Complejo Asistencial Universitario Of Leon

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Samaniego E.,Complejo Asistencial Universitario Of Leon | Redondo P.,Clinica Universitaria de Navarra
Actas Dermo-Sifiliograficas | Year: 2013

Lentigo maligna is a type of in situ melanoma. It develops mainly in middle-aged and elderly individuals on areas of the skin chronically exposed to sunlight. It progresses to its invasive form, lentigo maligna melanoma, in 5% to 50% of cases. Management of lentigo maligna is open to debate, with a notable lack of randomized trials and specific guidelines and protocols. Early diagnosis and treatment is necessary to achieve cure if possible and prevent progression to invasive melanoma with the corresponding risk of metastasis. The treatment of choice for lentigo maligna is surgery. When surgery is not possible, other alternatives are available although outcomes and rates of recurrence are variable. The objective of this study was to review the diagnostic methods and criteria for lentigo maligna, as well as the different surgical options and alternatives to surgery, in order to provide information on the best approach in each case. © 2012 Elsevier España, S.L. y AEDV. Todos los derechos reservados.


Ariza-Miguel J.,Leon Institute of Technology | Hernandez M.,Leon Institute of Technology | Fernandez-Natal I.,Complejo Asistencial Universitario Of Leon | Fernandez-Natal I.,University of León | And 2 more authors.
Journal of Clinical Microbiology | Year: 2014

We report for the first time mecC-positive methicillin-resistant Staphylococcus aureus (mecC-MRSA) in livestock in Spain. One isolate (sequence type 130) was found in milk samples among 601 S. aureus isolates obtained from 229 dairy sheep farms. This finding highlights the potential for zoonotic transmission of mecC-positive MRSA and the need for surveillance programs to monitor its presence and clonal evolution. Copyright © 2014, American Society for Microbiology. All Rights Reserved.


Vidal-Casariego A.,Complejo Asistencial Universitario Of Leon | Calleja-Fernandez A.,Complejo Asistencial Universitario Of Leon | Villar-Taibo R.,Complejo Asistencial Universitario Of Leon | Kyriakos G.,Complejo Asistencial Universitario Of Leon | Ballesteros-Pomar M.D.,Complejo Asistencial Universitario Of Leon
Clinical Nutrition | Year: 2014

Introduction: Arginine improves healing and modulates inflammation and the immune response. A systematic review and meta-analysis were conducted to assess whether arginine-enriched enteral formulas reduce complications (fistulas, wound infections, other infections) and hospital length of stay (LoS) in patients undergoing surgery for head and neck cancer. Methods: Medline, CENTRAL, and Trip Database were searched using the search strategy "Head and Neck Neoplasms" AND "Enteral Nutrition" AND "Arginine" OR "Immunonutrition". Inclusion criteria comprised: type of study (RCT), language (English, Spanish), outcomes (complications of surgery, LoS), and methodological quality (Jadad scale). The odds ratio (OR) and confidence intervals (95% CI) were calculated using the Mantel-Haenszel method, and the mean difference (MD) with the random effects method. Heterogeneity was assessed using Cochran's Q. Results: Six studies were included, with 397 patients receiving peri/postoperative enteral nutrition with different doses of arginine (6.25-18.7g/L). Enteral formulas containing arginine were associated with a reduction in fistulas [OR=0.36 (95% CI 0.14-0.95), p=0.039; Q=3.93, p=0.269], and LoS [MD=-6.8 (95% CI-12.6 to-0.9) days, p=0.023; Q=2.44, p=0.486]. There were no reductions in wound infections [OR=1.04 (95% CI 0.49-2.17), p=0.925; Q=1.60, p=0.809] or other infections [OR=0.79 (95% CI 0.48-1.31); p=0.369; Q=7.94, p=0.094]. Arginine administration did not increase the occurrence of diarrhoea [OR=1.80 (95% CI 0.50-6.52), p=0.375; Q=0.16, p=0.691]. Conclusions: The administration of arginine-enriched enteral nutrition led to a significant reduction in fistulas and hospital stay in patients undergoing surgery for head and neck cancer. © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


Vidal-Casariego A.,Complejo Asistencial Universitario Of Leon | Calleja-Fernandez A.,Complejo Asistencial Universitario Of Leon | Cano-Rodriguez I.,Complejo Asistencial Universitario Of Leon | Cordido F.,University of La Coruña | Ballesteros-Pomar M.D.,Complejo Asistencial Universitario Of Leon
Nutrition | Year: 2015

Objective: Glutamine has been proposed as a preventive treatment for toxicity related to cancer therapies. The aim of this study was to test the efficacy of glutamine in the prevention of radiation enteritis. Methods: A randomized, double-blind, controlled trial was performed including 69 patients who were assigned to receive either glutamine (Gln, 30g/d) or placebo while they were receiving abdominal radiotherapy. Patients were re-evaluated 1y after completion of treatment. The presence of chronic enteritis was assessed using the Radiation Therapy Oncology Group scale. Nutritional status was evaluated using subjective global assessment, weight, and bioimpedance. Relative risk (RR) and its confidence interval (CI) were also calculated. Results: The trial initially included 69 patients (34 Gln, 35 placebo), but 11 patients were lost during follow-up (4 Gln, 7 placebo; P=0.296). Chronic enteritis was developed by 14 % of patients: Gln 16.7 % versus placebo 11.1% (RR=1.33; 95 % CI, 0.35-5.03; P=0.540). Most cases of enteritis were grade I (75%), with no differences between groups. The stool frequency increased after radiotherapy in patients who received Gln (from 1±1 to 2±2 stools per day, P=0.012), but remained unchanged with placebo (1±1 stools per day, P=0.858; difference between groups P=0.004). There were no differences between the two groups in terms of weight, fat mass, or fat-free mass index, or between patients with enteritis and those without intestinal toxicity. Conclusions: Chronic enteritis is a relatively infrequent phenomenon, and Gln administration during radiotherapy does not exert a protective effect. •Glutamine has been proposed as a nutrient with potential protective effects against the toxicity induced either by chemoradiotherapy, but few trials have studied this effect.•The administration of oral glutamine during abdominal radiotherapy was related with the development of gastrointestinal symptoms.•One year after finishing radiotherapy, the patients who received glutamine referred significant changes in stool frequency and characteristics.•Glutamine was not related to better nutritional outcomes compared with placebo. © 2015 Elsevier Inc.


Mata-Zubillaga D.,Complejo Asistencial Universitario Of Leon | Oulego-Erroz I.,Complejo Asistencial Universitario Of Leon
Journal of Perinatology | Year: 2012

We want to illustrate the difficulty of establishing a brain death diagnosis in newborn children and how an easy and useful tool, the transcranial Doppler ultrasonography, can leave an unexpected result that complicates the process despite the rest of the diagnostic tests. We describe a 36-week gestation newborn male who was diagnosed of brain death after asphyxiated and offered for donation. After initial stabilization at admission, we established brain death diagnosis by checking and meeting every criterion. The donation process was complicated because of persistent blood flow on transcranial Doppler ultrasonography. Transcranial Doppler ultrasonography is a very useful method to assess cerebral blood flow. However, caution and individualization are needed when interpreting this complementary exam, especially in highly conflictive situations like brain death diagnosis. © 2012 Nature America, Inc. All rights reserved.


Gonzalez-Diaz E.,Complejo Asistencial Universitario of Leon | Moreno Cea L.,Complejo Asistencial Universitario of Leon | Fernandez Corona A.,Complejo Asistencial Universitario of Leon
International urogynecology journal | Year: 2015

INTRODUCTION AND HYPOTHESIS: The objective of this study was to investigate the association between the trigonometric properties of episiotomy in operative vaginal delivery (OVD) and obstetric anal sphincter injuries (OASIS).METHODS: The study included 72 primiparous women who had an OVD and episiotomy. Cases (n = 36) had sustained OASIS at birth, while controls (n = 36) had not. The groups were matched for instrumental delivery. The episiotomy scar was identified and its trigonometric characteristics were measured at 8-12 weeks postpartum. Data were analysed using conditional logistic analysis.RESULTS: The angle of episiotomy behaves as a factor associated with anal sphincter injury, so women with a mediolateral episiotomy and an angle greater than 20° have an 87% less risk of having an OASIS (odds ratio 0.13, 95% confidence interval 0.03-0.58). The study showed that scarred episiotomies at 8-12 weeks after OVD with an angle ≤ 20°, depth and distance between the episiotomy and anus ≤ 15 mm, total upper triangle perimeter ≤ 75 mm, para-anal triangle perimeter ≤ 15 mm and areas between scar and midline ≤ 250 mm(2) were significantly associated with higher risk of OASIS.CONCLUSIONS: When a mediolateral episiotomy is performed in OVD the technique has a strong effect on the occurrence of OASIS. Additional research is needed to determine if the optimal technique for mediolateral episiotomies produces less OASIS than deferring the performance of episiotomy.


Angioplasty is a feasible, safe, and effective procedure, and can be the procedure of choice for treatment of critical limb ischemia. Targeted primary angioplasty following the angiosome model may prove beneficial in terms of better wound healing and subsequent limb salvage. This concept may allow deliberately focusing arterial flow reconstruction in specific limb ischemia areas that exhibit tissue loss and fluctuating "rescue-vessels" supply. Further technical improvements and large comparative studies and prospective data are also needed to make a proper clinical validation. As well as appropriate revascularization, aggressive control of concurrent risk factors in wound healing also play an important role. The present paper proposes a review of the main contemporary publications that share this theory on the treatment of critical limb ischemia. © 2011 SEACV. Publicado por Elsevier España, S.L. Todos los derechos reservados.


Vidal-Casariego A.,Complejo Asistencial Universitario Of Leon | Calleja-Fernandez A.,Complejo Asistencial Universitario Of Leon | Ballesteros-Pomar M.D.,Complejo Asistencial Universitario Of Leon | Cano-Rodriguez I.,Complejo Asistencial Universitario Of Leon
Nutrition and Cancer | Year: 2013

Glutamine is a nutraceutic with antioxidant and immune functions that can protect from adverse effects associated with radiation therapy (RT). The aim of this study was to test whether oral glutamine prevents oral mucositis (OM) or acute radiation-induced esophagitis (ARIE) and favors nutritional status. This retrospective, cohort study included patients treated with RT for cancer on head and neck (HN) or chest areas during the 2008-2010 period. Data on glutamine treatment (initiated before RT, during RT, or no glutamine), appearance of mucositis (according to World Health Organization criteria), weight loss (WL) during RT, moderate [body mass index (BMI) <20.5 kg/m2 or WL > 5%) or severe (BMI < 18.5 kg/m2 or WL > 10%) malnutrition, and nutritional support were collected. Quantitative data were compared using Student's t-test and analysis of variance, and qualitative data using the chi-square test. The risk difference was calculated with its 95% confidence interval (95% CI). The sample included 117 patients. Overall, glutamine was associated with a significant reduction of mucositis, WL, and enteral nutrition. The risk difference for developing OM in patients receiving glutamine when compared with controls was -9.0% (95% CI = -18.0% to -1.0%), and for ARIE it was -14.0% (95% CI = -26.0% to -1.0%). More of the patients not receiving glutamine developed severe malnutrition when compared with those receiving this supplement, but there were no differences in other outcomes such as interruption of RT, hospitalization, use of opioid analgesics, or death during RT. Glutamine may have a protective effect during RT, reducing the risk and severity of OM and ARIE, preventing weight loss, and reducing the need for nutritional support. Prospective trials are required. © 2013 Copyright Taylor and Francis Group, LLC.


To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. Data for 159 patients (105 < or =65 years; 54 >65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale.


Izquierdo F.,Complejo Asistencial Universitario Of Leon | Suarez-Vilela D.,Hospital Valle Del Nalon | Honrado E.,Complejo Asistencial Universitario Of Leon
American Journal of Dermatopathology | Year: 2012

Granular cell tumors (GCT) are nerve sheath neoplasms composed of Schwann cells with granular cytoplasm. Perineurial cells are the cellular component of the perineurium and of perineuriomas, neoplasms supposedly derived from perineurial cells. However, perineurial cells have also been found in other Schwann cell-derived tumors. These cells have not been well studied in GCTs. We studied the presence of perineurial cells in a series of 24 GCTs with EMA, claudin-1, and Glut-1, which are immunohistochemical markers for perineurial cells. Three cases lacked nerve fascicles. Three cases showed no perineurial proliferation (grade 0), 7 showed grade 1 proliferation, and 11 showed grade 2 proliferation. For comparison, we studied 17 cases of neoplasms with perineural invasion (PNI): 7 cutaneous neoplasms [squamous cell carcinomas (n = 3), cutaneous lymphoma, malignant melanoma, eccrine carcinoma, congenital neurotropic nevus (n = 1 each)] and 10 noncutaneous tumors [prostatic (n = 2), gastric (n = 2), and colonic (n = 2) adenocarcinomas; invasive ductal carcinoma of breast (n = 2); urothelial carcinoma of bladder (n = 1); and oral squamous cell carcinoma (n = 1)] with the same antibodies for perineurial cells. We found perineurial cell proliferation in 10 cases, 6 grade 1, and 4 grade 2. These perineurial cells were limited to the areas around the nerve fascicles. Most of the tumor was devoid of perineurial cells. Thus, it was interpreted more as a hyperplastic or reactive phenomenon than a neoplastic component. Claudin-1 was the most sensitive of the 3 markers that we used. Such proliferation was less intense in non-GCTs. In conclusion, proliferation of perineurial cells in GCTs and neoplasms with PNI is a common finding that had not been previously studied. It seems to be a non-neoplastic phenomenon. Copyright © 2012 by Lippincott Williams & Wilkins.

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