RADIOLOGY

Author: CONCEPCIÓN ARAMENDIA LUIS ALFONSO.
Year: 2003.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: MEDICINA.
Place of preparation: FACULTAD DE MEDICINA - UNIVERSIDAD MIGUEL HERNÁNDEZ.

Author: ABADAL VILLAYANDRE JOSÉ M..
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.

Summary: OBJECTIVE Evaluate the effectiveness of prostheses autoexpandibles as palliative treatment of colon cancer in patients obstructive inoperable, placed through an interventionist approach. Other secondary objectives of the study are: * To review the indications of the proposed treatment and alternative therapies that exist today, developing a protocol for action in the management of these patients. * Conducting a study of costs of the procedure and establish a comparative economic (cost minimization study) with the colostomy. MATERIALS AND METHODS Between April 1995 and December 2002, have been treated 160 patients with colon obstruction box acute malignant presumably by colorectal prosthesis. In 70 patients (43.7%) this treatment was unique, final and palliative. In 70% of patients the treatment was initially considered palliative and in 30% it was secondarily after securing an adequate estadiaje and once settled table of acute obstruction. Of the 70 patients, 29 were women and 41 men. The average age of the group was 73 years. The 68% of patients had comorbidity factors that allowed greater surgical risk and were classified in Group III and IV of the ASA. The procedures were carried out primarily by interventional radiologists. Inclusion criteria for patients included: * Clinical features of acute obstruction of the colon. * Location of stenosis in descending colon or rectum sigma. * No radiological signs of intestinal perforation. The study design was observational, longitudinal retrospective / prospective, non-comparative and non-randomized. The economic study is Minimizing costs, is a descriptive, restrospectivo between two techniques and primarily directed at health as a manager responsible for taking decisions. RESULTS The technical success of the procedure was 90.0%. In 6 patients the failure was due to the inability to cross the channel and area estenótica with the guide. In another patient, although it managed to pass the guide hidrofílica ys epudo exchange for a rigid guide (Amplatz ®), it was impossible to cross the stenosis with the catheter carrier stent. The clinical and radiological was resolved in 92.0%. In 52% of cases, after the release and opening of the stent, clinical response occurred in less than 6 hours. The time estacia half hospital: 6 days. The total percentage of major complications was 15%. 3 cases of stent migration, 2 reobstrucciones by overgrowth tumor and 2 drilling symptomatic. The mortality at 30 days was 1.5%. The median survival of patients was 152 days. The primary patency of 270 days was 87% and the secondary 88%. The reoperation rate was 3%. It demonstrated no statistically significant difference in the effectiveness of the stent, depending on the location of the stenosis (rectosigma / left colon), the type of tumor (primary / secondary) or from the center where the procedure was performed. The average cost per process in patients treated with colostomy was 5,777 euros, with an average stay of 16 days. The average cost to process patients treated with stent was 5,450 euros, with an average stay of 6 days. CONCLUSIONS The acute obstruction of the colon is a picture of emergency clinic, mainly caused by a tumor (the most common carcinoma of the colon), which is presented in an advanced stage of the disease. In 43% of cases of acute obstruction of the colon, colorectal stent marked the palliative treatment, definitive and unique, the stage of the disease or the factors that allowed comorbidity increased surgical risk. The placement of colorectal prosthesis in patients with colonic obstruction (left colon / rectosigma) acute allows an effective resolution of the clinical picture. The procedure has a high technical success and a low associated morbidity. This technique allows decompression of the table obstructive and hold 8 imiento 634 intestinal transit along the patient's life. Therefore, it can be regarded as definitive treatment. The main causes of clinical failure in the short / medium term were due to reobstrucción and occurred in about 3% of patients. These puedieron be treated in a minimally invasive, through the placement of a second stent. This technique helps to avoid other more invasive procedures palliatives as a colostomy, which allows a better quality of life for the patient. The algorithm was proposed therapeutic useful in the management of patients with acute obstruction of the colon and can be used to guide practice clínico-quirúrgica. The colonic stenting in this context is proposed as the first treatment to be performed. The study of minimizing costs, which compares with colostomy patients treated with the stent through treaties, the technical interventionist identified as cheaper alternative. The work in multidisciplinary teams (interventional radiologist, endoscopist ..), it increased the success of the procedure and greatly reduce radiation to the patient and the professional.

Author: RIVAS GARCIA ANTONIO.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL VALL D'HEBRON.

Summary: INTRODUCTION The biopsy is the process that obtains and analyzes tissue. The surgical biopsy (BQ) is their choice, but complications justify the use of minimally invasive techniques such as the BVP. The new technology and multidisciplinary work from the 90 made the BVP is a technical routine, reliable and cost-based. ASSUMPTIONS AND OBJECTIVES The BVP election is to confirm the presence of focal lesions of the spinal column and establish an accurate diagnosis of the tumor or infection, obtaining sufficient sample tejió by more than 90% of cases and accurate in more than a 80%. MATERIALS AND METHODS This is a retrospective study of 222 BVP made within a period of 8 years and track clínico - radiológico minimum of one year. There are 119 men and 103 women (average 58th) from whom data were collected clinical and pathological image. It exploded statistically using SPSS system. The technique regulated biopsy was selcción, consent, use of computed tomography (CT) as a guide, punción coaxial fine needle and thick, wide distribution of the sample and final assessment. The results were distributed in six groups of lesions (metastases, myeloma, lymphoma, other tumors, infection and other injuries), one of normality and without a final diagnosis. RESULTS 75% of lesions were solitary and radiological predominant pattern was osteolítico. Only 23% of 42 BQ were for biopsy. We found statistically significant association between the location, the radiographic appearance and the type of injury. In 95% of macroscopic sample was hemática no association between the type or quantity of sample and the end result except the "pus" indicative of discitis. Confirmarmos a learning curve for the technique. The 59% of the series were metastases and infection. The statistical study by groups of pathology showed a sensitivity (S) of 95% with a positive predictive value (VPP) of 97% for metastasis, S-100% and VPP of 95% for myeloma S of 64% and VPP lymphoma of 100% for S of 85% to 92% and VPP for infection. There were no serious complications. DISCUSSION This is a series of broader, which showed results similar to ours and the BQ. Coincide age, the type and pattern radiological pathology confirmed the many advantages of the BVP guided by CT. There is a high diagnostic accuracy in metastasis and myeloma difficulties in infection and lymphoma. CONCLUSION MAIN The BVP is a simple technique, secure, reliable, sensitive and reproducible for the diagnosis of focal lesions of the spinal column. Their results are totally acceptable and even comparable to those of open surgery for those injuries that is indicated in a study histólogico. The safety and the percentages in diagnosis makes the BVP technology of choice for obtaining tissue sample and identify the type of injury at that pathology that affects the column more frequently.

Author: BARGALLÓ ALABART NÚRIA.
Year: 2004.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA, UNIVERSIDAD DE BARCELONA.

Summary: The main objective of this thesis is to study the flow of CSF and the pathology associated with the same technique of using a non-invasive neuroimaging. Magnetic Resonance initially allowed studies of high-resolution structural brain, but not functional or dynamic studies. At present, have developed new streams RM, for example the sequence in contrast phase, which renders the fabric static while enhancing moving structures such as blood and CSF. The sequence of phase contrast in MRI provides two useful tools for the study of CSF: qualitative study and quantitative study. The qualitative study to evaluate the movement of the CSF by Cine MRI technique. The sequence in phase-contrast images acquired several CSF during the cardiac cycle. If these images are displayed sequentially, allow observe the passage of CSF across narrow holes and the ventricles and the subarachnoid space. For his part, the quantitative study allows to study various parameters of the movement of CSF at a given location. So you can calculate the speed, flow and volume of fluid circulating, for example, in the aqueduct. This thesis has developed three lines of study. The objective of the first study protocol is the behavior of CSF in healthy people in order to better understand the pathology that is derived. This has been studied a group of healthy subjects of different ages, which in turn enables know if changes occur with age. The movement of LCR related to the cardiac cycle crank direction when changing systole to diastole, always starting at acueductal and ending at the level of the basal cisterns. The flow velocities vary intersujeto while the volume of flow is worth more reproducible. These peculiarities flow of CSF show altered in patients with stenosis aqueduct, with the Arnold Chiari malformation type 1and with HCA. From the results of the first protocol indicates that the qualitative study of CSF is essential to make the diagnosis and establish the h'atamiento in patients with stenosis aqueduct and in cases of Arnold Chiari malformation type 1, while the quantitative study is important for the diagnosis of patients with HCA. The main objective of the second study protocol is to determine the effectiveness of the quantification of the volume of flow in the aqueduct for the diagnosis of HCA. When the flow diastolic volume exceeds 91 mm3la sensitivity and specificity of this test is 82.4% and 77.8%. Thus it is proposed to carry out a study for Magnetic Resonance in phase contrast in all patients with suspected HCA and more invasive diagnostic test only in cases where there is a dissociation clinical radiation. The third study protocol of this thesis aims to evaluate the usefulness of the sequence of Magnetic Resonance in phase contrast in monitoring patients for ventriculostomía premamilar endoscopic by presenting hydrocephalus. This technique makes it possible to assess the patency of the ventriculostolIÚautilizando the sequence quality, but also by measuring the volume of flow, you can predict the workings of the ventriculostomía premamilar. This study shows that when the absolute volume of flow (volume flow systolic and diastolic) obtained in the first study posquirúrgico exceeds 75mm3, the sensitivity of the test to determine which patients would improve after treatment was 76.5% and the specificity was 100%.

Author: FERNANDEZ PUJOL RAMON.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The European Commission has issued the directive 97/43/EURATOM, currently vigor.Esta legislation requires the establishment of a quality control scans radiologícas covering aspects of image quality and dose level in each exploration, evaluated through determination of NRD, was a lack of studies in Spain dose comprehensive patient scans studied (intraoral, and OPM NAFTA) and had not been defined criteria defined image quality based on anatomical detail. In intraoral X-ray doses were measured in 307 facilities recommended a value of 3.5 mGy as NRD.Se developed a proposal that includes quality criteria image, NRD and technical details on the conduct of exploration. The measurement techniques developed for OPM doses were used in the study of 12 facilities on 190 pacientes.Permitiendo propose a NRD-700 uGy extent in the area occipital.El study of the distribution of dose in finding locations symmetrical allowed asymmetries are justified the erratic movement of the entire transceiver hotbed for exploration effect which can be used for evaluation of quality control equipos.Se defined criteria of image quality, following the model used in radiology periapical. The technique in determining dosage NAFTA, was used in a study on 7 plants with a sample of 523 patients, led recommend NRD-400 uGy measured at the point porion in piel.Los quality criteria were developed for image use with various techniques cephalometric analysis.

Author: GONZÁLEZ BERMÚDEZ M. DOLORES.
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD AUTONOMA DE BARCELONA.

Summary: The International Standards Organization ISO) was founded in the year 1949 with its headquarters in Geneva and its mission was to gather and harmonize a set of rules to ensure that the minimum requirements needed to meet the goods and / or communication systems in Europe. It is the end of the year 1999 and after an exhaustive review of previous ISO 9001:94 when drawing up the current rules UNE-EN-LISO 9001:2000 and are based on the 8 principles of quality management: 1 , customer-focused organization (pacientes-usuarios). 2-Leadership managers. 3-Participation of the people. 4-orientation management processes. 5-Guidance System to management. 6, - Continuous Improvement. 7, Management Directive-oriented decision making. 8-beneficial relations and positive collaboration between the organization and its suppliers. The objective of this thesis is to create all the documentation that allows to apply the system of quality management in Services Diagnostics Image (SDPI) primary care Institut Catalá de la Salut (ICS). Five documents are required: 1, System Quality Management 2-Responsibility of the Directorate 3-Resource Management, 4-Product Realization 5-Measurement, analysis and improvement Prime Document MANAGEMENT SYSTEM * QUALITY Politics and quality objectives * Quality Manual. Paper + /-25 pages in which is reflected in a systematized: The policy and quality objectives SDPI - The procedures to be used in the SDPI and their interrelationships-You can have a "Welcome manual" for people of new addition to SDPI. * Procedures Manual (protocols) are the operational documents that describe specifically how to direct, perform and record moon activity or process that is done in the SDPI. In this Guide includes records, which are documents that provide the results of its activities. Secondary RESPONSIBILITY OF THE ADDRESS * * Commitment Responsibility, authority and communication * Review by the direction Third RESOURCES MANAGEMENT * Providing resources * * Infrastructure Management skills: Human Resources and Training * Environment Working Document Fourth THE MAKING EXPLORATION AND SERVICES * Making exploration imaging * Processes purchases * * Servicing of control devices measure Fifth Document MEASURE, ANALYSIS AND IMPROVEMENT * Survey satisfaction of patients and users of SDPI * Conduct * Internal Audit Tracking and measuring processes * Controlling non-conforming products * Corrective actions RESULTS * The field work was conducted from 2000 to 2003 in three SDPI: Hospital Comarcal Hospital Ambulatory third level * Only in the Ambulatory possible implant ISO and GET AN AGENCY CERTIFICATION FOR EXTERNAL (AENOR). RESULTS CLINIC * Reduction of 75% of waiting lists:-21-day passes to 7 in the normal-explorations of greater than 10 days to 3 days in the preferred explorations. * It applies a model of "management skills" on the staff: identification of those responsible for the process, the registration of documents and internal audits. Training in the "non-conformity" and for continuous improvement. CONCLUSIONS 1, ISO - are the first step in developing a system of quality management. 2-Certification allows health centers and / or services ACREDITADOS 3 - The methodology IDEFO provides training, teamwork, key processes and know how to improve them.

Author: GARCÍA-CASTAÑO GANDIAGA M. BEGOÑA.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The objective of this study is to assess the quality of CT examinations of the abdomen and pelvis for the indication of lymphoma, according to the criteria proposed in the European Quality Criteria in CT. The criteria were assessed in a sample of 100 patients studied by cutting single helical CT in five public hospitals in the Community of Madrid. Five radiological, one for each school participating in the study, independently assessed compliance with the criteria of image in the selected examination. The index has been defined image quality (ICI) for a full examination of the abdomen and pelvis. In parallel measurements were made delas magnitude of dose to estimate the values of the CT dose index (CTDI), the product of dose per length (DLP), and the effective dose (E). We have found a high compliance with the criteria of individual image in the abdomen. In the pelvis compliance has been reduced, especially for three criteria. The ICI by center is between 83% and 92% with varying degrees of internal deviation. Mean CTDIw by center were between 16 and 23 mGy, and the DLP between 430 and 750 mGy cm, and the effective dose between 7 and 12 mSv. In general, no correlation was found between the ICI and the dose to the patient (DLP) in the entire sample (r = 0.04) or centers (r minor 0.36). It has confirmed the usefulness of the quality criteria of the EC. We have developed a single list of criteria of image quality and suggest dose levels of reference for exams CT abdomen-pelvis in patients with lymphoma.

Author: JODAR PORLAN SALVADOR.
Year: 2004.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA/ODONTOLOGÍA.

Summary: Featured are 2,371 official reports of quality control of dental radiology facilities belonging to dental clinics that use some form of dental radiology apparatus (intraoral and / or pan). The study evolutionary corresponds to the first five revisions of such plants as a result of the new rules in the general obligations of this type of facility (1997-2001). The results presented a quantitative analysis of the parameters contained in these reports, with special reference to physical characteristics (kVp, mA, filtration, collimator, length of the trigger), as well as deviations detected in its operation. It identifies the characteristics of the process for obtaining radiological images in these facilities (type revealed, control times revealed, renewing liquid radiographic film type, storage and expiration of the film) and the dosi average of ionizing radiation used in the to get the same X-ray image of a tooth in the same working conditions in each room. All of this in its evolutionary process during the five years following the introduction of legislation for quality control. Overall, the results show a decrease in the average doses administered during these five years of study. However, only 63.54% of radiological facilities could reach to fulfill all the recommendations of the European Union on the performance characteristics of these teams dental radiology. Although the degree of compliance with official recommendations on radiation protection is not satisfactory, there have been significant improvements in performance by the Radiological dental professional over the five years of evolution. Therefore, the introduction of this legislation to produce a slow but gradual improvement of the performance tooth in the Autonomous Region of Murcia.

Author: Gomez-Ferrer Sapiña Ramón.
Year: 2004.
University: VALENCIA [www.uv.es].
Place of defense: Facultat de Medicina.
Place of preparation: Departament de Medicina.

Summary: There has been a study in patients with coxartrosis unilaterally using kinetic biomechanical techniques, in particular platforms dinamométricas. Through the establishment of well-defined protocols measure has been analyzed a sample of 28 healthy people control of both sexes and 45 people with unilateral hip osteoarthritis. The age distribution of the two populations were homogeneous. It has been obtained as a first step characterization curves average running with the confidence intervals of the population decoupling the normal speed, so they can get the curves averages for the entire continuum of speeds between speed lowest and most high registered. We compared the average curves of each subject pathological curves over half of the normal population, and have obtained evidence of the existence of three different kinetic patterns in the progress of patients with osteoarthritis of the hip that could sided match rates limp associated with osteoarthritis described in the literature. By the parameterization of the curves have been analyzed ongoing differences between the kinetic parameters of healthy member of a party member with the disease pathology and a member of a normal subject, found that the parameters for the healthy member of a subject pathological differ the parameters of a healthy member of a normal subject. There has been a multivariate analysis to explore possible relationships between the kinetic parameters and variables obtained from the scale functional Harris, obtaining a meaningful relationship between one of the main and the value of scale functional, albeit with we can prédictivo, it is assumed that both sets of variables contain additional information. Finally there has been a power discriminant analysis of the variables. Kinetic obtaining diagnostic tool as a prediction of 93.2% for the six selected variables.

Author: PEREZ MARTÍN ALVARO.
Year: 2004.
University: SEVILLA [www.us.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD MEDICINA.

Summary: Study of cross prospective done to women older than 35 years, selected at random, which was performed for bone densitometry assessment of the condition of mineralization esqueletíca as it is the diagnostic test known intenacionalmente as a standard for measuring the bone mass. Anteriomente conducting a clinical interview prior to the execution of densitometry. We performed a estudío the density minerla bone in adult female population in order to determine the bone mineral mass at different points in the skeleton (lumbar spine, femoral neck, trochanter and tiángulo Ward) in random conditions, austando the resutados to different segments age, it would pretnede study the influence of age, weight, height, imc, age and years of menopause in bone mass, osteoporosis among different locations measures, and even using the t-score and z-score as measure. The necessary sample size was obtained from the formula pair estimating uan proportion considering situalción of maximum uncertainty (prevalence = 0.5) with an error alpha of 0.05 and an accuracy of 6%. Since the vast majority of the work on all of these items are made in foreign population, it has been considered that this thesis can provide information of interest in Spanish population, where there is a shortage of results.

Author: AYUSO COLELLA JUAN RAMON.
Year: 2004.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The existence of long waiting lists for liver transplantation of the body to treat liver disease irreversible and hepatocarcinoma requires the search for alternatives such as liver transplantation from living donors. The study prequirurgico of potential candidates for living donor liver should include a determination of the volume is going to transplanted liver, and the distribution arterial, portal venous and biliary liver presented by the donor. All this should be done with less aggressive techniques at our disposal. The magnetic resonance imaging (MRI) to evaluate these parameters in a single scan. This paper has tried to show that MRI is the technique of choice in the study prequirúrgico of living donor liver, as it is safe and reliable in assessing vascular and biliary anatomy, the study parenchyma and in determining the volume hepatic way that can be used as a single technique in the overall assessment of the donor. We have evaluated 39 living donors of the right hepatic lobe consecutive in which studies were obtained dynamic multifasicos during intravenous paramagnetic contrast, sequences colaniografícas strong potential in T2 sequences colangiograficas additional after contrast administration of biliary excretion and volume calculation. The findings observed in vascular MRI were correlated with those obtained by angiography and surgery. Findings from the colangiofrafía by MRI were compared with those of intraoperative cholangiography. The liver volume estimated for the right hepatic lobe on MRI compared to the weight of the piece hepatectomia right in the operating room. The correlation observed between liver volume based on the MRI and the weight of graft, using the Pearson correlation analysis gave a value of r2 = 0.78, with an overestimation by MRI of 18% on average. The hepatic artery, splenic, mesentérica identified celiac trunk and always excellent. The right and left hepatic arteries were observed in a manner sufficient in 74% and 71.7% of subjects. The distribution pattern artery was assessed following the classification of Michels and MRI correctly clasifico this pattern in 92.3% of subjects. The portal vein and its branches were identified lobares and segmental so excellent in 100% of individuals. The pattern of distribution portal vein were evaluated according to the classification of Cheng, and MRI findings were concordant with the angiography and surgery for the 97.4% of the donors. The Fisher exact test showed a significant association between MRI and angiography and surgery to differentiate between normal patterns and variations in arterial blood vessels and in the portal vein. The 3 veins liver were displayed so excellent in all studies of MRI. The S of MRI to identify veins accessory requiring additional shunt was 80%, E of 100% and DP of 94.8%. To evaluate the distribution pattern biliary continued classification Couinaud. The contrast with cholangiography was much better than that obtained without contrast, allowing the first to identify the correct distribution pattern in 88% of subjects while the second did only in 57% of them. In conclusion, MRI study of the candidates for living donor liver allows precise definition in a single volume lobares review and evaluate the vascular and biliary anatomy essential for surgical planning. The angiography should be reserved for situations where not get adequate representation of the hepatic arterial vascularization.

Author: SANTOS ROMERO ANA LUZ.
Year: 2005.
University: CÓRDOBA [www.uco.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: In this dissertation is intended to assess the characteristics of breast cancer in young women aged less than or equal to 40 years: frequency, clinical presentation, diagnostic methods profitability, prognostic factors and survival, establishing whether there were statistically significant differences with patients older. MATERIALS AND METHODS We conducted a retrospective study of cases and controls. The group cases formed of 184 patients is, age less than or equal to 40 years, who had been diagnosed and treated for breast cancer in the Reina Sofia University Hospital in Cordoba from January 1985 to December 2000. The control group was composed of 327 patients aged over 40 years, diagnosed and treated for breast cancer from January 1988 to December 1990 at the Reina Sofia University Hospital in Córdoba. In the cases has been recorded a total of 193 carcinomas, and the cancer has been bilateral 9 patients in the control group had collected 327 carcinomas. It has been regarded as a prerequisite for the selection of patients in both groups that the patient had preoperative diagnostic mammogram. We have reviewed the medical histories of patients and methods of image made (mammograms and ultrasound) to collect the following information: age, family history, personal history, reasons for visits, the findings of physical examination, findings mamográficos and ultrasound, biopsy, results of pathological anatomy. Likewise, it has been collected from the patient estadificación, prognostic factors, treatment performed, time evolution until the completion of adequate treatment and recidívas locoregional Monitoring of patients in both groups has been carried out until éxitus or until the last audit performed before May 2005, reflecting the existence of recurrence, disease distance or éxitus. There were valued differences between the two groups, profitability of the methods of image, overall survival and disease-free. In the cases analyzed the influence of treatment and prognostic factors in the survival of patients. Results The incidence of breast cancer in young women is low (6%) over the total number of cases diagnosed in that period.

Author: CARALT ROBIRA TERESA MARIA DE.
Year: 2005.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The pulmonary hypertension (HP) is defined by the presence of a pulmonary artery pressure media (PAPm) greater than 25 mm Hg at rest or more than 30 mm Hg during the year. The prognosis of PH is associated with hemodynamic several factors, among which are the PAPm and right ventricular function. The measurements have been quantified through the pulmonary hemodynamic study carried out by cardiac right caterismo (RCD), which is the gold standard but has the disadvantages of being a non-invasive technique and free of complications. Accurate assessment of the right ventricle (VD) in pulmonary hypertension is clinically important and care practice valuation functional with non-invasive techniques such as echocardiography or ventriculography isotope has its limitations because of the anatomic morphology and disposition of VD. This leads to the study and development of alternative methods for the non-invasive assessment of hemodynamic changes associated with pulmonary hypertension. This study seeks a greater understanding of the behavior of the right ventricle and the pulmonary arteries in pulmonary hypertension using magnetic resonance imaging as a technique recent and rapidly expanding in the field of cardiovascular disease. This work has assessed the behavior of the right heart in a series of 60 subjects, 18 patients with arterial HP, 17 patients with HP associated with caradipatía, 15 patients without HP and 10 healthy subjects, through a non-invasive imaging technique as magnetic resonance without the need of using contrast media. There were correlated parameters obtained by magnetic resonance with the results obtained with the hemodynamic gold standard cardiac catheterization which is the right and also the results have been evaluated in the various study groups. The conclusions are: The MRI has applicability in the clinical evaluation of patients with pulmonary hypertension, because it offers an excellent visualization of the right ventricle and the pulmonary artery leading to a few parameters - anatomical and functional MRI, which reflect current ventricular hemodynamic right. It has been proven correct accuracy of the technique for quantifying RM-flow through the design of an experimental model. MRI quantifies cardiac output with an accuracy similar to the CCD through the technique of flow - RM. The parameters of the RM-VD and the PA are correlated with measurements of hemodynamic PAPm and RVP. The thickness of the wall free of VD is the parameter which shows a better correlation hemodynamic. All parameters RM-show significant differences between groups. The HPA is the group that presents the most pronounced changes, which would indicate more severe illness that affects one remodelamiento delVD more important than in the HP group associated with heart disease. The HP group associated with heart disease presents some minor alterations over the parameters RM-could be an indicator of HP in a passive or reversible phase, which is important for prognosis of the heart transplant.

Author: MELLADO SANTOS JOSE MARIA.
Year: 2005.
University: ROVIRA I VIRGILI [www.urv.cat].
Place of defense: DEPARTAMENT DE MEDICINA I CIRUGIA.
Place of preparation: FACULTAT DE MEDICINA I CIENCIES DE LA SALUT.

Summary: OBJECTIVE investigate the prognostic value of magnetic resonance after surgical repair of the ruptured sleeve rotador. MATERIALS AND METHODS 78 cases of break sleeve rotador in 74 patients (32 men, 42 women) were retrospectively selected from all cases repairers in our center through technical open mini-open or arthroscopic. Clinical evaluation was performed based on the scale UCLA (University of California at Los Angeles). Conducted radiological assessment based on studies of pre - and postoperative MRI, reviewed independently by two observers for the analysis of quantitative variables, and consensus for the analysis of the qualitative variables. We conducted systematic correlation of clinical and radiological with comments intraoperative. RESULTS In the overall series (n = 78), after a postoperative follow-up of 48.4 months half, 62 shoulders (79.5%) showed clinical outcomes favorable, and 45 shoulders (57.6%) showed on postoperative magnetic resonance imaging iterative a break . Breaks iterative were significantly more prevalent in patients with clinical outcomes regular or ill (81.3%), preoperative breaks in two (78.9%) or three (100%) tendons and shoulders with degrees of fatty degeneration properatoria older than 1 ( 91.6%). The iterative breaks were also significantly larger in these subgroups. The supraspinatus tendon ruptures iterative showed tendency to involve their side later. In the subgroup of massive breaks (n = 28), after a postoperative follow-up of 44.4 months half, 20 shoulders (71.4%) achieved clinical outcomes favorable, and 25 shoulders (89.2%) showed on postoperative magnetic resonance imaging of a break sleeve rotador, 19 of which were true iterative breaks. A coronal diameter of breakage = 34 predicted postoperative clinical outcomes favorable with a specificity of 85.7% and a positive predictive value of 92.9%. Grades postoperative fatty degeneration of muscle infraespinoso = 2 predicted favorable clinical results with a specificity of 87.5% and a positive predictive value of 90.9%. CONCLUSIONS The repair of breaks sleeve rotador can achieve favorable clinical results despite a high prevalence of iterative breaks. The extent of intraoperative tear has only a limited prognostic value, not uniformly demonstrable in a number of breaks variable amplitude. Patients with integrity tendinosa posteoperatoria showing improved clinical outcomes overall, but not evenly. The extent of breakage iterative correlated with the extent of intraoperative tear, with the strength postoperative, and clinical outcome overall. The iterative breaks are more prevalent and broad in patients with preoperative higher fatty degeneration. The supraspinatus tendon ruptures iterative tend to involve their side later. The age, time tracking and surgical technique does not play a major role in the prevalence of breaking interativa. The massive breaks, the degree of fatty degeneration of muscle infraespinoso determines postoperative clinical outcome. The rupture iterative, fatty degeneration and atrophy postquirúrgicas are interrelated. The first two correlate with clinical outcomes. The resonance of the sleeve rotador surgically repaired provides information of clinical significance and prognostic relevance.

Author: BURREL SAMARANCH MARTA.
Year: 2005.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA, UNIV. BARCELONA.

Author: DE LAS HERAS GARCIA JOSE ANTONIO.
Year: 2005.
University: SALAMANCA [www.usal.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: A prospective study was performed on 151 patients treated for his syndrome ictérico obstructive through percutaneous drainage of the biliary tract. We try to establish which of the clinical variables, analytical, and technical etiologic's drainage can be prognostic factors in the evolution of the patients after the decompression performed percutaneous biliary route. The results set variables that valued independently can be viewed on prognostic factors: -

Author: HERNÁNDEZ MONTERO SOFÍA.
Year: 2005.
University: ZARAGOZA [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL UNIVERSITARIO MIGUEL SERVET.

Summary: OBJECTIVES To analyze the predictive ability of the MPO in terms of skeletal BMD refers attempted to establish a correlation between variables measured in panoramicradiograph mandible and densitometrías studied. To compare different indices radiomorfométricos panoramic jaw and identify the most reliable, simple and reproducible. MATERIALS AND METHODS All patients included in the study had been submitted in accordance with the criteria of the American Association of Clinical Endocrinologist (AACE), or according to the criteria of the National Osteoporosis Foundation (NOF) to measure bone mineral density ( BMD). Bone mineral density was assessed by bone densitometría (DXA; Hologic QDR-1000). His assessment allowed us to classify patients according to the pattern established by WHO in Normal, Osteopénicas and Osteoporóticas according to BMD. The densitometric scans were performed in femoral head or lumbar spine is both acceptable and appropriate measurements and showing no differences as the American College of Radiology (ACR) in its approach when it comes to osteoporosis and bone mineral density is concerned. Three indexes were entered into this study based its selection on the characteristics of reproducibility, simplicity and objectivity offering: PMI, MCW MCI. RESULTS statistically significant correlation shows that our work between MCI and BMD makes in the index radiomorfométrico of choice for the diagnosis and prognostic guidance regarding studies on OP is concerned. MCW The index is a useful supplement to the previous and next to MCI should routinely included in the valuation of the ortopantomografia is done. CONCLUSIONS The panoramicradiograph, ortopantomografia, stands in a diagnostic and prognostic tool and should be included as a method of screening in perimenopausal women to assess their bone mineral status. The Oral and Maxillofacial Surgeons, Dentists, Radiologists and General Physicians are able, based on the Ortopantomografia, referring perimenopausal women suspected of osteoporosis skeletal units densitometrías.

Author: GUTIÉRREZ GARCÍA VERÓNICA.
Year: 2005.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: OBJECTIVES The purpose of our study is to show that the scales of Brasfield and Chrispin-Norman for the simple chest radiography are reliable and valid in adult patients suffering from cystic fibrosis. To do so, we evaluate the agreements and intra and interobservador correlacionamos both scales with clinical parameters and tests of lung function. PATIENTS AND METHODS Two thoracic radiologists performed chest radiographs of 51 adult patients suffering from cystic fibrosis, using scoring systems of Brasfield and Chrispin-Norman. The radiographs were re-four months later by one of the observers. The agreements within and interobservador and the correlation of scales with some clinical and spirometric parameters were calculated using the Pearson correlation coefficient, the intraclass correlation coefficient and the student's t test. RESULTS The variable inter-and intraobservador we got were excellent: interobservador agreements (r = 0.89 and 0.82) and intraobservador (r = 0.92 and 0.93) for the scales of Brasfield and Chrispin-Norman respectively. Both scoring systems had a good relationship with lung function: forced expiratory flow in the first second and forced vital capacity and its percentage of the theoretical value standard (FEV1, FEV1%, FVC%) (r increased 0.5, p less 0,001 ). Scores Brasfield were lower and the Chrispin-Norman higher in males (p less 0.05). Scores Brasfield were lower in those patients receiving antibiotic therapy orally or intravenously in the year prior to the completion of chest radiographs. CONCLUSION The scales of Brasfield and Chrispin-Norman show good agreements between and intraobservador in adult patients suffering from cystic fibrosis and have a good relationship with lung function, especially with FEV1%. Being male and have received antibiotic therapy orally or intravenously was related to a worse situation radiation.

Author: NARANJO GARCÍA PABLO.
Year: 2006.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA DE LA UCM.

Summary: OBJECTIVES review scientific evidence on the use of digital mammography (MD) with respect to the analog mammography (MA), thus making the health managers, the information needed for decision-making with respect to the acquisition of such technologies. MATERIALS AND METHODS It first conducted a systematic review of literature on the clinical and economic aspects associated with the MD from a search of MEDLINE and ENBASE. Selected publications comparing results of Full Field Digital Mammography (MDCC) and MA in the same group or in two groups of patients. It was subsequently performed a comparative analysis of various fixed and variable costs estimated and published for the MDCC; as for the conventional MA. Finally, we analyzed the impact organizational manpower, the activity of the facility and the interconnection with the radiological information system of the plant.