INTERNAL MEDICINE (4)

Author: RIVAS OTERO BEATRIZ DE.
Year: 2005.
University: COMPLUTENSE DE MADRID [More theses of this university] [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.

Summary: PURPOSE OF THE STUDY The objective of this study was to assess the effect of pioglitazone on blood pressure (BP), insulin resistance and other cardiovascular risk factors in patients with refractory hypertension and type 2 diabetes mellitus (DM). METHODS USED In 27 patients with refractory hypertension and DM (MAP of 24 hours less 125/75 mm Hg) in hypertensive therapy (mean: 4.1 + - 0.8 drugs), it (HOMAR-IR), and analysis of blood glucose, insulin, HbA1c, lipid parameters and routine laboratory. RESULTS After 20 weeks with pioglitazone, a significant decrease was observed in the PA in MAP of 24 hours (PAS: 144.35 +-13.14 to 135.92 +-15.87 mmHg, p = 0001; PAD: from 79.46 +-8.89 vs. 7565 +-10.45 mmHg, p = 0001). These reductions were greater in patients with initial resistance to insulin. Insulin resistance (HOMAR-IR) was reduced in a significant way (4.47 + - 2.78 to 2.85 + - 1.37, p = 0001). It also reduced fasting glucose (151.5 +-38.85 to 139.48 +-30.84 mg / dl p = 0042), insulin (11.1 +-5.54 uU / ml (p = 0001) and HbA1c (6.56 +-0.89 to 6.29 +-0.77, p = 0057). figures decreased triglycerides (208.3 +-304.9 to 135 , 12 +-66.67 mg / dl, p = 0016) and increased HDL (47.7 +-10.41 to 56 +-10.57 mg / dl, p less 0001). There is no change in total cholesterol, LDL and Apolipoproteína B. Conclusions These results suggest that insulin resistance plays an important role in refractory hypertension in diabetic patients. In these patients the addition of pioglitazone to antihypertensive therapy can produce substantial reductions of figures PA.

Author: BAZA CARACIOLO M. BEGOÑA.
Year: 2005.
University: COMPLUTENSE DE MADRID [More theses of this university] [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: CENTRO SANITARIO SANDOVAL.

Summary: INTRODUCTION The publication of cases of HIV (+) patients with vascular disease unexplained, has launched numerous studies to try to answer the question of whether HIV patients (+) show an increase of Cardiovascular Risk. We raised the hypothesis that HIV infection itself produces lipid abnormalities that increase the risk of cardiovascular infected patient. Since they are not very numerous studies conducted in untreated patients, we have proposed: to characterize the profile of HIV patients lipídico (+) untreated buying presenting subjects with HIV (-), in order to know the lipid abnormalities that produces HIV infection itself in the framework of the so-called Acute Phase Response. PATIENTS AND METÓDOS 521 male homosexuals: 280 HIV (+) untreated, and 241 HIV (-). Biochemical Determinations: Total cholesterol (COL), HDL-Colesterol (HDL), VLDL-Colesterol, LDL-Colesterol (LDL), Triglycerides (TG), Apolipoproteínas A1 and B (ApoA1 and APoB) and Lipoprotein a. Cocientes cardiovascular risk (RCV); COL / HDL, LDL / HDL, log (TG / HDL), and Apo B/ApoA1. The HIV (+) patients were divided into groups according to CD4 counts and according to Viral Load (CV). RESULTS Patients HIV (+) presented COL, HDL and Apo A1 minors and TG, VLDL and ratios RCV older. A 76% of patients had HIV (+) agreements low HDL (less than 40 mg / dL), compared to 31% of subjects HIV (-). Among the different groups according CD4 count differences primarily in terms of LOC, lower in the group most inmunodeprimido respect to the control group, and HDL and ApoA1 minors and ratios RCV higher in all groups, regardless of their CD4 count, regarding the control group. Of the groups were observed as HP COL, HDL and apo A1 minors and ratios RCV higher in the group CV highest regard not only in the control group, but also of other groups with HP minors. CONCLUSIONS The lipid profile of patients HIV (+) differs from untreated HIV presenting subjects (-). The changes in lipid patients HIV (+), grouped according to CD4 counts, are independent of the degree of immunosuppression. There is an association between lso values of HP and plasma lipid abnormalities observed, suggesting that viral replication has a direct effect on lipid metabolism. Ultimately, in our study, the HIV infection, which produces alloy lipid created in the subject seropositive a situation proaterogénica therefore be regarded in itself as a cardiovascular risk factor.

Author: HERRERO BERRÓN JUAN CARLOS.
Year: 2005.
University: COMPLUTENSE DE MADRID [More theses of this university] [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL 12 DE OCTUBRE DE MADRID.

Summary: Faced with the increase in the age of patients on the waiting list for kidney transplant and the difference between supply and demand, various policies have been used to increase donation. Since December 1996 at the hospital on October 12, lso used kidneys from donors older than 60 years depending on the age and the percentage of glomeruloesclerosis (GE) in biopsy pretrasplante. We studied transplants performed in the hospital in period Diciembre/1996 to Diciembre/2001, dividiendolos into three groups: Group I, donor more than 75 years, or between 60 and 74 years with GE increased 15%, putting the two kidneys in the same receiver (n = 56). Group II, donor between 60 and 74 years with GE reduced 15%, each placed in a receiver (n = 141). Group III, donors younger than 60 years (n = 395). Follow-up averaged 36 +-18 months (3-63). Average age of the recipient: 62 + - 5.9 years in GI, 63.9 +-7 in G and 42.7 +-11 in G III. Average age of the donor: 74.7 +-5.3 years in GI, 68.5 +-4.7 in G and 37.6 + - 14.2 in D III. GE Percentage: 17.5 + - 9.6% in GIy 5.8 +-4.3% in GII. Acute rejection: 22% in GI, 19.6% and 19.7% G II in D III. At 4 years of follow-up serum creatinine was better in G III (1.4 mg / dl) for the GI (1.75 mg / dl) and G II (2.15 mg / dl). Causes more frequent exitus, ischemic heart disease and failure multiórganico. Causes Frequently loss grafts: exitus receiver with functioning grafts and chronic renal graft. The graft survival censuring the exitus with graft funcinante to 4 years: 78% in the GIy IGI and 89.9% in G III. In conclusion, the kidney transplant donors older than 60 years implanted in older recipients, have a survival being lower than a control group are satisfactory, allowing increased use of such donors.

Author: JIMÉNEZ LÓPEZ-GAURCH CARMEN.
Year: 2005.
University: COMPLUTENSE DE MADRID [More theses of this university] [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL UNIVERSITARIO 12 DE OCTUBRE.

Summary: Pulmonary arterial hypertension is a rare disease which is characterized by an increase in pulmonary pressure, and that without treatment, it has evolved rapidly progressive heart failure right refractira and death. Prostacyclin in continuous intravenous infusion has been shown to increase the survival and quality of life, exercise capacity and hemodynamic parameters in patients with PAH. The stable prostacyclin analogue treprostinil and iloprost have shown their beneficial effect on these patients at three months, although there are very few published data on its effect over the long term. OBJECTIVES To examine the effect of treatment with intravenous prostacyclin and its analogues stable in the long term in patients with severe pulmonary arterial hypertension associated with idiopathic and collagen diseases, toxic oil syndrome and HIV infection. MATERIAL AND METHOD cohort study of 88 patients with severe pulmonary arterial hypertension, advanced functional class (III and IV of the NYHA) epoprostenol treated with intravenous (42), treprostinil subcutaneous (28) and inhaled iloprost (18) between 1990 and 2004. We analyzed the clinical outcome (NYHA functional class modified), the ability of effort (test 6 minutes), hemodynamic parameters and survival at 3,12,36 and 60 months. We studied the fctores demographic, clinical and hemodynamic predictors of mortality. RESULTS intravenous epoprostenol, treprostinil and iloprost resulted in a clinically significant improvement in functional class, the ability of effort and survival, in the 3 months to one year and 3 months, one year and 3 years follow-up . The survival of the patients improved significantly with respect to the theoretical equation obtained by the expected survival of the National Institute of Health USA (88%, 73% and 64% vs 63%, 51% and 40%, p less 0,001 p 0,008 p 0.01 a year, 2 years and 3 years, respectively). In the multivariate analysis, the parameters predictors of mortality were age greater than 43 years (RR 2.6, 95% CI 1.3-5.2), the maximum dose of prostacyclin systemic lower 14ng/kg/min (RR 4.8, 95% CI 2.3-10 ) and the presence of right heart failure clinic at the time of diagnosis (RR 2.3, 95% CI 1.3-4.6). The most serious adverse effects in patients treated with epoprostenol was infection central catheter (1.68-infecciones/paciente). About 10% of patients treated with treprostinil suffered pain at the point of forcing infusion discontinuation of therapy. Conclusions Treatment with stable prostacyclin and its analogues in patients with severe pulmonary arterial hypertension in functional class III and IV of the NYHA produced significant improvement in clinical parameters, capacity and effort survival at 3 months, a year and 3 years follow-up.

Author: BARRIALES ALVAREZ VICENTE.
Year: 2006.
University: OVIEDO [More theses of this university] [www.uniovi.es].
Place of defense: EDIFICIO SANTIAGO GASCON.
Place of preparation: UNIVERSIDAD DE OVIEDO.

Summary: The normal aging process is associated with a series of changes that require cardiovascular establish some baseline standards suitable for normal age. However, it may sometimes be difficult to prove definitively that the observed changes are due to a primary biological aging and not to other external causes pathological. Objective: To study the effect of aging on the heart of healthy individuals, analyzing the morphological findings, both systolic and diastolic function at rest and anatomical characteristics. Methods: We studied 406 healthy subjects older than 65 years and 307 healthy controls between 20 and 50 years. The study was conducted in a way "My two-dimensional echocardiographic and Doppler pressed for obtaining various morphological and systolic and diastolic function. Results: There was a significant increase in thicknesses sistólicos and diastólicos both the septum and the posterior wall in the group of elderly compared with younger controls, no significant differences in the dimensions cavitarias. The systolic function was not altered with age. All parameters analyzed diastolic function presents significant difference between the group of old and young, with increased speed of the wave A, the time of slowdown in the flow and mitral relaxation time isovolumétrica left ventricular and decline in speed Wave E and the relationship I / A. The calcification of the mitral ring aortic and fibrosis were significantly more common in the elderly. Conclusions: In our series of normal elderly, aging is associated with a slight thickening of the ventricular wall with conservation of systolic function, and diastolic alterations that seem to interact independently with age. The existence of these variations must be taken into account before the diagnosis in this age group, other diseases often associated.

Author: HECTOR ALONSO VALLE.
Year: 2006.
University: CANTABRIA [More theses of this university] [www.unican.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: On prosthetic valve endocarditis continues despite the progress made in its aboradaje, high mortality (20-45%). In order to identify clinical features and prognostic factors for mortality, a study cohort ambispectivo January 1986 to December 2005. The signs and symptoms most frequently encountered were the presence of fever, heart failure and breath regurgitante emerging. The microorganism most frequently isolated from blood cultures was S. Epidérmidis. It highlighted a high percentage of patients with abscess objectified in echocardiography (29%). Mortality intrahospital was 29% and was higher in cases of endocarditis early respect to late. The prognostic factors in the multivariate analysis were: presentation in the first 3 months after valve replacement surgery, leuecocitosis or leukopenia in analytical initial abscess isolated in Eco or surgery, urgent surgery, cardiac respiratory failure, renal failure, neurological complications , uncontrolled infection, severe sepsis and septic shock. The medical treatment was associated with lower mortality in the long term.

Author: Montiel Dacosta José Antonio.
Year: 2006.
University: AUTÓNOMA DE BARCELONA [More theses of this university] [www.uab.es].
Place of defense: Facutad de Medicina.
Place of preparation: Facultat de Medicina. Universidad Autónoma de Barcelona. Hospital de la Santa Cruz y San Pablo.

Summary: This thesis describes the characteristics of the patients older than 70 years with acute myocardial infarction admitted in the emergency department of hospitals Spaniards and the treatment and complications in acute emergencies. It also identifies the predictive factors of mortality acute myocardial infarction in this age group.

Author: RICART VAYÁ JOSE MARÍA.
Year: 2006.
University: VALENCIA [More theses of this university] [www.uv.es].
Place of defense: FACULTAD DE MEDICINA DE VALENCIA.
Place of preparation: FACULTAD DE MEDICINA DE VALENCIA.

Summary: Behcet's disease is a disease multisistémicas home not filiado. It is characterized by the appearance of oral sores, genital skin manifestations such as erythema nodosum, pseudofoliculitis, thrombotic events, neurological disorders and lung disorders among others. In this thesis has been rated the epidemiological and clinical characteristics of the EB in the Valencia region, noting that wings are similar to other geographical areas both in Spain and elsewhere in the world. We have analyzed the possible mechanisms protrombóticos in these patients, found that patients who develop EB tables thrombotic levels of activated protein C lower than those of patients who did not develop EB. On the other side were evaluated defects trombofilicos, homocysteine levels, the presence of FV Leiden, the mutation G20210A of protombina and polymorphism C677T of Metilentetrahidrofolatoreductadas (MTHFR) as a risk factor for the development of thrombosis in patients with EB. We found that the presence of the mutation G20210A of prothrombin confers an increased risk for development of thrombosis in patients with EB. Finally evaluated parameters hemorreológicos as erythrocyte aggregation, blood viscosity and plasma viscosity higher than controls, not noting differences compared the group of patients with ED who developed thrombosis with which not development. Therefore alterations hemorreológicas presenting patients with EB not seem to explain the tendency of these thrombocytopenic patients. Finally erythrocyte aggregation was assessed with two agregèmoetros different, the Sefam and Myrene in patients with EB and a control group, noting that it was higher in patients with EB. However, when we compare the aggregation between the group of patients with EB not developed thrombosis and that if the developed, we found no difference between the two groups. All works are published in PubMed.