PEDIATRICS

Author: TAPIA COLLADOS CARIDAD.
Year: 2003.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: MEDICINA.
Place of preparation: UNIVERSIDAD MIGUEL HERNÁNDEZ.

Summary: The study conducted in three queries pediatria of health centers teaching area 17 of the Valencian community, during a follow-up period of three months and through primary sources, is raising with the primary objective to quantify the incidence of children hiperfrecuentadores and the secondary objectives of determining the profile of the child hiperfrecuentador analyzing different variables predicioras assess the influence of maternal anxiety in the hyperfrequencies of children and to determine the characteristics of -- to demand pediatria. The incidence of children hiperfrecuentadores is 14.89%. They generate the 36% of consultations, a proportion almost -- more than expected. Factors associated with hiperfrecuentación are lower age of the children, not to attend Guarderia, occupy the second place among the brothers, the younger of mothers and mothers who have not worked (in the multivariate analysis retain the significance Age child and maternal employment status). Mothers of hiperfrecuentadores have higher scores on anxiety).

Author: RIZO BAEZA M. MERCEDES.
Year: 2003.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: MEDICINA.
Place of preparation: UMH.

Summary: OBJECTIVE check whether there were differences in food and nutritional status of school children and adolescents according to their urban environment, which is in turn influenced by the social, economic and cultural development. This has been considered both quantitative and qualitative data of different foods they eat children for seven consecutive days and those qualitative parameters that give insight on the cultural rituals in the eating and that are marked from childhood, during the socialization . RESULTS has been designed a survey to assess nutritional habits for themselves and eliminates potential biases pollster. There was an overweight (BMI greater 85%) in 34.9% in school, and 26% among adolescents. In the social environment more depressed is the greatest% low weights 11.9%. The hours of TV you see are higher 2h/día in all groups, being higher in the most depressed neighborhood, like seeing during meals (60-65%). The meals are made with parents except breakfast and snack that make it a 76.4% alone. Increased participation in the preparation of meals by kids and both parents are in the neighborhood of greater status and vice versa. The largest number of daily meals and the school canteen is in the kids in the neighborhood of greater status, besides being in these canteens menus more balanced. With regard to specific food there is a generally low intake of grains, vegetables, fruits and vegetables, which is more acuasada in the neighborhood more depressed, particularly in cereal. In the group of food protein, is the meat of choice, being dobre consumption that fish, eggs do not reach general to 2/semana and vegetables are consumed only adequately in the neighborhood socioeconomic higher. With milk a similar situation occurs, not llegnado the recommendations in the neighborhood depremido. The increased consumption of pastries, sweets and fats are in the municipality that can be seen as social media, and it has a greater percentage of overweight. Finally, the consumption of fresh juices is higher in both groups higher status in the neighborhood, while commercial juices and soft drinks are paradoxically at the lower purchasing power. With the diet was found deficiencies in fiber, vitamins D and E, Ca and Fe, especially in the depressed neighborhood, and in all groups iodine deficiency. In short, there is a need to establish educational programs in schools and institutes, in close collaboration between professionals children in the area of health and education, stressing especially in neighborhoods and towns with lower social, economic and cultural development. There should be to design these programs without taking into account the cultural characteristics of each of the target populations.

Author: TORRES ARDANUY SILVIA.
Year: 2003.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: UNIVERSITARIO VALL DE HEBRON.
Place of preparation: ESCUELA DE POSTGRADO.

Summary: A cohort study of patients to whom he has made a surgical excision in the period between January 1990 and June 1999 at the Unit of Pathology Mamaria Hospital Vall d'Hebron. In total we have done 1028 surgical excision of benign. There has been an evolutionary control through mammography and clinical examination. Benign lesions of the breast are divided into 3 categories according to the classification Paget and Dupont: Injuries not proliferativas in 700 patients (68.1%), segudio of injuries proliferativas without atypia in 301 patients (29.3%) and proliferativas of lesions with atypia in 27 patients (2.6%). The average time of follow-up was 56.9% months (95% CI: 54.9-58.8), with a maximum follow up of 143 months. Duante monitoring was diagnosed breast cancer to 10 patients. The Kaplan-Meier survival curve, the probability of malignancy to 5 years is 1% and 10 years of 4.8%. The injuries are not proliferativas population control with RR 1. Proliferativas lesions without atypia had an RR high of 5.6 with respect to injuries not proliferativas, confidence intervals that are meaningful 26. The lesions with atypia proliferativas presented RR 25.6 with respect to injuries not proliferativas, confidence interval significant. Injuries proliferatifas with atypia present RR 3.7 with respect to injuries proliferativas without atypia, although the confidence interval is not significant. Factors independently associated with risk of cancer are kind of injury (RR = 4.2, 95% confidence interval 1,5-11,13), so that there is a progressive trends as higher degree of risk of injury and after biopsy ( RR: 4.2: 95% CI, 1.04-17.1).

Author: CAMACHO DIAZ JUAN ANTONIO.
Year: 2003.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The inmovilizaciÃÂ charges has been considered a risk factor for renal stones in patients undergoing it, possibly by an increase in resorciÃÂ ³ n ÃÂ ³ So generarÃÂa an increase in renal calcium supply and hypercalciuria. The relaciÃÂ ³ n inmovilizaciÃÂ ³ n-litiasis been mentioned as etilogÃÂa of lithiasis in adults, without reference to this fact in childhood. In a revisiÃÂ ³ n of our cases lithiasis in niÃÂ ± or a 13.4% (15 niÃÂ ± ÃÂ ³ s) tenÃÂa as background a inmovilizaciÃÂ ³ n prolongada.En 9 of these 15 existÃÂan data analÃÂticos of hypercalciuria. The INMOVILIZACIÃâN COMPLETE provocarÃÂa in niÃÂ ± os the apariciÃÂ charges of a HIPERCULCIURIA SECONDARY, aparecerÃÂa in all niÃÂ ± os about the same momento.La demostraciÃÂ ³ n of this fact podrÃÂa allow prevenciÃÂ charges of patologÃÂa later. OBJECTIVES 1.Demostrar the existence of hypercalciuria in niÃÂ ± os immobilized. 2. Quantify the figures of calcium in these niÃÂ ± ÃÂ ³ s and check relaciÃÂ charges with time inmovilizaciÃÂ ³ n. 3. Determine that time of inmovilizaciÃÂ ³ mc appears hypercalciuria. 4. Check that the time is normalized calcium after deleting the inmovilizaciÃÂ ³ n. 5. Check the presence or absence of lithiasis time despuÃÂ © s the episode inmovilizaciÃÂ ³ n. RESULTS After applying criteria for inclusiÃÂ ³ n 33 niÃÂ ± os immobilized by different processes were considered vÃÂ facilities for the study through aplicaciÃÂ ³ n treatment estadÃÂstico T-Test. Age: M = 7.6 + / -4.1 aÃÂ ± os. 10 niÃÂ ± ace and 23 niÃÂ ± os. The calcium, normal in the first determinaciÃÂ ³ n, baseline, where the patient takes less than 4 dÃÂas immobilized (between 1 and 4), now stands at the second determinaciÃÂ ³ n, from 5 dÃÂas of inmovilizaciÃÂ ³ n.Esa figure not only increases but medicos exceeds normal values. Mean values obtenidoos rising paulativamente accordance do dÃÂas of inmovilizaciÃÂ ³ n, T3 (15-21d) and T4 (mÃÂ ¡s-21d). Values obtained when the patient has already begun his movilizaciÃÂ ³ n full onset of bipedestaciÃÂ charges were have completely normalized. Sex does not influence the value of calcium. There are significant differences in the value of calcium between different patologÃÂas estudiadas.El further research llevÃÂ ³ out 5 aÃÂ ± os despuÃÂ © s of inmovilizaciÃÂ ³ n: None of the patients reviewed habÃÂa submitted sintomatologÃÂa urinary suggestive of the existence of lithiasis. The radiografÃÂa simple abdomen and figures calcium five aÃÂ ± os despuÃÂ © s are normal. The study five aÃÂ ± os despuÃÂ © s confirms that inmovilizaciÃÂ does not necessarily have been responsible for apariciÃÂ charges of lithiasis.

Author: PARAREDA SALLES ANDREU.
Year: 2003.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: HOSPITAL UNIVERSITARI VALL D'HEBRON..
Place of preparation: ESCOLA DE POSTGRAU.

Author: BÚRDALO RODRÍGUEZ MARIA BELEN.
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE CIENCIAS BIOLÓGICAS.
Place of preparation: FACULTAD DE CIENCIAS BIOLÓGICAS-UCM.

Summary: The criptorquidia is presented in 0,7-i% of men m ayoresde one year of age and can develop infertility and testicular malignización in vida'adulta. The criptorquidia is a syndrome that has many controversial aspects relating mainly to the pathogenesis, diagnosis and treatment, have been studied testicular biopsies of 73 children criptorquídicos and 11 cases of monorquia. As controls were used 30 testes of autopsies on children without pathology gonada!. In all cases have identified the following parameters: VT, DTM, 1FT, NCO, lCS, LIpCNAG, LIpCNASYNCGA. Quantification of spermatogonial DNA was obtained in 32 testes of male criptorquídicos fixed in formaldehyde yen controls has been studied in a simple linear correlation between the VT, DTM, 1FT, NCG, LIpCNAGY NCGA. It has also conducted an analysis of linear regression between VT and DTM, DTM And 1FT, 1FT And NCG and LIpCNAGe 1FT regard to age, location and laterality testicular. The discriminant analysis has been evaluated in the testicles criptorquídicos depending on the age and laterality in connection with monórquicos and controls. In the present work has not identified any cases of NITCO. That is why we question the conduct of testicular biopsy child on the early diagnosis of cancer in the criptorquidia. The testicles descended not present low levels in most of the variables studied except those related to the Sertoli cell. However, they are commonly observed alterations gonada1esdiferentes in children criptorquídicos with the same age, location and laterality testicular. This is due to the great variability 1esionalexistente in criptorquidia. The discriminant analysis has determined that the NCG, DTM and VT have the capacity to classify 95.9% of the testicles criptorquídicos in relation to the checks and monórquicos. These three variables are considered essential in the clinical study of the criptorquidia; In all three cases, which have received more than 30,000 IU of RCG is observed bilaterally a lCS and LIpCNASelevados. These total doses should be avoided because it is not known whether these alterations can produce infertility. They relate changes in the testis. Criptorquidia at least part of them, with an intrinsic factor or gonada. This partnership is apparent by the case of disruption in bilateral and unilateral criptorquidia earliness and no progressivity of testicular injury. Therefore, in all these cases need not be treated very early, which could be delayed until the 2-3 years.

Author: FIGUEROA MURUAGA CECILIA INÉS.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: HOSPITAL DEL MAR.
Place of preparation: ESCUELA DE POSTGRADO.

Summary: OBJECTIVES To study the influence of children's exposure to snuff in the induction of allergic respiratory symptoms and in the first 4 years. Identify periods of increased susceptibility, separating the effects of prenatal exposure of postnatal. To estimate the influence on the anthropometric parameters at birth and 4Â fourth years. To validate and quantify exposure to the biomarkers and establish a dose-response association. Valuing the correlation between different biomarkers. MATERIALS AND METHODS Study cohort multicenter prospective in three locations: Ashford (UK), Barcelona and the island of Menorca (Spain). We included 1611 children, followed from pregnancy until 4Â fourth years of life, through questionnaires of disease annually. He queried especially smoking from both parents and the children's symptoms. Symptoms considered were wheezing, roncus, night cough, colds, ear infections, use of antibiotics for chest infection, hospitalization due to respiratory infection, medical diagnosis of asthma, rhinoconjunctivitis, purito skin and eczema. The levels of IgE were measured in cord blood and 4Â fourth year in venous blood of children. The anthropometric parameters were measured at birth and at 4Â fourth year. The confounding variables were considered: the child's sex, a history of asthma or atopy in parents, social class, maternal age, breastfeeding and home density. We obtained biomarkers of exposure to snuff such as cotinina in different arrays. All statistical analysis was performed using Stata version 8. RESULTS Percentages of maternal consumption of snuff were 0-nunca consumption: 41.8%, 1-siempre consumption: 26.8%, 2-consumo just before and during pregnancy: 3.3%, 3-consumo just before pregnancy: 10.9% 4-consumption just before and after pregnancy: 12.2% and 5-consumo only after pregnancy: 5.2%. S. RESPIRATORIOS: In the multivariate analysis noted an association between postnatal exposure to snuff and late-onset wheezing, OR = 2.48 (95% CI 1.08-5.7), as well as the medical diagnosis of asthma to 4Â fourth year, OR : 1.73 (95% CI 0.97 - 3.07) with an increased risk even greater when the mother is atopic. The group of children whose mothers smoked always had more persistent wheezing OR = 2.18 (95% CI 1.49 -3.2). The exclusive postnatal exposure is associated with the presence of early roncus OR = 2.37 (95% CI 0.91 -6.20). Children of mothers who smoked only in the prenatal stage have an increased risk of respiratory infections in low tracks, especially the first year, OR = 2.96 (1.1 - 7.7) and asthma early OR: 3.64 (0.76-17.41). SYMPTOMS ATÓPICOS: Children of atopic mothers exposed to smoke snuff in postnatal life, have a risk 3.7 (95% CI 1.22-11.24) to present allergic rhinoconjunctivitis to 2Â fifth birthday and 2.61 (95% CI 1.00-6.88) to 4 Â fifth year. However, the children of mothers who smoke NOT atopic submitted an OR = 0.59 (95% CI 0.34-1.00) to 2Â fourth year and OR = 0.54 (95% CI 0.26-1.00) to 3Âş year for skin itch. PARAMETERS ANTROPOMÉTRICOS The weight of the children of smokers is 181.9g smaller, the size 0.8cm lower and head circumference 0.4cm lower than that of children whose mothers did not smoke. When the father also smoked parameters at birth decline further. At 4Â th year there was a decrease weight and height, but disappears after adjusting for birth weight. BIOMARCADORES: Levels of biomarcador coincide with the self properly in each group. The risk of respiratory symptoms is greater, the higher are l 8 os level 8f5 is cotinina. The biomarkers are correlated well between them, especially urine samples with the birth of 4Â fourth year (r = 0.70). CONCLUSIONS The prenatal exposure exclusive to snuff increases the occurrence of wheezing, the early diagnosis of asthma and respiratory infections of tracks casualties in the first 2 years of life, for not associated with the presence of roncus, coughing or infections the upper airway. The exhibition serves as exclusive postnatal an inducer of bronchial asthma and wheezing late to 4Â fourth year, especially those in atopic table obstructive develops earlier, in addition to facilitating the development of roncus and cough since the early years of his life by irritant effect . The síntomos atopic less important (rhinoconjunctivitis, pruritus) are augmented by exposure to snuff, especially postnatal only in children with a history of atopy. In those without a history of atopy, the frequency of symptoms is lower among children exposed to the tab jr. The total IgE cord blood IgE, and specific 4Â grade are not influenced by exposure to smoke snuff. Persistent exposure to snuff increases every respiratory symptoms both tracks casualties as high pathways, with a clear dose-response effect. All parameters antrompométricos at birth are diminished due to the exposure of non-smoking pregnant as consumer asset it with a dose-dependent effect. The deficits observed to 4Â grade depend exclusively prenatal exposure to snuff. Surveys of self-declaration of smoking is properly validated with biomarkers. The cotinina cord blood is the most valuable marker at birth, while the cotinina in the urine of children is to 4Â fourth year.

Author: MIR MESSA INÉS DE.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: ESCUELA DE POSTGRADO UAB.

Summary: BACKGROUND AND OBJECTIVES bronchitis sibilantes repetition in children under 4 years are a very common condition, but there are no extensive data on the presence and characteristics of hyperresponse bronchial inflammation and bronchial at this age. OBJECTIVES 1-Evaluate the efficacy and safety of the method for measuring auscultation hyperresponse tracheal bronchus in children under 4 years, and its presence in children in this age group with bronchitis repetition. 2-To determine the normal values of exhaled nitric oxide (FE NO) in healthy children younger than 4 years of age, and appreciate the presence of bronchial inflammation in children of this age with bronchitis repetition, by identifying FAITH NO, phase intercrisis. METHODS We included 63 children aged 6 months to increased 4 years who have submitted greatest 3 episodes sibilantes last year, and a control group of healthy children (n = 16) with no history of smoking or atopy. We tested for bronchial provocation with metacholine by the protocol (shortened) inhalation volume flow for 2 minutes. It was considered a positive test to a certain concentration of metacholine (PCW) if auscultaban sibilantes in trachea, lowered the SaO2 increased 5% or increased respiratory rate more than 50%. It was found exhaled nitric oxide through technical collection off with spontaneous breathing flow volume, with nose mask, a collection system in Mylar bag and measurement subsequent quimioluminiscencia. STUDY RESULTS OF HIPERRESPUESTA BRONQUIAL In healthy children, 10 did not react to metacolin and 6 did to peak concentrations of 8 mg / ml. In the group with bronchitis there were 10 non-responding, 10 who reacted to the maximum concentration and 43 who responded to concentrations lower than those in the control group The difference between the 2 groups was statistically significant (5.8 vs 13.3 mg / ml ) (p less 0001). In 30% of patients, there was a decrease in SaO2, which in any case was below 88%, and in all cases the auscultation and SAO2 were normalized after administration of salbutamol. The only variable that influenced the PCW, was the age at which they had submitted the first bronchitis. STUDY OF FAITH NO group of patients with bronchitis introduced as a half FAITH NO higher than the control group. If we distinguish in the group of patients who were between the treatment and those who did not, we note significant differences between the group and the untreated control, but not among the group treated with ICG and control. The increase of eosinophils in the blood, in the group with bronchitis repetition was related to an FE NO higher. CONCLUSIONS The method of auscultation tracheal changed is effective and safe for valuing bronchial reactivity in children under 4 years of age, and does not require sedation. A high percentage of them presented hyperresponse bronchial; 68% react to lower concentrations respect to healthy children. Measurement of exhaled nitric oxide through the collection off-line volume flow is simple and requires no sedation or active collaboration of children. Children under 4 years old suffering from bronchitis sibilantes repetition in asymptomatic phase, presented bronchial inflammation, as reflected by an increase in the concentration of FAITH NO. However, the result does not discriminate adequately healthy children of children with bronchitis, and there is a large area of overlap. Patients receiving treatment with inhaled corticosteroids had a value equal to FAITH NO children 8 healthy 313 while those who had not received an increase in the FE NO.

Author: ANTON PACHECO SANCHEZ JUAN LUIS.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.

Summary: Introduction: The pathology of the trachea estenosante includes a diverse group of entities ranging from obstructions intraluminales to! Malacias and extrinsic compression. We divided into two main blocks that are the foundation of this thesis: tracheal stenosis (congenital and acquired) ytraqueomalacia (congenital and acquired). Objectives: Defmir a protocol of treatment depending on the type of injury, the patient's clinical, endoscopic findings, and the presence of associated malformations. Study comparatively different endoscopic surgical techniques and in each type of injury estenosante, selecting the most appropriate procedures and establishing their direction. Analyzing the results obtained in our series and compare them with those of ótros authors. Materials and Methods: In the period between January 1991 and December 2003, 78 patients with tracheal pathology estenosante have been diagnosed and / or treated in our unit. In developing this project, we conducted a retrospective study of clinical records. The 88.4% of the cases, 69 patients, other associated malformations. Thirty-four patients (43.5%) had received medical treatment and 42 (53.8%) had been treated with endoscopic procedures and / or surgery. In two patients (2.5%) could not be put in place adequate treatment due to his critical condition. The therapeutic outcome has been satisfactory in 58 patients (74.3%), regular 7 (9%), and bad in 5 cases (6.4%). The value of the latter group. Corresponds to the patient died due attributable to the disease or the treatment estenosante traqueobronquial established; Nine patients over. The series (11.5%) have died for reasons other than (severe malformations. Partner, sudden death, etc..). Overall survival in the series has been 82% (64 patients) and the median follow-up period of 5.5 years (range 3 months-164 months). Conclusions: In congenital tracheal stenosis, or asymptomatic cases with mild symptoms can be treated so conservative. In symptomatic patients recommend a surgical treatment: in the short stenosis  "30% of the tracheal length), resection of the stenosis with anastomosis termino-terminal; in cases with a long stenotic segment (less 30% of the trachea) The traqueoplastia deslizada and when there is a stricture associated mainstem bronchus, traqueoplastia with costal cartilage grafting: There is no single surgical technique applies to all forms of congenital tracheal stenosis. We have not seen significant alterations in the growth and development tracheal in patients who have intervened. In traqueomalacia congenital, the majority of patients (63%) can be dealt with expectant, as it produces clinical improvement with spontaneous resolution of the pathology before the 3 years of life. The endoscopic or surgical treatment is used in cases with severe clinical impact: aortopexia, forms secondary esophageal atresia, the tracheostomy, when there laryngeal pathology associated, and the placement of prosthetic endoluminales if previous techniques fail or there bronchial malacia. The purchase gives tracheal stenosis, the morphological characteristics of the stenosis and its etiologia determine the type of treatment: endoscopic dilation with the implementation of laser-like lesions in the membrane and in the inflammatory; surgical resection, with the stricture loss of support cartilaginous trachea. In strictures. Secu.ndarias a systemic disease, or infectious origin, is due ins, taurar a tratamientq doctor. In arqueomalacia adqueida, correctness uerúrgica is necessary in those cases inthe that decanulación is not possible. In our view, the most effective surgical technique is pexia cricotraqueal provided there is sufficient support cartilaginous.

Author: PADILLA GALO ALICIA.
Year: 2004.
University: MÁLAGA [www.uma.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: There has been an exhaustive review of the pathophysiology, evolution and possible treatments for cystic fibrosis and their relation to the nutritional status of paciente.El working hypothesis raises as the relationship between the existence of malnutrition and poor prognosis of the development of the fibbrosis quísitca and the ability to prevent the onset of this malnutrition at an early stage as a measure of prevention of complications and as a means of improving the quality of life of patients, both made significant therapeutic implications. The work has been performed in 46 adult patients (mostly women) diagnosed with cystic fibrosis which has been valued Stadium severity of the disease through the system of valuation of NIH amended, nutritional status and diet, respiratory function, and quality of life. The main conclusion of the study is the presence of alterations in the metabolism of carbohydrates, in the fatty acid profile of the serum phospholipids and high antibody titre anti-LDL oxidized in patients with cystic fibrosis.

Author: ARIAS LÓPEZ ISABEL.
Year: 2004.
University: EXTREMADURA [www.unex.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE BADAJOZ.

Summary: Heart concienitas are a relatively common condition in our midst, although its epidemiological characteristics are not known as in many other provinces, forming a disease with great impact cúnica and is now a specialty in full swing, which is changing their attitudes therapeutic in recent years, thanks to breakthrough in medicine and technology. This study pretend to know the incidence, epidemiological characteristics and attitudes current versus heart disease concienistas in our province through the analysis of a sample of patients to consult cardiology pediatria of HMI In Badajoz, which is the only pediatrica cardiology consultation in the province of Badajoz.

Author: ULLOA SANTAMARÍA M. ESTER.
Year: 2004.
University: CÓRDOBA [www.uco.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE CÓRDOBA.

Summary: Mechanical ventilation leads to changes in kidney function that resulted in a decrease in the renal excretion of sodium and water, and which have been attributed, among other factors, a decline in the venous return, modificacines of hemodynamics intrarrenal sucundarias stimulation sympathetic, activation of renin-angiotensin-aldosterone axis, to increase and decrease of ADH natriurético headset factor (ANF), The present study aims to demonstrate how in a child population sométida surgery extracorporeal the transmission to the mediastinum of the presiónpositiva generated by mechanical ventilation decreases the transmural pressure of both atria and, secondarily, secretion ANF.Para it were studied prospectively 32 pediatric patients who required mechanical ventilation in the postoperative period of cardiac surgery extracropórea and were ventilated using various forms of assistance respiratory. The results indicate that the positive pressure intrarorácica induced by mechanical ventilation in the postoperative extracorporeal cardiac surgery, and were ventilated using different modes of ventilation. Results indicate that presiónpositiva intratorácica induced ventilation mecácinica transmitting the mediastinum, porvocando a disminuciónproporcional of diuresis and natriuresis. These metabolic disorders could not attributable to changes in hemodynamic status, or in the secretion of ADH or aldosterone. It found that the transmural atrial pressure is the main stimulus for the secretion of ANF and that in situations where the complianza lung diminished there is less transmission of the pressures generated by the respirator the mediastinum, and higher levels of ANF . Finally, the decline in the secretion of ANF was related directly to a lower renal excretion of sodium and water, suggesting the important role of this peptide in the metabolic alterations hidrosalino triggered by mechanical ventilation. Keywords. Mechanical Ventilation factor natriurético headset, ADH, renin, aldosterone.

Author: HERNANDEZ RODRIGUEZ MIGUEL ANGEL.
Year: 2004.
University: LA LAGUNA [www.ull.es].
Place of defense: FACULTAD DE MEDICINA. UNIVERSIDAD DE LA LAGUNA.
Place of preparation: FACULTAD DE MEDICINA.UNIVERSIDAD DE LA LAGUNA.

Summary: INTRODUCTION: THE POPULATION UNDER 15 YEARS MEANT AN IMPORTANT PERCENTAGE OF TOTAL POPULATION AND INDUCE A CONSIDERABLE VOLUME OF PRESCRIPTION. THERE POCA ESCASOS STUDIES AND SCIENTIFIC EVIDENCE THAT AVALEN TREATMENTS FARMACOLOGICOS CURRENT. THE RELATIONSHIP THERAPEUTIC - PARENTS IN MEDICAL ATTENTION PRIMARY INFLUYE IN THE PRESCRIPTION. JUSTIFICATION: ESCASAS PUBLICATIONS ON STUDIES COMPARATIVE SUPRANACIONALES. NEED FOR METHODS REPRODUCIBLES And COSTE-EFECTIVOS. NEED TO COMPARE EUROPEAN COUNTRIES OF DIFFERENT LEVEL OF DEVELOPMENT. SUITABILITY OF DESIGN STUDIES NATURALISTICOS THAT IMPLIQUEN to Physicians PRESCRIPTORES. GENERAL OBJECTIVES: TO STUDY OF COMPARATIVE USE OF DRUGS IN PRIMARY CARE FOR CHILDREN IN 7 LOCATIONS OF 5 EUROPEAN COUNTRIES. DESCRIBE THE PATTERNS DIAGNOSTICOS And TERAPEUTICOS. IDENTIFY AREAS FOR IMPROVEMENT. SPECIFIC GOALS: MAKING UP AND VOLCADO DATA HOMOGENEOS. DESIGN AND DEVELOPMENT OF A DATABASE RELACIONAL SPECIFIED. DESCRIPTION AND COMPARATIVE ANALYSIS OF THE PATTERNS DIAGNOSTICOS And TERAPEUTICOS. DESCRIBE THE POTENTIAL BENEFITS ANALYSIS BY INDICATIONS TERAPEUTICAS. EXAMPLE OF SHOW PROSPECTIVO LONGITUDINAL STUDY IN TENERIFE BETWEEN 1982 AND 1997. PATIENTS AND METHODS: SURVEY CONDUCTED UNDER THE EUROPEAN GROUP FOR RESEARCH IN USE OF DRUGS (EURO-DURG). DESIGN DESCRIPTIVE, CROSS, NATURALÍSTICO, MULTICÉNTRICO AND INTERNATIONAL. SE RECOGIERON SAMPLES OF BETWEEN 1000 AND 2000 CONSULTATIONS BY LOCATION (TENERIFE, Barcelona, Valencia, TOULOUSE, SOFIA, BRATISLAVA AND SMOLENSK) BY REGISTERED BETWEEN 15 AND 50 DOCTORS. MAJOR DATA WERE REPORTED: IDENTIFICATION OF DATA (NO PERSONAL), DIAGNOSTICOS AND ITS EVOLUTION TIME, FARMACOS, INDICATIONS TERAPEUTICAS, STRENGTHS AND ROUTE OF ADMINISTRACION.SE DISEÑÓ A DATABASE RELACIONAL SPECIFIED FOR THE VOLCADO, ENCODING AND ANALYZING THE DATA. ENCODING: ICD-9 (DIAGNOSTICOS E INDICATIONS) ATC AND LEVEL 4 (FARMACOS). IS ABSOLUTELY GUARANTEED THE PERSONAL PRIVACY ON THE IDENTITY OF CHILDREN. RESULTS: This thesis has been submitted by "Compendium of publications" and is based on the following items: Eur J Clin Pharmacol 2004; 60 (1) :37-43; Eur J Clin Pharmacol 2004, 60 (2) :127-134 and Acta Paediatrica 2005, 94:1-8. VARIABLES ANALIZADAS WERE THE MAIN: 1. PROFILES DIAGNOSTICOS, NUMBER OF FARMACOS BY CHILD GROUPS FARMACOLOGICOS USED, GLOBAL USE OF ANTIBIOTICS, USE OF ANTIBIOTICS IN THE INFECTIOUS PATOLOGIAS FREQUENTLY IN PRIMARY CARE. 2. DESCRIPTION OF SPECIFIC PATTERNS OF PRESCRIPTION FOR OTITIS MEDIA ACUTE. 3. INDICATIONS TERAPEUTICAS ANALYSIS BY THE USE OF MUCOLITICOS, ACID ACETILSALICILICO AND DESCRIPTION OF PATTERNS OF WRONG PRESCRIPTION ANTIBIOTICA. 4. DESCRIPTION OF CHANGES IN THE PATTERNS DIAGNOSTICOS And TERAPEUTICOS IN A PERIOD OF 15 YEARS IN THE AREA OF HEALTH TENERIFE. DISCUSSION: HE COMENTAN THE LIMITATIONS OF THE STUDY (NO GRADING DIAGNOSTICA, SIZES MUESTRALES, SINCRONIZACION FROM THE COLLECTION OF SAMPLES, DIFFERENT OORGANIZACIÓNSANITARIA). METHOD TO PROVIDE A VALIDO, REPRODUCIBLE, ESTANDARIZADO ECONOMICAMENTE VIABLE AND EDUCATION FOR THE PURPOSE OF USE OF DRUGS. THE SOBREUSO AND WRONG CHOICE OF ANTIBIOTICS IS THE MAIN PROBLEM DETECTADO. THE TREATMENT OF OTITIS MEDIA PRESENTS ACUTE NOTABLE IRREGULARITIES WITH RESPECT TO RECOMMENDED BY THE SCIENTIFIC EVIDENCE. STUDY BY THE INDICATIONS TERAPEUTICAS VARIABILIDAD ALLOWED TO IDENTIFY AREAS IN THE PRECTICA CLINIC AND PATTERNS OF WRONG PRESCRIPTION, AND IN A METHOD FOR MONITORIZACION TERAPEUTICA VALIDO. HAS FOUND AN MEJORIA OVERALL IN THE PATTERNS OF PRESCRIPTION FOR THE PERIOD IN TENERIFE ESTUDIADO BUT MANY AREAS CONTINUE TO IMPROVE TO HABRIA 8 TO REE 5ff VALUAR. CONCLUSIONS: THE REALIZATION OF STUDIES COMPARATIVE SUPRANACIONALES OF USE OF DRUGS IN PRIMARY CARE OF PATIENTS CAN EJECUTARSE IN PRACTICE TO A COST ASUMIBLE. PROVIDED THE HOMOGENEIZACION OF INFORMATION AND MONITORIZACION OF CHANGES. AVERAGE NUMBER OF FARMACOS BY PATIENT PRESENTS BROADER DIFFERENCES. SE DETECTA SOBREUSO GLOBAL AND ANTIBIOTICS NOT CONSIDER THE FIRST ELECCION.LA VARIABILIDAD Found IN TREATMENT OF OTITIS MEDIA IS NOT ACUTE COHERENT WITH THE RECOMMENDATIONS OF CURRENT TREATMENT. THE FOCUS OF STUDY BY THE INDICATIONS TERAPEUTICAS ALLOWED TO GET MORE INFORMATION SPECIFIC ON PRESCRIPTION AND ALLOW AN ANALYSIS OF COMPREHENSIVE ABANICO. WAS FOUND AN IMPROVEMENT IN THE PATTERNS OF GLOBAL PRESCRIPTION FOR THE PERIOD IN TENERIFE ESTUDIADO.

Author: MARTINÓN TORRES FEDERICO.
Year: 2004.
University: SANTIAGO DE COMPOSTELA [www.usc.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The bronquilitis acute baby is a high incidence of disease, which has no proven effective treatment, and carries a high morbidity and mortality and a major cost health derivative. The HELIOX, is a mixture of very low density gas, which has been used effectively in treating patients with chronic obstructive respiratory rate, primarily by reducing labor respiratory patient and the improvement of gas exchange. The pathophysiological features of acute bronchiolitis, with a pattern of obstructive predominantly affectation, and the peculiarities of the respiratory physiology infant compared to the adult, would justify the use of HELIOX as a treatment in infants with acute bronchiolitis. Its application could improve the patient's respiratory status, preventing or delaying the development of fatigue and acute respiratory failure, and therefore changing the prognosis of the disease, without assuming further biological risks to the infant because of the inert nature of the treatment. This work prospectively evaluated the applicability, safety and therapeutic efficacy of the administration non-invasive HELIOX patients infants with acute bronchiolitis moderada-grave: on the one hand, as initial therapy elective, which is administered through a mask with pool without re-inhalación in patients with spontaneous breathing: on the other, as rescue therapy in patients refractory to standard medical therapy, administered in a non-invasive positive pressure in combination, through a system adapted to the realization of CPAP with HELIOX. Our results show that treatment with HELIOX administered elective not invasivamente infants with acute bronchiolitis moderada-grave in spontaneous breathing, through mask with pool without re-inhalación improves their respiratory status of a simple, safe, non-invasive and safe, objetivándose in the remarkable improvement in clinical score, declining tachycardia and tachypnea attendant, and reducing the amount of time spent in the Intensive Care Unit Pediátricos in almost two days with standard treatment. Moreover, the combination of HELIOX and CPAP noninvasive also appears safe and effective in the treatment of infants with acute bronchiolitis severe refractory to standard treatments, and even in those patients resistant to treatment with HELIOX through with mask reservoir without re-inhalación, reflected both clinically (improvement of clinical score on the scale and reduced tachypnea) and gas exchange (increase in arterial oxygen saturation and mark reduction in the levels of carbon dioxide). Moreover, although at present there are no special arrangements for the conduct of non-invasive ventilation with HELIOX in children, it appears that the adjustments that we made in a sales team for its administration are sufficient to implement it safely and effectively, and without interference the operation of the device. The benefits of treatment with HELIOX, both administered with a mask in combination with reservoir pressure, positive, starts during the first hour of his administration and persist while maintaining the treatment, suggesting that 8 an hor 684 to can be a window period sufficient to detect responders. Treatment with HELIOX provides time for other therapeutic agents do their effect or that the disease will be resolved in a natural way, but according to our results, it could also be avoiding more aggressive interventions, such as endotracheal intubation and mechanical ventilation. In conclusion, we believe that treatment with HELIOX is a therapeutic option rescue safe and effective that it should be considered in all patients with severe acute bronchiolitis refractory to conventional therapy before the unsaturated invasive mechanical ventilation. Moreover, given the lack of alternatives with proven in the treatment of acute bronchiolitis, and considering the benefits of implementing HELIOX in this context, we believe that it could be considered as a first-line treatment for infants suffering from moderate bronchiolitis or serious.

Author: MÁLAGA DIÉGUEZ IGNACIO.
Year: 2004.
University: OVIEDO [www.uniovi.es].
Place of defense: FACULTAD DE MEDICINA DE OVIEDO.
Place of preparation: UNIVERSIDAD DE OVIEDO.

Author: ESCOBAR STEIN JULIANA.
Year: 2004.
University: OVIEDO [www.uniovi.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION: The celiac disease is a permanent intolerance to gluten which develops in genetically susceptible individuals causing injury to the lining of the small intestine. It is the result of interaction among several factors, being an entity multifactorial where HLA genes, and other genes with environmental factors, such as diet containing gluten, are involved in the development of the disease. His diagnosis is important because treatment with a gluten-free diet can be achieved clinical remission and complete histological, and the decline in long-term complications. The only known treatment so far is a gluten-free diet for life. The main feature of the histological gluten action on the lining of the small intestine is increased intraepithelial lymphocytes (LIE), which is defined as more than 40 lymphocytes per 100 epithelial cells. In latent forms may be the only abnormality. The LIE and the plate itself, activated are capable of producing a number of cytokines, which have a potential lytic. The mechanism by which cytokines cause alteration of the mucosa is not entirely clear, but it seems that they are important because they induce the degradation of extracellular matrix, are involved in the increased proliferation of crypt cells, the increase the loss of epithelial cells and altering the permeability of strong unions. The epithelial cells form barriers that allow selective generate and maintain different compartment, which help to the passage of different molecules, as well as the maintenance and functioning of cells. Each epithelial cell is linked to another by a specialized system of unions, which are strong unions or zonula ocludens. Unions serve as a strong barrier and defense regulating the way paracelular and maintaining the polarity of the cell. In celiac disease active, the permeability of the epithelial barrier is increased and there are changes in such unions heavy damage consistent with the role of the integrity of the barrier. OBJECTIVES: To examine the changes Immunohistochemical of zonula ocludens-1 (ZO-1) in active celiac disease and its possible relationship with LIE. MATERIALS AND METHODS: We analyzed the immunohistochemical expression of ZO-1 at the citoplasmático and nuclear, the villi and crypts, in the duodenal mucosa biopsies from 26 patients with celiac which they had conducted an initial diagnostic biopsy and another biopsy with a gluten-free diet, and a control group of 27 biopsies duodenal mucosa of children with suspected celiac disease being normal biopsy. It analyzed the number of LIE, CD3 and CD8, in both groups of patients, both in the villi in the crypts. RESULTS: The expression of ZO-1 in the cytoplasm of cells in the active CD patients was significantly lower than in healthy patients (P = 0.001). There was no significant difference when analyzing the staining of ZO-1 in the crypts. In cases of CD active showed an average number of nuclei stained significantly higher than in control biopsies, both of hairs (8.1 vs. 3.0, P = 0.001) and crypts (11.9 vs. 3.9, P = 0.001) . We analyzed the presence of the line that draws the surface of the epithelium, with its presence in all controls and its absence in all patients (P = 0.001). In biopsies of the cases showed a level of the villi an average number of CD3 (53 vs. 26.7, P = 0.000) and CD8 (28.6 vs. 15.9, P = 0.001) significantly greater than in biopsies control. In biopsies of the cases was demonstrated in the crypts an average number of CD3 (13.56 vs. 6.30, P = 0.001) and CD8 (9.92 vs. 2.81, P = 0.000) significantly greater than 8 the bio 572 psias control. There was a significant correlation with the percentage of CD3 and CD8 in hairs and the percentage of nuclei stained for ZO-1 in the crypt. All these results were observed when comparing the first and second biopsy patients celíacos. CONCLUSIONS: In patients with active CD, are shown alterations in the expression of ZO-1, both citoplasmático as nuclear, demonstrating that it may be a marker of epithelial integrity and could have possible implications both diagnostic and therapeutic. The LIE, CD3, can be used to identify patients with latent EC, besides it can be assumed that contribute to the alteration of ZO-1 in the active phase of the disease.

Author: MARTIN IBAÑÉZ ITZIAR.
Year: 2004.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: BACKGROUND AND OBJECTIVES The highest survival in childhood cancer affects more concern for late effects of their treatment. The objectives are: 1-Expand awareness of the late effects of cancer treatment on puberty and gonadal function in survivors of childhood cancer. 2-Define markers gonadales children and pre-, intra-and postpuberales. PATIENTS AND METHODS were defined a study group and a control group. The first included patients with a history of childhood cancer, which carry less than 2 years in complete remission without treatment, aged 7-18 years at the start of the study. We selected 126 patients (72 boys and 54 girls). The second included healthy children from 7 to 18 years (58 boys and 56 girls). We performed a clinical assessment, valuing growth curve, according to Tanner puberal development, testicular volume and menstrual cycle. The children were categorized according to their puberal development: stage I, II, III and IV-V. We conducted a determination of the basal serum FSH, LH, testosterone, estradiol and inhibin B. In men's study group aged 15 and over are proposing a seminograma, and the girls puberales with pelvic ultrasonography. CONTROL GROUP RESULTS In the boys inhibin B increased to early onset of puberty, highlighting a negative correlation between FSH and inhibin B since the middle of puberty. In girls hormones increased during development with a possible correlation between them. The Study Group A 6% of boys had delayed puberal and 15% of girls advanced or early puberty. The seminograma took place in 10 men (2 with azoosperina, 2 with astenozoosperina and one with aspermia). The pelvic ultrasound was normal in 35 of 38 girls. Among men, 19 (26.4%) had insufficient tubular significantly associated with age at the start of treatment and bone marrow transplantation (BMT), and 5 (7%) inadequacy of Leydig cells, significantly associated with radiotherapy and TMO. Among girls, 11 (20.4%) had insufficient ovária partial significantly associated with radiotherapy, chemotherapy gonadotóxia, TMO and central nervous system tumors. CONCLUSIONS The prepubertal age at the start of treatment does not protect the adaño gonadal. All children treated for cancer should be carefully monitored during puberty, because since the prepubertal and early stages of development may occur clinical and analytical gonadal failure. There is a marker clinical, hormonal or ultrasound to determine whether there is sufficient gonadal failure, which requires that the monitoring be extended to adulthood.

Author: GUSSINYÉ CANADELL MIGUEL.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: Valld'Hebron Area Materno-infantil.
Place of preparation: UNIVERSIDAD AUTONOMA DE BARCELONA.

Summary: In the article: Spontaneous, but not induced, puberty permits adequate bone ...

Author: CARCELLER BELTRÁN RAQUEL.
Year: 2004.
University: ZARAGOZA [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Author: SAEZ DE ADANA PEREZ M. ESPERANZA.
Year: 2004.
University: ZARAGOZA [www.unizar.es].
Place of defense: HOSPITAL INFALTIL UNIVERSITARIO MIGUEL SERVET.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Observational study retrospective (15 years) and transverse and longitudinal prospective in 263 patients diagnosed with type 1 diabetes at the Diabetes Unit of the University Hospital Infantil "Servetus" of the following renal function parameters determined by a collection of 24-hour urine : glomerular filtration rate (GFR), uricosuria, calcium, fosfaturia, magnesuria, tubular reabsorption of phosphate (TRP), fractional excretion of uric acid (EFAU), fractional excretion of sodium (FENa), fractional excretion of potassium (EFK) , fractional excretion of chlorine (EFCl) index uric acid / creatinine (AUo / Cro), index calcium / creatinine (Cao / Cro), index magnesium / creatinine (Mgo / Cro), and microalbuminuria. OBJECTIVES 1 .- Describing the values of the above parameters in type 1 diabetic age infanto - juvenil checked at the Hospital Infantil Universitario Miguel Servet. " 2 .- To determine if these values are conditioned by years of evolution (7 groups from 0 to 15 years of evolution), sex, puberal development (prepúberes / púberes), metabolic control (mean Hb A1c the previous year ) or glycosuria (£ 20, between 20 and 50,> 50 g / l). 3 .- To determine whether there are differences between the measured values and those described in the normal population. 4 .- To determine the frequency of microalbuminuria and its relationship to the time evolution of the disease, metabolic control (Hb A1c to first determine microalbuminuria ³ 20 mg / min) and the rest of renal function parameters . RESULTS It describes the parameters glomerular filtration rate (GFR), uricosuria, calcium, fosfaturia, magnesuria, tubular reabsorption of phosphate (TRP), fractional excretion of uric acid (EFAU), fractional excretion of sodium (FENa), fractional excretion of potassium (EFK), fractional excretion of chlorine (EFCl) index uric acid / creatinine (AUo / Cro), index calcium / creatinine (Cao / Cro), index magnesium / creatinine (Mgo / Cro), and microalbuminuria in function the years of evolution of diabetes, sex, puberal development, metabolic control and glycosuria. The renal function parameters studied are not, in general, relevantemente altered respect to the normal population except for the debut. The management group in the middle that does not take into consideration the factors studied could hamper discrimination between changes in physiological development and disturbances caused by the disease. Sex does not condition relevant differences in the results. It would be of interest benchmarks on the basis of sex for better assessment of the EFAU. There is a sexual dimorphism in the values of RFG to 3.5 years of evolution. The years of evolution determine differences in the values of the majority of the tests are studied as the GFR, EFAU, the index AUo / Cro, uricosuria, fosfaturia and EFCl. There are differences in the values of magnesuria, FENa and the EFK's debut respect of the values on the rest of disease progression. The development puberal conditions remain differences in patients púberes lower the values of EFAU, the index AUo / Cro, the uricosuria of fosfaturia, the index Mgo / Cro, the magnesuria, FENa of EFK and the EFCl. The glycosuria influencing the decline in the renal excretion of uric acid, phosphate and potassium, as well as an increase in the excretion of calcium. The metabolic control in the previous year determines the outcome of all evidence of renal function studied except for the magnesuria, FENa and the EFCl. The pathological values of microalbuminuria may be present from the debut, regardless of later developments of the same. More than 1 / 6 of the patients who had microalbuminuria at some point along the study presented the first determination of microalbuminuria patol 8 ógica at 42b the stage of Tanner 1, and those who started in Tanner stage ³ 2 appear for the first submission time before the 5 years of evolution. The number of years with Hb A1c ³ 9% is relevant as a factor distinguishing the group of patients with persistent microalbuminuria. No significant relationship was observed between the value of microalbuminuria and pathological tests of renal function determined simultaneously.