Panes J.,Hospital Clinic IDIBAPS |
Panes J.,Research Center Biomedica En Red En El Area Tematica Of Enfermedades Hepaticas gestivas |
Lopez-Sanroman A.,Hospital Ramon y Cajal |
Bermejo F.,Hospital Of Fuenlabrada |
And 14 more authors.
Gastroenterology | Year: 2013
Background & Aims A small placebo-controlled trial reported the efficacy of mercaptopurine therapy for children newly diagnosed with Crohn's disease, yet little is known about the efficacy of early thiopurine therapy in adults. Methods We performed a prospective double-blind trial of adult patients with a recent (<8 weeks) diagnosis of Crohn's disease. Patients were randomly assigned to groups given azathioprine (2.5 mg · kg-1 · day-1, n = 68) or placebo (n = 63) at 31 hospitals from February 2006 to September 2009. Corticosteroids but no other concomitant medications were allowed for control of disease activity. The primary measure of efficacy was sustained corticosteroid-free remission. Results After 76 weeks of treatment, 30 patients treated with azathioprine (44.1%) and 23 given placebo (36.5%) were in sustained corticosteroid-free remission (difference of 7.6%; 95% confidence interval, -9.2 to 24.4%; P =.48). The rates of relapse (defined as Crohn's Disease Activity Index score >175) and corticosteroid requirements were similar between groups. A post hoc analysis of relapse, defined as a Crohn's Disease Activity Index score >220, showed lower relapse rates in the azathioprine group than in the placebo group (11.8% vs 30.2%; P =.01). Serious adverse events occurred in 14 patients in the azathioprine group (20.6%) and 7 in the placebo group (11.1%) (P =.16). A larger percentage of patients in the azathioprine group had adverse events that led to study drug discontinuation (20.6%) than in the placebo group (6.35%) (P =.02). Conclusions In a study of adults with Crohn's disease, early azathioprine therapy was no more effective than placebo to achieve sustained corticosteroid-free remission but was more effective in preventing moderate to severe relapse in a post hoc analysis. EudraCT 2005-001186-34. © 2013 by the AGA Institute.
Espinos J.C.,Centro Medico Teknon |
Turro R.,Centro Medico Teknon |
Mata A.,Centro Medico Teknon |
Cruz M.,Centro Medico Teknon |
And 3 more authors.
Obesity Surgery | Year: 2013
Background: We report our initial experience and 6-month outcomes in a single center using the per-oral Incisionless Operating Platform™ (IOP) (USGI Medical) to place transmural plications in the gastric fundus and distal body using specialized suture anchors (the Primary Obesity Surgery Endolumenal [POSE] procedure). Methods: A prospective observational study was undertaken with institutional Ethics Board approval in a private hospital in Barcelona, Spain. Indicated patients were WHO obesity class I-II, or III, where patients refused a surgical approach. Results: Between February 28, 2011 and March 23, 2012, the POSE procedure was successfully performed in 45 patients: 75.6 % female; mean age 43.4 ± 9.2 SD (range 21.0-64.0). At baseline: mean absolute weight (AW, kg), 100.8 ± 12.9 (75.5-132.5); body mass index (BMI, kg/m2), 36.7 ± 3.8 (28.1-46.6). A mean 8.2 suture-anchor plications were placed in the fundus, 3.0 along the distal body wall. Mean operative time, 69.2 ± 26.6 min (32.0-126.0); patients were discharged in <24 h. Six-month mean AW was 87.0 ± 10.3 (68.0-111.5); BMI decreased 5.8 to 31.3 ± 3.3 (25.1-38.6) (p < 0.001); EWL was 49.4 %; TBWL, 15.5 %. No mortality or operative morbidity. Minor postoperative side effects resolved with treatment by discharge. Patients reported less hunger and earlier satiety post procedure. Liquid intake began 12 h post procedure with full solids by 6 weeks. Conclusions: At 6-month follow-up of a prospective case series, the POSE procedure appeared to provide safe and effective weight loss without the scarring, pain, and recovery issues of open and laparoscopic bariatric surgery. Long-term follow-up and further study are required. © 2013 Springer Science+Business Media New York.
Rodriguez-Ausin P.,Hospital Gregorio Maranon |
Gutierrez-Ortega R.,Clinica Novovision |
Arance-Gil A.,Clinica Novovision |
Romero-Jimenez M.,Clinica MGR |
Fuentes-Paez G.,Centro Medico Teknon
Cornea | Year: 2011
Purpose: To report 2 cases of keratopathy after uneventful cross-linking procedures for grade 3 keratoconus. Methods: Two patients (21 and 11 years old) with grade 3 keratoconus underwent uneventful cross-linking in 1 eye. In both patients, multiple peripheral stromal precipitates, which extended centripetally, were observed 48 hours after the procedure. Sample cultures were negative for bacteria, fungi, and parasites. Results: Cornea infiltrates slowly resolved after combined topical antibiotic/antifungal/povidone/steroids treatment. Final best spectacle-corrected visual acuity was 20/25 for patient 1, after uneventful bilateral toric intraocular contact lens (ICL) (Staar Surgical) implantation, but faint and paracentral scarring persisted. Final best-corrected visual acuity was 20/25 for patient 2 with gas-permeable contact lens wear, despite stromal scarring. Conclusions: Cross-linking associated with sterile keratitis is an unusual entity of unknown etiology, which can lead to stromal scarring. Copyright © 2011 by Lippincott Williams & Wilkins.
Vallejo R.,Millennium Pain Center |
Vallejo R.,Illinois State University |
Vallejo R.,Centro Medico Teknon |
Barkin R.L.,Rush University |
And 2 more authors.
Pain Physician | Year: 2011
The perpetual pursuit of pain elimination has been constant throughout human history and pervades human cultures. In some ways it is as old as medicine itself. Cultures throughout history have practiced the art of pain management through remedies such as oral ingestion of herbs or techniques believed to have special properties. In fact, even Hippocrates wrote about the practice of trepanation, the cutting of holes in the body to release pain. Current therapies for management of pain include the pervasive utilization of opioids, which have an extensive history, spanning centuries. There is general agreement about the appropriateness of opioids for the treatment of acute and cancer pain, but the long-term use of these drugs for treatment of chronic non-malignant pain remains controversial. The pros and cons regarding these issues are beyond the scope of this review. Instead, the purpose of this review will be directed towards the pharmacology of commonly prescribed opioids in the treatment of various chronic pain syndromes. Opium, derived from the Greek word for "juice," is extracted from the latex sap of the opium poppy (Papaverum somniferum). The juice of the poppy is the source of some 20 different alkaloids of opium. These alkaloids of opioids can be divided into 2 chemical classes: phenanthrenes (morphine, codeine, and thebaine) and benzylisoquinolines (agents that do not interact with opioid receptors).
Lanas A.,University of Zaragoza |
Ponce J.,Quiron Hospital |
Bignamini A.,University of Milan |
Mearin F.,Centro Medico Teknon
Digestive and Liver Disease | Year: 2013
Background: Evidence supporting appropriate medical therapy to prevent recurrence of colonic diverticulitis is limited. Our goal was to evaluate the potential of rifaximin given periodically in addition to fibre for the prophylaxis of recurrences. Methods: We conducted a multicentre, randomized, open controlled study in patients with a recent episode of colonic diverticulitis, currently in remission. Patients received 3.5. g of high-fibre supplementation b.d. with or without one week per month of the non-absorbable antibiotic rifaximin (400. mg b.d.) for 12. months. Primary endpoint was recurrence of diverticulitis, encompassing acute symptomatic flare with or without complications, analyzed by multivariable logistic regression analysis and by Cox proportional hazard method. Results: After randomizing 165 patients, the study was interrupted since the recruitment rate was largely below the minimum anticipated, and the trial was switched from evidence-gathering to proof-of-concept. Recurrences occurred in 10.4% of patients given rifaximin plus fibres vs. 19.3% of patients receiving fibres alone. The logistic analysis adjusted for sex, age, illness duration, time from last episode, disease localization and centre recruitment rate, yielded a significant treatment effect (odds ratio 3.20; 95% confidence interval: 1.16-8.82; P= 0.025). Patients with diverticulitis diagnosed since ≥1. year receiving rifaximin also had a lower incidence of recurrences (10%; 95% confidence interval: 2-47% vs. 67%; 95% confidence interval: 37-100%). Both treatments were safe. Conclusions: This study represents a proof-of concept of the efficacy of cyclic rifaximin treatment, added to fibre supplements, to reduce the risk of recurrences of diverticulitis in patients in remission. © 2012 Editrice Gastroenterologica Italiana S.r.l.
Rieder F.,Cleveland Clinic |
Kessler S.,Cleveland Clinic |
Sans M.,Centro Medico Teknon |
Fiocchi C.,Cleveland Clinic
American Journal of Physiology - Gastrointestinal and Liver Physiology | Year: 2012
Fibrosis is a serious condition complicating chronic inflammatory processes affecting the intestinal tract. Advances in this field that rely on human studies have been slow and seriously restricted by practical and logistic reasons. As a consequence, well-characterized animal models of intestinal fibrosis have emerged as logical and essential systems to better define and understand the pathophysiology of fibrosis. In point of fact, animal models allow the execution of mechanistic studies as well as the implementation of clinical trials with novel, pathophysiology-based therapeutic approaches. This review provides an overview of the currently available animal models of intestinal fibrosis, taking into consideration the methods of induction, key characteristics of each model, and underlying mechanisms. Currently available models will be classified into seven categories: spontaneous, gene-targeted, chemical-, immune-, bacteria-, and radiation-induced as well as postoperative fibrosis. Each model will be discussed in regard to its potential to create research opportunities to gain insights into the mechanisms of intestinal fibrosis and stricture formation and assist in the development of effective and specific antifibrotic therapies. © 2012 the American Physiological Society.
Larrosa F.,Centro Medico Teknon |
Dura M.J.,Centro Medico Teknon |
Roura J.,Hospital Quiron |
Hernandez A.,Centro Medico Teknon
European Archives of Oto-Rhino-Laryngology | Year: 2013
The field of medical applications is currently one of the most dynamic in medicine due to the great potential for improving clinical practice they hold. However, clinicians' opinion around their usability in daily clinical care has not been thoroughly addressed. This study aimed to analyze the otolaryngologists response to a rhinoplasty application. It was designed as a survey of 21 otolaryngologists with regards to a rhinoplasty planning application for the iPhone with the capacity to project potential surgery outcomes through tactile morphing software compared to a photo tracing method used as the gold standard. The participants were asked to rate the usefulness of the two technologies on a visual analog scale from 0-10. Questions addressed included four topics: physician-patient communication; imaging process time; perceived usefulness for preoperative planning; and perceived usefulness for surgery. A one sample t-test was applied to compare the scores of both methods for each question. The test subjects (mean age 43.21 years) rated the utility of the iPhone application as superior to that of the photo tracing method (p < 0.05) concluding that the iPhone application could facilitate an immediate preliminary analysis of the options for nasal improvement. © 2013 Springer-Verlag Berlin Heidelberg.
Effect of intrarectal povidone-iodine in the incidence of infectious complications after transrectal prostatic biopsy [El gel de yodopovidona intrarectal en la incidencia de complicaciones infecciosas tras biopsia prostática transrectal]
Sedo J.M.G.-V.,Centro Medico Teknon |
Garcia R.A.-V.,Centro Medico Teknon
Archivos Espanoles de Urologia | Year: 2012
OBJECTIVES: To assess the incidence of genitourinary infections associated with transrectal ultrasound-guided prostate biopsy (TRUS-BX) using endorectal povidone-iodine gel as a bactericidal agent. METHODS: We prospectively studied a total of 530 patients who were given 30g of 10% povidone-iodine intrarectally before TRUS-BX. Each patient received antibiotic prophylaxis with ciprofloxacin, starteing the previous day (1g/day × 3 days), as well as cleansing enemas. RESULTS: One patient (0.20%) presented with an E. coli acute bacterial epididymitis after biopsy. CONCLUSIONS: In our study, the intarrectal use of 10% povidone-iodine gel in TRUS-BX is associated with a much lower rate of infectious complications compared to those described in recent literature.
Varas Lorenzo M.J.,Centro Medico Teknon
Revista Espanola de Enfermedades Digestivas | Year: 2010
A male presented with a metastatic, plasma serotonin-secreting (high 5-HIAA in urine), malignant pancreatic carcinoid with a carcinoid-like syndrome, and was assessed using ultrasounds (US), computerized tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) and Octreoscan; he sequentially received chemotherapy, interferon and octreotide, with long-term, 12-year survival after diagnosis. Given this unusual case, the second reported in our country, the overall literature is reviewed. Copyright © 2010 ARAN EDICIONES, S. L.
Palacin Casal J.M.,Centro Medico Teknon
Cirugia Plastica Ibero-Latinoamericana | Year: 2011
Tuberous breast or constricted breast is a female mammary gland congenital malformation which can be unilateral or bilateral. It was first described by Rees and Aston in 1976. It can be present in different grades of severity. Numerous surgical techniques have been described during the last 40 years, and the main objective is the recreation of the lower pole by using glandular flaps or radial incisions. This article describes a personal surgical technique based on three transverse incisions that include the whole glandular thickness and together with anatomic cohesive gel mammary implants, provide enough volume to the lower pole, achieving a better shape and thus helping to improve a greater percentage of hypoplastic tuberous breast.