Internal mammary artery perforator flap for repair of an upper thoracic tracheo-oesophageal fistula.

Tracheoesophageal fistulas (TOF) following esophagectomy for esophageal cancer are rare but potentially fatal. There is no consensus on treatment between stenting and surgical repair, although the latter is associated with better distant survival. In surgical repair, the interposition of a flap improves healing by providing well-vascularized tissue and reinforcing the repair zone. The flaps described are usually muscular and decaying. We present the case of a malnourished fifty-year-old man who underwent intrathoracic surgical repair of symptomatic recurrent TOF using a skin flap based on the perforators of the internal thoracic artery (IMAP). The perforator flap was completely de-epidermized and tunneled under the sternum by a proximal and limited resection of the 3rd costal cartilage and placed at the posterior aspect of the trachea, with the excess tissue rolled up on either side. At 9 months, the patient showed no recurrence and improved general condition. The de-epidermized IMAP tunneled under the sternum intrathoracically is a reliable alternative to the conventional muscle flaps described in TOF management and an attractive additional tool in the plastic surgeon's surgical arsenal.

Medicinal Plants in Traditional Herbal Wines and Liquors in the East of Spain and the Balearic Islands.

Homemade herbal preparations from the East of Spain are the witness of traditional medicine inherited from the ancient complex formulas of herbal teas and medicinal wines. In this study, we document the use of traditional alcoholic beverages, identify their ingredients, almost exclusively botanical, record the local medicinal uses of these mixtures, and discuss patterns of distribution of this knowledge in regions of eastern Spain, the Balearic Islands and Andorra. We determine marker species and relevant patterns of herbal formulas in the different regions of the territory. Homemade liquors and liqueurs are consumed for their digestive and tonic-restorative properties but they also play in some cases an important social role. The elderly remember other medicinal uses such as aperitif, emmenagogue, or antidiarrheal, for some of the most popular preparations. The herbal liqueur formulas include predominantly Lamiaceae, Asteraceae, Rosaceae, Rutaceae, and Apiaceae species. Herbs (58%), fruits (28%), and mixtures of both (12%) are ingredients of liquors and wines, being the aerial parts the most frequent in terms of species (30%) and records (49%). Dictamnus hispanicus, Santolina villosa, Salvia blancoana subsp. mariolensis, Rosmarinus officinalis, Thymus vulgaris, and Clinopodium serpyllifolium subsp. fruticosum are the species most frequently used. Others species used to a lesser extent as Polygonatum odoratum, Thymus moroderi, and Saxifraga longifolia are restricted to locally homemade preparations because their collection and uses require special knowledge of the rare or endemic flora. Sustainability of these practices is strongly limited by the overall loss of local traditional knowledge and by the limited availability of most of the wild species; some of them are endangered or threatened mainly by the loss of their natural habitats. Cultivation and domestication are a promising alternative to collecting from wild populations. The cultivation of Thymus moroderi in the province of Alicante and Polygonatum odoratum in the province of Teruel are good examples. There is a notable decrease in the complexity of the formulas registered throughout the nearly 15 years of the study. This is interpreted as a consequence of a loss of knowledge, less accessibility to wild resources, and changes in traditions and preferences.

Noncontractible loops in the dense O(n) loop model on the cylinder.

A lattice model of critical dense polymers O(n) is considered for finite cylinder geometry. Due to the presence of noncontractible loops with a fixed fugacity ξ, the model at n=0 is a generalization of the critical dense polymers solved by Pearce, Rasmussen, and Villani. We found the free energy for any height N and circumference L of the cylinder. The density ρ of noncontractible loops is obtained for N→∞ and large L. The results are compared with those found for the anisotropic quantum chain with twisted boundary conditions. Using the latter method, we derived ρ for any O(n) model and an arbitrary fugacity.

Universal behavior of the Shannon mutual information of critical quantum chains.

We consider the Shannon mutual information of subsystems of critical quantum chains in their ground states. Our results indicate a universal leading behavior for large subsystem sizes. Moreover, as happens with the entanglement entropy, its finite-size behavior yields the conformal anomaly c of the underlying conformal field theory governing the long-distance physics of the quantum chain. We study analytically a chain of coupled harmonic oscillators and numerically the Q-state Potts models (Q=2, 3, and 4), the XXZ quantum chain, and the spin-1 Fateev-Zamolodchikov model. The Shannon mutual information is a quantity easily computed, and our results indicate that for relatively small lattice sizes, its finite-size behavior already detects the universality class of quantum critical behavior.

Shared information in stationary states of stochastic processes.

We present four estimators of the shared information (or interdepency) in ground states given that the coefficients appearing in the wave function are all real non-negative numbers and therefore can be interpreted as probabilities of configurations. Such ground states of Hermitian and non-Hermitian Hamiltonians can be given, for example, by superpositions of valence bond states which can describe equilibrium but also stationary states of stochastic models. We consider in detail the last case, the system being a classical not a quantum one. Using analytical and numerical methods we compare the values of the estimators in the directed polymer and the raise and peel models which have massive, conformal invariant and nonconformal invariant massless phases. We show that like in the case of the quantum problem, the estimators verify the area law with logarithmic corrections when phase transitions take place.

Meal replacement with a low-calorie diet formula in weight loss maintenance after weight loss induction with diet alone.

BACKGROUND/OBJECTIVES: Weight loss in obesity can reduce morbidity and mortality and benefits persist as long as weight loss is maintained. Weight maintenance is difficult in the long term and new strategies need to be developed to achieve this goal. We aimed to evaluate the efficacy of substituting a low-calorie diet formula for a meal in a weight loss program during the maintenance phase. METHODS: Randomized paralleled clinical trial including 62 adult patients with at least a 5% weight loss with diet alone for 6 months, randomized to two groups: daily replacement of one meal with a low-calorie diet formula, or dieting alone for another 6 months (weight maintenance phase). RESULTS: Weight maintenance or further weight loss occurred in 83.9% of patients in the intervention group, whereas only in 58.1% in the control group (P=0.025). As a whole, patients in the intervention group lost a further 3.2+/-3.7% of initial weight compared with a 1.3+/-3.6% in the control group (P=0.030). Body fat mass diminished in both groups, with no differences between them (1.6+/-3.5 vs 1.0+/-9.3 kg, respectively, P=0.239), and the same happened with free fat mass (0.9+/-3.3 vs 0.4+/-6.7 kg, respectively, P=0.471). A multivariate logistic regression analysis (R (2)=0.114, P=0.023) retained only the intervention as a predictor of the achievement of weight maintenance with an odds ratio (95% confidence interval) of 3.756 (1.138-12.391). CONCLUSIONS: Substitution of a low-calorie diet formula for a meal is an effective measure for weight loss maintenance compared with dieting alone.

Two-component Abelian sandpile models.

In one-component Abelian sandpile models, the toppling probabilities are independent quantities. This is not the case in multicomponent models. The condition of associativity of the underlying Abelian algebras imposes nonlinear relations among the toppling probabilities. These relations are derived for the case of two-component quadratic Abelian algebras. We show that Abelian sandpile models with two conservation laws have only trivial avalanches.

[An analysis of the papers presented in national congresses of the Spanish Society of Intensive Nursing and Coronary Units in an 8-year period]. / Análisis de las comunicaciones admitidas en los congresos nacionales de la SEEIUC en 8 años (1998-2005).

INTRODUCTION: The research on critical care nursing is generally presented in the annual national congresses of the Spanish Society of Intensive Nursing and Coronary Units (SEEIUC). This study has aimed to analyze the main features of the papers presented in the above-mentioned congresses in order to get a deeper knowledge of the research capacity of our professional group. MATERIALS AND METHODOLOGY: A descriptive, observational and retrospective study. SAMPLE: all the papers. Dimension studied: structure and process. Time: 8 years. DATA SOURCE: a collection of the papers presented in congresses. DEVELOPMENT: collected variables: number of authors, type of paper, city and region, type of study, timing, nursing role, dimension analyzed, topic, hospital, department, type of statistics, relevance, financing, structural quality and others. Statistical processing: descriptive statistics for quantitative variables with means and standard deviation (SD); qualitative variables are written in percentages. We have contrasted hypotheses with chi(2) accepting if p < 0.05 as a statistical significance. RESULTS: Papers 736 (65-119), oral papers 270 (40.4%), mean of authors 4.87 (1-16), SD 1.97; per provinces: Barcelona 146 (19.8%); per autonomous communities: Catalonia 166 (22.6%); hospitals: University Hospital from Bellvitge 27 (4.2%); research studies 426 (65.3%); prospective studies 333 (51%), quantitative 345 (53%); with descriptive statistics 305 (46.9%); with a health perception and health management pattern 76 (10.3%); analyzed quality area: structure 379 (51.5%); with the presence of an autonomous role 380 (51.6%); most mentioned theme: respiratory care 100 (13.6%), with relevance and/or applicability 450 (69%); financed 23 (3.5%). Fulfillment of scientific structure: 97%. CONCLUSIONS: Intensive Nursing Care shows an important amount of oral papers. Research studies stand out among these papers, the former having high structural quality and relevance and/or applicability.

Análisis de las comunicaciones admitidas en los congresos nacionales de la SEEIUC en 8 años (1998-2005) / An analysis of the papers presented in national congresses of the Spanish Society of Intensive Nursing and Coronary Units in an 8-year period

Introducción. La investigación en enfermería decuidados críticos suele comunicarse en los congresosnacionales de la Sociedad Española de EnfermeríaIntensiva y Unidades Coronarias (SEEIUC) que serealiza anualmente. El objetivo de este estudio esanalizar las características principales de lascomunicaciones presentadas en este evento paraconocer en profundidad la capacidad investigadoradel colectivo.Material y método. Estudio descriptivo,observacional y retrospectivo. Muestreo: todas lascomunicaciones. Dimensión estudiada: estructura yproceso. Tiempo: 8 años. Fuente de datos: libros decomunicaciones. Desarrollo: las variables recogidasfueron el número de autores, tipo de comunicación,ciudad y región, tipo de estudio, temporalidad, rol deenfermería, dimensión estudiada, tema, hospital,servicio, tipo de estadística, relevancia, financiación,calidad estructural y otros. Procesamiento estadístico:estadística descriptiva para variables cuantitativas conmedias y desviación estándar (DE), las cualitativas seexpresan en porcentajes. Contrastes de hipótesis con X2 aceptando significación estadística si p < 0,05.Resultados. Comunicaciones 736 (65-119), enformato oral 270 (40,4%); media de autores 4,87 (1-16), DE 1,97; por provincias: Barcelona 146 (19,8%);por Comunidades: Cataluña 166 (22,6%); hospitales:Hospital Universitario de Bellvitge 27 (4,2%); estudiosde investigación 426 (65,3%); prospectivas 333(51%); cuantitativas 345 (53%); con estadísticadescriptiva 305 (46,9%); patrón percepción-manejode la salud 76 (10,3%); área de calidad estudiada:estructura 379 (51,5%); presencia de rol autónomo380 (51,6%); tema más referenciado: los cuidadosrespiratorios 100 (13,6%); con relevancia y/oaplicabilidad 450 (69%); financiadas 23 (3,5%).Cumplimiento de estructura científica: 97%.Conclusiones. La enfermería de cuidados críticospresenta un número importante de comunicacionesorales, con predominio de estudios de investigacióncon una calidad estructural alta, y con relevancia y/oaplicabilidad

Introduction. The research on critical care nursingis generally presented in the annual nationalcongresses of the Spanish Society of IntensiveNursing and Coronary Units (SEEIUC). This studyhas aimed to analyze the main features of thepapers presented in the above-mentioned congressesin order to get a deeper knowledge of the researchcapacity of our professional group.Materials and methodology. A descriptive,observational and retrospective study. Sample: allthe papers. Dimension studied: structure andprocess. Time: 8 years. Data source: a collection ofthe papers presented in congresses. Development:collected variables: number of authors, type ofpaper, city and region, type of study, timing,nursing role, dimension analyzed, topic, hospital,department, type of statistics, relevance, financing,structural quality and others.Statistical processing: descriptive statistics forquantitative variables with means and standarddeviation (SD); qualitative variables are writtenin percentages. We have contrasted hypotheseswith X2 accepting ‘if p < 0.05’ as a statisticalsignificance.Results. Papers 736 (65-119), oral papers 270(40.4%), mean of authors 4.87 (1-16), SD 1.97; perprovinces: Barcelona 146 (19.8%); per autonomouscommunities: Catalonia 166 (22.6%); hospitals:University Hospital from Bellvitge 27 (4.2%);research studies 426 (65.3%); prospective studies333 (51%), quantitative 345 (53%); withdescriptive statistics 305 (46.9%); with a healthperception and health management pattern 76(10.3%); analyzed quality area: structure 379(51.5%); with the presence of an autonomous role380 (51.6%); most mentioned theme: respiratorycare 100 (13.6%), with relevance and/orapplicability 450 (69%); financed 23 (3.5%).Fulfillment of scientific structure: 97%.Conclusions. Intensive Nursing Care shows animportant amount of oral papers. Research studiesstand out among these papers, the former havinghigh structural quality and relevance and/orapplicability

Directed Abelian algebras and their application to stochastic models.

With each directed acyclic graph (this includes some D-dimensional lattices) one can associate some Abelian algebras that we call directed Abelian algebras (DAAs). On each site of the graph one attaches a generator of the algebra. These algebras depend on several parameters and are semisimple. Using any DAA, one can define a family of Hamiltonians which give the continuous time evolution of a stochastic process. The calculation of the spectra and ground-state wave functions (stationary state probability distributions) is an easy algebraic exercise. If one considers D-dimensional lattices and chooses Hamiltonians linear in the generators, in finite-size scaling the Hamiltonian spectrum is gapless with a critical dynamic exponent z=D. One possible application of the DAA is to sandpile models. In the paper we present this application, considering one- and two-dimensional lattices. In the one-dimensional case, when the DAA conserves the number of particles, the avalanches belong to the random walker universality class (critical exponent sigma_(tau)=32 ). We study the local density of particles inside large avalanches, showing a depletion of particles at the source of the avalanche and an enrichment at its end. In two dimensions we did extensive Monte-Carlo simulations and found sigma_(tau)=1.780+/-0.005 .

Divertículo de Meckel como causa de hemorragia digestiva baja en el adulto / No disponible

No disponible

Hipertensión arterial severa con nefroangioesclerosis: tratamiento y evolución a largo plazo / Severe arterial hypertension with nephroangiosclerosis: long-term treatment and course

El caso clínico aportado representa uno de los muchos casos de hipertensión arterial esencial severa, de difícil control, con afectación visceral (fondo de ojo, cardíaca y renal) que se pueden ver en una consulta médica. Este caso destaca por la gravedad y la dificultad del control de la presión arterial, pues precisó de 3 a 5 fármacos a lo largo del tiempo. A través de este caso se analiza la evolución que presentó durante 11 años de seguimiento, en los que desapareció la afectación cardíaca y de fondo de ojo, gracias al riguroso control de la presión arterial, y el consiguiente descenso del riesgo vascular del paciente, que no ha presentado ningún evento cardiovascular en estos 11 años. Asimismo, siguiendo las indicaciones de las últimas guías y los hallazgos de los últimos estudios, se revisan los distintos tratamientos que recibió

This clinical case represents one of the many cases of difficult-to-control severe essential arterial hypertension with visceral (ocular fundus, heart and renal) involvement that can be seen in a Primary Care or Specialized Care medical visit. The case of the patient chosen stands out for its severity and the difficulty of control of the blood pressure, the patient requiring 3 to 5 drugs throughout the time. In this case, the evolution of the patient over the 11 years of follow-up in our medical consultations has been analyzed. During that time, the heart and ocular fundus involvement disappeared, thanks to the rigorous control of blood pressure, with the consequent decrease in the vascular risk for the patient who has not had any cardiovascular event in these past 11 years. Furthermore, following the indications of the recent guides and the findings of the latest studies, the different treatments received by the patient have been reviewed (AU)

[Comparative study of burnout in Intensive Care and Emergency Care nursing staff]. / Estudio comparativo del burnout en personal de enfermería de Cuidados Intensivos y Urgencias.

OBJECTIVE: To assess and compare the burnout level between Intensive Care Unit and Emergency Unit, and study its association with the sociodemographic and work characteristics of the professionals surveyed. DESCRIPTION: Cross-sectional, descriptive study. Emplacement. Intensive Care Unit of the university hospital Morales Meseguer, Murcia-Spain. STUDIED SAMPLE: 97 nursing professionals: 55 professionals belong to the Emergency Department, and 42 professionals belong to the Intensive Care Department. METHOD: Two evaluation tools were used: a sociodemographic and work survey, and the Maslach Burnout Inventory, 1986. Quantitative variables expressed as mean +/- SD compared with the Student's T test and qualitative variables compared with the chi2 test. STATISTICAL ANALYSIS: SPSS 12.0(c). RESULTS: The comparative analysis of the burnout dimensions shows that emotional exhaustion level is significantly higher in the intensive care service than in the emergency one (25.45 +/- 11.15 vs 22.09 +/- 10.99) p < 0.05. The rest of burnout dimensions do not show significant differences between both departments. The masculine gender obtains a higher score in the depersonalization dimension of burnout (10.12 +/- 5.38) than female one (6.7 +/- 5.21) p < 0.01. There is greater vulnerability to emotional exhaustion among the professional group with more than 15 years of work experience (F = 3.592; p = 0.031). CONCLUSIONS: The burnout levels are moderate to high among the nursing professionals studied. A total of 5.15% of the sample studied achieves a high score in the three dimensions of the burnout syndrome. The intensive care professionals are the most vulnerable to suffering high levels of emotional exhaustion, and the masculine gender is more susceptible to depersonalization attitudes.

Estudio comparativo del burnout en personal de enfermería de Cuidados Intensivos y Urgencias / Comparative study of burnout in Intensive Care and Emergency Care nursing staff

Objetivo. Estimar y comparar el nivel de burnout existente en los Servicios de Cuidados Intensivos y Urgencias, y estudiar su asociación con las características sociodemográficas y laborales de los profesionales encuestados. Diseño. Estudio descriptivo transversal. Emplazamiento. Servicios de Urgencias y Cuidados Intensivos del Hospital Morales Meseguer (Murcia). Muestra. Noventa y siete profesionales de enfermería, 55 pertenecientes al Servicio de Urgencias y 42 al Servicio de Cuidados Intensivos. Método. Se emplearon dos instrumentos de evaluación: una encuesta de variables sociodemográficas y laborales, y el cuestionario Maslach Burnout Inventory, de 1986. Las variables cuantitativas se expresan como media ± desviación estándar comparadas con t de Student y las cualitativas se comparan con Chi2. El análisis de datos se realizó mediante el programa informático SPSS 12.0(C). Resultados. El análisis comparativo de las dimensiones que componen el burnout demuestra que los niveles de agotamiento emocional son significativamente mayores en el Servicio de Cuidados Intensivos que en el de Urgencias (25,45 ± 11,15 frente a 22,09 ± 10,99) p < 0,05. El resto de dimensiones que componen el síndrome no ha demostrado diferencias significativas entre ambos servicios. El género masculino obtiene una mayor puntuación en la dimensión de despersonalización (10,12 ± 5,38) que el género femenino (6,7 ± 5,21) p < 0,01. Existe una mayor vulnerabilidad al agotamiento emocional en el grupo de profesionales que llevan más de 15 años trabajando (F = 3,592; p = 0,031). Conclusiones. Los niveles encontrados de burnout resultaron ser moderados-altos. El 5,15% de la muestra total estudiada puntúa alto en las tres dimensiones del síndrome, los profesionales de Cuidados Intensivos son los más vulnerables a padecer elevados niveles de agotamiento emocional y el género masculino es el más propenso a las actitudes de despersonalización

Objective. To assess and compare the burnout level between Intensive Care Unit and Emergency Unit, and study its association with the sociodemographic and work characteristics of the professionals surveyed. Description. Cross-sectional, descriptive study. Emplacement. Intensive Care Unit of the university hospital Morales Meseguer, Murcia-Spain. Studied sample. 97 nursing professionals: 55 professionals belong to the Emergency Department, and 42 professionals belong to the Intensive Care Department. Method. Two evaluation tools were used: a sociodemographic and work survey, and the Maslach Burnout Inventory, 1986. Quantitative variables expressed as mean ± SD compared with the Student's T test and qualitative variables compared with the chi2 test. Statistical analysis: SPSS 12.0(C). Results. The comparative analysis of the burnout dimensions shows that emotional exhaustion level is significantly higher in the intensive care service than in the emergency one (25.45 ± 11.15 vs 22.09 ± 10.99) p < 0.05. The rest of burnout dimensions do not show significant differences between both departments. The masculine gender obtains a higher score in the depersonalization dimension of burnout (10.12 ± 5.38) than female one (6.7 ± 5.21) p < 0.01. There is greater vulnerability to emotional exhaustion among the professional group with more than 15 years of work experience (F = 3.592; p = 0.031). Conclusions. The burnout levels are moderate to high among the nursing professionals studied. A total of 5.15% of the sample studied achieves a high score in the three dimensions of the burnout syndrome. The intensive care professionals are the most vulnerable to suffering high levels of emotional exhaustion, and the masculine gender is more susceptible to depersonalization attitudes

Dieta y ejercicio / Diet and exercise

El tratamiento no farmacológico de la diabetes tipo 2 consiste en medidas precisas y escalonadas en el estilo de vida: alimentación y actividad física. La estrategia nutricional, cuando coexiste obesidad, estriba en la aplicación de una dieta moderadamente hipocalórica que consiga pérdidas modestas de grasa (especialmente visceral), y el mantenimiento de dicha pérdida, conservando la masa magra. El reparto energético entre lípidos, proteínas e hidratos de carbono tiene un margen muy amplio, y debe individualizarse según la edad, la presencia o no de sobrepeso y otras comorbilidades (dislipemia, hipertensión, etc.). En diabéticos tipo 2no obesos el tratamiento es el mismo, pero sin restricción calórica. Estas medidas se acompañarán de un incremento en la actividad física diaria y la recomendación individualizada de ejercicio físico más intenso semanal, por el potente efecto de mejora de la sensibilidad a la insulina y los factores de riesgo cardiovascular asociados. En esta exposición se aportan algunas propuestas de prescripción individualizada de ambos elementos del estilo de vida, basándonos en las evidencias científicas del momento (AU)

Non-pharmacological treatment of type 2diabetes consists of well-defined and progressive lifestyle measures: diet and exercise. In obese diabetic patients, the nutritional strategy consists of a moderatelyhypocaloric diet to achieve modest fat loss(especially visceral fat) and to maintain this loss while conserving lean tissue mass. Calorie distribution among lipids, proteins and carbohydrates has a wide margin and should be individually tailored according to age and the presence or absence of overweight and other comorbidities (dyslipidemia, hypertension etc.). Treatment is the same in non-obese type 2 diabetics, but without calorie restriction. These measures should be accompanied by an increase in daily physical exercise and individualized recommendations for more intense weekly physical activity due to its strong effect on improving insulin sensitivity and associated cardiovascular risk factors. The present article discusses some recommendations for the individualized prescription of both types of lifestyle modification, based on the latest scientific evidence (AU)

Peritonitis bacteriana espontánea como forma de presentación de síndrome nefrótico idiopático en un adulto de raza negra / Spontaneous bacterial peritonitis as form of presentation of idiopathic nephrotic syndrome in an adult black race

La peritonitis bacteriana espontánea es una complicación grave y observada a menudo en el síndrome nefrótico infantil. Sin embargo, en los adultos, pese a ser frecuentemente descrita en los textos de nefrología, es una complicación rara. En la revisión realizada sólo 16 casos están publicados con este tipo de complicación en adultos, y no hay ninguno descrito posterior al año 2000. A continuación exponemos el caso de un varón de 25 años, procedente de Senegal, con peritonitis bacteriana espontánea, fracaso renal agudo y coagulopatía por desnutrición como forma de presentación de un síndrome nefrótico florido. Además a través del caso aportado se discuten distintos aspectos de la epidemiología y del manejo de estos pacientes así como las últimas publicaciones sobre las opciones de tratamiento de la glomerulopatía responsable del cuadro

Spontaneous bacterial peritonitis is a serious and frequent complication in childhood nephrotic syndrome. However, this type of complication is very rare in adult nephrotic patients. In the review realized only 15 cases are published with this complication, and none of them after the year 2000. Later we expose the case of a male of 25 years old, proceeding of senegal, with spontaneous bacterial peritonitis, acute renal failure and coagulopatia for malnutrition as form of presentation of a nephrotic syndrome flowery. Besides across the contributed case different aspects of the epidemiology and of the managing of these patients are discussed as well as the last publications on the options of treatment of the glomerulopatia responsible of the clinical symptoms

Pair annihilation reaction D+D-->0 in disordered media and conformal invariance.

The raise and peel model is a stochastic model of a fluctuating interface separating a substrate covered with clusters of matter of different sizes and a rarefied gas of tiles. The stationary state is obtained when adsorption compensates the desorption of tiles. This model is generalized to an interface with defects (D) . The defects are either adjacent or separated by a cluster. If a tile hits the end of a cluster with a defect nearby, the defect hops at the other end of the cluster, changing its shape. If a tile hits two adjacent defects, the defects annihilate and are replaced by a small cluster. There are no defects in the stationary state. This model can be seen as describing the reaction D+D-->0 , in which the particles (defects) D hop at long distances, changing the medium, and annihilate. Between the hops the medium also changes (tiles hit clusters, changing their shapes). Several properties of this model are presented and some exact results are obtained using the connection of our model with a conformally invariant quantum chain.

[Spontaneous bacterial peritonitis as form of presentation of idiophatic nephrotic syndrome in a black adult]. / Peritonitis bacteriana espontánea como forma de presentación de síndrome nefrótico idiopático en un adulto de raza negra.

Spontaneous bacterial peritonitis is a serious and frequent complication in childhood nephrotic syndrome. However, this type of complication is very rare in adult nephrotic patients. In the review realized only 15 cases are published with this complication, and none of them after the year 2000. Later we expose the case of a male of 25 years old, proceeding of senegal, with spontaneous bacterial peritonitis, acute renal failure and coagulopatia for malnutrition as form of presentation of a nephrotic syndrome flowery. Besides across the contributed case different aspects of the epidemiology and of the managing of these patients are discussed as well as the last publications on the options of treatment of the glomerulopatia responsible of the clinical symptoms.

[Probesci strategy: a cheaper therapeutic approach for obese patients]. / Estrategia probesci: un abordaje terapéutico de menor coste para el paciente obeso.

Obesity has become epidemic in Western countries. From clinical practice, obestity may be considered as a disease characterized by an excess of body fat mass, but patients usually demonstrate different responses to the same therapeutic strategy. It could be possible that the latter may be a consecuence of different pathophysiological factors among obese patients. Therefore, a detailed and thorough phenotyping of patients may enable clinitians to establish groups of patients that may respond in a homogeneous and effective way to a specific treatment for obesity. However, this type of approach can be especially time-consuming and may increase costs. In this study we describe the "PROBESCI" strategy, which is a novel system of studying the obese patient at the first visit, performed in groups of patients, aimed to the collection and analysis of data in order to categorize phenotypic profiles which may achive homogeneous responses to a specific therapy. We also analyze the costs of this new strategy compared to those of an individual consultation, showing a decrease of 58% for the first visit, and of 21% of the total costs throughout treatment.