CLINICAL SCIENCES

Author: GUITART RIBAS MONICA.
Year: 2003.
University: AUTÓNOMA DE BARCELONA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: ESCUELA DE DOCTORADO Y DE FORMACIÓN CONTINUADA.

Summary: A model widely used pair studies contransmisión in SNA is the vas Dof rodents, which produces electrical stimulation EE joint release noradrenaline NA and ATP. There is also evidence on the differences between both anatomical and functional portion epididymal VDE and prostate VDP of VD. In addition, the strain of spontaneously hypertensive rats SHR is a model widely used in the study of human hypertension. The findings of this work are: EE segment VDE in SHR produces greater contraction that WKY. The components phasic and tonic were significantly higher in SHR than in controls. However, the muscular contraction generated by EE in the VDP VD showed no difference between animals and their SHR controls WKY. The magnitude of the phasic and tonic components were essentially similar in both strains. Although the component noradrenergic and purinérgico are dominant in the responses tonic and fásica respectively, it demonstrates a partnership of both contransmisores with different relative contribution, in both phases of the response in the muscle portion VDE of VD in SHR as WKY. The contribution of noradrenergic component is higher in the contractile response generated by EE in the Dof SHR. However, there appears to be a similar contribution of both contransmiores in WKY. The basic characteristics of the electrical activity due to the ATP and studied, therefore, VDP animal SHR and WKY, are not different from those observed in VD and other rodents. Where differences do exist between strains is at the level of values of potential rest (more despolarizado in SHR) and excitatory post-synaptic potentials spontaneous and induced EE (both higher in SHR). Finally, it proves the existence of a phenomenon empowerment postináptica of mechanism is not established between the NA and in the ATP section of VDE Dof the SHR and WKY, but the degree of synergy is higher in SHR. In the portion VDP, however, only that of SHR showed empowerment among contransmisores.

Author: BENITO CRISTOBAL CARLOS.
Year: 2003.
University: COMPLUTENSE DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: O.COMPLUTENSE MED. Y CIRU. EXPERIMENTAL H6619.

Summary: This thesis tries to demonstrate the usefulness neurorradiolÃÂ ³ gica a metodologÃÂa that exploits the possibilities of digital imaging to extract informaciÃÂ charges of the different modes of image diagnosed, mÃÂ ¡s allÃÂ ¡purely qualitative estructural.De the one hand, when the image cualitiva not provides informaciÃÂ ³ n is needed to explore other vÃÂas for extraction, a possible way is to valoraciÃÂ ³ n quantitative, hoping that the "nÃÂ fourth just see where blind eye estÃÂ ¡n", but ademÃÂ ¡s, we need to pull together knowledge that the details provided for each mode of the image and diagnosis have their valoraciÃÂ charges appropriately in the confrontaciÃÂ ³ No one another. This was the approach that was followed when attempting to address the valoraciÃÂ charges per image of schizophrenia, or rather our patients esquizofrénicos. SemiolÃÂ ³ gia radiolÃÂ ³ gica of this disease, like that of other patolÃÂ ³ gies not have a structural basis macroscÃÂ ³ pica in the Nervous System it is very poor, but in the bibliography are admitted for a few aÃÂ ± os quantitative findings dispersed. In this paper, thesis presents gia a metodolÃÂ ³ treatment of informaciÃÂ charges based on utilizaciÃÂ ³ n sequential several computer tools, articulated around the segmentaciÃÂ charges and integraciÃÂ charges of imÃÂ ¡genes. DespuÃÂ © s of introduciÃÂ ³ n in which he exposes the metodologÃÂa used. Inputs achieved with the aplicaciÃÂ charges of mÃÂ © everything is discussed in the capÃÂtulos siguientes.En the third capÃÂtulo outlines the contributions of the tool cuantificaciÃÂ charges for the establishment of the pathogenesis of the disease. In the fourth capÃÂtulo establishing relations between variables clÃÂnico radiolÃÂ ³ gicas and response to the terapÃÂ © utica.Ambos capÃÂtulos correspond to the exposiciÃÂ ³ n partial published reports. We discuss in the fifth capÃÂtulo the findings, proponiÃÂ © ndose the utilizaciÃÂ ³ n of this tool for investigaciÃÂ ³ No problems clÃÂnicos with similar approaches currently unresolved with the metodologÃÂa tradicional.Y by ÃÂ fourth Finally, the conclusions are outlined in capÃÂtulo sixth.

Author: REVILLA OSTOLAZA TERESA YOLANDA.
Year: 2004.
University: COMPLUTENSE DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Ultrasound scans were reviewed retrospectively brain (n = 2218) conducted at all preterm and low birth weight (n = 680), admitted to the Intensive Care Unit of the Service Neonatal Hospital on October 12 in the period from January 1991 and December 1998. The timing of the scans is grouped, whenever possible, especially in three points, on 1-2 of life on the day 10 of life and about the day 30 of life. A descriptive study was conducted of ultrasound findings in such as ultrasound ultrasonographic characteristics were analyzed in terms of its evolution over time and were related to weight and gestational age of infants studied. The 31.27% (n = 182) of the children had no visible ultrasonographic changes. While concurring with the group with the greatest weight and gestational age at birth. The mortality of the group of normal children is 9.34% (n = 17) compared with 14.50% (n = 58) group of children who presented some positive ultrasound findings. The ultrasound findings harsher (hiperecogenicidad parenchymal greater than or equal to the choroid plexuses, the presence of images anecoivsd and ventricular dilatation), ie those children of lower weight and gestational age. These are cases with a higher risk of sequels and complicacinoes in cuato the psychomotor development. The ultrasound findings classically considered minor, ie hiperecogenicidad parenchymal lower than the choroid plexuses and non-parenchymal involvement (choroid plexus and the lateral ventricles) ad integrum tend to recover without sequelae post. The ultrasound scan detects a precise time of the occurrence of abnormal brain and evolutionary changes of the same, so it is an ideal way to monitor these changes. The optimum time for the first ultrasound scan is the second week of life and it is mandatory to conduct a second ultrasound approximately day 28 of life to detect possible complications late whose involvement in the prognosis of psychomotor development is also important.

Author: MONTULL FERRER M. CATALINA.
Year: 2004.
University: BARCELONA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UB..

Summary: The CDL is an intermediate between normal aging and AD and is a group at high risk for developing the disease. The ERM provides information on brain function and neurochemistry of metabolimos lisutes.De Hence the hipítesis focus of this paper is to assess whether the ERM, IH can detect brain biochemical changes inthe specific DCL and directed toward the future convesión in EA.Los goals split between carctizar MRA of DCL and see the differences when compared to controls and EA and make a follow-up durate 4 years of the DCL seeing the pattern espectrocópico Regional at various stages of evolution. The conclusions are that the ERM-IH constitute reliable evidence in the early diagnosis of EE since detects an elevated ratio of MI / RC in the DCL, which precedes the time to change degenaritos conguntivos, besides MI / NAA is the best value them crimina the OCL from normal controls, being difficult only by ERM-IH the differential diagnosis between DLL and EA.

Author: VALLÉS FERNÁNDEZ ROSER.
Year: 2004.
University: BARCELONA.
Place of defense: FACULTAD DE FARMACIA.

Summary: Because of the special characteristics of operations and organization of emergency services (ED) physician-patient communication can be especially difficult in this area. Whereas it is important that the patient is properly informed to obtain adequate efficiency of their treatment, raised the realization of this thesis with two objectives: first, is described as prescribing and drug information in YOUR our environment, and second propose and evaluate measures of intervention, aimed at both the patient and the doctor, in order to enhance the quality of prescription and the information in the ITS. The study was carried out in two distinct stages: The first stage: descriptive cross multicenter study in six of the ITS region of western Valles (Barcelona), five YOUR Primary Care (AP) Institut Catalf1de Health and Hospital ITS Hospital Parc Taulí Sabadell. At this stage it was noted that in 34.8% of patients (n = 746) and in 48.4% of patients (n = 891), the doctor was unaware whether or not the patient was allergic to any medicine or whether or not taking concomitant medication, respectively. Likewise, only in 46.4% of the prescriptions tested (n = 1,258), the patient knew the whole pattern of treatment prescribed in the ITS. The information was obtained through patient surveys. - Second phase: study casi-experimental intervention controlled without randomization which evaluated the effectiveness of some posters and brochures aimed primarily to patients in the SU AP, but which could also serve as a reminder to doctors. Messages to transmit these elements of communication were that the patient's medical report to SUM about their allergies and medications already being taken, as well as to ensure that he understood the instructions that he gave the doctor. To assess the effectiveness of the intervention was conducted test Breslow-Day and Tarone. The posters and brochures were clearly effective in increasing awareness of the doctor on its concomitant medication (intervention group decreased, with regard to the first phase, 25% of patients that the doctor was unaware of this fact, compared to a decrease of 12.5% of the control group) and especially effective in increasing the understanding of the pattern of treatment prescribed by the patient (increase in the intervention group, with regard to the first phase, 16.8% of the prescriptions that there was a knowledge total dosage by the patient, compared with a decline of 1% in the control group). So, as key findings, this study showed that there is a little knowledge on the part of the medical THERE of allergies and concomitant medication of patients, in addition to an insufficient understanding of the treatment prescribed by the patient. The posters and brochures have helped to reduce the ignorance of the medical history Pharmaco patient and increase understanding of the overall pattern of treatment by the patient.

Author: SORIANO IZQUIERDO ANTONIO.
Year: 2004.
University: BARCELONA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Background: The treatment of inflammatory bowel disease has been based on the use of aminosalicilatos, steroids and immunosuppressive agents that help control outbreaks of the disease, but fail in their healing. The blockade of endothelial adhesion molecules, which allow the recruitment of leukocytes from the vascular bed to the inflamed area, might be a useful therapeutic target in this disease. Objectives: 1. To determine the value of endothelial adhesion molecules as new therapeutic targets in inflammatory bowel disease. 2. To assess the potential therapeutic value of its monoclonal antibody blocking modulation of endothelial adhesion molecules, peptides clover and cyclosporin A. Materials and methods: experimental model used has been to the DSS-induced colitis in mice, which remeda ulcerative colitis in humans. To quantify the in vivo expression of endothelial adhesion molecules has been used to the technique of double antibody marking and to evaluate its expression in vitro, the primary cultures of endothelial cells from human umbilical cord vein. Also, to analyze interactions leucocito-endotelio in venules colon has been used microscopy intravital fluorescence. Results and conclusions: 1. In experimental colitis induced by DSS there an increase in the expression of endothelial adhesion molecules ICAM-1, VCAM-1 and MAdCAM-1 and interactions leucocito-endotelio (bearing and accession) in venules postcapilares colon. 2. VCAM-1 esla main molecule responsible for the increase in leukocyte adherence to endothelium and plays a key role in the pathophysiology of inflammatory bowel disease pilot. 3. The inmunobloqueo sustained VCAM-1 has a therapeutic effect, as it improves the course of colitis. Instead, inmunoneutralización of ICAM-1 or MAdCAM-1 does not alter the clinical course in this experimental model. 4. The increase in the expression of endothelial adhesion molecules VCAM-1 and MAdCAM-1 in the colon is proportional to the severity of induced colitis. 5. The peptide clover TFF2 is useful in the treatment of experimental colitis, with its topical administration higher than systemic. 6. TFF2 produces, in an indirect way, a reduction in the expression of adhesion molecules on endothelial and leukocyte recruitment contributing to their beneficial effect. 7. Cyclosporine A induced improvement experimental colitis in mice by DSS. 8. The therapeutic effect of cyclosporine A is due, in part, to reduce the production of proinflammatory cytokines and the expression of vascular cell adhesion molecules, acting directly on the endothelial cell. What decreases leukocyte recruitment into the inflamed gut. Contents: 1. VCAM-1 is the endothelial adhesion molecule more important in this experimental model of colitis that remeda ulcerative colitis in humans. 2. The inmunobloqueo of VCAM-1, in contrast with that of ICAM-1 or MAdCAM-1, could attenuate the inflammatory response without altering the immune physiological mechanisms, since this molecule is not involved in the physiological recirculation of leukocytes. 3. The works that make up this Doctoral Thesis constitute the rationale for investigating the effect of the antibodies anti-VCAM-1 in patients with ulcerative colitis.

Author: SALINAS SANZ JOSE ANTONIO.
Year: 2004.
University: COMPLUTENSE DE MADRID.
Place of defense: FACULTAD MEDICINA.
Place of preparation: UNIVERSIDAD COMPLUTENSE.

Summary: Objective. Rate linear growth in the long term in pediatric liver transplantation and the factors that influence it. Patients and methods. We included 46 patients transplanted since 1986 with more than one year of follow-up excluding those with syndrome Alagille. They were valued anthropometric data, clinical and analytical pre and post up to a maximum of 6 years follow up. The size and speed of growth (VC) were analyzed as a z-score (tables Foundation Orbegozo F.). We define retardation if height z-score greater -2; catch-up if z-score of less sees O. was assessed the influence on the growth of the following factors: age at transplant, sex, disease basis, cumulative dose of steroids, immunosuppression , retrasplante, renal function and chronic graft dysfunction. The data were analyzed according to the following statistical test: comparison of mean (t student), and proportions (X). Results. Hubo24 varonesy 22 women, with unaedadmediaal trasplantede 5.16 + -4.37 years. The most common cause of transplant was the biliary 50% atresia, followed by metabolopatías 24%. The 82.6% received cyclosporine and 17.4% tacrolimus. The average duration of treatment with corticosteroids was 45.9 +-25.8 months. Presented acute rejection on 67.4%. Necesitó retrasplante the 20.5%. They had delayed height pretrasplante the 34.78% of the patients, of whom only 1 / 3 maintained that it was late at the end of follow-up. The catch-up was observed between 12 and 24 months post (mean z-score sees Or, 84 + - 2.48) in the group with delayed height pretrasplante (represented mainly by the biliary atresia) occurred before that and the rest was kept in both groups until the end of the study (average scorez sees 0.59 + -2.47). Among the factors analyzed statistically significant differences were found for doses of steroids (p = 0030), for chronic graft dysfunction (p = 0008) And for the retrasplante (p = 0.04). Conclusions. The transplantation improves the size and looks, especially in patients with late-class pretrasplante. The retrasplante, the cumulative dose of steroids and chronic graft dysfunction are the main variables that affect growth, although the statistical significance for any of the factors can be influenced by the sample size.

Author: MATEOS GONZÁLEZ M. ELENA.
Year: 2004.
University: COMPLUTENSE DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: PEDIATRIA.

Summary: Introduction. Early recognition of iron deficiency is crucial to establish an early treatment to prevent complications multisistémicas of iron deficiency anemia. The parameter blood CHr has proved more effective that conventional hematological and biochemical indices in certain populations to detect iron deficiency before his progression to anemia. Objectives. Evaluate the usefulness of this parameter CHr for the diagnosis of iron deficiency and iron deficiency anemia in a child population of our environment. To determine the value of the CHr (cutoff point) with improved performance for the diagnosis of iron deficiency. Materials and methods. Cross descriptive epidemiological study. The sample of subjects came from a child population of both sexes aged between six months and fourteen years a resident in an urban area of the southern municipality of Madrid. The study protocol, which included complete a questionnaire and conducting an analytical consisting of blood with CHr and biochemistry of iron metabolism, was approved by the Ethics Committee of the Area Health tertiary hospital where they conducted the survey. Results. They were included in the survey 237 children between January 2001 and January 2002, of which 60.76% came from a search of Pediatrics Primary Care Team and the rest of the outpatient of General Pediatrics at the hospital tertiary reference of the same Health Area. The subjects were classified into five diagnostic groups: depletion of iron, iron deficiency, iron deficiency anemia, anemia and ferropenic not normal. The average prevalence of iron deficiency and iron deficiency anemia was 17% and 5%, respectively. The age was a determining factor in the risk of iron deficiency, which is most prevalent disease among subjects younger than 24 months of age. Other epidemiological characteristics analyzed as gestational age, sex, birth weight percentile and its corresponding percentile of weight and height at the time of being included in the study, the existence and duration of breastfeeding, age introduction of whole milk , presence of certain dietary habits (including the consumption of meat and dairy), consumption of antibiotics, frequenting Hospital Emergency Services and consulting source for determining variables were not suffer iron deficiency. The CHr and sideremia were the only independent laboratory parameters that discriminate the presence of iron deficiency and iron deficiency anemia in multivariate analysis. In groups with iron deficiency and iron deficiency anemia, the average CHr was below 25 pg, while those with anemia not ferropenic and normal average of CHr was equal to or greater than that value. Conclusions. The value of the CHr of 25 pg proved to be the most appropriate cutoff point for the diagnosis of iron deficiency anemia or not accompanied by his best combination of sensitivity (90.7%) and specificity (80.1%). The CHr is a useful parameter to identify blood iron, whether or not associated with anemia in children for its high diagnostic yield.

Author: MARZULLO GONZALEZ LEOPOLDO.
Year: 2004.
University: MÁLAGA.
Place of defense: FACULTAD DE MEDICINA.

Summary: To compare in terms of clinical ultrasound and three methods of treatment of spontaneous incomplete abortion is not complicated, it did an investigation prospective, longitudinal and descriptive, in a universe shaped by the total number of patients who consulted with the Emergency Obstetrical University Central Hospital Dr. Antonio Maria Pineda, the city of Barquisimeto-Venezuela, within comperndido between 01 November 2002 to November 31, 2003; universe that took 2 samples one of 180 patients, and another 30 for a double-blind, which fulfilled the criteria for inclusión.La sample was divided into 3 groups of 60 patients each, for each type of treatment: Misoprostol group A, group B and group C Curetage spontaneous development, the second in 2 groups 15 each for the double-blind among medical management and espontáneo.Los results show that the development and clinical econsonográfica of patients treated medically, ie misoprostol and spontaneous development was satisfactory to the point, which alos 7 days 66% and 65% of the patients in each group had expelled the remains regardless of the same thickness and 14 days all had expelled; same results were obtained in double ciego.El 60%, 65% and 63.3% of patients in groups A, B and C medical treatments, Curetage and spontaneous evolution respectively, had no complications, only in group B, were significant: 3.22%, which this is, in turn, the most costoso.Durante the study, none patient left mismo.En conclusion, the non quirúrquico, if selected spontaneous abortions incomplete and not complicated, is a safe procedure, satisfactory and much cheaper than the Curetage, besides being accepted by the patients.

Author: LOBATO BANCALERO LUIS ALONSO.
Year: 2004.
University: MÁLAGA.
Place of defense: FACULTAD DE MEDICINA DE MALAGA.
Place of preparation: FACULTAD DE MEDICINA DE MALAGA.

Summary: The adhesions perotoneales postquirgicas are a social welfare problem of great importance, being responsible for a major disease (intestinal occlusions, female secondary infertility, pain abdomial chronic) being responsible for 1% of readmissions in a service of surgery. The adhesive peritoneal postquirurgicas formed after 90% of laparotomías. Therefore it is very important research in this field. We have used a large number of methods antiadherenciales including pharmacological methods through systemic and inland intrabdominal with very mixed results. Today, the methods used are called barrier methods. In our study we used in the test animal two types of methods atiadherenciales type macromolecules (Dextrano 70 and Icodextrina to 4%) Local Yun barrier method associated with the action of heparin (The mesh lnterceed associated with low birth weight heparin molecular). In our study we used three methods antiadheenciales have decreased the incidence of peritoneal adhesions versus control with statistically significant differences, with the most effective method the Icodextrina to 4%. Methods antiadherenciales type macromolecules acting for hidrotlotación also have proved effective in preventing the formation of adhrencias interasas front of the group contro. We conducted a study where none of the microbiological methods antiadherenciales favored the growth of bacteria, either in surgery clean, clean polluted or contaminated. Nor any of the methods antiadherenciales had a higher incidence of dehiscence or anastomotic leak.

Author: VIÑA RODRIGUEZ JOSE JUAN.
Year: 2004.
University: LA LAGUNA.
Place of defense: FACULTAD DE MEDICINA. UNIVERSIDAD DE LA LAGUNA.
Place of preparation: FACULTAD DE MEDICINA. UNIVERSIDAD DE LA LAGUNA.

Summary: (H) Homocysteine is an amino acid which is being given special importance as a risk factor for vascular over the past 15 years. It is metabolized primarily by two metabolic pathways involved in vitamin B6, B12 and folic acid, for this reason alone, or combined deficits of these vitamins produces hyperhomocysteinemia. OBJECTIVES 1 .- To study the prevalence of hiperhomoscisteinemia and analyze factors that depends H. 2 .- To study the relationship between Hy vascular risk factors, having suffered vascular events, presenting with cognitive impairment and congestive heart failure. 3-Analyze the prognostic value of homocysteine. We studied 440 patients over the age of 65 entered in a Department of Internal Medicine. Were collected antecendes person (including vascular risk factors, a history of vascular events and others like insufciencia cardiac cogenstiva), a valoraciónd nutritional status (dietary survey, body mass index, nutritional assessment subjective, waist ratio hip and arm muscle area), we applied a scale of dementia (teste Pfeiffer), an EKG and an analyst overall (H, vitamins B6. B12 and folic acid). For survival analysis was established telephone contact after discharge for averigurar if at the time of the call were alive or had died. Also explored to 2 control groups (over 65 years, with good general condition, and without a prior history of vascular events), one of 52 outpatient consultations in the Department of Internal Medicine and the other 23 patients from a query of preanestesia Surgery Minor. The análisi Statistical was performed by the program SPPS. Patients had a high prevalence dehiperhomocisteinemia (47.5% homocysteine greater than or equal to 15 µ mol / l), no differences were found with controls. The H depends independently of folic acid, vitamin B12, creatitnna, albumin and neutrophil. There are often factors independent of folic acid, vitamin B12. Creatitnna, albumin and neutrophil. There are often vascular risk factors in patients in the study (ETS: 62% DM: 45%, hyperlipemia: 35%, obesity: 22%, smoking: 28%) and a history of vascular events (myocardial infarction: 11 % ACV: 18%). None of the vascular risk factors or vascular events is related to an increase in homocysteine. Patients with insuficiencai cardiac congestive have higher homocysteine as well as patients with cognitive impairment. Stresses the overall poor prognosis of patients: 50% had died after little more than 3 years. The vascular risk factors were not associated with poorer prognosis. The H relates to the excess mortality both as a default. The decline in H below percentile 15 gets worse prognosis. Patients with sepsis, hypoalbuminemia or increased neutrophils have dismuida H. These data suggest that the decline in H may be due to infectious inflammatory processes. In survival analysis with the covariant H does not have independent prognostic value. The hospital admission, especially whether it is infectious or inflammatory process, it does not seem the right time to determine homocysteine as a risk factor for vascular.

Author: SANCHEZ FERNÁNDEZ RAQUEL.
Year: 2004.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA (UAM).
Place of preparation: FACULTAD DE MEDICINA (UAM).

Author: SADABA ARGAIZ MARIA CRUZ.
Year: 2004.
University: AUTÓNOMA DE MADRID.
Place of defense: UNIVERSIDAD AUTONOMA DE MADRID.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Multiple sclerosis (MS) is a demyelinating disease most common in young adults. Given its wide clinical variability, there have been many efforts to find a prognostic marker of this disorder. We have recently described the synthesis of IgM intrathecal (SIM), as evidenced by the presence of bands oligoclonales IgM (BOC IgM) restricted to cerebrospinal fluid (CSF), is an unfavorable prognostic marker in these patients. This paper elaborates on the role of IgM in this pathology. First, we studied the types of immune responses that represent the BOC IgM in MS. We studied them in a group of patients over time. We found that the presence or absence of SIM stands for the development of MS. In patients who present it, the pattern was largely the same in the different samples. This sustained response is characteristic of the responses T independents. Secondly, we analyze the subpopulation of B lymphocytes responsible for the production of these immunoglobulins. Patients with BOC IgM had a higher percentage of B lymphocytes that the remaining patients and controls, both in cerebrospinal fluid and in peripheral blood. This was because in patients with SIM had a significant increase in the subpopulation B CD5 +, the addition of B lymphocytes CD5 + cerebrospinal fluid had a cell activated phenotype. Thirdly, we explored the reactivity of the BOC IgM compared to the myelin lipids. In a very high percentage of the BOC IgM recognize any of them, and the majority acknowledged the phosphatidylcholine. Finally, we studied the relationship between the presence of specific IgM BOC versus lipids and disease progression. We analyzed the evolution of a group of patients with and without BOC IgM versus lipids. It was found that the presence of BOC IgM was compared with lipids and a factor of poor prognosis in MS, and that patients had suffered the greater n ° outbreaks and reached a disability index increased at the end of the study. All these data suggest that IgM compared to the myelin lipids produced by the cells CD5 + plays an important role in the pathophysiology of MS.

Author: SADIA MUSA ABDALLA.
Year: 2004.
University: COMPLUTENSE DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: It is a systematic and prospective study to evaluate the possible relationship between the level of ET-1 in liquid subretiniano and plasma intraocular pressure and blood flow in the eye retinal detachment and vitreorretinopatía proliferative. Just as the possible influence of the parameters studied in the success / failure and the surgical improvement in visual acuity Post-surgery. We conclude that high levels deET-1 in plasma and LSR are related to decreased blood flow velocities eye and, in turn, are associated with decreased IOP and VRP higher C2. All these factors related to the increased likelihood of surgical failure, particularly when levels of ET-1 plasma exceed 3.53 pgr / ml and in LSR 20 pgr / ml. Furthermore, we saw that there was a relationship between ET-1 in LSR and the improvement in visual acuity Post-surgery.

Author: ALA KHALID ABDEL AZIM HAMOUDEH.
Year: 2005.
University: CANTABRIA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Main Objective: To assess the quality of clinical trials published on the treatment of uveitis and analyze the variables of the article or the journal that are associated with higher quality. Method: Systematic review of controlled clinical trials. You do a search on PubMed successively combining keyword uveitis with the words cyclosporine, tacralimus, mycophenolate, prednisone, steroid, corticosteroid, etanercept and infliximab. Removing the information through a standard questionnaire, which contains information about the journal, the authors and caracteriístcas study (sample size, allocation of intervention, concealment, intention to treat analysis ...). Conclusions: 1. The number of clinical trials on the uveitis grew steadily over the study period. Most tests were conducted on the Post-surgery swelling. 2. The number of participants in the trials has generally been low. The studies funded by the pharmaceutical industry and those who have statistical significance were more sample size. 3. The sample size was determined in advance in cescasas occasions. The predetermination of the sample size was more frequent in trials funded (irrespective of the source of funding), in the most recently published essays, appearing in the magazine impact greater than 1.5 and work with statistically significant results. 4. The allocation was made on a aleatroia in almost all trials, but in most of them do not describe the procedure randomization. The description of randomisation procedure was more frequent with the magazines impact greater than 1.50 and with statistical significance. 5. In most trials the allocation to the intervention group, but not the method described in most of them. The allocator and the executor of the intervention were separated by one-third of the trials. The allocation and the separation of allocator and the executor of the intervention were more common in studies with public funding. The description of the method of concealment was more frequent with the magazine impact greater than 1.50. 6. The concealment took place in most of the trials studied but its success was reported in less than half of them. The masking was more often with the presence of a bioestadístico as author, in studies funded by industry or pubic and trials published in journals impact exceeding 1.5. In general, little information is provided to describe the actions of concealment. 7. The flow of participants and the duration of the test described in almost all of the tests: But the vast majority of items not reported on the decline of patients who participate in trials. The information from those who refuse to participate was more frencuente in trials involving a bioestadístico, published in the magazine impact greater than 1.5 and work with statistical significance. 8. Rarely was informed of the intention to treat analysis, in most trials the available information does not allow whether analyzed by intention to treat or adherence to treatment. The intention to treat analysis was associated with the pharmaceutical and finance a year of publication.

Author: GARCIA GALLEGO ALVARO.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: IIntroducción The related quality of life (HRQOL) health seeks to attribute greater importance to the views of the patient at the time of measuring the psychosocial components of their illness and the impact it produces on improving them their lives. In practical terms, the impact of the disease on daily life can be measured through questionnaires quality of life. Questionnaires type generic valued all aspects of the Quality of Life in a global and disease-specific questionnaires. Chronic obstructive pulmonary disease (COPD) has a significant morbidity and mortality, with huge deterioration in the quality of life, disability and tendency to high consumption of resources. The HRQL to assess the actual severity of the disease thanks to the information and opinion provided by the patient, bringing aspects of the sick and the disease does not normally analyze and must have a complementary role to conventional parameters. This study raises awareness for the quality of life of patients with COPD in the area of primary care and establish the factors that have the greatest influence on the quality of life related to health. Patients and methods. This is an observational study descriptive cross that was conducted in a population diagnosed with COPD belonging to the health center in Calpe (Alicante). The group of patients examined in our study was finally all patients with COPD acquaintances who come in a systematic manner to the queries from the center. Inclusion criteria: Patients diagnosed with COPD by clinical criteria and espirométricos according to the rules SEPAR103, understanding clinical criteria for the presence of cough and expectoration for at least three months in two consecutive years and in the absence of other causes of persistent cough. It was considered the chronic airflow limitation when the patient presented in basal conditions, values of FEV1 <80% and FEV / FVC <70% of the values teóricos.Criterios exclusion: 1) age less than 35 years 2) Entities specifically excluded from ladefinición COPD by SEPAR () 3) Inability to respond congarantía to questionnaires by physical or mental illness or problemassociales graves.Protocolo study: a structured questionnaire was designed for recording information dondese collected patient characteristics, the característicasde disease and the characteristics of tratamiento.El Nottingham Health Profile (NHP) is a generic questionnaire that abordala measure of the degree of involvement of the physical components, psicológicoy social life of patients and has been validated to Spanish porAlonso et al . The questionnaire consists of two parts. The first parteestá consisting of 38 items, which investigate on the "distress" received, collected in 6 different dimensions of health: Energy (3 items), pain (8 items), Mobility Physics (8 items), Reactions Emotional (9 items ), Dream (5 items) Isolation and Social (5 items). The second part has 7variables categorical that are valued independently. The contestacióna questions is through answer YES / NO. To pick up the puntuaciónse assigned "1" to "YES" and "0" to "NO". The score "0" significaque the patient is not suffering from the problems represented in this dimension, and "100" represents the suffering of all the problems expressed inthe items such dimensión.El St. George Respiratory Questionnaire is a specific enfermedadesrespiratorias like asthma and COPD, enables collection and quantify losprincipales aspects of the disease affecting the limitation físicade such patients. Its format consists of 76 items that dividenen three dimensions: Symptoms, Activity, Impact. The result can variarde 0 to 100. The score "0" indicates no change in the Calidadde Life; highest scores 8 indicate 1ff8 worse quality of life and "100" accords with maximum impairment of quality of life. We used a program informáticoespecífico in BASIC for obtaining individual scores dela scale SGRQ.Espirometría: All espirometrías was done by two nurses entrenadosy familiar with the test; themselves were responsible for calibrarel espirómetro with syringe 3 liters in each session , and also measured height and weight of the sujetos.Análisis statistics: Data analysis was performed using the Statistical Program SPSSversión 10.0.El descriptive study of all the variables included frequencies and porcentajesde qualitative variables and the mean, standard deviation and intervalosde confidence to 95% in quantitative variables. The relationship between variablesse studied with chi-square tests for discrete variables categóricasy Student's t in the continuous, except in cases where no secumplen conditions of normality of the data, which utilizaronpruebas not parametric. For the analysis of the dimensions of Perfilde Health Nottingham we used the T test for equality delas mean if categorical variables in 2 categories, and ANOVAcuando are more categories; for continuous variables was calculated lacorrelación Pearson. To relate scores CuestionarioRespiratorio Saint George with categorical variables of 2 categoríashemos used the non - parametric test of Mann-Whitney U, and for variablescategóricas more categories proof of Kruskal-Wallisdado that Nonparametric were not met criteria of normality in the case 2 variablescontinuas the test used has been the Pearson Correlation. The nivelde statistical significance was set at p less than 0.05. Statistical analysis was completed by a study multivariate conaquellas variables that reached statistical significance in the estudiobivariante and that proved most useful for the purpose of the study. It realizóla test by successive steps, involving a dependent variable convarias variables predictoras.Resultados1- descriptive study: We studied 125 patients with COPD, finally were 15por not excluded can be localized, 8 per éxitus and 7 because they gave their consentimientopara participate. Of the sample obtained, 83.4% were male and 17.6% female, with an average age of 66.95 years ( ± 9.92) and a level socioeconómicomedio-bajo (65.6%). We got a high percentage of smokers (46.4% frentea 50.4% of non-smokers), with an average packet / year of 55.6 ( ± 34.14). Spirometric values media showed an average FEV1 of 54.87% ( ± 16.85), an average FVC of 69.66 ( ± 15.40) and an average of FEV1/CVF de74, 42 ( ± 17.30). Up to 71.2% of patients had some enfermedadasociada to COPD, the most frequent were the osteoarticular (36%), followed by cardiovascular disease (29.6%) and psychopathological (5.6%). Regarding On the other hand we see that inthe year preceding the survey, 39.2% of patients had no ningunaagudización, 31.2% one aggravation, 14.4% two acute episodes, 5.6% and 9.6% three acute episodes over three acute episodes. We estimate a mediade 0.6 acute episodes per year. Regarding income, 88.8% not necesitóingreso Hospital, 8.8% and 2.4% had one elaborated two ingresos.La average revenue per year was 0.13. Of the 76.8% patients teníanalgún type of treatment scheduled (average of 2.02 medications  ± 0.88 per patient) reflect that the system was the most commonly used inhaler cartridge pressurized (66.7%), followed by accuhaler (24%) turbuhaler (18%) and aerolizer (5.2%). should underline that the 90.6% incorrectly performed the técnicainhalatoria.En figure 1 and 2 provides a breakdown of the average scores of dimensionesde questionnaires Nottingham Health Profile and Saint George RespiratoryQuestionnaire. The results of the responses that correspond to lasvariables categorical reflected that the current health status of nuestrospacientes causes problems mainly with: household chores (24.8%), hobbies and hobbies (17.6%), sex life (16, 8%), days defiesta (15.2%) and lowest percentage with their social life (11.2%), its puestode work (5.6%) and family life (4%). Fig. 1: Averages and diversions Typical of the dimensions of NHPy scoring total.Fig. 2: Averages and diversions Typical of the dimensions of SGRQy scoring total.2.-Análisis bivariate: exhibiting in tables 1 and 2 the results of the study bivariate queobtuvieron statistical significance or trend significativa.Tabla 1: Results of the relationship between the variables studied and lasdimensiones of NHP. Energy Pain Emotional Reactions Dream Isolation Social MovilidadFísica TotalNivel socioeconomic <360 euros/mes360-721 and / month> 721 euros / month 46,6624,8518,70 p = 0027 Diseases associated OsteoarticularesCardiovascularesPsicopatológicas 34,8224,2833,28 p = 0084 32 , 9211,2126,92 p = 0000 12839,8754,0 p = 0000 26, 2219,4565,71 p = 0000 8,03,7831,42 p = 0001 33,7719,6837,57 p = 0000 24,7514,7141,62 p = 0000 Symptoms DisneaNo dyspnea 28,1911,32 p = 0004 Cough / no cough Expectoración / non expectoration Agudizaciones 0123> 3 16,9726,6125,9228,5752,76 p = 0034 7, 6614,5916,6922,2125,94 p = 0057 20018 , 4623,3325,7145,0 p = 0080 21.2417, 0534,9130,4235,7 p = 0011 14,9516,7420,8423,1433,11 p = 0024 Ingresoshospitalarios 012 22,5545,3655,66 p = 0037 11.3132 , 3933, 33p = 0002 19,8245,4546,66 p = 0007 6,8418,1813,33 p = 0074 22,0737,5437,66 p = 0, 050 16,4535,235,33 p = 0001 Treatment SíNo 26669.65 p = 0006 26,5414,75 p = 0013 20,4512,29 p = 0032 N º drugs 012> 2 9,0318,2330,034,37 p = 0002 14,8122,8329,2628,96 p = 0032 11,6316,4321,3625 , 08 w = 0017 Table 2: Results of the relationship between the variables and dimensions of the SGRQ. Symptoms Activity Total Impact socioeconomic level <360 euros/mes360-721 and / month> 721 euros / month 56,6645,9437,2 p = 0035 49,8640,134,6 p = 0029 Diseases associated OsteoarticularesCardiovascularesPsicopatológicas 44045,5658,57 p = 0029 Symptoms DisneaNo dyspnea 45,2733,04 p = 0015 49,7219,04 p = 0000 37, 1425.95 p = 0000 42,3124,85 p = 0000 TosNo cough 49,9432,78 p = 0000 ExpectoraciónNo expectoration 50,1734,37 p = 0000 Agudizaciones 0123> 3 27,5145,2856,1656,4273,55 p = 0000 38,0438,9251, 3355,5773,0 p = 0000 31,4633,9735,0544,050,16 p = 0000 32,8137,2543, 5549,5760,91 p = 0, 000 Hospitalizations 012 41,6656,1853,33 p = 0085 42,4259,7268,33 p = 0051 33, 7247,5447,33 p = 0021 37,6452,6355,0 p = 0027 Treatment SíNo 47 , 4429.24 p = 0000 49,8327,13 p = 0000 36, 6930.51 p = 0053 42,4629,17 p = 0000 N º drugs 012> 2 29,4142,1148,6752,98 p = 0000 27,2942,3854, 8954, 65p = 0000 30,1632,2938,9628,96 p = 0007 29,0637,0546,0746,0 p = 0000 Technical inhalation CorrectaIncorrecta 65,3346,11 p = 0000 64, 048.47 p = 0000 51,8341,57 p = 0000 In the Table 3 details the correlations between FEV1 and dimensions of both questionnaires. Table 3: Correlations between FEV1 and dimensions of the NHP and the SGRQ. NHP SGRQ Energy Pain Emotional Reactions Dream Isolation Social Mobility Physical Activity Total Symptoms Impact Total FEV1 r =- 0261p = 0004 r = -0040p = 0661 r =- 0246p = 0006 r =- 0237p = 0, 009 r =- 0209 p = 0021 r =- 0328p = 0000 r =- 0310p = 0001 r =- 0329p = 0000 r =- 0527p = 0, 000 r =- 0267p = 0003 r =- 0445p = 0000 3. multivariate Analysis: The multivariate analysis allows clearing confounding factors, and represent the specific weight of those variables obtaining statistical significance. In linear regression analysis introduce as dependent variable 8 the punt 70d belo w total SGRQ. The predictor variables in the model were: total NHP, dyspnea, acute episodes and FEV1. This is a model significant (p = 0000). There was r2 = 0625. The final model calculated revealed: T NHP (Ã: 0.51, p = 0000), dyspnea (Ã: 12.5, p = 0000), acute episodes (Ã: 7.03, p = 0000), FEV1 (Ã: -0172, p = 0004). Conclusions: The multivariate analysis allows us to conclude that the variables dyspnea, acute episodes, the total NHP and FEV1 explaining 62.5% of the variability of change in the quality of life measured with the total SGRQ. On the other hand also shows that the variables dyspnea and acute episodes, with higher beta coefficients, are those that represent more specific gravity within this variability. - The profile of the patient with COPD is a man of 66 years of age, low education, low socio-economic and exfumador; presents osteoarticular diseases associated dyspnea and as a main symptom exacerbation for at least one year. - The Quality of Life patient with COPD in primary care is most affected to the extent Energy Physics and Mobility Dream of NHP and dimensions Symptoms and Activity SGRQ.

Author: RIVERO DE JESÚS VICTORIA.
Year: 2005.
University: AUTÓNOMA DE BARCELONA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The proper functioning of the auditory system allows an appropriate relationship with the environment which is essential for the full development of the capacities of human beings, and that the man passed his ideas mainly through language, so that the significance of the mechanism lingüstico of men and their implications must be studied from different vantage points, so it is useless to talk to your ear, their illnesses and causes that determine, or make considerations about their identification, diagnosis or treatment, but we think the functional consequence of the hearing, which is the oral language. So when I try to give people with severe deafness and / or deep the ability to receive sound information, to access to the codes communicative language spoken and written, we are seeking the restoration of one of the most important human functions. This can be achieved through cochlear implants. Since the beginning with the first cochlear implant surgery, the development of these has been estrepitoso especially in the last decade, the progress of multichannel cochlear implant has revolutionized the treatment of profound sensorineural hearing loss and now severe hearing impairment. At present, cochlear implants are the best hope for patients with severe and profound hearing loss in which no useful hearing aids, or the utility is very little, for this is their growing demand. To introduce a patient is a well-established need cochlear implant which consists of several stages, from the selection of candidates for implanted, surgery, programming, rehabilitation and monitoring of the patient. The most important stages in programs Cocleares implants are those in the selection of candidates for surgical implantation and to a large extent on the proper selection of the candidate's performance will depend on the outcome of the implant. Obviously the selection of candidates is of great significance for several reasons; so dedicated and expensive procedure and because it involves the practice of surgery entirely elective, basically healthy subjects, all of this is the need to choose the best candidates to take advantage of the best recusaos financial, especially when these are limited. However, the selection of suitable candidates for implanted could mean a dilemma if you do not have selection criteria established and consolidated, as might happen at the moment with the IC, which are changing so fast, there are now various selection criteria. As mentioned cochlear implantation increases the quality of life but does not increase life expectancy. Since resources in the health services are limited, the selection of patients by analyzing the cost has been subjected to constant and rigorous scrutiny to establish the benefits of a more precise manner, thus justifying the cost required for these. Therefore committees have been created to establish health criteria for selecting candidates for medical interventions that are explicit and evidence-based, particularly when technological advances invite relaxation of criteria. These limitations from the point of view socioeconomic also support the need to establish criteria for IC, and that with the continuing evolution of the IC have changed the criteria for implementation, have risen and fallen contra-indications and some of these would be questionable eg bilateral cochlear implant because it knows that the unilateral cochlear implantation for adult patients with profound hearing loss, has a high cost to health services (considering the above as to the criteria of valuation of benefits of a surgical intervention based on their impact on the decline of mortality) as discuss bilateral implantation, it would be questionable to many health institutions. 8 The imp 956 lante cochlear solution has been to reintegrate the world social and labor to patients with severe profound hearing loss for what we have done this research to analyze the impact of changes in the selection criteria for patients implanted. In this study we analyzed the criteria for selecting candidates for cochlear implant in adult patients, changes and flexibility of these criteria in the past 15 years, also evaluating functional outcomes obtendios by patients implanted. We believe that the selection of candidates is of great significance for several reasons, one of the reasons it is so delicate and expensive procedure and another point is important because it involves the practice of surgery entirely elective subjects basically healthy, those expecting good functional outcomes and complications would be unlikely, for all those who believe it is essential to choose suitable candidates for best results possible functional. Data for this study were collected retrospectively from the stories of 235 patients in the Clinical Institute Otología García-Ibález, from 1985 to 2005 of 235 patients were selected 149 patients met our inclusion criteria. The results showed a better outcome of cochlear implants in recent years, the following chart shows. In this analysis we found that statistical Yes there is a statistically significant relationship (p-valor = 0001), the year of introduction and performance of the implant valued through the hearing thresholds at three months after the implant. Our results clearly show that there was a statistically significant improvement in recent years of implantation, which can be attributed to increased surgical experience, and better evaluation of the selection criteria.

Author: MERABISHVILI GELA.
Year: 2005.
University: BARCELONA.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The superposition method acquires a vital importance in the cabinets of modern identification. The technique of two-dimensional X-ray overlay / photography makes it possible to develop a non-destructive technique and applicable in special cases, such as charred corpses and unrecognizable from major disasters. The main objectives of this work are: 1-To develop and refine the method of superposition of static images (radiography / photography) employed by Glaster and Brash-Blundell and Wilson (1937) with help of a method using digitized computer and software, based on empirical exact terms. 2-Define the anatomical point of reference in radiography and photography, taking into account the margin of error in the process of determining the anatomical points. 3-Defining the exact ratio or factor expanded radiography and photography. Among the advantages of its use is that all studies of identification can remain archived as computer records without damaging the originals, streamlining the process and reaching conclusions on certain rational individual identification. The coincidence of more than 12 points anatomical ago that the probability of belonging to the same individual is infinitely superior to that belongs to somebody else, so that identification is to be considered positive. There is a substantial evidence when match from 10 to 12 points, a figure determined empirically and establishes a position of certainty based on sound almost impossible (very low probability that two people chosen at random to have such a degree of overlap). The degree of certainty that we made is the same as that of other procedures to arrive at a figure very high probability, and that is what in Forensic Medicine is known as rational certainty, because the opposite hypothesis is almost impossible. The statistical studies conducted through the ROC curve (Receiver Operator characteristic curve) determined that the margin of error (cutoff point universal) in the valuation of the points is 0.20 cm. Of the 16 points anatomical used in the study, 14 get a similar statistical reliability. The remaining two, nasolaterales fall below this value, probably because they are more vulnerable to injuries, but this is not a contraindication their use, because they are two very individualizadores during malfunctions.

Author: MARTÍNEZ GÓMEZ VLADIMIR.
Year: 2005.
University: BARCELONA.
Place of defense: FACULTAD DE ODONTOLOGÍA.
Place of preparation: FACULTAD DE ODONTOLOGÍA.

Author: Juan Garcia Francisco Javier.
Year: 2005.
University: A CORUÑA.
Place of defense: Facultad de Ciencias de la Salud.
Place of preparation: Facultad de Ciencias de la Salud.

Summary: Introduction: The whiplash injuries associated with the cervical spine (LALC) are very common and about 50% of patients report symptoms of dizziness or instability. Previous studies indicate disturbances of balance in patients with LALC. The posturografía computer (PC) has been used to assess quantitatively and qualitatively the ability to maintain balance and postural strategies movement in healthy subjects and those with dizziness. The objective of this study was to analyze the responses of patients with LALC with and without dizziness, and these two groups was compared with a control group of healthy subjects. Methods: The study design was prospective observational three groups. Participants were 191 subjects with LALC, 146 with dizziness, 45 without dizziness, and 45 healthy subjects. To be included patients had to submit in connection with cervical trauma after traffic accident dizziness or instability, include 45 healthy subjects were recruited from among volunteers. The PC was used to measure the balance under different conditions sensory altering the vision and support. Each subject took a relaxed posture in bipedestación with bare feet on a force platform (Ned / EVS VBC r Platform dynamometer, Institute Biomecánico Valencia, Spain) was recorded reaction force land at the medio and antero - later. The limits of stability were studied with visual feedback, as well as the ability and effectiveness of control and antero medio. Results: The results of this study suggest that the energy and parameters posturografía are significantly different in the group with dizziness, compared to the group without dizziness. In the group without dizziness differences were greater than in the control group for all tests, but significantly in certain tests. The 54.1% of patients with LALC, dizziness and had exhibited abnormalities of the posturografía. The 30.8% had abnormalities type pattern somatosensorial. Conclusion: The results of this study suggest that people with LALC with or without experiencing dizziness riots quantifiable postural control using PC, compared with a group of healthy subjects. We found differences in the balance in terms eyes open and eyes closed suggesting that these patients may have trouble combining visual information, and vestibular propioceptivas neck to maintain control of balance. The PC is a useful tool for determining the degree of disturbance of balance in patients with LALC, differentiate patients with or without dizziness after LALC and whether it is necessary to use specific medication or rehabilitation. Also patients with LALC use more strategy hip to maintain balance in comparison with the group of healthy subjects. Keywords: Latigazo cervical, postural control, balance, posturografía, estabilometría, dizziness.