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Leal J.I.,Vascular Surgery Section | Orgaz A.,Vascular Surgery Section | Fontcuberta J.,Vascular Surgery Section | Flores A.,Vascular Surgery Section | And 5 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2010

Objective: Cerebral embolisation constitutes the main source of complications during transfemoral carotid artery stenting (CAS) and is associated with a high incidence of silent brain infarction. The goal of this study is to evaluate the incidence of new ischaemic cerebral lesions following transcervical CAS with carotid flow reversal for neuroprotection. Materials and Methods: Thirty-one consecutive patients underwent transcervical CAS with carotid flow reversal. A stroke scale and diffusion-weighted magnetic resonance imaging (DW-MRI) were performed within 24 h before and after the procedure. DW-MRI studies were compared blindly by two independent neuroradiologists. New hyper-intense DW signals were interpreted as ischaemic infarcts. The progress of all patients was followed for at least 30 days following intervention. Results: All procedures were technically successful. Nineteen (61%) patients were symptomatic Mean carotid flow reversal time was 22 min. There were no major adverse events at 30 days. All patients remained neurologically intact without increase in the stroke scale. Thirty subjects had paired DW-MRI studies. Post-procedural DW-MRI ischaemic infarcts were found in four (12.5%) patients, all ipsilateral to the treated hemisphere and asymptomatic. During follow-up, all stents remained patent and all patients remained stroke-free. Conclusions: These data suggest that transcervical carotid stenting with carotid flow reversal carries a low incidence of new ischaemic infarcts, significantly lower than that reported with transfemoral CAS. The transcervical approach with carotid flow reversal may improve the safety of CAS and has the potential to produce results comparable to those of carotid endarterectomy. © 2010 European Society for Vascular Surgery. Source


De Andres Ares J.,Complejo Hospitalario de Toledo | Roca G.,Hospital Germans Trias i Pujol | Perucho A.,Hospital Universitario Ramon jal | Nieto C.,Hospital Universitario Fundacion Alcorcon | Lopez D.,Consorcio Hospital General de Valencia
Revista de la Sociedad Espanola del Dolor | Year: 2012

There has been an important increase in radiofrequency procedures in Spain during the past five years. The Spanish Society RF Interest Group has always wanted to spread the use of RF techniques among pain practitioners. In this paper we analyze the different RF generators available in the spanish market, with their most relevant technical features. Source


San L.,Hospital Sant Joan de Deu | Serrano M.,Complejo Universitario Hospitalario Of runa | Canas F.,Francisco de Vitoria University | Romero S.L.,U.G.C. Hospital Virgen Macarena | And 2 more authors.
International Journal of Psychiatry in Clinical Practice | Year: 2014

Objective. To develop pragmatic and operational definitions of relapse in schizophrenia. Methods. A two-round Delphi consensus approach was used. The final questionnaire based on seven pre-established definition relapse models developed by a panel of eight experts was presented to 33 general psychiatrists who attended an "ad hoc" meeting. Results. The most frequent components of the pragmatic definition were the psychopathological severity of the psychotic spectrum (70%), more intense management of the case (68%), a previously stabilized episode (67%), and impairment in functioning and social behavior (67%). In the operational definition, reappearance of symptoms was considered indispensable by 71% of the participants, and reappearance of positive symptoms measured by clinical scales was considered recommendable by 67%. Between 46% and 53% rated worsening of severity status and worsening of functioning as indispensable or recommendable. An increase of ≥ 10 points in the positive subscale of Positive and Negative Symptom Scale was rated by 51% of the participants, a score of 6 points in the Clinical Global Impression scale (much worse) by 89%, and a reduction of ≥ 20 points in the Global Assessment of Functioning scale by 62%. Conclusions. A better understanding of the definition of relapse in schizophrenia is necessary to improve effective prevention strategies. © 2015 Informa Healthcare. Source


Gomez Oliveira G.,Hospital Universitario Of Canarias | Fernandez-Alba J.,Hospital Universitario Of Guadalajara | Martin Sastre R.,Complejo Hospitalario de Toledo | Carro Rey E.,Hospital Universitario Of La Coruna
Revista Espanola de Cirugia Oral y Maxilofacial | Year: 2012

Malignant eccrine spiradenoma (MES) is a rare malignancy of the eccrine sweat glands. It usually presents as a small, firm, reddish painful and small solitary nodule. Head and neck are rare locations. Etiology is unknown although previous trauma is believed to be an implicated factor. MES arises over a prior benign spiradenoma. Clinical behavior is aggressive with a high rate of recurrences and distant metastases. Prognosis is poor. Diagnosis is based on histological findings and treatment must be aggressive from the beginning to achieve the best results. Since Kersting and Helwig first described the case in 1956, and Beekley et al., reported its malignant transformation in 1971, only a few cases can be found in the literature. Based on these particular features we report a case of a 75-year-old man diagnosed on a MES that arises in a very unusual location, with a peculiar histopathology and behavior. © 2011 SECOM. Source


Remacha A.F.,Complejo Hospitalario de Toledo | Arrizabalaga B.,Hospital Universitario Cruces | Villegas A.,Hospital Clinico Universitario San Carlos | Villegas A.,Complutense University of Madrid | And 6 more authors.
Annals of Hematology | Year: 2015

This study aimed to evaluate the evolution of iron overload, assessed by serum ferritin (SF), in transfusion-dependent lower risk patients with myelodysplastic syndrome (MDS), as well as to describe the occurrence of organ complications, and to analyze its relationship with iron chelation therapy. This observational retrospective study was conducted from March 2010 to March 2011 in 47 Spanish hospitals. A total of 263 patients with lower risk MDS (International Prognostic Scoring System [IPSS] low/intermediate-1 risk or Spanish Prognostic Index [SPI] 0–1 risk), transfusion-dependent, and who had received ≥10 packed red blood cells (PRBC) were included. At MDS diagnosis, patients received a mean of 2.8 ± 3.9 PRBC/month, and 8.7 % of patients showed SF ≥1000 μg/L. Over the course of the disease, patients received a mean of 83.4 ± 83.3 PRBC, and 36.1 % of patients presented SF ≥2500 μg/L. Cardiac, hepatic, endocrine, or arthropathy complications appeared/worsened in 20.2, 11.4, 9.9, and 3.8 % of patients, respectively. According to investigator, iron overload was a main cause of hepatic (70.0 %) and endocrine (26.9 %) complications. A total of 96 (36.5 %) patients received iron chelation therapy for ≥6 months, being deferasirox the most frequent first chelation treatment (71.9 %). Chelation-treated patients showed longer overall survival (p < 0.001), leukemia-free survival (p = 0.007), and cardiac event-free survival (p = 0.017) than non-chelated patients. In multivariable analyses, age (p = 0.011), IPSS (p < 0.001), and chelation treatment (p = 0.015) were predictors for overall survival; IPSS (p = 0.014) and transfusion frequency (p = 0.001) for leukemia-free survival; and chelation treatment (p = 0.040) and Sorror comorbidity index (p = 0.039) for cardiac event-free survival. In conclusion, these results confirm the potential survival benefit of iron chelation therapy and provide additional evidence on the deleterious effect of iron overload in lower risk MDS patients. © 2014, Springer-Verlag Berlin Heidelberg. Source

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