MEDICAL SCIENCE (8)

Author: GARCÍA DEL POZO VICTORINA.
Year: 2005.
University: VALLADOLID [www.uva.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Bronchial Asthma is a chronic disease of high prevalence and impact for Public Health. It has conducted a study of use of medications that would allow evaluate the evolution of supply, consumption and cost of asthma drugs in Spain during the period 1992-2004. The offer was studied breakdown in monofármacos and associations to fixed-dose, and was taken from the catalogs Pharmaceutical specialties. The consumption data were extracted from the database ECOM the Ministry of Health and Consumer Affairs and is expressed in Defined Daily Dose per 1,000 inhabitants per day (DHD). Stocks were provided by the National Statistics Institute. Costs were calculated by multiplying the cost of each package to PVP at the number of containers and was also calculated the average daily cost treatment. During the period in question there have been significant changes in the supply and consumption of asthma in Spain. Incorporating adrenérgeticos action and long inhaled steroids inhalation, as well as their associations would be the most important therapeutic developments. In general terms, on the other hand, we can say that the offer has been rationalized, habiéndose removed from the same number of associations of dubious efficacy and safety. The use of asthma in Spain experienced an increase of 65% over the period studied, rising from 27.53 DHD to 46.63 DHD. Growth has taken place mainly at the expense of the group of "other asthma inhalation" and especially the sociación salmeterol and fluticasone. The subgroup of theophylline and derivatives, including forms which was delayed more decreased consumption. Despite the modest increase in overall consumption, costs grew by 520% commonplace, and a 320% in constant currency. The cost treatment average day fell from 0.30 euros in 1992 to 1.05 euros in 2004. There are differences in consumption among the different Communities Autó nomas, but not qualitative,

Author: Macedo Ana.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: UDIMAS.
Place of preparation: UNIVERSITAT AUTÒNOMA DE BARCELONA.

Summary: A new drug development is undoubtedly a slow and hard process that demands a commitment of the pharmaceutical industry, with an important human, technological and financial effort. Nowadays, and during the last decades is not enough to "believe" in the effectiveness of a drug. It is necessary to prove it. In this context clinical trials became an angular stone. In general sense, clinical trials do not present absolute results but instead they give us relative information about drug effectiveness. The use of placebos in clinival research repesents the need of a reference point, against which we will compare the experimental drug results. This study aimed to characterize the placebo effect in migraine clinical trials and to analyse the impact of methodological and external factors in the placebo effect dimension. Several meta-analysis were conducted in order to determine the placebo effect in acute migraine clinical trials and in migraine profilaxis clinical trials, globaly and according with specific methodological factors as study design (paralel versus cross-over); drug administration route (oral; parenteral; intranasal) and countries included in the study (Europe versus North America). Computer based information searches were conducted on the Medline database. Meta-analysis were computed using Mantel-Haenszel's technique. In acute migraine 98 clinical trials were analysed. In these trials 28.6% of the patients in plabo groups had improved after 2 hours , and 8.8% were pain-free. The percentage of patients (in placebo groups) who reported adverse events was 23%. In migraine profilaxis 32 clinical trials were included. In placebo groups the reduction in the monthly frequency of migraine attacks was 21% and 30% of those patients reported adverse events. In actute migraine clinical trials, injectable placebo was more effective, in pain free outcome, than oral or intra nasal placebo. However, patients on injectable placebo reported significantly more adverse events. Concerning the impact of study design in placebo effect, placebo groups in paralel studies showed better efficacy results and a higher percentage of adverse events versus cross-over studies. Finally, this study concludes that cultural and social differences seem to affect clinical trial results. In the placebo groups, efficacy results were higher in Europe and adverse events occurence was higher in clinical trials performed in North America. These data reinforce the need for knowing the magnitude of the placebo response in each specific situation during the planninf of clinical trials.

Author: MUÑOZ PEREZ MIGEUL ANGEL.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: UNITAT DOCENT UAB HOSPITAL DEL MAR (UDIMAS).
Place of preparation: UNIVERSITAT AUTÒNOMA DE BARCELONA.

Summary: Although the mortality from ischemic heart disease has declined in recent years and that Spain is one of the countries with a lower incidence of this disease is still the leading cause of death in our country. In this thesis addresses various aspects of coronary heart disease: the use of health services, the presence of inequities in the treatment received in terms of social class or age, and the effectiveness of preventive treatment intensive done since the primary health care. The objectives of the study were to determine if the time elapsed from a coronary event and the perceived quality of life after it relates to an increase in the use of primary health care services; examine whether there are differences in the treatment received and the the degree of control achieved by patients with coronary heart disease based on their level of education or social class, to analyze whether patients older than 64 years with stable coronary artery disease were treated differently from younger ones in preventing recurrences and analyze the effectiveness of an intensive program of secondary prevention in reducing recurrence and mortality and improvement in the control of cardiovascular risk factors, lifestyles and quality of life in patients with stable coronary artery disease. A clinical trial was conducted in the community, multicenter, randomized to the intervention by conglomerados- Areas Basic Health (ABS) -. It identified two groups of patients independent and geográficamene separated by random allocation of 23 ABS. One group received an intensive preventive and other routine care. It incluyerion 983 patients who had suffered an unstable angina or myocardial infarction at 6 years prior, and were clinically stable at the time of recruitment and were siguó for three years. The group received intervened quarterly reminders to include your médiico family. In follow-up visits were made measurements of blood pressure and weight and were advised about healthy lifestyles. Semestralmente were conducted to evaluate analytical lipid and glycemic control. The control group was only contacted to obtain information initial and final study. The analysis of the cross-sectional studies showed that patients who suffered a coronary event most recently consulted more frequently with their family doctor, coronary patients using the public health system received preventive treatment and reached a controlling risk factors like , regardless of their socioeconomic level, and patients older than 64 years received a minor treatment in preventing recurrences coronary anyone under that age. The clinical trial, after three years of follow-up, showed that the implementation of an intensive program of secondary prevention of ischemic heart disease, led by primary care physicians failed to reduce the number of recurrences or coronary death, did not improve the quality of ity of patients and only got better control of blood pressure and increased numbers of HDL cholesterol in people intervened.

Author: CORTE TORRES MARIA DANIELA.
Year: 2005.
University: OVIEDO [www.uniovi.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: INSTITUTO UNIVERSITARIO DE ONCOLOGIA DEL PRINCIPADO DE ASTURIAS.

Summary: Rationale and Objectives: The hyaluronic acid is a glicosaminoglicano high molecular weight located in the matrix tissue and biological fluids of all vertebrates, which plays a key role in regulating migration and cell differentiation. Pilot studies hyaluronic acid involved in the progression of several types of tumors as fribrosarcoma, prostate cancer, breast cancer, ovarian, colon, stomach. The present study analyzed, using a method of analysis inmunoradiométrico, concentrations intratumorales of hyaluronic acid in breast cancer primary, its possible correlation with clinical features of patients and their tumors, and its prognostic significance in a wide range for patients with breast cancer. Methods: The study included 850 patients diagnosed with invasive breast carcinoma. The hyaluronic acid was determined in tissue samples using a method inmunoradiométrico. The content of estrogen receptors, progesterone, c-erbB-2, tPA, is determined by a specific enzyme immunoassay for each of them, the EGFR PS2 and catepsina D by testing inmunoradiométricos specific and finally DNA content and percentage S-phase cells by flow cytometry. The average duration of follow-up was 55.1 months. Results: The levels of hyaluronic acid in the tumors showed a wide variability (4-59767 ng / mg protein; median: 4960), being significantly higher in younger patients (p = 0.0001) and premenopausal (p = 0.001) compared the older and postmenopausal, respectively. AH levels were also significantly higher in tumors, and lobular ductales than in other less common histological types (colloids, or papillary core) (p = 0.0001). There was a significant positive correlation between the concentrations of hyaluronic acid and levels of RPg (r: 0.11, p = 0001) in the overall group of patients. In the subgroup of patients with breast carcinoma infiltrating ductal hyaluronic acid levels were also significantly higher in well-differentiated tumors and diploids. In addition there was a significant correlation of the concentration of hyaluronic acid and the RPg (r: 0.11, p = 0001), EGFR (r: 0.14, p = 0001), c-erbB-2 (r: 0, 19, p = 0.0001), pS2 (r: 0.11, p = 0008), tPA (r: 0.31, p = 0.0001) and catepsina D (r: 0.21, p = 0, 0001). Moreover, there was no significant association between levels intratumorales of hyaluronic acid and the time disease-free and overall survival in the overall group of patients. However, high levels intratumorales of hyaluronic acid were significantly associated with a shorter time free of disease in the subgroup of patients with tumors ductales (p = 0.01) as well as those patients who did not receive any type of systemic therapy. Conclusions: The results suggest that contrary to what the experimental data suggest a role of hyaluronic acid in tumor progression, high levels intratumorales this proteoglycan may be associated with a favorable development in a subset of patients with breast cancer, so the hyaluronic acid may provide additional useful prognostic information in patients affected in this type of malignancy

Author: LOPEZ CIMA MARIA FELICITAS.
Year: 2005.
University: OVIEDO [www.uniovi.es].
Place of defense: DEPARTAMENTO DE BIOQUIMICA, UNIVERSIDAD DE OVIEDO.
Place of preparation: UNIVERSIDAD DE OVIEDO.

Summary: Lung cancer represents a high incidence of disease in industrialized countries, and although the snuff is the first risk factor, several studies suggest the existence of different individual susceptibility to the disease. The polymorphisms in DNA repair genes are associated with the ability to repair damage in the DNA, which could potentially increase the risk of developing cancers associated with snuff. The main mechanisms of DNA repair are the nucleotide excision repair (NER), the base excision repair (BER) and repair of breaks in the double chain (DSBR). This study has investigated the relationship between polymorphisms in two genes NER: XPC (TAP) and XPD (Asp312Asn and Lys751Gln), the gene BER XRCC1 (Arg399Gln) and the gene DSBR (Thr241Met) and the risk of developing lung cancer in a case control study base hospital in which they collected 516 incident cases of lung cancer and 533 controls matched by age, gender and area of residence. Different genotypes were determined by PCR-RFLP and the results were analyzed by logistic regression untied. A significant association was found in the genes NER (XPC and XPD), whereas no association was found for genes BER and DSBR. Genotypes XPD 312Asn/Asn and XPC TAP + / + is associated with an increase of developing lung cancer (adjusted OR: 1.58, 95% confidence interval 0,99-5,53 and adjusted OR: 1.31, CI 95 %: 0,90-1,92, respectively). In conclusion, our results suggest that polymorphisms in genes involved in the mechanism of nucleotide excision repair (NER) contribute to the susceptibility to develop cánce lung, whereas no association was observed in the genes involved in the other two repair mechanisms studied (BER and DSBR).

Author: GARCÍA BOTELLO STEPHANIE ANNE.
Year: 2005.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA.

Summary: Introduction: The perioperative administration of supplemental oxygen may have beneficial effects on wound healing after colorectal surgery. The objective of this study is to determine the effect of the use of supplemental oxygen on the perioperative pHi and PCO2 gap of colorectal anastomosis using tonometría. Materials and Methods: We have conducted a prospective study, randomized and controlled between September 2003 and January 2005. A total of 45 patients who met the inclusion criteria were included. After randomization, 23 patients were assigned to receive a FiO2 of 80% and 22 patients were assigned to the group of FiO2 of 30%. After anesthetic induction was adminstró oxygen concentration assigned, and lasted until 6 pm in the postoperative period. It placed two catheters tonometría, an inland nasogástrica in the stomach and another by transanal level colorectal anastomosis and measurements were taken in the immediate postoperative period, at 6 and 24 hours. PHi were compared and PCO2 gap between each group Results: There was a significant increase in PCO2 gap anastomotic respect to PCO2 gap gastric and lower pHi anastomotic pHi respect to the stomach in the group FiO2 30%. These differences were present for 30 minutes (pHi p = 0,006; PCO2 gap p = 0.006) and remained until 6 hours post operatively (pHi p = 0,024; PCO2 gap p = 0.036). Likewise, no significant differences were observed between the values of PCO2 gap or pHi anastomotic and in the gastric group FiO2 80% (p> 0.05). The analysis of 24 postoperative hours, once the patient breathed air with FiO2 21%, showed no significant difference in these parameters in either group assignment (pHi p = 0,131; PCO2 gap p = 0,139). Conclusion: The administration perioperative oxygen at a concentration of 80% on an intraoperative and during the 6 early hours was associated with postoperative improvement of hypoperfusion on the anastomosis as evidenced by the measures pHi intramucoso and PCO2 gap with the area gastric phenomenon that does not occur in the group receiving oxygen at 30%.

Author: RUBIO MARTÍNEZ LUIS MANUEL.
Year: 2005.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA-UNIVERSIDAD DE MURCIA.

Summary: In recent years is becoming increasingly routine "maltreatment" is referred to children, women or elderly. The concept of abuse of the elderly is being overhauled, without reaching a consensus definition at the international level. Most researchers believe that the incidence of abuse is increasing and is considered a problem undervalued. The family doctors assume within the Primary Care all the skills in the care of the elderly, and among them are also working in the community to change. To the extent possible, the adverse conditions for a envbejecimiento sarisfactorio. Being therefore in a unique position to detect suspected abuse. There are few studies of incidence / prevalence population, either national or international, that are sufficiently useful to know the real extent of the problem of abuse of the elderly. Increased knowledge on the actual impact of the abuse of the elderly in our country would be basic to educate society the true dimension of the problem, and encouraging greater social debate involving more to the various authorities and allow better address the issue from a multisectoral approach. Objectives: 1. Knowing the prevalence of suspected abuse and their different types in the region .2. Analyze the factors associated with the suspected abuse. 3. Define the profile of the elderly abused by different typologies. 4. Making an estimate of the risk of abuse and their types. 5. Knowing the sociodemographic characteristics of the elderly in the region who go to health centers. 6. Proposing an instrument for detection of suspected abuse applicable in Primary Care. Materials and Methods: observational study on the prevalence of descriptive population consisting of persons aged 65 years and over living in the region. The sample size was 451 subjects, for an estimated prevalence of 12%, an accuracy of 3% and a confidence level of 95%. The measuring instrument was a questionnaire of 58 items through which we explored different groups of variables. Conclusions: 1. The prevalence of suspected abuse elders in the region is 44.6%. 2. Being a woman, living alone or with children, other relatives at home or on a rotating basis and earn an income of less than 600 euros per month increases the risk of being maltreated. 3. Factors associated with abuse are empeoramineto recent health or dependency for the realization of the basic activities of daily living. Just as coexistence with people who abuse alcohol or other drugs, mentally ill or that debate. 4. The presence of signs of alrma associates significantly to the suspected abuse. 5. The elderly probably abused consults frequently in Primary Health Care, rely on their family doctor no medical problems, so we believe that the primary care physician is in a prime location for the elderly rely susituación abuse, but concerns have little time to search for hacerlo.6. Subjects abused manifested mostly not found either loved or feel at home, happy and not be found alone often or always. 7. The types of abuse with higher prevalences are leaving with more than 30%, followed by psychological abuse and physical neglect. The lowest prevalence obtained the sexual abuse. 8. The age and sex of the elderly and significantly determine type of abuse received and the risk of sufrirlo. 9. The socio-demographic profile of people over 65 years who require care in primary care has an average age of 74 years, are married, living with her partner 8, or if 554 No children at home. They live with a monthly income of less than 600 euros in half semiurbano. The 75% suffering from a enfernedad chronic, with 27.8% subordinate to perform basic activities of daily living. 10. We believe that the detection of suspected abuse should be conducted under the comprehensive assessment of the elderly in Primary Care. We believe the proper use of the questionnaire designed by the American Medical Association and the Canadian Task Force but, after the study, we believe that some of the questions are not sufficiently adapted to the Spanish context, so we propose the addition of new questions.

Author: CABANILLAS FARPON RUBEN.
Year: 2005.
University: OVIEDO [www.uniovi.es].
Place of defense: EDIFICIO SANTIAGO GASCON.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The inducible factor by hypoxia 1 (HIF-1) is a transcription factor whose activity under physiological conditions, allows the cellular adaptation to changes in the partial pressure of oxygen. HIF-1 is sobre-expresado in several human tumors and in some areas its overexpression has been associated with a worse prognosis, however, its role in carcinomas epidermoides head and neck is controversial. Given its potential use as prognostic factor, and the possibility of using their inhibitors in the treatment of these tumors, we studied by immunohistochemistry expression in 116 carcinomas epidermoides supraglóticos, and 49 metastases ganglion of the same. To deepen his characterization, analyzed simultaneously the expression of p53, and the rate was determined apoptótico, and the degree of vascularization of tumors. To complete the ex vivo, we developed a mouse model of squamous cell carcinoma of head and neck that can reproduce in a way credible behavior of these tumors in humans, and what we use to analyze in vivo the effects of overexpression of HIF -1. Conclusions: HIF-1 seems to play different roles in carcinomas epidermoides supraglóticos therefore while in a specific subgroup of patients its overexpression is associated with a worse prognosis, in other unrelated to it. The indiscriminate use of inhibitors of HIF-1 does not appear to be indicated in these tumors, therefore, can benefit a subset of patients, while others prove ineffective, and some might even promote tumor progression.

Author: Pérez Rodríguez María Almudena.
Year: 2005.
University: A CORUÑA [www.udc.es].
Place of defense: Hospital Abente y Lago.
Place of preparation: Facultad de Ciencias.

Summary: The von Willebrand factor (FVW) is a glycoprotein that half multimérica's accession as platelets to subendotelio of vessels damaged; also serves as conveyor factor VIII (FVIII) in circulation. This factor is required for a normal hemostasis, upon the formation of thrombus in places of vascular damage. The von Willebrand disease (EVW) is a congenital bleeding disorder caused by genetic defects in the gene FVW. It is classified into types 1, 2 and 3. In turn, type 2 is divided into four subtypes: 2A, 2B, 2M and 2N. The prevalence of the disease in the general population is about 1%. Its transmission is autosomal dominant or, less commonly, recessive. The EVW type 1, characterized by a slight reduction in the FVW structurally normal, it is quite difficult to diagnose because of the incomplete penetrance, considerable variability in levels of FVW low specificity of symptoms of bleeding and low sensitivity of the diagnostic test. This is further complicated by the fact that most patients with EVW have a slight disorder at low levels of blood FVW very close to normal. Furthermore, it has been found that there is a linkage between the inconsistency of EVW type 1 and the locus of FVW. In order to improve the diagnosis of type 1 and EVW seizing the opportunity that gave us the European Union (EU) to participate in a multicenter European project devoted to the study of EVW type 1 (MCMDM-1VWD) and focus on families included in our center, we set out the following objectives: a) To determine the relative value of a series of clinical and molecular markers in the diagnosis and treatment of type 1 and EVW its value in the treatment. B) To examine the relationship between haplotypes of the gene FVW and clinical and laboratory diagnosis in EVW type 1. C) To determine the proportion of EVW type 1 is not associated with mutations in the gene FVW or linked to the gene, suggesting that genetic factors are involved. D) Reconsider the diagnosis of EVW to view the results.

Author: MARCOS-GRAGERA RAFAEL.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: UNITAT HOSPITAL VALL D'HEBRÓ.
Place of preparation: UNITAT D'EPIDEMIOLOGIA I REGISTRE DE CÀNCER DE GIRONA- INSTITUT CATALA D'ONCOLOGIA-GIRONA.

Summary: Over the past 20-30 years have described a significant increase in the incidence of lymphoid neoplasms, although the causes for this increase are not fully known, it appears that improved diagnosis of these diseases and the AIDS epidemic have contributed part of the growing incidence reported recently, but in the vast majority of cases the risk factors are still unknown. The objectives of this study were to estimate the incidence population of lymphoid neoplasms according to the sex and age of different entities histopathological taking into account the latest WHO classification for hematologic diseases, analyzing their geographical distribution of the incidence; estimating survival observed and relative population attributable to calculate the incidence of AIDS in the incidence this pathology. From January 1994 to December 2001, there were 1,288 patients with the diagnosis of lymphoid neoplasia in the population covered by the registration of cancer population of Girona. We reviewed the diagnostic pathology and blood for the reclassification of retrospective diagnoses according to the latest WHO classification for hematologic diseases. we could not reclassify. The crude incidence of lymphoid neoplasms was 35.8 cases per 100,000 men and year and 25.7 new cases per 100,000 women and year. large (13.5%), chronic lymphocytic leukemia / lymphoma linfocítico small cell (13.3%) and follicular lymphomas the most common in adults (9.7%). The geographical distribution of the incidence of lymphomas in the Region Sanitary Girona (RSGi), is different depending on the histological variant. It is currently estimated that the RSGi there is an incidence of lymphoid neoplasms in males above the rest of the Spanish state, but being found close to the European average and globally. Survival on the 5 years of all lymphoid neoplasms was 52.5% (95% CI 49.4-55.8). The histological subtypes with improved survival on the 5 years are lymphomas of extranodal marginal zone (MALT) [SR5%: 77.6], Hodgkin's Lymphomas [SR5%: 75.4]; chronic lymphatic leukemia / lymphoma of linfocítico small cell [SR5%: 73.5], T and NK cell neoplasms [SR5%: 64.4]. The worst prognosis is the Leukemia / Lymphoma Burkitt [SR5%: 23.2], mielomas / plasmocitoma [SR5%: 29.6], B lymphoma and diffuse large cell leukemia / lymphoma linfoblástico B cell precursors [SR5 %: 40.0]. According to the sex, survival on the 5 years of lymphoid neoplasms is higher in women than men, these differences are significant in the case of Hodgkin's lymphoma, T-cell lymphomas / NK lymphomas and diffuse large cell B . The only option that survival is significantly higher in men, it is in option leucemias-linfomas linfoblásticos B cell presursoras. There is an increased risk of suffering from lymphoma in patients with AIDS, this risk is different depending on the type of lymphoma, sex, route of exposure to HIV and time in relation to the diagnosis of AIDS. The meta-analysis conducted in this study makes clear the extent of the risk and uniformity in different territories. The histological variant more common in these patients was B lymphoma diffuse large cell lymphoma continued Burkitt. The attributable fraction of the AIDS population in the incidence of non-Hodgkin's lymphomas f 8 ue of 8 3b3, 7% and 2.7% for Hodgkin's lymphomas. This fraction was higher in men. There is a decline in the population attributable fraction of the incidence of AIDS in the NHL since the introduction of highly active antiretroviral therapy (HAART).

Author: Jiménez Altayó Francesc.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: F.Medicina.
Place of preparation: Facultad de Medicina, Universidad Autónoma de Barcelona.

Summary: This thesis focuses on the study and analysis of the structural changes, mechanical and functional occurring in the middle cerebral artery an inflammatory process in general and specifically in an episode of cerebral ischemia. This study has shown that after a process of ischemia produced a series of structural changes, mechanical and miogénicos in rat cerebral artery average. The ischemia causes a significant decrease of vascular tone accompanied by an increase in the production of superoxide anion and an increase in the size of the vascular wall due to an increase in the number of cells adventitious. In addition, the size of fenestras of the internal elastic lamina artery cerebral media becomes larger after the ischemia, a fact that could be associated to the increase in distensibility mechanics of these arteries. In the second part, it has been shown that the inflammatory process caused by IL-Beta produces a marked endothelial dysfunction due mainly to the formation of superoxide anions, which are produced in greater measure by the enzyme xanthine oxidase. The contributions of this thesis opens up new lines of research to design drugs capable of preventing possible episodes of cerebral ischemia.

Author: GRACIA GOZALO ROSA MARIA.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: Unidad docente Vall d'Hebron.
Place of preparation: UNIDAD DOCENTE VALL D'HEBRON.

Summary: The pathology of traumatic origin, the fourth leading cause of death and first in terms of lost years, is a significant health problem, which also causes high morbidity and disability, and a high cost of health and social sectors. Knowing his approach has been made by analyzing databases of patients and surveys to professionals. This research work is aimed at knowing if the patient assistance with the TEC in the adult ICU Catalan reference for this condition is comparable in terms of epidemiology, approach and results, which shows the literature to other countries in our area . A study was raised with a double main objective on the one hand, describe the demographic and clinical characteristics of patients and on the other, analyzing and monitoring therapeutic approach. As secondary objectives were raised awareness of the variability of the preceding paragraphs, depending on the seriousness TEC know if clinical practice embraced the major recommendations of clinical practice guidelines in place and know the end result of neurological patients, identifying possible variables epidemiological study that could influence the result and the presence of secondary insults. A study observational, prospective multicenter and in the 7 UCIs Catalan reference to this pathology. Demographic data were collected, clinical, radiological, monitoring, treatment, complications and outcome of patients entering ICU affections of a TEC with or without polytraumatism during the first 15 days of stay. We included 370 patients for one year. The main results show a predominance of males, with an average age of 40 years and whose main cause was the traffic accident. A 36% of the cases were admitted directly in the center of reference but only 26% in the first 60 minutes. The profile of gravity of the TEC was about 53% Graves, 27% and 20% Moderate Leves, with an injury encefálica predominant type II Marshall (39%). The presence of SAH was 49%. CIP was monitored in 69% of the TEC serious, SjO2 in 27% and the DTC at 50%. The intensity of monitoring and the use of therapy is increased in accordance with the greatest severity of the patient. There was a high adherence to the recommendations of the clinical practice guidelines regarding the use of systemic and neurologic monitoring, use of barbiturates, and less in terms of the use of steroids and hyperventilation. The overall mortality rate in ICU was 22%, from 31% for severe. The explanatory variables "éxitus" was the status of pupils, the type of radiation injury, sex and severity of the TEC. The presence of complications prehospitalarias (hypoxia, hypotension, bronchoaspiration, cardio, hypothermia or convulsions) are found in 15% of patients and is associated with cumulative form of a bad outcome. As a general conclusion, this research supports the hypothesis that the initial attention to the TEC in the ICU Catalan studied is comparable in terms of epidemiology, approach and results, which shows the literature concerning other countries around us.

Author: MONSERRAT RAMAJO MARÍA DEL CONSUELO.
Year: 2005.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA. MURCIA.

Summary: This thesis explores the introduction, propagation and development of Homeopathy in the Community of Valencia along the nineteenth century through the life and work of the doctors who practiced. It consists of an introduction in which he made a brief literature review of the historical background of Homeopathy, and the life of Samuel Hahnemann, the state of traditional medicine at the time, the definition and general principles of homeopathic therapeutics, and homeopathic medicine. And a second block whose information has been derived almost exclusively from primary sources: manuscripts and files from archives and specialized medical journals of the nineteenth century, from hemerotecas. This block has been divided into four sections: the first one involves the introduction of Homeopathy in the Community of Valencia, the second of doctors who began practice before 1850, with their biographies and summaries of their works Written and published the articles, and the third, the time of maximum expasión of Homeopathy, homeopathic publications that emerged in the Commonwealth and the homeopaths most important at the time, along with their biographies, and the fourth section deals with the homeopathic practitioners in the last third of the nineteenth century.

Author: NAVARRETE FAUBEL FRANCISCO ENRIQUE.
Year: 2005.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA.

Summary: ELTRATAMIENTO CONSERVADOR HIP FRACTURES IN AGING OBJECTIVE: To study the evolution of patients aged 60 or older with hip fracture, which will be subject to some risk factors that influence their treatment and survival. MATERIALS AND METHODS: Study Period: January to December of 1998. Support was provided for 809 patients with hip fracture; 156 were not operated and they formed the study group with 111 patients. Of the 653 operated got a control group of 90 patients who continue for 12 months or until death. The non-operated patients were studied prospectively. The surgery will be randomly selected once completed the study period. Data were collected by telephone interview. Then we applied a statistical study. RESULTS: The mortality in the group of patients not operated was highest in the first 3 months after fracture (41%), being the cumulative mortality of 62% per year. In the group of patients operated, mortality was uniform over the study period, about 4.5%, with a cumulative mortality of 18% per year. The statistical study performed, the factors that were making the decision on the type of treatment (conservative or surgical), in that order, were mental state, the general condition and functional status beforehand. For survival, the main risk factors were the general condition and mental prefractura and to a lesser extent sex and age. By introducing the variable being operated or not, this becomes the most important in terms of prognosis vital. DISCUSSION: Reviewing the literature, the age is not a risk factor for high levels of evidence. Controversy exists on sex as a factor in riesto. The general state prefactura emerges as a clear risk factor for mortality. The mental state is a factor to be taken into account in our study is the 2Â eighth in importance. The functional status and the type of fracture did not seem to be relevant in life expectancy. Based on these results, we think it should be every effort to control the overall status and mental prior to the fracture, trying to redirect patients to surgery, thereby seeking greater survival at 12 months and a better quality of life.

Author: TENIAS BURILLO JOSE MARIA.
Year: 2005.
University: VALENCIA [www.uv.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Basis. This thesis presents four time series studies that analyze the relationship between short-term air pollution levels and various indicators of morbidity and mortality in the city of Valencia. It also presents two systematic reviews which help to contextualize the results for mortality and morbidity by circulatory diseases. Methodology. The time series studies are based on ecological designs in which discusses the relationship between the daily variations in the levels of air pollution and changes in health indicators analyzed. By autoregressive models Poisson regression was controlled serial correlation of the series by including variables that represent the trend and seasonality, weather variables (temperature and humidity), the effects of timing (weekdays, holidays) and the incidence influenza. Systematic reviews were performed using explicit criteria for the search, selection, evaluation and summary of the relevant literature. Results. We found positive and significant associations in all health indicators analyzed. The findings were consistent for pollution particles that are positively associated with all health indicators. The increases in incidence associated with increases in 10 mg/m3 of black smoke ranged from 1.3% (mortality) to 4.1% (emergency room for asthma). The photochemical pollution, represented by ozone levels were significantly and positively associated with the emergency room for respiratory diseases, with increases of greater than 6% in the emergency room for asthma and COPD for an increase of 10 mg/m3 of this pollutant. The revisions were selected 73 original studies that analyzed the effect of air pollution on mortality and 60 studies that assessed various aspects of the relationship between air pollution and diseases of the circulatory system. Conclusions. The results obtained in the city of Valencia showed that the relationship between air pollution and health is a finding consistent with those obtained in other cities and coherent modulation risk obtained depending on the seriousness of the indicator studied. The revisions show the great consistency of the mortality studies conducted so far and the many accumulated evidence which can establish a causal link between particulate pollution and diseases of the circulatory system.

Author: GONÇALVES MADUREIRA RUI MANUEL.
Year: 2005.
University: VALENCIA [www.uv.es].
Place of defense: F.ODONTOLOGIA.
Place of preparation: UNIVERSITAT DE VALÈNCIA ESTUDI GENERAL.

Summary: INTRODUCTION THE GOAL OF THE ENDODONCIA IS PREVENTING OR TREAT OF PATHOLOGY THE COMPLEX DENTINO-PULPAR AND COMPLICATIONS APICALES. THE MAIN ETIOLOGÍA OF PATHOLOGY ENDODÓNCICA IS OF ORIGIN MICROBIAL, FOLLOWED THE TRAUMÁTICA, EXISTIENDO OTHER FORMS ETIOLÓGICAS WITH MINOR IMPORTANCE. THE EVOLUTION OF PATHOLOGY THIS IS COMPLICA MORE FORTHCOMING THE CLOSER THE BACTERIA IS OF PULP. IF THIS ARRIVE THERE, AND DUE TO THE PROVISION OF PECULIAR FABRIC PULPAR NOT MINERALIZADO IN THE INTERIOR OF THE PORTION CALCIFICADA THE SAME, WITH AN DIMINUTA CONNECTION VÁSCULO-NERVIOSA WITH FOREIGN THROUGH THE HOLE APICAL RADICULAR WITH OFTEN ENDS IN AN NECROSIS PULPAR , WHICH IF THESE ARE NOT, EVOLUCIONARÁ TO COMPLICATIONS INFECTIOUS AND INFLAMATORIAS OF TISSUE NEIGHBORS, EMPEZANDO THE AREA PERIAPICAL. CAN AFIRMAR THAT THE MAIN CHALLENGE OF ENDODONCIA IS THE ABILITY TO ELIMINATE OR AT LEAST FOR THE CONTROL OF MICRO CONDUCTOS RADICULARES AND THE CANALÍCULOS DENTINARIOS. TO SEE THE TREATMENT ENDODÓNCICO MUST APOYADO IN BIOLOGICAL SINGLES PRINCIPLES. TREATMENT ENDODÓNCICO OF PATHOLOGY PULPO-PERIAPICAL ATTEMPTS TO CONSERVE THE DIENTE IN THE ARCH, MANTENIENDO THERE IS POSSIBLE WHEN VITALITY AND IN THIS CASE OTHERWISE, MANTENIENDO OPERATION DENTARIO THROUGH THE CLEANING AND DISINFECTION OF CONDUCTOS, WHICH ARE, LATER, PREPARED FOR YOUR OBTURACIÓN; WHAT THIS HAS TO BE MORE HERMÉTICA POSSIBLE IN THREE PLANES OF SPACE; RECONSTRUCTION CORONAL COMPLETE THIS TREATMENT. THE TREATMENT OF CONDUCTOS RADICULARES HAPPENS FOR VARIOUS STAGES: ACCESS TO THE CAMERA PULPAR, IDENTIFICATION OF CONDUCTOS RADICULARES, PULPECTOMÍA, CLEANING AND DISINFECTION OF INTERIOR OF SYSTEM CONDUCTOS, ENSANCHAMIENTO OF CONDUCTOS FORM CÓNICA WITH YOUR CHILD IN DIAMETER AREA APICAL TO FACILITATE THEIR OBTURACIÓN THREE-DIMENSIONAL TO BE THE LAST PHASE OF TREATMENT ... etc..

Author: SAMBOLA CABRER IGNACIO.
Year: 2005.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAT DE MEDICINA.
Place of preparation: UNIVERSITAT AUTONOMA DE BARCELONA.

Author: Sanjuás Benito Carlos.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: Facultad de Medicina.
Place of preparation: Hospital del Mar. Institut Municipal d'Investigacions Mèdiques (IMIM).

Author: Soliva Vila Juan Carlos.
Year: 2005.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: Escola de Postgrau (sala de graus).
Place of preparation: Facultad de Medicina.

Author: DUARTE OLLER ESTHER.
Year: 2005.
University: ROVIRA I VIRGILI [www.urv.cat].
Place of defense: FACULTAT DE MEDICINA I CIENCIES DE LA SALUT.
Place of preparation: UNIVERSITAT AUTONOMA DE BARCELONA.