INTERNAL MEDICINE

Author: RUIZ GASPÁ SILVIA.
Year: 2001.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA DEPARTAMENTO DE MEDICINA UAB.
Place of preparation: UNIVERSIDAD AUTONOMA DE BARCELONA.

Summary: Introduction: The human osteoblast cultures derived from bone explants are a good model to study the functionality osteoblástica. There is a high correlation between cellular activity that presents the osteoblasts in vitro and in vivo (bone biopsies). The primary culture of osteoblasts derived from trabecular bone is the best model for studying intrinsic abnormalities in the cells of patients with metabolic bone diseases. Statins or specific inhibitors of the enzyme HMO-CoA reductase act by inhibiting the synthesis of hepatic cholesterol. The estatínas are used to lower cholesterol levels and provide an important new avenue of approach in the treatment of hyperlipidemia and atherosclerosis. In the latest years has been that pleiotrópicos can have effects on bone. The purpose of this study was to analyze the implication of the functionality osteoblástica in the metabolism of bone through primary culture of human osteoblasts. This work has been separated into four different substudies whose colunma spinal the primary culture for studying the role osteoblastica. Objectives: Subestudio 1: Analysis of the primary culture of human osteoblasts and the line tumor MO-63 as a model for the study of metabolic bone diseases and the effect of regulatory factors and drugs into bone. Subestudio U: Study of cell proliferation and gene expression system OPOIRANKL, factors Cbfal and BMP-2, Yel collagen type 1 and osteocalcin in primary culture of osteoblasts in patients with postmenopausal osteoporosis. Subestudio Ill.: Analysis of the effect of simvastatin and atorvastatin on cell proliferation and gene expression of BMP-2, collagen type l osteocalcin in human osteoblasts and primary normal cell line MO-63. Subestudio IV: The study of cell proliferation and gene expression of collagen type I and osteoca! Tape in primary culture of osteoblast men with idiopathic osteoporosis. Methodology: For the primary culture of human osteoblasts were used samples of the knee, head of the femur and iliac crest. We extracted the trabecular bone and troceó in explants of Imm3. The explants were washed away by mechanical agitation with a saline solution and deposited on a sheet of Petra half full supplemented with serum. After about four weeks, the crop came to the intersection and at this time, prior to conducting experiments came to the characterization of osteoblasts by detecting the activity of alkaline phosphatase and osteocalcin gene expression, in both cases using primary human fibroblasts as a negative control. To quantify the expression of genes analyzed in each substudy technique was used for real-time PCR. Based on the treated cells in a manner specified in each of the substudies was performed using total RNA extraction method Trizol. Each sample RNA aisladonse evaluated its entirety through a agarose gel and were measured for the subsequent reaction retrotranscripción from Img RNA. Finally, we measured the levels of gene expression by real-time PCR. This technique is to monitor the PCR reaction as it takes place. We conducted through technology TacMan using some probes fluorogénicas that allow the detection of specific PCR products as they are synthesized. In this technique marks a threshold of fluorescence at a point where the reaction is in exponential phase. The cycle in which the reaction amplification crosses the threshold is called fluorescence Ct (TresholdCyc1e) and depends on the amount of cDNA present in the sample. Results: Subestudio I: All lines used showed primary osteoblast phenotype osteoblastito since 8 all and d59 llas presented alkaline phosphatase activity and expressed gene osteocalcin. Subestudio II: We collected a total of 21 samples from menopausal women undergoing surgery for prosthetic knee. It was separated into two groups depending on pathology osteoporótica following criteria densitométrícos of WHO -2.5DS. It turned out a total of 9 samples in the group of osteoporotic patients and 12 samples in the group of non-osteoporotic patients. No statistically significant difference in cell proliferation between the two groups. There was a statistically significant decrease in levels of gene expression and COLl A1 in the gupo of osteoporotic patients. There was a statistically significant difference in levels of gene expression on OP under the spur of vitamin D 17p-estradiol. Subestudio III: There was a statistically significant decrease of cell proliferation in crops treated with different concentrations of simbastatina and atorvastatin in primary osteoblast and the cell line MO-63. There was an increase in gene expression COLlA1, osteocalcin and BMP-2 in primary osteoblast and the cell line MO-63. Subestudio IV: We collected a total of 30 samples from biopsy crest ílíaca of male patients. It was separated into two gmpos in nmción pathology osteoporótica following criteria densitométrícos of WHO -2.5DS. It turned out a total of 14 samples in the group of osteoporotic patients and 16 samples in the group of patients not osteoporótícas. There was a statistically significant reduction of cell proliferation in the sample group osteoporotic patients. A trend of a decrease in gene expression COLl AI in basal conditions and vitamin D in the middle. There was a statistically significant decrease in levels of osteocalcin gene expression in the presence of vitaminaD in samples from the group of patients with osteoporosis. Conclusions: Subestudio I: The primary culture of osteoblasts is a good model for studying patologias metabólícas bone (such as osteoporosis) and the effect of factors and drugs into bone. Subestudio II: osteoblasts from patients with postmenopausal osteoporosis have a defect that affects the expression of genes characteristic of the role osteoblástica. Subestudio III: statins (simvastatin and atorvastatin) affects the role osteoblástica favoring differentiation through inhibition of cell proliferation and an increase in the expression of genes characteristic of osteoblasto differential with a high secretory activity. Subestudio IV: The osteoblasts from male idiopathic osteoporosis patients have a defect that affects cell proliferation and gene expression characteristic of the role osteoblástica.

Author: LOPEZ AZKARRETA IÑIGO.
Year: 2003.
University: MIGUEL HERNÁNDEZ DE ELCHE [www.umh.es].
Place of defense: MEDICINA.
Place of preparation: FACULTAD DE MEDICINA UNIVERSIDAD MIGUEL HERNÁNDEZ.

Summary: Main Objectives: To identify risk factors of post-thrombotic syndrome (PTS) after a proximal deep venous thrombosis (DVT). Secondary: Describe the prevalence of thrombophilia in an unselected population with DVT. PATIENTS AND METHODS type prospective observational study with a follow-up to a year in a cohort of 87 patients. Results The incidence of PTS was 54%. The use of elastic stockings understanding strong decrease the incidence of PTS in a 45%. The antecedent of independently developing IESPT the prevalence of thrombophilia was 38.1%, being Hyperhomocysteinaemia with a 15.5% and Factor V Leiden with a 11.9%, more hypercoagulable states observed. CONCLUSIONS Regular use of high compression socks decreases the incidence of PTS by almost 50%. The presence of thrombophilia is not associated with the development of PTS. The thrombophilia hyperhomocysteinemia is more common in people with disease troboembolica venous and older.

Author: ORÚS DOTÚ CÉSAR.
Year: 2003.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION rinometría acoustic RA is a complementary test for the exploration of the nasal fossa which allows an objective measure of the areas of cross section of the nasal fossa depending on the distance. Currently its use is universalized and their applications are well defined. However, the values of normalcy needed to assess the results of their clinical applications, are not universal but depends on the population of which has been extracted and the selection criteria used. Moreover since its emergence in the field of rinología have been published many studies comparing it with rinomanometría anteriror active computer with mixed results and conflicting. OBJECTIVES 1-Establish values rinométricos normality of the nasal fossa by sex at baseline in a healthy adult. 2-quantify areas and the increase in volumes which produces nasal vasoconstriction. 3-Study differences rinométricas between the nasal fossa male and nasal fossa of women. 4-A comparative study between rinomanometría and rinometría acoustics. 4.1-Studying the sensitivity and specificity of rinometría previous active and rinometría acoustic regard to the subjective sensation of nasal obstruction and with respect to the detection of obstructive mechanical alterations. 4.2-Study of the correlation between the clinical nasal exploration rinológica and objective evidence. 4.3-Estuidar the possibility of creating a model extrapolation from the results obtained with rinometría acoustics and rinomanometría. RESULTADOS-CONCLUSIONES 1-VALUES OF NORMALCY may be seen as a nasal fossa an adult male is rinométricamente normal when its dimensions are as follows: 1Â th escotadura: 0.77 cm2 (95% CI = 0.60-0.94) and located at 0.18 cm (95% CI = 0.04-0.32) of the same. 2 Â ª escotadura: 0.56 cm2 (95% CI = 0.44-0.68) and located at 1.87 cm (95% CI = 1.69-2.05) of the same. Volume from the marina at ATM is 1.75 cm3 (95% CI = 1.38-2.12) Volume from the marina at ATM is 5.17 cm3 (95% CI = 4.12-6.22) from Volume navy is the seventh centimeter of 8.35 cm3 (95% CI = 6.51-10.19) can be considered as a nasal fossa of an adult woman is rinométricamente normal when its dimensions are as follows: 1Â th escotadura: 0.55 cm2 (95% CI = 0.42-0.68) and located at 0.26 cm (95% CI = 0.12-0.40) for the navy 2Â th escotadura: 0.47 cm2 (95% CI = 0.38 - 0.56) and located at 1.83 cm (95% CI = 1.67-2.00) for the Navy. 8-MODEL EXTRAPOLACIÓN MEASUREMENT It is feasible to design a model extrapolation between measures rinométricas and rinomanométrica across a recipe that follows the regression equation: Flow to 75 Pa (cc / sec) = 37.6 + 27, 9 x volume 3 (cc) However, the confidence interval of the extrapolations is too broad to have a clinical utility. 9-COMPARISON BETWEEN RINOMETRÍA ACOUSTIC AND RINOMANOMETRÍA The different methodologies used by the RA and MRI ago that its results are not directly comparable. Nothing replaces the other but are complementary. Volume from the narina the ATM is 1.29 cm3 (95% CI = 1.06-1.52) Volume from the narina the fifth centimeter is 4.35 cm3 (95% CI = 3.53-5.17) Volume since the narina the seventh centimeter is 7.42 cm3 (95% CI = 5,99-8,85) 2-EFFECT OF A VASOCONSTRICICÓN The vasoconstriction leading to an increase in all dimensions of the nasal fossa. The average increase depends on the richness in erectile tissue. The average increase in the volume of the first 5 centimeters is about 30%. The area that suffers a further increase is the area of cross section of the fourth centimeter with an average increase of 55% in males and 39% in females. The minimum cross-sectional area increases by 12.5% in your area. 3-EFFECT OF ALTITUDE Measures rinométricas suffer a direct and proportionate increase with increasing height of the individual. The nasal fossa of individuals senior is rinométricamente greater than that of individuals low. 4-EFFECT OF SEX The dimensions of the nasal fossa of women so 8 No more eg a23 queñas that of a male of the same height as a character tied to sex, both as a baseline in vasoconstriction. 5-ESPECIFICIDAD AND THE SENSITIVITY OF THE RONIMETRÍA ACOUSTIC AND RINOMANOMETRÍA REGARDING THE SENSATION OF RESPIRATORY FAILURE NASAL In our series, from the point of view whatsoever (presence or absence of symptoms) rinometría noise was more sensitive but less specific the rinomanometría regarding the sense of IRN (87.5% vs. 72.5%, 31% vs. 69%, respectively), although both had the same absolute value (71%). From the point of view of the level of intensity of the symptoms and the level of disturbance of the objective test, while the RA as the MRI showed similar matches. The NMR, despite being more functional, it correlates better than the RA. So it could be argued that both techniques are acceptable for monitoring nasal symptoms of respiratory failure. In addition, there are factors beyond the objective evidence that this correclación no cause can ever be complete. 6-ESPECIFICIDAD AND THE SENSITIVITY OF THE RINOMETRÍA ACOUSTIC AND RINOMANOMETRÍA REGARDING THE DETECTION OF DISORDERS ANATÓMICAS NASAL In our series, from the point of view whatsoever (presence or absence of anatomical alteration) rinometría noise was more sensitive but less specific the rinomanometría regard to the detection of alterations anatomical (93% vs. 75%, 59% vs. 75% respectively). However RA got a better overall value that the MRI (86% vs. 71%). From the point of view of the level of intensity of the symptoms and the level of disturbance of the objective test, the RA showed a slight correlation that the better MRI. Both techniques are sufficiently valid to be used in the assessment of the anatomic abnormalities of the nasal fossa. 7-CORRELATION BETWEEN ACTION RINOMÉTRICAS And RINOMANOMÉTRICAS Measures rinométricas and rinomanométricas have a statistically significant correlation. The correlation, quantitatively more significant, is set between the volume of the first seven centimeters in the pit and flow to 75 Pa (r2 = 0.29, F = 43.4, p = 0001).

Author: SOTO DEL CASTILLO ALVARO.
Year: 2003.
University: PAÍS VASCO [www.ehu.es].
Place of defense: FACULTAD DE MEDICINA Y ODONTOLOGIA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The demyelinating diseases, including multiple sclerosis, affecting the 0,1-0,2% of the population. As of today, there are only palliative remedies to address the problem and have not identified ways to enhance the remielinización in vivo against these injuries. Ignorance of the etiopatología of demyelinating disease requires the use of experimental models in animals. One of them is based on the vulnerability of oligoendrocitos to signals excitadoras glutamatérgicas. These substances to sobreactivar receivers glutamatérgicos type AMPA and kainato attending oligodendrocytes, causing his death both in vitro and in vivo. In vivo, the optic nerve injuries in producing demyelination and nflamación, and leads to plaques with properties that recall those seen in multiple sclerosis. The project has as its ultimate objective the study of the recovery of demyelinating lesions that previously have been caused by excitotoxicidad. In addition, for this reason it is essential to the analysis and study of the development of precursors oligodendrogliales and its entire lineage using cell mitogens. Therefore, these have been used Immunohistochemical and electrophysiological techniques.

Author: DESCO MENENDEZ M. MAR.
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.

Summary: Introduction: The Circulatory Assistance applications are widespread in the field of surgery cardíaca.Cada ever more frequent use of these devices pending perform transplants cardíacos.Las standards for approving such devices are very strict and should include a battery studies specifically for the use that he is going to give the device biomédico.En this work is carried out an in-depth study, grouping all of the techniques related to the materials used in the construction of dispositivmos of mechanical circulatory assistance, mainly targeted grade polyurethanes biomedical and seeks to ensure that the physicochemical characteristics of these materials and their biocompatibility in dispisitivo assistance BCM. Materials and Methods: The work is carried out in rats, mice and rabbits in the first phase studies (toxicity of materials) and sheep in etudios second phase (full use of the device). Test was performed in vitro (on fibroblasts and on whole blood as well as their components aistados: red cells and platelets) and test "in vitro" making implants biomterial and injections of soluble extract in experimental animals. Results and conclusions: It proves that the material does not produce toxicity isolated "in vitro" and "in vivo" in any of the tests. In chronic experiences with the device implanted and running on animals were not detected side effects due to the material. After studies conducted biocompatibility we can say that the system of mechanical circulatory assistance BCM manufactured in Tecoflex ® may be involved in humans without causing processes imcompatibilidad biological.

Author: SEGADO SORIANO ANTONIO.
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of preparation: COMPLUTENSE.

Summary: Objectives To establish the efficacy of the markers biolÃÂ ³ ments of styling and HAA. To analyze the frequencies of mutations genÃÂ © policies on alcohol dehydrogenase ADH aldehÃÂdo dehydrogenase ALDH and cytochrome P450 2E1 CYP2E1 and establish their possible asociaciÃÂ charges with the development of acute hepatitis alcohÃÂ ³ lica HAA. There were estidoadp a total of 120 patients EspaÃÂ ± oles classified into three groups funciÃÂ charges of lesiÃÂ ³ n histolÃÂ ³ gica hepÃÂ ¡tica and alcohol consumption: Group 1 = abstemious; groups 2 = drinkers without HAA, Group 3 = drinkers with HAA, mÃÂ ¡s group 4 or external composed of 72 blood donors. The diagnÃÂ ³ stico of HAA is estableciÃÂ ³ based on the presence of infiltration of polymorphonuclear leukocytes in the biopsy. RESULTS GGT and VCM showed high negative predictive values. The BR and leukocytosis were especÃÂficos but insensitive to HAA. We found no mutations R369C or E487K or relaciÃÂ charges between mutaciÃÂ ³ n R47H and HAA. The mutaciÃÂ ³ n c1/c2 of CYP2E1 is hallÃÂ ³ in 45% of patients in group 3, compared to 7%, 15%, 7% group 1.2 and 4. The presence of mutaciÃÂ ³ n Rsa I mostrÃÂ ³ influence on the development of HAA (odds ratio [OR] = 3.11 (CI 0.82-11.7). Results are discussed with others being the main differences regarding mÃÂ © all employees. CONCLUSIONS 1-markers biolÃÂ ³ ments clÃÂ ¡sicos of etilismo mÃÂ ¡s effective to discard consumption in patients with hepatopatÃÂas are VCM and GGT2. Prevalence of mutaciÃÂ ³ n R47H in group 1 is two times higher than that found in groups 2 and 3, sugiriÃÂ © Ndo elposible protective role that can be exercised against the excessive consumption of alcohol.3. data suggest a possible asociaciÃÂ charges between the presence of mutaciÃÂ ³ n Rsa I CYP2E1 and development of HAA. This asociaciÃÂ charges can help to correctly interpret the patogÃÂ © nia of HAA. KEYWORDS enzymes of alcohol metabolism, mutations, acute hepatitis alcohÃÂ ³ lica.

Author: FERNANDEZ PORTALES JAVIER.
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD COMPLUTENSE MADRID.

Summary: Objectives: We intend to evaluate the performance pronÃÂ ³ stico of markers bioquÃÂmicos in patients who consult in an emergency unit with a pain TorÃÂ ¡cico.MÃÂ © todos.Estudio monocÃÂ © ntrico and propectivo of 321 consecutive patients with suspected unstable angor IIIB and less than 12 hours evoluciÃÂ ³ n.Se analizÃÂ ³ CPK CPKMB mass mioglobina cardiac troponin T and the 6.12 and 18 hours after the start of cuadro.Se comparÃÂ ³ utility pronÃÂ ³ sightseeing segÃÂ fifth n the cut point and time evoluciÃÂ charges of sÃÂntomas analyzing the correlation between determinations, checking their value independently by anÃÂ ¡lisis multivariate. Resultados.CPK mass mioglobina reached mÃÂ ¡maximum sensitivity and specificity for new events isquÃÂ © monkeys in lÃÂmites laboratory wings 6 hours, not asÃÂ in troponin T in which we must wait for the 12 horas.Un cutoff point cardiac troponin T of more than 0.04 ng / ml at 6 am on pain torÃÂ ¡cico becomes the variable isolated with a higher relaciÃÂ ³ n sensitivity especificadad for new events isquÃÂ © micos.Cinco variables obtained were independent predictors few new events permitendo sort correctly 82% of pacientes.La edaad, cardiopatÃÂas isquÃÂ © mica previous prolonged pain in the 15 dÃÂas previous pain +, -, ST changes in emergencies and troponin T greater than 0.1 ng / ml at 12h of home pain, were identified by the regresiÃÂ ³ n logÃÂstica. Conclusions: A ÃÂ º nica determinaciÃÂ ³ n bioquÃÂmica of troponin T the 6h the onset of pain torÃÂ ¡cico seems sufficient to complete the estratificaciÃÂ ³ n pronÃÂ ³ sightseeing aÃÂ ± adiendola variables ECG and clÃÂnicas.Es can correctly identify mÃÂ ¡s of 80% of patients admitted with pain torÃÂ ¡cico without escalating ST with variable clÃÂnicas, ECG and bioquÃÂmicas within 6h from the onset. Unstable angina, pronÃÂ ³ stico, mioglobina, troponin T KPC MD.

Author: MANTILLA MORATO TERESA.
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: MEDICINA.
Place of preparation: COMPLUTENSE.

Summary: Patients with Diabetes Mellitus presented mÃÂ º ltiples cardiovascular risk factors increases propabilidad of sufir cardiovascular disease. PURPOSE The purpose of this thesis is to identify factors predictive control dyslipidaemia in DM type 2. Secondary objectives, assess the distribuciÃÂ ³ n and control of cardiovascular risk factors, assessing the degree of control of dyslipidemia; estimate reisgo coronary of diabÃÂ © ticos without cardiovascular disease; assess the impact of atenciÃÂ ³ n mÃÂ © dica. MATERIAL AND MÃâ ° ALL 800 patients with diagnÃÂ ³ stico DM type 2. The cÃÂ ¡lculo CR is realizÃÂ ³ using the Table of Framingham by CategorÃÂas. The criteria for good control of dyslipidaemia used were those recommended psor American Diatetes Association (LDL menro 100 mg / dl, HDL greater 40mg/dl; TG lower 150 mg / dl). The anÃÂ ¡lisis eatadÃÂstico is realizÃÂ ³ with the help of the program SPSS-10. The significaciÃÂ ³ n estadÃÂstica was p less 0.05. RESULTS mean age 68.4 aÃÂ ± os. Women 54%. Smokers 12.6%. With CVD 16.3% HbA1c less 7% 55.5%; PA smaller 130/80 mmHg: 22.5%; LDL lower 100 mg / dl: 20%; HDL increased 40 mg / dl: 81.3%, TG minor 150 md / dL: 63.9%. With 2 or mÃÂ ¡s FRCV: 51.4%. SegÃÂ fifth n the RC calculated on women dominated the RC moderate and men RC high. Factors predictive control dyslipidaemia (LDL lower 100 mg / dl) were CT (OR 1.2), TG (OR 0.96) and HDL (OR 0.81). Conclusions Among the factors predictive control dyslipidaemia highlights HDL as a factor predictor of good control. The degree of control of dyslipidemia in diabÃÂ © ticos study is low, while emphasizing the figure rise of HDL. All patients diabÃÂ © ticos with hypertension were treated farmacolÃÂ ³ gico, though only 22.5% well controlled. The diabÃÂ © ticos SCS are older, male-dominated, have better control of their FRCV and greater prescripciÃÂ charges of statins and antidiabÃÂ © oral ticos.

Author: FERNҁNDEZ AVILES FRANCESC.
Year: 2003.
University: BARCELONA [www.ub.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL CLINIC (BARCELONA).

Author: ARROYO GONZALEZ RAFAEL.
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of preparation: MEDICINA INTERNA.

Summary: Keywords: Multiple Sclerosis, Herpes Virus Human 6, quantitative real-time PCR. Introduction: Multiple sclerosis (MS) is a demyelinating disease of the CNS that affects younger patients and that presents the greatest cause of neurological disability due to illness common in our environment in adulthood. His etiologi is not at all well known, but it should affect environmental factors, genetic and immunological favoring enfermedad.En recent years a number of environmental factors, including viruses, have been implicated in the pathogenesis of EM.Dentro's family the viruses Herpes Virus have been studied and believe that specifically Herpes Virus Human 6 (HHV-6) is an optimal candidate in the etiology of the disease, remains latent power and revived its neurotropism and their ability to produce in vitro demyelination . In recent years many studies have appeared on the possible etiologic role of Herpes Virus Human 6, but we believe that the conclusions were not final by employing a methodology not appropriate. Assumptions and Objectives: To study whether there is an association between HHV-6 and multiple sclerosis in its various forms clinics, recurrente-remitente and secondarily progressive by quantitative PCR technique time real.Verificar this association in relation to the charges viareles of HHV-6, with the controls healthy donors and patients with rheumatoid reumatoide.Demostrar whether treatment with interfón beta affects the presence of HHV-6 and his viral load. Results and Conclusions: The prevalence of DNA HHV6 blood and very specifically serum (active replication) of patients with multiple sclerosis recurring sender is statistically superior to that found in controls and patients with artrítis arthritis, and the option A HHV-6 the only one that is present.The treatment with interferon beta could be preventing replication active HHV-6

Author: MATILLA PEÑA ANA M..
Year: 2003.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The ruptured bleeding varices esofagogástricas is the most serious complication of the syndrome PTY. Pharmacological treatment of chronic PTY represents the most appropriate therapeutic option to prevent both the first bleeding varices as successive relapses. Beta-blockers are the drugs to that better results were obtained in the treatment of chronic PTY. However, this drug induces an increase in the hepatic vascular resistance and portocolateral limiting their pressure lowering effect of portal can submit a harmful effect on the liver function by decreasing blood flow esplácnico and a not insignificant number of patients have contraindications or drug intolerance. We must therefore find new pharmacological alternatives with greater efficiency and tolerance for the treatment of patients with PAH. Numerous studies have also shown the utility of vasodilators in the treatment of PAH. Moreover, his administration combined with beta-blockers increase the pressure lowering effect of the portal. The carvedilol is an alpha and beta adrenergic antagonist, devoid of partial agonist activity. His administration achieves a sharp decline in the portal pressure significantly greater than that obtained with propranolol, besides increasing the proportion of patients who responded. However, they are not yet sufficiently explained the mechanisms involved in this decline, and it is unknown whether this effect is maintained during chronic administration. Moreover, the acute administration of carvedilol induces a sharp drop in blood pressure and systemic vascular resistance, and may harm in long-term treatments, both tolerance and safety of the drug in terms of the occurrence of renal retention water and sodium and renal failure in cirrhotic patients. In this thesis compares the pressure lowering effect of portal chronic administration of carvedilol and its safety profile compared with propranolol. 51 patients were randomized to receive carvediolol (n = 26) or propranolol (n = 24). We conducted an evaluation of hemodynamic and renal function baseline and after 11.1 + -4.1 weeks, carvedilol resulted in a decrease significantly greater than propranolol (-19 + -2% Vs. -1 + -2%, P less 0.01) . The proportion of patients who achieved a reduction in HVPG largest 20% of baseline or less 12mmHg was higher with carvediololl (54% vs. 23%, p less 05). Only carvedilol resulted in a significant decrease in blood pressure (-11 + -1% Vs. -5 + -3%, P = 05), as well as increased plasma volume and body weight (11 + -5% 2 + -1% respectively, p less 05). The glomerular filtration rate did not change in either of the two treatment groups, but in the group treated with carvedilol was significantly more frequent need to increase the dose of diuretics (27% vs.. 8%, p = 07). Side effects that forced the suspension occurred on treating two patients treated with carvedilol and three treaties conpropranolol. In conclusion, carvedilol has an effect superior to hipotensivo portal of propranolol in patients with liver cirrhosis. But its clinical applicability may be limited in its effect hypotensive sitémicos. Further studies are required to confirm the potential therapeutic role of carvedilol.

Author: ROUSTAN GULLÓN GASTÓN.
Year: 2003.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA UNIVERSIDAD AUTÓNOMA DE MADRID.

Summary: INTRODUCTION The cutaneous melanoma is one of the malignancies in which is seeing an increase alarmente their impact. OBJECTIVES To deepen and improve our knowledge on this disease to prevent its occurrence, get early diagnosis and improved survival. PATIENTS AND METHODS were studied clinical characteristics of 245 patients seen at the Dermatology Service between the years 1993-2003. In addition we studied their likelihood of survival and disease-free survival, development metástais and various factors that may influence the prognosis of the disease. The data obtained were analyzed by the test of x2 Pearson, the test of survival Kaplan-Meir and Cox. RESULTS There was a slight higher incidence in females, with a distribution etaria trimodal (25-35, 45-60 and 75-85), with an average age of 52.1 years. Patients had a phototype II or III and often referred sunburn in childhood, in many cases with blisters. Many patients had lentigos solar many in the back. Few patients had multiple new melanocytes. Most cases had a tumor thickness less than 2mm, were not ulcerados and exceptionally observed satelitosis microscopic and a high rate of mitosis. The identification of a nevo or remains were observed in 22% of cases. The probability of survival at 5 years was 79.8%. The most significant prognostic factor and independent tumor thickness was greater than 4mm or between 2-4mm well as histopathologic ulceration, the presence of sate litosis microscopic and age greater than 65 years. Conclusion The incidence of cutaneous melanoma continues to increase despite prevention campaigns. The death rate remains low, primarily for early diagnosis. Most melanomas are diagnosed at early stages, when the tumor thickness is less than 2mm. The tumor thickness remains the most significant prognostic factor.

Author: MÉNDEZ BAILÓN MANUEL.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA. HOSPITAL GENERAL GREGORIO MARAÑÓN DE MADRID.

Summary: INTRODUCTION The propéptido natriurético N-terminal type B (NT-proBNP) is a marker that is elevated in situations of volume overload before changes demilitarized miocardíca as in subjects with heart failure (CI). Preliminary studies demonstrate its utility for the diagnosis of acute dyspnea associated with CI in patients who come to emergency rooms. However, its usefulness in elderly populations are not so clear. Objectives To compare the values of NT-proBNT serum of elderly patients with acute dyspnea attributable to CI compared to other causes of acute dyspnea. Concer sensitivity, specificity, and predictive value of NT-proBNT compared with a clinical diagnosis of IC. Knowing the degree of association between the determining NT-proBNP serum and other clinical variables in the diagnosis and prognosis of IC. MATERIALS AND METHODS It included 79 patients with acute dyspnea in the emergency room more than 65 years. We excluded patients with acute coronary syndrome and renal insufficiency with Cr greater 3mg/dl. The diagnosis of IC was established with criteiros of Framingham and variable ecocardiográficas. All patients were measured (so blind to the diagnoses) values NT-proBNP through the method of Roche Diagnostics. It relizó track prospective to 18 months after hospital discharge assessing riengreso by IC. FINDINGS AND CONCLUSIONS values NT-proBNP are higher in the patients with IC than in those patients with dyspnea cause breathing. In elderly patients, the cutoff point of NP-proBNP in 730 pg / ml is the most accurate for the diagnosis of dyspnea associated with watery IC. This point cut NT-proBNP presents a sensitivity of 98%, a specificity of 80% with a negative predictive value of 95% and a positive predictive value of 91% for the diagnosis of heart failure. From the statistical point of view, in the elderly, NT-proBNP is an independent factor for diagnosing IC and a prognostic marker for this cause readmission to the 18-month follow-up from hospital discharge.

Author: GARROTE DIAZ JUAN MANUEL.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.

Summary: There has been a cross-sectional study descriptive on a population aged 65 and over an area of rural health in the province of segovia. Out of the total number of the largest non-institutionalized population of this area and through the questionnaire barberse has selected the fragile elderly population and / or dependents. On the whole fragile elderly or dependent has extracted a significant sample. Of the sample has done a comprehensive geriatric assessment, including basic activities of daily living, instrumental activities; mobility; TE ST (cognitive) has been added to a study on the homes of anciandos studied particularizando in precipitating factors or aggravating fragile or dependence in the homes studied, we have made a study of diseases and drugs taken by the elders of the sample. There were extradio conclusions of this study.

Author: CEPEDA CONZÁLEZ CONCEPCIÓN.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL UNIVERSITARIO 12 DE OCTUBRE.

Summary: In patients infected with HIV in our country, the prevalence of co-infection with hepatitis C is greater than 70%, and of these, the possibility of developing liver failure is higher than 50%. LOPINAVIR / RITONAVIR is an essential antiretroviral for the treatment of HIV infection. For these reasons, we designed a study Phase IV / I, open comparison between two groups of patients, one with hepatic insufficiency and other checks, the pharmacokinetics of lopinavir / ritonavir in phase equilibrium. From our study we conclude that hepatic insufficiency amending the pharmacokinetics of the levels of lopinavir total free lopinavir and ritonavir, bringing all the same concentrations. These findings allow us to advise the close monitoring of adverse effects that may result from increased plasma levels of the drug.

Author: MOLINA PUENTE JUAN IGOR.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: The clasificaicón in different types of shock is defined by the ruling in one of the elements to maintain the tissue perfusion. Spending heartbeat, volume and vascular resistance. Faced with the deterioration of one of these other factors are liable for compensatory way. Thus, in the not cardiogenic shock, cardiogenic not, the answer the heart is essential. We know the morphological variation suffers heart during non-cardiogenic shock, but did not have any parameter measurement to define their functional status and therefore its responsiveness as far as prognosis is concerned. After knowledge of the troponinas as markers of myocardial damage in heart attack and unstable angina, it is intended to give them value in the non-cardiogenic shock. We evaluate the response of the value of troponin T in the early stage of this kind of shock, demonstrating that this can occur with high values in serum. Following this result, we relate the elevation of troponin T in the stage rpecosz of non-cardiogenic shock with increased mortality of patients in whom this and thus giving it a prognostic value.

Author: FERRANDO GISBERT JOSÉ M..
Year: 2004.
University: AUTÓNOMA DE BARCELONA [www.uab.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA. ESCOLA DE POSTGRAU.

Summary: This thesis presents a collection of works that summarizes various possible ways of improving the quality of the materials incorporated most commonly used in pathology herniaria abdominal, taking into account three areas for action or targets: a-surgical technique, analyzing the best implant site and quality of the interfaces and surrounding fascia; b beneficial effects of arginine with exogenous input on the integration and differentiation of materials implanted in the abdominal wall; c properties mecánico-estructurales of the most commonly used prosthesis and its expression in the adaptability and resilience. Jobs made a few experimental designs (Sprague Dawley rats). METHODOLOGY Correlation between morphological aspects (electronic and optical microscopy), biochemical aspects (chromatographic techniques, Western-Blot, zimografía) and mechanics (tensile tests: strength, deformation, stiffness, elasticida studies, fatigue, creep and fracture). First RESULTS: On the site of the implant found, correlating with morphological aspects mechanics, a response improved integration for placement above or praponeurótica. Second: On the beneficial effects of ariginina This prompted best embodiment tissue neoformado both from the point of view of molecular and functional. The interfaces treated with arginine induced higher capillary density, better response to immune cells and fibroblasts lso increased collagen deposition, best expression of alfa-SMA and increased activity metaloproetásica, particularly when the prostheses were placed in the surface layers or preaponeuróticos. Additionally, the mechanical response was also improved by translating greater tensile strength and less rigidity. Third: The prosthesis composite proved to be a suitable implant to treat defects in the abdominal wall as it has a large biocompatibility and integration capability in the light of our results morphological and mechanics. Fourth: The monofilament polypropylene has demonstrated behavior viscoelástico as it possesses a good relaxation of tension and creep as well as a profile fractográfico adequate in terms of plastic deformation.

Author: MARTINEZ ALBIACH JOSÉ MANUEL.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: SUMMARY: In the last 40 years there has been reporting an increase in unusual ways or inusules of TB as well as a significant delay in diagnosis. Objectives: This is analyzing, in our midst, if TB has changed since 1958, before the antibiotic era, until the year 2000. Analyzing the influence of risk factors and assess whether smoking modifies the severity of the disease. Material v method are conducted 2 studies: a retrospective from 1958 (population 1) (Pl) n = 98 And another prospective from 1998 to 2000 (Population 2) (P-2) n = 96. Profile data collection with 56 variables including history, symptoms, a hemogram, a chest X-ray, a Mantoux and a study microbiology. Statistical treatment: Comparative study of proportions using the "i" with Yates correction for qualitative variables and the "t" Student for quantitative accepting significance p greater 0005. For the correlation of the variables used the "X2" with the correction of Pea'rson. Results: At the P-2 regarding IP note: greater ftecuencia in men (84.3% vs. 73.46%), a higher frequency peak between 15-21 years; an increase in smoking (55.2 % vs. 38.7%), especially in younger (66%), which is associated with more extensive injuries, and more hemoptysis greater tendency to cavitarse; ignorance of the biggest outbreak of infection (20% vs.42%); greater abuse alcohol enjólel1es (52.45 vs. 26.7%), cough and expectoration have decreased their frequency especially in adults (82.4% vs. 93.2%) decrease in hemoptísis (21.33% vs. 47, 95%) increase in cases with anemia and lymphopenia in women (33.3% vs. 3.7%); amnento ways unusual (9.4% vs. 4%); declining pattern miliary (3.1% vs. 7.1%) and more advanced lesions in the elderly (40% vs. 25%). Conclusions: The unusual forms have risen from 4% to 9.4%. Excessive alcohol consumption and increased smoking, especially among young people is associated with more advanced forms, more and more inclined to hemoptysis cavitation. Keywords: Tuberculosis. Clinic. Radiology. Hemograma. Smoking. Alcohol

Author: CASAS ROJO EDUARDO.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: F. MEDICINA.
Place of preparation: F. MEDICINA UNIVE. SAN CARLOS.

Summary: The index TEI or myocardial performance index (MPI) is an index of ventricular function obtained by Doppler echocardiography which is the ratio between the amount of time recruiting and relaxation isovolumétrica and ejection time. The objectives of the study are four: the study of MPI as a predictor of heart failure in the acute phase of myocardial infarction (AMI): validation of a method for calculating the MPI with doppler tissue; assess the usefulness of MPI to quantify the response in ischemic stress echocardiography; And finally check the prognostic value of MPI on track after an AMI. The method was to divide the study into four phases, covering home goal in each stage, all applied to the same group of patients who were clinically and second with Doppler echocardiography. The results showed that a MPImayor 0.46 was one of the independent predictors of heart failure in the acute phase of AMI is not complicated; values obtained from tissue doppler but showed a similar degree of concordance only moderate; MPI was not useful for distinguishing patients in the ischemic stress echocardiogram; MPI measured at baseline proved to be a powerful predictor of events (death or readmission for heart failure) in the follow-up to 12 months. We conclude that the MPI measured in the acute phase of AMI complicated it is not useful for his ability as a predictor of heart failure in the short term and its high prognostic value in the medium term, however, its usefulness in tracking or stress echocardiography is low; its measurement doppler tissue provides no equivalent values which should be taken into account when interpreting studies that use this method.

Author: COTO LOPEZ ANGEL LUIS.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: MEDICINA.

Summary: Objective: To determine whether the mutation of hyperhomocysteinemia and the metilentetrahidrofolato reductase (MTHFR) 677C-T associated with venous thromboembolism in adults young Spaniards. Patients and Methods: We studied 100 patients younger than 50 years and 177 controls with a similar age and sex of the patients. Results: We found hyperhomocysteinemia in 21% of patients and 3.3% of controls (p = less 0001) and mutation MTHFR 677C-T in 25% and 14.7% respectively. (P = 0.03). odds radio (OR) thromboembolism in patients hiperhomocisteinémicos was 7.5, CI, 95% ,2,9-19, 2, p less 0001, and in patients with the mutation MTHFR 677-T was 1.9 CI 95% ,1,1-3, 5, p = 0.03. In a subgroup of 76 patients without other factors trombogénicos thromboembolism associated with hyperhomocysteinemia persisted, but not the mutation MTHFR 677-T. Conclusions: hyperhomocysteinemia, although no mutation MTHFR 677-T, is a risk factor for venous thromboembolism in young adults without other factors trombogénicos.