MEDICAL SCIENCE (2)

Author: HERNANDEZ DIAZ FRANCISCO JOSE.
Year: 2004.
University: LA LAGUNA [www.ull.es].
Place of defense: FACULTAD DE MEDICINA. UNIVERSIDAD DE LA LAGUNA.
Place of preparation: FACULTAD DE MEDICINA. UNIVERSIDAD DE LA LAGUNA.

Summary: INTRODUCTION: Metabolic syndrome is an important association of factors related to cardiovascular disease, as a marker for risk of the same. Recent contributions of diagnostic criteria have facilitated the consensus for diagnosis in large populations. Scant research conducted in Spain and the Canary Islands on its prevalence, and the social characteristics associated with it. These are the objectives of this research work. SUBJECTS AND METHODS: He has taken a sample of the population for the first cut of the study CDC-Canarias. This is a cohort study of the population of the Canary Islands of legal age and that with a follow-up of twenty years, aims to study cardiovascular disease, diabetes and cancer in this archipelago. The criteria used by us for the diagnosis of metabolic syndrome has been proposed by the third of the Adult Treatment Panel (ATP-III) of the National Cholesetrol Education Program (NCEP) in the United States. In our work we have proposed the term Potential of Metabolic Syndrome compliance with at least two of the ATP-III criteria, assuming that these subjects will be a future burden on the health system if over time add a third criterion diagnosis. FINDINGS AND CONCLUSIONS number of individuals studied: 4,258. Prevalence of Metabolic Syndrome: 24%, with no difference by sex, or between different islands in the archipelago. The prevalence increases with age (6.4% in children under 32 years, up to 48.3% greater than 56 years). It also increases with poverty (from 13% between subjects quintile more wealthy, to 37.4% of the least favored quintile). The prevalence of different diagnostic criteria were: abdominal obesity exist in the 26% of men and 42% of women, high blood pressure in 54% of men and 42% of women and blood sugar high in the 18% of men and 13% of women. We have not found any significant differences between subjects with or without metabolic syndrome factors regarding physical activity, calorie intake or other habits. The paternal and maternal history of diabetes mellitus was associated with an increased frequency of metabolic syndrome (estimate relative risk 1.5-ic 1,14-2- and 1.6-ic 1,28-2 respectively). The potentiality of the metabolic syndrome has a prevalence rate of 50%.

Author: PEREZ CRUZ MIGUEL ANGEL.
Year: 2004.
University: LA LAGUNA [www.ull.es].
Place of defense: FACULTAD DE MEDICINA. UNIVERSIDAD DE LA LAGUNA.
Place of preparation: UNIDAD DE FARMACOLOGIA. DEPT MEDICINA FISICA Y FARMACOLOGIA. FACULTAD DE MEDICINA.

Summary: Introduction: Although scientific information on the pharmacological properties of ethyl alcohol is widened and exhaustive related to the pharmacological properties of the wine is scarce, even more so when it comes to comparing the red wine with white wine. Probably this information deficit comes from the assumption that the effects of wine can be attributed to ethanol containing. There is no doubt that, in large part, this is true, but it should not underestimated the presence of other compounds in these beverages. Therefore, given the different composition of red wine and white wine can be assumed that there are differences in their pharmacological effects, in this case chose the field of conduct for its study. Materials and Methods: The experiments were designed to reflect the effects of wine when administered orally in a single dose, as well as when administered daily after eight and 21 days. Four groups were established in studies: a group of administration of ethanol to 12% v / v, red wine to 12% v / v, white wine at 12% v / v and a control group (water). The dose of ethanol was for any alcoholic solution of 1g/Kg/día. At the end of each period, the animals under treatment were subjected to the following tests of conduct after 30 minutes of administration: open field, cross maze high test active acquisition in two ways. It proceeded to determine plasma concentrations of ethanol at 30 and 60 minutes after the period of single dose and 21 days. Likewise, at the end of the experiments of eight and 21 days, livers and brains of the animals were examined histologically. Conclusion: Based on the outcome, this thesis is the first work he has tried to determine the potential behavioral differences after administration of the red wine and white wine. It is plausible that the effects of both wines are mostly due to the action of ethanol and therefore that there are no significant differences between the two wines. The slight differences found in the behavior and in the levels of blood alcohol can be pharmacokinetic mechanisms. Therefore, the chemical composition of different red wines and white does not appear to influence substantially the effect of alcohol they contain.

Author: PEREZ GARCIA CARLOS GUSTAVO.
Year: 2004.
University: LA LAGUNA [www.ull.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: This thesis provides a study of the patterns of expression of certain genes that are involved in the precesos rolling cortical and regionalization. The brain alterations presenting the mutant mice for these genes will help us understand the possible role played during cortical development. The route signs Reelin-Dab1 is a complex cascade activation plays a key role in the development of laminated structures of the brain as the crust. Reelin is a protein that is evolutionarily conserved in the scale of vertebrates from amphioxus to the human, which is an indication of the role that seems to have played in developing the pallium vertebrate. Reelin is expressed during development in cells Cajal-Retzius; postnatally and in the adult stage, interneuronas GABAergicas of the crust (Pérez-García et al., 2001). Dab1 and recipients VLDLR/ApoER2 are expressed during development in the cortical plate, being very intense marking at the top of the cortical plate which is in direct contact with the area secreting Reelin (Pérez-García et al., 2004 ). The immunoreactivity at the ventricular zone for Dab1 and both receivers suggests a possible role for neurogenesis. In postnatal stages, Dab1 and VLDLR/ApoER2 appear at the pyramidal cell layers of III and V. The role postnatal Reelin seems to be more associated with neuronal plasticity and sinaptogénesis, while during cortical development is related to the regulation of migration radio. A subpopulation of cells Cajal-Retzius the rodent express, in addition to Reelin, VLDLR. On the other hand, cells Cajal-Retzius of human express the four components of the known route (Reelin, Dab1, VLDLR and ApoER2), suggesting a possible effect autocrino or paracrino the route Reelin-Dab1 level of cells Cajal-Retzius (Pérez-García et al., 2004). The mutant mice for Reelin, Dab1 or both receivers lipoproteicos lead to a phenotype Reeler, characterized by an investment cortical and cerebelar hypoplasia. The cells Cajal-Retzius in mice Reeler Orleans and Scrambler, are not affected by the mutation, while there is a cortical plate totally disorganized and alterations in the expression of Reelin in the cortical interneuronas. The mutant mice for each of the recipients lipoproteicos show differences notables.La absence of ApoER2 is most visible in the cortex and hippocampus, with a phenotype cortical more like the mutant mouse to cdk5 and irregularities at the level of the cortical plate, whereas the level hippocampus, presents additional layers and abnormal alterations in the lamination. Instead, the defects in mutant for VLDLR are most visible at the level of the cerebellum, but the cells Cajal-Retzius are diminished in number at the hippocampus and cortex, possibly related to the subpopulation of cells Cajal-Retzius expressing VLDLR. The limit choroid telencefálico (TBI) is a new concept neuroanatómico. The TBI is a structure telencefálica transient appearing between neuroepitelio future hippocampus and choroid plexus epithelium of being the main source of cells Cajal-Retzius for telencéfalo. The cells Cajal-Retzius been characterized by the expression of p73 and have their origin in the TBI, where migrating medio-lateralmente (Meyer et al., 2002). During the cortical development, there are two TBI, a level dorsal (LCTd) that appears early, and one in ventral levels (LCTv), which appears later. Both TBI disappear when you start to form the hippocampus. Genes Emx2 and Pax6 roles anatagónicas and intervene in the processes of regionalization early crust. The ra 8 tones mu 4bd tant for Emx2 and Pax6 (Sey) have serious brain disorders. In both mutants, the LCT is not developed properly, thereby cells Cajal-Retzius are going to see affected: there is an overexpression in mice mutant Sey and a notable decrease in the mutant mouse to Emx2. These data support previous results observed in the mutant to p73, in which alterations in the development of TBI will see reflected in the number and distribution of cells Cajal-Retzius (Meyer et al., 2002, 2004).

Author: GARCIA-VALDECASAS CAMPELO MARIA ELENA.
Year: 2004.
University: LA LAGUNA [www.ull.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Osteopathy patient alcohol has been studied in recent decades and has been characterized as primarily a osteoporosis. The bone is a tejdio dynamic that not only provides support, physical protection and allows movement but also is a major storehouse of minerals and alkaline reserve. It is subject to a constant process of remodeling, which represents a balance between osteoblasts and osteoclasts. In every moment of life adult bone mass is determined by the peak bone mass and the relative intensity of synthesis and destruction of bone. In this balancing act various hormones, muscle mass and physical activity and malnutrition among others. In the alcoholic patient there alteration of all these factors: malnutrition, chronic myopathy, altering the synthesis of vitamins and hormones and their intestinal absorption. In recent years it has been found that osteoclast activity is regulated by the system osteoprotegerina / RANKL (OPG / RANKL), which would act as a final common path on exercising their action hormones involved in maintaining bone mass. OBJECTIVES To analyze the prevalence of osteopenia and osteoporosis in lacohólicos, cirrñoticos and non-cirrhotic, and the relationship between bone loss and alteration of metabolism calcio-fosfórico with liver function, severity of alcoholism and nutritional status and to explore the role of the system IPG / RANKL, as well as cytokines that govern this system, osteopathy and metabolism calcio-fosfórico of ethyl patients, and its relationship to liver function, alcohol and nutrition. METHODS study of 81 men entered in the Department of Internal Medicine at the University Hospital of Canary from complications of alcoholism and the analysis of those variables related to alcoholism and osteopathy. RESULTS The bone mineral density of patients was lower than that of controls, significantly more intense in the cirrhotic patients and in relation to the deterioration of liver function and more scarce over time consumption. The relationship between nutritional status and bone mass was statistically significant, and the multivariate analysis showed that the bone mass of cirrhotic relates to nutritional factors but osteoporosis is related to the deterioration of liver function. In the study of bone markers were observed both disminuición of synthesis, low levels of osteocalcin, and increased bone resorption, increased levels of telopéptido C-terminal. The study of hormone axis governing bone metabolism there are statistically significant differences for free testosterone, IGF-1 and vitamin D. The study of the system OPG / RANKL was observed elevated levels of MPO in patients and even higher in cirrhotic presented positive correlation with the time consumption and cytokines and conversely with nutritional status and IGF-1, multivariate analysis revealed that presented an independent activity protombina. Conclusions Patients alcoholícos show a decline in bone mass in the entire skeleton. This decline is higher in cirrhotic and indpendiente of age and the consumption of snuff. The loss of bone mass is related to the deterioration of liver function. It is also related to the decrease in lean mass, reduced muscle strength and also with the decline in lean mass. The MPO is high in alcoholic patients, especially in cirrhotic, relevant to the deterioration of liver function. Its relationship with bone mass is low. The MPO directly related cytokines activators reabsorption (IL6 and TNF-alpha) and reverse a promoter of bone synthesis (IGF-1), it is possible that the MPO in alcohol, behave as in other situations characterized by loss demasa ós 8 ea, expe 2c3 rimentando higher compensation.

Author: García Medina Manuel.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: Instituto Municipal Investigaciones Médicas.
Place of preparation: Instituto Municipal Investigaciones Medicas.

Summary: The tissue plasminogen activator (tPA) plays a vital role plasmin generated from plasminogen. Classically, tPA has been studied in blood and central nervous system in processes related to learning and memory. In this study, we found that tPA is involved in Alzheimer's disease. Human Brains from Alzheimer's presented a strong expression of tPA colocalizando with amyloid-rich regions, Erk1 / 2 activated and tau fosforilada in epítopo AT8. In primary cultures of rat neurons hipocampales, adding tPA leads to activation of Erk1 / 2, which involves the NMDA receptor, G protein PKC. This activation Erk1 / 2 results in the activation of GSK3 and leads to aberrant phosphorylation of tau, destabilization of microtubules and apoptosis. Effects similar to those described are produced by aggregates of amyloid in a way dependent on tPA, as evidenced by results in neurons of mice and wild-tPA / -.

Author: Fernández Delgado Lourdes.
Year: 2004.
University: SEVILLA [www.us.es].
Place of defense: Facultad de Medicina. Universidad de Sevilla.
Place of preparation: Facultad de medicina. Universidad de Sevilla.

Summary: At present, every day there are more evidence of the involvement of neutrophils in allergic diseases in general, and asthma in particular. The polymorphonuclear leukocytes are neutrophils, which play an essential role in the immune system, the first line of defense against infection by bacteria. Their role in the inflammation is thought that was restricted their ability to phagocytosis and release of enzymes and other cytotoxic agents. However, currently known as these cells can release various mediators who can exert a profound impact on the airways of asthmatic individuals. Previous studies have shown that a provocation to a specific allergen, neutrophils arrive before eosinophils to the target organ. The neutrophils possess the three IgE receptors on the cell surface. And our group has shown in numerous works, including specific allergens can functionally activate neutrophils of allergic patients sensitized to these and mediators release after a stimulus IgE dependent. The lactoferrina is an iron carrier protein, which is present in the grain or specific secondary neutrophils and reveals increasingly as a key element in the pathophysiological events linked to infection and inflammation. Participates in antibacterial mechanisms of polymorphonuclear and behaves as an important regulator of mielopoyesis and iron metabolism. The lactoferrina plays a central role in the modulation of inflammation of the airways, their ability to join the free-ferrous ions makes these do not contribute to catalysis of toxic oxygen radicals will be able to continue to exercise their functions. At the same time, lactoferrina is able to promote the adhesion of leukocytes to endothelial wall, which amplifies the cellular inflammatory response. Speakers in the activation of natural killer cells and promotes activation of macrophages by promoting the secretion of TNF, IL-8, NO, IL-1Ã, GM-CSF. The lactoferrina neutrophilic in amounts similar to those found in the liquid from the airway eosinophils induces in several effects: the production of superoxide, the degranulation of the same with the release of EDN, and the synthesis of leukotriene with the subsequent secretion the leukotriene C4, suggesting that the accession of the lactoferrina the epithelium may constitute a mechanism of the inflammatory process originator eosinofílico into the airway. Therefore it is possible that other factors than IgE (eg lactoferrina released by neutrophils and their receptors), act as inducers of activation of eosinophils in the processes atopic IgE-mediados. In addition, the findings that CCA secreted by neutrophils stimulated release of the lactoferrina by glands serosas of the lining of the respiratory tree, it increases the possibility that the eosinophil activation of this lactoferrina can take place via a positive feedback mechanism generated by the CCA's eosinophil with the consequent persistent activation of this unit within the air. Therefore it is possible that the activation of the neutrophil-mediated IgE may modulate the response of eosinophils in atopic processes. Different granules have different physiological functions, the exocytosis of the same is governed by independent mechanisms, while the degranulation of azurófilos can be done without being made to the side and vice versa. Well, our group has demonstrated as specific granules are released through a mechanism IgE-dependiente. Faced with the increased presence of lactoferrina in allergic diseases, we wanted to see that actually could make a exocytosis of granules side or especí 8 Features and 1978 specifically for the release of lactoferrina, by a mechanism antígeno-específico IgE-mediado . The neutrophils from asthmatic patients were stimulated with the allergen which were specifically sensitive measuring the release of lactoferrina in the cell supernatant. The treatment of neutrophils with the allergen resulted in the release of the lactoferrina by neutrophils from patients who were allergic to that specific allergen, revealing the release of lactoferrina is rather higher in the cells of asthmatic patients incubated with the allergen that are sensitive to compare it with the lactoferrina released by neutrophils from healthy controls and neutrophils from asthmatic stimulated with an allergen to which they are not aware. Therefore, we can conclude that the release of lactoferrina it is a specific reaction and depends on the existence of allergen sensitivity tested, and that this release was to turn dose and tiempo-dependiente. We have also demonstrated how neutrophils from patients with skin test and positive allergen-specific IgE were studied on the cell surface of neutrophil positive allergen-specific IgE, and after incubation with the same, only in these neutrophils showed release lactoferrina as a deduction appears to be IgE-specific cell surface of the neutrophil responsible for the release of the lactoferrina through a mechanism IgE-dependiente. In no case was found or specific IgG in the serum or in supernatant from the elution of immunoglobulins from the surface of neutrophils, which exclude the participation of IgG. Besides specific IgE eluted from the cell surface corresponds completely with the amount of IgE-specific serum. Moreover, as the figures for specific serum IgE increases so does the amount of lactoferrina released by neutrophils after stimulation specific allergenic, which further strengthens the role of IgE in liberating lactoferrina. But despite this, we do not get a correlation between the total number of lactoferrina released and the amount of serum specific IgE, which is even talk that a mechanism dependent on the amount of this immunoglobulin, there may be other factors that influence the release of lactoferrina by neutrophils in atopic patients. Like all the studies conducted so far had been conducted in patients allergic asthmatics could believe that these findings may only be able to achieve with cells from these patients, which might lead us to think that they do not reflect the nature of Eczema the patients, but his asthmatic condition. To check this end we have studied the release of lactoferrina by neutrophils stimulated with the allergen that are sensitive in patients with bronchial asthma and rhinitis in patients with extrinsic. When encourage neutrophils in both groups of patients, we observe as there were no significant differences in the lactoferrina secreted in both cases. This shows that our findings are a result of the nature of atopic patients, independent of the clinical picture (rhinitis / asthma). To discard that one can only produce the release of lactoferrina after stimulation of neutrophils with a single allergen, we decided to study the lactoferrina secreted after stimulation of neutrophils with different allergens to which patients were sensitive. In this way we could see how the secretion lactoferrina is not specifically single allergen but after stimulation of neutrophils with any of the allergens to which the patient is allergic. Subsequently, in order to clarify whether the release of lactoferrina by neutrophils of allergic patients is related in some way with the respiratory function of asthmatics, and thus in turn clarify the role of products secreted by the on neutrophil function respiratory, we studied the correlation between the amount of lactoferrina released after incubation of neutrophils with these allergens and lung function of patients, measuring FEV1, and found that there is an inverse relationship between the release of lactoferrina and FEV1. This corroborates the possible role of the neutrophil in impairment of respiratory function in patients with bronchial asthma extrinsic. We have seen through the bronchial provocation with normal saline and metacholine not observed variations in the amount of lactoferrina released from the baseline determination and following the provocation. By provocation allergen specific note as there is a larger quantity of release of lactoferrina after provocation, whether the patient has had only an immediate response as if it had dual immediate and late. And when there is a belated reaction determinations after the provocation are higher than if it only gets an immediate reaction. Not surprisingly, since this reaction is conditioned by the presence of secondary effector cells such as eosinophils and neutrophils themselves. We have also tested as to compare levels of lactoferrina in different degrees of severity of asthma and in healthy controls, there is a greater amount of lactoferrina released in all subgroups of asthma compared with the healthy control subjects, while the figures lactoferrina released by neutrophils of the patients are older, the greater the severity of asthma.

Author: MOYA VILLAESCUSA MARIA JOSE.
Year: 2004.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGIA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGIA - UNIVERSIDAD DE MURCIA.

Summary: The dissertation appreciates the originality and innovative features in a simple and effective technique for the evaluation of tissue perimplantarios. The adequacy of the material to the problem and the methodology used, as well as the consistency between its goals and the conclusions it has reached.

Author: BURGUÉS GASIÓN JUAN PABLO.
Year: 2004.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAT MEDICINA I ODONTOLOGIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGÍA.

Summary: Introduction: The effectiveness of intravesical chemotherapy as adjuvant treatment after TUR superficial bladder tumors is limited by resistance to individual drugs or multirresistencias several agents. We have developed various tests quimiosensibilidad in vitro, but most crops based in monolayer or suspension of individual cells. The cultivation of the three-dimensional esferoides tumor cell interactions and retains the original architecture tissue, which is a model closer to reality, to be able to reproduce the molecular mechanisms of resistance both unicellular and multicellular. Objectives: 1) Develop a test quimiosensibilidad to agents intravesicales commonly used in clinical practice: epirubicin (EPI), adriamicina (ADR) tiotepa (TIO) and mitomycin C (MMC). 2) To investigate the effect of verapamil (DPM) on the resistance to epirubicin. 3) To determine the cytotoxicity induced by ciprofloxacin (CIPRO) alone or in combination with epirubicin. Materials and methods: We took 2 biopsies gripper cold in 40 patients. The samples were fragmented, introduced in a jar based agar and supernatant modified Eagle medium supplemented by Dulbecco, and made to grow in an atmosphere of 5% CO2, 37Â ° C and relative humidity of 100%. In the 2 days were selected 72 esferoides each tumor under microscopic vision and were transferred to 3 on 3 a plate with 24 wells, 6 of them with CIPRO 0.2 mg / ml. 3 days later added: 1) wells 1-3: PPE 1 mg / ml; 2) wells 4-6: PPE 1 mg / ml + DPM 0.5 mg / ml; 3) wells 7-9: ADR 1 mg / ml; 4) wells 10-12: THIO 1 mg / ml; 5) wells 13-15: MMC 1 mg / ml; 6) wells 16-18: PPE 1 mg / ml + CIPRO 0.2 mg / ml; 7) wells 19-21: CIPRO 0.2 mg / ml; 8) wells 22-24: control without chemotherapy. After 2 hours proceeded to the collapse of esferoides with 0.25% tripsina-EDTA and cell viability was determined in each well through the procedure of excluding cells stained with blue tripano a hemocitómetro of Neubauer. We calculated the resistance Agent X and the fraction between the viability average wells with agent X viability average of the monitoring wells) and sensitivity as the 100% - resistance. Results: The test was applicable to 77.5% (31 of 40 tumors), but if we do not take into account tumors G3 or partners in CIS (subsidiary of BCG and not intravesical chemotherapy), the evaluability test was 84 %. Each patient was possible to discriminate significant differences between the various agents used intravesicalmente. Overall, the best medicine was MMC, followed by TIO and finally EPI and ADR. The combination DPM + EPI EPI was higher than in all cases, and always exceeded MMC TIO, PPE or ADR. The CIPRO applied 72 h did not produce any effect only or in combination with ILD. Conclusions: It is possible to test in vitro sensitivity of superficial bladder tumors to different agents used in intravesical instillation. This "antiquimiograma" could have a potential clinical utility to assign each patient the drug more active and able to reduce the number of relapses. The model also has a clear utility to test new experimental drugs or combinations. Consistent with the literature, DPM reverses the resistance to PPE. Furthermore, the combination DPM + PPE is always better than any of the drugs tested. Other in vitro studies give CIPRO a cytotoxic effect by itself or empowering PPE when applied over a period of 24-96 hours urinary concentrations which are achieved with oral administration. We have not noticed any change in cell viability c 8 on the ad 2b5 ición of CIPRO.

Author: CARRASCO SANMARTIN HECTOR MANUEL.
Year: 2004.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAT MEDICINA I ODONTOLOGIA.
Place of preparation: FACULTAT MEDICINA I ODONTOLOGIA.

Summary: We studied the incidence of accidents low in Spain (1999-2001) by the nature of the injury and the anatomic region affected. We studied the evolution of the economic costs of accidents at work in Spain in the period 1998-2001. It was determined the incidence of accidents eye, what type of injuries occur, their distribution by sex, age, type of work, as well as its causes. We studied the presence of ocular symptoms in workers who use display screen of data and its subsequent compared with non-users of workers display screen data.

Author: RUEDA SORIANO JOAQUIN.
Year: 2004.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGIA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGIA.

Summary: OBJECTIVES OF WORK HAVE BEEN AWARE DEMOGRAPHIC PROFILE, CLINICAL AND ELECTROCARDIOGRÁFICO OF PATIENTS INGRESADOS WITH BREAKDOWN OF SYNDROME CORONARIO ACUTE WITHOUT RISE OF CONTINUING SEGMENT ST. ANALYZING THE IMPACT OF EVENTS SIDE ISQUÉMICOS DURING AND AFTER A HOSPITALARIO INCOME UP FOR LONG. IDENTIFY THE VARIABLES THAT LEARNED IN INCOME THAT ARE PREDICTIVAS OF EVENTS SIDE ISQUÉMICOS. AT WORK HAS BEEN OBSERVADO THAT PATIENTS ESTUDIADOS FORMING A GROUP HETEROGÉNEO, MIDDLE AGE WITH A HIGH, AND MORE PROPORTION OF MEN'S PREVALENCE OF HIGH RISK FACTORS, FUNDAMENTALMENTE HIPERTENSIÓN ARTERIAL, HIPERCOLESTEROLEMIA, CARDIOPATIA ISQUÉMICA PRIOR AND ARTERIOPATÍA PERIFÉRICA. AT THE TIME OF ENTRY TO 30% OF PATIENTS NOT SUBMITTED ALTERATION OF THE REPOLARIZACIÓN BUT THESE ARE OBSERVARON IN THE 100% OF PATIENTS WITH NO LIFTING OF MYOCARDIAL CLIP ST. MORTALITY INTRAHOSPITALARIA WAS OF 2.7% AND THE IMPACT OF COMBINED EVENTS OF 4.6%, PRESENTADOSE MORE THAN HALF OF THEM IN THE FIRST 48 HOURS. THE VARIABLES ASSOCIATED WITH GREATER INCIDENCE OF DEATH OR COMBINED EVENT MYOCARDIAL HOSPITALARIO WERE: AGE OR MORE EQUAL TO 70 YEARS. FEMALE SEX, NOT LIFTING OF MYOCARDIAL CLIP ST, ANGINA PROGRESSIVE, DIABETES MELITUS, RENAL, INSUCIENCIA HEART PRIOR, HEART FAILURE KILLIP MAYOR OF I CHANGES OF CLIP ST-ONDA T DESCENT OF CLIP ST, HEART HIGH FREQUENCY AND HIGH LEVELS OF FIBRINÓGENO, GLUCEMIA And CKMB. THE VARIABLES PREDICTORAS INDEPENDENT EVENT OF COMBINED INTRAHOSPITALARIO WERE: AGE OR MORE EQUAL TO 70 YEARS, THE DESCENT CLIP AND LEVELS OF ST FIBRINÓGENO OR EQUAL THAN 385 MG / DL. PATIENTS SUBMITTING AN HIGH INCIDENCE OF COMPLICATIONS SERIOUS ISQUÉMICAS DURING THE 3 FIRST YEAR, LIKE TO FILED IN ACUTE PHASE. THE VARIABLES PREDICTIVAS INDEPENDENT OF COMBINED EVENT OF DEATH OR HEART MYOCARDIAL INFARCTION NOT FATAL FOR LONG WERE: AGE EQUALS OR MORE OF 70 YEARS, DIABETES MELITUS, HIPERTENSIÓN ARTERIAL, RENAL, ACCIDENT CEREBROVASCULAR PRIOR, HEART FAILURE KILLIP MORE OF THE INCOME I , DESCENT OF ST SEGMENT IN THE INITIAL ECG AND LEVELS OF FIBRINÓGENO OR EQUAL THAN 385 MG / DL.

Author: POLO ROMERO FRANCISCO JAVIER.
Year: 2004.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: COMPLEJO HOSPITALARIO UNIVERSITARIO DE ALBACETE.

Summary: Acute renal failure frequently occurs as a complication of diseases prior generally serious. It affects 5% of the subjects admitted to hospital, increasing to 30% for patients admitted to intensive care units. Among the possible causes is rhabdomyolysis, an entity in which it produces the dissolution of striated muscle with the consequent release the bloodstream of intracellular components, including mioglobina. The mioglobina is a pigment hematínico whose function is the storage of oxygen and transport it within the muscle cells. Excess mioglobina in the light of renal tubule is at the root of the pathogenic mechanisms by which the kidney damage occurs within the rhabdomyolysis. For the study of acute renal failure mioglobinúrico has developed an experimental model in rats in the induction of rhabdomyolysis by intramuscular injection of glycerol hypertonic. This model has revealed important aspects of pathogenicity accepted the existence of three pathophysiological mechanisms: tubular obstruction, renal vasoconstriction and the toxic effect of ferric component of the mioglobina through increased oxidative stress. The cornerstones of treatment for acute renal failure mioglobinúrica affect mainly in correcting the deficit volume and associated renal ischemia and the elimination of proteins hemo of light tubular. This study was designed to test the usefulness of antioxidant N-acetylcysteine in the treatment of acute renal failure mioglobinúrica to act on oxidative stress as one of the pathogenic mechanisms of the table. It was distributed to the animals in 4 groups: (1) induction of rhabdomyolysis and slaughter of animals without treatment, (2) rhabdomyolysis and treatment with N-acetylcysteine; (3) rhabdomyolysis and placebo treatment, and (0) group control without intervention to know the values of normalcy. All rats were sacrificed at 24 am and measured parameters of renal function and morphologic alterations total antioxidant status (TAS) in serum. As a result of the study showed three facts: 1) that animals treated with N-acetylcysteine had a lesser degree of deterioration of renal function with respect to the animals that did not receive any treatment or for those who were treated with placebo; 2) the animals receiving N-acetylcysteine had a higher level of serum TAS that other groups, including the control group and 3) that did not exist at histologic differences arising from the use of N-acetylcysteine. In the first case, found improvement in renal function in rats treated with N-acetylcysteine was statistically significant, but not able to get a normalization of renal function. In the case of TAS, the difference was significant between the group treated with N-acetylcysteine and who did not receive treatment after rhabdomyolysis, but there are no differences between the group treated with N-acetylcysteine and placebo-treated. Our results must be viewed with caution derived from the limitations of the study in the absence of a phase of long-term survival, while in the first 24 hours there is a beneficial effect on renal function with the administration of N-acetylcysteine. Therefore the use of substances such as antioxidants N-acetylcysteine must take place as early as possible to get a greater benefit. The fact that the improvement of renal function at biochemical not mean normalization of the same and that there is no benefit histology demonstrated in the early hours leads us to believe that the role of 8 the N-ac 340 etilcisteína, although beneficial, limited alone, thus constituting an adjunct to the classically accepted by the scientific community.

Author: BAÑOS MADRID RAMÓN ISIDORO.
Year: 2004.
University: MURCIA [www.um.es].
Place of defense: HOSPITAL UNIVERSITARIO VIRGEN DE LA ARRIXACA.
Place of preparation: HOSPITAL UNIVERSITARIO VIRGEN DE LA ARRIXACA.

Summary: Beginning in 1980 are beginning to resurface infections caused by Gram-positive bacteria. S. Aureus appears alongside other Gram-positive bacteria as one of the predominant pathogens in hospitals. The bacteremia by S.aureus is a classic problem, difficult and comprehensive, with a component of yatrogénia important. At the present time is one of the micro-organisms found more frequently as a cause of bacteremia, with a percentage ranging from a 10-15% of the published series recent years to appreciate a high mortality. It is characterized by nosocomial acquisition and the increase in strains resistant to methicillin. It gives rise to severe clinical manifestations difficult therapeutic management. This leads us to consider a prospective observational study with three goals. First conduct a comprehensive study descriptive and prognostic factors. Secondly assess the meaning of resistance to methicillin in the clinical setting, and finally the influence of antibiotic treatment in its evolution. It studied 213 patients admitted to the Hospital Virgen de la Arrixaca Murcia with the diagnosis of bacteremia by S. Aureus during 2.000-2.003. The results were as follows: Patients with bacteremia by S.aureus is characterized by diseases base and predisposing factors. Among the highlights basic diseases diabetes and heart disease. With regard to the risk factors highlighted making broad spectrum antibiotics before the bacteremia, as well as the existence of vascular catheters. The bacteremia by S. Aureus are basically of nosocomial acquisition. It has detected a small number of patients with endocarditis, while this figure in relation to a decrease in the number of patients ADVP. Certain factors such as a table septic previous burns, income units in high-risk, the presence of vascular catheters, tracheostomy, intubation orotraqueal, broad spectrum antibiotics and diabetes, and we must do predispose suspect infection SARM. Patients with bacteremia by SARM presented more clinical severity at the start of bacteremia, a greater number of complications and mortality bacteremia by SASM. The severity of the disease basis, the initial clinical condition and treatment appropriate to the characteristics of bacteremia remain the main prognostic factors in patients with bacteremia by S. Aureus. A proper treatment to start with a period adjusted to the rate of infection has greater influence in practice bacteremia by SARM and this level must act if we are to improve the prognosis of infection. With regard to bacteremia by SASM, has more influence on the type of antibiotic used, appreciating a better prognosis in patients treated with cloxacillin. There is a higher mortality for those patients who have been treated with a treatment not appropriate at the beginning of the bacteremia or duration of treatment was not adjusted to the severity of the same. Patients with bacteremia by SASM treated with glycopeptide have a higher number of therapeutic failures compared with patients treated with cloxacillin. Cloxacillin is the treatment of choice in bacteremia by SASM, with a need for new drugs, not glycopeptide, which offer a suitable alternative for patients with allergy to beta-lactams. With regard to patients with bacteremia by SARM, those who are treated with vancomycin have a worse developments that patients treated with teicoplanin or linezolid. Therefore, it requires a better understanding of the epidemiology, clinical factors, risk and prognosis that facilitate diagnosis of suspicion and early treatment more effective bacteremia by S. Aureus.

Author: García Teruel María de la Paz.
Year: 2004.
University: MURCIA [www.um.es].
Place of defense: Facultad de Medicina. Universidad de Murcia..
Place of preparation: Facultad de Medicina.Universidad de Medicina..

Summary: A primary objective of this work was to analyze the doctoral thesis remodeled coronary artery induced hypertension, both in early stages as the most advanced of the same. Also, we studied the effect of the deficiency estrógenica on remodeling associated with hypertension. Moreover, we appreciate the effect of exogenous administration of estradiol. To that end, we used a model of spontaneous hypertension, SHR rats, in early stages of hypertension (18 weeks old) and in more advanced stages (33 weeks) and has been compared with a group of normotensive rats, rats WKY, in the same age. To assess the effect of deprivation estrógenica conducted a ovariectomia bilateral eight weeks prior to the time at which the study was conducted of arterial remodeling. A portion of these animals were implanted subcutaneously a pellet estradiol liberation lens that prevented the estrogen deficiency. The study of arterial remodeling, changes in the structure of the vessels as fibrosis perivacular was held in vessels that came from cuts semifinos left ventricular using specific staining techniques, these images were captured through a system of video-microscopio the images analyzed by a computer program to analyze images. All studies of arterial remodeling were carried out at 18 and 33 weeks of life of these animales.Como result, we see an eutrophic remodeling, which is characterized by a rise in the wall / Light unchanged in the area of the wall in early stages of hypertension, which was aggravated by estrogen deficiency. Exogenous administration of estradiol was able to prevent this effect of ovariectomy. In later stages of hypertension, remodeled presenting is a hypertrophic, characterized by an increase in the area of the wall and the wall relationship / light without the ovariectomy or exogenous administration of estradiol produced no effect. A second objective of this paper thesis doctotal was to study the importance of regulating extracellular protein kinases (ERK 1 / 2) at the effect of estrogen deficiency on vascular remodeling in the early stages of hypertension. His determination took place in samples that came from aortas and mesenteric vascular bed, using techniques of Western Blott. Observándose how estrogen deficiency increased the active form of these kinases. This increase was prevented by the administration of exogenous estradiol. Lastly, we have to assess the effect of chronic inhibition of the angiotensin converting enzyme (ACE) on the structural changes induced by ovariectomy in the early stages of hypertension. In turn, we studied the effect of joint estradiol and inhibition of ACE with captopril. Observádose that captotril isolated did not prevent the effects of ovariectomy on the arterial remodeling. However, the effect of estradiol increased captopril previniéndose changes induced by ovariectomy. In considering the implication of the kinases ERK1 / 2, in samples from aortas and mesenteric vascular bed, we note that treatment with estradiol and captopril prevented the increase in the active form of this kinase induced by ovariectomy, whereas treatment isolated with captopril did not change significantly the effect of ovariectomy on the active form of these kinases.

Author: Marin Garcia Ma. Dolores.
Year: 2004.
University: MURCIA [www.um.es].
Place of defense: Hospital Morales Meseguer.
Place of preparation: Universidad de Murcia.

Summary: The growing concern about the risks psicisociales suffered by the worker in elejercicio his profession has focused primarily on collective welfare, acting on a salaried activity in institutionalized frameworks, where specific conditions bind a large number of triggers high levels of work-related stress as overhead work, conflict or ambiguity roles. In our collective, most employed persons also factors as treatments unforeseen or work alone will generate high levels of stress. That is why we have raised this study based on the following objectives: 1 .- To determine levels of anxiety and burnout in a sample of dentists in our geographic environment, which allows us to develop a reference guide 2 .- To study the possible relationship between indicators of stress and sociodemographic characteristics and labor. 3 .- Establish differential patterns according to the selected variables. 4 .- To determine differences or similarities between our results and those of other studies of different demographic areas. Using a sample of 100 dentists in the region, and employ 4 questionnaires: a general questionnaire data sociodemographic and labor, two self-assessment questionnaires to measure anxiety and burnout and a test of psychomotor. The conclusions drawn after interpreting the results are: 1 .- Comparing our results with those obtained in the reference sample of MBI We can say that the dentists in our sample show lower rates of burnout. 2 .- anxiety levels measured by the STAI Our shows have proved to be lower than the levels of anxiety among the general population. 3 .- The emotional exhaustion is the scale of MBI Qu enuestra shows in the highest scores get higher. 4 .- The depersonalization is the scale of MBI In our sample obtained highest scores lowest. 5 .- The tiredness is explained by emotional anxiety trait, the depersonalization and sociodemographic variables and labor. 6. The depersonalization is explained by emotional exhaustion, personal fulfillment and labor variables. 7 .- Given the characteristics of the study sample, the professionals who get high scores in two of the scales of MBI Are professionals 41-50 years who have a higher labor saturation due to the increased number of patients. 8 .- The levels of anxiety, burnout and psychomotor disturbances in dentistry professionals who exercise their self-employed activity are at a lower level than other health groups that carry out their activities in an institutionalized framework

Author: MONTIEL COMPANY JOSE MARIA.
Year: 2004.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE VALENCIA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGIA DE LA UNIVERSIDAD DE VALENCIA.

Summary: Introduction: After 6 years of the latest epidemiological survey, pending the implementation of a program of children's dental care (PADI) in benefits Valencian Health Service in the region of Valencia, there is a need to determine the current state of health Oral child population and assess their progress in the period 1998-2004. Materials and Methods: There has been a cross-sectional study of prevalence court or from a random sample through a cluster sampling. We selected a representative sample of children aged 6 years (509 children), 12 years (478) and 15-16 years (401) throughout the Community of Valencia. The scans were performed in the same school for three explorers previously trained and calibrated during the months of November and December 2004. At the same time conducted a survey of hygiene to children 12 and 15-16 years. Results: At the age of 6 years, the prevalence of caries in primary teeth is 32.2%, with the cod index of 1.08. For 12 years, the prevalence of tooth decay in permanent teeth is 42.5%, the index co (d) 0.19, the index CAO (D) of 1.07 and SiC of 2.94. For the 15-16 years the prevalence of tooth decay in permanent teeth rises to 55.9% and the index CAO (D) stood at 1.84. The rate of restoration at the age of 12 years is 32.7%. We have found significant differences between the rates of decay and the prevalence of the same among immigrant children and children Valencia, the latter with better standards of oral health. As for the Community Periodontal Index, the average sextants with bleeding falls to 6, 12 and 15-16 years at 0.16, 1.57 and 1.1 respectively and miscalculations in 0.14, 0.76 and 0.87.La average permanent teeth sealed at the 12 years is 0.33 and the percentage of individuals sealant is 14.6%. Regarding the most important hygiene habits in children aged between 12 and 15 years of age, 79.6% are brushing your teeth daily, 56.7% of fluoride rinses has done for over two years and 71.5% had visited the dentist once a year. Rather a 14.3% ingested food cariogénicos between meals. Conclusions: The decay rates and the prevalence remains at levels similar to those achieved in the previous survey 1998 at the ages of 6 and 12 years. At the age of 15-16 there is a decrease in prevalence (from 69.3% to 55.9%) and the ICAO (D), which rises from 2.45 to 1.84. There is a phenomenon of concentration of the largest number of cavities in an ever smaller percentage of the population. The immigrant school population looms as a problem emerging oral health in our community, because of their high levels of decay. The periodontal health is maintained at levels similar. There was a slight increase to 12 years of age in the proportion of individuals with teeth sealed in the average teeth sealed. The hygiene habits have improved slightly for the study of the year 1998. Introduction: After 6 years of the latest epidemiological survey, pending the implementation of a program of children's dental care (PADI) in benefits Valencian Health Service in the region of Valencia, there is a need to determine the current state of health Oral child population and assess their progress in the period 1998-2004. Materials and Methods: There has been a cross-sectional study of prevalence court or from a random sample through a cluster sampling. We selected a representative sample of children aged 6 years (509 children), 12 years (478) and 15-16 years (401) throughout the Community of Valencia. The scans were performed in the same school for three explorers previously trained and calibrated during the months of November and December 2004. At the same time conducted a survey of hygiene at 8 os boys 1796-12 and 15-16 years. Results: At the age of 6 years, the prevalence of caries in primary teeth is 32.2%, with the cod index of 1.08. For 12 years, the prevalence of tooth decay in permanent teeth is 42.5%, the index co (d) 0.19, the index CAO (D) of 1.07 and SiC of 2.94. For the 15-16 years the prevalence of tooth decay in permanent teeth rises to 55.9% and the index CAO (D) stood at 1.84. The rate of restoration at the age of 12 years is 32.7%. We have found significant differences between the rates of decay and the prevalence of the same among immigrant children and children Valencia, the latter with better standards of oral health. As for the Community Periodontal Index, the average sextants with bleeding falls to 6, 12 and 15-16 years at 0.16, 1.57 and 1.1 respectively and miscalculations in 0.14, 0.76 and 0.87.La average permanent teeth sealed at the 12 years is 0.33 and the percentage of individuals sealant is 14.6%. Regarding the most important hygiene habits in children aged between 12 and 15 years of age, 79.6% are brushing your teeth daily, 56.7% of fluoride rinses has done for over two years and 71.5% had visited the dentist once a year. Rather a 14.3% ingested food cariogénicos between meals. Conclusions: The decay rates and the prevalence remains at levels similar to those achieved in the previous survey 1998 at the ages of 6 and 12 years. At the age of 15-16 there is a decrease in prevalence (from 69.3% to 55.9%) and the ICAO (D), which rises from 2.45 to 1.84. There is a phenomenon of concentration of the largest number of cavities in an ever smaller percentage of the population. The immigrant school population looms as a problem emerging oral health in our community, because of their high levels of decay. The periodontal health is maintained at levels similar. There was a slight increase to 12 years of age in the proportion of individuals with teeth sealed in the average teeth sealed. The hygiene habits have improved slightly for the study of the year 1998. Introduction: After 6 years of the latest epidemiological survey, pending the implementation of a program of children's dental care (PADI) in benefits Valencian Health Service in the region of Valencia, there is a need to determine the current state of health Oral child population and assess their progress in the period 1998-2004. Materials and Methods: There has been a cross-sectional study of prevalence court or from a random sample through a cluster sampling. We selected a representative sample of children aged 6 years (509 children), 12 years (478) and 15-16 years (401) throughout the Community of Valencia. The scans were performed in the same school for three explorers previously trained and calibrated during the months of November and December 2004. At the same time conducted a survey of hygiene to children 12 and 15-16 years. Results: At the age of 6 years, the prevalence of caries in primary teeth is 32.2%, with the cod index of 1.08. For 12 years, the prevalence of tooth decay in permanent teeth is 42.5%, the index co (d) 0.19, the index CAO (D) of 1.07 and SiC of 2.94. For the 15-16 years the prevalence of tooth decay in permanent teeth rises to 55.9% and the index CAO (D) stood at 1.84. The rate of restoration at the age of 12 years is 32.7%. We have found significant differences between the rates of decay and the prevalence of the same among immigrant children and children Valencia, the latter with better standards of oral health. As for the Community Periodontal Index, the average sextants with bleeding falls to 6, 12 and 15-16 years at 0.16, 1.57 and 1.1 respectively and miscalculations in 0.14, 0.76 and 0.87.La average permanent teeth sealed at the 12 years is 0.33 and the percentage of individuals sealant is 14.6%. Regarding the most important hygiene habits in children aged between 12 and 15 years of age, 79.6% are brushing your teeth daily, 56.7% of fluoride rinses has done for over two years and 71.5% had visited the dentist once a year. Rather a 14.3% ingested food cariogénicos between meals. Conclusions: The decay rates and the prevalence remains at levels similar to those achieved in the previous survey 1998 at the ages of 6 and 12 years. At the age of 15-16 there is a decrease in prevalence (from 69.3% to 55.9%) and the ICAO (D), which rises from 2.45 to 1.84. There is a phenomenon of concentration of the largest number of cavities in an ever smaller percentage of the population. The immigrant school population looms as a problem emerging oral health in our community, because of their high levels of decay. The periodontal health is maintained at levels similar. There was a slight increase to 12 years of age in the proportion of individuals with teeth sealed in the average teeth sealed. The hygiene habits have improved slightly for the study of the year 1998.

Author: REDONDO SENDINO ÁUREA.
Year: 2004.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: OBJECTIVES: This dissertation deals with the study of gender differences in health in the older population Spanish. The three specific objectives posed are: 1 .- To examine the contribution of sociodemographic factors, lifestyles, social network, chronic morbidity and use of health services to lower-related quality of life (HRQOL) health of women, compared to men, older population of Spain. 2 .- To describe the differences between men and women in the use of health services in the older population Spanish, and explore the influence of risk factors, and facilitators need on these differences. 3 .- Examine the relationship between the social network and the presence of hypertension (ETS), knowledge of! Hypertensive status, antihypertensive drug therapy, blood pressure control, and adherence to treatment, as well as to analyze the differences of gender in the association of social network with these variables, the elderly population of Spain. PERSONS and METHODS: Data were collected from a survey conducted on a sample of 4,000 individuals representative of the Spanish population non-institutionalized population aged 60 and over. The study subjects were selected using probability sampling cluster polietápico. The information gathering was done through personal interview with a structured questionnaire and a physical examination to measure blood pressure and anthropometric variables. The HRQOL was measured by the Questionnaire Health SF-36. Information was collected on the use of health services following: assistance for medical consultations, home visits, immunization antigripal, hospitalization and the number of medicines. In addition, there was blood pressure and related variables. The data analysis was performed using multiple logistic regression. RESULTS: The odds ratio (OR) of suboptimal health of women, compared to males was higher than 2 (p greater 0.0001) at all scales of the SF-36. When adjusting for sociodemographic variables, there was a statistically significant reduction of OR in the scale of social function, while the adjustment reduced lifestyles in the OR scales general health and social functioning. The adjustment for variables social network and health did not change significantly in the OR none of the scales of the SF-36. Generally, the contribution of variables to study the differences in HRQOL among genders was lower in the older age groups. Compared with men, a higher proportion of women visiting the doctor, received home visits and consumed 3 or more medicines. There were no gender differences in hospitalization or vaccination antigripal. The adjustment factors need or facilitators of service use resulted in a reduction in the OR for use of several health services. After simultaneously adjusting for the number of chronic diseases and HRQOL, there was a reduction in the OR (p greater 0.05) for all variables in use of health services, except vaccination antigripal of similar magnitude, and even higher the case of hospitalization, to that observed after adjusting for all variables necessary. In addition, when adjusting for these two variables, the OR for hospitalization for women in relation to men was 0.68 (confidence interval 95% CI 0.56-0.84). Which suggests a reduction in the use of women to equal need. Individuals who are married and living together with ETS presents less often than unmarried and living alone, respectively. The likelihood of knowing the status is higher in hypertensive men who see relatives more frequently, and lower in women who see friends or go 8 cinos co 554 No more frequently. CONCLUSIONS: In older population, socio-demographic factors and lifestyle explain a substantial portion of the differences between women and men in some dimensions of HRQL. Some of these factors, such as lower educational level and the largest of obesity and sedentary women, are potentially modifiable. The more variables that explain the increased use of health services for older women, compared to men, are the number of chronic diseases and HRQOL. After adjusting for these two variables, we noted some inequity in the hospital, which was less frequent in women. In the elderly Spaniards, hypertension is associated with some social variables, such as marital status and the situation of coexistence. Among those with hypertension awareness of hypertensive status depends partly on the attendance of relatives, friends or neighbors.

Author: RESINO GARCIA SALVADOR.
Year: 2004.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: MOLECULAR CENTRO DE BIOLOGÍA MOLECULAR SEVERO.
Place of preparation: FACULTAD DE CIENCIAS.

Author: BOLÓS FERNÁNDEZ M. VICTORIA.
Year: 2004.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: INSTITUTO DE INVESTIGACIÓN BIOMÉDICAS "ALBERTO SOLS" CSIC-UAM.
Place of preparation: FACULTAD DE MEDICINA.

Author: ALONSO POZA ALFREDO.
Year: 2004.
University: VALLADOLID [www.uva.es].
Place of defense: FACULTAD DE MEDICINA. UNIVERSIDAD DE VALLADOLID.
Place of preparation: FACULTAD DE MEDICINA. UNIVERSIDAD DE VALLADOLID.

Summary: INTRODUCTION. The Laparoscópica Surgery is a way of minimally invasive approach that respects the most of anatomy and physiology. It is subject to a learning curve, requires selection criteria until they can randomizar work eventually will be more dependent surgeon that the type of pathology, patient or technique. The justification of the work is based on that new technologies provide advantages to patients and institutions, the implementation of any new technology requires a study and the demonstration of effectiveness legitimándose the laparoscopic to compare their results with conventional surgery. Within the operational working hypothesis the null hypothesis was: laparoscopic surgery no statistical difference with regard to the open intra-and postoperative parameters, with a higher morbidity and complications. And the alternative hypothesis was: laparoscopic surgery provides significant differences in these parameters in the open offering benefits to patients and institutions to the same or lower morbidity. The objectives were to evaluate the results of laparoscopic surgery once they have reached the plateau of the curve, comparing intra-and postoperative variables of the open surgery to laparoscopic compare totally laparoscopic surgery with the laparoscopic assisted and converted to conventional surgery . MATERIALS AND METHODS. It involved 98 patients via open and 54 laparoscopic becoming 10, operated by the laparoscopy 30 were carried out assisted. The diseases treated were: 58 diseases Crohn, 45 diverticulitis, 24 polyps multiple or irresecables endoscopically, 15 inertia colónicas, 8 suboclusiones adherenciales and 2 vólvulos. Practicándose 6 adhesiolysis, 9 stomata, 12 resections of thin, 23 íleo-cequectomías, 24 colectomías right-8 left wing, 42 sigmoidectomías, 12 colectomías expanded and 16 total. We analyze quantitative variables: age, ASA n ° trócares, surgical and anesthetic time, n ° procedures and anastomosis, the ICU and hospital stay, days of analgesia, SNG peristalsis, drainage, transfusions and readmissions. And qualitative variables: gender, pathological history, symptoms, pathology treated ténica surgery, intervencionismos and seconds procedures, intraoperative complications, postoperative complications of surgery, postoperative complications of surgery is not exclusive and overall morbidity. We performed a descriptive statistical analysis, inferential for qualitative and quantitative variables according to their probability distribution and in the contrast of assumptions. RESULTS AND DISCUSSION. In comparing the Open with Laparoscópica Surgery, addressed more significantly by laparotomy patients with a history of previous surgery, digestive symptoms long time and the existence of a disease fistulising in the case of diverticulitis and Crohn, on the contrary if the symptom is acute and florid (rectorragia, diarrhea), there is a greater tendency to deal with the pathology by laparoscopy; were placed significantly more stent ureterales surgery mini-invasiva, but when I had to make a major release of adhesions or add a resection small intestine procedure main approach was done by laparotomy, the number of procedures or resections carried out in the open surgery was statistically greater than that for laparoscopy. The benefits of laparoscopy were based on the lowest postoperative ileus, time with the probe naso-gástrica (SNG), days to appear intestinal peristalsis, days analgesia, stay in the ICU and hospital stay, as well as a lower overall morbidity. The surgical time equates to reach the plateau of the learning curve because it has gained in experience, but the anesthetic longer stays by intervencionismos and preparations q 8 ue requi ceb ere laparoscopy. Within the description of the sample operated by laparoscopy noteworthy that took place in 50% of multiple polyps and the vólvulos and in 36.2% of Crohn. It was used in 55.5% of the stomata, 54.2% of colectomías rights and 43.5% of íleo-cequectomías. The conversion rate cirujano-dependiente was 16.7%, primarily because of bleeding, perforation and adhesions, becoming mainly Crohn and multiple polyps. In the comparison of Surgery Fully Laparoscópica (CTL) and Assisted, pathology and procedures on the left colon were totally laparoscopic to perform a mechanical anastomosis intraabdominal, and the pathology and procedures on the right colon were carried out assisted by conducting a shunt manual extracorporeal. The number of anastomoses practiced was higher in the assisted while the number of CTL further developed trócares, less analgesia and stay in the ICU, so it seems less aggressive yet. In the comparison between surgery and Laparoscopy became open, you lose the benefits of the approach mini-invasivo, the number of procedures was higher in the open, while in the laparoscopic surgical times were few and anesthetic longer further qualitative variables morbidity and intraoperative bleeding were higher because they were the reasons for conversion. CONCLUSIONS. The learning curve in the colon surgery Laparoscópica years and requires many procedures. Once the plateau laparoscopy get equal results in variables intraoperative and postoperative better on the (ileus, SNG peristalsis, analgesia, stay in the ICU and hospital) and the overall morbidity. The CTL and Assisted obtained similar results. On the other hand, the conversion makes Laparoscópica lose their advantages over open surgery remains the worst complications peroperatorias and duration of the proceedings. You need to keep selection criteria in the light of experience of the surgeon, unless we want the results of harming the conversion of the laparocopia is complete. However, when they reach the plateau selection bias disappears at the expense of maintaining the rate of conversion. The Surgery Laparoscópica has to be the procedure of choice in addressing the pathology benign colorectal profit generated by the patients and institutions.

Author: FORNER CORDERO ISABEL.
Year: 2004.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGÍA.
Place of preparation: FACULTAD DE MEDICINA Y ODONTOLOGÍA.

Summary: Objectives: To compare the results of conservative and surgical treatment of traumatic paraplegia in terms of neurological recovery, frequency of medical complications and postoperative, periods of hospitalization and kyphosis and long-term pain. As secondary objectives, we try to identify other factors that could influence clinical outcomes, as well as evaluate the benefits of steroids NASCIS according to the pattern. Materials and Method: A retrospective cross analytical observation of a cohort of patients with traumatic paraplegia, admitted to the Hospital La Fe, Valencia between 1988-2002. In a second phase of prospective follow-up, patients were followed over time to assess Kyphosis in the outbreak of fracture and long-term pain. Sample: were included 223 patients with spinal cord injury, with a median age of 27 years. There were 175 males (78.5%) and 48 women (21.5%). They received conservative treatment 115 patients (51.8%) and surgical 107 (48.2%). Results: The neurological recovery was greater in grades ASIA after conservative treatment (mean: 0.45, 95% confidence interval 0.30-0.60) than in the surgical (0.15, 95% confidence interval 0.00 -0.30) (F = 8014, p = 0005). These differences in favor of conservative were found in injuries incompletas.El 85.2% of patients experienced a complication after conservative approach compared to 74.8% of patients (p = 0064). There we found differences in the prevalence of urinary tract infection, UPP, flebotrombosis, pneumonia and pleural effusion between grupos.No find differences in neurological recovery or in the frequency of complications according to the administration of corticosteroids. In the thoracic and lumbar spinal column, surgical treatment got better Kyphosis correction Focal fracture that conservative treatment. In the long term, the radiological study performed in 90 cases showed that the correction was maintained over time at toracolumbar (average Kyphosis Correction: 5.6 Â °, 95% CI: 1,5-9,6 in surgical; half -8.2 Â °, 95% CI = -13.9 to -2.4 Â °) (p = 0.0005). In the thoracic and lumbar spine, there was no difference between the two treatments. The 32.6% of patients had chronic pain in the outbreak of fracture, with no difference between the two tratamientos.El time encamamiento was higher in the conservative (55.8 days) than in the surgical (31.7) (p = 0 , 0005), although there was no difference in total hospital stay (p = 0094). The stay was positively associated with total number of complications suffered (Ã = 16.5, 95% confidence interval 10,6-22,5, p = 0.0005). Conclusions: 1. In our study, neurological injury, from entry to discharge remained unchanged at 71.5% of the patients improved by 26.2% and the 2.3% worsened. The 95.8% of the injuries to complete comprehensive income continued to hospital discharge, while the 51.5% of incomplete improved at least one grade. 2. The neurological recovery was greater with conservative treatment. 3. There was no difference in frequency urinary infection, UPP, DVT, pleural effusion and pneumonia among the groups, so that it could not be shown that surgical treatment decreases the risk of such complications. 4. The pain was more frequent after surgical treatment. The deformity was similar in both groups. 5. The surgery caused superficial or deep infection in a 15% of the intervention, rupture or displacement of osteosynthesis material occurred in 12.1% and was forced to carry out the extraction of osteosynthesis material in 15%. 6. Surgical treatment got an immediate correction of greater Kyphosis Focal fracture in the chest and toracolumbar stalk. This correction was maintained in the long term, at Rachis tora 8 columbar 5aa but not stalk chest. Lumbar low level, there was no difference between the two treatments. 7. In the long run, surgical treatment was more effective than conservative treatment in reducing spinal Printing, especially in toracolumbar stalk. 8. In the long term, see no relationship between the presence and intensity of pain Focal fault with the type of treatment received, we can not conclude that surgical intervention would be able to prevent pain. 9. The administration of steroids, was not related to neurological recovery or complications. 10. Surgical treatment was associated with a shortening of time encamamiento, although no influence on the hospital stay.