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Magrina J.F.,Mayo Clinic Hospital | Espada M.,Clinica Quiron | Kho R.M.,Mayo Clinic Hospital | Cetta R.,Mayo Clinic Hospital | And 2 more authors.
Journal of Minimally Invasive Gynecology | Year: 2015

Objective: To determine perioperative outcomes and factors impacting operating time, length of hospital stay, and complications of patients undergoing surgery for stage 3 or 4 endometriosis. Design: Retrospective review of medical records (Canadian Task Force classification II-2). Setting: Mayo Clinic Hospital, Phoenix, Arizona. Patients: Women (n = 493) with endometriosis stage 3 and 4 undergoing surgical excision between March 15, 2005, and December 31, 2011. Interventions: Robotic-assisted (n = 331) or laparoscopic (n = 162) excision. Measurements: Age, body mass index, comorbidities, number and type of procedures per patient, type of surgical approach, operating time, blood loss, intraoperative and postoperative complications (within 42 days), and length of hospital stay. Main Results: The mean patient age was 39.5 years; body mass index, 25.9; number of procedures, 3.3; operating time, 130.4 minutes; blood loss, 88.5 mL; and hospital stay, 1.0 days. Major complications occurred in 5 patients (1.5%). Fifty-nine patients (12.0%) underwent modified radical hysterectomy, 90 (18.3%) underwent ureteral and/or intestinal resection, and 3 (0.6%) underwent diaphragm resection. Factors significantly associated with operating time included age (p =.008) and blood loss, number of procedures per patient, and robotics (all p <.001). Length of stay was affected by age, operating time, and blood loss (all p <.001). Operating time was the only significant factor associated with postoperative complications (p <.001). Conclusion: Operating time is an independent and significant factor for postoperative complications and hospital stay. © 2015 AAGL. Source

Modrego P.J.,Hospital Miguel Servet | Fayed N.,Clinica Quiron | Artal J.,Hospital Miguel Servet | Olmos S.,University of Zaragoza
Academic Radiology | Year: 2011

Rationale and Objectives: This work is aimed at determining whether magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) may correlate with disease severity in a series of Parkinson disease (PD) patients. Materials and Methods: We recruited a consecutive sample of 39 PD patients in several stages of the disease according to Hoehn and Yahr scale. There were 22 men, and the mean age was 74.5 years (SD 7.5). Disease severity was measured with the Unified Parkinson Disease Rating Scale (UPDRS). All of them underwent 1H MRS in basal ganglia and the anterior cingulate area, as well as DTI in bilateral substantia nigra. Correlation was made between radiological findings and UPDRS. Results: We found significant negative correlation between UPDRS scores and the Glx (glutamate+glutamine) levels in the right (r = -0.35; P = 03) and the left (r = -0.44; P = 006) lentiform nucleus; as well as with glutamate (r = -0.43; P = 008), the Glx/Cr ratio in the right (r = -0.41; P = 01), and in the left lentiform nucleus (r = -0.36; P = 02). We also found positive correlation between UPDRS scores and DTI in right rostral substantia nigra (r = 0.36; P = 02). Glx was increased in lentiform nucleus and fractional anisotropy was reduced in the rostral SN of subjects with PD in early stages. Conclusions: The results are consistent with the view that more than half the dopaminergic neurons in the nigrostriatal projection are lost before the onset of PD. © 2011 AUR. Source

Dominguez-Luna A.,Hospital Universitario Of Fuenlabrada | Dominguez-Luna A.,Hospital General Universitario Gregorio Maranon | Fernandez-Miguez M.D.M.,Hospital General Universitario Gregorio Maranon | Dominguez-Luna S.C.,Clinica Quiron
Matronas Profesion | Year: 2012

This article describes the experiences of women with preterm premature rupture of amniotic membranes (PPROM) during bed rest in hospital and investigates their needs to improve clinical practice. Objetive: To investigate pregnant women's experience when they are resting in hospital in cases of preterm premature rupture of membranes. Methodology: This is a qualitative, descriptive, observational approach with a phenomenological focus. Data collection: Observation and individual interviews with pregnant women who are in the high risk obstetrics ward in "Gregorio Marañón" Hospital with PPROM. They will be between 24 and 31 weeks pregnant. Results: This study shows that in the non-interventional management of PPROM, which is based primarily on bed rest and admission into hospital, the mother can be emotionally charged showing high levels of anxiety and stress, worry and fear, in relation to fetal loss or perinatal health and sadness, emotional liability and uncertainty about the experience. It manifested in women the sense of loss of functional capacity, dependency and loss of control of her life, mainly by feeling worthless and having low self-esteem, experiencing a strong sense of guilt and grief. Conclusions: Bed rest in hospital for women with PPROM involves emotional crisis. Understanding the needs felt by women with high-risk pregnancies by healthcare professionals will improve the quality of care and can help reduce stress levels during this vulnerable period, and help them cope with motherhood. It is the responsibility of the healthcare professionals to care for women during this period and avoid the experience being traumatic. ©2012 Ediciones Mayo, S.A. All rights reserved. Source

Subira D.,Flow Cytometry Section | Uriel M.,Clinica Quiron | Serrano C.,Unilabs Laboratory | Castanon S.,Flow Cytometry Section | And 4 more authors.
Cytometry Part B - Clinical Cytometry | Year: 2011

Background: Fetal erythrocytes cross the placenta during gestation, but invasive prenatal procedures might develop into fetomaternal hemorrhage (FMH). We examine whether flow cytometry immunophenotyping might be useful for measuring the volume of FMH after such procedures. Methods: Fetal erythrocytes (%) were determined in 153 pregnant women after amniocentesis (129) and chorionic villous sampling (24) using a monoclonal antibody against fetal hemoglobin. Fetal erythrocytes were identified for their high expression of fetal hemoglobin (HbF ++). Blood samples from two control groups, 53 healthy males and 21 pregnant women not submitted to invasive tests, were used to establish normal values of circulating HbF ++ erythrocytes in adults. Results: The highest percentage of HbF ++ erythrocytes in the control groups was 0.015%. The rate of HbF ++ erythrocytes in samples after invasive tests ranged between <0.01% and 0.15%. Seventy three women (47%) had ≤0.015% HbF ++ erythrocytes, and this rate was higher in 80. Nine women presented >1 ml of FMH (volume of packed cells corresponding to 0.054-0.15% HbF ++ erythrocytes), but only two had sonographic evidence of bleeding. Conclusions: Most women in our series had a very low volume of FMH after the invasive tests. Acute bleeding should be thoroughly investigated in women with either more than 1 ml of packed cells or more than 0.05% of HbF ++ erythrocytes. Intermediate values between >0.015% and <0.05%, should be carefully considered depending on the week of gestation. Data obtained before 15 weeks might reflect previous cell trafficking between fetus and mother instead of acute hemorrhage. © 2010 International Clinical Cytometry Society. Source

Modrego P.J.,University of Zaragoza | Fayed N.,Clinica Quiron | Olmos S.,University of Zaragoza
Neuroradiology Journal | Year: 2010

We assessed the influence of a history of amnesic mild cognitive impairment (MCI) in patients with Alzheimer's disease (AD) at presentation from a clinical and radiological point of view. A consecutive sample of patients fulfilling the criteria of probable Alzheimer's disease according to the NINCDS-ADRDA work group not previously diagnosed nor treated underwent neuropsychological assessment including mini-mental test, Blessed dementia rating scale (BDRS), ADAS-Cog, neuropsychiatric inventory (NPI), and a daily living activities scale (DAD). Radiological evaluation consisted of magnetic resonance imaging, left hippocampal volumetry and magnetic resonance spectroscopy (MRS) of the brain. We divided the patients into two groups according to positive/negative history of MCI for a period longer than one year. The AD patients with a history of MCI were more likely to have a history of depression (OR: 5.5; 95% CI: 1.12-26) and have more depressive symptoms at presentation in the NPI than those without a history of MCI. They also had a history of hypertension more frequently than the remainder. The presence/absence of ApoE4 alleles did not have influence in the clinical course. With regard to radiological findings the patients with previous MCI showed lower values of N-acetyl-aspartate (NAA) in parietal (p=0.0001) temporal (p=0.08) and occipital (p=0.00001) lobes than the other group, as well as a smaller left hippocampus although the difference was not statistically significant. A history of MCI in AD patients represents a form of the disease with slower progression from clinical and radiological view-points. These patients present with more depressive symptoms and a history of depression than the remainder. The lower NAA levels on MRS are compatible with a longer disease duration when AD is preceded by amnesic MCI. Source

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