postprandial plasma glucose, insulin, triglyceride and free fatty acid concentrations in healthy dogs over 12 hours; secondly, to develop a triglyceride meal challenge test and associated reference intervals; and finally, to evaluate a minimally invasive catheterization and blood collection technique for reliability in collecting the blood volumes required for these studies. For the studies in this thesis, twelve healthy dogs were fed each of three diets for three weeks in a three period cross-over design. For the meal response test at the end of each three-week period, 10 blood samples were collected over 13 hours. Reference intervals for fasting and postprandial triglyceride concentrations at single and multiple time points after eating a standard meal were determined in healthy dogs. Associations between fasting and postprandial triglyceride concentrations, and time to measure highest postprandial triglyceride concentration were also evaluated. Blood volume obtained, resistance on aspirating the blood sample, and methods used to improve blood flow during collection were recorded for the 358 samples collected. The results of the studies in this thesis demonstrated that a moderate carbohydrate diet resulted in lower peak and postprandial glucose concentrations compared with a traditional diabetic diet (CHO 55 %ME) and a maintenance diet (CHO 45 %ME). Fasting triglyceride concentrations were found not to be predictive of peak postprandial triglyceride concentrations. The highest triglyceride concentration measured at 2, 5, and 6 hours after eating had the closest agreement with peak postprandial triglyceride concentration. Glucose, insulin and triglyceride concentrations in some dogs were significantly above baseline concentrations at 12 hours after eating each of the diets. Of 358 blood samples collected, 93 % achieved the required 4 mL volume, while the remaining samples were greater than 1.5 mL, and 87 % were obtained with minimal resistance. It was concluded that the moderate carbohydrate and fibre test diet warrants evaluation in diabetic dogs. It was found that when following the same protocol, blood samples should be collected 2, 5, and 6 hours after eating to determine the highest postprandial plasma triglyceride concentration. For future nutritional studies, dogs may need to be fasted for at least 12 hours, and analytes measured over at least 12 hours after feeding to evaluate fasting and postprandial plasma analyte concentrations. Finally it was demonstrated that percutaneous catheterization of the cephalic vein using a 20-gauge catheter allows for successful collection of multiple 4 mL blood samples over 13 hours in conscious dogs. This thesis presents new information for future nutritional studies in healthy and diabetic dogs by suggesting that there may be no glycemic benefit feeding the high carbohydrate and fibre diet compared with a moderate carbohydrate and fibre diet. A triglyceride meal challenge test was developed to assist the diagnosis of canine hyperlipidemia. Finally, a minimally invasive method for obtaining serial blood samples was evaluated and described. These findings are expected to help in designing future studies in the nutritional management in healthy dogs, and dogs with diabetes mellitus and hyperlipidemia.

Η κατασκευή συστημάτων τομογραφίας του ανθρώπινου ιστού τα οποία θα χρησιμοποιούν το υπέρυθρο φάσμα ακτινοβολίας αποτελεί σημαντική προοπτική για τη δημιουργία νέων ιατρικών διαγνωστικών μεθόδων. Ένα από τα σημαντικότερα προβλήματα που πρέπει να επιλυθούν είναι η μικρή διεισδυτική ικανότητα και ο υψηλός βαθμός απορρόφησης και σκέδασης που παραμορφώνει ισχυρά την ακτινοβολία που διαδίδεται μέσα από τον ανθρώπινο ιστό. Στα πλαίσια της διδακτορικής διατριβής, μελετήθηκε το πρόβλημα του εντοπισμού της θέσης των αγγείων σε ψηφιακές φωτογραφίες του ανθρώπινου δακτύλου που έχουν ληφθεί στο υπέρυθρο φάσμα. Για τον σκοπό αυτό αναπτύχθηκε μεγάλος αριθμός πρωτότυπων μεθόδων κανονικοποίησης της φωτεινότητας της εικόνας, μη-γραμμικής ενίσχυσης της αντίθεσης, αφαίρεσης των γραμμών δακτυλικών αποτυπωμάτων, εντοπισμού του προτύπου ή δικτύου αγγείων και βελτίωσης του προτύπου των αγγείων χρησιμοποιώντας μεθόδους μαθηματικής μορφολογίας. Συνοπτικά στην παρούσα διδακτορική διατριβή προτάθηκαν και εξετάσθηκαν διαφορετικές πρωτότυπες μέθοδοι και αλγόριθμοι με επίβλεψη ή χωρίς επίβλεψη για την εξαγωγή του προτύπου αγγείων από υπέρυθρες εικόνες του ανθρώπινου δακτύλου καθώς και διαφορετικές πρωτότυπες μέθοδοι και αλγόριθμοι χωρίς επίβλεψη για την εξαγωγή του δικτύου αγγείων από αμφιβληστροειδικές εικόνες του ανθρώπινου οφθαλμού. Επίσης, η ερευνητική προσπάθεια επικεντρώθηκε στην βελτίωση των εικόνων που λαμβάνονται από το προτεινόμενο σύστημα απόκτησης εικόνων, γεγονός το οποίο οδήγησε στην ανάπτυξη πρωτότυπων μεθόδων προ-επεξεργασίας και τη μετέπειτα βελτίωση των αρχικών αποτελεσμάτων κατάτμησης που προκύπτουν από την εφαρμογή των μεθόδων ή αλγορίθμων κατάτμησης προτύπου αγγείων, γεγονός το οποίο οδήγησε στην ανάπτυξη πρωτότυπων μεθόδων μετά-επεξεργασίας. / The construction of tomographic systems of human tissue which use the infrared spectrum of radiation constitutes an important capability of making new medical diagnostic methods. One of the most crucial problems which must be resolved is the low penetrating ability and the high degree of absorption and scattering which strongly distort the radiation that pass through the human tissue. In this thesis, the problem of the extraction of finger vein pattern from infrared images of finger and the similar problem of retinal vessel tree segmentation were studied. Moreover, the problem of shading and non-uniform illumination correction was also studied in images which suffer from the above problems either due to imperfect set-up of the image acquisition system or due to the interaction between objects and illumination on the scene. In this thesis, existing algorithms were improved and novel algorithms were developed. Both vein pattern extraction algorithms and shading and non-uniform illumination correction algorithms were proposed. The proposed methods include novel preprocessing modules for intensity normalization, elimination of fingerprint lines, non linear contrast enhancement using spatial information, and shading and non uniform illumination correction. The vein pattern extraction was performed using ten novel methods that use structural classification methods, spatial derivatives information and fuzzy set theory. The effectiveness of the proposed methods and algorithms was evaluated both on real and artificial images distorted by different types of noise and different signal to noise ratios. The majority of the methods present satisfactory accuracy on the detection of vein network, something happens due to the successful collaboration between the preprocessing methods and the vein pattern extraction methods. In addition, the problem of improving the vein network extraction accuracy was successfully handled using advanced postprocessing methods based on binary mathematical morphology. Finally, in this thesis two novel methods for retinal vessel segmentation were proposed and evaluated. They also compared with the most important methods have already been presented in the literature and one of them achieved the best experimental results from all the unsupervised methods evaluated in the publicly available DRIVE database.

This thesis was about thrombomebolic disease in pregnancy. The incidence of venous thromboembolism (VTE) probably increases 2- to 4-fold when a woman becomes pregnant. I looked on this problem from many aspects. I looked on health care from her gynaecologist and eventually hematologist, recognition her VTE risk, laboratory tests and her medication. I looked on effectivity of medication too.