MEDICAL SCIENCE (13)

Author: HERNÁNDEZ IZQUIERDO RAFAEL SILVESTRE.
Year: 2005.
University: SEVILLA [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE SEVILLA.

Summary: General review on the historical evolution of Medical School in Spain, Europe, America, doctors EOEs of Andalusia. Rational use of medicine, pharmacology and Social EFG. Experimental Study on Botiquines School. OBJECTIVES Knowing the state of Botiquines School in Seville and conduct an investigation into their current situation; analyzing and evaluating certain variables: content, location, accessibility, maintenance, revocation, therapeutic groups, as well as the presentation of guidelines for use sound in first aid. MATERIALS AND METHODS Studies descriptive cross observational eligíendose on a stratified random sample size represents 174 public schools out of a total of 385 - (45.2% of the universe), the spot check the Botiquines School (BE). RESULTS A 32.2% of BE were located at the address and secretariat, a 14.1% in the staff room, by 9.6% in the toilets of teachers, 1.2% of pupils in classrooms and 41, 9% in two places earlier. The 26.36% are considered well-located and 75.64% were poorly located. The charge for a periodic review of the content of BE was the Director 43.8% in 2Â th position the Secretary 24.1% and Head of Education 19.8%. According to our study, 57.4% are not well equipped or keep a minimum order or setup and were dirty. The 7.35% of the drugs are expired and 2.25% are in poor state of maintenance (not used SIGRE Point blank). The drugs most frequently prescribed to students of special educational needs due to disability are the valproic, carbamazepine, clonazepan, gabapentin, methylphenidate, topiramate and permethrin. CONCLUSIONS 1-Andalusia is the only autonomous region that has a stable workforce Medical School EOEs dependent on CEJA, but nevertheless lacks Health Law School. 2 - The professional practice of the Medical School of the Andalusian, is a pioneering experience in Spain for 19 years and a model applicable in the rest of the autonomous communities in the future. They act as mentors and technical advisers from prevention to intervention. 3 - There is no specific legislation or regulations specifically governing the distribution, content, maintenance and use of the chest School. 4, - there is usually responsible professor who really is responsible for maintenance, control and supervision of the chest. 5-At present the use of the kit is still a cause of controversy in schools and doubt among teachers regarding the administration of medication to students and their legal liability because, as legal obligation to the contrary, is not reflected in any rule of law. 6-Most of the teachers who have participated in this study, says that is inadequate advice and training they receive in the administration, in terms of the use of the chest at the school. 7 - There are no practical programs for Health Education at the school, on the rational use of medicine or in Andalusia in Spain. Nor have conducted pilot studies or preliminary assessments of the impact that this type of program could have on the responsible consumption of drugs for adolescents and adulthood. KEYWORDS Medical School, Prevention, First Aid for Schools, Social Pharmacology.

Author: GONÇALVES MADUREIRA RUI MANUEL.
Year: 2005.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGÍA.
Place of preparation: UNIVERSIDAD DE VLENCIA ESTUDIO GENERAL.

Summary: SECURITY fractures of some instruments taper and diameter greater have occurred in working the 5Â eighth and last through, probably by cyclic fatigue and agree with what is reflected in the literature reviewed. Moreover, the loss of apical permeability has also occurred only with rotating systems. While the manual system that has not happened in any case. CONCLUSIONS After the study on different systems endodóncicos instrumentation revolving tools níquel-titanio various conicidades and designs, using the technique corono-apical (Crown-Down), as amended, following the recommendations of the various manufacturers and a technical manual tools K stainless steel using a technique blanceada and widening coronal initial strawberries gates glidden, and responding to the objectives set, we can establish the following conclusions: After preparing biomechanics, the final form of conduit respect to taper and depends on taper diameter and the diameter of the tools, when used instrumentation techniques and materials for the manufacture of such instruments. All transport systems presented with duct transformation of the apical curvature in an area with straight and smoothing of the first bend, leading the biggest wear on the inner walls of the bends and only on them in increasing the diameter from 25 to 35. Preparation is the man who has the largest absolute transport. The flexibility of the instruments is inversely related to the transport of the enclosure. The transport of níquel-titanio presented less than those of stainless steel, and increasing the diameter of the same material and design of the instrument are always a more straight through. The existence of apical zip only in systems that use tools taper 02 suggests that the instruments of taper 04 should be used throughout the length of the enclosure. The security of the systems studied is acceptable, with a 3.33% fracture with instruments níquel-titanio and 0% in stainless steel. The maintenance of apical permeability has been verified in 88% of all channels. With regard to these two factors, the system Hero 642 and the manual are safer with a 0% loss and fracture permeability. The system protaper is less secure with two fractures (9.52%) and 4 losses permeabiliad (19.04).

Author: GRANDE BAREZ SUSANA.
Year: 2005.
University: SALAMANCA [www.usal.es].
Place of defense: EDIFICIO HISTORICO.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Introduction: The childhood accidents are the leading cause of death and disability in children older than 1 year in developed countries and an important source of morbidity. The prevention based on knowledge of epidemiology is the best weapon to fight any disease, including disease "accident". Objectives of the study understand the epidemiology of childhood accidents in the town of Salamanca and start a register of pediatric trauma Methodology: descriptive epidemiological study, longitudinal, prospective accidents in children under 14 years who come to the emergency department of the university hospital of Salamanca between January 1 and December 31, 2002. It was considered an accident in categories 800 and 900 of the CIE-9-MC (External causes of injury and poisoning), excluding Contratiempos during medical care (870-879) and side effects of drugs and medicines for therapeutic use (930 - 949). Variables Estudiadas: age, sex, place of residence, means of transport to the hospital, assistance prehospitalaria, month, day, time and place of the accident, the accident mechanism, types of injuries, explorations complementary treatments, the patient's destination after care in emergencies. Results: During the year 2002 were met in emergency 5,147 children injured, of whom joined 169 (3%) and were discharged after care in emergencies 4,978 (97%). The 41% of the children were púberes (10-13 years), 24% school (6-9 years), 17% preschoolers (3-5 years) and 18% infants (0-2 years). All types of accidents were more frequent in males, except for traffic accidents. The 60% of the accidents occurred on the street, 25% at home and 15% in school. The 56% of children lived in Salamanca capital, 35% in other villages in the province, 5% in other provinces and 1% from abroad. There were no statistically significant differences in the distribution of monthly or weekly accidents. The most frequent time period for all types of accidents was between 17 and 21 hours. They received assistance prehospitalaria the 44% of the admitted and 13% of those not admitted. They arrived at the hospital by ambulance for 34% of the admitted and 0.45% for non-admitted. Only cervical collar brought the 24% of children in that it was indicated. The most frequent types of accidents were falls, followed by shock and bruises and sporting accidents. The types of accidents with the highest rate of admission were poisoning and traffic accidents. The most frequent diagnoses were not admitted bruises, sprains and injuries, and the entrants, fractures and luxations, trauma craneoencefálicos (TEC), and poisoning. The 169 entrants generated 515 days of hospital stay with an average of 3 days per child. It was diagnosed in polytraumatism to 14 children, with an average of 3.9 injuries per child, being present in all the TEC. Died 8 children (3 of the attending emergency room and 5 at the scene of an accident), 6 of them by automobile accident. The health spending generated by childhood accidents in 2002 was 1,009,000 â ¬, with an average cost of 2500 â ¬ for each child admitted and 155 â ¬ per not entered.

Author: MORALES CAMACHO ROSARIO MARIA.
Year: 2005.
University: SEVILLA [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: We studied obese prepubertal children (n = 58, mean age 7.99 years) at baseline compared with a control group (n = 61, mean age 7.74 years), evaluating parameters normal metabolic syndrome, endothelial dysfunction, inflammation, hemostasis and atherogenesis. Following usual treatment is reassessed obese children in the 3 and 9 months. A baseline is comprised metabolic syndrome, disfunciónen dotelial, inflammatory and haemostatic abnormalities in the group of obese that reversal after the treatment of obesity.

Author: MIR RIVERA PABLO.
Year: 2005.
University: SEVILLA [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD DE SEVILLA.

Summary: In Parkinson's disease (PD) there is a gap in the basal ganglia. That deficit could also lead to changes in how different cortical areas interact with each other. The connectivity between cortical areas can be studied using repetitive transcranial magnetic stimulation (rTMS). The rTMS premotora, with an intensity of 90% of the motor threshold assets and a frequency of 5 Hz, it is able to increase the excitability corticoespinal, although a useful tool for the study of the plasticity interregional connections premotoras-motoras ipsilaterales. The main objective of this study was to assess the effect of treatment on the dopaminergic interactions premotoras-motoras in PD patients. It studied the clinical and electrophysiological effects of rTMS to 5 Hz infraumbral on premotora cortex in PD patients with and without dopaminergic therapy. As a secondary objective electrophysiological parameters were evaluated by EMT studied, compared with PD patients and untreated subjects and healthy controls. By undertaking this study, it was observed that the functional connectivity between areas premotoras and motor primary PD patients depends on the dopaminergic therapy. The rTMS to 5Hz on premotora cortex in PD patients with dopaminergic therapy was able to enhance the excitability corticoespinal as in normal subjects, which did not happen when they are without him. Therefore it is concluded that the dopaminergic deficit of the basal ganglia in PD also affects connections premotoras-motoras.

Author: MUNUERA MARTÍNEZ PEDRO VICENTE.
Year: 2005.
University: SEVILLA [www.us.es].
Place of defense: ESCUELA UNIVERSITARIA DE CIENCIAS DE LA SALUD.
Place of preparation: ESCUELA UNIVERSITARIA DE CIENCIAS DE LA SALUD DE LA UNIVERSIDAD DE SEVILLA.

Summary: In a sample of 373 feet to 208 individuals, 118 men and 90 women, aged in the third decade of life, have been studied by a number of factors morphological the first segment metatarso-digital related pathologies hallux valgus abductus ( HAV) and hallux limitus (HL). The objectives of this work have been studying which of these factors influence the etiology of these deformities, and determine if there are any morphological factor to be determined by the establishment of one or other pathology. This would have formed three groups: normal feet, feet with HAV and feet with HL. In the two groups of pathological feet have included only those cases of HAV or HL that were in the initial phase. These factors have been studied in radiographs dorsoplantares laden, which have made a series of linear and angular measurements using the program Auto CADÂ ®. The results have revealed significant differences in several variables linear and angular among the three groups. The most important differences have arisen in those variables expressing size of the first segment metatarso-digial, pathological between the two groups and the control group. The shape of the head of the first metatarsal has shown significant differences among the three groups with each other. All this shows that the occurrence of these two diseases affect the size of the first metatarsal and the first finger, and that the shape of the head of the first metatarsal is the factor that determines which of morphological them will be developed in the first articulation metatrasofalángica . Finally proposes a theory about the emergence of HAV and HL depending on the results of this work, bearing in mind that these alterations have a multifactorial etiology, and that there were factors which analysis has not been the subject of this thesis.

Author: VEGA GÓMEZ JOSE ELOY DE LA.
Year: 2005.
University: PAÍS VASCO [www.ehu.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA. UNIVERSIDAD PAIS VASCO.

Summary: The biopsy ganglion Sentinel is a new technique for the diagnosis of nodal metastases, and is used in various types of cancer, mainly in epithelial malignancies. Thanks to it, with lengthy study anantomopatológico single node through new procedures immunohistochemistry, we could get a estadiaje more accurate than with the classic radical lymphadenectomy. Cancer of the oral cavity and region orofaringea has a particular tropism for the lymph nodes and it is one of the tumors that more is being investigated on the usefulness of the technique of GC. The affectation metastatic Ganglionar in malignant tumors of Head and Neck has enormous therapeutic and prognostic significance. Thus, in our research work we wanted to deepen in the use of this technique without being expensive or invasive, allows us to establish reliability and efficiency with lymph node involvement in the tumor's malignant solid tumors as noses and oral cavity. In our study we found that the technical study of GC in tumors of the oral cavity decreasing time surgical intervention and the average stay in hospital. Likewise, patients who are made the study of the GC elaborated lower occupancy of such beds regard to the group of patients who were not conducted the study. Thus, we found that the study of GC allows reduce the economic costs of treating patients with malignant solid tumors of the oral cavity. Thus the procedure for locating and study ganglion Sentinel allows a more precise, less aggressive surgery which involves the realization of a cervical emptying, as to whether or not deméstastasis ganlgionares in pathology malignant tumor of head and neck.

Author: TOURIÑO GONZÁLEZ CARLOS FRANCISCO.
Year: 2005.
University: VIGO [www.uvigo.es].
Place of defense: FACULTAD DE CIENCIAS DE LA EDUCACIÓN DE OURENSE.
Place of preparation: FACULTAD DE EDUCACIÓN DE OURENSE.

Summary: Although the Synchronized Swimming (NS) is a structured sport under the International Federation of Amateur Swimming (FINA) and included in the Olympic program since 1984, is a sport little known outside the specific area of their practice , which also is very small. To delve into the nature of this sport. The present study seeks to identify the most characteristic features of sport both theoretical and practical level (through an empirical study), there is a profound review of the literature and an approach to the origin, development and consolidation of a NS Throughout history. The text is an important effort at deepening the three pillars on which rests the structure of the sport NS: the regulatory framework, which regulates the whole process of this competitive sport, the technical framework, which defines the technical foundations on which argues executions and finally, the dimensions that make up the artistic nature of the NS. To do this we try to learn the rating that experts give to the different components of artistic merit of the routine free group. The contributions of the thesis, they are placed in two dimensions, technical and artistic. From a technical standpoint, it provides a model for analyzing the technical foundation and is a cataloging and describing them, and from the artistic point of view, it contributes to the definition of synchronized swimming, highlighting the feature art beside the sport feature: while articulates so operational, the abstract concept of artistic merit contained in the legislation.

Author: IRIONDO BEDIALAUNETA JUAN RAMÓN.
Year: 2005.
University: PAÍS VASCO [www.ehu.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD MEDICINA - UNIVERSIDAD DE PAIS VASCO.

Summary: The syndrome apnea hipoapnea obstructive sleep (SAHOS) has been described for more than 3 decades, but only recently has been increasing interest. Its prevalence is high, is a cause of respiratory, cardiovascular or other, which can even cause death in these patients, and hipersomnolencia that produces this syndrome causes of traffic accidents and work, so there is considerable cost to society causing. Therefore, in this study we wanted to analyze the predictive value of clinical parameters, epidemiological and anthropometric in identifying patients with suspected syndrome apneas-hipopneas obstructive sleep (SAHOS), trying to define the clinical parameters that could have a predictive value important to distinguish those patients requiring treatment early SAHOS. We have prepared a sample of 433 patients, 83.37% and 16.63% male women with a mean age +-standard deviation of 47 +-11.10 years (range, 18-75 years), who we discussed the importance of factors such as age, sex, weight, history, diseases associated anatomical factors, apneas, hipersomnolencia and maneuver MÃ ¼ ller. Thus, we obtained the following formula to predict the AHI / Time: IAHt = -12.04 + 0.36 * p.cuello + 2.2286 * c.far. (GM) + 0.1761 * ESS + 0.0017IMC * AGE + 1.1949 * E.faringe. Where the most significant variables were the perimeter cervical Maneuver of the MÃ ¼ ller (GM), Epworth Sleep Scale (ESS), BMI * AGE interaction and exploration faringea. This may result in substantial savings of time to prioritize these patients at the time of making the necessary diagnostic study, or for the introduction of treatment in the most serious forms of the disease.

Author: SANTAOLALLA MONTOYA MARCELA.
Year: 2005.
University: PAÍS VASCO [www.ehu.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA, UNVIERSIDAD DEL PAIS VASCO.

Summary: This research work has been done a retrospective review of 850 patients who are sensitive to Anasakis 209 of whom were allergic to Anisakis. Have been collected and analyzed data related to personal history, clinical manifestations, the consumption patterns of fish, professional relationship, skin test results, total and specific IgE and its relationship with the clinic as well as assessment of the recommended diet and clinical variation and the IgE according to the same. The results emphasize that 19.5% of new patients attending the Consultation Allergy are sensitized to Anisakis simple, and 4.8% of new patients are allergic to Anasakis simplex. The occupational exposure to Anisakis simplex conditioned the existence of specific IgE values higher and more severe symptoms, and housewives are a group at risk of suffering from allergy Anisakis simplex wholesale exposure. A 47.4% of patients associated their reaction to the intake of anchovies or anchovy, a 31% of patients associated with the intake of seafood and a 14.6% intake hake or whiting. Most patients consume fresh fish (55.9%), 3 or more days a week (81%), and raw or slightly cooked (559.4%). The consumption of fresh fish, and in fact little more than three days a week, is not associated with an increased frequency of submission of anaphylaxis. Yes associates fresh consumption and high frequency of consumption with higher values of specific IgE. The distinction between frozen fish or freeze and cook does not imply the existence of significant differences in symptoms or declining levels of total IgE and IgE-specific, so that previously frozen fish allows most tolerate their intake without the need to cook well later. However, the indication of previously frozen fish consumption is not effective in 100% of the time, since the 10.6% of these patients presented symptoms at some point after eating fish previously frozen. Finally, the study by Immunoblotting of patients who do not tolerate frozen fish reveals the presence of specific IgE versus Ani s 1 in 50% of patients and compared with allergen thermosetting 9-kDa, Ani s 4, recently described in the 30%. The latter finding would explain not be tolerated in this percentage of patients. Thus, we have contributed to better understanding of this disease, and progress in assessing the effectiveness of different dietary recommendations, with the aim of recommending the less restrictive diet safe.

Author: MARTÍNEZ PATIÑO MARÍA JOSÉ.
Year: 2005.
University: VIGO [www.uvigo.es].
Place of defense: FACULTAD DE CIENCIAS DE LA EDUCACIÓN.
Place of preparation: FACULTAD DE CIENCIAS POLÍTICAS Y SOCIALES.

Summary: The overall aim of the thesis is to analyze the situation of female athletics in Spain; specifically analyze the level of participation, performance and attitudes of the Spanish high-level athlete. This is an approach to the problems of women in sport in general, resulting in a sexist conception, in which the myth of a weak women because of their gender, should not engage in certain types of activities of the firm as their own sport. Subsequently discusses the historical evolution of women in the context of athletics, since its incorporation to the gradual normalization of Spanish women on athletic activity and their first raids at the international level. It also discusses the introduction, development and decontrol of sex in high-level athletics. The empirical part of this thesis is examined in two chapters. The first of these indicators evaluated by objective-type sports development of women in athletics Land in Spain, participation, development and performance of Spanish women in athletics. In the second study pretending to know the level of satisfaction, perception of benefits and discrimination in the practice of sports in a sample of top athletes. In both studies outlined the most relevant results in relation to the dedication to sports, to the development of athletics, the perception beneficial to the grounds and satisfaction, as well as in relation to the perception of discrimination. It identifies some final conclusions of both studies and future lines of investigaicón in relation to the subject of this dissertation.

Author: KHOSRAVI SHAHI PARHAM.
Year: 2005.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of preparation: FACULTAD DE MEDICINA DE UNIVERSIDAD COMPLUTENSE DE MADRID.

Summary: 1-INTRODUCTION The marker CD45 is a transmembrane glycoprotein with activity tirosin-fosfatasa essential in regulating the immune system. The polymorphisms of exon 4 of the gene CD45 (C77G and C59A) have been linked to various diseases. In a preliminary study found an increased frequency of these polimorifsmos in neoplasms of the immune system. 2-ASSUMPTIONS AND OBJECTIVES The combination of these polymorphisms of exon 4 of the gene CD45 are the development of leukemia / lymphoma may indicate an increased susceptibility to the development of these processes and / or influence the progression of the disease once established. The objective of this study is to analyze the probable association between polymorphisms of exon 4 of the gene CD45 (C77G and C59A) and syndromes mielo and lymphoproliferative malignancies. 3-METHODS We conducted a survey of prevalecíais, to check the genotypic frequencies of polymorphisms of exon 4 (C77G and C59A) gene CD45 between the two study groups (group control-individuos healthy, and casos-enfermos with neoplasms of the immune system), which needed a sample size of 568 subjects. 4 - RESULTS In this study we have included a total of 819 subjects, 517 subjects in the control group and 302 in the group of cases. The frequency of genotypic polymorphism C77G was 1.99% in the group of cases, compared with 1.16% of the control group (p = 0342). In a subgroup analysis of cases genotypic frequencies of C77G were 2.4% in SLP (p = 0217), 2.17% in LF (p = 0451), 4.5% in LLC (p = 0254 ), from 3.3% in LH (p = 0328), 3% in transplant (p = 0132), and 5.9% in GM (p = 0039). The frequency genotypic C59A was 0% in both groups of the study. 5-Conclusions In our study we found an increased frequency of genotypic discreetly for the polymorphism C77G in the group of patients (cancer of the immune system) over the control group (healthy), but this difference is statistically significant. However, in the subgroup of multiple myeloma that difference reached statistical significance, which requires more research for confirmation.

Author: ALCARAZ BETHENCOURT AMELIA.
Year: 2005.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA - UNIVERSIDAD COMPLUTENSE.

Summary: INTRODUCTION Prevalence of insulin resistance is rising, by genetic factors and lifestyle OBJECTIVES Establish and compare the prevalence of insulin resistance with three indirect methods: Homeostasis Model Assessment (HOMA), and QUICKI Mc Auley. Comparison of Cardiovascular Risk Calculation of three equations (Framingham-Anderson: Framingham-Marrugat and SCORE for low cardiovascular risk populations). Describe in people with insulin resistance, the prevalence of other cardiovascular risk factors associated with Metabolic Syndrome. DESIGN MATERIAL AND METHODS: A cross-sectional study POPULATION: Both sexes, from 35 to 74 years, residents in Segovia, with sample size of 2992 (analyzed 900). STATISTICAL ANALYSIS: Assessment of association between variables with Chi-square test and between quantitative and qualitative variables with the Student's t test and / or ANOVA. To explore partnership between variables were used Pearson correlation coefficient or Spearman. We adjusted with Logistic regression model. PROGRAM: SPSS FOR THE CALCULATION OF CARDIOVASCULAR RISK: The three equations above, using Visual Basic. To calculate matching classification was used index Kappa. RESULTS Prevalence of insulin resistance: 24.9% HOMA, 21.7% and 24.9% QUICK Mc Auley. There was no agreement between the three methods, but between HOMA and hyperinsulinemia and fasting (Kappa) 0767). The degree of concordance between the three equations for calculating cardiovascular risk is low (kappa Anderson versus Marrugat: 0095 and Kappa Anderson versus SCORE; 0073). Conclusions Insulin resistance is a risk factor for cardiovascular disease and more reliable indirect method for diagnosis is the HOMA. Further studies are needed for calculating the cardiovascular risk because of the discrepancy observed in this study. KEYWORDS Match classification Kappa: HOMA; Framingham.

Author: RABAGO TORRES LUIS RAMÓN.
Year: 2005.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL DE LA PRINCESA.

Summary: The laparoscopic cholecystectomy is now the technique of choice for cholelithiasis not complicated. The coexistence with a coledocolitiasis described up to 16% of cases and is often conditional either open surgery or add diagnostic and therapeutic endoscopic examinations. The Colangiografía backward endoscopic (ERCP) with conducting a preoperative endoscopic sphincterotomy has been a therapeutic alternative in the case of Cole-coledocolitiasis it avoids the traditional open cholecystectomy, with a morbidity acceptable provided that the suspicion coledocolitiasis is high. If the degree of suspicion coledocolitiasis is not very high, have appeared a range of options laparoscopic or endoscopic therapy to replace preoperative ERCP and laparoscopic cholecystectomy later. However at present is continued without knowing which of the possible therapeutic options is the best: 1-preoperative ERCP and laparoscopic cholecystectomy. 2 - Laparoscopic cholecystectomy and intraoperative ERCP. 3 - Laparoscopic cholecystectomy with postoperative ERCP. Our study was a prospective randomized clinical trial conducted at the Hospital Severo Ochoa June 1999 to June 2003, approved by ethics committees and research center, which seeks to study in patients with gallbladder and intermediate, and high risk of coledocolitiasis which of the following approaches have lower morbidity and treatment is more cost effective: preoperative ERCP with subsequent laparoscopic cholecystectomy compared with laparoscopic cholecystectomy intraoperative cholangiography and ERCP intraoperative CIO. The intraoperative ERCP was performed using the technique of Rendez-Vous provided that the EOC objetivó the existence of coledocolitiasis. RESULTS Of the 1060 colecistectomías laparoscopic 136 patients were selected to be included in the study, refusing 7 to inclusion and 6 were excluded after randomization by the contraindications anesthetic or high suspected tumors. It included a total of 64 in the group of preoperative ERCP "PRE" and 59 in the group of ERCP intraoperative "INTRA" patients were included in both treatment groups. Both groups were similar except that the levels of bilirubin and GGT, and the rate of patients treated with ERCP during his first hospitalization, were higher in the group "ERP". The success rate for solving the coledocolitiasis (without resorting to new surgeries or open cholecystectomy) were similar (96.6% in the ERP group and 90.2% in group INTRA in the study protocol). Morbidity total post ERCP, and the rate of acute pancreatitis post ERCP were significantly higher in the group "ERP", did not find differences in the rate of coledocolitiasis residual rate ERCP postoperative performed, frequency conversion to open cholecystectomy, need of reoperaciones, nor in the surgical morbidity. The hospital stay and cost per patient were significantly lower in the group "INTRA" despite having a higher consumption of time surgery. The univariate analysis found no relationship between morbidity and bilirubin levels and GGT. The logistic regression analysis confirmed that the disease was only related to the therapeutic group, which included the patient, and eventually used in the operating room during cholecystectomy. The relative risk of disease patient included in the group "ERP" was 4.37 and 1015 for the time spent in the operating room. The relative risk of morbidity for conducting ERCP was 3.88 and 1.41 was done papilotomía. CONCLUSIONS The laparoscopic cholecystectomy ERCP intraoperative has a disease, a hospital stay and cost per patient significantly less than the two-stroke therapeutic ERCP with preoperative and CL later. THE decreased morbidity due to a lower incidence of pancreatitis and acute cholecystitis post ERCP in the intraoperative group ERCP. The decrease in costs is mainly due to the 8 disminuc 413 ion in the number of ERCP made, the smaller of the same disease, and the decrease in hospital stay in that group, despite having higher consumption of time for surgery . Both types of therapy have similar efficacy in resolving the coledocolitiasis of about 90%. The degree of satisfaction expressed by patients in the survey of satisfaction was very high, with no difference between groups. We found no difference between the two groups in the frequency of coledocolitiasis residual conversion to open surgery, frequency of postoperative reoperaciones and ERCP.

Author: VILLAGRAN HERRERA M. ELENA.
Year: 2005.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Chagas disease or American Trypanosomiasis, is regarded as the most important parasitic disease in the Latin American region and the third infectious disease after tuberculosis and AIDS. At work doctoral thesis are considered 4 lines of investigation related to the infection. * Study the prevalence sexológica to Trypanosoma cruzi rural populations in the state of Querétano through 4 conventional tests by applying statistical treatment between them. * The search for antibodies in the same population, using new diagnostic techniques based on the molecular biology of the parasite. * Determine the correlation between population reactive to Trypanosoma cruzi, and alterations cardiológicas measures by electrocardiograms and ecocardiogramas. * With the vector species caught, survey entomological in the state, estimating the prevalence and distribution municipal also calculate the major indexes entomological conventional. * Conduct a statistical study of the most important parameters in the epidemiology of Chagas' disease. We collected 1033 blood samples to the residents of 12 municipalities in the 18 that comprise the state of Queretaro. We applied 4 serological tests, used for the antibody antitripanosoma cruzi, in the chronic phase to the total sample of serum and only the seroreactivos and an equal number of serums used as a control, the enzyme SODFe as antigen in a Wester - Blot. It got a 6.2% with the ELISA tests and ELISA recombinant, and the enzyme SODFe and ELISA, showed a 8.2%. A 84 individuals seroreactivos and 84 seronegative used as a control, were applied studies ecocardiograficos and electrocardiográficos to detect any cardiac, we denotara disease chagasica, called dilated cardiomyopathy. The 55% of HIV infections since filed Lock branch and has left of His, Dysfunction diaastólica grades 1, 2 and 4, heart failure, increase and decrease of the right ventricle and left ventricle increased. And 37% of seronegative presented only half of these alterations. By age group, 4.7% were seropositive for the pediatric age, 8.8% of reproductive age and labor and 12.5% aged (51-80 years). The capture of triatomineos, was conducted in 10 homes by community at the rate of 1 hour / man / housing, both in the atmosphere as peridomiciliario intradomiciliario using lamps hand, tweezers Entomological and jars properly prepared for the conservation and transport of triatomineos until laboratory. It captured 4 species Tratoma Mexican 94%, Triatoma dimidiata 3%, Triatoma gerstaeckeri 2% and Triatoma pallidipennis 1%, mostly municipalities Tolimán and Cadereyta. With the species caught and slaughtered was conducted classification (Keys Carcavallo and Lentz) and assembly of the first entomological collection of the Autonomous University of Queretaro and state. We examined 230 homes, 10 homes by community, 23 communities studied, 464 bedbugs captured and 47 nymphs fished at home. These data allowed us to calculate indexes entomological most important in entomology. The rate of overcrowding and density were low, the rate of infestation in 6 of the high municipalities, except Halpan, the rate of colonization, was low in Jalpan and Peñamiller, and the rest medium, and finally the natural infection rate zero in Halpan, medium and high in 5 municipalities alone in Tolimán. Only significant difference in symptoms experienced during the survey, which is reflected in the seropositivity filed with serological evidence applied not in the other variables such as coexistence with animals (98%), 99.3% had never traveled to other communities , sex (74% female and 26% male), Characteristics of the housing (63% of thatch, sheet metal, cardboard, 80% of loose stone wall, 30% of its flat land, paving stone, rock), age (15.2% of 1-15 years, 83.3% of 16-50 years and 15% of 51-8 95 years) 408. Therefore it is concluded that to reduce costs by applying 3 conventional tests, according to the rule 2 of these should be positive for a person is considered to be infected, it is recommended to use the test as the sole enzyme SODFe because it does not react other parasites and is also specific genre of trypanosome. The state of Queretaro is endemic area and must be applied by the standard serological evidence in antibody, in addition to providing support to the rural population, and health, education and especially the improvement of housing, that for the eradication of vector.

Author: DELGADO MARTINEZ MARIA PILAR.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: HOSPITAL VALL D'HEBRON.
Place of preparation: HOSPITAL VALL D'HEBRON.

Summary: After intracerebral hemorrhage (HIC) will trigger a series of processes that contribute to secondary brain damage it causes. In these processes involves a series of molecules that could be used as markers of clinical evolution and radiation of patients who have a HIC. The objectives of the thesis are reviewing the literature concerning these processes and determine to a large sample of patients with HIC, plasma levels of D-dímero, S100B, various metaloproteasas and their endogenous inhibitors (MMP-2, MMP-3, MMP-9, TIMP-1 and TIMP-2) and molecules involved in apoptosis (caspase-3 and soluble Fas), and its relationship with later developments of patients. Among all the processes described taking a dominant role systems coagulación-fibrinólisis and phenomena neuroinflamación. In later stages, the brain damage is compounded by the involvement of proteolytic enzymes and substances derived from the lysis of erythrocytes, among others. In our patients, all biological markers to study found so elevated basal plasma (with the exception of soluble Fas and TIMP-2) and presented a profile temporarily (24 hours, 48 hours, 7Â fifth day and the third month) defined for each one of them. The baseline D-dímero predicted independently neurological impairment (with systolic blood pressure) and mortality (next to the volume of HIC). Protein S100B was related to the initial volume of the HIC. MMP-9 and its inhibitor TIMP-1 joined the swelling perihematoma baseline and MMP-3 was associated with residual volume and the third month mortality. Among the markers of apoptosis, soluble Fas suffered a significant decline, and was associated with subsequent growth of edema. Furthermore, the activation of the system Fas / Fas ligand was found in the areas perihematoma in brain tissue.

Author: PENENGO SALISBURY MARIA.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: HOSPITAL DEL MAR.
Place of preparation: UNIVERSIDAD AUTONOMA DE BARCELONA.

Summary: Background: Despite extensive literature on antipsychotic (AP) - induced D2 receptor occupancy (D2RO), it is still unclear which is the D2RO associated to symptom control in chronically dosed, stabilized schizophrenic patients as measured by 123I-IBZM single photon emission computed tomography (SPECT) and its relationship with AP pharmacokinetics (PK). Usually, D2RO is measured at a single time point after medication intake, and the influence of the scanning time within the AP interdose interval (i.i.) may be relevant for an adequate interpretation of D2RO measurements. Aims: 1) To define the striatal D2RO in stabilized schizophrenic patients on clinically relevant doses of risperidone, olanzapine, clozapine and quetiapine using 123I-IBZM SPECT, and to investigate the relationship between D2RO and plasma concentration (CP) for these AP by means of an adequate CP . D2RO model. 2) To investigate the time course of AP - induced D2RO (D2RO-time model) and corresponding CP within the i.i. for each AP. 3) To investigate, by means of simulations, the influence of changes in specific parameters included in the abovementioned models on relevant model readouts. Methods: Forty-six schizophrenic patients (32M, 29.5+-6.5 yrs., PANSS score 44.4+-8.4) stabilized on their clinically required doses of risperidone (n=12, 1.5-7 mg/day), olanzapine (n=12, 5-30 mg/day), clozapine (n=12, 50-600 mg/day) or quetiapine (n=10, 200-900 mg/day) were included. A 123I-IBZM SPECT scan was performed on each patient at a single time point after last dose intake. Patients within each AP group were randomly distributed in 4 subgroups of n=2-3, which were assigned a different scanning time based on known AP PK (the time of maximum plasma concentration Tmax and the plasma half-life T1/2), as: pre-Tmax, Tmax, early after-Tmax (before T1/2) and late after-Tmax (after T1/2). For D2RO calculations, 123I-IBZM SPECT with MRI co-registration and the tissue ratio method were used. AP CP were measured during the SPECT scan. For risperidone, the active moiety (risperidone+9-hydroxy-risperidone) was considered as CP. A sigmoidal maximum effect model (CP-D2RO model) was tested to fit the CP vs. D2RO data, as D2RO=[(D2ROMAX*CPÆgamma)/(EC50Ægamma+CPÆgamma)], where D2ROMAX is the maximum D2RO, EC50 is the CP inducing 50% of the D2ROMAX and gamma is a curve shape parameter. Naive Pooled Data (NPD) and Population-PK (Pop-PK) analyses were performed to obtain estimates of CP profiles over time (CP-NPD and CP-Pop, respectively), based on a one-compartment open linear PK model with first-order absorption and elimination, following multiple oral doses at steady state. D2RO (D2RONPD and D2ROPop) profiles over time were obtained combining the sigmoidal maximum effect and PK models. In order to reflect the fluctuation of D2RO over time, the percentage of variation between the D2RO achieved at the maximum CP (CPmax) and minimum CP (CPmin) (D2ROmax and D2ROmin, respectively) during the i.i. (24 h for risperidone and olanzapine and 12 h for clozapine and quetiapine) was calculated as %VarRO=100*[(D2ROmax-D2ROmin)/D2ROmax], for both NPD and Pop-PK analyses (%VarRO-NPD and %VarRO-Pop, respectively). The percentage of CP variation between CPmax and CPmin within the i.i. (%VarCp-NPD and %VarCp-Pop) was calculated similarly. A parameter homologous to the plasma half-life, the brain half-life (T1/2-B) was defined and calculated for the four AP. The influence of specific CP-D2RO and D2RO-time model parameters on relevant readouts was tested by means of simulations: a) effect of CP-D2RO model parameters on the curve shape; b) effect of CP-D2RO model parameters on defined outcome measures related to the CP needed to obtain 50 and 80% D2RO (C50 and C80, respectively); c) effect of PK parameters on the D2RO over time; d) effect of CP-D2RO model parameters on the D2RO over time; e) effect of PK and CP-D2RO model parameters on the calculated brain half-life. Results: Observed striatal D2RO and CP ranges were 28-75% and 9.4-60.5 n 8 g/mL for 1ff8 risperidone, 22-84% and 8.6-89.5 ng/mL for olanzapine, 5-53% and 41.6-818.2 ng/mL for clozapine and 0-64% and 37.9-719.6 ng/mL for quetiapine. A relationship was found between CP and D2RO for the four AP, with 29% of D2RO variance explained by CP for risperidone, 81% for olanzapine, 15% for clozapine and 70% for quetiapine. Estimated PK parameters from both NPD and Pop-PK anlayses showed an acceptable correspondence with the range of values reported in the literature for the four AP. D2RONPD and D2ROPop patterns over time for risperidone, olanzapine and clozapine showed a maintained D2RO, ranging between 14-67% for 1.5-7.5 mg/day risperidone, 26-80% for 5-30 mg/day olanzapine, and 12-50% for 100-600 mg/day clozapine, dissociated from the CP-NPD or CP-Pop profiles over time, respectively. However, D2RONPD and D2ROPop patterns over time matched the corresponding CP-NPD and CP-Pop curves for quetiapine at all doses. D2ROmax at peak quetiapine CP ranged from 3% at 200 mg/day to 57% at 800 mg/day. Olanzapine showed the lowest %VarCp-NPD (15%) and %VarRO-NPD (7%) whereas quetiapine showed the highest (87% and 100%, respectively). %VarRO-Pop were 35+-18% for risperidone, 15+-11% for olanzapine, 28+-13% for clozapine and 96+-9% for quetiapine. The calculated T1/2-B were 35.1+-19.4 h for risperidone, 92.5+-59.8 h for olanzapine, 20.0+-7.7 h for clozapine and 2.7+-2.3 h for quetiapine. Results of the simulations performed indicated that changes in CP had a greater impact on D2RO when CP was close to the EC50. T1/2 is the most influential PK parameter on the slope of the decrease of the D2RO over time within the interdose interval. The CP-D2RO model selection impacts the reported D2RO profiles over time. Conclusions: Stabilized schizophrenic patients showed a wide range of both D2RO and CP at clinically effective doses of the four AP. A CP-D2RO sigmoidal maximum effect relationship was described for the four AP. Chronic treatment with risperidone and olanzapine in stabilized schizophrenic patients led to an extremely stable D2RO over time for olanzapine and a moderately stable D2RO over time for risperidone during a 24-h interdose interval, with CP declining significantly faster than D2RO. However, variation in D2RO measurements within a 12-h interdose interval was seen for clozapine and quetiapine, moderate for the former and substantial for the latter. For clozapine, CP declined significantly faster than D2RO, whereas a matching pattern was seen for D2RO and CP profiles over time for quetiapine.

Author: Rubiera del Fueyo Marta A..
Year: 2006.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: Hospital Universitario Vall d'Hebron.
Place of preparation: Hospital Universitario Vall d'Hebron.

Summary: the ischemic stroke is one of the most pressing problems of society

Author: DE LA FUENTE FREIRE MARÍA.
Year: 2006.
University: SANTIAGO DE COMPOSTELA [www.usc.es].
Place of defense: Facultad de Farmacia.
Place of preparation: FACULTAD DE FARMACIA.

Summary: The objective of this work has been designing new systems nanoparticulares composed of polysaccharides, for the administration of genetic material via topical eye. First, using a technique extremely soft, known as ion gel, it has been possible to prepare nanoparticles of hyaluronic acid and quitosano, with properties suitable to be run on the surface of the eyeball. Moreover, it has been possible to incorporate these nanoparticles plasmid DNA effectively. In Vitro Studies, the nanoparticles have shown a high ability to be internalized by cells derived from human conjunctival and corneal epithelia, resulting in high levels of gene transfection. Finally, in vivo studies show not only that the nanoparticles interact effectively with the ocular surface epithelia, but also its apparent ability to effectively transfectar of both tissues. Therefore, the results presented in this thesis represents proof of concept of the potential of these nanoparticles in gene therapy eye.

Author: TORRES ANDRÉS JUAN PABLO.
Year: 2006.
University: VALLADOLID [www.uva.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE VALLADOLID.

Summary: There has been a esudio epidemiologico transverse (prevalence study), with its dual component descriptive and analytical about Burnout Syndrome among workers in the Municipality of Valladolid. We have used the following protocol: 1. Demographic characteristics and labor 2. Test Maslach (MBI) to measure the dissatisfaction labor 3. General Health Questionnaire Goldberg (GHQ) has been conducted validation and reliability of the scales used (Cronbach alpha coefficient, ceficiente of Pearson correlation and factor analysis with orthogonal rotation by the method varimax). The degree of involvement of burnout and general health (GHQ) and its relationship with socio-demographic variables were studied by T Student test, analysis of variance and Pearson correlation coefficient. The determinants of the degree of affectation as the GHQ has been studied by logistic regression.